Posted By Alejandro Adrian LeMon, Ph.D., LMHC on Mar 18, 2013 | 8 comments

You might have heard it already. The state of Illinois may become the third state in the nation that gives prescription privileges to psychologists, despite protests by psychiatrists and physicians.  The other two states include New Mexico and Louisiana; as well as the armed forces, the Indian Health Service and the US Public Health Service.

The Senate Public Health Committee voted 8-0 last week to advance a measure that would allow clinical psychologists the right to prescribe psychotropic medications.

Psychologists would first need to complete a new master’s degree in psycho-pharmacology, pass a national certification exam and renew it every two years.

Currently there are at least 300 certified prescribing psychologists in the nation.

Why the measure?

Psychologists don’t have a degree in medicine, but because of a diminishing number of psychiatrists in the state, some say they could fill in the gap and improve patients’ access to care.

“Illinois faces a critical shortage in mental health professionals who are trained to prescribe medicine, resulting in inadequate treatment for mental illness across the state,” said senator Don Harmon. In fact, over 70% of psychiatric medications today are prescribed by general practitioners according to the American Psychological Association as referenced by the National Alliance on Mental Illness.

Primary care physicians or general practitioners have extensive medical and pharmacology training, but may have limited training in psychiatry and psycho-pharmacology, according to the National Alliance on Mental Illness.

Prescribing privileges have limitations

In the states of Louisiana and New Mexico,  medical psychologists (as they are termed) are only authorized to prescribe psychiatric medications (e.g., Effexor, Elavil, etc).

They cannot write prescriptions  for other diseases not related to mental health (arrhythmias, blood dyscrasia, etc.).

There may be other limitations as well. In New Mexico, prescribing psychologists are also required to have an ongoing collaborative relationship with a physician.

Controversy

As expected, many psychiatrists and physicians (and many psychologists) argue that because psychologists don’t have a medical degree, they are not qualified to have prescription privileges.

This is not the first time there has been controversy regarding who should have the authority to prescribe. At one time there was an outrage when nurses fought for prescription privileges as a result of a shortage of doctors in the 1960s. Today,  advanced registered nurse practitioners (ARNP) are able to  prescribe medications, and this list can include psychiatric nurse practitioners, clinical nurse specialists (psychiatric),certified nurse anesthetists and certified nurse midwives.

Linda Gruenberg, president of the Illinois Psychiatric Society, doesn’t believe that psychologists can safely prescribe medications to patients, “Without comprehensive medical education that you get from four years of medical school, four years of residency training and practice, you are not prepared to prescribe psychotropic medication.”

Thomas Brady, a California psychiatrist who trains some of the psychologists who prescribe psychiatric drugs, believes that they already have a proven track record of care. “I am convinced that there is a safe track record going back years in several states, ” Brady said.

“It leads me to conclude that they (prescribing psychologists) can prescribe safely. ”

There are other concerns as well. Some people fear that an increase in prescribing psychologists will lead to a decline in psychotherapy. The same happened with psychiatry many years ago. They went from providing mental therapy to drug therapy.  To many psychiatrists, “talking” just doesn’t pay enough. And there are other people that fear that this movement could be the start of a new rivalry between psychiatrists and psychologists.

However, according to some reports from practitioners that work in New Mexico and Louisiana,  psychiatrists and medical psychologists appear to work well as a team. Instead of competing for clients, they both work collaboratively to better help patients without taking away business from one another.

The shortage of psychiatrists is a bigger problem

There is extensive evidence that people who live in rural areas have significantly poorer health when compared to the urban population.  Many of them smoke more, exercise less, have less nutritional diets, and  are at higher risk for mental problems; and the shortage of psychiatrists in states like Illinois is a far bigger problem than allowing psychologists the right to prescribe psychiatric medications.

So if psychologists get the appropriate medical training, consult regularly with a  physician, and provide needed care then why not give them a chance?

After all, medical schools have not shown an interest in admitting more psychiatric students to meet the demand, and the psychiatric community has yet to provide an alternative solution to the lack of psychiatrists in the nation.

What do you think? Would you be comfortable seeing a psychologist for medication management?

References

Chicago Tribune. Senate committe passes bill allowing psychologists to prescribe drugs. 2013. Available at: http://tinyurl.com/bgoxs4k

Grohol, J. Why Psychologists Shouldn’t Prescribe. 2010. Available at: http://psychcentral.com/blog/archives/2010/03/23/why-psychologists-shouldnt-prescribe/

National Alliance on Mental Illness. Prescribing Privileges for Psychologists. Available at: http://tinyurl.com/y75v39

Long Jr., James. The Debate Over the Prescription Privilege for Psychologists and the Legal Issues Implicated. National Register of Health Service Psychologists. 2005. Available at: http://www.nationalregister.org/trr_fall05_long.html

Stambor, Zak. Pursuing Prescription Privileges. American Psychological Association. 2005. Available at: http://www.apa.org/monitor/julaug05/privileges.aspx