Prescribing Psychology Poised for Expansion

Psychologists in the U.S. have been prescribing medication since 1994.

Source: Image by Arek Socha from Pixabay.

With the passing of HB23-1071, Licensed Psychologist Prescriptive Authority, in Colorado on March 3, 2023, there are now six states and a U.S. territory, along with the U.S. Department of Defense, Public Health Service, and Indian Health Service, which allow for psychologists to prescribe psychotropic medication. At least six other states have or have indicated that they are submitting prescribing psychology bills this year (e.g., Arizona).

Getting to this point took some time. Psychologists in the U.S. military first achieved prescriptive authority in 1994, so this isn’t exactly a radical or new idea. What is behind the push now?

Multiple factors in play appear to be converging at this moment. One is the nationwide shortage of mental health professionals, particularly in certain geographic areas. The main contributor to Colorado’s decision, for example, was the significant difficulty Coloradans have accessing mental health care, a problem exacerbated by increasing needs for mental health services related to the pandemic. Expanding the skillset of appropriately-trained psychologists is expected to improve access to care.

However, supply has been a problem despite demand, and the infrastructure to train and maintain prescribing psychologists has been wanting. Thus, another major factor is that training for psychologists has become more widely available. The first training program for prescribing psychology was the pilot program conducted by the military at the Uniformed Services University of Health Sciences. This program existed only long enough to complete the pilot, which ended in 1997, leaving a need for civilian programs to develop in order for prescribing psychology (also called clinical psychopharmacology and/or medical psychology) to further develop as a specialty.

Civilian programs began to slowly materialize in the early 2000s leading to the current state of six formal training programs at The Chicago School of Professional Psychology, Idaho State University, New Mexico State University, Fairleigh Dickinson University, Alliant International University, and Drake University. These graduate schools provide the master’s degree in clinical psychopharmacology (which must be obtained in addition to the psychology doctoral degree needed to practice as a psychologist), the educational requirements such that graduates can successfully complete the requisite specialty examination (i.e., Psychopharmacology Examination for Psychologists), and the necessary supervised clinical training.

Additionally, prescribing psychology was only recently formally recognized as the 17^th specialty in professional psychology by the American Psychological Association (APA) in 2020. This is a critical milestone for any specialty, and the designation established prescribing psychology as a highly defined area of practice requiring advanced knowledge, skills, education, and training.

With the formal recognition by APA as a specialty area of practice comes the ability of APA’s Division 55, the Society for Prescribing Psychology, to fully bring clinical psychopharmacology up to the same standard as the other specialty areas of practice by developing a mechanism for board certification through the American Board of Professional Psychology. Board certification is the highest formal standard of competence available to psychologists in the U.S. Division 55 is steadily progressing through this process.

The time does seem ripe for the expansion of prescribing psychology, as a confluence of mental health needs in the U.S. collides with the maturation of the infrastructure for this specialty. As the profession matures and more states take advantage of the advanced training of these psychologists, those seeking mental health services are expected to see treatment availability and options expand.