Erin E. Wood
In the last thirty years, many parties within the American Psychological Association have made motions to promote the motion for clinical psychologists to have prescriptive privileges. With the motions made to promote prescriptive privileges, there have also been motions to counter the arguments made supporting prescription privileges. To research the claims made by both sides of the issue, the American Psychological Association has created a task force to assess the effects that prescriptive privileges will have on education as well as psychology as a whole. This paper will discuss the arguments revolving around professional integrity, financial implications, the amount of professionals interested in prescriptive privileges, safety, and educational consequences of prescription privileges as well as my own opinions as to whether I support or oppose the motion for clinical psychologists to obtain these privileges.
Since the birth of psychology, American society has evolved to the point that individuals demand instant gratification. The desire for instant gratification has caused individuals “‘one-stop shop’ for mental health services” and medical professionals who can directly prescribe medications—causing physicians to become increasingly popular in comparison to psychologists (McGrath, 2010: Levine & Schmelkin, 2006). By being able to prescribe medication while proving effective treatments to patients, prescriptive privileges will not only assist patients by cutting out the middle-man, it will also, according to Barnett and Neel (2000), “result in higher quality care.” Although physicians are currently able to provide medication, they are often uneducated on the effects drugs have on mental health (Barnett & Neel, 2000). Psychologists in favor of prescriptive privileges argue that, through training and practice, they are more apt to deal with prescribing medications and treatments that will treat mental health disorders than physicians who have very little training on mental health disorders (Barnett & Neel, 2000). While some psychologists believe that prescription privileges is essential to keep psychotherapy from becoming superfluous in comparison to pharmacology and will assist in increasing the care for patients, others believe that these privileges will change the change the “professional identity” of those practicing psychology (Wiggins & Wedding, 2004).
Those who believe that psychologists should be allowed prescription privileges believe that not only will prescription privileges keep psychologists from becoming overshadowed by physicians, they also believe that clinical psychologists would be “in a unique position to assess and to monitor” when it comes to prescribing medication because, through doctoral training, they are more apt to study the effects of medications on patients (Barnett & Neel, 2000). This would allow clinical psychologists to retain and extend their psychotherapeutic roots by giving them the opportunity to research the effect medications have on mental disorders while giving behavioral and cognitive therapies to patients. While psychologists in support of prescriptive privileges argue that prescriptive privileges will give way to many new opportunities in psychology, those in opposition to these privileges claim that the authority to prescribe medication will not create such a large window of opportunity and will cause psychologists to fall prey to advertising from pharmaceutical companies.
Many of the psychologists in opposition to prescriptive privileges believe that the addition of prescription privileges will change the direction of psychology towards an undesired direction—ultimately jeopardizing their professional integrity. They believe that, by placing more of an emphasis on medical treatments rather than behavioral treatments, “psychology as we know it will come to an end” because psychologists will be more interested in providing medications than therapy (Caccavale, 2002). Psychologists may not prescribe medications to patients based on their effectiveness, but more because will be encouraged by pharmaceutical companies.
Currently, pharmaceutical companies create advertisements that strategically influence the opinions that physicians have on medications and bribe psychologists – through means of money and continuing education – to encourage them to prescribe these medications (Antonuccio, Danton & McClanahan, 2003). Bribing and advertising does not only affect practicing physicians, according to Antonuccio, Danton and McClanhan (2003), pharmaceutical companies assert their influence as early as medical school—meeting with students to promote medication. This influence asserted by pharmaceutical companies over physicians and medical students can taint the objectivity of psychologists and, in extreme cases, place the patient in harms way. Although psychologists who are against prescriptive privileges believe that the integrity of the profession will be negatively impacted by the bribes and advertising of pharmaceutical companies, those who support prescriptive privileges believe that these privileges will increase the financial status and interest in the profession.
The pharmaceutical industry is one of the fastest growing industries in the United States being dubbed “the most profitable industry in the United States” (Antonuccio, Danton & McClanahan, 2003). By being one of the most profitable industries in the nation, if psychologists were given the right to prescribe, it would not only give clinical psychologists an ‘edge’, it would also encourage individuals to join the profession. With prescriptive privileges, psychologists will also be able to partake in the benefits of pharmacology by receiving insurance reimbursements and increased status within health institutions (McGrath, 2010). McGrath (2010) claims that this increased status will not only benefit psychologists in private practice, hospitals, and other intuitions, it will also benefit the academic community by funding research projects. Although there are many financial benefits to both the counselling and academic communities of clinical psychology, there are also drawbacks that could potentially outweigh the benefits.
First, while pharmaceutical companies have been known to provide bribes and false information to professionals with prescription privileges to increase drug sales, they have also been responsible for increasing levels of “commercialism and malpractice allegations” within health professions (Antonuccio, Danton & McClanahan, 2003: Stuart & Heiby, 2007, p. 6). Commercialization of medications has further tainted the objectivity of health professionals because, according to Stuart and Heiby (2007), although prescribers are able to deny medication to patients, they are more likely to give medications that have been “requested” by the client—even if they are ill-informed of the drug. Physicians may be becoming more willing to prescribe requested medications because the negative side effects of drugs have drastically decreased making it less of a risk for them to prescribe them (Levine & Schmelkin, 2006). While medications have become safer to prescribe, when complications arise, the professionals who prescribe the medications will be the ones at risk for malpractice lawsuits—not the pharmaceutical companies.
In the article To Prescribe of Not to Prescribe: Eleven Exploratory Questions, Stuart and Heiby (2007) discuss the lack of support insurance companies have for professionals in malpractice lawsuits. Many insurance companies have created new policies when dealing with malpractice because “the rate and cost of settlements [that have] risen so sharply during the past decade” (Stuart & Heiby, 2007, p. 22). Because of this, it can be very expensive for a psychologist to pay for the insurance to cover malpractice, or pay for the legal counsel because their insurance does not cover malpractice. According to Wiggins and Wedding (2004) only a small majority of psychiatric nurses – clinical psychologists who have gone through training to prescribe medication – have insurance policies that cover malpractice—even when it is in many ways cheaper than other forms of insurance (p.150). This could be because, although psychiatric nurses are able to prescribe medications, very few of them actually utilize prescription privileges (Wiggins & Wedding 2004, p. 149). Due to the amount of psychiatric nurses who refrain from prescriptive privileges, before the APA
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(Antonuccio, Danton & McClanahan, 2003)
(Wiggins & Wedding 2004)
(DeLeon, Dunivin & Newman, 2002)
(Levine & Schmelkin, 2006)
(Robiner et al., 2002)
(Muse & Neel, 2010)
(Stuart & Heiby, 2007)