Counterpoint

October 1, 1997
David Schultz, MD

Volume 14, Issue 10

The psychologists appear to believe that large numbers of untreated mentally ill would get better if their psychologists could prescribe medication for them, thereby making up for a resource-poor and underfunded mental health system. There is no lack of prescribers. Psychiatrists know that the biggest problem for the mentally ill isn't a lack of medication, it is the dearth of supportive services available to augment, among other treatments, the taking of medication. So why are psychologists fleeing the duties they have long been mandated to provide? The answer is simple: Money.

ArticlePointIn a bid to expand their turf and increase revenues, certain California psychologists have persuaded state senator Richard Polanco (D-Los Angeles) to seek medication prescribing privileges for them.

The psychologists appear to believe that large numbers of untreated mentally ill would get better if their psychologists could prescribe medication for them, thereby making up for a resource-poor and underfunded mental health system.

There is no lack of prescribers. In fact, an oversupply of qualified physicians argues merely for better utilization. Psychiatrists know that the biggest problem for the mentally ill isn't a lack of medication, it is the dearth of supportive services available to augment, among other treatments, the taking of medication. This is the very kind of care that psychologists are trained to provide. So why are psychologists fleeing the duties they have long been mandated to provide? The answer is simple: Money.

In sharp contrast to the jackpot this could represent for psychologists, the taxpayer is hardly likely to benefit financially from a law that would allow thousands of psychologists to start tossing around drugs that can cost anywhere from $1 to $20 a day. The argument that they will charge less than a physician to hand out medications doesn't hold water. Even if they did charge less for a while, it won't be long before they try to raise prices by arguing that, since they are doing the same work as doctors, they should be paid the same. Medicines won't be any cheaper, but those who prescribe them will be less well-trained. Costs won't drop, but quality will. Then social workers will complain about not having prescription privileges and use the same arguments the psychologists are using now. Even if these methods save money in the short run, the benefits will be offset by the costs of litigation and human suffering that are sure to result.

Psychologists with Ph.D.s obtained college degrees in psychology and then continued for four or five years of postgraduate training. They haven't received any medical training. Their education focuses on the psychological and social aspects of mental illness. They are trained to give and interpret psychological tests, and to provide "talk therapy."

Psychiatrists, on the other hand, take a broad array of advanced science classes. They receive eight years of postgraduate training. Four of those years are spent in medical school, side-by-side with classmates who will become surgeons, internists and family physicians. After they earn a medical degree, they study for another four years to become certified psychiatrists.

Since psychologists have no medical training, they are unaware of how to diagnose or treat the vast majority of mental illness. For example, depression is a symptom of major depression, a psychiatric disorder, but it can also be caused by HIV, stroke, meningitis, tumor, seizures, illicit drugs and medication. A psychiatrist is trained to identify cases such as these. They are instilled with the notion that the first law of psychiatry is to rule out physical causes before assuming and treating symptoms as "purely mental." All doctors learn that before prescribing a medication a detailed physical and medical history must be performed. No medication is safe, any medication can kill and maim if used improperly. The psychiatrist as a medical doctor has a cumulative and vast wisdom of the human body and of disease that stands behind every decision to use a drug; he is aware of the pitfalls and his knowledge prevents disaster. As good physicians learn more about the many ways drugs can harm, they grow more and more cautious as they reach for the prescription pad.

When presented with the facts, only a politician could still be in favor of allowing psychologists to persist in pursuing such a plan. Certainly those with concern for the mental and physical health of Californians will see this plan to allow psychologists to dole out medication for what it is: Dangerous, ill-founded-a prescription for disaster.