Adopted by the Board of Directors of the American Association for Geriatric Psychiatry in October 2004
Position 1: Prescribing privileges for psychologists is a patient safety issue because psychologists are not qualified to prescribe medication.
Rationale: Psychologists, who can earn a PhD by taking only a single course in the biological basis of behavior, are trained in the social and behavioral sciences and provide services that do not physically invade the body cavity, such as psychological assessment and psychotherapy. During the training, which typically occurs in a non-medical setting, they do not observe or participate in the treatment of patients with medical illnesses or patients with comorbid physical and mental illness. Their training and experience is relating to patients with mental health conditions. This limited training does not adequately prepare psychologists to detect and treat concomitant non-mental illnesses or to understand and deal with the interactions of psychotropics with other medications prescribed to help other medical conditions.
The problem is exacerbated in the treatment of geriatric patients, who are most often affected by comorbidities and require a sophisticated level of medical expertise in all phases of treatment, including prescription medications. Safe patient care requires that the treatment of other illnesses and the effects of other medications be integrated with the use of psychotropics.
The psychotropic medications used to treat mental disorders are among the most powerful available to modern medicine. Psychotropic medications have potential disabling and deadly side effects. For example, many antidepressant medications can cause a stroke, coma, seizures and tremors. This situation is further complicated among geriatric patients by the fact that pharmaceutical studies on the safety and efficacy of new drugs typically exclude older adults, making the medical judgment required for prescribing even more important. There are no simple algorithms for prescribing medications for geriatric mental health patients.
Effective use of mediations to treat brain disorders requires medical training, with a thorough understanding of physiology, chemistry, drug interactions and medical problems that masquerade as or cause brain malfunctions. Diagnosing and using medications to treat mental illnesses such as clinical depression and schizophrenia requires the same level of medical skill and knowledge as diagnosing and treating heart disease or diabetes. It is as important to know when not to prescribe as when to prescribe.
Position 2: Psychologists do not have the medical model training of non-physician providers who have limited prescribing authority.
Rationale: Non-physician health providers (e.g., nurse practitioners, clinical nurse specialists, physician assistants, optometrists) who have prescriptive authority have substantial training in the medical model, which psychologists do not have. Furthermore, in most states, advanced practice nurses and physician assistants are authorized to dispense limited types of medications (e.g., birth control pills, antibiotics, topical skin medications) under physician supervision. Podiatrists and dentists, whose prescribing privileges are respectively limited to the foot and the mouth, are trained in the medical model.
Some psychologists do prescribe as licensed nurse practitioners or physician assistants. This avenue to earn prescribing privileges through medical education is open to them.
The prescribing training program proposed by organized psychology will not provide psychologists with the medical training necessary to prescribe psychotropic medications safely. The American Psychological Association’s model curriculum for training psychologists to prescribe -- a two-year program of evening, weekend or home study courses -- requires only 300 hours of didactic instruction, and a clinical practicum involving 100 patients. Continuing education courses on pharmacology taken by psychologists are not approved by medical authorities or medical colleges. Such psychology-focused and developed courses are no substitute for medical education.
Position 3: There is no societal need to grant psychologists prescribing privileges.
Rationale: There is no shortage of prescribing professionals, nor is there consumer demand for additional prescribers. Training psychologists to prescribe unnecessarily duplicates health care services already provided by medical professionals.
Psychologists are not geographically better situated to serve rural populations, as they are generally located in the same area as psychiatrists. The needs of underserved areas can best be met by improving the mental health training of general physicians and other medically trained practitioners, who are more widely distributed than psychologists.
Granting psychologists prescribing authority would increase health care costs. Psychologists’ liability insurance would rise dramatically and additional training and regulatory resources would be needed. These costs would be passed on to patients and taxpayers.
Position 4: Prescribing authority for psychologists would compromise patients’ access to effective collaborative treatment.
Rationale: High quality and cost effective treatment for mental health consumers can be provided by collaboration between psychologists and medical professionals. This type of collaboration has worked for many years.
The responsibility for patients’ medical care should rest with those professionals who have medical training and experience.
Position 5: The issue of psychologists’ prescribing is divisive within the profession of psychology.
Rationale: Many psychologists, both practitioners and academicians, as well as the American Association of Applied and Preventive Psychology (the American Psychological Association’s clinical affiliate) and the Society for the Science of Clinical Psychology (a division of the American Psychological Association) oppose prescription privileges for psychologists.
Prescribing would change the nature of clinical psychologists’ practice and training at the undergraduate, graduate, post-doctoral and continuing education levels. Many psychologists do not want their profession to be legislatively defined.
Prescription authority, when sought by other non-physicians, such as advanced practice nurses, was not controversial within the profession because their training was already medical in nature.