Prescriptive authority for psychologists movement

The Prescriptive authority for psychologists (RxP) movement is a political effort to give prescriptive authority to clinical psychologists, enabling them to prescribe psychotropic medications to treat mental and emotional disorders. Prior to RxP legislation and in states where it has not been passed, this role is played by psychiatrists, who possess a medical degree and thus the authority to prescribe medication. The movement is a reaction to the growing public need for mental health services, particularly in less urbanized and therefore under-resourced areas where patients have little or no access to psychiatrists. ^[1]

In states where RxP legislation has been passed, psychologists who wish to be granted prescriptive authority must possess a doctoral level degree (PhD/PsyD) and a license to practice, and undergo rigorous post-doctoral education and training. The medications they may prescribe are limited to those indicated for mental and emotional health problems; the specific list of approved medications differs by state. The psychologist is required to collaborate with a physician on treatment.

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Supporting arguments

There are several core arguments put forth by RxP advocates, including the following:

• Other non-physicians have prescription privileges, such as optometrists, nurse practitioners, physician's assistants, and pharmacists.^[2]
• The training model is proven based on a complete lack of legal complaint after eight years regarding the practice of the initial ten psychologists trained by the U.S. Department of Defense.^[2] However, it is noted that enlisted patients cannot sue the military.
• Access to medication would be immediate as opposed to long waiting times that are sometimes necessary to see a specialist.^[3]
• It would not come at the expense of adequate training in the science of psychology, assessment, or psychotherapy because such education would be post-doctoral.^[3]
• It would address the fact that many lack access to psychiatrists (especially in rural areas) and must therefore look to general practitioners who are generally under-trained regarding psychotropic medications.^[4][5]
• It would make a clear separation between doctoral and masters-level practitioners.^[4]
• It would allow the psychologist control of the entire treatment process, which would avoid the complications of interprofessional collaboration while also saving clients money.^[4]
• Adding competence to consult with general practitioners who need professional advice regarding psychotropic medications.^[6]
• Psychopharmaceutical training allows for better client advocacy.^[6]

Opposition

Opponenets cite the declining relevance of doctorate level clinical psychology training in the setting of todays mental health care system. Clinical social workers, nurse practitioners, master's level psychologists, and physician assistants have been increasingly prevalent. These professionals may also be quite effective in practicing psychotherapy. Thus, there is a reported decline in demand for doctoral-level clinical psychologists. Thus, there is an increasing threat to psychology training programs to remain relevant. Many such programs support prescription priveledges as it may increase the number of tuition-paying applicants to their programs.

Other opponents to legislative efforts to expand prescription authority to psychologists cite the presence of existing physician assistant, nurse practitioner, and medical school programs that prepare students to prescribe medications. They believe that the separate development of psychologist psychopharmacology training programs is redundant and not cost-effective.

Opponents also cite the fact that the Department of Defense program was shut down in 1998 due to a GAO report stating that training psychologists to prescribe did not produce a clear benefit to patients and that it actually increased costs.

Opponents argue that the required training programs are too short and that psychologists completing this training will not be adequately equipped to understand the biomedical effects of a medication and thus anticipate possible adverse reactions, interactions with other medications or side effects, thus putting patient safety at risk. ^[7]

Additionally, critics express concern that, if RxP became the norm, the biomedical approach would begin to encroach on the traditional psychology curriculum and clinicians in training would receive less grounding in psychotherapeutic interventions and research. ^[8]

History

In 1988, the U.S. Department of Defense approved a pilot project to train psychologists in issuing psychotropic medications "under certain circumstances". Guam became the first U.S. territory to approve RxP legislation in 1999. New Mexico became the first state to approve RxP legislation in 2002, and Louisiana followed in 2004. As of April 2007, 5 other states have introduced RxP bills that are under discussion but have yet to be approved. ^{[1] [9]}

References