Prescriptive Privilege

In this age of globalization, businesses are racing to combine products to offer one-stop-shop services. The profession of psychology has secured a place on the track by championing prescriptive privileges to psychologists. The shortage of psychiatrists to prescribe psychotropic medication is one of the leading reasons that drive proponents within the field of psychology to advocate the movement to grant prescriptive authority to psychologists.

Although obvious implications of psychologists having prescriptive authority may include positive results for public mental health and the psychologists in particular, prescriptive power should not be allowed because it will negatively affect the profession of psychiatry and minorities. Furthermore, the changes needed to be made in order to grant prescriptive authority to more psychologists will drastically affect educational curriculum and training, threaten the of purity of psychotherapy, and leave the profession vulnerable to new legal issues, forcing attention away from old ones.

Many proponents of the prescriptive movement try to sell the notion of convenience for clients and argue that other non -physician professionals already have prescriptive authority. This leaves many psychologists wondering why the same privilege cannot be given to their profession. The fundamental concerns with prescription privileges are neither the client convenience nor marketability of psychologist’s profession, but education and training. For most of the lay community, the only thing that differentiates a psychologist from a psychiatrist is the ability to prescribe psychotropic medications.

This is untrue. There are significant differences in undergraduate, pre –doctoral, and post-doctoral training of each discipline. More specifically, psychiatrists are required to complete a considerable number of hours in physical science and pharmacology coursework. This academic disparity puts psychologists at a severe disadvantage for competently prescribing psychotropic medications. According to Robiner, Bearman, Berman, Grove, Colon, Armstrong, Mareck, and Tanenbaum.

(2003), “strict continuing education requirements would be warranted to keep psychologists up-to-date with the burgeoning formulary of psychotropic and nonpsychotropic medications (with which they may interact) and to assist them in overcoming gaps associated with their condensed training” (p. 218). Robiner et al. , (2003) further asserted: Psychologists’ relative limitations in training in the physical sciences and diverse medical areas are essential in considering their preparation for prescribing and, arguably, for undertaking further training to prescribe.

We believe it would be counterproductive to trivialize these discrepancies in light of the importance of practitioners’ scientific foundation and clinical proficiencies in prescribing currently and in being prepared to understand and integrate the advances in pharmacotherapy that are likely to guide future prescribing practices. ( p. 219) Is the ability to offer a convenient one-stop-shop to a client worth the risk of compromising the health of that patient by incompetently prescribing psychotropic drugs?

Despite the consideration of implementing abbreviated training, the new lesson plan for psychologists leaves many opponents doubtful that such training will close the knowledge gap between psychiatrists and psychologists. Whereas proponents within the field of psychology echo that prescriptive authority is a logical extension of the profession, they neglect to recognize the potentially adverse effects on the purity of psychotherapy.

As Denelsky (1991) noted, “the acquisition of prescription privileges could move psychology from a predominantly behavioral field toward one increasingly similar to a medical specialty” ( p. 188). Such actions would undermine the foundation that psychology is built upon. Although not inclusive, a widely adopted definition of psychology states the discipline as a field dedicated to improving human functioning by ways of assessments, diagnosis, interventions, and therapeutic treatments.

The addition of prescriptive privileges could lessen the effective and lasting application of therapeutic treatments. As Denelsky (1991) explained, “the use of medication has the potential to undermine psychotherapeutic efforts by supporting the belief that a client’s improvement is the result of external agents rather than from his or her own efforts” (p. 188). Such a belief would negate the hard work laid out by the profession to guide clients to self-efficacy.

Consequently, the pursuit of obtaining prescriptive authority presents new legal issues and reduces priority in old ones. As emphasized by Denelsky (1991), “substantially higher malpractice insurance rates can be expected for psychologists who prescribe and those who train others to prescribe; psychiatric malpractice insurance rates are currently 3 to 24 times higher than psychological malpractice overage, depending on the state” ( p. 189).

Furthermore, Denelsky (1991) noted: Issues such as inclusion of psychological services in health maintenance organizations (HMOs), hospital privileges, minimum mental health benefits, closing the Employment Retirement Income Security Act of 1974 (ERISA) loopholes, and marketing of psychological services would all have to assume reduced priority…All current psychology licensing laws preclude prescription of medications, and would have to be revised or amended. These licensing laws would be opened up at a time when psychology’s opponents were mobilized against it.

It is not too difficult to imagine attempts to eviscerate existing psychology licensing laws and strip away many of the significant gains of the past. (p. 190) Like a predator to prey, pharmaceutical companies are drawn to anyone with a prescription pad. With special incentives for those who prescribe medication in their favor, pharmaceutical companies could significantly influence psychologists hand in prescription decisions. The likelihood of over-prescribing to make more profit is a notion that should not be taken lightly.

Psychologists may find it easier to administer psychoactive pills opposed to considering the welfare of the client. Due to different cultural background beliefs and practices, the health seeking pathways may differ among different race and ethnic groups. The barriers they encounter could also differ. This attempt to maximize the effectiveness of psychology is yet again missing the mark. In this push to provide better services, proponents are neglecting to consider the effects on different race groups. As mention earlier, the shortage of psychiatrist, mainly in rural areas, is the driving force for prescriptive privileges.

It is logical to assume that because psychologist charge less than psychiatrists a large portion of their clients are of African descent. Despite unique barriers these clients are receiving non-medication therapy. The simplest mention of medication could deter a client from returning to therapy or worst sentence a client to a life of drug dependability and side-effects. How far down the track must psychologists run before they realize no one in the stands is cheering for them to have prescriptive authority? Proponents of the prescription privilege have lost sight of the true purpose of psychology.

Instead, they have set their sights on a prescription pad in the shape of dollars. Allowing psychologist to prescribe will be putting quality of care last in the operations of mental health. References DeNelsky, G. Y. (1991). Prescription privileges for psychologist: The case against. Professional Psychology: Research and Practice. 22 (3), 188-193. Robiner, W. N. , Bearman, D. L. , Berman, M. , William, M. G. , Colon, E. , Armstrong, J. , Mareck, S. , & Tanenbaum, R. L. (2003). Prescriptive authority for psychologist: Despite deficits in education and knowledge. Journal of Clinical Psychology in Medical Settings. 10 da (3), 218-219.

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