Let them prescribe!

Psychologists are trained professionals with expertise in various types of mental health and therapy. In order to be practicing, each has to obtain a doctoral degree in the field of psychology. In order to be licensed in the state of Hawaii, an additional one year of training is required as part of an internship under the guidance of an already licensed psychologist.

Psychiatrists are trained medical doctors who have completed four years of medical school and after that,  four years of additional training in their chosen field. They are therefore experts in some of the same techniques available to psychologists, and many more. The big difference is that psychiatrists have the ability to prescribe and regulate medications for their patients.

There is a movement this session in the Legislature to have Hawaii join other states, such as New Mexico, Louisiana and Illinois, in allowing psychologists to receive extra training and obtain the authority to prescribe medications.

Psychologists who receive extra training should be able to prescribe.

Pöllö via Wikimedia Commons

The rationale is that there aren’t enough psychiatrists available nationwide, especially in rural communities, and one way to fill the unmet need would be to allow psychologists not only to see patients for therapy, but to prescribe medications, as well.

Seems simple enough, right?

In medical practice, there are nurse practitioners who have prescribing abilities; physician assistants can prescribe, as well. Given the increasing demand for medical services, and the growing shortage of doctors, it only makes sense to find creative ways to fill the widening gaps that can help people to have greater access to the services they need.

Many urgent care clinics are typically staffed by non-physician personnel, such as nurse practitioners. It’s become part of the normal practice to increase availability, especially after-hours when working people might need services and their doctor’s offices are closed. Although it took awhile for medical doctors to accept it, we all have. Now such practice is commonplace.

It’s reasonable to expect, then, that the medical community would be on board for expanding prescription-writing approval to medical professionals who can handle mental health issues. Well, not so fast. At least not yet.

The center of the debate lies in the ability of psychologists to be able to fully grasp the complexity of prescribing medication and potential side effects without going to four years of medical school and beyond.

If a patient sees a psychologist and needs medication, she/he has to find a medical doctor to prescribe it. In some rural areas, there are no available psychiatrists, and finding a doctor taking new patients is not as easy as it sounds.

According to the U.S. Centers for Disease Control, 11 percent of Americans over the age of 12 are taking antidepressants, and of these, less than one-third have seen a mental health professional in the last year. Where are they getting the medication? Their primary care providers, pediatricians, internists, and family practitioners.

So, how much training do internal medicine doctors, like myself, receive in school about psychiatry? In the first year of medical school there is a semester-long class in pharmacology that reviews all medicines, and in the third year, a four-week rotation in psychiatry. During my residency training, I had an additional four weeks. Total time: eight weeks with a few days of pharmacology class hours dealing with mental health medicines. That’s it.

Although I am not trained in the field of psychiatry as an internist, I have the same ability to prescribe medications that they do. Perhaps not as well, since I didn’t spend the additional four years in training, but I routinely prescribe antidepressants, anti-anxiety medications and more.

Why shouldn’t psychologists be able to do the same?

I wholeheartedly support additional training to receive prescribing certification. I wouldn’t mind a refresher myself. But the best way to manage medicines is to use them as an adjunct to therapy, and I have no doubt that a psychologist with a doctoral degree can learn the intricacies necessary to achieve the same level of knowledge as I do about the different types of medications, side effects and monitoring.

Other states have made this change, creating a separate certification for those who choose to take psychopharmacology classes, pass strict examination requirements and receive additional training similar to what I had to do in medical school.

Helping everyone in Hawaii access the mental health services they need should be something we can all agree on. This is one step in the process that needs to be more carefully considered.