To Prescribe or Not to Prescribe? That is the Controversy

What’s New in Psychology?

To Prescribe or Not to Prescribe? That is the Controversy     

Jim Windell

 

            The movement to grant psychologists the right to provide medication actually started back in the 1960s. That’s when the American Psychological Association first identified psychopharmacology as a discipline of psychology.

           However, it wasn’t until the 1990s that the Department of Defense would carry on a six-year trial program to train 10 psychologists to prescribe medication at assigned military bases. Because of the success of that program which demonstrated that psychologists could be taught to prescribe psychotropic medications safely, appropriately trained psychologists may now be credentialed to prescribe in the Defense Department, the U.S. Public Health Service, and the Indian Health Service.

           And, in 2002, New Mexico became the first state to enact a law allowing psychologists to prescribe. Since then, several other states have passed such laws. Just this year Utah became the latest state to allow trained psychologists to write prescriptions.

           Yet, the American Psychiatric Association, not to mention some psychologists, stand in strenuous opposition to granting psychologists this privilege. The American Psychiatric Association argues that the training offered is insufficient and could jeopardize patient safety – an argument that goes back to the 1990s.

           While the American Psychological Association (APA) has embraced the idea of psychologists being able to prescribe psychotropic drugs, still very few psychologists have jumped at the opportunity. According to an article recently published in Clinical Psychology, as of 2024, only 226 psychologists had prescriptive authority.

           Everyone seems to agree that there is a shortage of psychiatrists to meet the needs of patients who need medication, still the debate continues as to whether or not psychologists can be adequately trained to write prescriptions. Writing in Medscape Psychiatry, Alicia Ault recently reviewed the controversy and the current thinking from the psychiatric point of view.

           Robert Trestman, M.D., chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing, is quoted by Ault as saying that the interest in having psychologists prescribe “continues to trickle based on just the frustration that people have about not getting adequate access to psychiatry.”

           While states may be trying to increase access to care, granting psychologists privileges is “not a very effective way of doing it,” said Trestman, who is also Chair of Psychiatry and Behavioral Medicine at Virginia Tech Carilion School of Medicine in Roanoke. Psychologists are needed to deliver psychotherapy, he said. And he added: “It makes almost no sense to try to make them into pseudo medical professionals. It just exposes people to risks.”

           On the other Deborah Baker, director of legal and regulatory policy for the APA, was quoted by Ault as saying, “I feel like we’re on an upswing again. The access issue continues to be a perennial kind of driver.” She noted that at least six states pursued expanding privileges this year.

           There are some psychologists who support the psychiatric opposition to training psychologists to write prescriptions. One of those psychologists is William Robiner, Ph.D. He is quoted by Ault saying that he is concerned about patient safety and “about some of the disingenuous reasons” that psychologists want to prescribe. Among these are the ability to increase status and income, Robiner, a professor of Medicine at the University of Minnesota Medical School, and a board member of Psychologists Opposed to Prescription Privileges for Psychologists.

           In order to receive training, a psychologist must possess a Ph.D. or Psy.D. They must also obtain a master’s in clinical psychopharmacology and then, subsequently, pass the Psychopharmacology Examination for Psychologists. In addition, they must also obtain a Drug Enforcement Administration license, although they are not allowed to write prescriptions for schedule 2 medications. The APA has developed guidance for master’s programs, which currently number just over a handful in the United States.

           The controversy over whether psychologists should be able to expand their scope of practice continues, however, it is not clear as to whether access to medication for mental health conditions has been increased in those states where psychologists have been granted the privilege. The relative few psychologists who have become prescribers is, according to some critics, negated by the fact that often psychologists practice in the same areas as psychiatrists. And even the APA acknowledges that psychologists typically don’t establish practices in under-served rural areas.

           While we wait for this controversy to be resolved, the under-served populations will go on being denied access to appropriate mental health treatment.

           To read more on this topic, find two articles with these references:

Ault, A. (Dec. 13, 2024). Psychologists and Psychotropic Prescribing: An Old Debate Heats Up.  Medscape.

Robiner, W. N., & Tompkins, T. L. (2024). The workforce of prescribing psychologists: Too small to matter? Worth the cost? Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000253

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