Beth Rom-Rymer

Beth Rom-Rymer, president of the Illinois Psychological Association, said psychologists “took on organized medicine” during a 12-year fight to pass a bill allowing them to prescribe medications. Such a measure awaits Gov. Pat Quinn’s signature. (Phil Velasquez, Chicago Tribune / June 8, 2014)

After a contentious, 12-year battle, Illinois may become the third state to allow specially trained psychologists to prescribe certain medications commonly used to treat mental illness.

The new legislation would require that psychologists undergo extensive training, work under the supervision of a physician, only be permitted to prescribe a limited class of drugs and be prohibited from writing prescriptions for minors, seniors or any patient with a serious medical condition.

The measure advanced out of the General Assembly last month and is awaiting the signature of Gov. Pat Quinn, who said he is reviewing it.

Advocates say the proposal would improve access to mental health care, especially in some of the state's most underserved areas.

"When someone needs help, they can't wait weeks or travel great distances," said the Senate sponsor, Don Harmon, D-Oak Park. "These shortages can cost lives and cause needless suffering. ... But properly trained psychologists, in consultation with medical doctors, could relieve this problem."

Typically, a patient sees a psychologist, who is a Ph.D., for therapy and a psychiatrist, who is an M.D., for medication, such as antidepressants. Opponents of the bill have argued that psychologists are not as qualified as psychiatrists to prescribe medications. Without the proper credentials, expanding prescriptive authority will only compromise patient care, they say.

"There is a lot of training that is involved in being a physician, and while psychologists are certainly very adept at doing counseling, you don't have to worry about drug interaction and the way things are metabolized if all you're doing is therapy," said Dr. William McDade, president of the Illinois State Medical Society.

But proponents say the system is working well in New Mexico and Louisiana — the two states that already allow psychologists to prescribe medications. In Illinois, psychologists would be able to prescribe antidepressants, such as Prozac, but not stimulants, such as Ritalin, commonly used for attention deficit disorder.

Licensing authorities in both New Mexico and Louisiana have said there have been no relevant disciplinary actions or adverse events.

The long legislative fight in Illinois, the law's advocates contend, has less to do with protecting patients than protecting turf.

"We took on organized medicine," said Beth Rom-Rymer, president of the Illinois Psychological Association, reflecting on the victory. "We were optimistic; we stayed the course ... and we knew we could meet the need."

Many other states have introduced similar proposals, but they haven't gotten much traction despite the fact that other clinicians — such as nurse practitioners and dentists — are allowed to prescribe.

McDade balked at the suggestion that his group's opposition to the measure amounted to a turf war and said ensuring proper care for patients is what drove its concern.

While both sides sought to keep the focus on patients, that was often overshadowed in the nasty fight the measure sparked in Springfield. Even lawmakers used to being lobbied intensely on any number of issues said the matter saw some of the most heated arguments in recent memory.

After more than a decade of fighting, something gave. McDade chalked it up to psychologists finally realizing they needed to agree to tougher oversight and training if they wanted the right to prescribe.

"They lost year after year after year," McDade said. "The true sign of insanity is doing the same thing and expecting a different result."

The Illinois State Medical Society helped negotiate the oversight and educational requirements in the measure, which also prohibits psychologists from prescribing to vulnerable patients such as the young, elderly and those with developmental disabilities, who are more susceptible to adverse drug interactions.

"If they wanted to go into this field, we wanted to make sure it would be in the safest possible environment," McDade said.

Under the new law, psychologists could earn the right to prescribe after they have completed 21/2 years of additional, postdoctoral training, with course work requirements including graduate-level instruction in numerous areas such as neuroscience and psychopharmacology. In addition, training would require that psychologists treat a minimum of 100 patients under the supervision of a qualified medical practitioner, according to the legislation.

While there's general consensus of a mental health crisis in the United States, there's intense debate on how best to fix it. In 2013, Illinois had only 1,462 psychiatrists statewide, while dozens of counties had no psychiatrists at all, according to the Illinois State Medical Society. In many hospitals and clinics, psychiatric medications are usually prescribed by internists or family practice physicians.