Prescription Privileges For Psychologists

A pretty significant thing occurred recently, although I don't doubt that most readers may have missed it so far. The state of New Mexico recently approved a law allowing properly trained and licensed Psychologists to prescribe psychiatric medicines. This new law, is the first of its kind in the United States. It is groundbreaking legislation that has the potential to significantly reform for the better the current inefficient mental health care delivery system. Or change it around anyway.

Everyone knows that the mental health care system has undergone massive changes over the past decades. Power has increasingly shifted away from doctors and towards health insurance and drug companies. Traditional health insurance plans have all but died out, replaced by more `efficient' managed care models. Drug company breakthroughs have also occurred, so that it is now possible to treat most mental disorders with medicine, rather than with psychotherapy alone. As a result, when mental health care is offered these days, it is generally first offered in the form of medicine. Drug companies, for their part, now market directly to potential patients who, in turn ask their doctors to prescribe specific medicines. Patients and physicians both have come to expect a medical solution to mental health problems.

But this reliance on medicine to fix mental health problems has created a bottleneck. In a truly just world with unlimited resources, psychiatric medicines should be prescribed by a knowledgeable licensed physician who possesses expert knowledge of mental health issues, (a Psychiatrist). The thing is, though, that we don't live in a truly just world, and there just aren't nearly enough Psychiatrists around to meet demand. This shortage of qualified Psychiatrists is particularly acute in rural areas of the United States.

Two alternative classes of professionals exist who might be able to fit the bill; General Practitioner physicians, and Psychologists. General practitioner physicians are able to prescribe psych medicines, to be sure, but, by necessity of their general medical calling, cannot treat mental illness as more than just a sideline. Psychologists, in contrast, are expert with regard to mental illness, but are generally disqualified from prescribing regardless of how well trained they might be to do so because they are not physicians.

It does make sense for Psychologists to be able to prescribe psychiatric medicines if they are properly trained and licensed to do so. Psychologists have typically completed five or more years of doctoral clinical training in mental health diagnosis and treatment, have completed a year long hospital residency, and have practiced under supervision for 2000 hours (a full year) before being allowed to practice independently. Psychologists already deal with psychiatric medicines on a regular basis (many of their patients are on them and they must become aware of what medications are used for what in order to do good work). In many cases, Psychologists are actually in a better position than Psychiatrists to know when medication adjustments should be made; They see their patients multiple times per month (in the course of psychotherapy) while Psychiatrists are lucky to see a given patient six times in a year. Other things to keep in mind are that making psychiatric prescriptions is not really rocket science (although it clearly does require a rigorous course of study, supervised practice, licensure, and continuing education in order to be done properly and accountably), and that Psychologists are generally very bright people who can learn how to do it right. By and large, prescription-making is not a creative art, but rather a matter of learning standard dosages, drug interactions, side effect profiles and how to handle emergencies. Psychologists will only gain prescription privileges for a limited subset of medications relevant to their work; they will not become licensed to offer surgery or anything really complicated like that. It just makes sense that prescribing and psychotherapy functions could be rolled up into one profession to achieve significant cost and communications savings. And there will be significant cost savings - because Psychologists are willing to work for less money than Psychiatrists.

There is another motive too, a little more guild-related, to which I (as a Psychologist) will admit to. The profession of Psychology is in and has been in a crisis of identity for some time. In the 1940's, Psychiatrists provided psychotherapy and Psychology didn't really exist as a clinical field. Throughout the 50's, 60's and 70's, Psychiatry started to move away from psychotherapy (partially because the dominant Freudian school of thought didn't produce results, and partially because the new psychiatric medicines that were introduced during those decades did). Clinical Psychology (as doctoral a profession as Psychiatry) moved in and appropriated psychotherapy, turning it into a measurably useful set of methods for treating mental illness. However, the rise of managed care and the continuing introduction of new and ever more useful psychiatric medications in the 80's and 90's resulted in less funding for and less access to psychotherapy. At the same time, a host of masters level professions (lead by Social Work) started becoming psychotherapists too - and Social Workers are willing to work for even less money than Psychologists. . . Psychology is thus today squeezed between Psychiatry (prescription privileges) and Social Work (cheap therapy) and fighting for ground. Among other purposes, prescription privileges will help Psychologists to have a place to go.

It goes without saying that many Psychiatrists don't like this new law. For Psychiatrists, any prescription ground gained by Psychologists will be perceived as a loss. But it is ultimately money that rules the day in America, and not guild prestige. If Psychiatrists are going to be successful in holding on to their turf, they'll have to convince those with power that they are fighting prescription privileges for Psychologists on grounds more substantial than that they don't want to earn less money.

Perhaps more surprisingly, many Psychologists oppose prescription privileges for Psychologists. Generally, the argument within Psychology against prescription privileges goes something like, “Right now, Psychologists are expert at psychotherapy. We will lose this expertise and become nothing more than junior physicians if we go down the path of prescription privilege”. Generally, this argument is made either by senior therapists, already finished with retirement planning and putting kids through college, or by academicians who have an investment in an idea of professional purity.

There is some merit to this argument, I think, but it is short-sighted and a little petrified too. The main stream of treatment has been drifting away from psychotherapy as exclusive treatment, (from being a part of treatment at all in some cases) and towards medicine. For Psychologists to not pursue expertise as prescribers of medicine is foolish for the profession, and (dare I say it) ultimately harmful to those persons served by Psychologists who deserve the best and most integrated care that our strained healthcare system can afford to fund.

And so, if it wasn't apparent before, hopefully it is now: The new New Mexico law is the first beachhead in a turf battle between mental health care professions. Having lost professional ground to Social Workers who showed merit as psychotherapists, Psychologists have been using the same tactics on the medical profession, and have now won a significant battle. But a battle is not a war. It remains to be seen how well the prescribing Psychologists of New Mexico will do, and how tenaciously the Psychiatrists will hold on to their monopoly. I'm betting on the Psychologists myself although it will probably take a few more decades before the dust settles. Why? Because we can do it for less. Maybe the Psychiatrists should consider taking up surgery? For that matter, maybe the Social Workers should take up surgery.

Mark Dombeck, Ph.D.
Director, MHN

Comments
  • Anonymous-1

    for the poor unwashed masses the giagantic task of keeping people mentally healthy falls on a group known as mental health counslers. They deal with such problems as drug abuse,physical and sexual abuse issues. Most are unpaid volunteers dealing with serious mental illness that has a dramatic effect on society.

  • Anonymous-2

    You forgot another important group of individuals out there who already DO prescribe (albeit with a collaborative agreement w/ a physician in many States), and that is PMHNP's--Psychiatric Mental Health Nurse Practitioners. We not only have extensive education in anatomy, physiology, disease process and pharmacology, but also in methods of psychotherapy.There is also extensive clinical experience included with this certification. Nurses are really in a superb position to provode therapy as we can assess symptoms with a broad knowledge base of both physiological and psychological illnesses and extensive education in pharmacology & psychopharmacology. And guess what...we are often less expensive than a psychologist. The world IS changing and nurses are in a great position to help those in need of psychiatric services.

  • Robert H. Gillespie, LMSW

    I am always amazed at the lack of introspection SOME (fortunately not all) psychologists have. Dombeck should be in public relations as his wording is emotional and judgmental. Referring to social workers as "cheap therapy" is just untrue. Most insurances (including Medicare/Medicaid) make no distinction in regards to payment between MD/DO, PhD, and MSW's doing THERAPY. Medication checks are paid more as the liability for prescribing is much higher than with psycho-talk-therapy. Why? Because a person can die from SSRI therapy (i.e. Serotonin Syndrome) and use of neuroleptics (i.e. NMS) just to name two. To me, psychologists (who want and support prescriptive rights) are showing how poorly educated in biochemistry, anatomy, physiology, and pharmacology they truly are. The argument of nurse practitioners, PA's, and pharmacists are equally educated as a PhD psychologist is bogus. Nurse practitioners, PA's, etc. have the BASIC SCIENCE understanding and education as well as hours of intense supervision BEFORE they are allowed to graduate with their degrees, let alone prescribe. They get this as the major component of their education. Psychologists, on the other hand, spend most of their doctoral education on testing, theory (not based in chemistry, biology, physiology) of psychopathology, and dissertation requirements (which is more statistical than medical). 450 hours of "medical sciences" proposed by many "medical" psychologists (and the psychologists being supervised by a physician on 100 patients) is pathetic, laughable if it were not for the serious consequences. How can a person truly understand biochemistry (which you must understand for physiology, anatomy, pathophysiology, etc.) if the person has never had college chemistry let alone organic chemistry? And the argument "why do you need to know that stuff" is ignorant. Biochemistry is quite possibly the most fundamentally important paradigm to understand when practicing medicine. I also feel psychologists who want to prescribe are in effect telling people mental health is not a physical/medical problem. Since when did the brain become removed from the rest of the body? The brain is one of the most poorly understood organs in the body. With that being said, the brain is also one of the most important organs in the body. If a medicine effects the brain, there will be somatic effects as well. Will the "supervised" treatment of 100 patients under a physician help the psychologist recognize subtle medical problems? How will a psychologist be taught to order and interpret lab results if they do not know what to look for? How will the psychologist deal with incidences of serious PHYSICAL side-effects psychiatric medication with non-psychiatric medication? What is defined as psychiatric medication? Anti-convulsants? Benzodiazepines? MAOI's? What is the likelihood one of the 100 patients seen by the psychologist as he/she is being "supervised" will have these conditions? How will the psychologist know to even contact a primary care physician when many serious complications to psychiatric medications arise? Complications can mimic a cold or flu initially and if not recognized can lead to death. Another misleading point supporters of psychologist prescribing is the Department of Defense (DoD) study. Initially one hears DoD and immediately a certain amount of credibility is lent to prescribing psychologist. However, if you look at the study several major flaws are immediately apparent. The study included 10, not 100 or even 1000, non-randomly picked practicing psychologist within the DoD. As an interesting note, as significant portion of these psychologist left their post and went to medical school. This was even after their "special training". To me this study seems a little narrow to base large scale, potentially life threatening laws allowing psychologists (even with the "special" 450 hour crash course in medicine) to prescribe. I respect people with mental illness and feel just because someone is diagnosed with a mental illness they should have poorly trained and educated "medical" providers. The final misleading point psychologists state is the number of rural PhD/PsyD practitioners. In comparison, clinical social workers far out number psychologists and psychiatrist. Educationally, clinical social workers have graduate school (two years after undergraduate school if at masters level and four to six at the PhD level) as well as 2-3 years of clinical supervision. It is interesting many psychologists state the psychology PhD/PsyD programs are more intense than the MSW or PhD in social work. This is not the case. Social work educates its students on the effect of not just one or two systems within an individual's life, but tries to identify where and/or what systems are breaking down as well as what to do to ease the system and preventing it from disintegrating into chaos. Because social workers do not assign numbers to human behavior and social workers do no seek to describe the complex of human behavior with one model or theory, they are deemed "cheap". The psychologists are using the argument insufficient education of social worker to exclude the MSW from prescribing. It is interesting, however, that the education of psychologists (even PhD/PsyD) and MSW's are much more similar than that of a PhD psychologist and a psychiatrist. So to all of you psychologists salivating at the chance to prescribe, I say do it! But do it the right way. Educate yourself on the basics of science (yes even college chemistry, organic, microbiology, cellular anatomy). Like it or not, the brain is not separate from the body. there is no treating one without considering the other. There is no short-cut to being a medical doctor. Go to medical school, nurse practitioner school, PA school. A degree does not define a person. But it does define the responsibilities the person must live up to in order to be a safe and ethical practitioner.

  • Ben Lesczynski

    Let's face it, psychiatry's future is limited. On top of that psychologists seem to be the only professionals that pratice empirically supported techniques outside the realm of prescribing drugs (I'm talking to you LCSW's) in terms of psychotherapy. I believe one downfall of the APA has been the lack of effectively marketing psychologists. For example, pull people off the street and ask them what the difference between a psychotherapist and licensed clinical psychologist is, and they probably won't know. Ask them what the difference between a nurse and an MD is, and they probably will. The point is that for the "public" to fully have access to the benefit of mental helath's-- empirically supported treatments-- they (the public) need to have access to pyshcologists as well as fully understand the unquie and professional expertise that psychologists have. Giving perscription priveleges to psychologists will only increase the scope of a psychologist's ability to pratice effectively. "Psychiatry" please show me one instance of a DOD pyshcologist or a psychologist licensed to presribe in one of the two appropirate states of abusing or misuing these privileges. When psychologists can gaing the right to prescribe, all of society in regard to the menatal health will benefit. respectfully, Ben Lesczynski graduate student clinical psychology (APA accredited program)

  • Buddy Poje, M. A., Clinical Psychology Intern

    I am posting in support of psychologists having prescription privileges with appropriate training. It is very misleading to assert that by definition, psychologists have poor education in the neurosciences, pharmacology, pathophysiology, etc. and believe that the mind is separate from the brain is very misleading. In reality, some of the world's leading neuroscientists are psychologists a large and growing number of psychologists maintain strongly biological theoretical orientations towards mental illness. The reason for this is not solely due the existence of pharmacological agents used in the treatment of mental disorders, but rather due to empirical scientific work in the field of psychology. This should not be a surprise as the primary degree held by psychologists is the Ph.D. degree. The Ph.D. degree is the traditional degree of scientists. As such, when a patient goes to see a Ph.D. psychologist, they are not going in to see a person trained via dogma and personal opinion, but rather a person trained with the corpus of scientific knowledge underlying mental illness as well as its treatment. Having Ph.D psychologists being able to prescribe is not a danger, but rather an advantage. Ph.D. training in psychology provides rigorous exposure to the multifactorial contributions to mental illnesses and treatments over the lifespan (yes, including neuropathology, neurochemistry and psychopharmacology) as well as multidisciplinary and collaborative treatment conceptualization. Psychologists traditionally have been quick to acknowledge the importance of psychopharmacology in the treatment of mental illness, not resistant to it. Currently, with the trends of psychiatrists moving towards medication management only, it would seem that this reciprocity is no longer flourishing in the clinical setting. Another advantage to Ph.D. psychologists being able to prescribe is that psychologists, with professional scientific and research training are able to critically evaluate the efficacy claims purported by the pharmaceutical industry. Additionally, psychologists are in a key position to conduct their own research on the, psychological, and psychophysiologial effects medications have on patients, as well as clinical efficacy. Indeed, expanding prescription privileges to psychologists may usher in an era of greater understanding of the variability in efficacy of agents across individuals if psychologists are allowed to use these medications in their clinical practice as well as clinical research. Ph.D psychologists also have extensive clinical training. As such, they would be able to administer a wide spectrum of empirically supported psychotherapuetic approaches in addition psychopharmacological agents (as appropriate). It has been repeatedly shown empirically that a combined approach of psychosocial and psychopharmacologic treatments works better that either alone, and can produce short and long-term benefits for patients. Who would want to limit patients' access to efficacious treatment? Additionally, it is untrue that all psychologists wish to tred on the psychiatrists' turf. Furthermore, it is not the case that psychologists feel that they should be able to prescribe medications without the proper training. In reality, a majority of psychologists do not wish to endeavor in the additional training required to be licensed to do so, only a subset of psychologists wish to pursue this additional training this subset of psychologists hold strong biological and cognitive (which are commonly biologically influenced) theoretical orientations. Lastly, now that states are now establishing adequate training to qualified psychologists, and that studies have shown that psychologists are capable of acquiring effective clinical skill in psychopharmacology without increased morbidity, why would we want to limit patients of additional sources of quality mental health care? Expansion of benefits to psychologists would, in my opinion only help to further integrate the practice of psychiatry and psychology which would in turn provide a further benefit to patients. Clearly it is only a matter of time that these privileges will be expanded to properly trained psychologists and in doing so, will enhance the future of mental health care.

  • Anonymous-3

    Further evidence of the pharmaceutical companies' greed, and the lack of an ethical guidon in psychology. The precise point is already made: psychologists are not doctors. If you want to prescribe medication, go to medical school. Otherwise, return to your beads and incense.

    Editor's Note: If your idea of what a modern clinicial psychologist does involves "beads and incense, you have no idea what you are talking about. Beyond that primary observation there are a few other problems to comment upon. Psychologists are not medical doctors, true, but it is not fair to say they are not doctors. There are multiple professionals who are not medical doctors (with an MD) who have the ability to prescribe medication under certain circumstances (e.g., Nurse Practitioners, Dentists, Physicians's assistants, etc. There is no question that additional training will be necessary on top of the standard psychological curriculum No psychologist will ever prescribe without first receiving adequate pharmacological training and supervision.

  • Anonymous-4

    All the talk about adapting training programs for psychologists in order to prescribe is just an attempt by psychology training programs to remain relevant. Lets face it, clinical psychology is going the way of the do-do bird. Without psychopharm programs, doctoral-level psychology programs will go belly-up. Without presription priveleges there is no clear reason to have extensive psychopharm programs.

    In all the debates and retoric, I rarely see it mentioned that psychologists can go to an already-existing physician assistant or nurse practitioner program and gain prescribing authority.

    Yes psychologists are smart. I think they should be smart enough to see what is really going on and that the programs are already available.

  • JR

    Not really convinced by the head article. The debating techniques employed seem particularly partial, not to mention not particularly skilful. For example, taking cheap shots at "competitors" (psychiatrists and social workers) comes across, with all due respect, as something that may be appropriate in undergraduate student debating society circles, but it sits less well in a submission advocating the interests of a serious group of health professionals in such a serious matter.

    Speaking of cheap shots - "If Psychiatrists are going to be successful in holding on to their turf, they'll have to convince those with power that they are fighting prescription privileges for Psychologists on grounds more substantial than that they don't want to earn less money." Well, when one takes a cheap shot, one should take care that one's gun is not prone to backfire. Are we supposed to accept the unsupported inference that the upper end of the psychological cohort may not be motivated in this matter by a desire to earn more money?

    There is a more substantive problem. The head article declares that "making psychiatric prescriptions is not really rocket science". Really? Even accepting the qualifications attached here to that assertion, it is one that is difficult to accept, just like that. Some of my best friends are, or have been, psychiatric patients, and I have seen many cases of, let us say, problematic prescribing. The most memorable is a case of a fellow in-patient in a reputable hospital suffering from addiction problems as well as a significant, accepted psychiatric illness. Over a period of several weeks, a team including three consultant psychiatrists struggled to arrive at a balance of medication that would stabilise this man's condition in a manner that did not actually worsen his state of body and mind with, it has to be said, limited success. And this, remember, was in a strictly controlled in-patient context, supervised by a team of doctors qualified to "professor" level with a supporting team of psychiatric registrars and psychologists.

    Again accepting that the prescribing rights of psychologists may always be circumscribed, should this branch of the mental health profession really want to get into this sort of thing? Is it really going to be in the interests of their patients? Is it in the interests of psychologists themselves? What happens to all concerned if something goes seriously wrong - something that can happen in a very short time ? Of course, lacking medical or psychology qualifications myself, and not perhaps being a "very bright person", I can accept that I may not be best placed to offer answers to these questions. I am, after all, only a lawyer.

    While there may - just may - be merit in allowing psychologists to issue simple repeat prescriptions, for example (to relieve the inconvenience to patients that may arise from the lack of regular availability of psychiatric supervision), the argument for going beyond this does not yet convince. It does not surprise in the least that some psychologists have reservations about the wisdom of such a course, bearing in mind the interests of all concerned.

    Best regards, JR.

  • Richard

    Problamatic perscriptions are the result of a complete lack of concern for patient well being by corrupt Psychatrist getting drug company kick-backs. It's the very same moronic doctrine that causes teachers to land an LD title on every student they possibly can, and it's time for a revolution. I say let the war wage on.

    General practioners perscribing mental health drugs is the most insane thing I have ever seen in a health care system. I would be most satisfied with the legislation if it not only gave perscription rights to clinical psychologist, but striped the same sort of privlages from GP's with no real expert training in this highly refined SPECIALIST ONLY field. The number of patients I've wittnessed being perscribed dangerous mental helath drugs without any real investigation into the patients activities and habits fills me with the urge to vomit. Almost always, these patients got there perscription from a General Practioner, more often from a doctor-in-a-box orginization like Patient First.

    Regarding the idea that Psychologist should go to med school if they want perscription privilages, they would love to. Only problem is their a little busy paying attention to their patients needs and giving a damn about their moral credibility to waste time training in fields they will never use, so they can see a patient just long enough each year to ensure he is properly doped up, and spend the rest of their time rubbing their hands together while laughing mischeviously at their bank accounts.

    If the insurance companies (the real enemy in this fight) think they have a leg to stand on, let them come, and see whose side the maker is on. In the mean time let me show you where you can put that M.D. I want nothing to do with it.

  • Anonymous-5

    Both of my parents have suffered from mental illness. I grew up wanting to help those suffering from mental illness. While studying psychology in college, I planned to become a PhD psychologist. However, I realized that psychologists are only trained to do psychotherapy and can’t prescribe medicine. So, I became a social worker and then went to medical school to become a psychiatrist. I care very deeply about mental illness and have devoted my life to helping those who suffer from it. From my experience as a rural mental health worker to social worker to psychiatrist, I have learned a lot. I believe that RxPhD legislation would do more harm than good and should NOT be passed. Here are some reasons why.

    1) This is a way to save psychology as a profession at the cost of taxpayers’ money and physical safety.

    This bill is simply a way for professional schools of psychology to increase the number of tuition-paying students. The number of applicants has decreased dramatically over the past 20 years. Managed care companies are no longer willing to pay over-priced PhD’s to do psychotherapy that a master’s degree level therapist can do just as well. The professional schools bottom lines are threatened and the livelihoods of psychologists as well. So, psychologists need to make a new niche for themselves or eventually they will die out as a profession. RxPhD is nothing more than a desperate attempt by the psychologists to save their shrinking profession.

    2) Psychologists are not in rural areas.

    Like other health professionals, psychologists are not in the areas where they are needed. Prescribing psychologist legislation will not in any way improve access to mental health professionals.

    3) Prescribing psychologist’ education is far less than for any other prescribing health profession.

    The APA would require 400 hours of biomedical education for prescribing psychologists. This is less than half that of a physician assistant! Compare this to over 4000 hours for a medical school graduate. This is before internship and residency which would add at least another 4000 hours!

    4) There is no data to show that psychologists can prescribe safely.

    Psychologists have not studied their own safety. Why would they? It would show that inferior education leads to poor outcomes. It would not be in their interest to study their own outcomes. Besides, it’s like the fox guarding the henhouse.

    5) The National Alliance on Mental Illness does NOT support this bill.

    6) All medical societies are opposed to this bill.

    7) There is no required regulation of prescribing psychologists by medically trained persons.

    This type of legislation would set up regulation of prescribing psychologists by a counsel made up of seven psychologists, and one layperson. They would not be required to know anything about prescribing medications or have any medical expertise.

    8) There is no ongoing medical supervision of prescribing psychologists.

    There is a vague requirement for a “referring relationship” with a physician. This is not a supervisory or oversight position. The PhD psychologist could just send them to the emergency room.

    9) PhD psychologists would be impersonating real physicians.

    A person with mental illness would not be able to tell the difference between a person wearing a white coat, calling themselves “doctor” and holding a PhD in psychology from a person wearing a white coat, calling themselves “doctor” and having gone to medical school and actually being a physician with a medical degree.

    10) The prescribing psychologist 1-year “fellowship” has no educational component.

    There is only a vague requirement for “supervision” on a weekly basis. This “supervision” could consist of a weekly phone call.

    11) The Department of Defense pilot program that trained 10 psychologists to prescribe medications was shut down due to the massive cost associated.

    This pilot program was a flop but is used as proof that allowing psychologists to prescribe is a good idea. The cost was enormous, so they shut it down. The psychologists only treated the healthy and young in an outpatient setting. There were no adverse outcomes because they didn’t look for any! Also, the program required 800 hours of medical education compared to the APA's 400 proposed hours. In addition, there was ongoing supervision by a physician.

    12) Prescription drug abuse is a growing problem and will only get worse if RxPhD legislation is passed. With under-qualified psychologists prescribing drugs like amphetamines, methylphenidate, Xanax, Valium and others, there will be more drug addicts. This is especially true if the person giving the drugs doesn’t know what they are doing.

    13) The quality control of psychologists is much lower than for other prescribing professions, especially psychiatrists. Psychiatrists score highly on the MCAT( medical college admission test), pass 3 levels of national boards, a general practical exam, specialty boards with another practical exam and pass the specialty boards every 7 years in addition to 30 Continuing Medical Education credits each year to maintain their liscense. Psychologists have to pass only the PEP.

    14) RxPhD is redundant. Psychologists can already go to a Physician Assistant (PA), Nurse Practitioner (NP), or Medical Degree (MD) program and obtain prescribing authority. We dont need to start an entirely new medical profession from scratch.

  • Kimberly Ann RN, BSN

    I am not in agreement with psychologists prescribing. There is a reason Doctors of medicine go through evey area of specialty! When you put it in your body it is just that in your body not just your mind. Whta about preegnant patients, or pateints, with asthma, heart disease, dehydration, drug withdrawl, intestinal diseases, and the list goes on. It is not about giving medicatiopns it is about knowing what they do and how they act on the bodya dn what they do. As well as understanding how they interact with other conditions. One must know pathophyiology, and anotomy and phys. I wouldnt want a phsycologist to give me heart meds by the same means i wouldnt want them giving me psych meds when i had a bad heart. It is not justabout the right drug for the right mental illness!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  • Casey R. Guillot

    I agree with the main points made in the article. I think that clinical psychologists will be able to prescribe psychotropic medications safely after obtaining additional training in psychopharmacology. However, psychotherapy should remain the focus and the first option considered, except for with severe cases that require medication.

  • Casey R. Guillot

    One imbalanced part of the prescription privileges argument I've noticed is saying that medical professionals obtain more training related to prescribing than the amount of hours proposed by clinical psychologists interested in prescribing. However, such a statement leaves out a vital piece of information: As far I can tell, clinical psychologists in general are not interested in being able to prescribe the full range of medications available they are interested only in prescribing psychotropic medications. Therefore, why wouldn't it take less training to be able to prescribe psychotropic medications in comparison to being able to prescribe all medications?

  • Timothy Tumlin, Ph.D.

    How refreshing to see a debate over prescriptive authority for psychologists. Such a debate is not allowed within the American Psychological Association, which has a gag rule on dissent and will not ask its membership whether they support the very expensive 13-year-old turf war against medicine.

    Psychologists have always had access to prescriptive authority. The most obvious path is medical school, but shorter legitimate pathways have existed for many years, such as taking *medical* training as physician assistants, nurse-practitioners, etc.

    The real issue is whether the special interests iinfluencing one psychology organization, spending millions of dollars without accounting to the membership, can create special licensing laws to allow psychologists to practice medicine with an absolute minimum of training acquired in psychology schools and be supervised, licensed, and regulated by psychologists rather than medical specialists.

    Psychologists can create rich and full practices by either getting medical training through medical sources, or collaborating with patients' family doctors to make sure prescriptions are effective and safe.

    I would suggest that any psychologist who truly wants to prescribe (and I commend anyone so ambitious) should wonder if he/she is being hoodwinked by this one organization and its sub-units. They are making psychologists wait many, many years and spend millions in lobbying money for this special legislation. Instead, the same organizations could be creating hundreds of "prescribing psychologists" with medical training, or training others to collaborate knowledgeably, filling their practices with patients and helping many in the process.

    Sorry, my friends, but as I see it, those who think of themselves as pro-RxP psychologists are actually being duped.

    Editor's Note: No one is questioning whether additional training above and beyond that necessary to practice psychology is needed before psychologists can prescribe safely. I also doubt that anyone is thinking that psychologists can do this training on their own without the input and supervision of physicians - that would be foolhardy at least in the short and medium terms. What is being argued for is that a psychologist can earn the right through advanced training and supervision to legally prescribe as a psychologist and not as a psychologist who also happens to be a nurse or PA. As to whether this position means that psychologists are being duped, I can't say. It's certainly a protracted and contentious political process both within APA and within state legislative bodies.

  • Anonymous-6

    hey man I have been practicing this "pseudo science" for twenty years and this and perscribing necissary medinice to my patients would be much easier than stealing it

  • Jacques Lacan

    Great!

    The U.S. mental health professionals have declared that words are not important anymore for my mental health !

    If somebody tells me, 'I hate you' and after that I feel depressed, it does not matter. I can go and visit a PA, or a RN, or a MD, or a RPMHN , or a Psychiatrist, or a RxPhD or even my Dentist to prescribe me the magical solution for my sadness, depression, anguish, irritability or anger.

    After that, wow, now the world is wonderful again, plenty of love, yeah! and the good thing is that act happened without words, who needs words? Words are too cheap. Maybe is the reason why poets are poor, don't you think? Even a presidential candidate in the U.S. was warned , and told that 'words are not important'.

    Pharmaceutical products can fix my neurochemistry. The good thing is that I still feel disgraced but I don't care. I take my pills, pay ($$$) the religious visit to my prescriber and 'I feel good'.

    Have you ever thought that maybe is the lack of words that so many kids are on the street so desperately asking for the unprescribed magic pills?

    Oh, well, my dream is a world full of pills, to control any specific disturbing emotion and we are getting closer and closer.

    I think that american psychologists are getting to the same conclusion.

    Soon we will have a world of silent prescribers with silent patients and its silent symptoms.

  • Anonymous-7

    Wait until the trial lawyers get hold of you.

  • Gene Courter LCSW/DCSW/BCD

    Are you kidding me! LCSW's and MSW's have been around a lot longer then Psychology. MSW's and MD's were the first to work in Mental Health Institutions with the Severly Mentally Ill in the early 1900s, while Psychology were chasing Rats around a Lab! The first LCSW's to be Licensed were in Claifornia in 1940. MSW/LCSW were providing Psychotherapy much before Psycholgy, so LCSW's did not take anything away from you poor lost Psychology souls. If you want to prescribe meds get a MD! By the way, I charge $175.00 an for 50 minutes, what do you charge, you poor lost Psychologist?

    Gene Courter LCSW/DCSW/BCD

  • Who cares?

    Who cares if the MSW's have been around longer than psychologists. The fact of the matter is psychologists have an extra 3 more years of training/psychology/assessment verses those with MSW's. It doesn't matter how long MSW's have been around verses Psy.D's or PH.D's. PH.D's have been around the longest dating back to times of for instance, Socrates and Aristotle except it wasn't called a "PH.D."

    Who cares?

  • Gene Courter LCSW/DCSW/BCD

    No Phd Psyd do not have 3 more years of anything more when it comes to training. You need to re-take math!

    Editor's Note: Not sure I understand the intent of your comment. Are you stating that Ph.D. and Psy.D. psychologists do not currently receive three years of additional training in psychopharmacology? Of course, this is true right now. What I asserted in the article is that psychologists could become qualified to prescribe if they were to receive necessary additional training (however long that training would take in years). I think we can all agree that psychologists are not qualified to prescribe given their training as it exists currently.

  • james freeman

    let's see: what we need is MORE mental health professionals dolling out psychotropics and not having time or financial incentive to to non-medication therapy.

    If you ain't a doc (MD), you don't need to be prescribing medications. No good will come of this: more folks on meds who should not be on meds will be only one of the negative results.

  • DrP

    Mr. Gillespie,

    You seem to be very unaware of the training of Psycholoigst (which is doctorate level only, with a disputed execption with school psycholoigist). I would rather you examine if Psychratrist could even come close to matching the over training of Psychologist, in regard to effectively assessing, treating, and thus alleviating psychological dysfunction, wherever it lies within or out side the indivudal. (This is an human ecological based idea)

    Furthermore, your basic asummption that the brain "causes" psychopatology is well off the mark. The current data (evidence that is collected and obejtively analyased using the scientifc method, not done by ANY MSW I have ever known, which is quite a few now) currently support an EXTREMLY complex interaction between: (a) genetics, (b) neruoscience, (c) indivdual psycholgical ascpects (i.e. behaioval conditoning, cognitions, emotions, etc.), (d) extenal variable (culture, social relations, ect.), and development across the lifespan. All contributing different portion of variance (a statisitical term) to a given dysfunction at any given time.

    Thus, it may be thoughts, feeling, behaviors, or socail eveirmant (singly or most likey in combonation) that "cause" or elicates a dysfuctnion from someones genetic makeup (that would be many genes interaction potentially), that then LITERALLY changes the brain and its functioning. Therfore, focusing upon only a demension or two (Meds for Psychtatics, External envrionment for Social workers, etc.) is ineffective in the longer run, and now that I think about it, possibly unethical, that is if your professions has such high standards.

    One big thing I learned between being a Masters level person to becoming a PhD was: Learning to know what I don't know, which allows me to focus upon what I do know while avoiding to speak about things I am unaware about. I am bound to what I know emperically...

    So with that said, high quality training that leads to skills wich promote a holistic, ecolocially, grounded intervetion seems to be an overwhelming advantage to everyone. (Even Psychratist who would, by my professional ethics, be forced to do what best over time, not just 15 mins. every month or so)

    P.S. you need to really take a closer look between the Social Work, DSW/PhD training and PhD Psychology. Not even close. Admittedly Psy.D training can be suspect in terms of the scientific side, they do, however, spend a great deal developing "clinical skills". (which would out class any Psychratist or MWS/DSW training)

    DrP

  • Mike

    What is the title (name) of the certification or degree that allows clinical psychs to perscribe psychotropic medications?

  • Matt Pharm.D.

    While psychologists may be experts at evaluating components of mental illness, they are in no way qualified to understand the complexities of how medications affect different body systems. Many health professionals with years of experience in both didactic curriculum and clinical residencies still do not do a great job of selecting medication regimens that are individualized for a given patient. One can't overstate the value of knowing your limits. Psychologists do not have training in pharmacokinetics, drug interactions, individualizing therapy, disease-drug interaction dynamics, or handling adverse effects of therapy. Certainly these topics cannot be adequately covered with even 2-3 years of additional training. Without the background sciences to put everything in context, learning about these topics would only scratch the surface in attaining adequate clinical knowledge. Nevermind that using many psychotropic drugs requires ordering routine labs, screening for and DIAGNOSING comorbidities, and dealing with one of the largest problems with these medications, non-compliance.

    Many health professionals already use these medications inappropriately and do not have a grip and the permanent and disasterous complications that some of these medications can cause. Using these meds inappropriately can be worse than not using them at all and does result in overdoses, suicides, withdrawals, EPS, etc. I say be proud of the expertise that you have in your own area and develop that the best you can. No one can be a master of all and the results of trying are disasterous to patients.

  • Anonymous-8

    Ask 100 of those newly licensed psychologists what malignant neuroleptic syndrome is and see what happens. Ask them how to diagnose it and how to treat it. Ask them about the differential diagnosis. Psychologist are not trained to diagnose , treat or distinguish drug reactions from other toxic ,metabolic , or intracranial disorders that effect behavior-mentation.

    Psychologists are not trained in .diagnostic medical testing.You will never see me seek medical care from a psychologist or a nurse practitioner.

    Psychologists who want to practice medicine shoud attend medical school

  • PsyD - Anonymous

    To all who ply these waters,

    These comments are all well and good, and obviously vital nuances of the prescription privileges debate. However, if one were to step back and look at the underlying trends in these arguments certain things invariably seem to take shape. Primarily, that this discussion on any website I have visited always seems to degenerate into a lot of persons with titles, associated ego's and associated economic concerns working to find their place in the MSW, PsyD, PhD, MD professional pecking order. I would further argue that this distillation of such arguments exposes the seeming surface concern for “patient welfare” as rather hiding “unconscious” economic turf battles. Since presumably honesty, clarity, and following occam’s razor, simplicity are our professional concerns, I would assert that such turf battles are essentially wasted energy distractions from the fact that this prescription privilege decision will, like most health care decisions in our country, hinge on economics and profit.

    There would be almost certainly an exponential increase in profits available to drug companies with the advent of prescription privileges for psychologists and the concomitant savings to private, or the currently debated "public," insurance companies this being the case when the much more numerous psychologist population prescribes in comparison to the scarce psychiatrist population, or GPs/Nurse Practitioners who are willing or dare to take the risk of doing so (New Mexico would agree). I would argue that the power of his economic reality and the potential profits behind it - well over and above the power of the AMA in Illinois, will ultimately move this decision, regardless of whether or not Illinois will be the last state to capitulate.

    Thus, I would argue that what ever your perspective and however valid and critical the nuances of your position may be, in this practical economic context they are smoke and mirrors, or rather footnotes to the ultimate decision. If you don’t find this compelling or rather dismiss this assertion as cynical hot air than I would suggest you take a look at the ethical state of drug trials and/or drug advertising on TV today to see where this prescription privileges debate and decision is headed!

    PsyD, anonymous.

  • WCR

    I ended up with a PhD in clinical psychology and then an MD. There is differences in the training one receives from various PhD programs-NOT SO MUCH IN ANY RELATION TO MD/DO. Also, I am sorry, there is little difference in the outcome from practitioner to , when type of degree is considered. If you have no personality, all the clinical skills in the world will not save you. I have met MSW and MA counselors who blow the sox off PhD candidates. As for PsyD's, the multitude of 3 page reflection papers, in place or any really hardcore studies, speaks volumes. However, I have never known a PsyD who was not better at psychotherapy than any Phd, nor a PsyD who could beat the research skills of a PHd. Essentially breathing with a pulse, will get you into PsyD programs, but they do make you a therapist. I am not looking forward to the first trial of a PhD treating a patient with an underlying issue, unable to explain to a court the multitude of medical issues involved. Folks with PhD's, go get an MD, or at least get into an MD/PhD program. Quit slamming MSW's, some of the best clinicians I supervise are of that breed. Get over this, you make enough money-I assume the next step is the push for LSCSW's, LCPC's and LMFT's to prescribe medicine. Manage care is here folks, the real root of this is surviving competing specialities. PA's and ARNP's, depending on what state they are in, have prescription services under physicians or not I do not see them wanting to practice psychotherapy and adminstering the WAIS either.

    There is also flack about school pschys-there are many Phd and PsyD school psych routes and frankly little difference in an EdS program from the former. Please lose the egos and get out and redefine what the hell psychologists were intended to do-test and extrapolate! Before going to medical school, at KU, I managed a mental health center and did fine with masters level therapists the two doctoral level psychologists I had, were great, and had thier place. Reality=money. Do I hire a master's level psychologist for $45G or a PhD for $60G to do the same job. Thinking like this tends to bring us down to reality. By the way all us PhD's, what we really need to fear are all the MS psychology people stealing our jobs, not those seemingly "cheap therapy" oriented social workers who provide 75% of all therapy! Hmmmm.

  • KC

    Those who throw stones should be careful. Giving favortism to MD's, Ph.D.'s, or MSW's while bashing Psy.D.'s shows a very distorted bias. If you are truly going to be rational and consistent, then judge a person based on merit and not degree. You contradict your own logic by defending other degrees from those who attack them only to attack Psy.D.'s! Hypocrisy rears its ugly head. Think it through next time before posting a poorly defended rationale.

  • LCSW

    A recent MSW graduate and recently being LCSW, working in a mental health setting, I am finding that the level of clinical understanding is not just based by profession (MSW, PH.D., MD), but also year education is received. Obviously, research and understanding of mental health changes and I find that older Psychologist and MSW are often not up to date on the research, diagnose, or best practice skills. I continue to see psychologists completing the axis 5 diagnose wrong and refusing to relearned it because they were taught that way years ago. I see LCSW who are not very comfortable with assessments, because their graduate training did not concentrate as much on diagnosing as it is now. I've also noticed that older psychologist and LCSW are not as comfortable in CBT, which dominates the field now but not then. My point is that research change and knowledge is not often based on degree but the willingness to relearn. Saying this I do believe that if psychologists are required to go back and received “appropriate” education and training in medicine, I don't doubt that they won't be effective. Just with 3 years of experience, when I bring a client to see a psychiatrist, I can typically guess what medication the psychiatrist will prescribe.

    As much as many M.D. hates to admit it, I do see psychologist being able to prescribe medication in the next 10 or so years. Mainly because our health care system is driven by cost. Psychiatrist are just to expensive and like PH.D., many are not willing to work for less. Because of this, you see many Psychiatrists either working part-time, only in urban city, being double booked, or owning their own practice because no one wants to pay them $150/hr but Medicaid only reimbursing $35 every 15 min. session. I think psychologist being able to prescribe meds might be too drastic of a change and I think sometime more limited like allowing them to prescribe certain common psychiatric meds might be more appropriate. At the same time, I would also like to see LCSW and Psychologist be able give medication advised with certain limitation/guidelines. I run into multiple situations where M.D. do not have the time to discuss with client about effects or side effects of meds because of time constraint. LCSW and Psychologist can easily fill in this gap, as many are educated about medication to certain levels and would offer safer and better practice for the client.

  • jessica

    If psychologists have the right to prescribe that does not mean they will be handing out meds to patients. This actually may prevent over-prescription from occuring as often as it does. Studies show that people who suffer from mental illness often get their prescriptions from primary care physicians. It is less likely that they will get their prescriptions from psychiatrists. The problem here is that many MD's may not feel psychotherapy is necessary aside from medication, when in many cases, it is more effective in combination with therapy. Psychiatrists, may only spend a certain amount of time with patients and not provide proper therapy.

    The truth is, many people are taking medications when they do not need it. For example, depending on the type of anxiety disorder (and the person's background, circumstance, etc.), it is better to treat the patient mentally and have them understand their anxiety and sit with it, rather than having them depend, or become addicted to drugs like Klonopin or Xanax. However, sadly, MD's or psychiatrists may prescribe these medications without second thought and be hurting their patients (e.g. addiction to medication) than helping them. I do understand that some people really do need these medications, and that is where a psychologist could make a decision: Does this patient really need the medication or would their circumstance be better suited with psychotherapy alone? This is not an easy decision that primary care physicians (in their 15 minute appointment) may be able to make.

    Every patient/client is different. It takes time and a certain relationship to be able to understand what a patient or client needs. The right to prescribe may lower the amount of prescriptions handed out.

    Also, a complaint heard from cleints is that the interaction with their psychiatrist feels impersonal. They may feel awkward and misunderstood, that they are prescribed medications without a full explanation. This could also be reduced with prescriptions privledges given to psychologists.

    Extra training should be required, but some states allow nurse practitioners, and physician assistants to prescribe with less training than doctors. Studies also show that there have not been an influx of bad consequences that have come about from this. Nurse practitioners and physician assistants may even see patients without having input from MD's.

    The debate is warranted along with people's hesitations. It's understandable since big parmacy companies complicate the issue. But it is an opportunity to better treat clients.

    I guess we'll see in years to come with New Mexico. If you would like more inofrmation from a peer-reviewed, professional journal article, (From a well-filtered, selective journal) or where I have gotten some of my information for this post, check out the article titled: "Prescriptive Authority and Psychology: A Status Report." Authors: Ronald E. Fox, Patrick H. DeLeon, Russ Newman, Morgan T. Sammons, Debra L. Dunivin, Deborah C. Baker. From the May/June 2009 issue of the American Psychologist.

    Thanks for the post! An important debate.

  • B.H., LCSW

    Well, I think this thread just goes to show the immaturity of us all. Is not what we do about patient/client care. The truth is that professions change and times change. What stays the same are the problems that people face. I think that each profession represented in this thread should take a good hard look at his/her own uniqueness. I work with Psychologists, Psychiatrists, PA's/NP's, Substance Abuse Counselors, and other LCSW's. There is NO pecking order. Everyone has input into the care of the patient. Good heavens, some of the comments here are juvenile and just plain ignorant. Why on earth did some of you go into a helping profession if you are going to play "turf battle" with eachother? Get your priorities straight people.

  • ajsqueen

    I believe this is a wonderful step for psychologists, especially with the shortage in rural health areas where ANY psych care is almost non-existant.

    I am a Physician assistant in a designated area of healthcare shortage and I see and treat MANY psych patients almost daily. It is common place for us to prescribe medications for simple depression, etc. but we know our limitations, and anything that is not relatively simple gets referred. I think having a psychologist who could do both therapy and prescriptions is brilliant. Our closest psychiatrists are 40 miles away, patients cannot get into see them, and when they do, they get a whopping 5 minutes of their time. This is why primary care providers have had to take over. It's not by choice...it's by default.

    Also, for the person below who states "PA's and NP's are even seeing patients without the input of a physician"...where have you been? I have my own practice, my own patients and have functioned independently, even in my own clinic 11 miles away from the nearest other practitioner for decades. The laws in each state are different and require very little input from a physician. In fact NP's do not require ANY input from a physician whatsoever. I also know some pyschiatric NP's who are very fine mental health practitioners. I would send my mother to them, or a prescribing psychologist any day prior to sending them to a psychiatrist.

    Congratulations New Mexico. Psychologists deserve the authority and we need the help despirately!

    AJS MS, PA-C

  • GD

    I being a Student to psychology and further going to study clinical psychology, i am delighted on the news. It is true that without proper training even we the psychologists(who according to many are not eligible for prescribing), woundn't like to danger people's lives by our inaccurate medications. Psychology is a subject which is taught from the basics if taken Arts. having studied and trained,plus taken training in psychopharmacology, I think the future for mental health will be safe. For those who have juvenile negative comments I woud like to add that we psychologists are well aware of importance of each stream in medical stream and expect the same from you. we never boast about our profession(which we can) and also respect other professions. we are eligible mentally due to the having mental abilities required to safely treat the patient, without hurting him/her.

    It is a great news and I hope that me, myself by proper traing would be able to give justice to the bill.

  • Anonymous-9

    I have worked in hospitals and healthcare for 35 years. I have critical care as well as psych experience- odd mix yes, extremely enlightening yes. I will never, ever, allow any one I know, to have a psychologist prescribe for them. They simply don't have the medical background or understanding to do so. The person below who discussed NP's was also uninformed.

    Registered Nurses have many years of medical knowlege, and despite what ridiculous television shows expound for drama, if you don't have a good nurse taking care of you in the ER or ICU you are doomed. Everything you see "doctors" do on the TV shows, it's actually the RN doing it. They have far more knowledge concerning medications and reactions than any psychologist, and frequently call MD's on mistakes and save the patient.

    That said, acceptable, knowledgeable, SAFE providers would be psychiatrists, NP's specializing in psychiatry, or PA's with many years of experience. All medications interact with other meds, can cause medical reactions and side effects, and often there are many diseases that need to be considered and ruled out before making a psychiatric diagnosis.

    Psychologists just don't have a grasp or idea of what goes into prescribing meds. If they spent about 3 months with an RN of MD, they wouldn't WANT to prescribe meds if they cared about their patients.l

    That said, I would much prefer a PsyD to do therapy with my family members. Care is so complicated now you just can't know EVERYTHING. Stick to your specialty and don't be a jack of all trades-master of none.

  • annonymous

    As an aspiring clinical psychologist, as well as an advocate for individiduals suffering from neurological dissabilities, I would have to agree that the ability for clinical psychologists to prescribe psychiatric medications to clients would be very beneficial. If you take a look at the roles of psychiatrists years ago, you will notice that many (if not all of them) provided psychotherapy along with medicinal treatment. Today, we see a majority of psychiatrists leaving psychotherapy to therapists, and handling only the medicinal aspect of treatment. Due to the limited access to mental health care, clients are often times forced to seek psychotherapy from one office or organization, and medicinal therapy from another. This can create a very difficult gap in services and ultimately lead to less communication between professionals.

    Because psychiatrists are in such high demand, they are often times only able to see a client for five to ten minutes. Though this time frame is enough to allow them to consider the necessary concerns in regards to medication interactions, it inhibits them from gaining an indepth understanding of the circumstances behind the psychological illness.

    I have seen so many clients overmedicated because of this time restraint, as well as the lack of communication between professionals. For instance, I worked with a client who suffered from a brain injury/developmental dissability who had taken 1800mg of Lithium, 1200mg of Oxcarbazepine, and 2mg of Guanfacine over several years. As anyone who has training in pharmacology is aware, the duration this individual was taking these medications should be questioned, let alone the prescription of the medications themselves.

    It does not take a professional with an advanced degree to identify that psychotherapy and medication go hand in hand. It is essential for psychotherapy to assist the individual in identifying and learning to cope with and/or change the underlying causes of their disorder. Treating psychological illness does not have a black and white approach. Every illness is unique to each client, and ultimately impacts their life in different ways. Psychiatric medications work to inhibit or excite neurological processes in order to reduce or increase neurological reactions which impact psychological illness.

    Clinical psychologist are highly trained and extremely qualified to assess, diagnose, and treat psychological disturbances. In the case of psychologists prescribing medications, there would be extensive post-doctoral training in pharmacology and other study necessary to qualify them to prescribe psychiatric medications. Therefore, I believe it would be very beneficial to the client, as well as our society for psychologists to be afforded the opportunity to prescribe medications, however I do agree with many concerns and feel that strict regulations and limitations need to be in place.

  • S.M.D.

    Yes, psycholigists are specialists in the field of mental health and they do deal with psychotropic medication on a consistent basis, and may even know when an adjustment or change may be necessary. No one is disputing that. However, there is more to prescribing medication than, being able to write the prescription. It is not just a matter of "learning standard dosages, drug interactions, side-effect profiles, and how to handle emergencies" (Dombeck, 2002). Whereas the arenas of mental and physical health co-exist, and integrate with each other, they still remain separate and distinct in specialty and application. Psychiatrists are doctors of medicine - psychologists are doctors of philosophy. There is a dfference in focus, training, and experience.

    The issue that seems to be most overlooked, is the safety and well-being of the client. As an example, a client sees a psychologist and describes a profile of symptoms. The psychologist conducts a mental status and history assessment, determines the presence of a mental condition and makes a DSM diagnosis. Based on the diagnosis the psychologist prescribes medication appropriate to the treatment of the disorder. However, the psychological symptoms identified by the psychologist have an underlying medical condition. The psychologist has no knowledge of the possiblilty of a medical issue as his/her specialty is in mental and not medical anomalies. In this case, the client is being treated for a condition that warrents medical intervention. The medication prescribed adversely interacts with the client's physiology and potentiates the underlying medical condition. The client is now being treated incorrectly and as a result, is being deprived of appropriate medical treatment. Who is liable? Is the psychologist, who is not medically trained, but is allowed to prescribe medication (in this case innapropriately) negligent of malpractice do to the lack of medical knowledge? Does the psychologist's lack of medical competence place the client in physical jeopardy?

    I have read many articles regarding this issue and have pondered the pros' and con's (not to mention consideration of health insurance and HIPAA concerns). While the argument continues as to whether psychologists should be allowed prescription-writing privileges and attention is placed on the fact that "it makes sense that prescribing and psychotherapy functions can be rolled into one profession" (Dombeck, 2002), the question remains. Who is concerned about the safety and well-being of the client? It seems that the issue is not fully one of concern for more effective treatment in mental health care, or for cost-effectiveness in providing treatment, or for creating more available resources for treatment. It appears that there is somewhat of a self-serving component for independent identity of psychologists.

    As with the trend of holistic and psychoneuroimmunological approaches toward healthcare, psychologists should be more concerned with integration rather than idependence. Understand that the field of psychology is a necessary and difficult specialization. Howver, overstepping its boundaries may provoke serious health, safety, and legal repercussions.

  • Ben Chico

    Well... I think prescription right for Psychologists is a step in the right direction. Psychologists are not just Doctors of philosophy, they have knowledge of physiology, pharmacology, and neuroscience, sometimes better than some physicians depending on years of experience and level of training. What is properly needed is a little more content of biological psychology and pharmacology in the training program. Psychologists must also be sensitive as to when to refer a Patient to another professional as is currently the practice. Consider that Nursing was not a prescribing proffession for sometime in the same vein psychology taking up the prescription of psychotropic medication would help the profession, the patients, and the nation.

  • board cert. psychologist

    I commented on this "debate" back in 2006. I now currently work (as a psychologist) at a DOD army hospital and there is one psychologist licensed there to prescribe meds who works in primary care (in most federal institutions, it does not matter what state you are licensed in-- i.e. that is the case of this prescribing psychologist I am speaking of he is licensed in a state that allows it, but is able to work at this federal institution in another state). Anyway, point is the primary care docs, etc. love this person as he has vast knowledge on both the best mental health treatments and psychpharm (the MDs/ NPs in this primary care setting routinely turn to him for advice regarding what pills to prescribe). He has a long waiting list for patients… I don't know, proof is in the pudding... right? The only resistance came several years ago when psychiatry tried to block the credentialing which didn’t work (a little worried psychiatry, huh?)… Also, in terms of psychiatrists there about 10 to the 50 psychologists at this hospital. I am not turning this into some sort of psychiatry vs. psychology debate—but many NPs, PAs, and GPs turn to the psychologists for help with behavioral health treatment. Psychiatry is dying (I am seeing it first hand), psychologists will have to get presepction privileges eventually—it’s only a matter of time!

  • krystopher

    this is unfair to me, because i was studying psychology in the past, i did one year, and then i realize that i wanted to be a psychiatrist because i wanted to give therapy and prescript, and the only way to do it, was studying medicine because you need that preparation to prescript, and i know that psychologists are happy with this, but then again what is the purpose of a psychatrist that does double the effort of career than a psychologist?

  • aPa doc

    In response to why become a psychiatrist: I think that part of the point is that if a patient needs a less "evasive" medication it is easier for a psychologist to prescribe something like celxa then jump through the hoops of referring out. Also, I think it's more complicated than this. On one hand I'll post a link to show some more of my point: (http://www.psychologytoday.com/blog/the-new-psychiatry/201003/psychologists-and-prescription-privileges-conversation-part-one) ~If the link doesn't work it's an essentially MD supporting psychologists prescribing through a motivational interviewing/ Socratic method/ technique. When you place the credentials side-by-side of many of those with rx privileges next to the [credentials] of the “concept” of prescribing psychologists it becomes silly to not let them prescribe (as it becomes apparent it's more of political move on the part of psychiatrist to protect their craft, then the idea that doctoral level psychologist with extra training and supervision could not safely and effectively prescribe—sort of like the white elephant in the room). On the other hand, leading psychiatrists like Stephen Stahl MD (author of books like the prescribers guide) believe in aggressive poly pharmacy approach to --psychotropic medications -- as the only true approach to treating serious psych conditions (e.g. google California rocket fuel and 800 mg Effexor, which is way outside the FDA approved range). I do not trust psychologist taking this approach to prescribing and should they ever try this approach, my guess the debate will stop and all progress will be lost (kind of like nuclear powered airplanes :-) Also, truly psychotic individuals who needs heavily doses of powerful medication (for bipolar, schizophrenia, psychosis, et al.) should not be treated with prescribed medication by psychologists (I’ll also add the ever present powerful borderline cocktails of mood stabilizers and anti-depressants and meds like Gabapentin should also not be prescribed by psychologists). Here is lies the importance of psychiatry and the dying/ symbiotic/ duel relationship between psychologist and psychiatry—which is really the only true way to treat these severe patients, can’t we all just get along?). Bottom line, psychologist = rx = for most anti-depressants (not MAOIs), benzos, newer meds like lyrica and Cymbalta, psycho stimulants, most sleep meds, some atypical anti-psychotics, and Provigil (and some of the other newer meds for lethargy) = ok on these. NO GO for rx psychologists (except under extreme conditions—rural areas, other access to care issues, etc.) no on all mood stabilizers, most off label use / FDA outside of guideline use (700 mg Effexor for instance~no), and most typical/ and atypical psychotics~no. I think psychologists should prescribe under the above stated conditions. I think it’s necessary and I support it. Most well trained psych docs PhDs I believe are way better suited (again under the above said circumstances) than primary care doctors and nurses. I would trust their opinions over those other providers for better treatment outcomes. Period.

  • ana

    Clinical psychologists are experts in evaluation and diagnosis of simple emotional problems and mental disorders. Moreover, the relationship they have with their patients is empathy which helps to improve the problem being treated. However, in some occasions (not all), these patients need a little help with psychotropic drugs to make a little quicker psychological treatment. Psychologists used an hour for each patient once a week, so there would be a better monitoring of psychopharmacological treatment in addition to psychotherapy that it is essential.

    For these reasons and more, I support the idea that psychologists have permission to prescribes psychotropic drugs. But they have to be clinical psychologists with a master in psychopharmacology and neuroscience.

    By the way, I'm from Guatemala.

  • Anonymous-10

    I am a Physician Assistant (PA-C) as well as a student of psychology at the current time. And I think it would be a very bad idea for a psychologist to have the abilities to write for prescriptions. I have seen some of the psychology pharmacology classes and they are a joke. They don't give a good enough understnading of the drugs and how they work. You also have the problem of the patient, when you start mixing drugs. The patient may not tell their PCP that they are taking some psych medication, and when the doctor gives them something to treat something else it can be potentially fatal. I think the psychologist needs to reach out to the PCP and let them know that based off their work they would like the patient to be on a certain drug regimine and that they want all the blood work and other tests done that are needed for proper care. This will allow the two to work together and be a harmonious relationship rather than an antagonistic one.

  • Dave

    if you want to be a physician, go to medical school.

    if you want to be a psychologist, get a TV talk show and call yourself something folksy like "Dr. Phil"

    the argument is ultimately, should there be such a thing as prescription drugs- i.e. should a consumer need any one else's authority to purchase/use them? Pharmacists seem to know quite a bit about medications, as do many nurse, PAs, social workers, counselors, drug addicts, etc. Psychologists (especially PhD vs. Psy D) seem to know the least!

  • Anonymous-11

    I'll tell you exactly what the big deal is. If a patient needs psychotropic medication they have 2 choices: primary care/gp/nurse practioner (hello?!) which only receive close to 6-8 weeks of training in med school to deal with the truly epidemic proportions of mental health-care patients, or a psychiatrist that charges WAY too much for anyone with a low income (the overwhelming majority of mental health patients) to ever be able to see on a regular basis.

    I am a patient who has suffered from recurrent, treatment resistant depression for over a decade and has seen far too much irresponsible prescription practice from primary care physicians than anyone should have to endure. I am a 3rd year psychology major, yet over the course of my illness, I have accumulated way more knowledge of psychopharmacology than my current primary care physician will probably ever know. The unfortunate thing here is that I, the patient, have to double check every single change in my treatment regimen because if I didn't (like I used to do) I would never have been able to make any real improvement. I spent over 5 years taking what was essentially thrown at me before I finally had enough money to start seeing a psychiatrist on a regular basis. I do agree that psychiatrists are vastly superior in their knowledge of pharmacology, but that is not at all the point! There are WAY TOO MANY patients and they deserve more than to have to either go without care because they can't afford both a therapist and a psychiatrist, or have to get their prescriptions from some moron (sorry, it's just true) that hides behind snazzy pamphlets that he just got from a drug rep/pusher and tries to browbeat anyone that has the audacity to complain. I have seen this happen so many times that it should be criminal, and in 3 cases which I have personally witnessed, it has been. That's what happens when you are forced to beg for help from income-based providers that are so overbooked that it takes on average, 3-4 months just to schedule an appointment with some burnout that had to take the job because his damn license got pulled two states over (happened to my father, who was started on 90mg of Adderall/day + 4mg of Xanax. Thanks Dr.-who-shall-remain-nameless for destroying my entire family and I hope you are enjoying prison.)

  • Anonymous-12

    So heres the question...If you have an LCSW degree and are able to conduct therapy in a private practice setting, then decide to go to medical school for psychiatry could you practice both together. IE. See a patient on monday for therapy, then see the same patient as a psychiatrist on wednesday, would that be legal?

  • Anonymous-13

    This law is presented as a solution for lack of psychiatrist in rural areas!!! Are psychologists present in those areas??!!I don't think so.

    I think that such law would be only for the benefit of insurance companies!! Psychiatrists stopped doing psychotherapy when insurance companies argued that they can pay LCSW less for the same work!! I think the same would happen with such law! Insurance companies will bargain with psychiatrist saying that they can pay less for psychologist for the same work!!

    In addition, are psychologist as trained as psychiatrist to do the same job? After finishing medical school (where they study pharmacology, neuroscience, and molecular biology), psychiatrist do four years of training in hospital where they apply the above mentioned concepts. During those four years of training, they have to work up to 80 hours per week i.e. around 16,000 hours of training!

    Such laws would make people stop going to medical school and getting long training when they can get similar privilages with shorter training.

  • JHDK

    I'm a clinical psychologist working in rural South Africa (Northern KZN). Currently, our hospital serves around 1000 psychiatric patients per month.

    We have access to a psychiatrist for 3 hours per month (via Telemedicine and/or flying in). I will present only the most difficult cases to this medical specialist (which will come down to presenting at the most 6 patients to her. Thsi means that in our area, 6 out of a thousand patients have access to a psychiatrist per month.

    The rest of the psychiatric populations' needs are seen to by a clinical psychologist (we have three in the district), professional nurses and Medical Officer's (MD's).

    The clinical psychologist is UNfortunately, the only professional who is competently trained in differential Mental Health Dx, and also the only DEDICATED mental health professional. (In our degrees we already do more psychopharmacology +- 1year than MD's, followed by two years of practical training).

    Its not so much that we want to prescribe... It just feels a bit unfair towards the patients and towards the other members of the MDT if we (clinpsych's) do not intervene more hands-on with holistic psychiatric care (including checking up/advising on prescriptions). It would be nice to just sit in my office and practice psycho-analysis or CBT or family therapy... but is that really the need of the rural population...While the other 994 patients per month are just being

  • Alani Asturias

    Do you know what universities are giving this education? Or what is needed to aquire prescription privileges?

  • r1mahem

    I think that your comment regarding social work as a "cheap therapy" is offensive, especially when science is moving toward a more nature and nurture outlook on how behavioral health should be treated. As far as I'm concerned, as a clinical social worker myself, time and time again, when a PsyD is measured against a lisenced clinical social worker, I'll take the social worker any day. They're trained to look at the whole person and environment. And this is even more applicable when we are looking at the intergenerational transmission of trauma.

    If you want and armchair psychologist, then sure hire the Psy.D. however, if you want an individual who has knowledge of systems and of a wide array practice settings, a social worker is more qualified hands down. If fact, I dont see many Psy.D's working hospital settings for that matter either.