Academic journal article American Journal of Law & Medicine

Fool's Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

Academic journal article American Journal of Law & Medicine

Fool's Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

Article excerpt

I. INTRODUCTION

Mental illness is a serious problem in the United States. Based on "current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year."1 Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians2 write more of them.3 State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications.4 Over the past decade other groups have gained some form of prescriptive authority.5 Currently, psychologists6 comprise the primary group seeking prescriptive authority for psychotropic medications.7

The American Society for the Advancement of Pharmacotherapy ("ASAP"),8 a division of the American Psychological Association ("APA"),9 spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists' education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians;10 2) the Department of Defense Psychopharmacology Demonstration Project ("PDP") demonstrated non-physician psychologists can prescribe psychotropic medications safely;11 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications;12 4) this privilege will increase availability of mental healthcare services, especially in rural areas;13 and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two-one for psychotherapy and one for medication.14 Conversely, some organizations challenge these contentions as unfounded and oppose granting psychologists prescriptive authority.

The American Psychiatric Association (the "Association")15 is the strongest opponent to granting psychologists prescriptive authority. The Association argues "safe and effective use of potent psychotropic medications requires extensive medical training and a thorough understanding of the brain and body."16 Accordingly, psychologists lack the requisite education and training to safely prescribe such medication.17 The Association contends "the needs of rural and other underserved patients can best be met through collaboration between psychiatrists and other medical professionals."18 Along with the Association, the Committee Against Medicalizing Psychology opposes granting psychologists prescriptive authority because they believe this privilege would diminish the traditional benefits of talk-therapy.19

This Article challenges the psychologists' arguments, favoring legislative approval that grants them prescriptive authority. While the data show primary care physicians do lack expertise at treating mental illness,20 psychologists are at an immensely greater deficit of assessing and treating non-mental health illnesses, even with additional post-doctorate training.21 As for the PDP study, it did show successful training of non-physician psychologists,22 however, it did so under controlled, military settings.23 It is grossly inappropriate to argue this study "conclusively demonstrated psychologists' ability to prescribe safely and effectively,"24 especially in regard to non-military psychologists prescribing independently.25

The psychologists seeking prescriptive authority further contend their behavioral science education26 ensures they can prescribe safely.27 Yet, these psychologists complete fewer science courses and shorter clinical internships than nurses trained under the medical model,28 and who possess no prescriptive authority.29 The psychologists skew their arguments, avoiding discussion of the potentially catastrophic effects on patients suffering from missed or incorrect diagnoses, missed drug interactions, missed drug side-effects, incorrect test interpretations, or missed necessary test orders due to the psychologists' inferior medical background. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.