Prescription Privileges to Psychologists - Research Paper Example

? Prescription Privileges to Psychologists Issues regarding legitimacy of prescriptions privileges to psychologists have been faced with significant debate, whereby people have sought to determine whether they have the right to prescribe psychoactive medications; in fact, this debate has raised concern among numerous parties involved in public health care services for the past two decades. In this case, there have been proponents who claim that there is a crisis in the field of mental health care services, which requires this mental health needs to be met. However, this report focuses on addressing the state legislature through recommendations based on a stance that prescription privileges should not be given to psychologists; therefore, this report will present ideas through a discussion against prescription privileges for psychologists. Moreover, this discussion will entail a critical analysis of the argument to facilitate their coherence. Nevertheless, there is need for more research in order to draw conclusion that prescription privileges for psychologists can be a solution for tribulations experienced in metal health care systems. Table of Contents Executive Summary 4 Introduction 5 Methods 9 Results 9 Conclusion 12 Recommendations 14 References 16 Executive Summary This report will present details of an argument against psychologist, who are seeking to acquire prescription privileges; in fact, it addresses the state legislature by offering recommendation to discourage effort towards favor of prescription privileges for psychologists. In this case, the report includes an introduction section with an overview of potentially negative effects of these privileges on the future of patients with mental health. The report will cover a brief section explaining the methodology applied in gathering relevant ideas from different sources. The result section will present ideas gathered from different sources, where all arguments opposing the prescription privileges will be evaluated. The report will conclude by indicating that there is a significant cost associated with effort to seeking to acquire the right for prescribing psychoactive medications by psychologists. In fact, this is leads to a notion that it would cause a significant alteration professional psychology in numerous ways; for instance, some professionals may be less appearing to the public. Lastly, the report will offer recommendations indicating that state legislature should not support the prescription privileges for psychologists, and necessary reasons to support this idea will be presented. Introduction Treatment of psychiatric disorders involving use of psychotropic prescription has increased in the past few years. However, there have been researches aimed at increasing understanding of nature of human brain, mental illness, and somatic treatment; in fact these are considered as the mainstay of psychiatric treatment (Dombeck, 2013). On the other hand, the shift of mental illness paradigm towards neurobiological etiologic has rendered to establishment of principles of practices and compensation for health care services offered; in fact, this reimbursement has been significantly directed towards pharmacological interventions. This report focuses on presenting an argument against offering prescription privileges to psychologist; thus, it recommends that the state legislature should not to allow prescription privileges to psychologists. Compensation for psychotherapy has reduced significantly leading to incorporation of medication in the process of offering standard care to psychiatric patients (ISPN, 2001). In addition, prescription of medication and management is not a role that has been taken by the psychologists. Patients’ basses have decreased in terms of compensation trends and influence caused by new knowledge regarding treatment standards. Therefore, this has led to effort by the clinical psychologist seek advocacy for prescription authority in cases involving psychotropic medication; in fact, they want this to be considered a legal role for their profession. Psychologists without prescriptive authority are bound to seek assistance of nurses, who are a group of non-physician care contributors with the relevant prescriptive authority; therefore, nurses are considered safe, efficient, and highly regarded by the public due to their prescriptive roles (ISPN, 2001). For instance, nurses are making proposals that prescriptive privileges are not the only purview of the medical occupation; in fact, non-physician professionals are considered safe and effective. In this case, this has led to establishment of premise of efficacy in regard to non-physician prescribers, hence contributing to flaws in this debate. Argument against offering prescription privileges to psychologist can be drawn from the difference between nursing and psychology, which can be explored in dimension of depth and degree based on biological and scientific nature. For instance, nursing is a scientifically-based occupation, which deserves prescriptive privileges to facilitate advancement of their profession (Lavoie & Fleet, 2002). Moreover, unlike psychologists, nurses have portrayed significant ability to take prescriptive privileges with a high degree of efficiency due to their foundation in biological science. Other factors that contribute to their role include centrality of holistic, evaluation and familiarization to physiological bases of diseases (Dombeck, 2013). However, psychologists do not possess any of these pertinent attributes, which can make them eligible for being offered prescriptive privileges. There are other suggestions indicating that clinical psychologist have two or one supplemental courses in pharmacology, which can be considered ample for providing relevant knowledge; thus, this knowledge can be applied in their role of prescribing psychotropic medications. Nonetheless, this can be considered underestimation of the sophistication involved in pharmaco-dynamics and pharmaco-kinetics (ISPN, 2001). Moreover, this notion is a manifestation of ignorance of knowledge, which is required in order to have a substantial understanding of prevention and treatment of illness, while considering drug interaction and various side effects. Prescriptive privileges have been revered for physicians and nurses, whereby physicians’ assistants, nurses, and clinical nurse specialists are offered the prescriptive authority. Besides, commonality among these professionals can be defined by their knowledge in human biology and psychopharmacological (ISPN, 2001). Therefore, unlike psychologist, nurses and physicians are not expected to take one or two classes for acquisition of relevant knowledge in this field. Moreover, training and knowledge acquired by nurse and physicians can be defined in terms of fascination and attentiveness on issues regarding functionality of human body. Additionally, they gather relevant information concerning influence of the drugs on human body and role of pharmacotherapies in the process of treating a disease. There is no analogy in the content of information concerning medication and prescriptive knowledge and ability to prescribe. In this case, there is a significant complexity of arrays that involve Pharmacotherapeutic prescriptions and synthesis of information in order to make relevant clinical decisions. Therefore, this involves assumptions in regard to the foundation of knowhow, which depends on the wide range of biological information. On the other hand, knowledge of anatomy and physiology is based on the effectiveness involved in the process of prescribing medication to the mentally ailing (Dombeck, 2013). Apparently, this requires understanding of pharmacologic principles, legal consciousness, encouragement, and ability to interpret laboratory findings. For instance, there is need to understand issues regarding concomitant and co-morbid health states and being up-to date on issues regarding developments in genetics, immunology, and other fields of biological science. Unlike, psychologists, nurses are offered prescribing authority due to the nature of their profession, whereby it is considered a helping profession (ISPN, 2001). In this case, the cognizant of their uniqueness have led to awareness of significance associated with their interdisciplinary connections. Also, this has led to establishment of construct resonating in mental health due to the foundation of interdisciplinary practices and collaboration; therefore, nurses take the vital role of helping psychologists through their effort to acquire prescriptive authority. However, this has been running counter their role of advocating patients and knowledge based on the role and orientation of psychology (NAMI, 2002). On the other hand, there are cases of ethical dilemmas, which are likely to involve clinical psychologists, focusing on acquiring prescriptive authority (Walker, 2001). For that reason, this has become an issue that has raised nurses concern, hence requiring consideration on the response required from nursing profession. Etiological frameworks have been offered by various fields of psychology and this are applied in perceiving relevant ideas regarding mental health and diseases. In fact, this psychological perception dominated through these frameworks leading to predication on substantial understanding of developmental environment impact on the expression of mental illness (ISPN, 2001). On the other hand, there are non-somatic models, which are considered exclusive psychic in nature; in fact, they are substantially reflected through duality, which segregates body’s neurobiological brain from intellect concept. Nonetheless, psychologists have insignificant experience with physiology, biological principles, which are caused by lack of consistence with etiological philosophy, educational curricula. Psychology is considered to be a profession, which facilitates understanding, imminent, and theoretical basis of care practices based on the perspective of psychotherapy evaluation and learning theory. In this case, psychology has significant interconnections with nursing practice and medicine (Dombeck, 2013). There has been a pattern of compensation associated with status of the staff, whereby they follow biological etiology models; in fact, there has been a decrease in the emphasis, and relative significance of conventional psychology. Therefore, this is gradually eroding the somatic-based treatment such as medication. Methods In this research information was gathered from secondary sources, whereby researchers used the commonly known search engine (Google) to retrieve relevant materials from databases through the internet. Validity of the sources was evaluated by focusing on the authors, year of publishing and source. Therefore, the researchers conducted a literature search in order to gather relevant journals, which have recently been published, while appearing on Psychlit and Medline databases by use of “prescription privileges” as the keywords. In this case, sources were gathered and explored in order to gather relevant concepts to compete this research. Results Through a research about prescription privileges to psychologists led to identification of cases, where doctoral-level psychologists were offered these privileges in 2001 by Governor Gary Johnson in New Mexico (Ax, & Resnick, 2001). In this case, he signed this bill into law, which stipulated that doctoral level psychologists, who have acquired training and taken a certification program, would be eligible to having prescription privileges for psychiatric medications. Moreover, there had been a Surgeon General’s report that had been released earlier in 1999 indicating that less than a third patients suffering from mental illness are treated in America during that year (United State Public Health, 2000). Furthermore, there was another research on Schizophrenia PORT in 1998 indicating that there were fewer than half of patients diagnosed with schizophrenia, who received treatment in that year. Therefore, this is an indication that there are difficulties involved in accessibility of treatment for patients with mental illness. In this case, the results of low rate of treatment are attributed to by a factor that there insufficient number of qualified psychiatrists, who can offer substantial treatment and services to these patients (Walker, 2001). On the other hand, convincing evidence has been identified indicating that the number of psychiatrists is significantly reducing, and this has led to shortages of the treatment services, especially for low-income earners, and those that rely on public mental health systems for treatment service (Ax, & Resnick, 2001). Furthermore, there are increased problems in most of the rural parts of the country; in fact, in New Mexico, there were eighteen licensed psychiatrist of the total number of ninety, who are in Santa Fe or Albuquerque, besides, 175 of 400 licensed psychologists dwell outside the population centers. The bill that was passed into law in New Mexico giving prescription privileges to psychologists has been considered unique, without clear evidence on whether it will lead to increased accessibility to treatment for patients with mental illness, especially in rural areas. In fact, this has led to arguments against the motion indicating that these psychologists are not amply prepared to prescribe medication; thus, extending this prescription privileges to them is a compromise of the quality of mental health care service and safety of people with mental illness (Lavoie & Fleet, 2002). On the other hand, effort to offer prescription privileges to psychologists has been discouraged since 1990 in twelve states by legislation; for instance, some of the states that rejected this bill on multiple occasions include Texas, Alaska, Connecticut, California Montana, Florida, Georgia, Hawaii, Illinois, Tennessee, and Missouri. Apparently, there are substantial efforts made by both American Psychiatric Association and American Psychological Association, through the state federal chapters in order to oppose this motion, thereby supporting legislature effort to discourage offering of prescription privileges to psychologists. In that case, only the nursing and physician profession should have the authority to prescribe medication, especially the psychiatric nurse practitioners, clinical nurses’ specialists and certified nurse anesthetists (Ax, & Resnick, 2001). Therefore, laws that permit advancement of nursing professionals to prescription of medication have a limit of terms in regard to practitioners, who are allowed to have prescription privileges. Another argument against prescription privileges for psychologists indicates that numerous people have a perception that psychologist do not have to prescribe medication; hence, there is no need for it (NAMI, 2002). In fact, they have a conviction that during cases where medication is required they can collaborate with physicians or nurses for getting the treatment. Furthermore, this has been attributed by a notion that there is need for thoroughly trained professionals in medicine, nursing, and psychiatry in order to meet the need in the society. There are other arguments indicating that, psychologists may lack the necessary knowledge for prescribing the necessary treatment for the patient. In this case, this would results to serious problems in situations, where the patient is denied a chance to get prescriptions from a physician since the psychologist has the prescription privileges (Ax, & Resnick, 2001). On the other hand, allowing psychologists to have prescription privileges, would lead to a negative impact on the field of psychology. For instance, in cases where psychologists are offering treatment through prescription, there are increased chance of ruining various treatment technique, and moreover, this would have a negative impact on patients’ accessibility to treatment which is not medically based. Therefore, introducing medicine into the field of psychology can result to a change based on different categories and the teaching that is offered to these categories. The final argument against this motion has a consideration on numerous people with problems concerned with training required in giving prescriptions. Currently, there are no psychologists, who are fit for prescribing medicine; thus, there is difficulty in training a clinical psychologist (Lavoie & Fleet, 2002). Moreover, this argument is based on the notion that there is a lot of information that is required and years of learning in order to acquire prescription privileges. On the hand, addition of extra classes for psychologists would result to a significant burden on students and the lecturers. In addition, training would be prolonged, based on the notion established by ethical guidelines, which suggests that short term courses of prescription are unsafe for patients (NAMI, 2002). Nonetheless, clinical psychologists would not be effective in offering prescriptions given that they have not relevant foundation of knowledge from medical schools. Conclusion In conclusion, this report has presented numerous reasons against prescription privileges for psychologists. These arguments are focused on justifying that psychologists do not deserve these prescription privileges and that they are not necessary. In this case, some of the ideas that have been put forth to support this argument indicate that psychologists lack necessary background knowledge on medicine. There are other notions that there is increased cost of implementing the policies that would offer prescription privilege to psychologists. On the other hand, there was a crucial arguments citing lack of safety for psychologists prescribing mediation to treatment, which would lead to a negative impact to the field of psychology and training difficulties. In this case, the paper has covered introduction section that offered an overview of the issues involved, thereby exploring ideas from various opponents to the motion of offering prescription privileges for psychologists. In this case, there are arguments that this motion would lead to de-emphasis in regard to medical models, which support social and behavioral approach that regard to the training offered to psychologists; in fact, they are expected to conduct psychological assessment and provide psychotherapy and not to provide medical treatment. On the other hand, medicines used for treating mental illness are very strong, and they have a potential to disable and threaten the life of a patient; thus, there is need for required level of expertise among practitioners with prescription authority, who can also monitor these patients. There is need to recognize that clinical psychologist have made a significant contribution to the process of treating mental illness; thus, they have an effective profession that facilitate metal health for patients. Moreover, it is important to understand that this profession has long history of eminent theory based care practices; in fact, they have made a contribution that come from their unique perspective, through it is somatically based. Nonetheless, the current paradigm of psychology has been confronting with neurobiological foundation of mental illnesses and theoretical perspective, which is associated with conventional learning practices, which constraints exposure to knowledge regarding biological science. This report illustrates that Psychopharmacology is increasingly becoming a vital aspect of treatment for mental illness. However, effective and safe utilization of the medication involved in the process of treatment needs profound knowledge regarding human body and indispensable understanding of effect of medication on human body, physiological reaction of drugs and foods interactions. In this case, it is evident that clinical psychologists lack this k knowledge; in fact, they have insignificant level of supervision in their role. Lastly, this report indicates that people who are mentally ill have numerous needs; thus lack of accessibility and inadequate availability of prescribers for psychologist has not potential impact on the nursing practice. In this case, the desire to satisfy various’ need, though the pressure involved in meeting these needs is not enough to influence nurses into getting involved in unethical behaviors. It is evident that the struggle by clinical psychologists has been taking place for a long period, thereby leading to challenges for nurses; thus, this requires response from nursing as a profession. Therefore, this report focuses on advocating for patients and offering ideas that are against people who lack relevant background to be offered prescription privileges. In addition, this report indicates that the legislature has the role of ensuring that ethical responsibility is observed in clinical practice in order to avoid subjecting patients to risk. Recommendations Research has indicated that training is not the solution for solving the process of psychologist being denied prescription privileges; in fact, this notion is supported by relevant parties such as American Medical Association, the American Psychiatric Association, and American Society for Geriatric Psychiatry (Lavoie & Fleet, 2002). In this case, this has led to a conviction the decision made by the legislature in New Mexico posed a significant risk to numerous mentally ailing patients (NAMI, 2002). Therefore, this report recommends that the legislature should consider training and learning undertaken psychologists does not involve background experience, which can enable them prescribe powerful medication in treatment of mental illnesses. On the other hand, the state legislature, should consider that there is not psychology that is designed and administered in regard to drug prescribing that can substitute the knowledge and skills of a physician (Lavoie & Fleet, 2002). In fact, it is important to consider that physician skills and knowledge is acquired through medical education and thorough clinical experience. Furthermore, there are fourteen state legislatures, which have discouraged prescription privileges to psychologist, and this was a decision made through consideration to scientific data and risks pose to public health (NAMI, 2002). Therefore, this report recommends that the state legislature should consider not placing the potent mediation for treatment of mental diseases to people without medical education or training. References Ax, R.K., & Resnick, R.J. (2001). Prescription privileges: an immodest proposal. Monitor on Psychology. 32(1), p. 53-54. Dombeck, M. (2013). Prescription Privileges for Psychologists. Seven Countries Service Inc. Retrieved on June 25, 2013 from: http://www.sevencounties.org/poc/view_doc.php?type=doc&id=1236.. International Society of Psychiatric-Mental Health Nurses (ISPN) (2001). Response to Clinical Psychologists Prescribing Psychotropic Medications. Position Statement. Retrieved on June 25, 2013 from: http://www.ispn-psych.org/docs/11-01prescriptive-authority.pdf Lavoie, K, Fleet, R. (2002). Should Psychologists Be Granted Prescription Privileges? A Review of the Prescription Privilege Debate for Psychiatrists. The Canadian Journal of Psychiatry. Retrieved on June 25, 2013 from: https://ww1.cpa-apc.org/Publications/Archives/CJP/2002/june/reviewPaperLavoie.asp National Alliance of Mental Illness (NAMI). (2002). Prescribing Privileges for Psychologists: An Overview. Policy Topics. Retrieved on June 25, 2013 from: http://www.nami.org/Template.cfm?Section=Issue_Spotlights&template=/ContentManagement/ContentDisplay.cfm&ContentID=8375 United State Public Health. (2000). The Surgeon General’s Report on Mental Health in America: Rockville: US Government Press. Walker, K. (2001). An ethical dilemma: clinical psychologists prescribing psychotropic medications. Issues in Mental Health Nursing. 23(1), p. 17-29 Read More