Psychologists Continue Push for Prescribing Rights

Despite stringent requirements, psychiatrists maintain it would pose a public safety risk
The Lund Report
May 6, 2011—Psychologists are attempting to pass legislation allowing them to prescribe psychotropic drugs after Governor Ted Kulongoski vetoed such a bill in 2009. This is their fifth try.
 
House Bill 3523 continues to receive fierce opposition and lobbying pressure from the Oregon Pediatric Society, the Oregon Psychiatric Association and the Oregon Medical Association. Because of its $290,000 fiscal impact, the bill needs approval from the Joint Ways and Means Committee, and a hearing has not been scheduled.
 
Rep. Bill Kennemer (R-Oregon City), who practiced as a clinical psychologist for 25 years, sponsored the legislation. If passed, Oregon would become the third state, after New Mexico and Louisiana, to allow psychologists to prescribe drugs.
 
Under the legislation, psychologists would have to be certified by the Oregon Medical Board which would establish an oversight committee comprised of three physicians, including one psychiatrist and four psychologists, one of whom must have expertise in treating children. Psychologists could prescribe drugs to treat anxiety, depression, attention deficit disorder and other mental and emotional illnesses, but not narcotics.
 
There are other limitations built into the bill. A psychologist must have a master’s degree in clinical psychopharmacology, clinical training in physical assessments, pathophysiology, psychopharmacology and clinical management, and at least one year of experience in a mental health setting.
 
“There are so many safeguards built into this bill,” said Robin Henderson, past president of the Oregon Psychological Association.
 
But detractors insist that’s not enough and contend giving prescribing rights to psychologists poses a public safety risk.
 
“The biggest issue is not having people adequately trained to prescribe very powerful medications,” said John McCulley, lobbyist for the Oregon Psychiatric Association.  
 
These are “powerful drugs,” he said, that can cause liver and kidney impairment, effect the brain, and other parts of the body. “It’s a prescription of medicine and should be done by those who have medical training.”  
 
Tanya Tompkins, a psychology professor at Linfield College, agrees.
 
“As a psychologist, I’m not adequately prepared to practice medicine. And prescribing medicine is practicing medicine. This is a radical expansion of scope of practice. We're talking about a psychologist who may have not taken any biological sciences before going to graduate school.”
 
But psychologists already work with people in need of psychotropic drugs and can “work carefully” with their primary care physician, Henderson said.  
 
“And, we ask, is it going to be helpful? A short term course with psychotropic medication can be very effective,” Henderson said.
 
There’s a stark division between the training and background of psychologists and psychiatrists, McCulley insists. Psychiatrists receive more scientifically-based training, while psychologists are trained to provide behavioral-based therapy—whether it’s cognitive behavioral therapy, or other therapies that emphasize stress reduction and exercise.
 
“We have a lot of different tools in our belt,” Henderson said.
 
It boils down to “medical training versus behavioral training,” McCulley said.  
 
The bill would fundamentally “blur the lines between psychology and psychiatry,” according to Tompkins. “What we’re dealing with is a top-down push to redefine the profession of psychology.”
 
Her students at Linfield conducted a survey recently among 130 of the state’s 1,318 psychologists. Of the 83 who responded, 44 percent were in favor of prescribing rights, 7 percent said they’d pursue such training, while 36 percent were opposed.  
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Proponents insist the legislation would combat the shortage of psychiatrists in rural areas, giving people greater ability to receive medications. But McCulley disputes that idea. “It’s not going to increase access,” he said
 
Tompkins is fairly confident the bill won’t pass this session. “It doesn’t have the votes to pass the Senate this time,” she said, adding that it “will be close” in the House, which is split between 30 Democrats and 30 Republicans.
 
 
FOR MORE INFORMATION
 
To read previous articles from The Lund Report about psychologist prescribing rights, click here.

 

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Comments

Saying psychiatrists are more scientifically trailed than psychologists is the most incorrect statement I have ever seen in the media. Psychology is the ONLY doctoral level health profession in which the entry level training requires training in scientific methods. Psychiatry does NOT require training as a scientist.

Psychologist training requires NO biomedical education. Anyone who thinks that a non-medical professional (say, an astronomer or English professor) can learn enough in ONE year of online classes from a psychology school to practice medicine is grossly deluded, or is very eager to make more money writing prescriptions. A full 78 percent of licensed clinical psychologists (and I am one of them) have agreed that psychologists who prescribe must have at least the same training as other non-physician prescribers. This bill - like all of those written in Washington DC by the American Psychological Association for its puppet organizations such as the Oregon Psych Association - falls pitiably short of that. Ethical and competent psychologists have always been able to obtain medication for their patients through collaboration with medically trained professionals with legitimate prescriptive authority. Any psychologist who can't, or won't, should go into another profession. Such misleading and greed-driven campaigns as this bring shame and dishonor upon the rest of us who are proud to practice psychology.

Only specially trained psychologists will be able to prescribe these medications. Currently psychiatric medications are being prescribed to many patients by nurse practitioners, who never attend medical school, or general physicians with no training in psychological issues. Psychologists will never replace psychiatrists, but psychiatrists are prescribing medications for a small fraction of the population that needs them.

Psychiatric drugs are already overprescribed, especially for children, marketed by big pharma with skewed studies and the truth about the dangers are not advertised to the public or the prescribers, and prescribers are using these powerful psychotropic drugs without telling patients their risks. There is NO evidence base that antidepressants work on children. In 2004, the FDA found 12 of 15 studies failed to show better performance than a placebo in children 10-25% of children prescribed ADHD medicine are diagnosed with bipolar disorder after 3 years 50% of children prescribed an antidepressant are labeled as bipolar after 10 years. THERE HAS BEEN A 4000% INCREASE IN THE DIAGNOSIS OF BIPOLAR DISORDER IN CHILDREN IN THE U.S., MANY ON CHILDREN AS YOUNG AS TWO YEARS OF AGE We need to be discussing whether or not the prescribing of psychiatric drugs to kids should be happening at all given the horrific outcomes. Antibiotics are now much more judiciously prescribed by physicians due to the evidence of their overuse creating superbugs. Antidepressants and Stimulants need the same--their overuse has created one million bipolar children in the United States. Sources: http://forum-network.org/lecture/psychotropic-drugs-and-children Frontline Report: January 8, 2008; Anatomy of an Epidemic by Robert Whitaker; Medication Madness by Peter Breggin M.D.; More Information on Facebook Page: First Do No Harm: http://www.facebook.com/pages/First-Do-No-Harm/104070433012416?sk=wall

"Psychiatric drugs are already overprescribed, especially for children..." --Excellent point. So, why do you think this is? I am a licensed psychologist, and I can't count the time when kids, adults, men and women were taking powerful drugs, prescribed by psychiatrists who misdiagnosed them. Some of the patients needed to detox from the drugs before I could redo their assessment just to find out that they had trauma that they dealt with, and were not bipolar or schizophrenic, or (my personal favorite) Mentally Retarded. Psychologists by far have the most training in assessment, treatment, and research in the Mental Health field. So why would they be denied the opportunity, with appropriate training and after careful assessment, do what they do best -- assess and treat mental illness? Do people know what training in mental health psychiatrists typically receive? I worked with psychiatrists residents (who already have medical degrees and can prescribe meds), and their mental health training is very limited -- I'm talking about 1 or 2 courses!!! Wouldn't that account for so many misdiagnoses or over prescription? Do you know how psychiatrists assess for ADHD typically? -- they just look at the patient and say -- "well they kind of look hyper and lack attention". Would you call that an assessment? A typical psychologist has way more tools. They have assessment instruments such as Connor's, they are trained in examining the results of formal psychological tests to look for evidence of attentional problems, they have more than 15 minutes to spend with the patient to obtain a good history, and they have a number of tests that they can use to rule-out malingering. Anyone knows what the street value of Stratera or Ritalin or Adderall is? Wouldn't it be common sense to suspect that some patients can fake symptoms in order to sell their meds or abuse them? So, why would someone deny psychologists the right to treat patients if they are the best prepared and trained in mental illness? Do you know how typical psychiatrists or physicians diagnose Mental Retardation? -- they just look at the patient and say "They look kinda slow. May be like a 10 year old" That's it! Is that a good assessment? Can you imagine what is it like for the patient to hear that he has Mental Retardation and the impact it makes? My statements are not at all aimed at criticizing medical professions or professionals. My hope is that we can move passed the issue of safety. Psychologists with proper training can do much good for patients, raise the quality of care, and be responsible in prescribing and managing medications. The people that are opposed to the psychologists getting prescription privileges are simply involved in the turf war. Any prescribing professional is welcomed by any insurance company. If you are not a prescribing mental health professional, you are not valued by the insurances. Having more prescribing professionals, who would be more careful with prescribing medications, will minimize and possibly eliminate this disparity.

There is a big difference between psychiatrists and psychologists. Anyone can get a psychology PhD from Podunk State College with some kind of thesis picked out of Psychology Today, whereas a psychiatrist has to have a medical degree (MD/DO) i.e. from a med school. How many psychologists have taken organic chemistry or physics, or know what DNA stands for?

Pardon me: my Ph.D. is from a research one university, the University of Oregon... thesis required knowledge of many complex psychological concepts, advanced research methods, advanced statistical applications such as Structural Equation Modeling, etc., etc... Your answer only shows how ignorant people are about Ph.D. training which in my oppinion prepares licensed psychologists to know more about mental health issues and to understand behavioral research better than many physicians. Second, many Family Medicine doctors don't know anything about mental health (well they did 6 week rotation in med school) and yet can prescribe many "powerful medication" as can Nurse Practitioners and PAs... Third, Psychiatrists can get their medical degree at the University of Barbados or Bahamas :-)... not to mention that some DO schools are not exactly Nobel Prize material... In the final analysis it all comes down to post graduate training and ability to pass the board exam which has been done successfully by graduates of international medical schools from countries such as Bulgaria and Albania, and I am sure that they didn't get much better education than the Podunk State College... You would be surprised how many psychologists have taken and successfuly college physics (again, we are not talking Nobel level classes here - anyone who is willing to study hard can do pretty well in these classes - simply introductory, some basic scientists would say superficial college-level sciences... and FYI: everyone knows what the DNA stands for, and RNA and mRNA, and tRNA - as one Russian physicist said: "in science there is Physics... everything else is just stamp collecting"-and he wasn't talking about college physics pre-meds take either ;-)...

Although I don't yet live in Oregon, I have been seeing a licensed "Clinical and Medical Psychologist" for several years. My therapist has often suggested I see my MD and inquire about certain medications - and the therapist has most always been right on. Within their scope of practice and with proper training, this seems like a good idea to me.

It is heartening to see clinical psychologists striving for prescribing rights. GIven the intellectual rigor of modern Ph.D. and Psy.D. programs in clinical psychology, replete with courses in physiological psychology, neuroanatomy, cognitive science, neuroscience, experimental psychology, psychopathology, mathemeatical psychology and psychopharmacology, it is about time that such rights were awarded with the proviso that additional indepth courses in psychopharmocology, neuroanatomy, clinical pharmocology, etc. are expanded and reinforce with post doctoral basic medical sciences and clinical supervision. I would like to see the model at Yale Medical School, e.g. the M.D., Ph.D. model utilized in clinical psychology programs, also. Yes, give the doctoral level science/practioners in clinical psychology prescription rights with the further psychopharmological training noted above in this writing. However, I believe that future trainng of clinical pscyologists should be augmented as follows: Pre-clinical psychology undergratuate training should include: organic chemistry, physics in addition to biology and calculus. Statistics should also be a requirement. Most of all, every pre-clinical major must take psychology of personality, abnormal psychology, PHYSIOLOGICAL PSYCHOLOGY, anatomy, physiology, neuroanatomy, learning and motivation, experimental psychology, introductory to psychology (2) semesters, etc. At the graduate level, the first two years of the doctoral program should be spent in medical school, in order to get a comprehensive picture of the funtioning of the central nervous system in the human body. The last 2 years must contain psychopharmocology, physiological psychology, neuroanatomy, and clinical pharmocology, and a comprehensive analysis of all currently-used and proposed psychotropic drugs. The degree awarded could either be the Ph.D. in clinical psychology alone or the M.D., Ph.D. (psychiatrist) designation. Dr. Durante

I really don't think this is about qualifications as much as physicans protecting their "terf". As a psychologist(25 year) I am not professionally interested in providing perscriptions but it is clear to me that health care professionals often do not have the time to spend with their patients to sort out the issues and thus prescribing becomes hit or miss. My experience is that health care providers become comfortable in using one-two drugs and then stick with that for everyone( I do work with the military). It seems unfortunate that we as a culure cannot work together to assess clients more sensitively to find the right medicine and the right dose. Physicans ( related to managed care pressures) don't normally spend adequate time to monitor their clients to maintain feedback as to what is working, what is not and how can we change that for the better.

Of course it is all about "turf." Both PAs and Nurse Practitioners in some states can prescribe psychotropic medications (and they have far less education than a Ph.D. level psychologists who would get yet more additional training through an M.S. training in psychopharmacology). Also, as someone who has worked in an inpatient unit with a team of psychiatrists I have seen how random prescribing can be (e.g., one psychiatrist will say that he "likes Haldol" for schizophrenia, and then another one comes in and says that there is really more of a "mood component" to this patient so he/she will "add Abilify", etc.-all these decisions are quazi-scientific at best). Basically, psychiatrists have to be honest with themselves and recognize that a lot of their clinical decisions are not even evidence-based (i.e., they often say "in my clinical experience"), and I have see many patients suffer, needlessly, because of the decisions psychiatrists make. Psychiatry as a science lags far behind other medical disciplines - we still cannot prove how even SSRIs work (exact mechanisms are unclear) and it all gets reduced to somewhat speculative "chemical imbalance," which has yet to be determined... Historically, I think it is especially laughable that psychiatrists are "protecting" the public given that they came up with such intrusive treatments like lobotomy, ECT and medications which to this date have crippling effects on their patients... The whole field is in a need of major reform...