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A new law took effect in January that allows psychologists in Louisiana to prescribe medications for their mental health patients. And some here see it as a model for expanding the right to another 48 states that still force most patients to see a psychiatrist to get a prescription for the many drugs designed to help them.

Psychologists insist that the new law isn't an open invitation to quick certification. In order to prescribe drugs for mental health patients, psychologists have to first complete 450 hours of classroom work taught over two years.

"The training is post-doctoral," says Linda Upton, Ph.D., president of the Louisiana Psychological Association and a practicing psychologist in Baton Rouge. "Only psychologists who have a particular interest in pharma-psychology and are willing to get the extra training will be certified."

The coursework runs the gamut from anatomy to biochemistry, neuroscience, pharmacology, right through pathophysiology and lab assessments.

"This is quite an extensive program of study," says Dr. Upton, who's preparing for her own exams in the next few months. "Psychologists learn all the basics in biological processes that are involved in the mechanisms of medications, drug interactions and side effects."

Psychologists who are certified to prescribe drugs in Louisiana won't have carte blanche. Under the law, they will still be required to work in collaboration with a primary care doctor or attending physician.

Dozens of psychologists from around the state have been preparing for this new law for years. The first class of 35 psychologists to complete the coursework graduated in 1999.

"We think it's a great leap forward in the quality of care for mental health patients," says Dr. Upton. For many patients, she adds, it's one less trip to see a psychiatrist specifically to obtain a prescription. And that can be particularly important in underserved areas, where qualified professionals can be hard to access. Adds Upton: "We believed in our position that doctoral-level providers can be trained to safely provide for the medication needs of their patients."

That argument was well-honed over the years as her group fought an uphill battle to gain acceptance against a well-organized group of psychiatrists - and physicians - who have long maintained that it took someone with their mental and medical training to be qualified to safely prescribe drugs.

David Edward Post, M.D., a Baton Rouge psychiatrist and president of the Louisiana Psychiatric Medical Association, said recently that the new law doesn't protect patients, doesn't create adequate training standards and might need to be brought up with lawmakers again.

"This was a big issue for us," says Dr. Post, one that despite their best efforts kept making advances in legislative sessions over the last eight years. And even with the law's passage he remains critical of the type of training psychologists will have: textbook-based, revolving around weekend courses with none of the huge time commitment psychiatrists make to hands-on clinical experience.

Now the issue is in the hands of the Louisiana State Board of Medicine, he adds, which is considering what rules to apply to the collaboration that will take place between physicians and psychologists in prescribing for patients. And Dr. Post would have plenty of support in any renewed fight on the issue from the state's physicians.

"We believe that the present rules do not provide adequately for the safety and protection of patients," agreed Vincent Culotta, Jr., M.D., an obstetrician/gynecologist, and spokesperson for the Louisiana State Medical Society, in an interview with Psychiatric News. "There's no real definition of 'consultation' with physicians, and if that is not adequate, then patients may not get the best medications or may have problems with drug-drug interactions. We hope that there will be no problems, but we remain very concerned."

The American Medical Association has also weighed in against the measure, opposing any move by state Legislatures to expand the role of a practice.

There are a number of cases in which medical professionals who haven't been to medical school are allowed to prescribe for mental health patients, says Dr. Upton, including nurse practitioners and physician assistants. But only Louisiana and New Mexico now allow psychologists to prescribe medications, she adds. Another nine Legislatures have been debating similar measures, but only Tennessee and Georgia appear to be anywhere close to passing a law. Upton hopes that other states will look at the Louisiana experience as a model for adopting the same laws around the country.

"Certainly we feel that our law provides a model for other states," says Dr. Upton. And her association would welcome the outside scrutiny. "We have no reason to be concerned about that. We have had sound training and the law is very clearly and carefully written. And the rules are very specific to what's expected."

As for the psychiatrists in the state, not everyone is convinced the fight is over.

"It could be something that is revisited" in future legislative sessions, says Dr. Post. "It's an open question."

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