Reflecting on Health Care, How, When and Where We Practice.


Pat DeLeon, former APA President

© Nuiiko | - Rising Sun In The Morning.

© Nuiiko | – Rising Sun In The Morning.


From a policy perspective, it is informative to reflect upon how long change may take even if it makes intuitive sense and is in the best interest of those who might initially oppose. At this year’s exciting State Leadership Conference Katherine Nordal urged those present to: “Shake off the negative attitudes some of our colleagues have about what’s happening in health care. The world is changing and health care is moving ahead – with or without psychology. We need to think creatively… how we practice… where we practice… and what we practice.”

Back in the early 1990’s, Bruce Bennett shared the Physician Specialty Report of a major pharmaceutical company indicating that of the 135+ million psychotherapeutic prescriptions written during 1991, only 17.3% were by psychiatrists; less than internists and family practitioners. Several years later, Morgan Sammons and I were collaborating on an article and we independently proffered the same percentages. In August, 1995 the APA Council of Representatives endorsed prescription privileges for appropriately trained psychologists and called for the development of model legislation and a model training curriculum. To date, New Mexico, Louisiana, and this year Illinois have passed enacting statutes; Guam and Indiana having yet to implement their earlier RxP laws.

Dan Ullman: “In January, 2015 the Nebraska Psychological Association (NPA) entered an administrative review process to create a new credential, the prescribing psychologist permit. This administrative review is required in Nebraska before a legislative bill may be introduced, and provides an opportunity to develop a credentialing proposal that stands a better chance of passing through the political, legislative process. Based on feedback received during this process, NPA’s proposal is being slightly modified for a subsequent review. The prescribing permit would be a voluntary, supplemental credential with its own set of standards and requirements and would not affect the general scope of practice of psychology. Much of the impetus for the proposal stems from serious problems with access to care in Nebraska in both rural and urban areas of the state. One large area of the state has never had a child and adolescent psychiatrist. Primary care providers (PCPs) will often not prescribe to clients if they have chronic or severe mental illness. Also, data indicated consumers may wait 2-3 months for an appointment with a psychiatrist. A consumer noted that she could not obtain reliable care from a psychiatrist, and was frustrated trying to find a PCP who had the skills to provide mental health medications for her chronic and complex conditions. The NPA is committed to the creation of the prescribing psychologist permit to address the unmet needs of behavioral health clients. A newspaper article in the panhandle (rural) area of the state was appropriately titled, ‘Psychologists look for additional ways to help clients’.”

Alaska’s James Fitterling noted that in March, 2015 Nebraska’s Governor turned aside the objections of organized medicine and signed legislation making his state the 20th in the nation to allow nurse practitioners (NPs) to work independently; i.e., without physician supervision. “Looks like nothing’s gonna change.” Aloha,

Pat DeLeon, former APA President – Division 31 – June, 2015