On June 25 of this year, Governor Quinn of Illinois signed into law SB 2187 (Public Act 098-0668), a bill allowing appropriately trained psychologists to prescribe psychotropic medications. This makes the third state, following New Mexico in 2003 and Louisiana in 2007, to pass legislation enabling psychologists to prescribe. At this point three states, one territory (Guam), the United States Department of Defense and portions of the US Public Health Service (the Indian Health Service) have legislation or regulations enabling psychologists to prescribe.
As in New Mexico and Louisiana, the signing of the bill was the culmination of years of activism. Opposition to the bill was prolonged and fierce, led, as is always the case, by organized psychiatry. Such endeavors cost far more than money, although a significant amount was needed over the years to hire additional lobbyists to support the bills in Illinois and other states. The backing of the state psychological association and support of APA’s Practice Organization was critical, as was legislative support from allied health care professionals. But most importantly, success entailed the sustained, long-term and almost single minded attention of one or a very small group of individuals. In the case of Illinois, it was Dr. Beth Rom-Rymer, a Chicago psychologist who was past-president of the Illinois Psychological Association and a past-president of APA’s Division 55, who can be credited with the legislative victory. Just as in New Mexico and Louisiana, a small group of tireless campaigners (Elaine LeVine, Mario Marquez, John Bolter, Jim Quillen, Glenn Ally and friends) were totally committed to the legislation. Whether or not one supports prescriptive authority, these activists’ work highlights the profession and our ability to engage in effective legislative action. For this alone, the entire profession owes Dr. Rom-Rymer a vote of gratitude.
The bill is not without controversy. It is very much a “foot-in-the door” bill that requires prescribing psychologists to take a significant didactic and clinical sequence on top of standard doctoral work in order to prescribe. It is a collaborative practice bill, meaning that prescribing psychologists must practice in collaboration with a physician. It very much reflected the legislative process of debate and compromise. But in the end, Dr. Rom-Rymer’s group was able to pass legislation that had the support of the Illinois medical and psychiatric associations.
The bill requires, among other things, 60 credit hours of instruction in pharmacology, physical assessment, and related coursework is required, as is currently offered in APA designated post-doctoral training in psychopharmacology. A full-time, 14 month practicum is required, with rotations in various specialty areas such as obstetrics and gynecology, geriatrics, and related fields. It is not a bill for the faint-hearted, and in many respects is designed more for psychologists in training than those already in the field.
Some may criticize the training requirements as being too stringent. But the bill accomplished its major objective, which was to allow appropriately trained psychologists to add pharmacological interventions, where necessary, to their therapeutic regimens. I note that this is exactly the legislative strategy pursued by other professions, such as nurse practitioners, who, shortly after demonstrating that they could safely prescribe under supervision, have expanded their prescriptive ability such that they now prescribe completely independently in many states, and have collaborative authority in the remainder. There is great wisdom in following the success of others who’ve gone before us.
It is hoped that the passage of this legislation will spur renewed interest in other states considering prescriptive authority legislation. As mental health service provision expands according to the dictates of both parity legislation and the Affordable Care Act, prescriptive authority a clear mechanism that will allow psychologists utilizing their expertise in behavioral and pharmacological interventions to act as full-fledged members of an integrated healthcare delivery team. While each jurisdiction must carefully consider requirements for training, it is hoped that each will consider well-established training standards that allow psychologists to efficiently acquire the additional skills needed to add psychopharmacology to their already wide repertoire of assessment and intervention skills.
Note: The majority of this article was previously published under the same title in the Fall, 2014 issue of the California Psychologist and is reproduced with the kind permission of the California Psychological Association.