Psychologists and medications in the era of interprofessional care: Collaboration is less problematic and costly than prescribing.

Abstract

Increasing emphasis on interprofessionalism and teamwork in healthcare renders psychologists' collaborations critical and invites reexamination of psychologists' roles related to medications. The Collaboration Level outlined by the APA's Ad Hoc Task Force is more achievable and in synch with health reform than prescription privileges (RxP). RxP remains controversial due to training and safety concerns, lacking support from health professionals, psychologists, and consumers. Differences in educational preparation of psychologists relative to prescribing professionals are discussed. Enactment of only three of 170 RxP initiatives reveals RxP to be a costly, ineffectual agenda. Alternatives (e.g., integrated care, collaboration, telehealth) increase access without risks associated with lesser medical knowledge. Concerns about RxP and the movement toward team-based care warrant reconsideration of the profession's objectives regarding psychopharmacology. Collaboration and Prescribing 3Psychologists and Medications in the Era of Interprofessional Care: Collaboration is Less Problematic and Costly Than PrescribingThe premise that doctoral-level psychologists should prescribe psychoactive medications to meet mental health needs that are unmet by current prescribers, while theoretically helpful if done well, warrants reassessment as we enter an era emphasizing team-based healthcare. Concerns about the background, breadth and comprehensiveness of training for prescribing that the American Psychological Association (APA) currently advocates to complement psychologists' doctoral training (i.e., most of which is not oriented toward preparing to prescribe) have been raised; many psychologists believing that if psychologists are to prescribe their knowledge and training should be equivalent with that of other prescribers (Baird, 2007). Compromised training for prescribing raises questions about quality and safety that pose both regulatory and public health concerns, and uneasiness for numerous stakeholders. Consideration of whether or not organized psychology should pursue prescriptive authority also should be assessed within the context of existing alternatives-e.g., interdisciplinary care, in which psychologists collaborate with other professionals whose medical training allows more comprehensive management of medications compelling healthcare trends that provide psychologists opportunities to contribute substantively to patient care, but that lack the controversy of the agenda promoting prescription privileges for psychologists (RxP). We also review some of the history and concerns about psychologist prescribing, the relative limitations of the APA training model, and the impact of the pursuit of prescription privileges on the field, including the limited success and substantial costs of its legislative record. Medication TrendsMedications serve important roles in the arsenal of mental health treatments.According to the Substance Abuse and Mental Health Services Administration (SAMHSA; 2012), use of psychoactive medi...

Prescriptive authority: Psychologists’ abridged training relative to other professions’ training.

“…Recent changes to the MCAT and competencies and principles outlined in Scientific Foundations for Future Physicians resulting from the AAMC partnership with the Howard Hughes Medical Institute (HHMI) suggest synergy between premedical and medical education that integrates broad-based science competencies and greater knowledge in behavioral and social health, communication, and cultural competence (AAMC/HHMI, 2009). Robiner et al (2013) address the importance of psychologists' roles as members of interdisciplinary teams, noting that changes in care delivery highlight the need for psychologists to collaborate effectively rather than prescribe. Integrating mental health services in primary and specialty care settings may improve access and leverage psychologists' impact given that there are more physicians, NPs, and PAs who prescribe than mental health prescribers.…”

“…To date, five states have granted psychologists prescriptive authority (see Table ). Despite these milestones and other initiatives, stakeholders, including psychologists, question the appropriateness and ponder the benefits, challenges, impact, and necessity of RxP (e.g., Robiner, Tumlin, & Tompkins, ; Stuart & Heiby, ). McKay () noted a generation of psychologists has been exposed to a preponderance of messages about the virtues of, and relatively little about, the downsides of RxP (Baird, ; Fagan, Ax, Liss, Resnick, & Moody, ; Robiner et al, , ; Sammons, Gorny, Zinner, & Allen, ; St. Pierre & Melnyk, ; Tompkins & Johnson, ; Walters, ).…”

What Oregon Psychologists Think and Know About Prescriptive Authority: Divided Views and Data‐Driven Change

“…Opponents, however, question the adequacy of these claims, raising concerns about the current APA training model, in terms of background, breadth, and comprehensiveness of training, and questioning the parallels made between RxP and other non‐physician prescribing training (Heiby, ; Heiby et al., ; Robiner, Tumlin, & Tompkins, ). For example, in his review of the history of RxP training models, Robiner et al.…”

“…Echoing worries about safety, Hawaii's Governor cited consumer protection concerns in her rationale for vetoing Hawaii's bill in the only other state besides Oregon where enabling legislation passed both legislative chambers (Lingle, ). Although opponents are often portrayed by proponents as unnecessarily raising concerns about potential health hazards (e.g., Resnick & Norcross, ), there is wisdom in exploring established routes that require a prerequisite science background and would not require legislative capital that could better be used to increase interprofessional care (Heiby et al., ; Robiner et al., ).…”

Common Misconceptions About Psychopharmacology In Undergraduate Psychology And Pharmacy Students

“…Also, clinical psychologists greatly contribute to the identification, support, as well as management of mental disorders; and even in some countries, they are able to prescribe psychotropic medication (Robiner et al, 2013). However, opportunities for collaboration between pharmacists and clinical psychologists remain relatively unexplored or in need of further development (Supper et al, 2015).…”