Missouri became the first state to see psychologist prescribing legislation
this year when a bill was introduced January 8 in the state Senate. An
identical companion measure was introduced in the House nine days later.
The two bills (SB 917 and HB 1739) would authorize the licensure of"
prescribing psychologists," who could "prescribe certain
Schedule II stimulants and Schedule IV tranquilizers or any other
psychological treatment or laboratory test as it relates to the practice of
psychology, excluding electro-convulsive therapy," according to the
APA and the state's three district branches are strongly opposing the
Jack Croughan, M.D., president of the Eastern Missouri Psychiatric Society,
testified early last month against the Senate bill before the Senate Financial
and Governmental Organizations and Elections Committee. He told legislators
that all medications for mental illness have potentially serious side effects
and that patients taking them require careful and knowledgeable
Carolyn Robinowitz, M.D., president of APA, testified that the measures
would allow psychologists to write prescriptions after completing training
requirements set by the Missouri State Committee of Psychologists, not the
State Board of Registration for the Healing Arts (see Proposed Prescribing
Bills Put Patients at Risk).
"In fact, there is no medical involvement or oversight in this
legislation," she said.
Drugs used to treat mental illnesses also affect other organ systems and
interact with other medications, Robinowitz said. She noted that about half of
all patients with mental illness are taking medications for other medical
Psychiatrists were critical of the bills' training requirement for"
weekly supervision by a physician" because the oversight could be
provided by physicians with little background in psychotropics or other
medications that psychologists would have authority to prescribe.
"These bills are bad medicine and not the way to address mental
health care access issues," Rebecca DeFilippo, executive director of the
Eastern Missouri Psychiatric Society, told Psychiatric News.
Opponents of the bills also pointed out that the requirement, as stated in
the bills' summaries, for psychologists to complete 400 hours of"
didactic educational training recommended by the American Psychological
Association and a one-year fellowship" would focus on about only 5
percent of the medications in the Physicians Desk Reference, whereas
psychiatrists must have a much broader medical
The bills also require psychologists to pass "a national examination
testing competency to engage in the practice of prescriptive authority."
However, no such examination exists, opponents said.
The bills state that prescribing psychologists must complete at least 20
hours of "psychopharmacology continuing education credit" in
addition to 40 hours of continuing education within the two years before
license renewa. This latter requirement was criticized because the content of
the continuing medical education is not specified.
Similar to psychologist-prescribing advocates in other states, proponents
of the bills have argued that granting prescriptive authority to psychologists
would be cost-effective and increase access to care, especially for rural
populations in Missouri.
The measures were introduced by state Rep. Danielle Moore (R) and state
Sen. Jack Goodman (R), rural representatives, who have framed them as an
important part of their efforts to reduce the cost of health care and reduce
the number of uninsured residents below 700,000.
"There is nothing more important to the welfare of our citizens than
having access to health care, whether it is for treatment of an injury or for
treatment of an emotional or mental disorder," Moore said in a statement
issued by an advocacy coalition called the Missouri Families for Access to
Comprehensive Treatment. "When people run into obstacles finding
affordable care, they become frustrated and too often will go
A coalition statement said that the legislation would reduce waiting
periods that are now as long as eight months in rural and inner-city areas to
see a psychiatrist and obtain needed prescriptions.
Psychiatrists acknowledge that there are access problems—especially
to pediatric and geriatric psychiatrists—in some areas of the state, but
family physicians are already trained to prescribe medications for mental
illness and are better spread throughout the state than are psychologists.
In answer to psychologists' contention that general practice physicians
have only about eight weeks of training in mental health—according to
research by the Missouri Psychological Association—Robinowitz said the
health care needs of underserved populations are best met by improving the
mental health training of primary care providers, who already have far more
pharmacological training than the bills require.
Supporters of the bills said that the enactment of psychologist prescribing
laws in 2002 in New Mexico and in 2004 in Louisiana, along with Guam in 1998,
have paved the way for other states to take similar action. However, the
description of the discontinued Department of Defense Psychopharmacology
Demonstration Project (PDP) as "proof" that psychologists can be
trained to prescribe psychotropic drugs safely to patients drew a sharp
"Not only were the participants carefully screened and selected, but
the didactic and clinical psychopharmacology training they received far
exceeds the curriculum of any psychopharmacology training course in existence
today," Robinowitz said.
Psychologists in the PDP undertook a full year of didactic classroom
lectures and spent a second year training full time under the direct
supervision of military psychiatrists.
"To propose crash-course, shortcut training based on ever more vague
standards and requirements is an insult to persons who need treatment for
mental illness, including substance use disorders," Robinowitz said.
This year promises to be a busy one for psychologist-prescribing advocates
and opponents, as Missouri has joined three other states—California,
Hawaii, and Mississippi—in considering such bills.
In 2007 psychiatrists helped halt bills in 10 states that would have
extended prescribing privileges to psychologists. One effort helped win a veto
by Hawaii's governor, Linda Lingle (R) (Psychiatric News, August 17,
2007). Supporters of psychologist prescribing have reintroduced the measure in
the Senate (SB 2531) and the House (HB 2411). The House held its first hearing
on February 6.
In California, a wide-ranging bill (SB 993) to expand psychologists' scope
of practice was temporarily stopped in 2007 by the Senate Committee on
Business, Professions, and Economic Development, but the legislation is still
active due to that state's two-year legislative session.
Last year, Mississippi legislators considered a bill that would have
authorized prescribing privileges for "medical psychologists" who
have "specialized training in clinical psychopharmacology and have
passed a national proficiency examination in psychopharmacology"
approved by the Mississippi Board of Psychology. Although supporters were
unable to muster enough support in either chamber, they introduced new bills
(HB 148 and SB 2863) on January 22 and February 5, respectively.
APA also is watching for bills in six states that are considered likely to
introduce such measures: Alabama, Florida, Georgia, Minnesota, New Hampshire,
New Jersey, Ohio, Oklahoma, Tennessee, and Washington.
The text of most of these bills can be accessed on the official Web
sites of the respective state legislatures. ▪