Arguments for and against Prescription Writing by Psychologists
Psychologists are knowledgeable in various social and psychological issues affecting individuals in society. These include mental health and drug use, among others. Psychologists have a wealth of knowledge about the role of drugs in society, the dynamics of drug use, the biological effects of drugs on individuals, as well as the impact of drugs on behavior. They can also link various personal issues such as drug abuse and mental disorders, to different social, cultural, and psychological factors. Most importantly, psychologists study the treatment and preventive strategies of different conditions, including drug abuse and mental disorders, among others (Hart 18-9 ). However, these are not responsible for prescriptions, which are handled by physicians.
According to Hart, compared to other professionals in health care, psychiatrists are more knowledgeable in issues regarding mental disorders (183). These have intensive training in diagnosing but not prescription of mental disorders, since their study is not deeply rooted in medicine. Therefore, psychologists today can only diagnose a mental health condition, while medical doctors do the prescriptions (183). This has resulted in inadequacies in the mental health care sector. Clinical psychologists and medical doctors fail to collaborate to ensure efficiency, mainly because of the discrepancies in their practices (Hart 183). Nonetheless, this keeps hurting the patients, since most states have not granted prescription privileges to psychologists. This therefore, has resulted in a persistent debate, whether psychologists should be granted prescription privileges or not.
Hart notes that only two states grant psychologists prescription privileges, but with conditions attached. Psychologists however, argue that granting them prescription privileges will improve the quality of mental health care in different ways. On the contrary, there has been considerable opposition from various professionals to this proposal by psychologists. For instance, the medical doctors argue that psychologists lack intensive knowledge about all medical prescriptions, and therefore, are more likely to put the health of patients at risk (Hart 183). Therefore, this heated debate between psychologists and other professionals over psychologists’ prescription privileges continues to persist.
Most psychologists want to be involved in is the prescription of psychotropic medication. The American Psychological Association (APA) first raised this issue in1989. The APA holds that psychologists, who deal with cases of mental health, can be able to prescribe medication, after undergoing training. They have argued that this move will ensure effective mental health care (Long WEB). Over the years, the APA has put in more efforts in spreading this initiative in the USA, and among the concerned regulatory authorities. The first success was achieved in 2002, when New Mexico allowed psychologists prescription privileges. In 2004, the state of Louisiana became second to allow psychologists prescription privileges (Hart 183). However, the laws by these states are different; therefore, disparities exist in the prescription privileges of psychologists in these states. Nonetheless, for a psychologist to have a prescription license in these states, they must undertake a two years’ training in physiology, pharmacology, and other medical topics. Thereafter, they should work for one year under the supervision of a licensed physician, and upon passing examinations; these are allowed a license for prescription (Hart 183).
Most psychologists desire prescription privileges, claiming that this will result in better psychotropic treatment, compared to what physicians are offering today. The rural areas today experience insufficient psychotropic treatment, therefore, if psychologists were allowed to prescribe, this would increase the number of physicians concerned with psychotropic medication, thus reaching out to the marginalized populations (Lovoie and Barone 53). In addition, psychologists are widely knowledgeable about mental illness, therefore, are in a better position to prescribe, compared to physicians, who lack intensive knowledge about mental illness. It is crucial that a professional has intense knowledge about a condition they want to prescribe. Today however, this is not the case, as Lovoie and Barone (53) note that general practitioners, who are not widely trained in mental health, are responsible for the prescription of over 80% of psychoactive medication. Physicians are trained in mental health for a period of two months only, compared to psychologists, who take a longer training period. Therefore, this does not make physicians competent in addressing issues of mental health, as these result in misdiagnosis and wrong prescriptions. Lovoie and Barone (59) estimate that physicians today misdiagnose between 30-50% of the women with depression, and do not monitor their patients appropriately. Psychologists on the other hand, are more familiar with needs of mental health patients, therefore, if allowed to prescribe, some of the problems experienced might be eliminated. In addition, psychologists adhere to the standards of APA, therefore, quality is guaranteed in their services.
Psychologists supporting prescription privileges argue that, since the APA has developed a psychopharmacology training curriculum, this will provide psychologists with more skills and knowledge for prescription (Long WEB). To support their argument, most psychologists refer to the case in the USA from 1991 to 1997, where the Department of Defense’s Psychopharmacology Demonstration Project (PDP) undertook the training of different clinical psychologists in the unit to carry out prescription of psychoactive medication to patients with mental illnesses, aged between 18-65 years (Merrick 4-7). This exercise was analyzed, and considered effective. A study conducted in De Las Cuevas and Sanz showed that more psychologists had a better understanding about the prescription of benzodiazepines, compared to less than 43% of physicians, who lacked knowledge that immediate cessation of this drug might harm the patient. This therefore, proves that if psychologists are better trained, they are capable of correct prescriptions (Lovoie and Barone 59). Further argument holds that, overall, the number of psychiatrists is reducing (Lovoie and Barone 58), therefore, closing out many patients, especially those in rural areas, from accessing mental health care services (Heiby 591). Therefore, by allowing psychologists to prescribe medication, this would ensure that more patients are attended to. When patients are not attended to, and their recovery is slowed, this influences negatively on the economy of a country. In addition, Lovoie and Barone (62-3) have argued that if granting prescription privilege to psychologists would help in cutting down on costs for patients. Today, most patients have to visit a psychologist for diagnosis, then a physician for prescription. This might be expensive for some patients.
On the other hand, the American Association of Applied and Preventive Psychology (AAAPP) are among those opposed to prescription privilege for psychologists. These are more concerned with the safety of the patients involved, citing that psychologists do not possess the necessary training, which would make them suitable to prescribe medicine (AAAPP Web). Although the APA has come up with a training curriculum for psychologists, most opponents consider it insufficient, in addition to having not been evaluated. However, the opponents of prescription privilege emphasize that it is not wrong for psychologists to prescribe medicine, but only under the right circumstances, including completing training in a medical school. The lack of a medical academic background for psychologists, therefore, is the major claimed cause of their incompetence in prescribing medicine to patients (AAAPP Web). In their statement, the AAAPP also argued that prescription privileges for employees require them to train, thus, increasing the costs of the country on training facilities and equipment, hence, spending the taxpayers’ money (AAAPP Web: Heiby 593).
There are different outcomes that would result if all psychologists were granted prescription privileges. Therefore, it might be hard to take a firm stand for or against prescription privileges for psychologists. However, through observations, I have noted that in most places, there are no psychologists, who are conveniently located. In addition, people requiring to see a physician might be forced to wait for a long time before seeing the physician. Some appointments last for as long as six months. This therefore, means that mental health care still lags behind in efficiency. Although many argue that there are more than enough practitioners in mental health care, this inefficiency proves otherwise.
Clearly, if psychologists were granted prescription privileges, this would increase efficiently in mental health care. It would be easier for patients to visit a psychologist, who would conduct diagnosis and prescription at the same time. On the contrary, it would be inappropriate to grant psychologists prescription privileges given there is a great discrepancy between the academic backgrounds of psychologists and the prescribing professionals. To some extent, it is true that psychologists lack the expertise and training to prescribe. For these to be granted prescription privileges, they must be conditioned to undertake the relevant training. In as much as the mental health patients need sufficient professionals to attend to them, the quality of the services provided by the professionals equally matter, as this influences the life of patients. Nonetheless, granting psychologists prescription privileges would be advantageous. However, to ensure effectiveness, this would require various changes to be implemented in order for prescription standards to be maintained in mental health care.
In conclusion, the debate whether to allow prescription privileges to psychologists has persisted for the last two decades. It remains to be known whether other states will follow the path of the state of Louisiana and New Mexico, by granting prescription privileges to their psychologists. Nonetheless, considering the conditions attached to the privileges, it is more likely that most psychologists might not be ready to undergo the extra training in order to acquire a prescription license. Although the mental health care is currently faced with challenges with regard to efficiency, granting prescription privileges to psychologists might not be an effective solution, as the conditions tied to the privileges might scare most psychologists. Thus, better strategies need to be adopted by the concerned health bodies to ensure this question is addressed, and efficiency is restored back to the mental health care sector.
American Association of Applied and Preventive Psychology (AAAPP). “Statement in
Opposition to the Prescription Privileges for Psychologists.” Web. Viewed 7 April 2013
< http://www.narpa.org/prescribe.htm >
Hart, Cart. “Drugs, Society, and Human Behaviour.” 15th Ed. New York: McGraw-Hill. 2012.
Heiby, Elaine M. “Prescription Privileges For Psychologists: Can Differing Views Be
Reconciled?” Journal of Clinical Psychology 58.6 (2002): 589-597. Academic Search Premier. Web. 7 Apr. 2013.
Lovoie, Kim L., and Barone, Silvana. “Prescription Privileges for Psychologists: A
Comprehensive Review and Critical Analysis of Current Issues and Controversies.” CNS Drugs 20.1 (2006): 51-66. Academic Search Premier. Web. 7 Apr. 2013.
Long, James E. “Power to Prescribe: The Debate over Prescription Privileges For Psychologists
And The Legal Issues Implicated.” National Register of Health Services Register. Web. Viewed 7 April 2013 < http://www.nationalregister.org/trr_fall05_long.html>
Merrick, Lynn. “Prescriptive Authority for Psychologists: Issues and Considerations.” Honolulu,
HI: Legislative Reference Bureau. 2007. Web. Viewed 7 April 2013 <http://lrbhawaii.info/lrbrpts/06/rxauth.pdf>
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