Psychotherapy Articles

Psychotherapy Articles

The Vibrant Public Policy Process

The public policy/legislative process is anything but static.  It continues to evolve, reflecting subtle societal changes that many of our colleagues do not appreciate.  Former APA President Ron Fox used to remind those of us interested in prescriptive authority (RxP) that visionary Ohio academic leaders were nursing’s critical RxP catalyst.  With significant foundation support, they successfully lobbied for RxP authority for their advanced graduate students, under faculty supervision.  Upon graduation, those cohorts asked the Ohio legislature: “If I could provide needed clinical services as a student, why can’t I continue to serve my patients now that I have graduated?”  This past month I again had the pleasure of attending the AACN (American Association of Colleges of Nursing) Dean’s Annual Conference where one of the invited speakers discussed her vision for the role of physicians.  She was immediately met with considerable “push back” by the audience who spontaneously objected to AMA’s systematic efforts to restrict nursing’s clinical practice and called for the enactment of national scope of practice legislation, modeled after that adopted, again notwithstanding considerable medical opposition, by the Department of Veterans Affairs (VA).  With the current leadership of academic nursing seemingly focusing upon what are essentially clinical practice issues, perhaps significant change is in the winds.

New Mexico

On March 6, 2002, New Mexico’s landmark RxP legislation was signed by their Governor, becoming the first state (other than Indiana and Guam) to enact this authority.  On February 29, 2024, their current Governor signed SB. 127 significantly updating New Mexico’s precedent setting legislation.  Leslie Dozzo, President of the State Psychologist Association (SPA) of New Mexico and a prescribing psychologist: “In over twenty years of practice in New Mexico, prescribing psychologists have been providing safe and effective services primary to rural and underserved communities and populations across the state.  A recent survey of members found most responders provide roughly 95% of their services to Medicaid recipients or to the indigent.  Our new legislation states: ‘psychotropic medication’ means a controlled substance or dangerous drug that may not be dispensed or administered without a prescription but is limited to only those agents related to the diagnosis and treatment or management of mental, nervous, emotional, behavioral, substance use or cognitive disorders, including the management of or protection from side effects that are a direct result from the use of those agents, whose use is consistent with the standards of practice for clinical psychopharmacology.’  This is a significant improvement over the language that previously defined our practice.  Instead of specifying which agents we can prescribe, this broadens the scope of our practice to that of ‘clinical psychopharmacology’ which more closely resembles the practice of other psychiatric providers.  The legislation further broadens our scope of practice in that it now allows us to treat ADE’s (side effects) of psychotropic medications, which is much closer to the standards of psychiatric practice, albeit in consultation with the patient’s health care professional.

“The bill also adds prescribing psychologists with at least four years of experience as independent-level prescribers to the list of ‘supervising clinicians’ for a psychologists who is undergoing RxP training.  The change of the supervisor terminology from ‘prescribing physician’ to ‘prescribing clinician’ opens the door to prescribing psychologists (with 4 years’ experience), who are now included in the term of ‘prescribing clinician’, to supervise psychologists during practica.  This will need to be clarified in rule promulgation.

“Regarding the membership of the Board of Psychological Examiners, the bill now guarantees that of the five psychologist members, two shall be prescribing psychologists, an important change in the make-up of the board.  It also recognizes our organization as eligible to nominate prescribing psychologists to fill those seats.  Finally, the bill states: ‘A psychologist with a conditional prescription certificate may prescribe and administer psychotropic medication injections under the supervision of a supervising clinician and upon completion of board-approved training.  A prescribing psychologist may prescribe and administer psychotropic medication injections upon completion of board-approved training.’  Prior to this, we have been able to prescribe injectable psychiatric medications, however we were unable to administer them.”

Evolving National Trends

During a recent membership briefing, Victor Dzau, President of the National Academy of Medicine (NAM), discussed the impressive NAM Strategic Plan Implementation progress.  Within their Goals for Science, Critical Issues, Transformation, Equity, and Readiness were critical policy issues including emerging technology, misinformation, climate change, artificial intelligence, workforce concerns, and two which should be of particular interest to psychology and nursing; i.e., their Culture of Health and Women’s Health initiatives.  For over two decades, the Institute of Medicine (now NAM) has conducted a series of studies on health disparities, beginning with its 2003 report on Unequal Treatment: Confronting Racial Bias and Ethnic Disparities in Health Care.  It is estimated that the economic burden of racial and ethnic health disparities in 2018 was $75.1 billion in excess medical care costs and $286.9 billion arising from excess premature deaths.  Policy experts continue to report that the United States ranks last compared to other high-income countries in how health systems perform on measures of quality, access, efficiency, equity, outcomes, and life expectancy.  This is despite health care expenditures that are twice that of the next closest nation.

Social determinants of health (SDOH) are the conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.  Across the lifespan these environments influence one’s health and how one navigates the health care system.  It is the unequal distribution of health-promoting and health-damaging resources in those environments, along with a myriad of historical and current societal forces, that contribute to unequal health and health care outcomes across racial and ethnic populations.

NAM’s most recent report notes that our nation has made progress in advancing health care equity; however, racial and ethnic inequity remains a fundamental issue.  These inequities in health care are complex and driven by key societal forces such as racism and oppression, social determinants of health, social norms and values, and laws and public policies.  A diverse health and science workforce, representative of the communities it serves, is essential to health care equity.  Yet, our nation has made little progress addressing this goal.  Emerging approaches to achieving health care equity show promise and are poised for increased investment, implementation, and expansion so that progress is translated into long term improvement in outcomes.  Continued research and evaluation, as well as accountability, is essential to advancing health and health care equity.  Unfortunately, public awareness of health disparities is still low, with less than 50% of the general public recognizing that health disparities exist.

Women’s Health

In his State of the Union address, President Biden laid out his vision for transforming women’s health research and improving women’s lives all across America.  The Uniformed Services University (USU) is most fortunate that Lynette Hamlin of the Graduate School of Nursing is actively involved.  “The President and First Lady announced more than twenty new actions and commitments by federal agencies.  I am honored to have been asked to lead two of these actions.  The Department of Defense (DOD) and Department of Veterans Affairs (VA) are launching a new Women’s Health Research collaborative to explore opportunities that further promote joint efforts to advance women’s health research and improve evidence-based care for Service members and Veterans.  I am the DOD co-chair for this Collaborative.  USU established a dedicated  Director of Military Women’s Health Research Program, a role that is responsible for identifying research gaps, fostering collaboration, and coordinating and aligning a unified approach to address the evolving needs of Active Duty Service Women, for which I am serving as the inaugural Director of the MWHRP.”

The President’s March 18, 2024 Executive Order expressly noted: “My Administration is committed to getting women the answers they need about their health.  For far too long, scientific and biomedical research excluded women and undervalued the study of women’s health.  The resulting research gaps mean that we know far too little about women’s health across women’s lifespans, and those gaps are even more prominent for women of color, older women, and women with disabilities….

“It is time, once again, to pioneer the next generation of discoveries in women’s health.  My Administration seeks to fundamentally change how we approach and fund women’s health research in the United States.  That is why I established the first-ever White House Initiative on Women’s Health Research – which is within the Office of the First Lady and includes a wide array of executive departments and agencies and White House offices – to accelerate research that will provide the tools we need to prevent, diagnose, and treat conditions that affect women uniquely, disproportionately, or differently.

“Together with the First Lady’s tireless efforts, the Initiative is already galvanizing the Federal Government to advance women’s health, including through investments in innovation and improved coordination within and across agencies.  We are also mobilizing leaders across a wide range of sectors, including industry, philanthropy, and the medical and research communities to improve women’s health.

 “It is the policy of my Administration to advance women’s health research, close health disparities, and ensure that the gains we make in research laboratories are translated into real-world clinical benefits for women.  It is also the policy of my Administration to ensure that women have access to high-quality, evidence-based health care and to improve health outcomes for women across their lifespans and throughout the country.”

Accompanying the President’s announcement, the White House highlighted several of these new initiatives including: “Expand Fellowship Training in Women’s Health Research.  CDC… is expanding training in women’s health research and public health surveillance to OBGYNs, nurses and advanced practice nurses… (and) will invite early career clinicians to train in public health and policy to become future leaders in women’s health research.  (And) Connect Research to Real-World Outcomes to Improve Women’s Mental and Behavioral Health.  The Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting a range of health care providers to address the unique needs of women with or at risk for mental health and substance use disorders.”

Licensure Mobility

Alex Siegel, Director of Professional Affairs, Association of State and Provincial Psychology Boards (ASPPB): “The Psychological Interjurisdictional Compact (PSYPACT), endorsed by APA, which allows for increased access of care and continuity of care for providing psychological services across state lines, continues to add new jurisdictions.  Currently, there are 39 jurisdictions which enacted legislation to adopt PSYPACT and are currently part of the PSYPACT Commission and 2 states which passed legislation (VT and SD) and will become active participants on July 1, 2024 bringing the total at that time to 41 jurisdictions.  There is active legislation in Massachusetts (SB. 1980), New York (SB. 6883), California (AB. 2051), and Mississippi (SB. 2157).  There are only 10 jurisdictions out of 55 not part of PSYPACT nor have legislation (AK, GU, IA, HI, LA, MT, NM, OR, PR and VI)  As of 3/31/24 there were 11,408 Authority to Practice Interjurisdictional Telepsychology (APIT) holders which allow psychologists to interjurisdictional practice into another compact jurisdiction and 675 Temporary Authorization to Practice (TAP) holders which authorizes those psychologists to temporarily physically go into another compact jurisdiction.”

Senior Psychologists Keep On Truckin’

Former APA President Ron Levant: As I wrote in Rod Baker and Pat’s excellent volume, Retirement experiences of psychologists, I retired from my job but not my profession.  As Ron Fox used to remind us, we are part of the educated elite (less than 2% of the U.S. population have a doctoral degree), and it is therefore our affirmative duty to utilize our expertise to address society’s most pressing problems.  I spent many decades of my life developing my expertise in the psychology of men and masculinities.  Now, in retirement, freed from my daily professional and clinical duties, I have been active in sharing this knowledge with regard to the problems associated with masculinity in general and with regard to gun violence in particular.  On that point, most (more than 90%) acts of gun violence are committed by boys and men, yet most (more than 90%) males do not commit acts of gun violence.  This year I am bring out two books, one is my memoir: Levant, R. F. with Bowman, A. (2024), The problem with men: Insights on overcoming a traumatic childhood from a world-renowned psychologist. Virginia Beach, VA.: Koehler books.  In press.  And the other is a clinical handbook: Levant, R. F., & Pryor, S. (Eds.) (2024).  Assessing and treating emotionally inexpressive men.  New York: Routledge.  In press.  I am also working on a third volume: Hoffman, E., Wolfe, G., & Levant, R. F. (Eds.) (2025).  Oxford Handbook of Masculinities and Mental Health.  In preparation.  I am also giving interviews to the press, appearing in podcasts, and writing OpEds.”

“Yo, in the sauna.  Man’s not hot (Never hot).  Yeah, skidika-pap-pap” (Man’s Not Hot, Big Shaq)”.  Aloha,

Pat DeLeon, former APA President – Division 29 – April, 2024

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Pat DeLeon is the Distinguished Professor at the Uniformed Services University of the Health Sciences (DoD) in the School of Nursing and School of Medicine. He was elected to the Institute of Medicine of the National Academies of Science in 2008 and served as President of the American Psychological Association (APA) in 2000. For over 38 years he was on the staff of U.S. Senator Daniel K. Inouye (D-Hawaii) retiring as his Chief of Staff. He has received numerous national awards including the Order of Military Medical Merit; Distinguished Service Medal, USUHS; National League for Nursing Council for Nursing Centers, First Public Policy Award; Sigma Theta Tau, Inc., International Honor Society of Nursing, First Public Service Award; Ruth Knee/Milton Wittman Award for Outstanding Achievement in Health/Mental Health Policy, NASW; Delta Omega Honor Society Award for Outstanding Alumnus from a School of Public Health; APA Outstanding Lifetime Contributions to Psychology Award; American Psychological Foundation Gold Medal for Lifetime Achievement in the Practice of Psychology; and Distinguished Alumni Award, University of Hawaii. He has been awarded three honorary degrees. He is currently the editor of Psychological Services. He has over 200 publications.

Cite This Article

DeLeon, P. (2024, April).Yo, big Shaq, the one and only. Psychotherapy Bulletin, 59(2), 46-50.

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