prescription privileges

Prescription Privileges

Should Psychologists have the right to prescribe?

Leanne Fraser

November 8, 2005

Field of Psychology• Psychology can be defined as being directed

toward psychological and behavioural interventions that result in more adaptive functioning (Fox, Barclay, & Rogers, 1982, as cited in

DeNelsky, 1996).

• The field of psychology is not a unitary entity, but a grouping of vastly differing models of study and practice (Klein, 1996)

Psychoactive Drugs

• A psychoactive drug or psychotropic substance is a chemical that alters brain function, resulting in temporary changes in perception, mood, consciousness, or behaviour

The Privilege Debate

Five key issues:

1. Heritage of Psychology

2. Effectiveness of Psychoactive Drugs

3. Education and Training

4. Effect on Psychology as a Profession

5. Public Interest

Heritage of PsychologyAgainst

• Psychology

• Psychological intervention

Heritage of PsychologyFor

• As in every other field, psychology has to move with the times and should welcome the opportunity (Klein, 1996)

• Results from current opinions should not direct the future (Naussbaum, 2001)

Effectiveness of Psychoactive DrugsAgainst

• Effectiveness is overstated (DeNelsky, 1996)

• Psychoactive drugs are over-prescribed (Dobson & Dozois, 2001)

Effectiveness of Psychoactive Drugs

For• When psychotherapy is effective, significant

neurobiological alterations have occurred (Naussbaum, 2001)

• There are times when psychotropic medications will be effective where psychotherapy will not (Naussbaum, 2001)

Education and TrainingAgainst

• More time learning about medications than about psychotherapies (DeNelsky, 1996)

• Lengthy and Costly (Hayes, Walser, & Bach, 2002)

Education and TrainingFor

• Lesser trained medical specialists already prescribing psychotropic medication (Cullen & Newman, 1997, as cited in Walters, 2001)

• Lengthy education not an issue (St-Pierre & Melnyk, 2004)

Effect on Psychology as a Profession

Against • Greed (DeNelsky, 1996)

• Dilute the identity of psychologists (Dobson & Dozois, 2001)

Effect on Psychology as a Profession

For• Propel therapeutics to new levels

(Nussbaum, 2001)

• Enhance income and status (Healy, 1995, as cited in Walters, 2001)

Public InterestAgainst

• Lack of demand (DeNelsky, 1996)

• Privileges will not change attendance to certain populations (Dozois & Dobson, 1995)

Public InterestFor

• Psychotherapy patients use psychotropic drugs (Olfson & Pincus, 1994, as cited in Pagliaro, 1995)

• Medication being prescribed without proper knowledge (Zimmerman & Wienckowski, 1991, as cited in Walters, 2001)

New Mexico

• Prescription privileges for psychologists

• Law employs a two-step process

• Still some controversy

Possible Solutions from the Opposition

• Doctorate in Mental Health (Hayes et al, 2002)

• Collaboration between medical practitioners and psychologists (Dobson & Dozois, 2001)

What Does the Majority Think?

Study conducted by St-Pierre & Melnyk (2004)

• Surveyed Canadian psychology students and clinical psychologists

Questions Posed• 1. “Do you think it is possible for psychologists to

attain the required training in order to properly prescribe psychotropic medication?”

• 2. “Do you think the attainment of prescription privileges is theoretically or philosophically opposed to the field of psychology?”

• 3. “Do you think that the attainment of prescription privileges would compromise psychological service delivery in any way?”

• 4. “How probable do you think it is that Canadian psychologists will ever attain prescription privileges?”

Results

• Trained psychologists should have prescription privileges

• CPA should advocate for prescription privileges

• Graduate students would seek privileges

• Do not believe rights will be granted

Graduate Studies

Keith Dobson PhD

University of Calgary

Can obtain a PhD in Clinical Psychology

Edouard St-Pierre

Lakehead University in 2004

ReferencesDeNelsky, G. Y. (1996). The case against prescription privileges

for psychologists. American Psychologist, 51(3), 207-212.Dobson, K. S., & Dozois, D. J. A. (2001). Professional psychology

and the prescription debate: Still not ready to go to the alter. Canadian Psychology, 42(2), 131-135.

Dozois, D. J. A., & Dobson, K. S. (1995). Should Canadian psychologists follow the APA trend and seek prescription privileges? A reexamination of the revolution. Canadian Psychology, 36(4), 288-304.

Hayes, S. C., Walser, S. D., & Bach, P. (2002). Prescription privileges for psychologists: Constituencies and conflicts. Journal of Clinical Psychology, 58(6), 697-708.

Klein, R. G. (1996). Comments on expanding the clinical role of psychologists. American Psychologist, 51(3), 216-218.

ReferencesNussbaum, D. (2001). Psychologists should be free to pursue prescription

privileges: A reply to Walters. Canadian Psychology, 42(2), 126-130.Pagliaro, L. A. (1995). Should Canadian psychologists follow the APA

trend and seek prescription privileges? Of course they should! An invited critical commentary of Dozois and Dobson. Canadian Psychology, 36(4), 305-312.

Pettifor, M. E. J., & McCrea, S. (1997). The Canadian code of ethics and the prescription privilege debate. Canadian Psychology, 38(1), 49-51.

St-Pierre, E. S., & Melnyk, W. T. (2004). The prescription privilege debate in Canada: The voices of today’s and tomorrow’s psychologists. Canadian Psychology, 45(4), 284-292.

Walters, G. D. (2001). A meta-analysis of opinion data on the prescription privilege debate. Canadian Psychology, 42(2), 119-125.

White, J. H. (2003). APNA participates on task force on psychologists prescribing. Journal of the American Psychiatric Nurses Association, 9(2), 68-70.

What do you think?