Overview: After rigorous training prepares them to meet the highest practice standards, prescribing psychologists, like all other healthcare providers, are committed to providing the most effective treatment for their patients.

Emerging empirical research has clearly demonstrated that prescribing psychologists provide safe and effective treatment for their patients.

• The first psychologists to prescribe were military psychologists in 1992.. In 2002 and in 2004, civilian psychologists earned prescriptive authority in the states of New Mexico and Louisiana. Since then, psychologists have been prescribing in the United States Public Health Service, Indian reservations under the aegis of the Indian Health Service (IHS), in the United States Coast Guard, and, most recently, in the United States territory of Guam. The results have been unequivocally successful:

- After writing hundreds of thousands of prescriptions over a period of 20 years, not one complaint has been made against a prescribing psychologist

- over a period of 20 years, not one malpractice suit has been filed against a prescribing psychologist

- A 2010 (or 2011?) survey of family physicians who refer patients to prescribing psychologists in the Army Medical Command’s Western Region found that overwhelming majorities believe that prescribing psychologists not only prescribe “safely,” but that prescribing psychologists have “improved” patient care

- Dr. Robert Sherrill, Chair of the New Mexico Psychology Licensing Board, has stated that from the time that New Mexico prescribing psychologists first wrote prescriptions in 2004, no complaints alleging patient harm by prescribing psychologists have ever been filed with the State Board and no allegations of improper or inappropriate prescribing have ever been filed with the New Mexico State Board of Pharmacy.

- The Chief Executive officer of the Insurance Trust of the American Psychological Association (APAIT) has reported that there have never been any complaints filed with APAIT against prescribing psychologists.

• In a 2008 empirical review of the work of the prescribing psychologist, it was noted that prescribing psychologists are careful diagnosticians, taking comprehensive histories as they formulate diagnostic impressions, treatment plans, and referral recommendations.

• Patient Richard Magee sings high praise of the integrative care that he received in New Mexico from prescribing psychologist Dr. Elaine LeVine:

- “I was referred to you for psychotherapy right after my family’s horrific tragedy. … Not only have you been extremely careful in prescribing medicines, always making sure that I understand what they do and what kinds of sideoeffects they may have, you have masterfully coupled this with the kind of listening and analysis no one I know who only sees a psychiatrist receives.” – Magee in a letter to New Mexico officials

Prescribing psychologists will prescribe in collaboration with the other healthcare providers who are caring for their patients. Coordination of care is essential in the provision of excellent and effective treatment.

Illinois prescribing psychologists are ready to tackle the state’s mental health care crisis to make the RxP Difference. Prescribing psychologists around the nation have a proven track record of care, meeting the highest levels ofsafety standards,patient satisfaction, and collegial commendation.

The Department of Defense trained ten psychologists to prescribe psychotropic medication. Exhaustive evaluations of their practices have found that they “filled critical needs and performed with excellence wherever they served.” (U.S. General Accounting Office, 1999)

The links below will take you to interviews of these prescribing military psychologists as they describe how prescriptive authority has improved their ability to help patients without sacrificing any of the traditional psychological tools that are so important to mental health treatment.

Why are Illinois psychologists pursuing prescription privileges?
1. To make appropriate medications available to underserved populations;

2. To give patients the option of a broader continuity of care from their psychologists 3. To enhance psychologists’ expertise in and knowledge of brain-behavior relationships.

Would any licensed psychologist be eligible to prescribe?
Absolutely NOT — no responsible licensed clinical psychologist recommends this. What is being proposed is that persons who are already licensed clinical psychologists would complete additional didactic and clinical training and pass a rigorous exam before being certified to prescribe. Illinois psychologists are asking that psychologists licensed to prescribe offer only psychoactive and ancillary medications.

Can psychologists be trained to prescribe with an appropriate level of safety without completing medical school, a psychiatric residency, and board certification?
Yes. Experts in psychopharmacology consulted by the American Psychological Association and independent evaluators who have reviewed the performance of those psychologists who have already been trained to prescribe have verified psychologists can prescribe safely. Additionally, the licensed clinical psychologists who have completed ADDITIONAL training offered by the Department of Defense Demonstration Project have been able to prescribe safely (see Cullen and Newman, 1997.)

There is also evidence that other non-physician prescribers can do so with an appropriate level of safety.

Would all psychologists seek this additional certification?
NO — this proposed model of training would require an extensive commitment of time and energy. Surveys of licensed clinical psychologists who are in favor of prescriptive authority for specially trained and licensed psychologists indicate that only about twenty-five percent of psychologists would pursue this additional training at this time. However, it is hard to predict what would actually happen.

What, exactly, is being proposed?
1. First — become a licensed clinical psychologist.

Under this proposal, only licensed clinical psychologists would be eligible to enter this additional training. Many people are unaware of the requirements for training clinical psychologists. In the state of Illinois it is necessary to obtain a doctoral degree from a program in psychology that meets the following requirements:

Coursework:

Three years (if full-time) graduate course work covering the following seven content areas: biological basis of behavior; cognitive-affective basis of behavior; social basis of behavior; individual differences —theories of normal and abnormal personality functioning; assessment including clinical interviewing and the administration, scoring and interpretation of psychological tests; treatment modalities for mental, emotional, behavioral or nervous disorders; and ethics. The usual number of individual graduate level courses is between 18 and 27.

Clinical Training:

Practicum: 1500 hours (pre-doctoral)
Internship: one year full time ( pre-doctoral)
Post-doctoral: one year full time

Research Requirement:

Acceptance of a doctoral dissertation (Ph.D., Psy.D., Ed.D) or a doctoral clinical project (Psy.D.)

Examination:

Pass the state administered licensing examination

2. Next — the following is the additional training, which would be required to become a “psychologist licensed to prescribe.”

The proposed additional training includes course work, clinical training, and passing an examination.

Course work:

A graduate level course in each of the following areas neuroscience, pharmacology, psychopharmacology, physiology, pathophysiology, physical and laboratory assessment, and clinical pharmacotherapeutics.

Clinical training:

Shall include at least 400 hours of management of the pharmacological treatment of a minimum of 100 patients under the full supervision and control of a designated qualified practitioner. So far, the supervisors have almost all been board certified psychiatrists.

Examination:

Passing an examination prepared by experts in the field of psychopharmacology.

Why would a psychologist pursue this training now without a guarantee of being able to prescribe?
Although the reasons given for pursuing training vary, many of the licensed psychologists undergoing the training argue that the additional knowledge gained helps them work more effectively in collaboration with other providers including psychiatrists and other medical providers — making their assessment of a patient’s progress and reaction to all modes of treatment more cogent when asked for input by prescribing physicians and helping them understand their patients reactions to medication better. The scope of practice for licensed psychologists, in some states, includes making treatment recommendations regarding psychoactive medications to physicians, even though the psychologists themselves do not prescribe.

Some argue that the training satisfies a psychologist’s natural curiosity about this treatment modality, and some do not intend to obtain the actual prescribing authority themselves, but are motivated by a desire to understand neuropsychological functioning.

What is the likelihood that psychologists who are trained under this model will be allowed to prescribe?
Some psychologists do already prescribe in the military and Indian Health Service, while this expanding scope of practice is most likely to be seen in rural and remote areas of the United States first, because the need for additional providers there is most obvious. Psychologists in New Mexico, Louisiana and Guam with this training have been granted prescriptive authority. However, even in urban areas there remain large populations of persons who would benefit from this mode of treatment who are not now being served. Obviously, advocates for this new training and certification hope that the privilege will become more widespread and are working toward that end.

More than 2,796,000 Illinois citizens are in need of mental health treatment that includes expert diagnosis, psychotherapy, and, perhaps, pharmacotherapy. There are too few psychiatrists to meet this need. Psychologists are already taking the additional training necessary to add medication assessment and management to the other effective treatments they provide. The fine record of prescribing psychologists in the military, in the states of New Mexico and Louisiana, on Indian reservations under the Indian Health Service, in the United States Public Health Service, and in the United States Coast Guard, demonstrates that this is a way to make additional services available to the people of Illinois.

• There are many citizens who need mental health services who do not receive them.

• 614,000 seriously mentally ill adults (18 years and older) in Illinois are in need of treatment.

• 1 in 10 Illinois children has a mental health problem (1,265,000) severe enough to cause impairment, but only 1 in 5 of those (253,070) receive treatment.

• 230,927 adolescents (age 13-17) show signs of depression severe enough that they are unable to participate in their normal activities for more than 2 weeks in a row.

• 306,000 older adult citizens of Illinois suffer from depression and 175,000 older adult citizens of Illinois suffer from an anxiety disorder.

• Suicide is 11th among the leading causes of death in Illinois. Suicide is the 6th most common cause of death in Illinois children ages 5-14 (13 deaths in 2002) and it is 3rd among the leading causes of death among Illinois’ young people ages 15-25.

• Suicide rates for rural areas are 5% higher than for urban areas.

• There are not enough psychiatrists.

• The federal government has determined what the citizens of Illinois already know: there are too few psychiatrists in Illinois. 74 counties (out of 102) have been listed as Mental Health Shortage Areas and 70 of these are rural counties.

• Illinois has only 1 psychiatrist or psychiatric resident, for every 1,553 citizens who are in immediate and ongoing need of mental health services, with the greatest shortage in those with subspecialty training in child and adolescent psychiatry. Illinois has only 1 child and adolescent psychiatrist for every 5,750 children who are in immediate need of mental health services.

Many people who have come to rely on clinical psychologists for psychological services would prefer to have the doctor who knows them best manage their mental health medications. Some have expressed concern that it is more costly and time consuming to have to meet with two different doctors.

If you would like to express your desire to make it possible for your psychologist to manage your mental health medication, you can send a letter or email to your Illinois Senator and Representative easily by clicking on the link below.

If you are interested in contacting your Senator or Representative regarding the issue of Medical Psychologists, please click the icon below and then scroll down to “Issues and Legislation” and click “Go”.

What is a clinical psychologist?

A clinical psychologist is a highly-trained mental health professional who specializes in the evaluation, diagnosis, and treatment of mental, emotional, and behavioral disorders. Clinical psychologists are non-physician doctors (PsyD or PhD) who specialize in mental health, including substance use disorders. Clinical psychologists are trained to conduct psychological assessments, and provide various forms of psychotherapy and psychosocial interventions, as well as other treatments, depending on the needs of each patient.

Prescribing psychologists are specialized clinical psychologists who have completed the education and training requirements of a clinical psychologist, as well as education and training in clinical medicine. Prescribing psychologists are able to prescribe medication, in addition to psychological assessment and psychotherapy, and can order medical/laboratory and imaging tests that provide a comprehensive profile of a patient’s physical state. Because of their extensive training, prescribing psychologists understand the body’s functions and the complex relationship between emotional illness and other medical illness.

What training do clinical psychologists receive?

Clinical psychologists must complete an undergraduate college education followed by at least four years of graduate school that leads to a doctoral degree (PhD or PsyD) in clinical or counseling psychology. After completion of coursework, psychologists-in-training complete a one-year internship in clinical psychology, followed by a one- to two-year postdoctoral fellowship in clinical psychology or another specialty or sub-specialty of psychology. The internship and fellowship are held in academic medical centers, university counseling centers, hospitals, community mental health centers, correctional facilities, private practices, schools, etc. and include supervision by senior clinical psychologists and further instruction in many aspects of psychological assessment, diagnosis, and treatment. After the postdoctoral fellowship is complete, psychologists-in-training must pass a national, standardized exam, the Examination for Professional Practice in Psychology (EPPP), to practice clinical psychology independently.

Prescribing psychologists must complete undergraduate biomedical coursework, including courses in medical terminology, general biology or molecular and cell biology, chemistry or biochemistry, microbiology, human anatomy, human physiology, and anatomy and physiology. They must also complete a two-year Master of Science degree in clinical psychopharmacology (MSCP) that includes coursework in clinical biochemistry, neuroscience, neurophysiology and clinical medicine, pharmacology and clinical pharmacology, physical assessment, pharmacotherapeutics, advanced psychopharmacology, and treatment of special populations. Prescribing psychologists-in-training are then required to complete a 1,620-hour prescribing psychology fellowship over the course of at least 14 months that consists of nine rotations, including psychiatry, family medicine, internal medicine, pediatrics, geriatrics, surgery, emergency medicine, obstetrics/gynecology, and one elective. The final step to practice prescribing psychology is to pass a national, standardized exam called the Psychopharmacology Examination for Psychologists (PEP). Once licensed, prescribing psychologists must maintain a collaborative agreement with a physician with whom they meet at least monthly to review cases.

Some psychologists also choose to become board certified in one of several psychological specialties through the American Board of Professional Psychology (ABPP). These specialties include addiction psychology, behavioral and cognitive psychology, clinical child and adolescent psychology, clinical health psychology, clinical neuropsychology, clinical psychology, counseling psychology, couple and family psychology, forensic psychology, geropsychology, group psychology, organizational and business psychology, police and public safety psychology, psychoanalytic psychology, rehabilitation psychology, school psychology, and serious mental illness psychology. They must be re-certified every 10 years.

What kind of treatment will be provided?

Your clinical psychologist will interview you about your history and talk with you to define problems and determine the treatment approach that suits you and your needs. Some clinical psychologists may administer a series of psychological or neuropsychological tests to assist in the evaluation.

A clinical psychologist might recommend psychotherapy, which is a talking intervention that helps you learn more effective ways of dealing with problems. Your clinical psychologist might also recommend meeting with your entire family or may suggest that you participate in a therapy group. Clinical psychologists sometimes use specialized techniques such as biofeedback, neurofeedback, EMDR, behavioral modification, and stress management training. In some cases, the clinical psychologist may refer you to a physician or prescribing psychologist for a physical assessment or medication evaluation. For some people, treatment involves only a short term of therapy; for others, a longer time will be required to work on problems that have built up over years. The frequency of psychotherapy is typically once or twice a week. Treatment may be provided through outpatient care or in an inpatient setting.

How helpful is psychological treatment?

Various studies have demonstrated that almost everyone who seeks psychological help experiences some relief that makes them less troubled and makes their lives more pleasant.

Psychological treatment is a very effective way to get help to deal with life’s problems. Psychologists continually conduct research on the effectiveness of treatment and that research is communicated to your therapist. Clinical psychologists refrain from using treatments that are controversial or ineffective.

When is it time to contact a clinical psychologist?

Clinical psychologists see a variety of people for all sorts of reasons, including marital and family problems, illness or injury, loss of a loved one, anxiety, loneliness, depression, psychological aspects of medical illnesses, addictions, behavioral problems, disturbances in eating and sleeping, sexual issues, difficulties at work, educational problems, and caring for the elderly. Clinical psychologists also assist during a crisis, including natural disasters and terrorism.

Whatever your problems are, a clinical psychologist is someone on whom you can rely. Together, in a confidential and supportive atmosphere, you and your clinical psychologist will work to understand and resolve problems—problems that, until now, may have resisted your best efforts.

What to ask before or during your first appointment

Here are some questions you might ask:

• How many years have you been practicing?
• Do you have experience with my particular problem?
• How would you approach dealing with my particular problem?
• What are your fees?
• Do you accept my insurance policy?

How do I pay for psychological treatment?

Private insurance typically covers at least part of the cost of mental health services. The best way to verify whether you are covered is to call the phone number on your insurance card and ask about your mental health benefits or look up your coverage information online. Ask if there is a deductible or copayment, whether you need pre-authorization, whether there is a limit to the number of sessions, and whether you need a referral from your physician. If you are covered by Medicare or Medicaid, contact these agencies for benefit descriptions.

If you do not have coverage, you will be responsible for paying for your treatment. Some therapists will accept a lowered fee in the case of financial hardship or they may offer a payment plan.

Clinical psychologists are required to protect your confidentiality

Clinical psychologists are bound by strict rules of confidentiality. Talk to your clinical psychologist about any limits to confidentiality. Some of your protected health information may be released to obtain insurance reimbursement. With your consent, your clinical psychologist may contact others involved in your care, such as physicians, hospitals, and previous therapists.

How can I find a clinical psychologist?

There are several ways to find a clinical psychologist.

• Ask a friend or medical provider to recommend a clinical psychologist.

• Call your health insurance company. Many people today have insurance plans that direct them to clinical psychologists who are reimbursed by their insurer.

• Contact your local hospital, mental health center, place of worship, or search for “psychologists” on an online search engine.

• Call the Illinois Psychological Association at (312) 372–7610 or visit the referral section of this website for a referral to a clinical psychologist. All clinical psychologists referred by the Illinois Psychological Association are licensed and insured.

Some of the previous content is adapted from Talk to Someone Who Can Help brochure (APA, 1996).

What is the difference between a clinical psychologist and a psychiatrist?

A clinical psychologist is a non-physician doctor (PsyD or PhD) and has extensive training in research and/or clinical practice. Clinical psychologists conduct psychological and neuropsychological evaluations and treat mental disorders with psychotherapy. Illinois also has prescribing psychologists, who are able to prescribe medications and other medical treatments, in addition to psychotherapy and psychological and neuropsychological evaluations.

A psychiatrist is a medical doctor with specialized training in psychiatry. A psychiatrist is able to prescribe medications and other medical treatments. They also may conduct psychotherapy, although fewer than 10% currently engage in psychotherapy.

Therapy and medicine are effective.
For many conditions research shows that a coordinated combination of psychological treatment and medicine is the best way to achieve lasting improvement. Prescribing Psychologists provide such treatment.

Prescribing Psychologists are well trained.
Psychologists are the most highly trained mental health professionals. They average more than seven years of doctoral training in the assessment and treatment of emotional and behavioral disorders.

Prescribing Psychologists have completed an additional postdoctoral certification in clinical psychopharmacology. They are highly qualified to manage psychological and physical aspects of care.

We need and appreciate your help.
Legislators need to hear from you. We will help you contact your state senator and representative to convey your support for prescriptive authority for specially trained Prescribing Psychologists.

Prescription for progress
Prescribing Psychologists in Illinois would be able to prescribe mental health medication such as antidepressants and medicine for anxiety under the bill to be introduced in the next session of the Illinois legislature. They would be authorized to prescribe only mental health medication and not general medication such as antibiotics or cardiac medicines.

This progressive legislation will increase access to comprehensive and cost–effective mental health care, especially in the underserved rural and inner–city areas of Illinois. Want more information?

Want more information?
Call the Illinois Psychological Association at 312–372–7610 or read the other information in the Prescribing Psychologists section of the IPA website if you are interested in this proposed improvement for Illinois citizens.

Disclaimer: The Illinois Psychological Association (IPA) does not determine or warrant the competence of any psychologist listed in the IPA Referral Search. Use of this Referral Search to locate a psychologist is voluntary and will not result in any liability against IPA. In no event shall IPA be liable for damages to any user of the Referral Search for the voluntary selection of psychologist, for the services provided by any psychologist listed herein, or for any other damages which may occur. IPA cannot and does not provide any warranties related to the information contained in or resulting services from a psychologist listed in the IPA Referral Search.

Acceptance/Understanding:
Use of the IPA Referral Search indicates your understanding and acceptance of the terms and conditions above.

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