Should psychologists be able to prescribe medication

Carrie Steckl earned her Ph.D. in Counseling Psychology with a Minor in Gerontology from Indiana University – Bloomington in 2001. She has spent over ...Read More

My home state of Illinois is edging toward a point of no return, and I’m not sure how I feel about it. You see, the Illinois Senate Public Health Committee recently voted 8-0 to advance a bill that would allow licensed psychologists to prescribe medications for psychiatric purposes. Psychologists would be required to complete a master’s degree in psychopharmacology (the study of the use of medications to treat mental disorders), pass a national certification exam, and renew their certification every two years.

The Senate Committee’s passage of the measure is not a guarantee that the bill will actually be approved. Psychiatrists and physicians are lobbying hard against the bill, not surprisingly. I must admit that they make a compelling argument.

Consider the amount of training required in the journey to become a psychiatrist or other type of physician – years upon years of medical school, residency, and often a post-residency fellowship to acquire specialized experience in a field such as adolescent or geriatric psychiatry. A master’s degree in psychopharmacology, in contrast, takes a couple of years to complete and involves coursework (some of which is available online) plus 462 hours of supervised practice.

According to the Illinois Psychiatric Society, if the bill is approved, the state’s standards for prescribing medication would be the lowest in the United States. Granted, if this scenario comes to fruition, Illinois would join Louisiana and New Mexico as the only states that allow psychologists to prescribe drugs.

Sounds bad, doesn’t it? Yet psychologists and other proponents of the bill state that passing the measure is necessary to meet the growing needs of mental health clients in the state. The bill’s sponsors claim that a grave shortage of Illinois psychiatrists has led to an inability to adequately treat the state’s residents with mental illness. Plus, although Illinois would be one of only three states with such a measure, it should be noted that our nation’s military also allows psychologists to prescribe psychotropic medication.

So, what’s a state to do? According to the two sides, Illinois has only two choices: pass an unsafe bill or neglect to serve its residents with mental health problems. But are the legislature’s options really that limited and polarized?

My mind turns to several years ago when I was working on my doctorate in counseling psychology and planning on one day earning my license to practice. I ended up forgoing the license in order to work in community outreach and then to pursue a career in writing and teaching (none of which requires a license), but I remember the excitement and trepidation involved in planning a career as a mental health clinician. While I wanted to make a difference through counseling, the responsibility of such a vocation overwhelmed me. Looking back, prescribing medication in addition to providing psychotherapy would have been the last thing I would have wanted to do. Psychologists and psychiatrists exist for different, equally important reasons. They complement each other in their varying approaches to psychiatric phenomena, resulting in a more balanced treatment plan.

I understand that my home state is in a predicament, and I sure don’t want people’s mental health needs to go unmet. But is this really the road we want to travel? If psychologists are allowed to prescribe drugs, what group will lobby for this privilege next? Perhaps there are other solutions to this problem. For instance, why are psychiatrists so scarce in Illinois? Could incentives be offered to recruit more to our state? Could family physicians and internists – who already know how to prescribe drugs – receive additional training in psychiatry? Could psychiatric nurses be recruited to monitor clients on psychotropic drugs in order to lighten the workload of psychiatrists?

I’d be curious to know your thoughts on this issue. Do you feel that the bill should be passed, or is there a better solution?

Source:

Guerrero, R. (March 13, 2013). Senate committee passes bill allowing psychologists to prescribe drugs. Chicago Tribune: http://articles.chicagotribune.com/2013-03-13/news/ct-met-illinois-legislature-psychologist-presrcipt-20130313_1_psychiatrists-psychologists-senate-committee (Note: An account may be required to access this article.)

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John is worried. In fact, he’s so worried, it’s distracting him from his job, family, and responsibilities. His son has recently been diagnosed with depression and is in desperate need of both psychological treatment and medication. The boy has a good relationship with the psychologist in their town, but it seems as though therapy alone isn’t enough, and that the proper medication would significantly help control his son’s disease. The psychologist, who is unable to prescribe the appropriate medicine, had to refer John to the nearest child psychiatrist—a three-hour drive away. John’s son trusts his psychologist and is wary of seeing someone else. John wants to provide his child with the best care possible, but it seems that the easiest route is the only one he can’t take.

In most states, John and his son don’t have many options. But in Idaho, Illinois, Iowa, Louisiana, and New Mexico, the family would have a different option. In those states, appropriately trained psychologists can be granted the right to prescribe medications. Patients are able to work with one health care provider for psychological testing, psychotherapy, and medication management, if needed.

Most medications to treat mental disorders are prescribed by primary care providers. However, they have not received extensive training in the diagnosis and treatment of mental health disorders, unlike psychologists.

Psychologists trained to prescribe are also able to unprescribe, ensuring that all patients receive the proper combination of therapy and medication when they need it. Simply put, a prescribing psychologist offers an integrated and comprehensive approach to care that can save time and money.

What does it mean to be appropriately trained as a prescribing psychologist?

All licensed psychologists are highly-trained, health care professionals holding a doctorate (PhD or PsyD) and extensive training in the diagnosis and management of mental illness. Graduate school for psychologists takes an average of seven years, with coursework that includes the biological basis for human behavior.

After receiving their doctorate, a psychologist must complete between 1,500 and 6,000 hours of supervised clinical practice and take a national examination in order to become licensed (rules vary by state). In some states, a jurisprudence exam is also required.

While each state develops its own educational requirements, the training for a licensed psychologist to prescribe is rigorous in all the proposed legislation.

• In Louisiana, psychologists must complete a postdoctoral master’s degree in clinical psychopharmacology.
• New Mexico requires a minimum of 450 hours of didactic instruction along with a 400-hour supervised practicum as part of its eligibility criteria.
• In Illinois, psychologists seeking prescriptive authority must complete advanced, specialized training in psychopharmacology as well as a full-time prescribing psychology residency of 14 months of supervised clinical medical rotations totaling at least 1,620 hours in various settings such as hospitals, community mental health clinics, and correctional facilities.
• For Iowa, psychologists must complete a postdoctoral master of science degree in clinical psychopharmacology, 400 hours of supervised clinical training and practicum (of which 25% must be conducted in a primary care or community mental health setting) as well as two years of supervised practice involving a minimum of 300 patients.
• Idaho requires completion of a postdoctoral master of science degree in clinical psychopharmacology from an APA-designated training program, a supervised practicum in clinical assessment and pathophysiology and a two-year supervised provisional prescribing period.
• Psychologists seeking to be prescribers must pass a national exam in psychopharmacology.
• After completing their formal training, some prescribing psychologists must coordinate care with a patient’s primary care physician and others must obtain a conditional prescribing certificate before they become fully independent prescribers.
• Psychologists are also trained to know when to refer patients for the evaluation of other health problems.
• When all the training—doctoral and postdoctoral—is completed, prescribing psychologists have more training in diagnosing and treating (including prescribing) mental health disorders than primary care physicians.

History of the prescribing psychologists’ movement

The movement to grant psychologists the right to prescribe psychotropic medication took root in the late 1960s when APA identified psychopharmacology as a discipline of psychology.

• 1991–1997: The Department of Defense begins a six-year trial program to train 10 psychologists to prescribe medication at assigned military bases. The program was successful, demonstrating that psychologists can be taught to prescribe safely. Some of the psychologists are still prescribing and appropriately trained psychologists may now be credentialed to prescribe in the Defense Department, the U.S. Public Health Service, and the Indian Health Service.
• 2002: New Mexico becomes the first state to enact a law allowing appropriately trained psychologists to prescribe psychotropic medications.
• 2004: Louisiana passes legislation providing prescribing rights to psychologists.
• 2014: Illinois enacts legislation granting prescriptive authority to licensed psychologists with additional specialized training in psychopharmacology.
• 2016: Iowa passes legislation granting licensed psychologists who are trained in psychopharmacology with prescriptive authority.
• 2017: Idaho passes legislation providing prescribing rights to psychologists.

The need is great and the evidence is clear: Allowing prescribing rights for psychologists is an essential step to providing thousands of patients with access to comprehensive mental health care.

Last updated: January 2022Date created: June 2014

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