Visionary Leaders: Having the opportunity to spend time with the psychology and advanced practice nursing graduate students at the Uniformed Services University (USU) reinforces my appreciation for their passionate interest in learning the most up-to-date clinical skills. Reflecting upon the history and probable future of psychology's quest for prescriptive authority (RxP), Fernanda De Oliveira (1st Lt, USAF) and 2017 APA President Tony Puente proffered that those setting standards for APA accredited internships should facilitate the development of regular interprofessional seminars specifically focusing upon the potential use of psychotropic medications (pros- and cons-) for the patient populations being served. They further called for the establishment of specialty RxP post-doctoral experiences (e.g., with children or the elderly).
The APA Ad Hoc Task Force on Psychopharmacology was established by the Council of Representatives in 1990 and chaired by Michael Smyer, with Tony serving as a member. They concluded: "(T)he contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment." They proposed three levels of training for allpracticing psychologists. The first was rudimentary understanding of the use and limitations of psychopharmacological intervention. The second was a mid-level but more in depth understanding including specific application and interaction between psychoactive medicines and mental disorders; e.g., what types of medications might have best impact on what types of depression. Finally, the third level is what today is called prescription authority which entails both classroom and didactic training. Psychology's RxP journey began in the Department of Defense with Navy Commander John Sexton and then-Lt. Commander Morgan Sammons being the first graduates of the PDP in 1994. We would be veryinterested in learning whether any members of the Division have participated in interprofessional RxP seminars as envisioned by the Task Force. We would expect that nursing and pharmacy would be the most receptive to such collaboration.
When the APA Council began considering RxP in the 1990s, a conscious decision was made to conceptualize the development of this new clinical skill at the post-doctoral level. Last year, after two decades, the decision was made to relook at the timing of the educational requirements. One of our most visionary colleagues, Beth Rom-Rymer, who was absolutely critical in Illinois enacting their RxP legislation in 2014, recently hosted her fourth Chicago evening soiree for those committed to advancing the agenda. Beth has long supported providing the necessary didactic knowledge as early as possible in one's training:
"We had our biggest crowd, yet, for our Fourth Biannual Prescriptive Authority Networking Dinner, at my home, with over 100 people. We had two distinguished keynote speakers: Arthur Evans, our APA CEO, and Danny Carlat, the first psychiatrist, of whom I'm aware, to publicly support RxP for psychologists. Danny began to speak out, in our favor, in the late 1990's. Arthur talked about the importance of strengthening the voice of APA: advocating for the science underlying our psychological principles; increasing opportunities for psychologists in integrated care; advocating for RxP for appropriately trained psychologists; advocating for psychologists in their relationships with managed care; advocating for those individuals in our society who do not have a voice but profoundly suffer from societal injustice.
"In 2010, Danny had written a blog, entitled, Psychologists prescribing is the best thing that can happen to psychiatry. In part, he said: 'Psychiatry has boxed itself into a tiny corner of medicine called 'Psychopharmacology.' It's a silly way to practice our craft, because the essence of what we do is to understand the mind and to help people live better lives. Drugs are effective but only one of the tools available to us, and we have largely ceded psychotherapy to psychologists and social workers. The result is a fragmentation of care…. As the safety data gradually accrues, I predict that psychologists will attain prescriptive privileges in most states over the next 10-20 years. We saw the same pattern in the 1970's with Nurse Practitioners – psychiatrists and other physicians engaged in bitter turf wars initially, arguing that they didn't have enough training, but large scale health services research studies eventually demonstrated that NPs operated competently and safely, and now they are accepted as independent practitioners in most states…." Saturday night, Danny reaffirmed his commitment to the state by state pursuit of RxP. Since we had representatives from the states of Iowa, Ohio, Connecticut, and Virginia, the prescribing psychology advocates will collaborate with him as they move forward.
"There was a significant diversity of community partners that was represented at the Networking Dinner. No legislative initiative succeeds without the active support of the larger community. I recognized the indefatigable efforts of a number of our local healthcare systems. These outstanding and visionary leaders committed their time, their energy, and their expertise, to create a series of rotation experiences for prescribing psychology trainees that will continue into the foreseeable future. As we neared the end of our prepared program, I asked all of the 12 Psychology graduate students to come to the front of the room and introduce themselves to the group. Two of the student leaders talked about why they are choosing to take joint degrees in Clinical Psychopharmacology along with their doctoral degrees in Psychology. Several Early Career Psychologists introduced themselves, explaining why they are taking the training to become Prescribing Psychologists. The event lasted almost until midnight. There was a strong feeling of accomplishment in how we have progressed in the implementation of our statute and enthusiasm for the prominent roles that prescribing psychologists will take in repairing a faltering mental health system.
American Samoa – Federal Responsibility: Under the leadership of Dean Carol Romano, former Chief Nurse Officer for the U.S. Public Health Service, USU nursing graduate students have begun clinical placements in American Samoa. Located in the South Pacific, midway between Hawaii and New Zealand, this site was chosen in 1872 as a coaling station for the U.S. Navy. After the attack on Pearl Harbor on December 7, 1941, naval activity there increased significantly. It is a U.S. territory, covering seven islands and atolls. Its population approximates 55,500 with a land mass of 76.8 square miles, slightly more than Washington, DC. It is noted for having the highest rate of military enlistment of any U.S. state or territory. With an extreme shortage of health professionals health disparities are rampant. "It cannot save the few who are rich" [President John F. Kennedy, 1961]. Aloha,
Pat DeLeon, former APA President – Division 19 – February, 2018
