Should Psychologists Have the Privilege to Prescribe Psychiatric Medication?
Alliant and CSPP created the nation’s first Postdoctoral Master of Science Program in Clinical Psychopharmacology in 1998, with the aim of educating practicing psychologists “to integrate medication and its management in the biopsychosocial treatment of mental disorders.” Two current CSPP doctoral students explore the most basic question regarding prescription privileges for psychologists.
A “Conditional” Yes
By Zoë Brew
We live in a psycho-savvy society— pharmaceutical advertizing and the Internet have ensured that we are informed mental health consumers. Psychopharmacology has been normalized; Nurse Ratchet’s “medication time” is long gone, replaced by a series of glossy, non-threatening TV blurbs… Stigma, shame and the need for secrecy are out – people now wantonly embrace the soothing powers of their Klonopin, the power of Prozac, and the Ritalin Revolution. Yes, we’re pill happy.
And with this heady surge comes the inevitable abuse and misuse of medications, doctor shopping, and cases of mistaken mental health… Wait. Shouldn’t trained professionals be able to detect the players from the subtle and varied manifestations of psychological distress? Shouldn’t they use caution when scribbling out those prescriptions? Ideally. But the real world is far from ideal. General practitioners currently prescribe approximately 80% of psychotropic medications. But it’s okay, they know what they’re doing—they receive a total of 90 hours of behavioral science training over the course of their education! How can psychologists compete with that?
Right now we can’t. Despite the nine to ten years that we spend specializing in human behavior and the etiology of mental disorders, we don’t have the skills necessary to start doling out medications. The barriers are complex and mostly political; psychiatrists don’t want pesky psychologists to encroach on their domain since after all, we aren’t “real doctors.” Do they choose to ignore all the undertrained GPs out there monopolizing the marketplace of prescription medicine?
What if psychologists were given adequate pre and post-doctorial training in psychopharmacology, like residency programs in hospital settings? What if we had to pass a licensure exam that would directly assess a psychologist’s ability to prescribe medications? Wouldn’t such measures ensure competency? Or at the very least provide us with a viable starting point? Having survived the treacherous world of community mental health, I understand the machine. Psychiatrists enter the room. They meet with the client for 40 minutes and pull out the diagnosis stamp based on one interaction and supporting documentation (you know, the notes we pseudo-doctors write). Medicated. Next patient. And so it goes: the revolving door of frontline psychiatry.
Antiquated rationales aren’t going to cut it anymore—at its core, opposition stems from “protecting” prescription privileges to ensure differentiation (and perhaps the monetary spoils of that privilege?). But we’re past that. The days of doctor as master are gone. Mental health has been demystified; no more institutions, no more white coats … Psychologists, MFTs, and LCSWs have already upset the power differential and lifted the veil, inadvertently triggering fair trade in the booming economy of distress and disorder. Consider this Custer’s last stand.
For now we are stuck in the grayarea, between the pros and cons of a circular debate. Round and round we go, occasionally disrupting the swirl with a step towards progress. But it’s not all about us, our rights, and our roles—regardless of whether we ever get access to the prescription pad club, greater regulations are necessary for existing members.
Prescription Power Corrupts
By Manny González
By granting prescription privileges to psychologists, the public would be paid a great disservice in clarifying one of the most fundamental differences between psychiatrists and psychologists. Yet, as a discipline, are we willing to pay the price for the inclusion of such a privilege?
As it stands now, general practicing physicians with about 90 hours of behavioral health training prescribe 80% of all psychotropics. Ethical issues dovetail with clinical treatment as the heavy hand of pharmaceutical companies come to influence the prescription of medications. To make matters worse, Big Pharma has made bedmates with managed care agencies and companies to impact and guide the course of treatment for many clientele. For example, despite the relative clinical effectiveness of psychotherapy in the treatment of depression, many insurance plans cover antidepressants over psychotherapy for treatment.
In this purported utopia where prescribing psychologists could embody the core tenets of psychotherapy, it would not be inconceivable for an emphasis to be placed on reimbursement or payment for medication focused services. Although currently there are enclaves of psychiatrists that provide psychotherapy, this is generally reserved for clientele of higher socioeconomic status. As such, treatment for prescribing psychologists could be condensed to a 15 minute interval of medication evaluation, as is notoriously common for psychiatrists working with insurance providers. The perceived “base mode of treatment” through talk therapy would be reserved for social workers and MFTs.
Thus, the rift between disciplines would continue with psychologists being annexed into the medical community of physicians and psychiatrists, pitted against non-doctoral holding therapists. Is that what we truly want? Do we need to feed our own narcissism in finally being able to identify as “full-fledged doctors,” complete with prescription pads? Additionally, as the cleft between the disciplines widens, who is to say that our unique selling point of psychological testing and assessment wouldn’t be threatened by the encroachment of social workers and MFT’s?
Managed care now renders the need for our clients to meet medical necessity in order to continue treatment. We slap on a pathological label, that is allegedly justified since it comes from the medically inspired and constructed DSM, and we are granted more time with our clients, which is inevitably eaten up by treating the fall-out from the stigma associated with being labeled “mentally unwell.”
Put simply, the existing infrastructure of our health care system prohibits people from seeking treatment without being labeled “sick,” which can serve as a barrier for prospective clients seeking treatment. By prescribing medications, the differentiation between a medical-model focus of a clinician treating a clients’ symptoms may be blurred from a psychologically informed emphasis of a care provider treating a client. Wouldn’t this dynamically change the landscape such that our clients become patients? Although this is a reality for states like Louisiana and New Mexico, it is quite simply not a world in which I would want to live or work.
