Abstract
An ongoing issue in the field of clinical psychology is debating whether psychologists should have prescription privileges. The first reason why this should not be the case is that there is a shortage of psychiatrists, clinical psychologists are usually found in the same area and therefore giving them extra privileges will do little to help solve this problem. The second is that it may put pressure on medical services which are already straining to provide enough psychotherapies to patients: if everyone is able to prescribe medication, then there is even less impetus to provide expensive talking therapies, for example. The main concern, however, is related to safety. There is a reason that psychiatry training takes so long: psychiatrists have to be experts in brain chemistry, mental health, and behavioral disorders, and know enough about the rest of the body to prevent dangerous medication errors. The solution to this issue is to encourage more clinical psychologists to train as nurse practitioners or attend medical school if they wish to prescribe medication.
The idea that trained clinical psychologists should be allowed to grant prescriptions has been an ongoing one. Currently, the main type of clinical staff who make mental health prescriptions are trained psychiatrists, all of whom attended some form of medical school to allow them to do so (Benjamin Jr. & Baker, 2014). The American Psychological Association, on the other hand, suggests that properly trained clinical psychologists should legally be able to grant prescriptions to patients, largely because they are properly trained and already dealing with mental health and other psychological disorders (Durbin, Durbin, Hensel & Deber, 2016). Despite this, there are several reasons why clinical psychologists should not be granted the ability to prescribe pharmacological interventions to patients, which are presented here. The major issue is that, whilst clinical psychologists are well-trained to understand the mind, pharmaceuticals are broader and need to be considered by an individual with a medical background.
Firstly, it is important to cover why the American Psychological Association and some in the psychiatric/psychologic professions believe that trained clinical psychologists should be able to prescribe medications. The first is that it would allow psychologists to provide a comprehensive service to their patients: they would be the main point of call for all mental health and/or behavioral services (Benjamin Jr. & Baker, 2014). There would be no need to see multiple professionals for the same reason, and it may even bring insurance premiums down for the individual. As part of this same argument, pharmaceutical drugs have become a mainstay of the mental health professions and almost all patients being treated for a psychological condition are on a prescription drug (Riding-Malon & Werth, 2014). As such, many psychologists are already aware of the main types of anti-depressions, anti-psychotics, and anxiety medications on the market.
There is also the argument that psychiatrists are legally allowed to offer psychotherapy to patients with little training, and many believe that this should go both ways (Riding-Malon & Werth, 2014). If the professional is taking a holistic approach to care through the provision of psychotherapies and medications, it can be argued that one professional should be able to offer both. Similar arguments come from the fact that it is often the primary care physician, who has little training in psychiatry, that prescribes these prescription drugs and makes referrals to psychotherapy. In a sense, there is a belief that all mental health care should be offered by one individual and that fully-trained clinical psychologists should be able to offer this service as psychiatrists and primary care physicians are able to (Benjamin Jr. & Baker, 2014).
Unfortunately, there are several reasons why these arguments do not hold much weight. The first is that psychiatrists and other medical professionals are already providing these services to patients, and this would increase competition in the health marketplace. Increased competition has already seen the negative effect that more and more patients are being treated with these medications before or without therapy, due to the fact that therapies are expensive and medications are not (Benjamin Jr. & Baker, 2014). Without psychologists offering these services, it may mean that there are no available outlets for patients to receive psychotherapies and this will have an overall negative effect on patient mental health. It would be beneficial to patients to ensure that more psychotherapies are available, not less, and allowing fully trained clinical psychologists to provide prescription medication would be a significant barrier to these efforts.
One organization that is key in the fight against prescription privileges is known as the Psychologists Opposed to Prescription Privileges for Psychologists, or POPPP. This group argues against the idea that allowing psychologists these privileges would help solve the problem of too many prescriptions, not enough psychiatrists (Riding-Malon & Werth, 2014). Some suggest that allowing psychologists to prescribe medication would help to tackle the psychiatrist shortage, but actually the issue is geographical distribution rather than overall numbers, and psychologists have the same geographical pattern (Linden, 2015). This means that giving psychologists these privileges would not increase the availability of medication across the country, only in the specific areas that psychiatrists are already found in.
The main cause for concern, however, is the safety issue. The American Psychological Association has suggested that clinical psychologists should be able to take a short course that allows them to qualify to give these prescriptions. This would include 400 classroom hours on prescriptions and an additional year of supervised practice (Linden, 2015). This would equal around two years of medical school, which may seem adequate but is nothing like the current requirements for psychiatrists: to qualify, a psychiatrist is required to complete four years of medical school and at least four years of board certified residency placements (Durbin et al., 2016). The suggestion here is either that psychiatrists do not need to undertake this much training to fulfill their job requirements, or that psychologists will be able to understand the same quantity of information in much less time: both are controversial.
Another safety issue is that medications are extremely complex. To prescribe a medication, practitioners need to be able to take several body measurements, including blood pressure and heart rate (Benjamin Jr. & Baker, 2014). More importantly, the practitioner also needs to be aware of the other medications that the patient is taking and the interactions that these may have with the new prescription. Whilst fully trained clinical psychologists are experts in psychology and mental health, this requires a knowledge of all internal systems of the body and several medications: the kind of thing that only medical school can prepare someone for.
There are many ways that this debate may go in the future. One suggestion is that the American Psychological Association abandon these proposals and take a different view on the issue. There is no reason that a clinical psychologist cannot train to be a nurse practitioner or even attend medical school, both of which would provide them with some prescription privileges. The suggestion is that the Association promote these options to clinical psychologists who want to start prescribing medications as part of their service, and provide information about how these routes are possible in modern healthcare (Benjamin Jr. & Baker, 2014). This has the added benefit that it may help to deal with the current nursing shortage, and would also increase the number of psychiatrists if clinical psychologists decided to take this route.
In summary, there are many reasons why fully trained clinical psychologists should not have prescription privileges. The first is that, whilst there is a shortage of psychiatrists, clinical psychologists are usually found in the same area and therefore giving them extra privileges will do little to help solve this problem. The second is that it may put pressure on medical services which are already straining to provide enough psychotherapies to patients: if everyone is able to prescribe medication, then there is even less impetus to provide expensive talking therapies, for example. The main concern, however, is related to safety. There is a reason that psychiatry training takes so long: psychiatrists have to be experts in brain chemistry, mental health, and behavioral disorders, and know enough about the rest of the body to prevent dangerous medication errors. The solution to this issue is to encourage more clinical psychologists to train as nurse practitioners or attend medical school if they wish to prescribe medication.
- Benjamin Jr, Ludy T., and David B. Baker. From Séance to Science: A History of the Profession of Psychology in America. University of Akron Press, 2014. Google Scholar. Web. 21 Apr. 2017.
- Durbin, Anna et al. “Barriers and Enablers to Integrating Mental Health into Primary Care: A Policy Analysis.” The journal of behavioral health services & research 43.1 (2016): 127–139. Print.
- Linden, Wolfgang. “From Silos to Bridges: Psychology on the Move.” Canadian Psychology/Psychologie canadienne 56.1 (2015): 1. Print.
- Riding-Malon, Ruth, and James L. Werth Jr. “Psychological Practice in Rural Settings: At the Cutting Edge.” Professional Psychology: Research and Practice 45.2 (2014): 85. Print.
