Psychologists Prescribe Wrong Cure for Mental Health Care
By Joel Yager, M.D. UNM Medical School
State legislators, strongly lobbied by psychologists, are considering a bill to permit psychologists to prescribe psychiatric medications to their patients. The bill, HB 170, has already passed the House and is on its way in the Senate.
No other state in the country permits psychologists to prescribe, and for very good reasons. Psychologists are not physicians. The training they propose will not qualify them to prescribe safely. Psychology Ph.D's are well prepared to provide therapy and counseling. However, as many psychologists in our state agree: Permitting them to prescribe psychiatric medication is a bad idea.
We all want more general and child psychiatric care in our underserved rural areas, but giving psychologists prescription pads is not the way to do it. Studies elsewhere have already shown that psychologists are no more likely to practice in remote, rural areas than psychiatrists are. The proposed legislation would primarily allow those psychologists already concentrated in the state's larger cities to prescribe, not get psychologists out to rural areas.
The really bad consequence is that if psychologists in New Mexico are permitted to prescribe medications, we will have even more difficulty attracting qualified general and child psychiatrists to the state.
Psychologists propose taking course work at New Mexico State University, an outstanding institution of higher learning, but one that lacks both a medical school and a school of pharmacy, the types of schools necessary to provide the level of education required to prescribe medications. The psychologists then propose doing the equivalent of about 10 weeks of clinical work, which can be supervised by a single physician, in contrast to the several thousands of hours of training over four years after completing medical school in which psychiatrists have to be supervised by an entire medical faculty.
And, the fact is, most of the physicians from whom psychologists would seek supervision are family physicians. Our family physicians are themselves clamoring for more psychiatrists to whom they can refer their patients with serious mental illness, because they often feel unprepared to manage these complex patients. How can these busy rural physicians also do a competent job of supervising psychologists?
We are not just talking about prescribing antidepressant or anti-anxiety medications. We're talking about specialized medications for bipolar disorder, for schizophrenia and substance abuse as well as a host of other serious conditions.
People with psychiatric illness and with alcohol or substance abuse problems have twice as many medical problems as the population at large. All of the psychiatric medications have extremely complicated effects on the organs and immune system and complex interactions with other medications. That's why psychiatrists go to medical school.
We all know that New Mexico doesn't have enough neurosurgeons. Would you want us to provide more neurosurgical care by giving your nurse night or weekend courses for a year and then letting her operate on your brain under the supervision of your family doctor? Yet that is essentially what the psychologists are proposing for their training in psychopharmacology.
If the profession of psychology wants to evolve to the point where serious training in clinical psychopharmacology is desired, they should do it the right way. They should do the hard preparatory work of studying organic chemistry, biochemistry, and the anatomy, histology, physiology, pathology and clinical pharmacology of the whole body and then put in a substantial amount of time doing clinical training and being supervised in the use of medication under the guidance of highly qualified clinical psycho-pharmacologists including psychiatrists in both inpatient and outpatient settings.
They should have experience treating the seriously mentally ill, the aged, the children, and medically ill patients with psychiatric disorders to assure that they are really competent to treat your family. And, it would make sense for them to undertake that training in a setting where a medical school and school of pharmacy are present. Such schools are the only institutions of higher learning New Mexico authorizes to train health professionals who have prescribing privileges — physicians, upper level pharmacists, and higher level nurse-clinicians.
The psychologists' program has never been independently evaluated, and the program has not been proven safe. Understand that this would be an experiment. These psychologists would be allowed to treat patients of all ages, but there are no provisions for special training for children, for example, whereas child psychiatrists do two full additional years of training after general psychiatric training to be adequately prepared to treat children.
Do you want your child, elderly parent or other relative treated by someone with a very limited amount of unproven training? We strongly doubt that the legislators or the citizens of New Mexico really want to offer up their families to be guinea pigs for the sort of experiment these psychologists are currently proposing.
Joel Yager, M.D., is professor of psychiatry at the University of New Mexico School of Medicine, and a medical professor emeritus at the University of California at Los Angeles. Drs. Neil Arnet, Mary De Luca, James Goodman, and Laura Roberts contributed to this article. The Psychiatric Medical Association of New Mexico fully supports the views expressed.
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