FIG1 Working closely with the
Maine Medical Association (MMA), and with financial support from APA, the
Maine Psychiatric Association (MPA) successfully redirected a study bill in
the state legislature concerning psychologist prescribing privileges to a
broader study of access to mental health care.
Maine is following the lead of the New Hampshire Psychiatric Association,
which defeated a similar study bill in its legislature earlier this year and
fought a successful battle over psychologists' scope of practice last year.
APA Medical Director James H. Scully Jr., M.D., has congratulated the MPA for"
doing everything right" in response to the prescribing bill.
Storm warnings about a possible bill in the Maine legislature had come from
Paula Johnson, deputy director for state affairs in APA's Department of
Government Relations, as early as two years ago, and a psychologist bill had
been offered but quickly withdrawn last year. But despite a high level of
alertness, the MMA and MPA were surprised when state Sen. Mike Brennan, chair
of the Health and Human Services (HHS) Committee, submitted "An Act to
Allow Psychologists to Prescribe Psychotropic Drugs" in the current
Informal consultation with Brennan by MMA Executive Vice President Gordon
Smith and others led to a change in the bill's title to "Resolve, To
Establish the Commission to Study Access to Prescription Medication for
Persons With Mental Illness" (LD 1713).
Brennan asserted that he had not been lobbied by psychologists, but rather
had acted out of a genuine concern that people in rural Maine were unable to
access prescription medications. However, one psychologist in central Maine
had already begun taking courses in psychopharmacology and was quick to jump
aboard this "Trojan horse" all too conveniently appearing outside
the city gates. Not surprisingly the beast began to roll forward as the volume
of out-of-state psychologists' calls to the health committee mounted, despite
little enthusiasm from most Maine psychologists.
The MPA was faced with a dilemma. Historically, groups proposing a study
bill have come back to the Maine legislature in the subsequent session and
succeeded in gaining whatever privileges they were seeking to study. But
outright defeat of even this study bill, which was proposed by the Democratic
chair of a Democratic-majority committee, seemed a remote political
possibility. What to do?
As far back as fall 2002, Maine and Vermont had submitted a grant request
to the APA Committee on Advocacy and Litigation Funding (CALF) to hire media
strategist Jeff Toorish to develop a small-DB "pre-emptive strike"
pilot project to train speakers, educate the public and legislators about who
we are and what we do, and even help to develop enabling legislation to
consult with and better train medical colleagues.
His expertise as we shifted from a "peacetime" to a"
wartime" mode was amplified by the hiring of additional lobbyists
Cathy Lee and Andrea Maker (former MPA allies in parity campaigns) and the
in-depth knowledge of the legislature provided by MMA lobbyist Andy MacLean
A previously planned Psychiatrists' Day at the Legislature just a week
prior to the first hearing on LD 1713 offered a well-timed chance to meet with
Brennan, other members of the Health and Human Services Committee, and Senate
and House leadership. In addition to addressing the standard "talking
points" about patient safety, MPA members showcased initiatives we are
taking to work with nonpsychiatrist colleagues in rural areas. These include a
new telemedicine program led by MPA Legislative Committee Chair Ed Pontius,
M.D.; an innovative program proposed by MPA member David Moltz, M.D., to pair
MPA members with family practitioners for telephone consultation; and a
program of "user-friendly psychiatry" talks at MMA annual
In addition, we repeatedly pointed out to legislators that the majority of
psychotropic prescriptions in Maine are written by medically trained
professionals other than psychiatrists and that the distribution of these
professionals around the state is wide enough for all to have access to safe
These points were restated at the formal hearing on the bill a week later
by MPA President William Matuzas, M.D., and by Dr. Pontius, as well as other
medical colleagues and overwhelmed the sparser and less-well-prepared
testimony of two psychologists. We also submitted editorials and letters to
the editor to local newspapers.
The happy outcome of the groundwork laid by the MMA and MPA was a unanimous
(including the original sponsor Sen. Brennan!) "ought not to pass"
verdict on the bill by the HHS Committee. Better yet, the committee charged
the Department of Behavioral and Developmental Services with creating a task
force of stakeholders to "address issues concerning access to [mental
health] care and collaboration between and among medical care and [mental
health] care providers."
Perhaps Maine psychiatrists will now have the proactive opportunity to lead
a multi-disciplinary force of mental health professionals back to a
cash-strapped legislature in its next session to fight together for
much-needed services of all kinds for our patients!
Legislative victories do not come cheap. Crucial to defeat of this study
bill was strong financial support from APA. The original $45,000 grant from
CALF to Maine and Vermont has been used to train speakers and advance
educational and advocacy efforts on the prescribing issue, and a second CALF
grant allowed MPA to hire additional lobbyists. We urge all APA members to
amplify their own DB's efforts by working closely with their state's medical
association and by contributing to the recharging of the CALF treasury for the
long road ahead. ▪