Pat DeLeon (former APA President) Column, May 2016
Slow But Steady Progress At The State Level
The 1992 APA Task Force Report for the Council of Representatives, chaired by Michael Smyer, concluded that: “Practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge. The contributions of this new form of psychopharmacological intervention has the potential to improve dramatically patient care and make important new advances in treatment.” The Department of Defense (DoD) and U.S. Public Health Service have embraced these new practitioners, appropriately modifying their clinical regulations. Bob McGrath, one of the visionary architects of psychology’s civilian RxP training initiatives, estimates that currently there are at least 1,750 graduates of these programs. For those interested in history, in August, 1995 the APA Council of Representatives formally endorsed prescriptive authority for appropriately trained psychologists as APA policy.
In March, 2002 New Mexico enacted the first state-initiated prescriptive authority (RxP) legislation; followed by Louisiana in May, 2004, with John Bolter writing the first civilian script on January 20, 2005. Nearly a decade later, in June, 2014 Illinois passed their legislation, with Beth Rom-Rymer reporting that there are currently over 135 psychologists in-training to become prescribing psychologists. Few psychologists appreciate that back in March, 1993 Indiana enacted legislation which, when finally implemented, will authorize RxP. Similarly, Guam enacted their RxP legislation in December, 1998. Although Guam’s regulations were promulgated in March, 2012, the lack of support from psychiatry has apparently made it quite difficult for any psychologist seeking to be credentialed. One might surmise that ultimately the courts may need to become involved, pursuant to the 2014 U.S. Supreme Court holding regarding the North Carolina State Board of Dental Examiners, in order to address potential anti-competitive activities.
Significantly Renewed Activity in 2016
Exciting efforts occurred this legislative cycle on the RxP agenda in Iowa and Hawaii. An earlier Hawaii effort had been vetoed by their Governor nearly a decade ago.
Iowa’s Elizabeth Lonning:
“Our legislation was passed by the Senate in early April, 28 to 22. This was after it was voted down earlier in the session and ‘a motion to reconsider’ was filed by our bill mover, Senator Joe Bolkcam at that time. So, we spent several weeks visiting at the Capitol to speak to Senators about the possibility of changing their votes. The House indicated they would not take action on the legislation until the Senate finished their action. We were successful in getting several Senators to understand our legislation more thoroughly and the vote passed 28-22 as indicated, on April 6th.
We then started working on the House and while we were placed on the schedule, due to budget issues and our session winding down, we kept getting pushed to the following day. The opposition was quite strong with House members and our bill mover in the House, Rep. Linda Miller, called a meeting with both sides and highly encouraged cooperation. So, a final amendment as drafted on Monday, April 25th outlining that the Board of Psychology and the Board of Medicine would work together in the administrative rules process, as well as working together with the doctoral psychology programs in the state and the University of Iowa Medical College on a training program. This amendment changed the opposition’s position from ‘opposed’ to ‘neutral.’ That allowed the House vote to be 72-22 in our favor. Because the amendment was not part of the Senate version, the Senate then voted on the amended legislation on Wednesday, the 27th of April and it passed again 33-16. It is now on its way to the Governor. We are hopeful to schedule a meeting with his office next week.” [April 30, 2016].
Hawaii’s Jill Oliveira Gray:
“The 2016 Hawai’i RxP initiative was nothing short of exciting with a tremendous amount of activity across multiple sectors – community, grassroots, consumers, organizations, and professionals. The significant progress made this year was the most made in nine years, since the bill passed the Hawai’i legislature in 2007. Many individuals worked tirelessly to move HB 1072 through this legislative session. Front and center was an extraordinary consumer advocate from Maui, Don Lane, who courageously and poetically brought his personal story to the attention of Hawai’i legislators and to the public. Don is also a Media Specialist at Mental Health Kokua and created a documentary called ‘Haleakala: A Trek for Dignity,’ to raise awareness of mental illness and end stigma and prejudice associated with having mental illness. Don’s documentary was broadcasted on PBS Hawai’i (http://pbshawaii.org/insights-on-pbs-hawaii-title-pending/) and was followed by an in-depth discussion with Don and other mental health advocates and local resources talking about how to improve access to care and promote mental health well-being. Don and other consumer advocates continued to work fearlessly throughout the session to educate legislators about their personal struggle to obtain sufficient psychiatric care in their communities. Their voices have definitely had an impact.
Hawai’i Psychological Association (HPA) has been fortunate to maintain Lobbyist Alex Santiago who continues to bring forth his considerable legislative experience and commitment to advance RxP in Hawai’i. Ray Folen, a seasoned and longtime RxP advocate, recently assumed the role of HPA’s Executive Director. HPA’s new Legislative Committee chair, Julie Takishima-Lacasa, did a stellar job in re-energizing HPA’s Legislative Committee this year and put additional tireless effort into the RxP initiative as well. I continue to lead the HPA RxP Committee, working very closely with champion legislators, the Department of Health and Board of Psychology to improve on the bill language from last session with language mutually agreed upon and believed to be necessary and relevant for Hawai’i. Having this collaboration from the beginning of the session helped to demonstrate a higher level of support for, and investment in, HB 1072.
Kelly Doty Harnick also serves as the Neighbor Island RxP Chair. Kelly and Don actually started their grassroots efforts in 2014 and continue to build an even stronger community coalition on Maui. Kelly was instrumental in developing our social media presence (https://www.facebook.com/RxPHawaii/?fref=ts and website http://www.rxphawaii.com/), both of which serve as excellent informational hubs and forums for Hawai’i’s RxP efforts. The Hawai’i RxP petition, started by Don Lane, can be found on our website and now includes over 1,000 signatures of support.
Judi Steinman, Program Director for the University of Hawai’i at Hilo, Daniel K. Inouye College of Pharmacy, Master of Science in Clinical Psychopharmacology (MSCP) Program was incredible and steadfast in dispelling myths about the rigor of the psychopharmacology training program. She, along with other psychologists such as Marie Terry-Bivens (HPA Past President) and Nicole Robello (current student in the MSCP program) were influential in rallying major community, consumer, and legislator support from neighbor islands such as Kauai, Moloka’i, and Hawai’i island. Hundreds of other supporters were pivotal in our success this session, including our colleagues from APA, APAPO and Division 55. We are so grateful for all the wisdom, guidance, energy, and support we received.
Despite the significant progress this legislative session to include HB 1072 passing through two Senate hearings, two Senate floor votes (passed third reading with 22 ayes, 2 noe’s, 1 excused and final reading with 22 ayes and 3 noes), and an extended conference committee period, and, unprecedented support from the Department of Health and the Board of Psychology, in the final reading the House used a very controversial procedural rule to kill the bill in spite of our belief that a majority of members supported it. A concerted effort was made by RxP advocates to implore on House leadership to resurrect the bill and have it receive a fair floor vote on the last day of the session, unfortunately, this did not happen. Devastated but not beaten, Hawai’i’s RxP warriors will come back next legislative session stronger than ever and continue to stand up for access to care and prescriptive authority for psychologists.”
New Mexico’s Elaine LeVine:
Dear Colleagues – My heart goes out to you being so close and then being closed out in this way. This happened to us in New Mexico. The bill passed through the House and, then, did not get called up in the Senate, and we knew we had the votes. Mario and I sat in the chambers until 12:30 at night, until the session closed, hoping. This is a part of how our democratic system works (or not works?), but from a psychologist’s perspective, words like cowardly and passive aggressive come to mind. Even so, two very good things have happened. Getting so close in Hawaii has infused energy in the RxP movement. And, if New Mexico history is any indication, our bill went through the next year. Thank you for all your efforts, perseverance, cleverness and passion. You will prevail and, in the meantime, you have given all of us inspiration that was badly needed.”
The Beat Goes On.
Pat DeLeon, former APA President – Division 42 – May, 2016