Psychologists to Prescribe Medications with Canadian Doctors
In a USA Today article entitled "Who gets to prescribe?", Linda Temple reports that the National Society of Clinical Psychopharmacologists (NSCP) will have their members, who consist of individuals with doctorates in psychology with additional post-doctoral training in pharmacology, prescribe mental health medications that are reviewed and countersigned by Canadian doctors. Once the prescription is approved a Canadian supplier will then mail the prescription to the patient, located in the United States, at cut-rate prices.
Many individuals, medical groups, and patient advocates oppose measures whereby psychologists prescribe psychotropic medications for the primary reason that they do not have the medical knowledge necessary to effectively monitor side effects and understand how the medications affect other functions of a person's body, not just their mind. Psychologists contend that they are filling a void created by the shortage of psychiatrists, especially in rural area's. They also argue that there are others who have prescription priviledges with much less medical training than they intend to have, these include optometrists, podiatrists, nurse practitioners, physicians' assistants, veterinarians and even some midwives.
The last ten years have shown a stronger and stronger attempt at passing Psychologist Prescribing Priviledges legislation at the state level and in 2002 it was passed for the first time in New Mexico. Passion was high on both sides of this issue and regulations regarding the amount of training are still being analyzed and agreed upon. In response to this the NAMI Policy Research Institute (NPRI) convened a meeting of experts and stakeholders to discuss the complex issues surrounding the debate on prescribing privileges for psychologists as well as serious human resource shortages in the mental health workforce.
Based on the perspectives of psychiatrists, psychologists, psychiatric nurses, and county behavioral health directors on these issue and independent research conducted by NAMI staff, the following policy was adopted by NAMI’s Board of Directors.
Prescribing Roles and Impacts on Safety and Quality
- It would not be appropriate at this time for NAMI to adopt a position in support of state legislation allowing prescribing privileges for psychologists.
- Implementation of the New Mexico law granting prescribing rights to psychologists should be carefully monitored, through the Policy Research Institute and other vehicles, to assess its impact on patient safety and outcomes as well as its impact on addressing serious human resource shortages in public sector mental health.
- There appear to be a serious lack of clinical protocols guiding advance practice psychiatric nurses and other non-psychiatrists authorized to prescribe psychiatric medications regarding when to seek psychiatric supervision or transfer complex cases to psychiatrists. Clinical protocols and algorithms should be developed to guide practitioners in these treatment considerations.