Almost any mental health practitioner today knows that “something is up” with the “prescription privileges debate thingy,” but for most, that’s about as far as it goes. It may surprise many readers, however, to learn that the prescriptions privileges movement for psychologists is not new; it’s actually about three decades old.
As this movement gets more coverage (and finds success at more state legislatures), it becomes even more important that students and early career psychologists have some familiarity with the “prescription privileges debate thingy.”
I’ve been pleasantly surprised at the number of students I’ve encountered that do know there is such a movement, but who desire more information about it. In a short series of articles, I hope to leave my fellow students (and psychologists largely removed from the RxP debate) with a bit more information.
To get involved, or to find more information than this series offers, contact your state association and inquire as to whether there is an RxP Task Force already in place for your state (there likely is).
What is RxP?
RxP, or the RxP Movement, refers to the professional movement within the field of clinical psychology to provide additional training to psychologists (via a certification or post-doctoral master’s degree) in an effort to increase psychologists’ scope of practice to include prescription writing authority. This movement seeks to improve access to psychotropic care and also enhance the quality of that access by pairing psychological training with additional medical/biological training.
In the mid-80s, Dr. Floyd Jennings was the first psychologist to write a prescription. Santa Fe Indian Hospital was in desperate need of psychotropic providers, and recognizing Dr. Jenning’s already-established familiarity with the psychological aspect of mental health, the Indian Health Service granted him special permission to prescribe. During his first year, he treated 378 patients (with no known adverse outcomes). This unprecedented allowance was quite brazen for both Dr. Jennings, the hospital, and the Indian Health Service, as no law – either state or federal – permitted a psychologist to prescribe.
By the late 80s, the Department of Defense had initiated a program whereby a select few psychologists would undergo training to prescribe psychotropics to military personnel. While the details of this training are highly debated (and will be covered in a later article), the program ultimately produced ten military psychologists, all of whom successfully prescribed for various branches of the armed forces (and now also do so in a civilian capacity for RxP-friendly states). Many of these fine folks are to thank for the progress RxP has made in the last decade or two.
By the 90s, the APA was becoming more involved in researching and publishing its recommendations for psychopharmacological training. Today the APA defines three levels of RxP training, and it is highly active in supporting RxP as a national movement.
At the time this article was published, four states (Louisiana, New Mexico, Illinois, and Iowa) permit psychologists to prescribe in some capacity, as well as the U.S. military, the Indian Health Service, Guam, and Puerto Rico. Anyone interested should consider joining APA’s Division 55 (The American Society for the Advancement of Pharmacotherapy).
Why Should It be on My Radar?
It seems that “integration” is the new buzz word for psychology. More state conferences are offering workshops on integration; more publications are discussing the benefits of integrated care; more doctoral programs are incorporating integrative care into their curricula.
Even if one does not anticipate ever prescribing in their professional career, one would be wise to be minimally versed in psychopharmacological basics. As more early career psychologists make their way into the mental health field, the need to be marketable becomes clear.
Even outside of medical integration and primary care, patients routinely ask psychologists about psychotropic options . Many states have actually codified statutory authority for psychologists to consult on medication.
If the movement toward integrated care and professional marketing aren’t enough to convince you, consider how much benefit each of our patients is offered when they seek services from a professional who has received some additional training in “the other side” of mental health.
Levels of RxP Training
The American Psychological Association has identified three levels of RxP training.
This stage, the minimum acceptable level of psychopharmacology education, includes coursework that should already be offered at the doctoral level. The APA has declared that this is the level of education that all psychologists should obtain.
While counseling psychologists may be less inclined to seek out this basic training, any psychologists involved in healthcare should at least possess this fundamental level of psychotropic savvy. Note, however, that not all doctoral degrees require a full course in psychopharmacology; some only offer it as an elective.
At a minimum, a great opportunity for students (and an affordable one!) is to attend CEUs with psychopharmacology as the focus. Refer to marketing materials to select workshops that are appropriate for your level of current psychopharm training.
For example, the University of Cincinnati offers a full day psychopharmacology update that attracts psychiatrists and psychiatric nurse practitioners from across the nation. Having attended this particular conference before, I believe it is more appropriate for level 2 or level 3 practitioners. Students and early career psychologists, like myself, would find it overwhelming (I did). Consider introductory workshops or survey courses.
An additional way to obtain familiarity with psychopharm for students is via practicum. For example, my own experience, and that of student colleagues’, has been invaluable to achieve some basic psychology/psychiatry cross-breeding!
While one of my colleagues obtained some psychopharm introduction via placement in a psychiatrist’s private practice (which has proven valuable to both her and the psychiatrist), I select one day out of the week to shadow the chief psychiatrist at an inpatient psychiatric facility. I’m pleased to report that both she and I have received excellent cross-training, and the psychiatrists with whom we’ve collaborated report equally positive experiences in gaining exposure to psychologically-based interventions.
This stage, ideal for those who need more than basic knowledge, but have no intent to directly prescribe, prepares one to collaborate/consult on psychotropic drugs with other prescribers who may seek the counsel of a psychologist (pediatrician, family doctor, nurse practitioner, etc.). The idea is that the hybrid training of a psychologist who is familiar with psychotropics at this level is highly valuable to prescribers with limited (or no) psychological training.
Ideal ways to achieve this level are through either formal programs (like those mentioned below for level 3), or through formal internships which include this aspect in their training curricula (e.g., teaching hospitals which offer collaborative training with the departments of psychiatry).
The most comprehensive level described by the APA, level 3 prepares psychologists for independent prescribing authority – an ability to prescribe without oversight.
To achieve this, psychologists must already hold an active license, as well as complete a post-doctoral master’s or certificate program, and pass the Psychopharmacology Examination for Psychologists (PEP). Of course, with only four states offering psychologists the ability to prescribe, this level may seem unnecessary for many psychologists.
However, already holding such a degree becomes greatly beneficial when (not if) one’s state of practice does pass statutory authority. For example, in the state of Texas, pro-RxP legislation is continuously sought by the prescribing psychology taskforce, and in only my small rural district, six psychologists either already possess, or will soon possess, the training and credentials to prescribe.
An important word regarding state laws: psychologists should take careful note of the wording in statutory guidelines, as “collaborate” and “consult” can have different statutory meanings. The former suggests more agreement between professionals (e.g., psychologist and physician), and the latter suggests that a consultation must take place, but does not require agreement before action. Both of these should be examined on a state-by-state basis.
The Current State of RxP in the U.S.
If in the course of three decades only four states have passed RxP legislation (two of which passed within the last year), it might be fair to say that this movement has been a slow and difficult battle since day one.
However, approximately half the states in the U.S. have proposed such legislation. Many states also include laws on their books permitting psychologists to consult or collaborate with prescribers about psychotropic medication. More and more research is surfacing demonstrating both positive patient outcomes regarding prescribing psychologists, as well as positive physician endorsement.
Today, state psychological associations are seeking to partner with universities to offer more post-doctoral master’s degrees in psychopharmacology. Further, some are looking to combine programs with nursing schools or pharmacy schools. Universities like Fairleigh Dickinson and Alliant International have been offering psychopharmacology master’s degrees for many years, with a blend of online and in-person training which includes didactic and practical experience.
This progress, though, has been slow. Healthcare politics (especially inter-professional politics) can be ruthless. The nursing community, after years of demonstrating safe-prescribing practices, still faces political roadblocks regarding autonomous versus collaborative prescribing. The pros and cons of the RxP movement and the heated debate about it will be the foci of later articles in this series.
**The views and opinions expressed in this article are purely the article author’s, and not necessarily the views and opinions of Time2Track LLC.**
References VandenBos, G. R., & Williams, S. (2001). Is psychologists’ involvement in the prescribing of psychotropic medication really a new activity? Professional Psychology: Research and Practice, 31, 615-618-doi: 10.1037/0735-7028.31.6.615
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Latest posts by Ryan R. Cooper (see all)
- Prescription Privileges for Psychologists: An Introduction - March 20, 2017