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Should Psychologists Be Allowed to Prescribe Medication?
Carrie Steckl, Ph.D.: Tue, Mar 26th 2013
My home state of Illinois is edging toward a point of no return, and I'm not sure how I feel about it. You see, the Illinois Senate Public Health Committee recently voted 8-0 to advance a bill that would allow licensed psychologists to prescribe medications for psychiatric purposes. Psychologists would be required to complete a master's degree in psychopharmacology (the study of the use of medications to treat mental disorders), pass a national certification exam, and renew their certification every two years.
The Senate Committee's passage of the measure is not a guarantee that the bill will actually be approved. Psychiatrists and physicians are lobbying hard against the bill, not surprisingly. I must admit that they make a compelling argument.
Consider the amount of training required in the journey to become a psychiatrist or other type of physician - years upon years of medical school, residency, and often a post-residency fellowship to acquire specialized experience in a field such as adolescent or geriatric psychiatry. A master's degree in psychopharmacology, in contrast, takes a couple of years to complete and involves coursework (some of which is available online) plus 462 hours of supervised practice.
According to the Illinois Psychiatric Society, if the bill is approved, the state's standards for prescribing medication would be the lowest in the United States. Granted, if this scenario comes to fruition, Illinois would join Louisiana and New Mexico as the only states that allow psychologists to prescribe drugs.
Sounds bad, doesn't it? Yet psychologists and other proponents of the bill state that passing the measure is necessary to meet the growing needs of mental health clients in the state. The bill's sponsors claim that a grave shortage of Illinois psychiatrists has led to an inability to adequately treat the state's residents with mental illness. Plus, although Illinois would be one of only three states with such a measure, it should be noted that our nation's military also allows psychologists to prescribe psychotropic medication.
So, what's a state to do? According to the two sides, Illinois has only two choices: pass an unsafe bill or neglect to serve its residents with mental health problems. But are the legislature's options really that limited and polarized?
My mind turns to several years ago when I was working on my doctorate in counseling psychology and planning on one day earning my license to practice. I ended up forgoing the license in order to work in community outreach and then to pursue a career in writing and teaching (none of which requires a license), but I remember the excitement and trepidation involved in planning a career as a mental health clinician. While I wanted to make a difference through counseling, the responsibility of such a vocation overwhelmed me. Looking back, prescribing medication in addition to providing psychotherapy would have been the last thing I would have wanted to do. Psychologists and psychiatrists exist for different, equally important reasons. They complement each other in their varying approaches to psychiatric phenomena, resulting in a more balanced treatment plan.
I understand that my home state is in a predicament, and I sure don't want people's mental health needs to go unmet. But is this really the road we want to travel? If psychologists are allowed to prescribe drugs, what group will lobby for this privilege next? Perhaps there are other solutions to this problem. For instance, why are psychiatrists so scarce in Illinois? Could incentives be offered to recruit more to our state? Could family physicians and internists - who already know how to prescribe drugs - receive additional training in psychiatry? Could psychiatric nurses be recruited to monitor clients on psychotropic drugs in order to lighten the workload of psychiatrists?
I'd be curious to know your thoughts on this issue. Do you feel that the bill should be passed, or is there a better solution?
Guerrero, R. (March 13, 2013). Senate committee passes bill allowing psychologists to prescribe drugs. Chicago Tribune: http://articles.chicagotribune.com/2013-03-13/news/ct-met-illinois-legislature-psychologist-presrcipt-20130313_1_psychiatrists-psychologists-senate-committee (Note: An account may be required to access this article.)
Hmmmmm, I hope not - Sandra - Apr 1st 2013
Left a comment on Linked In as well. So I read the article. Well, I'm not for it since many a psychologist does not work with pills and they focus on helping the person be more aware and changing the way they THINK about themselves - pills and such only do one thing. Take care of SYMTOMPS. That is it. Behavior. What about geting to the root cause. And may people do not have a mental illness and instead have a history of abuse. When you see a person with a REAL mental illness that is really caused by some kind of something wrong in the brain -- they can't go off their meds. I'm going to say that at least 20% of people on medications - do not need to be on medications. It is cheaper to put patients on meds - then to work on REAL issues - and that is what the psychologist does.
I don't think it wise to tack on another 4 years of school for ANY PhD! No way. They have way too much to study for in the first place. Let the MD's do the pill stuff. That is what they are known for. you need a prescription, you go to an MD. Not a psychologist!
And if the northern states including Illinois needs more MDs . .. may be it is just too cold for many psychiatrists to move up there and practice up there? I don't know why that state seems to be short on that type of MD. Is it like that in Michigan or Indiana or Wisconsin? Those are cold states too and I know - the winter is so brutal in the winter. I lived near Hammond for 4 years. Perhaps the homelessness is a big issues in that state? It could be. What about crime rates? Are there more people getting out of jail/prison and now on the street? And I'm sure many many people in prison have a real undiagnosed mental illness.
TO answer the question I don't think American should allow any physhcologist to do the meds thing. That is WHY they went that route. If they had wanted to do the meds - they would have gone toward an MD and gotten that degree instead. It is a WRONG move for legistation to make that call. Keep the two professions seperate.
Thank you, Kerry! - Carrie Steckl, Ph.D. - Mar 28th 2013
Kerry, thank you so much for your insightful comment! I appreciate your description of how this issue is handled in Australia, and I really like your interdisciplinary team approach to treating individuals with mental health challenges. Let's hope that Illinois can recognize the importance of this team approach as well. Thank you again!
What about the 7+ Years a psychlogist trains - - Mar 28th 2013
Very shoddy writing -- you mention how long a psychiatrist trains for but you fail to mention psychologist study just as long: 4-5 years of Ph.D.-level courses, 1 year of pre-doctoral internship and 1-2 years of post-doctoral training and then they must pass a very difficult national licensing examination. In addtion, you fail to mention the fact that over 50,000 psychologist prescriptions have been written without a single complaint filed. How could you fail to mention all of this?
Agree! - Kerry - Mar 27th 2013
Thank you Carrie for your article. I am a Psychologist in Private Practice in Brisbane Australia. I totally agree with you. The complementarity of the two professions is the key to a balanced treatment for the individual. Unfortunately, we have the same problem of low numbers of Psychiatrists. In Australia, our General Practitioners are educated in psychotropic medication and are the first port of call for folks suffering from mental illness. GPs write referrals to Psychiatrists and Psychologists and prescribe necessary medication which will be reviewed by the Psychiatrist when an appointment can be made. In the meantime, the Psychologist can start to unpack the issues and begin treatment. The system works. The Psychologist provides six-weekly updates to the GP who also monitors other health issues the person might have. A team approach .