The debate on whether clinical psychologists should be permitted to issue psychoactive medication prescriptions has received significant attention over the past two decades. The ability to prescribe medications has been one of the key distinctions between psychologists and psychiatrists throughout history. In fact, some people felt that prescription authority was the only difference between the two professions. In recent years, however, some clinical psychologists have pursued prescription privileges. The first prescription privilege movement in which a psychologist sought a bill for prescription authority was initiated in Hawaii in 1985. In the 1990s and 2000s, the movement rose to a high-stake, high-profile debate (Goldberg & Wagner, 2019). The American Psychological Association (APA) published numerous articles supporting and endorsing prescription privileges for psychologists (PPP). While prescription privilege is an important and desired milestone in clinical psychology, the focus should be on helping patients cope with psychological distress and preventing illnesses by providing psychological knowledge through collaboration. The paper offers multiple perspectives on this controversial topic by critically analyzing why psychologists should or should not prescribe, possible consequences, and a historical perspective of the debate to support this thesis.
Historical Perspective of Psychologists Prescribing Privilege
The mental healthcare system has witnessed enormous changes over the last three decades. Power has significantly shifted from doctors towards drug companies and health insurance. However, traditional health insurance schemes have been replaced by more efficient and better-managed care models. Breakthroughs witnessed by drug companies have also occurred, making it possible to treat most mental disorders through medications. As a result, when mental healthcare is provided nowadays, the first intervention is in the form of medicine. The reliance on these medicines has created a bottleneck (Lakhan, 2007). In an ideal situation, prescriptions for psychiatric medicines should be offered by knowledgeable, licensed physicians who possess the necessary mental healthcare knowledge, psychiatrists. However, due to limited resources and the inability of the available psychiatrist to meet the demand, the need for psychologists to start prescribing medicines arose. The roots for the psychologist prescription privileges movement were introduced in the 1980s, with the 1990s and 2000s witnessing key milestones.
Several prominent and outspoken individuals have promoted the movement. For instance, Patrick H. DeLeon, a former president of the American Psychologists Association, Robert McGrath, president of the American Society for the Advancement of Pharmacotherapy and training director at the school of psychology, Fairleigh Dickson University, and Morgan T Sammons, a widely recognized expert on psychopharmacology have supported the movement (Lakhan, 2007). With the granting of prescription privileges in the states of New Mexico and Louisiana, the PPP movement received a major boost. Recently, numerous states have considered passing similar legislation (Goldberg & Wagner, 2019). The creation of APA Division 55 and psychopharmacology training programs for the military were other significant breakthroughs in the prescription privilege movement (Robiner, Tompkins, & Hathaway, 2020). Nevertheless, psychologists’ prescription privilege remains a hotly debated issue.
Multiple Perspectives on the Issue
The debate on prescription privilege for psychologists takes two major perspectives, with one side of the continuum arguing against, while the other supporting the issue. Looking at both sides provides a good ground for diagnosing the controversy.
Arguments in Favor of Prescription Privileges
Professional anatomy and identification. When psychologists are granted prescription privileges, these professionals are able to independently provide a broader range of services to their clients. Without the authority to prescribe medications, these professionals may feel restricted in what they can do to offer the best services to their clients. While it is extremely important to collaborate with other healthcare providers while providing services to clients, the ability to attend to some client’s aspects without necessarily having to rely on other physicians provides the much-needed autonomy to psychologists. Such autonomy is instrumental to developing the profession (Linda & McGrath, 2017). In 1989, the APA prioritized the need for psychologically managed psychopharmacological intervention (Lakhan, 2007). According to the APA, psychologists are not in a position to function independently unless they are granted the rights to prescribe medications to their clients. Additionally, the public may not be able to differentiate between clinical psychologists and other non-prescribing counselors and therapists if psychologists are not granted prescription privileges. As a result, the ability to prescribe would distinguish psychologists from the rest, an important step in enhancing professional identity.
Shortage of psychiatrists. In some parts of the country, especially the rural areas, there are not enough psychiatrists to meet the demand of the population adequately. A significantly low ratio of professionals with the ability and training to prescribe psychoactive medicines to the number of citizens who need them calls for the need to give clinical psychologists the authority to prescribe. The low number of psychiatrists in the states of New Mexico and Louisiana was the main argument behind the idea of granting prescription privileges.
Increased revenue for the profession. The clinical psychology profession and its members stand to benefit immensely from prescription privileges. The potential for enhanced revenues resulting from prescription privileges may offset the effects of decreased salaries reported by psychologists. Psychiatrist organizations and whose members stand to lose a lot of revenues if psychologists are allowed to prescribe were in fact the strongest opposition to the prescription privilege movement.
Client convenience. With prescription privileges, clients stand to benefit immensely from streamlined healthcare. For instance, if a patient requires both non-pharmacological interventions and prescription medications, they can be provided by the same professional, psychologists if the prescription authority is allowed. However, without it, the patient will have to book different appointments with a psychiatrist and clinical psychologist (Lakhan, 2007). Psychologists’ prescription privilege would save the patients time and financial resources, driving healthcare costs downwards. Additionally, without prescription privileges, clinical psychology will need to keep regular communications with psychiatrists, a process prone to miscommunication, hence risking care provision.
Arguments against Prescription Privileges
The potential influence of market forces and pharmaceutical companies. Drug companies have vested business interests in psychologists. In some instances, pharma companies try to offer gifts to prescribing officers, control research publications, and fund research hence end up influencing psychologists’ decision-making processes (Linda & McGrath, 2017). Opponents to prescription privilege movements argue that if psychologists are given the legal baking to prescribe, they will become a target for pharma companies. As a result, psychologists may be pressured to consider factors other than client wellness when prescribing medications.
Identity confusion and professional territory. If all active psychologists are not provided with prescription privilege, there would be an identity crisis within the profession. While some clinical psychologists will be prescribing, others will not. Therefore, opponents of the prescription privilege movement argue that providing prescription authority would create confusion and erase professional territory in clinical psychology.
Compromised healthcare quality. Psychiatrists are naturally threatened by the encroachment of psychologists in their professional territory. Prescription privilege to psychologists would influence fear on physicians, hence a feeling of loss of control over inpatient and hospital services (Lakhan, 2007). As a result, psychiatrists may offer inferior services in a bid to lower down their costs and attract more patients to counter the new competition. Consequently, the safety of patients would be put at risk.
Possible Consequences and Implications of Prescription Privilege
Prescription privilege to clinical psychologists could significantly impact the profession, the curriculum, and other professions. For instance, privilege will play a huge role in promoting professional autonomy whereby psychologists will offer treatment to patients without the need to rely on other physicians, such as psychiatrists (Goldberg & Wagner, 2019). Similarly, patients will benefit from streamlined care delivery, thus saving on time and money. Prescription privilege would also necessitate curriculum changes, forcing learning institutions to integrate prescription training and skills imparting programs in curriculums. The existing psychologists would also require further training on prescription skills and knowledge.
Personal Perspective and Conclusion
All professionals seek to improve and expand their special skills to new settings, with the overall goal being autonomy. For clinical psychologists, the ability to prescribe is a key milestone in achieving professional autonomy. Other professions have been able to achieve significant steps in their bid to achieve autonomy. For instance, Optometrists have prescription privileges in 55 states. Such a milestone in clinical medicine offers a perfect parallel model that can be used in clinical psychology. However, psychologists must maintain inter-professional collaborations with fellow physicians. Typically, psychology is founded on a bio-psychosocial model, which should not be compromised. Psychologists must offer healthcare services based on principle and scientific considerations. As such, the professionals must collaborate and exchange treatment and care ideas with other key providers. While prescription privilege is an important and desired milestone in clinical psychology, the focus should be on helping patients cope with psychological distress and preventing illnesses by providing psychological knowledge.
Goldberg, S. G., & Wagner, K. (2019). American Psychological Association practice guidelines for psychopharmacology: Ethical practice considerations for psychologists involving psychotropic use with children and adolescents. Journal of clinical psychology, 75(3), 344-363.
Lakhan, S. E. (2007). Prescribing privileges for psychologists: A public service or hazard?. Online Journal Of Health Allied Sciences, 6(1). http://cogprints.org/5712/1/2007-1-1.pdf
Linda, W. P., & McGrath, R. E. (2017). The current status of prescribing psychologists: Practice patterns and medical professional evaluations. Professional Psychology: Research and Practice, 48(1), 38. https://www.researchgate.net/publication/313284471_The_current_status_of_prescribing_psychologists_Practice_patterns_and_medical_professional_evaluations
Robiner, W. N., Tompkins, T. L., & Hathaway, K. M. (2020). Prescriptive authority: Psychologists’ abridged training relative to other professions’ training. Clinical Psychology: Science and Practice, 27(1), e12309.