Should Psychologists Prescribe Medication to Their Patients - Literature review Example

SHOULD PSYCHOLOGISTS PRESCRIBE MEDICATION? The issue izing prescriptive powers to the psychologists has been in debate for quite a long time. In 1938 the federal law allowed prescriptive privileges to only physicians, dentists and veterinarians. The issue of allowing psychologists to prescribe medication was first raised in 1970. The APA board of directors gave a consensus that this should not be done because the psychologists were doing better without it. In 1984 once again the issue was raised at the Hawaii Psychological Association where Senator Inouyae expressed his support for giving prescriptive authority to the psychologists for better quality care (DeLeon, 2005, pg.1-21). Although many psychologists do prescribe medicines but till this day no particular consensus has been reached on the issue. Those who advocate the prescriptive authority of the psychologists are of the view that it is very essential for them to prescribe medicines for better quality care (Hansson, 2001, pg.31). However there has been a mixed view on the topic under discussion. Some early surveys show that 58% of psychologists favour the prescriptive privileges whereas a recent survey showed 70% psychologists voted in favour of it. The largest survey conducted by APA showed that 30% psychologists strongly supported it, 38% favoured it and the remaining were not sure about it (Robiner et al. 2002, pg. 231-248). In this paper I intend to discuss the much debated issue whether psychologists should be allowed to prescribe medicines or not. Towards the end I intend to comment on the findings of my research on the topic. I have chosen the topic because I feel it is very important to find out why psychologists who have not been educated from the medical schools should be qualified enough to prescribe medicines and whether prescribing is that easy that any one with crash courses of medical schools could take it as a part of his profession. I believe it is very important to understand this point before the health of general public is put at stake. Upon exploring the literature one finds ambivalence over the issue of prescriptive privileges of the psychologists. My stance is that psychologists should not prescribe medicines and for this reason I am going to explore the literature that supports my argument. A prominent criticism has come from William Robiner (2002, pg. 231-248). Robiner and colleagues are of the view that psychologists are not qualified to prescribe medicines. Their education is not based on medical model and for this reason they are not able to understand the human anatomy and physiology. For prescribing medicines it is very important to understand the affect of any medicine on human body. Since psychologists are not educated in this field so it becomes very dangerous to prescribe without understanding the effect of medication on the body. Robiner rejects the success of PDP model because the psychologists were trained in a military environment and for a particular population. Medical school training requires study of human anatomy, biochemistry, cell biology, immunology, microbiology, pathology, pharmacology, physiology, lab experience in biological and physical sciences and physical and clinical training which the psychologists’ lack. They can never be substituted with the crash courses in these subjects. At the same time psychologists trained through crash courses can never be compared with other prescribers with full medical knowledge. Robiner (2002, pg.231-248) highlights the limitations of the graduates of the PDP model of the Department of Defense. He is of the view that the graduates lack certain skills which are important for the treatment of the medically complex patients. He also quotes the final report of the American College of the Neuropsychopharmacology which assessed the PDP graduates as weaker medically as well as psychologically than the psychiatrists. The report stated that the graduates attended patients between ages 18-85 and identified limitations in their diagnosis and many were unable to prescribe independently. In short they needed assistance of the physicians for prescribing medication. At the same time the graduates of PDP model strongly rejected the idea of short courses and stated that intensive full time clinical experience which should also include inpatient care was also important. Supporting Robiner’s views Jim Orford (2003, pg.189) further states that psychological treatment is based on the therapeutic model which requires treatment through therapies. Allowing prescriptive privileges to the psychologists would take psychology away from its therapeutic model towards a more redundant and decontextualized model. He says “some of us are disturbed that clinical psychology has already moved quite far in the direction of acquiescing in an individualistic, diagnostic model of human distress and difficulty- prescribing will only escalate that trend.” Instead of depending on therapies for a permanent or long term cure psychologists are attracted towards short cuts by prescribing medicines. Being a psychologist Johnstone (2003, pg. 186-187) is also against the prescriptive privileges of the psychologists. She criticizes the point raised by the advocates of prescriptive privileges that psychologists should prescribe to overcome the shortage of psychiatrists. According to her the basic truth behind her stance is the fact that there is no specific medication for any specific mental condition. Psychiatric medicines cannot be described as ‘treatment’ since their effect is temporary and they simply move the patient away from his feelings. She quotes the comments of Surgeon General in this case who stated that the precise cause of any mental illness is not known and that there is no particular medicine that could treat the symptoms of any mental illness. Supporting Surgeon General’s views Johnstone states that psychological medicines are not what they claim to be. For this reason medicines should not be prescribed because of their low benefits and frightening consequences. Psychology has to be in touch with the feelings of the patients and psychopharmacology takes the feelings away. She states that history is full such incidents of unacknowledged damage caused by psychiatric medicines. Robiner (2002, pg.231-248) further conducted some survey which showed that 43% psychologists felt they needed medical training for writing quality prescriptions. At the same time two third of the psychologists stated that their pharmacological knowledge was poor. He further states that the AAAPP, Section 3 of the APA division 12 and the American Psychiatric Association all state that prescriptive privileges should only be for medical school graduates. Robiner is of the view that the issue must not be judged on the basis of its popularity but on the basis of the fact that will psychologists be able to provide quality care to the patients or not. Will they be able to handle the risk of prescribing medicines with limited knowledge of human physiology, medicine and other related areas? Schaler (1998) rejects the prescriptive privileges of the psychologists on three points. He classifies them as category error, failure of psychotherapists and rejection of the notion that everyone should be free to prescribe medication. Allowing prescriptive privileges is a category error since the psychologists’ job is to study the behavior and not the disease. If they prescribe medicines then it means that they are acting like physicians and not as psychologists. Georgii (n.d.) states that psychologists must not prescribe medicines on a simple fact that they are not doctors. Prescription privileges should only be for psychiatrists and physicians and not for psychologists. She examines the basic difference between a psychologist and a psychiatrist and says that psychiatrists treat patients having mental illness due to body disorders. Those whose mental problems are not due to physical disorders are referred to the psychologists who treat them through therapies. Robiner (2002, pg.231-248) raises some other points against prescriptive privileges of psychologists. To allow prescription to psychologists on the basis of the fact that many other non physicians such as Assistant Physicians and Nurses also prescribe is dubious. Psychopharmacology is not an easy thing to be learned through crash courses. It requires knowledge of not only psychology and pharmacology but also medical education. Nurses and Assistant Physicians education and training is close to the medical model which is traditionally rejected by psychology. To adopt medical model in psychology would mean to revolutionize psychology towards a new direction. Robiner (2002, pg.231-248) has further criticized the proposed training model for psychologists which would allow them to prescribe legally. The under graduate and graduate training of the psychologists lack medical education. By the time the psychologists obtain doctorate degree their medical knowledge can in no way be compared with that of the physicians. Even the examination which qualifies a psychologist to practice clinically does not contain adequate representation of the medical knowledge. At the same time the APA training model has been criticized by Robiner who states that it lacks understanding of certain details such as the breadth of the patients’ mental health conditions, proper monitoring and feedback, exposure to severe medication effects, exposure to patients with comorbid medical conditions etc. Under such limited conditions the APA model can in no way train psychologists up to the level of psychiatrists. Upon analyzing the above articles several points come before us which suggests that psychologists should not prescribe medicines. First of all the PDP model of the Department of Defense has been rejected by Robiner who states that it cannot be accepted as an example since it trained psychologists in a military setting and for a military environment. This point appears a little far fetched. If the psychologists can be trained for a military setting then why can’t they be trained for any other setting to address the problems of general public? His point lacks the validity which could be accepted for rejecting the success of the PDP model. This however is only one of the many points raised by him in his article. Other points appear quite valid. At the same time literature has proven the point that only well trained psychologists should be allowed to prescribe medication. Even those who are against it favour the well trained psychologists for prescriptive privileges. They reject the APA training courses and are of the view that the PDP model has undergone several changes. The three years training has been reduced to two years. The didactic hours have been reduced by 48%. Under such conditions it becomes obvious that the crash courses can in no way compete with the full time training based on medical model. The surveys also indicate the fact that psychologists themselves are no comfortable with the issue. A majority of them are not satisfied with their prescriptive abilities and feel the necessity of medical education. There has been no definite consensus among the psychologists over the issue. For this reason it would be better to leave the prescriptive privileges for psychiatrists and physicians whose education makes them confident to write prescriptions. Since psychology deals with therapies so it would be better for psychologists to stick to the therapeutic approach and leave the psychopharmacology for physicians and psychiatrists. Johnstone’s article discloses some of the frightening facts which state that psychological medicines are not what they actually claim to be. One might be tempted to adopt a short term approach to cure a problem but its long term consequences must not be ignored. This further supports the notion that psychologists are not confident above their psychopharmacological practices. Johnstone’s article moves the foundations of psychopharmacology when she states that there are no particular medicines for the cure of any psychological problem. She quotes Surgeon General’s comments to support her point. Resnick (2003, pg.190) has criticized this point and quotes the same Surgeon General saying that he approves properly trained psychologists having prescriptive privileges. Surely there are medicines that are useful for certain conditions and psychologists have been prescribing medicines in collaboration with the physicians. To conclude psychologists should not be allowed to prescribe medicines on the basis of the fact that they are unaware of the human physiology which could be seriously affected by a wrong or unnecessary medication. Psychologists training should be focused on therapies and psychopharmacology in collaboration with physicians. Psychologists’ prescribing practices will make the adult population more vulnerable to the short comings in their medical training. For this reason they should confine their training to collaborative practices. This approach does not by any means undermine the great services provided by the psychologists. Rather it would enhance the quality of the services. The matter must not be discussed on the basis of its popularity but on the basis of its consequences on human health. References: DeLeon, P.H. (Winter 2005). “Prescriptive Authority-Welcome to the Twenty First Century”, The Specialist, American Board of Professional Psychology, Vol. 24, No. 21. Pg. 1-21. Hansson, L. (February 2, 2001). “Psychologists- Prescribing Efforts: A Brief History”, Psychiatric News, Volume 36, No. 3, American Psychiatric Association. Pg: 31. Johnstone, L. (April 2003). “Back to Basics”, The Psychologist, Vol. 16, No. 4. Pg.186-187. Georgii, C. (n.d.). “Psychologists Cannot Prescribe Drugs”, Retrieved on February 24, 2008 From http://www.helium.com/tm/341328/psychologists-cannot-prescribe-drugsmany Orford, J. (April 2003). “Don’t Go There”, The Psychologist, Vol. 16, No. 4. Pg. 189. Resnick, R. (April 2003). “No Harm in a Coat of Many Colors”, The Psychologist, Vol. 16, No. 4. Pg. 190. Robiner, W.N., Bearman, D.N., Berman, N., Grove, W.N., Colon, E., Armstrong, J., & Mareck, S. (2002). “Prescriptive authority for psychologists: A looming health hazard?” Clinical Psychology: Science and Practice, 9, Pg: 231-248. Schaler, J.A. (1998). “Commentary on Sanua’s ‘Prescriptive Privileges’”, Journal of Universal Peer Review, Retrieved on February 24, 2008 from http://www.schaler.net/sanuacomment.html Read More