Prescribing Law Tightly Restricts Psychologists’ Scope of Practice

Legislation granting psychologists in Illinois the right to prescribe some medications—under physician supervision and only after receiving extensive clinical training—was signed into law June 25 by Gov. Pat Quinn (D).

Passage of the Clinical Psychologist Licensing Act concludes years of lobbying by psychologists in the state who have repeatedly pressed for prescribing privileges against the opposition of the Illinois Psychiatric Society (IPS) and Illinois State Medical Society (ISMS). The final bill received legislative approval only after lawmakers agreed to include amendments advocated by IPS and ISMS that mandate extensive preclinical and clinical biomedical education and that significantly restrict the circumstances in which a psychologist can prescribe medicine as well as the drugs that can be prescribed and the patient populations to whom they may be prescribed.

Specifically, psychologists will not be able to prescribe to any patient who is under age 17 or over age 65, pregnant, or has a serious medical condition or developmental/intellectual disabilities.

Lisa Rone, M.D., a past president of IPS and current chair of the IPS Public Affairs Committee, said the prescribing legislation originally introduced was extremely inadequate in terms of education and training requirements. In public hearings on the bill, leaders from IPS and ISMS—as well as the Illinois chapter of the American Nurses Association, the Illinois Society for Advanced Practice Nursing, the National Alliance on Mental Illness (NAMI), and other groups—persuaded legislators that the bill needed to be significantly amended to protect patient safety, she said.

Physicians Get Major Changes Added

In a letter to APA Assembly members, APA CEO and Medical Director Saul Levin, M.D., M.P.A., provided background on the development of the legislation and on IPS and ISMS efforts. “On May 29, 2014, the Illinois House voted to add significant educational and clinical requirements to a bill that as proposed would have allowed broad prescribing authority to psychologists,” he wrote. “The IPS/ISMS negotiated an amendment to a bill to allow clinical psychologists who complete new stringent education programs akin to physician assistant education and training a very narrowly defined authority to prescribe psychiatric medications. Because of the IPS/ISMS amendments, the amended legislation now requires significant increases in biomedical education, clinical training, and supervision. Added to these requirements, the bill limits the population that psychologists may serve and the types of medications they can prescribe, all while under the auspices of a written collaborative agreement with a physician who cares for patients with mental illness.”

APA President Paul Summergrad, M.D., said, “Prescriptive authority should only be extended after very substantial biomedical education and training, which the Illinois bill more than achieves. The limitations in the scope of practice and the requirements for physician supervision, among other provisions, are important protections for psychiatric patients who have more—not less—medical comorbidity than patients without psychiatric illness. Our colleagues in the IPS and ISMS should be congratulated for upholding these important patient safety and quality principles.”

Efforts to expand prescribing to clinical psychologists have also been considered recently in Arizona, Hawaii, and Iowa; bills in those states have died in the legislature. A psychologist prescribing bill is pending in the New York legislature but is not expected to be acted on this year, but a New Jersey bill is likely to be taken up by the legislature in September.

Levin told Psychiatric News that APA is continuing to work with the AMA and medical specialty groups to insist on appropriate training for all clinicians who can prescribe medication.

“This Illinois bill is consistent with our long-held policy that nobody should prescribe medication absent significant biomedical education and clinical training in order to ensure patient safety,” he said. “We will continue to work with colleagues in Illinois and elsewhere to make sure these critical patient-safety and quality standards are upheld in legislation and regulation. Patients with psychiatric illness and their families deserve the same safety and quality standards as all other patients.”

Scope of Practice Tightly Restricted

The bill amendments that the IPS and ISMS successfully advocated restrict psychologist prescribing in at least three key areas: level of training required, supervision by a physician, and restrictions on which drugs psychologists may prescribe and what types of patients they may treat with medication.

The legislation forbids online education for prescribing privileges, and a clinical psychologist will be able to prescribe only after successfully completing the following minimum educational and training requirements:

Psychologists will not be allowed to prescribe benzodiazepines, narcotics, or any Schedule II controlled substances.

Finally, a written collaborative agreement is required between a prescribing psychologist and a physician who treats patients with mental illness.

Ken Busch, M.D., chair of the IPS Government Affairs Committee, said psychologists have pushed for prescribing rights for nearly 15 years, and this year brought a massive, lavishly funded lobbying campaign to the effort. Illinois psychologists had made some concessions with regard to collaborative supervision by a physician, but IPS and ISMS leaders insisted on very stringent training requirements and restrictions on drug classes and patient populations that could be treated, he said.

He added that in the end, IPS and ISMS did not support even the amended bill when it came to the House floor for a final vote, but agreed only to remain neutral—and then only after psychologists had agreed to every stipulation in the IPS/ISMS amendments.

“This bill leaves very limited scope for prescribing by clinical psychologists,” Busch told Psychiatric News. ■