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ALLOWING PSYCHOLOGISTS TO PRESCRIBE MEDICATIONS WOULD BE
DANGEROUS AND WOULD BE A PRESCRIPTION FOR DISASTER!
Texas should reject psychology’s attempts to gain prescribing privileges by the
Texas Legislature because psychologists do not have the medical background
necessary to safely prescribe medications for patients. Texas physicians, many
psychologists and mental health patient advocacy groups oppose the legislation.
Allowing psychologists to practice medicine without a medical degree would be a
high-risk experiment and would be a PRESCRIPTION FOR DISASTER.
THE CENTRAL ISSUE IS THE QUALITY CARE AND SAFETY OF PATIENTS.
• Legislation to give psychologists prescribing authority would be a high-risk
experiment in which one of the state’s most vulnerable populations -- persons
with mental illnesses -- would be subjected to substandard health care by a
group of inadequately trained providers who want to be physicians without the
requisite medical training and education.
THERE IS NO DEMONSTRATED HEALTH CARE NEED TO GRANT PSYCHOLOGISTS PRESCRIBING
AUTHORITY.
• In a statewide survey taken in February 2000, the vast majority of Texans
(72%) opposed legislatively granting prescription privileges to psychologists,
even it this measure would expand access to care.
• Psychologists have failed to demonstrate an actual health care need to justify
their being granted prescribing authority. There is no evidence of consumer
demand for prescribing psychologists. In Texas, physicians and psychiatrists far
out number psychologists, including in rural areas. There are even more
psychiatrists than psychologists licensed as Health Service Providers, a
designation which permits a psychologist to practice in a clinical setting. In
Texas, the practice locations of psychiatrists and psychologists are similar,
except that psychiatrists are located in 15 more counties.
• Rather than by giving psychologists prescribing authority, the health care
needs of underserved populations (e.g., rural communities) are better served by
improving the mental health training of primary care providers (e.g, family
physicians) who have better and broader health training and are more widely
distributed than psychologists.
• Granting psychologists prescribing authority will increase health care costs
with no apparent benefit to society. More providers prescribing medications
means more prescriptions being written, added cost to the State and to the
consumer. Prescribing psychologists would not be able to safely treat
psychiatric patients with multiple medical illnesses, which constitute over 50%
of the patient population. Patients with multiple medical conditions would have
to be referred to a physician, increasing the cost of care and disrupting the
continuity of care. Also, granting psychologists prescribing authority would
entail increases in, for example, state regulatory costs and liability insurance
rates. Ultimately, these costs are borne by all taxpayers.
• Texans are concerned about medical errors. Certainly, giving prescribing
authority to non-physicians, such as psychologists, would add to this concern.
MEDICATIONS FOR THE TREATMENT OF MENTAL ILLNESSES ARE AMONG THE MOST
POTENTIALLY DANGEROUS DRUGS FOR PATIENTS, REQUIRING THE UTMOST CARE AND TRAINING
IN THEIR USE.
• If not appropriately prescribed and monitored, these medications -- also known
as psychotropics — could have potentially disabling and life-threatening side
effects. For example, many anti-depressants can cause stroke, coma, seizures and
tremors. Other possible significant problems with psychotropic medications are:
convulsions, epilepsy, blood diseases, irregular heartbeat, and severe high or
low blood pressure. Psychotropic medications often are particularly vulnerable
to drug abuse.
• An estimated 50% of persons whose mental illnesses require psychotropic
medications also have other serious medical conditions requiring additional
medications. This interaction of different medications, which can magnify or
nullify the effects of certain drugs or even result in a deadly combination,
presents an extremely complex challenge to the most knowledgeable and skilled
physicians. Unlike physicians, psychologists simply do not have the broad-based
medical education and clinical experience that is needed to safely and
appropriately integrate treatments for mental illnesses and other medical
conditions.
PSYCHOLOGISTS LACK THE EDUCATION AND TRAINING TO PRESCRIBE SAFELY.
• A physician’s medical degree is clinically-focused, emphasizing the critically
important physical sciences (e.g., biology, chemistry, anatomy, physiology,
pharmacology, neurology) and earned in the context of hands-on evaluation and
treatment of ill persons under the supervision of experienced physicians.
Following medical school, medical residents specializing in psychiatry complete
at least four additional years of medical training, which occurs in a hospital
and other clinical settings. A psychiatric physician resident, for example, will
manage the care of about 2,000 patients with a range of emotional and other
physical disorders. Management of care includes performing physical
examinations, ordering and evaluating medical tests, making medical diagnoses,
prescribing medication and other treatments, and monitoring the effects of such
treatment.
• In contrast, a psychologist’s Ph.D. is an academic degree with course work in
the social and behavioral sciences. They are primarily trained to do
psychotherapy and psychological testing. Psychologists can obtain their degree
by taking only one or two courses in the biological bases of behavior. Their
training typically occurs in a non-medical setting in which they do not observe
or participate in the treatment of patients with medical illnesses other than
mental disorders. This limited training does not adequately prepare
psychologists to detect and treat concomitant non-mental illnesses or to
understand and deal with the interactions of psychotropics with other
medications prescribed to help other body systems.
• As part of their legislative strategy, psychology associations have arranged
for correspondence courses and in some instances, institutions of higher
education, to offer “pharmacology” courses for psychologists to demonstrate to
legislators that psychologists are ready to prescribe medications, presuming
that the legislature will pass their prescribing bill. The Texas Psychological
Association has convinced Texas A&M University College of Education to provide
such a course. According to the TPA literature about the course, it will “allow
psychologists to expand diagnostic and referral options; educate patients for
improved compliance; and, enhance consultation skills.” The promotional
literature says “this special type of training is based on a psychological model
rather than a medical model.” The course is offered on the weekends to
participants via video conference. TPA is actively recruiting faculty for the
course from the Texas A&M College of Veterinary Medicine. While the psychology
association privately touts to its members that this course will prepare
psychologists to prescribe medications pending legislative approval of their
prescribing initiative, the administration of Texas A&M University disagrees.
• According to the Texas Occupations Code which is the psychologists’ licensure
act, the “practice of psychology” is limited to: 1) using projective techniques,
neuropsychological testing, counseling, career counseling, psychotherapy,
hypnosis for health care purposes, hypnotherapy, and biofeedback; and, 2)
evaluating and treating mental or emotional disorders and disabilities by
psychological techniques and procedures. They are not permitted to “practice
medicine.”
PSYCHOLOGISTS DO NOT HAVE THE MEDICAL MODEL TRAINING OF NON-PHYSICIAN
PROVIDERS WHO HAVE LIMITED PRESCRIBING AUTHORITY.
• Psychologists’ argue that just as other non-physician health providers (e.g.,
nurses, physicians’ assistants, optometrists) prescribe, psychologists can
easily and readily prescribe medication. This argument fails because these other
providers have substantial training in the medical model, which psychologists do
not. Would you feel comfortable sending your child or family member to a health
care provider for prescription medications who had been trained using the
“psychological” model rather than the “medical model?” In most states, nurses
and physicians’ assistants are authorized to dispense limited types of
medications (e.g., birth control pills; antibiotics; topical skin medications)
only under physician supervision.
THE U.S. DEPARTMENT OF DEFENSE’S PSYCHOPHARMACOLOGY DEMONSTRATION PROGRAM (PDP)
WAS TERMINATED BY CONGRESS IN 1996.
• At a cost of more than $6 million, the PDP resulted in 10 prescribing
psychologists in the military health service. The Congressional “watchdog”
agency, the General Accounting Office, strongly criticized the PDP as “not
adequately justified because the [military health system] has not demonstrated
need for them [the prescribing psychologists], the cost is substantial, and the
benefits uncertain.”
• Reflecting their limited training, these psychologists needed to rely on
supervision and backup of physicians to ensure they weren’t missing underlying
serious medical problems in the PDP. Also, for patient safety reasons, these
psychologists were not permitted to treat certain categories of patients (e.g.,
children; elderly patients).
• The training requirements in the PDP were downgraded from over 1,400 hours to
700+ hours when 50% of the initial class failed. The discontinued and terminated
PDP’s training requirements are significantly more stringent than the 300+ hours
of instruction (unsupervised weekend courses) sought by psychologists who are
supporting prescription authority from state legislatures.
PRESCRIBING IS STRONGLY OPPOSED BY INFLUENTIAL ELEMENTS WITHIN THE PROFESSION
OF PSYCHOLOGY.
• Many psychologists, including practitioners and academicians, vigorously
oppose prescribing authority for psychologists. Most psychologists oppose
prescribing privileges because it would adversely redefine the practice of
psychology. Further, according to a report of The American Association of
Applied and Preventive Psychology (AAAPP), this prescribing movement “seemingly
derives from precipitous guild concerns” of practitioners [clinical
psychologists].”
• The clinical affiliate of the American Psychological Society, the AAAPP,
passed a resolution in 1995 to oppose prescription privileges for psychologists
and continues to lead the opposition within psychology. Commenting on the
resolution, the AAAPP president noted, “We are proud of the work we
[psychologists] do. We will continue to work with physicians when medication is
needed. We don’t want to see psychologists become just ‘junior doctors.’”
PSYCHOLOGISTS PRESCRIBING IS ALSO OPPOSED BY INFLUENTIAL MENTAL HEALTH
ADVOCACY ORGANIZATIONS.
• National Alliance for the Mentally Ill (NAMI) does not currently endorse
proposals before state legislatures to expand prescribing privileges to
psychologists. NAMI acknowledges that serious shortages exist in the mental
health professional workforce, particularly in public mental health systems and
in rural and medically under-served regions of the country. However, there is no
current evidence that expanding prescribing privileges to psychologists will
address these shortages. (January16, 2002)
• The National Depressive and Manic-Depressive Association (National DMDA), the
nation’s largest patient-directed, illnesses-specific advocacy organization,
believes it is in the patient's best interest to restrict psychotropic
medication prescription to medical doctors. The experience, broad knowledge
base, standards of care, and expertise make medical doctors the only
professionals National DMDA believes should be sanctioned to prescribe
psychotropic medications. (August 2002) (Following the passage of this position
statement, the organization changed its name to the Depression and Bipolar
Support Alliance).
PSYCHOLOGY PRESCRIBING IS NOT GOOD MEDICINE AND POSES A
THREAT TO
PATIENT SAFETY
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FEDERATION
OF TEXAS PSYCHIATRY