In November 1984, at the Hawaii Psychological Association (HPA) annual convention, U.S. Senator Daniel K. Inouye urged the membership to seek prescriptive authority (RxP): "When you have obtained this statutory authority… you will be an autonomous profession and your clients will be well-served." In 1990, the APA Council of Representatives established its Task Force on Prescriptive Authority, chaired by Michael Smyer, and on which APA Past President Tony Puente served. The task force concluded: "practitioners with combined training in psychopharmacology and psychosocial treatments can reasonably be viewed as a new form of health care professional, expected to bring to health care delivery the best of both psychological and pharmacological knowledge. The contributions of this new form of psychopharmacological intervention have the potential to dramatically improve patient care and make important new advances in treatment."
Having grown up in Connecticut, I admire CPA's renewed efforts to obtain this clinical responsibility, under the leadership of former CPA President and RxP committee chair Barbara Bunk. Connecticut has an impressive history of providing visionary leadership for the profession, with Alan Kazdin, Bob Sternberg, and the late Neal Miller serving as APA Presidents. Arthur Evans, APA's new CEO, and Dan Abrahamson, the driving force behind APA's extraordinary state level accomplishments, lived in the Nutmeg State for many years. Ken Pope and Jeff Zimmerman are dedicated to insuring that our profession becomes aware of the clinical and policy developments occurring within other professions. Academic and scientific colleagues across the nation have been blessed by the successes of Danbury's Alan Kraut who served as the first Executive Director of the Association for Psychological Science, and currently is Executive Director of the Psychological Clinical Science Accreditation System.
A major lesson learned from the initial RxP successes of Elaine LeVine (New Mexico) and James Quillin (Louisiana) is the importance of developing board-based grassroots support, especially from potential concerned beneficiaries. We are convinced that psychology will only achieve parity within the nation's healthcare environment by focusing upon society's real needs, and not overly concerning ourselves with "professional turf" issues. As your initial efforts under Michael Schwarzchild's leadership clearly demonstrated, RxP is fundamentally about increasing access to qualityhealthcare for those most in need.
Give an Hour: In our judgment, an exemplary example of "giving psychology away" has been the visionary efforts of Barbara Van Dahlen in establishing Give an Hour. To date, she and her colleagues have provided more than 124,000 hours of free mental and behavioral health care, valued at over $24 million, through volunteer mental health professionals, for active duty military personnel, Veterans, and their families. Recently, she has expanded her efforts to address the needs of those impacted by last year's extraordinary series of natural and man-made disasters, including Hurricane Harvey, as well as assisting other special populations who clearly are in need – including at risk teens, at risk seniors, survivors of gun violence, and victims of human trafficking.
"Building on the tremendous success of the first Global Summit on Mental Health Culture Change held in Los Angeles, California in May, 2017, Give an Hour – in partnership with the UK Ministery of Defense, the Royal Foundation and Combat Stress – brings this exciting gathering to London in June, 2018. The London Summit will continue the work accomplished in California by gathering together key thought leaders, government officials, stakeholders, policy makers and change agents to focus exclusively on addressing culture as a primary barrier to changing the way we think about, talk about and address emotional well-being and mental health so that all in need – including those who serve as well as civilians – are able to receive appropriate treatment and support.
"Give an Hour, the backbone organization behind the Campaign to Change Direction, has created A Global Summit on Mental Health Culture Change to showcase successful efforts, forge new alliances and create the strategic vision necessary to eradicate the fear, shame and guilt that prevents those who are suffering from receiving the compassionate care they deserve. Only through culture change will we achieve lasting change. Last year, we invited APA President Tony Puente to participate in the summit. I am excited to include several prominent psychologists among the presenters and participants this coming year" (Barbara Van Dahlen).
Interprofessional Collaboration: President Obama's landmark Patient Protection and Affordable Care Act (ACA) envisions a transformed healthcareenvironment in which patient-centered, integrated mental health care will be provided by interprofessional teams with an emphasis upon holistic and preventive care, in contrast to today's fee-for-procedure, acute care orientation. Three years ago, the California Technology Assessment Forum (CTAF) report Integrating Behavioral Health into Primary Care noted: "Despite a long history in the US of treating physical health conditions separately from behavioral health, the two are inextricably linked. Up to 70% of physician visits are for issues with a behavioral health component. A similar percentage of adults with behavioral health conditions have one or more physical health issues. Having a chronic condition is a risk factor for having a behavioral health condition and vice versa. Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions." CTAF further noted that anxiety and depression are the most common behavioral health disorders in primary care settings.
Visionary Initiatives – One Step at a Time: "From the mid-90s until the internship at Federal Correctional Institution at Petersburg, Virginia was closed in 2001, we had all our interns participate in psychiatry's rounds with the option to do a minor rotation in clinical psychopharmacology. We created medication information sheets for the inmate-patients. One of our interns, whose first language was Spanish, created a Spanish-language version which was very helpful. The first psychiatrist I worked with at the prison was adamantly opposed to giving patients information about meds. He thought that keeping them ignorant made them more compliant. Working with him was how I began to support RxP" [Bob Ax]. Linda Campbell who initiated one of psychology's first RxP training programs with her University of Georgia pharmacy colleagues: "A colleague and I have developed an integrated free clinic in Athens. We are growing a training program for pharmacy and psychology students working shoulder to shoulder in achieving incredible health outcomes for low SES rural populations. I have worked closely with the College of Pharmacy since our initial efforts and it has paid off."
Last year APA convened a Task Force to review, and where appropriate, update the criteria for the curriculum for APA designated RxP training programs. Their report is out for public comment and expected to be submitted to Council this year. Those interested in providing didactic training at the graduate level will be pleased. As Tony Puente and Fernanda De Oliveira have noted, many Early Career Psychologists interested in pursuing this clinical responsibility will no longer have to "start from scratch" and wonder if, during their already extensive training, they had obtained a sufficient foundation to pursue RxP. Hopefully, increasing opportunities for interprofessional psychopharmacology training will also evolve. [Tony Puente]. Aloha,
Pat DeLeon, former APA President – CPA – February, 2018
