Should all psychologists have prescriptive authority?
Jason Brien.
The roles of psychiatrists and psychologists is often misunderstood within society with the two terms used interchangeably despite significant differences between the two professions. Psychiatrists possess a medical degree, have residency experience and are legally allowed to prescribe psychotropic medications to patients. In this respect, psychiatrists are similar to medical doctors. Psychologists on the other hand, complete Masters, Doctorate and/or PHD level training, complete mandatory supervised experience and cannot legally prescribe medications to their clients.
Research has consistently shown that up to 70% of the psychotropic medications prescribed to mental health clients is done so by primary care physicians (GP’s, local doctors, hospital doctors, etc) and not by psychiatrists. The problem with this is that doctors are not necessarily trained in mental health the same way that psychiatrists are. This leads to concerns that mental health consumers are being prescribed psychotropic medications erroneously and unnecessarily by family physicians which could potentially lead to adverse events.
It is mainly for this reason that advocates of prescription privileges for psychologists (PPP) believe that psychologists should receive prescriptive authority. PPP supporters believe that doing so would ultimately benefit the psychologist’s clients in addition to the health care system as a whole. Some researchers see no valid reason why psychologists should not be granted prescriptive authority since they clearly possess the intellect required to be taught how to prescribe psychotropics properly and safely. Pharmacology trained psychologists have the equivalent training and education to that of entry-level psychiatric nurse practitioners and entry-level physicians.
Psychiatrists and family physicians in particular are concerned that a sudden influx of prescribing psychologists will increase the malevolent influence of pharmaceutical companies. This in turn would have the effect of exposing clients to over-medicalization and undue safety risks. Irrespective of the views or opinions of psychiatrists and family physicians, it is the continued and unrelenting focus on prescriptive authority which is causing considerable tension and conflict amongst psychologists.
There are growing concerns that the pursuit of prescription privileges is not feasible or practical and will only serve to create conflict and division amongst clinical psychologists and further exacerbate the hierarchical system that already exists amongst health professionals. The hierarchy usually consists of doctors and psychiatrists sitting at the top, followed by nurses and psychologists followed by counsellors and nurse aids for example. Some argue that the psychologists that re requesting prescription privileges are doing so merely to boost their ego and status as mental health professionals.
There is an upside to granting psychologists prescription privileges (some US states already have). Generally speaking, a psychologist spends much more time interacting with a client than a psychiatrist or doctor can or does. Psychiatrists and doctors often have a ‘rush, rush’ mentality and therefore they don’t have the time or the capacity to form genuine bonds with their clients. They don’t have the time or capacity to really get to know their client and their clients’ strengths and abilities before prescribing medications for depression, anxiety, schizophrenia, bipolar, etc.
Furthermore, a psychiatrist or doctor interacts with a client 1-2 times, prescribes medication, sends the client away and tells the client to come back for a medication review in 6-12 months. I have interacted with a lot of clients who have told me that they didn’t think or feel that their prescribed medication was working and so they have adjusted their doses at will or just stopped taking the medication completely (both of which can be very dangerous). When I asked why they didn’t consult their doctor, they say they couldn’t get an appointment or it was not ready for their review.
A psychologist who spends multiple sessions with a client will be in a better position to understand their client and their medication needs. A psychologist who sees their client regularly can monitor their client’s medication doses and consumption. A psychologist can also better gauge when to start weaning the client of their medication if it is deemed necessary to do so. Medications for depression and anxiety have their benefits but learning practical skills to manage the symptoms of depression and anxiety is also beneficial. Not all people can afford to take medication long-term.
I personally believe that the more that psychologists are granted the rights to prescribe medication, the more there is an increased risk that pharmaceutical companies will look to exploit the psychologists. If certain doctors and psychiatrists succumb to the temptations of money and kickbacks from pharmaceutical companies then it is entirely plausible that certain psychologists will also succumb. Overall, however, I think the pros outweigh the cons. I think psychologists are in a much better position to regularly monitor medication intake and I think it would put clients at ease not having to run around here there and everywhere seeing this person and that person.
Resources.
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Beardsley, R. S., Gardocki, G. J., Larson, D. B., & Hidalgo, J. (1988). Prescribing of psychotropic medication by primary care physicians and psychiatrists. Archives of General Psychiatry, 45(12), 1117-1119. htpps://doi.org/10.1001/archpsyc.1988.01800360065009
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De Vaney Olvey, C., Hogg, A., & Counts, W. (2002). Licensure requirements: Have we raised the bar too far? Professional Psychology: Research and Practice, 33(3), 323- 329. http://dx.doi.org/10.1037/0735-7028.33.3.323
Fitzgerald, J., & Galyer, K. (2008). Collaborative prescribing rights for psychologists: The New Zealand perspective. New Zealand Journal of Psychology, 37(3), 44-52. ISSN: 0112-109X
Fox, R. E., DeLeon, P. H., Newman, R., Sammons, M. T., Dunivin, D. L., & Baker, D. C. (2009). Prescriptive authority and psychology: A status report.(Author abstract)(Report). The American Psychologist, 64(4), 257-268. ISSN: 0003-066X
Heiby, E. M. (2010). Concerns about substandard training for prescription privileges for psychologists. Journal of Clinical Psychology, 66(1): 104-111. htpps://doi.org/10.1002/jclp.20650