Psychologist Prescribing Privileges in Oregon: A Potentially Dangerous Non-solution

April 6, 2010
Thomas E. Hansen, MD

As a fellow Oregonian, I concur with Dr Jim Phelps that the topic of psychologist prescribing is highly complex, and that even balanced opinions generate “affective discharge” approaching “invective."

As a fellow Oregonian,I concur with Dr Jim Phelps that the topic of psychologist prescribing is highly complex, and that even balanced opinions generate “affective discharge” approaching “invective."

The argument that underlies Dr Phelps’s support for psychologist prescribing in Oregon rests on the need for more competent psychotropic prescribers. Consensus exists that we need better access to care for our citizens. In my opinion, the best approach to address this complex issue would be for the governor to veto the inadequate bill passed by the legislature, and instead establish a commission of clinicians (from all mental health disciplines), scientists, public health professionals, and mental health advocates to develop a plan to best meet the mental health needs of underserved Oregonians. The process that led to the current bill represents the antithesis to careful study by an unbiased group of professionals. The work group that proposed legislation was closed to public input, highly influenced by political pressure and vested interests, and worked with a short timeline. The work group’s proposed bill changed dramatically in the recent short legislative session, with the final version created in a matter of minutes without public comment. This process is probably the most important reason that our governor should veto the bill and send us back to the drawing board.

Dr Phelps suggests that opposition to psychologist prescribing is driven in part by unrecognized unconscious bias (presumably by psychiatrists) to maintain a “beneficial status quo.” Accepting that most psychiatrists have waiting lists or do not accept new patients, where is the pressing need to keep psychologists from prescribing? Opposition to psychologist prescribing comes from within psychology itself (2 studies suggest that only a small minority of psychologists support prescribing privileges, and very few are interested in becoming prescribers,1,2 as evidenced by public testimony and written opinions. The OPA was joined in its criticism of the legislation by other medical specialties (the OMA, the Oregon Pediatric Society, the Oregon Council on Child and Adolescent Psychiatry). In the spirit of the author’s dialectic approach, one should ask why the American Psychological Association chose to bypass its usual approval procedures to embark on an expensive campaign to seek prescribing privileges across the country, and what undisclosed relationships does it have with the pharmaceutical industry? 

Readers from across the country may wonder what is happening in Oregon to improve access to care. Two pilot projects have been started, one with family medicine and one with pediatrics, in which psychiatrists have established relationships with clinics to provide advice and support. The Oregon Psychiatric Association has a “waiting list” of psychiatrists who have volunteered and are waiting for additional family medicine programs to ask for help.  Further, we offer free attendance to our statewide CME meetings to family practice physicians. My colleagues applaud the development of the new osteopathic psychiatric residency at Samaritan Health Service in Corvallis. It is not clear what assistance Dr Phelps expected would have come directly from the OPA, though readers might be interested to know that the residency is led by a former OPA president and legislative committee chair (and she has opposed psychologist prescribing as proposed). 

Dr Phelps’s comment that the bar for safety in Oregon is already low does not lead me to conclude that we should allow psychologists to prescribe. I concur with his additional comment that psychologist prescribing may not be the best solution--in fact, allowing prescribing privileges without fundamental knowledge of basic sciences and without incremental supervision is a non-solution, in my opinion. As a native Oregonian, I hope that we can come up with truly safe approaches to improve access to quality mental health care in Oregon. And I hope that my comments have been informative rather than simply “affective discharge.”  
 

References:

References1. Baird KA. A survey of clinical psychologists in Illinois regarding prescription privileges. Professional Psychology: Research and Practice.2007;38:196-202.2. Campbell CD, Kearns LA, Patchin S. Psychological needs and resources as perceived by rural and urban psychologists. Professional Psychology: Research and Practice. 2006;37:45-50.