Introduction
The prescription privileges debate has been one of the most long-lasting discussions in modern psychology of North America and the UK. According to Ashkanazi (2011), “Prescription Privileges is the term used to describe a political effort/movement in a state legislature to obtain prescriptive authority for properly trained psychologists, which would enable them to prescribe psychotropic medications for the treatment of mental health disorders.” Various contextual factors are involved, which are necessary to fully understand the problem. These include the interests of pharmaceutical companies, the urge to reduce the costs across the healthcare spectrum, and an oversupply of doctoral-level psychotherapists (Lavoie & Barone, 2006). Other factors include the “anticipated shortage of physicians in Canada, as “boomer” physicians retire and younger physicians seek a different work-life balance” (Sketris, 2009, p. 17). The proponents of prescription privileges insist that these factors imply adequate reactive measures. The opponents argue that there are safer approaches that do not strongly influence the field of psychology itself. While generally, the issue is still in limbo, there have been some advancements lately, such as the establishment of an Advisory Council on the Implementation of National Pharmacare.
Position and Arguments
This paper will advocate for granting adequately trained psychologists prescription privileges. This position is based on three main arguments that will consider reducing costs for the general public, increasing accessibility of healthcare, and the issue of professionalism of prescribers. Moreover, counterarguments by the opponents of the prescription privilege will be featured, reviewed, and analyzed within this paper. Finally, the results will be discussed, and a proper conclusion based on this data will be drawn.
Accessibility
Firstly, regarding accessibility, there is an opinion that currently, societal needs in the field of mental health are not met, and this problem will only worsen in the future with the mass retirement of boomers. According to Anderssen (2020), “Half of all Canadians live in parts of the country where the number of psychiatrists falls below the ratio recommended by a panel of experts with the Canadian Psychiatric Association; 2.3 million Canadians live in areas with no permanent psychiatrists at all.” Moreover, half of the Canadian psychiatrists are over the age of 55, and the replacement rate is lower than the retirement rate (Anderssen, 2020). At the same time, the demand for psychiatric assistance grows daily, and it will continue to do so in the future. Overall, it is undeniable that the problem exists and gets progressively worse year by year.
A relatively radical yet timely measure of granting adequately trained psychologists prescription privileges can be perceived as a necessity in times when the number of psychiatrists shrinks rapidly. The Canadian Code of Ethics for Psychologists suggests that psychologists should have a proactive position when it comes to vulnerable and underserved groups (Canadian Psychological Association, 2017). Prescription privileges may allow psychologists to be more active in helping vulnerable groups, whose number will only grow in the coming years.
Costs
Secondly, regarding the costs, the current situation when a person may have to consult two different professionals whose opinions on the issue may be dissimilar is ineffective in terms of both time and money spent. At the moment, such a necessity creates additional barriers for people who may need mental health services. In this case, granting psychologists prescription privileges will improve the continuity of care, and make the process more cost-effective, easier, and more accessible for different socio-economic groups. Furthermore, general healthcare costs for patients will decrease as well, as, on average, psychologists charge less than psychiatrists do for the same service (Lavoie & Barone, 2006). Overall, the proposed change regarding prescription privileges has the potential to significantly lower the costs of mental health services, thus increasing inclusivity.
Professionalism
Finally, regarding the professionalism of prescribers, it may be safer to let psychologists prescribe medicine rather than physicians. Physicians, being general specialists have higher chances of making mistakes when prescribing compared to additionally trained psychologists, who will be able to prescribe safely and effectively in that case. Moreover, newer antidepressants that are prescribed extensively by psychotherapists are considered relatively safe, which further decreases any risks associated with higher accessibility (Lam & Kennedy, 2004). This position is accepted and confirmed by different researchers (Lavoie & Barone, 2006). For instance, according to independent reviews, the US-based DoD project prepared ten psychologists who demonstrated very high levels of competence regarding care and medical prescriptions (American College of Neuropsychopharmacology, 1998). There is no reason to assume that such programs cannot be copied and implemented on a larger scale.
While such implementation creates additional educational costs, these training programs may still be more efficient than other alternatives mentioned earlier. This is further supported by Canadian psychology students and professionals, who believe that adequately trained psychologists should be able to prescribe medication (St-Pierre & Melnyk, 2004). Thus, this may be a relatively cost-efficient way of safely expanding access to professional mental health services for the county’s population.
Counterarguments and Analysis
The counterarguments to the point regarding the accessibility of psychiatric services often consider alternatives, such as an increase in the attractiveness of psychiatry as a profession. For instance, the Ontario Psychiatric Association (2018) article mentions such ideas as psychiatry exposure in medical schools, increasing the competitiveness of psychiatry with other specialties, increasing psychiatry residency spots, and reducing residency vacancies. While these policies are worth implementing, their presumable success is a matter of decades, and they do not solve the current crisis. Therefore, until there is some other plan that can ensure an increase in the supply of specialists to meet the rapidly growing needs, the expansion of prescription privileges seems to be the only correct reaction.
The debate around cost efficiency has a lot of issues regarding data. The opponents of the prescription privilege expansion argue that the costs of additional training will be high, while the benefits of continuity will be limited (Lavoie & Barone, 2006). The problem is that it is impossible to tell currently, as precise measurements are non-viable, and alternatives cannot be directly compared from a financial point of view. Still, both scenarios may be possible, and outputs can vary a lot based on the inputs and efficiency of the mechanism. Finally, according to the opponents of the prescription privilege, the examples of successful programs such as DoD are not enough to conclude just yet, and further experiments are to be conducted. While that is a reasonable position, from the proponents’ point of view, the logic behind the argument about professionalism still stands.
Conclusion
Overall, the issue of prescription privileges has been and still is one of the most debatable topics in modern psychology. This paper reviewed some of the classical arguments for expanding prescription privileges and analyzed the relevant counterarguments. It can be observed that currently, it is impossible to come to a definitive conclusion that will resolve the debates forever due to the lack of data. Therefore, it is necessary to conduct more experiments and gather data across countries to get closer to the objective answer. However, the logic of the position that prescription privileges should be granted to adequately trained psychologists stands and becomes more relevant year after year.
References
American College of Neuropsychopharmacology. (1998). DoD prescribing psychologists: External analysis, monitoring, and evaluation of the program and its participants.
Anderssen, E. (2020). Half of Canadians have too few local psychiatrists, or none at all. How can we mend the mental-health gap? The Globe and Mail.
Ashkanazi, G.S. (2011). Prescription Privilege. In Kreutzer J.S., DeLuca J., Caplan B. (Eds.), Encyclopedia of clinical neuropsychology. Springer.
Brandt, J., Shearer, B., & Morgan, S.G. (2018). Prescription drug coverage in Canada: A review of the economic, policy and political considerations for universal pharmacare. Journal of Pharmaceutical Policy and Practice, 11(28).
Canadian Psychological Association. (2017). Canadian code of ethics for psychologists (4th ed.). Author.
Lam, R.W., & Kennedy, S.H. (2004). Prescribing antidepressants for depression in 2005: Recent concerns and recommendations. The Canadian Journal of Psychiatry, 49(12), 1-6.
Lavoie, K. L., & Barone, S. (2006). Prescription privileges for psychologists: A comprehensive review and critical analysis of current issues and controversies. CNS drugs, 20(1), 51–66.
Sketris, I. (2009). Extending prescribing privileges in Canada. Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 142(1), 17–19.
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 / Psychologie canadienne, 45(4), 284 – 292.