Leading the way in unchartered waters

Legislative advancements in the 1990s paved the way for military psychologists to obtain prescription privileges (RxP). Recent advancements in state assemblies have added momentum for civilian psychologists to also acquire similar prescription privileges. Since my "retirement" in January 2012, I have had the privilege of serving on the faculty of the medical and nursing schools at the Uniformed Services University of the Health Sciences (USUHS), the nation's only federal health sciences university. I believe the unique training environment and curriculum offered by the USUHS Department of Medical and Clinical Psychology can serve as a model for training future prescribing psychologists.

Prior to USUHS, I served with the late U.S. Senator Daniel K. Inouye (D-HI) for 38+ years, retiring as his Chief of Staff. One of our most interesting initiatives was the directive by the conferees on the Fiscal Year 1989 Appropriations bill that the Department of Defense (DoD) establish a "demonstration pilot training project under which military psychologists may be trained and authorized to issue appropriate psychotropic medications under certain circumstances." Morgan Sammons and John Sexton (both U.S. Navy) were the first to graduate from DoD psychopharmacology training program at the June 17, 1994, ceremony held at Walter Reed Army Medical Center, attended by then APA President Bob Resnick. These two trailblazing colleagues unequivocally demonstrated that psychologists can learn to safely and cost-effectively provide high-quality psychopharmacological care. Several prescribing psychologists have since followed in Sammons and Sexton's footsteps. Military psychologists should be proud of their historical accomplishment, and they should be prepared to affirmatively assist other colleagues in obtaining this important clinical responsibility within the DoD, Veterans Affairs, and throughout the civilian sector. The political climate demands it.

During the past year, prescribing psychologists have made significant progress in two of our larger states. In New Jersey, Robert McGrath, psychology professor at Fairleigh Dickinson University and former president of Div. 55 (American Society for the Advancement of Pharmacotherapy) reports:

The New Jersey RxP bill passed our Assembly on April 29, 2013, despite strong opposition from several of the medical societies. Though they fielded five lobbyists on the day of the vote, they had no argument against the bill other than the usual claims that the training is insufficient and patients would be 'harmed,' without presenting a shred of data to support their position. Next we move on to the Senate. It's a remarkably expensive undertaking, and we can use any help we can get.

In Illinois, Beth Rom-Rymer, president of the Illinois Psychological Association and former president of Div. 55 (American Society for the Advancement of Pharmacotherapy) reports:

We have had a remarkable 14 months. On March 6, 2012, the Illinois State Senate Public Health Committee passed our RxP bill out of Committee by a vote of 6-4. With our lobbyists, we made the critical decision to spend the next 12 months educating our psychologists and legislators around the state on RxP issues; training Illinois psychologists in becoming effective advocates for RxP; and reaching out to mental health associations, social service organizations, law enforcement agencies, hospitals, mental health centers, physician groups, etc. to educate about, and advocate for, RxP. We have been very fortunate to work with strongly committed and dedicated legislative chief sponsors, including the Senate President pro Tem Don Harmon. On March 12, 2013, our RxP legislation passed out of the Senate Public Health Committee by the unanimous vote of 8-0 with one abstention. On April 25th, we overwhelmingly passed out of the Senate by a vote of 37-10 with 4 abstentions. On May 7th, our Senate bill was placed in the House Executive Committee. Over the next several days, we were continually conferring with our lobbyists over the advisability of calling our bill. We made the strategic decision that we wanted to take more time to work with our Representatives so that the vote would reflect an informed understanding of the issues. We will be working very closely, over the next several months, with our legislators and all of our third party groups around the state. We are very fortunate that although this legislative session has concluded on May 31st, we are in the 1st year of a 2-year sequence. We are, therefore, able to build on all of our terrific accomplishments, to date, and focus on the House. We are also in productive discussions with the Governor's Office. We are looking toward achieving passage during our next legislative session in the spring of 2014.

Legislative advancements in the past 30 years have made RxP for psychologists a reality. Now more than ever it is essential for doctoral programs in psychology to prepare students to successfully take advantage of these hard-earned privileges. Students and faculty around the country can look to USUHS's psychology training programs as a model for this type of training.

Established in 1972, the mission of USUHS is to "train, educate and prepare uniformed services health professionals, officers and leaders to directly support the Military Health System, the National Security and National Defense Strategies of the United States, and the readiness of America's Armed Forces." USUHS trains psychologists, nurses, physicians, dentists, biomedical researchers and public health specialists in a joint environment comprised of Army, Navy, Air Force and civilian students and faculty. As part of their core curriculum, medical students, nursing students and graduate students take courses within their departments and with each other, acquiring and incorporating knowledge from adjacent health disciplines while enhancing their own.

Located within the School of Medicine at USUHS, the Medical and Clinical Psychology Department provides an outstanding doctoral education for tomorrow's military and civilian clinical and research psychologists. Each year, students from Army, Navy, Air Force, and civilian backgrounds are accepted into the program. Students learn how to design methodologically rigorous research projects and conduct ethical, evidence-based psychotherapy. In addition to their core research and clinical curriculum, students take pharmacology, pathophysiology and neuroscience, among other courses, to enhance their clinical skills and their application of psychological principles to a variety of health conditions.

Importantly, the USUHS training model enables psychology students to communicate effectively with researchers and providers across multiple health disciplines in military and civilian contexts. Throughout their training, medical and clinical psychology students focus on working with military populations and researching military-relevant health problems, such as traumatic brain injury, suicide, and substance abuse. Due to its proximity to Walter Reed National Military Medical Center, the National Institutes of Health, and the American Psychological Association headquarters, students are able to interface and network with leaders in military-relevant health, research, and policy. Overall, the Department of Medical and Clinical Psychology at USUHS prepares its students to think critically about mental health concerns facing the nation's military, to work effectively in interdisciplinary environments, and to influence policy at the highest echelons of government.

Military psychology has played a critical role in the advancement of RxP for psychologists. As more and more psychologists advocate for and obtain RxP privileges, I expect military psychologists to continue to play a leading role in the field. Training psychologists alongside medical and nursing students can prepare future generations of clinicians to assume the challenges of RxP responsibilities. From the littlest of Acorns, those with vision see mighty Oaks.

Note

All uses of the pronoun "I" represent the first author's perspective.

About the Authors

Patrick H. DeLeon, PhD, JD, MPH, is the 2013 recipient of the American Psychological Foundation's Gold Medal Award for Life Achievement in the Practice of Psychology. In addition to serving as president of the American Psychological Association (APA) in 2000, he has served on the APA's Council of Representatives and Board of Directors. During his 38-year tenure on the U.S. Senate staff, DeLeon was actively engaged in shaping psychology's federal legislative presence, especially in the realm of prescription privileges for psychologists. Presently, DeLeon is on the faculty of the USUHS and the University of Hawai'i.

Army Capt. David M. Barry, MS, is a rising 4th year clinical psychology PhD candidate at USUHS. Prior to attending USUHS, he served as a combat engineer Platoon Leader, Battalion Engineer and Battalion S4 (Logistics Officer) in a mechanized, combined arms battalion. He is currently serving as the Div.19 Student Affairs Chair.