State Public Sector Initiatives: Over the years that we have been involved with the prescriptive authority agenda (RxP), there has been remarkably little discussion regarding the possibility of colleagues working within State prison and mental health systems providing this important clinical service. Fred Frese, a longtime advocate for psychology's increased involvement with individuals challenged by chronic mental health issues, recently reported on a 7-year follow-up study published in JAMA-Psychiatry finding that individuals with schizophrenia who are on reduced or no doses of anti-psychotic medications do better than those on medications. Other research Fred has highlighted suggests that those on antipsychotic medications live 15 to 25 years less than would be normally expected. As is the case with colleagues serving within federal institutions (i.e., the Department of Defense (DoD), Indian Health Service (IHS), and Department of Veterans Affairs (VA)), legislative restrictions on scope of practice issues frequently do not apply to public employees. We understand from Glenn Ally that since the enactment of their RxP legislation on May 6, 2004, medical psychologists in Louisiana have had an increasing presence within their public mental health system. Given the impressive and lengthy history of federal colleagues prescribing, we would hope that fostering state-based pilot projects would become a legislative priority for our State Associations.
During our recent Hawaii convention, we were very pleased to receive an update from Illinois RxP proponent Beth Rom-Rymer that in Ohio: "While, originally the Ohio RxP bill had been introduced as a small-scale demonstration project focusing upon the needs of the criminal justice system, legislative sponsors have urged us to introduce a full-scale RxP bill. This bill will be introduced in the 2014 legislative session, with a promise of doing well (Michael Ranney)." Those familiar with nursing's successful RxP quest over the years will appreciate the pivotal role that a small demonstration project in Ohio (when then-Dean Ron Fox was at Wright State University) evolved into a national success.
A New Era for Behavioral Health: President Obama's Patient Protection and Affordable Care Act (ACA) provides the states with considerable flexibility to implement a program that is tailored to their unique needs and strengths. Notwithstanding the current political climate, the political/policy experts that I am aware of do not seriously think that the ACA will be repealed or the newest phrase "unfunded." Unprecedented change has come to our nation's health care system with an emphasis upon integrated, interdisciplinary, patient-centered care, utilizing communications technology to objectively develop data-based "gold standard" protocols. The Administration has given a high priority to ensuring parity between mental health care and traditional physical health care, demonstrated by mental health and substance abuse services being among the ten "essential benefits" health insurers must provide under the state health exchange provision of ACA, which is to be implemented October 1, 2013. Aloha,
Pat DeLeon, former APA President – Division 31 – September, 2013
