Prescription Privileges 1
Abstract
Prescription Privileges has been a controversial topic during the last two decades in the
field of psychology. The movement of prescription privileges roots back to the 1980s, where it originated from but did not gain any traction until later decades. Many have argued that the training for a clinical psychologist is not as extensive as other professions in the medical field, causing a more thorough debate on whether clinical psychologists should have the ability to prescribe medication. Currently, in the United States, only five states have jurisdiction that allows psychologists to prescribe medication. There are benefits in allowing clinical psychologists to prescribe since it will help with the shortage of psychiatrists by giving more access and less waiting times to people who require medication therapy. Prescription privileges challenge the field of psychology as well as broadens horizons by creating a better bond between psychologists and patients.
Prescription Privilege
During these past two decades, prescription privilege has become a controversial topic
between clinical psychologists and psychiatrists. Prescription privilege is a movement allowing the clinical psychologist to prescribe medication to their patients, established during the 1980s, later gaining a high-profile debate during the 1990s and 2000s (Pomerantz, 2016). For clinical psychologists to prescribe medication, they require clinical psychopharmacology training accredited by the American Psychological Association (APA).
The APA formed division 55 to advocate for the prescription privilege. It was created to enhance the psychological treatments combined with psychopharmacological medications. The APA is the association that enforces safe prescription within prescribing psychologists. Many disagree with the notion of psychologists prescribing medicines due to the lack of extensive training, causing a challenge to those psychologists looking to be able to prescribe medication. On the other hand, with a declination in psychiatry, allowing clinical psychologists to prescribe will benefit the patient significantly.
As of 2020, New Mexico, Louisiana, Illinois, Iowa, and Idaho are the only five states to give psychologists jurisdiction to prescribe medication. With a total of 171 prescribing psychology gist that accounts for 0.18% of the workforce (Robiner, Tompkins, Hathaway, 2019). The requirements vary across the jurisdiction, which typically requires passing the Psychopharmacology Examination for Psychologists (PEP).
The requirements of training vary from the profession, due to psychiatrist who are medical doctors with a residency in assessment and treatment of mental health disorders are required a minimum of 1644.55 of didactic hours with a focus on pathophysiology and an estimate of 7,680 hours of supervised clinical practice (Robiner Tompkins, Hath- away, 2019). Prescribing psychologists are required to complete an estimate of 397 didactic hours with a focus on assessment and treatment of psychiatric conditions and no national time requirements but recommended to complete 3,420 hours of clinical practice (Robiner Tompkins, Hath- away, 2019).
Prescribing psychologists enter psychopharmacology after they have completed their clinical training, in which they receive the most didactics on mental health than any other profession. Due to the lack of extensive training in other aspects of medicine, clinical psychologists face a challenge in achieving prescription privileges out of the current five states that allow it. Many have argued that training standards for clinical psychology are minimal; therefore, they should not be allowed to prescribe because they do not fully understand the symptoms of the medication. This closes the doors on many clinical psychologists looking to have prescription privilege; not only does it affect the profession from broadening its horizons, but it also affects the client. The client may have to see the psychologist for psychotherapy. Still, if medication is required, they would have to make an appointment with a psychiatrist or prescriber to obtain the prescription they need making it inconvenient and costly for the client.
With the increase of mental health awareness, more and more people seek out mental health treatment causing a shortage in psychiatrists. Allowing prescription privilege will not only help the profession of psychology but will help the client. According to the years 2010-2015, the number of psychiatry residents increased by 5.3% between the Association of American Medical Colleges (Weiner, 2018). With a small increase in psychiatry residents, allowing the clinical psychologist to prescribe medication will positively impact the people seeking professional help. Obtaining an appointment with a psychiatrist can be nearly impossible with waiting times up to a month if it’s not considered an emergency. Allowing prescription privileges the process for seeking professional help can be accelerated, making it convenient for the client. Prescription privilege can positively impact rural areas that may not have many psychiatrists. For example, according to the National Alliance on Mental Illnesses within the state of New Mexico, only 18 out of the 90 licensed psychiatrists are located outside of Santa Fe or Albu- querque, whereas 175 out of the 400 licensed psychologist in the state reside outside of those cities (Riding-Malon, Weth Jr., 2014).
With the shortage of psychiatrists, patients can seek medical help with a psychologist. Apart from offering psychotherapy, they can also prescribe medication and not wait until a psychiatrist is available to seek medication. As treatment rises, the number of psychiatrist falls, according to the National Council for Behavioral Health, in 2025, the demand may outstrip the supply by 6,090 to 15,600 (Weiner, 2018). Untreated mental illness crucially affects our society. With this opportunity, the psychologist can provide a balance between treating mental illness and aid the shortage in psychiatry.
Prescription privileges can be looked upon by other professions in the medical field. Due to psychologists not having full-fledged medical school training, as they have more minimal requirements in biology and other organic sciences, they face the challenge of not prescribing psychoactive medication to their clients. Although there are beneficial factors that prescribing psychologists contribute, for example, due to the rise of more mental health awareness and a decline in psychiatry, prescribing psychologists can help those who may not have access to psychiatry. This factor is what I find essential over the controversial topic. With more prescribing psychologists, there will be more accessible in helping those who need medication therapy. Although there is an argument on the training of a prescribing psychologist do overall during their undergraduate program is far less extensive than other professions, I believe that with a change to the curriculum, psychologists can be better trained to prescribe medication. This opens new horizons in the field of psychology and helps with the declination of psychiatry.
Conclusion
Many may argue that allowing prescription privilege and redefining the profession of psychology may have a negative impact on psychiatry since the main distinction between psychiatrists and psychologists is the prescription of medication. I think this is not the case. As we know, psychiatrists must begin as medical doctors with a residency in the assessment and treatment of mental health disorders. This will still set them apart as they have knowledge of multiple subjects in the medical field. Psychologists should be able to train with the effects that medication takes on the body as well as focus on how our mind works. This benefits the overall population due to the shortage of psychiatrists. I strongly believe that by having more safe prescribers for psychoactive medication can make it more convenient for the client and both professions.
References
Pomerantz, A. M. (2016). Clinical Psychology: Science, Practice, and Culture. SAGE
Publications
Robiner, WN, Tompkins, TL, Hathaway, KM. (2019). Prescriptive authority: Psychologists’
abridged training relative to other professions’ training. Clin Psychol Sci Pract. https://
doi.org/10.1111/cpsp.12309
Weiner, S. (2018). Addressing the escalating psychiatrist shortage.
https://www.aamc.org/news-insights/addressing-escalating-psychiatrist-shortage
Riding-Malon R., Werth Jr. J. L. (2014) Psychological Practice in Rural Settings: At the
Cutting Edge. http://dx.doi.org/10.1037/a0036172