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. (January 16, 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