Psychologists Prescribe Medicine?

In a pevious thread -

BA to Psychiatry

It was mentioned that Psychologists ( NOT Psychiatrists ) might, in time, be able to prescribe medication to their patients (?).

Has anyone heard more about this and what do you think will become of this in the future?

CCBapt

 

It is true. The government is in the process of training some psychologists in how to prescribe certain class one drugs. Now as to how effective or how wide spread this will become is anyones guess. I have a cousin who is a PH.d in clinical pscy. working with the Dept. of Corrections in Michigan. He currently is part of the pilot program to be one of a few psychologists that can prescribe meds.


Interesting concept that I think has some potentional.


Sage

 

Already hapening

So far a few states have passed legislation that allow psychologists to perscribe. Off the top of my head New Mexico and Louisiana.

 

In addition, a few branches of the military tried this as a pilot project a few years ago. I am surprised that more states are not looking at this. I would be interested to know how the healthcare payors reimburse psychologists who prescribe. These days, many psychiatrists complain that they have been marginalized as 'medication managers', who write and monitor the psychotropic medication presecriptions, while the lower-paid psychologists, MSWs, counselors and the like do the actual counseling.

 

A search at PubMed (a public National Library of Medicine database) using psychologist and prescribing (MeSH subjects) will produce many interesting journal articles.

If you find any particularly interesting you may request them from your local public or academic library.

Pubmed's URL www.pubmed.gov

If you can't find any results that you find relevent feel free to ask me here, or by email. I am a librarian and I can provide them for you.

 

There's a solution to all this piciune micromanaging: legalize all drugs!

Then it will be "buyer be ware!" and the consumer can consult physicians or the sadly overtrained and wholey neglected dipensaries, the pharmacists.

This would mean a greater priority on literacy and reading skills than the US now tolerates. We would need to have competition among educators, instead of monopoly by the Orwellian named "teachers" unions, in order to ensure consumers have appropriate reading ability comensurate with such empowerment.

Only above average reading skills could empower citizens to read and actually understand those lengthy product inserts that come with medications.

My only question: what would the equally maliciously named "consumer groups" do without a state to carry out their will?

-Orson

 

Currently two states, New Mexico and Louisiana, allow properly trained psychologists to prescribe certain medications. This trend is likely to continue and other states will follow suit. My home state of Tennessee may be among the next states to pass such a law. The model being pushed is having psychologists get a post-doctoral masters degree in psychopharmacology and some supervised clinical practice. There are both positive and negative consequences of this and many psychologists are strongly opposed to the medicalization of the profession. I would imagine that some of this training could be done via DL. I am currently working in a Ph.D. program in clinical psychology at Fielding. We just had our national residency session in Santa Barbara and this topic was discussed as being a bit like same sex marriage ... there is a feeling of inevitability regarding its eventual adoption.

And yes I am LOVING my experience at Fielding!

Chris

 

I was just as surprised to hear from a friend who is in a new program in FL that is training his class to be some of the newest Psychologists who will have some limited prescription-writing rights. They will all graduate with PhD degrees for this right. Very interesting, indeed.

 

Psycologisy Rx

I did a bit more research on this. It appears there are SEVERAL schools offering 'psychopharmacology' classes to Psychologists. Even though some of the institutions are NOT in the states that are givng the Psychologists the right to prescribe. Some of these are DISTANCE accessible!!!!!

I found this link from the American Psychiatric Association:

Psychopharmacology Schools

The Psychiatrists sound a little ummmm..... jealous?

What I have found so far is that these degrees are POST Doctoral in form. In fact, I e-mailed Nova Southeastern in Florida about their program. They affirmed that it was ONLY a Post Doc degree.

'hikergirl' - do you know the school your friend is in? I am interested in getting my Masters in a 'science based' psychology program. Especially one that is nationally accredited and possiby CACREP approved. I later want to do a Doctorate in Jungian analysis( I LOVE Pacific Grad in CA). I need the science to be able to prescribe medication for clients who need the medical 'kick' to get moving.

I thought about the MD route. Too much, too old. I thought about Physicians Assistant - too hard to get in! I even thought about Nursing + counseling degree. NO! I even considered 'Medical Psychology' and that was the closest I could get. Even that seems too limited. Prescription priviledges - especially if there is a Masters Degree are just what I want. I would even settle for post doc if I can get it later.

I think chrislarsen is right. It WILL happen in time. I just want to be a part of it now so as not to back track later.

CCBapt

 

Pych Rx

mattoneil -

I missed your post until now. Thanks for the link. I will look at it tonight.

Orson- "... legalize all drugs!

Then it will be "buyer be ware!" and the consumer can consult physicians or the sadly overtrained and wholey neglected dipensaries, the pharmacists."

The lawyers would LOVE that one......... even if they were legalized for some time, just let one of those 'consumers' die from PERSONAL medicine mismanagement and they would sue ( even with it being legalized) the pants off the pharmaceutical company for making it too strong ... a.k.a. - effective. It would not stay legalized long.

Otherwise, I agree on the literacy thing.

CCBapt

 

I work with a Psychiatrist/Neurologist part-time who used to be the director of the National Pain Society. He and the psychologist on staff feel that prescriptive privileges for psychologists is going to backfire. How? Because there are so many contraindications and combinations of drugs relating to non-psychotropics for which the psychologist is not trained for (despite having the Masters of psychopharmacology) that there will be malpractice suits for botch ups. More money for prescribing is attractive to some psychologists but it will come at a price of headaches, phone-calls, and higher mal-practice insurance, etc. This makes sense, since psychologists are not trained in General Medicine + specialty as most doctors tend to be. That puts them at a disadvantage. I see many lawsuits coming down the pike.

 

Psych Rx

BlackBird-

That is very insightful. It does present the inherent dangers of Psychologists if they prescribe. And it is important thinking material for the future of this possibility.

What do you think about the complaints that come from those same Psychiatrists? Issues such as-

Psychiatrists primarily....

... do medical management of the prescriptions they write.
... give several medical consults an hour.

This is usually in place of therapy itself.

Reference this link -

BA to Psychiatry

CCBapt

 

Re: Psych Rx

CCBapt,

In the end, I believe that psychiatrists (MD's with specialization) are the best for administration of psychotropics because they have the most thorough training in the anatomical interfacing of drugs and complications all around. The downside of this is that they basically become drug-pushers and order-takers. Psychotherapy goes out the window. The ideal would be if psychiatrists would do psychotherapy, like in the old Freud and Milton Erickson days. The alternative is to revamp the psychologist training to be a marriage of psychiatry, standard general medicine, and psychotherapeutical competency. Just my two cents.

 

BlackBird

Thanks for the perspective.

Don't you think the client/ patient is BEST served by this combination of medication AND psychotherapy?

The exsisting system seems to be the Psychologist do the therapy and the Psychiatrists do the medicine. This can be VERY unhealthy. I saw this. I was a crisis case manager for a local mental health center. The Psychiatrist came in once a week and without interviewing the patient/ client made medical decisions based upon the counselors ( Non- Ph.D./ Psy.D.) MONTHLY evaluations. This case may be extreme, but it exsists.

The system needs altering. Psychologists prescribing seems to be one way to get better care to the mentally ill.

And - I agree with you. Psychiatrists should be the ones doing this but they are not. The reason? Money- Psychiatrists can get twice as much from med consults as they can from therapy. If they do therapy, they usuually have to charge the going rate to what most PsyD/PhD's charge.

This will probably not change. Truthfully - I would not change if it were my choice. The only other option is to let Psychologist 'move up' by letting them prescribe.

I am not trying to get you to change your mind (even if I could). However, it seems that this is the only way the system will change. And I agree with you, it will be risky!

CCBapt

 

As many of you have observed the psychiatrist has become the med manager and no longer does/or rarely does implement any type of non medication tx. While the prescriptive privilage for psychologists is interesting I would still much rather see an MD
or a DO participate in a therapuetic relationship like they once did.

 

Trun it around .... Psych RX

Let's turn the discussion around-

Are there any circumstances in which you WOULD want ( or allow) a Psychologist to prescribe medication ?

BESIDES having a M.D. or a D.O.

CCBapt

 

Re: BlackBird

CCBapt,
I'm sure you would agree that the best would could be broken down into:

1. Only Psychotherapy with no need for psychotropics.

2. Psychotropics for stabilization and then have a competent psychotherapist/psychologist bring sufficient emtional resolution so that patient/client can be titrated off medication.

3. Just psychotropics for cases that do not respond to ANY psychotherapy (extreme depression, etc.).

I see these three types of scenarios as representative of options to do depending each unique situation.

Hope this helps.

 

Re: Re: Psych Rx

This was in fact tried in CA in the 1970s. The degree was called the Doctor of Mental Health (DMH). The idea behind it was an attempt to blend clinical psyc. and psychiatry. It never flew. Although the graduates received quite a bit of psychiatric training, they were never granted prescrip. privileges.

 

Psych Rx

BlackBird - That does, in fact, help.

The REASON I am so persistent in this is area is that I am considering changing careers.

I have always wanted to be a M.D. - Psychiatrist in fact. If I do this now, it will mean MAJOR adjustments for me - too much, it seems. In a sense the ability to prescribe is the 'Holy Grain' of Psychotherapy. It lends credibility and increased income to all who posses it.

My other option is a MA in Clinical Psych. This would take LESS time to an aging 'Jungian' who wants to specialize in Men's issues. I would still like to prescribe. If I can not do this at some point, my choice of Masters degrees will be markedly different.

Your points are well taken and I consider them to be VERY valid. This is a difficult issue and could be the Pandora's Box of psychology.

The most important question is- once all the options are weighed, what is best for the client - and my pocket book

Just kiddin - kind of.

Thanks for the comments.

CCBapt

 

Rob Coates DMH

Rob -

Other than doing a general internet search, do you know where I could research the DMH issue?

CCBapt