COMMENTARY

Psychologist's Prescribing: A Threat or a Promise?

David J. Reinhardt, MS, PhD

Disclosures

June 24, 2010

In This Article

Why Do Psychologists Want to Prescribe?

The United States has a problem, and solving it demands far more cooperation and far less bickering and protection of self-interest. The traditional US healthcare system is breaking down. It is overly expensive, it relies too heavily on chemicals to solve every problem, and it allows many people to fall through the cracks. There has been a shift of mental health care from specialists, including psychiatrists and psychologists, to primary care physicians. Although they are well-meaning, the majority of primary care physicians are not sufficiently trained or experienced to provide mental health treatment and diagnosis.

There is a long-term shortage of psychiatrists that will not be resolved. Because of this shortage, primary care physicians have become the dominant prescribers of psychotropic medications. Some primary care physicians have taken on additional training to appropriately prescribe these drugs; many others, however, are too overworked to do so or are not interested. Drug companies, seizing on physicians' lack of training, have deceived them and the public about the safety, effectiveness, and benefit of psychotropic medications.

Consequently, patients have been put at risk and have become guinea pigs for questionable medications, such as antidepressants, antipsychotics, and other drugs that are marketed to treat behavioral symptoms. Because of their expertise in this matter, many psychologists believe that they have a responsibility to address the problems associated with using medications as a first-line treatment for behaviors.

Not all psychologists want to prescribe; those seeking prescription privileges have a personal interest in prescribing, special expertise, and willingness to devote more than 3 years of additional training. Prescribing psychologists can offer choice, safety, and competence to a public that has become increasingly fearful that a mental health referral automatically means treatment with chemicals. The right to prescribe is also the right to not prescribe.

Safety of Prescribing

Prescribing psychologists have no desire to be a one-stop health service; they believe the primary care physician is the appropriate gatekeeper in the collaborative healthcare model. Prescribing psychologists are trained in the importance of collaboration with physicians and other health professionals. No prescribing psychologist would claim to be an expert in thyroid disorders, diabetes, hypertension, or cardiovascular disease. Similarly, no prescribing psychologist would consider placing a patient with diabetes on an antipsychotic without consideration of the health implications and coordination with the appropriate specialists. Psychologists already have a proven track record of safety and benefit to public health. Many thousands of prescriptions have been written by prescribing psychologists at the US Department of Defense and in Louisiana and New Mexico, the 2 states that permit psychologists to prescribe. Specially trained psychologists are safe prescribers[2] -- so safe, in fact, that malpractice insurance rates among prescribing psychologists are low and are only slightly more than those of nonprescribing psychologists. Few of us would bet against the professional underwriters.

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