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PubMed2002

Should psychologists be granted prescription privileges? A review of the prescription privilege debate for psychiatrists.

BACKGROUND: The debate over whether clinical psychologists should be granted the right to prescribe psychoactive medication has received considerable attention over the last 2 decades in the US, but there has been relatively little discussion of this controversial topic among Canadian mental health professionals, namely psychologists and psychiatrists. Proponents of prescription privileges (PPs), including the American Psychological Association (APA), argue that psychologists do not and cannot function as independent professionals because the medical profession places many restrictions on their practice. It is believed that PPs would help circumvent professional psychology's impending marginalization by increasing psychology's scope of practice. Proponents also argue that PPs would enhance mental health services by increasing public access to professionals who can prescribe. OBJECTIVE: The purpose of this article is to inform psychiatrists about the major arguments presented for and against PPs for psychologists and to discuss the major implications of PPs for both professional psychology and psychiatry. METHODS: We conducted a literature search of relevant articles published from 1980 to the present appearing on Psychlit and Medline databases, using "prescription privileges" and "psychologists" as search titles. CONCLUSION: Although proponents present several compelling arguments in favour of PPs for psychologists, pilot projects relating to feasibility and efficacy are either sparse or incomplete. Thus, it is too soon to tell whether PPs could or should be pursued. Clearly, more research is needed before we conclude that PPs for psychologists are a safe and necessary solution to psychology's alleged impending marginalization.

Canada↗
PubMed2001

An investigation of the correspondence between psychological problems diagnosed by GPs and those subsequently targeted for treatment by clinical psychologists.

OBJECTIVES: 1. To observe the level of concordance between problems identified by GPs in the referral letter, and primary treatment targets identified by Clinical Psychologists following assessment within an NHS Clinical Psychology Department. 2. To examine whether concordance between GP and Psychologist varies for different psychological problem areas. 3. To examine whether concordance between GP and Psychologist varies with time spent on the waiting list. DESIGN: A retrospective review, and classification, of GP referral letters and Psychologists treatment targets. SETTING: A Department of Clinical Psychology based in Scotland. Sixty five GPs based across fifteen GP practices refer to the department. CASES: Four hundred and one patients consecutively referred by GPs to the Department of Clinical Psychology between April 1 1996 and March 31 1998, and subsequently assessed by one of the qualified Clinical Psychologists. Two hundred and seventy three cases were female (68.08%), 128 male (31.92%). RESULTS: Overall agreement between GP referred problem and Psychologist treatment target, coded in terms of EPPIC 'reasons for care' categories, was 'fair', and observed for 59.6% of cases. High agreement for eating disorders, moderate agreement for anxiety and depression, and low agreement for relationship/social problems was observed. Analysis indicated one third of anxiety referrals and one half of depression referrals were treated differently. Agreement levels were high for short waiting times, and lower for long waiting times, although findings for intermediate waiting times were mixed. CONCLUSIONS: Moderate agreement levels between GP and Clinical Psychologist in cases initially referred for anxiety and depression replicate previous findings. Low levels of agreement for relationship/social problems were not anticipated. The implications of results for future research and service provision are outlined.

Family Practice↗
PubMed1957

The clinical psychologist; his role in private medical practice.

The independent diagnosis and treatment of mental and nervous disorders according to California law constitutes practicing medicine. By this yardstick, an increasing number of clinical psychologists are entering the private practice of medicine. The medical profession has not provided through its leadership the opportunity for clinical psychologists to utilize their skills in a legitimate and supervised way in the treatment of private patients, nor has the medical profession taken sufficient interest in modern methods of treating patients with psychogenic disorders. If the psychiatric team is a feasible and practical approach to spreading the base of psychiatric treatment in hospitals and clinics, it should be applicable to private practice settings too. In the team setting, the psychologist can render great assistance to the physician in the diagnosis and treatment of patients with psychogenic disorders without compromising the principle that the primary responsibility for the patient is the physician's. By virtue of his training and experience, it is the psychiatrist who is best qualified to supervise the work of the psychologist; and until such time as the medical profession is better acquainted with psychotherapeutic techniques, the employment of psychologist assistants should be (according to good medical practice) left to the psychiatrist. The need for some regulation of the use of the title "psychologist" is increasing in order to protect the public from quacks who pose as psychologists. However, any law which is directed toward elimination of the quack should specifically define psychotherapy and contain provisions for its use under adequate medical supervision. The medical profession is obligated to take its traditional role in providing the best possible treatment for patients who are in need of it, and psychotherapy is an inherent part of treatment.

California↗
PubMed1989

[The psychologist in a somatic department].

A psychologist in a somatic department cannot replace the psychiatrist consultant and cannot take the responsibility for the further fate of any patient; he can, however, be useful in many other ways. The psychologist should be indispensible in the diagnostic process, similarly as the X-ray department or laboratory, he should be also consulted when the therapeutic strategy is elaborated. The psychologist can directly interfere with treatment, if he knows the necessary psychotherapeutic technique; the psychologist can effectively help the patients with adaptation to the disease and hospital environment, he can accompany the patient in more complicated situations which arise in conjunction with his disease and act as a mediator between the patient and health personnel. The psychologist should be invited to resolve more complicated problems in the department, such as conflicts, informing the patient on a malignant process, etc. The limiting factor as regards the use of the psychologist in a somatic department is the interest of clinical doctors in psychological problems of their patients and in aspects of the work contributed by the psychologist.

Humans↗
PubMed1995

The role of the psychologist in multidisciplinary treatments for chronic neck and shoulder pain: a controlled cost-effectiveness study.

This study was designed to determine a cost-effective use of psychologist resources in multimodal cognitive-behavioural treatments (MMCBT) for chronic neck/shoulder pain. A randomised controlled trial was conducted with 66 patients divided in two groups. The first group (A) was treated following the approach of MMCBT with the clinical psychologist only functioning as a "coach" to the other health professionals. In this group, the psychologist had on average 5 hours of input per patients. The second group (B) was treated with the same inpatient MMCBT but with the behavioural component administered by the clinical psychologist directly to the patients. In this second group the psychologist had on average 17 hours of input per patient in the entire intervention. The outcome variables included physical, emotional and social factors, and sick-leave. Both groups showed significant improvements over time. The improvements were evident only in sub-groups, specifically in women. The only significant difference between the groups was in "perceived helplessness" favouring the "psychologist contact" setting. It is concluded that in terms of input of clinical psychology, the treatment setting with the "coaching" technique proved to be the most cost-effective use of the psychologist in the two treatment settings investigated.

Adult↗
PubMed2004

Psychologists and tobacco: attitudes to cessation counseling and patterns of use.

BACKGROUND: Psychologists can play an important role in helping their clients stop using tobacco. The extent to which they do so, or quit themselves, has not been reported previously. The utility of snus in reducing smoking prevalence is also questioned and merits study. METHOD: A 36-item self-completion questionnaire was mailed to a random sample of 1000 Swedish psychologists. RESULTS: The response rate was 85%. Very few psychologists (1%) 'often' helped clients to stop using tobacco. While a majority (72%) believed that quitting tobacco use would improve their client's quality of life, most (75%) thought that it was not their responsibility to help clients stop and 74% felt they lacked the necessary skills. About 8% of psychologists smoked cigarettes daily. Use of snus as an aid to cigarette cessation was common in men, but not women, although overall, the percentage of smokers who had quit smoking (72%) did not differ by gender. CONCLUSIONS: Most Swedish psychologists have stopped smoking, but very few help their clients to quit. Targeted campaigns aimed at encouraging and supporting psychologists to treat nicotine dependence are needed. This could increase cessation rates in the population. Snus helped reduce smoking prevalence among men and is a potentially useful harm reduction tool.

Age Factors↗
PubMed2001

Derogation of student female athletes who consult a sport psychologist: an alternative perspective on the negative halo effect.

This study attempts to further research female student athletes' perceptions of the sport psychologist and other sport and mental health professionals. 90 British student athletes from 17 different sports completed a two-part questionnaire to examine the potential derogation effect as a result of consulting one of three identified professionals and to explore the perceived definition and role of the sport psychologist. A fictitious selection report of a female field hockey player was presented to subjects with coach, sport psychologist and psychotherapist as the three professionals. It was hypothesised that subjects' recommendations regarding selection would differ depending on the consultant used. No differences were found which suggests the absence of a negative halo effect and that derogation would not occur within this sample group. Definitions and perceived role of the sport psychologist varied with the subjective tone of the responses from participants being mainly positive (74%). These results indicate that this female student athlete sample has a moderated, even a positive, perception of the sport psychologist. A general acceptance of the sport psychologist falls in line with the suggestions of Murstein and Fontaine (1993) concerning a reported increase in acceptance of mental health professionals.

Adult↗
PubMed1996

Clinical psychologists as psychotherapists: history, future, and alternatives.

As managed care and other cost-containment strategies become central features of the American health care system, doctoral-level clinical psychologists will be increasingly supplanted in the role of psychotherapist by lower cost providers such as social workers, marriage and family counselors, and masters-level psychologists. To provide one basis for clinical psychologists to make judgments about their role in psychotherapy; this article describes what the field was like before psychotherapy became a core activity and then compares the present transition with its historical counterpart: the opening up of the psychotherapy profession to doctoral-level clinical psychologists after World War II. History suggests that efforts to resist the current changes will be unsuccessful and that the most adaptive coping strategy for clinical psychologists is to take advantage of the transition by reenvisioning training and practice of clinical psychologists.

Cost-Benefit Analysis↗
PubMed1999

Psychologists in medical schools in 1997. Research brief.

The activities, income, and medical staff membership and limitations on that membership for psychologists working in U.S. medical school settings in 1997 were examined. A total of 1,938 psychologists responded to a survey conducted by the Research Office of the American Psychological Association, in conjunction with the Association of Medical School Psychologists. Some of the most salient findings were that (a) the largest number of psychologists was involved in research activities, (b) just over half of medical school psychologists were required to generate all or part of their own income through clinical work and research, and (c) the majority of these psychologists were members of a medical staff but were not extended full medical staff privileges. These and other results are discussed in the context of academic rank, tenure status, and other relevant factors.

Humans↗
PubMed2001

Ethical issues for psychologists in pain management.

Pain management is relatively young as a specialty. Although increasing attention is being paid to issues such as pain at the end of life and pain in underserved populations, only recently has an open discussion of ethical issues in chronic pain treatment come to the fore. Psychologists specializing in pain management are faced with a myriad of ethical issues. Although many of these problems are similar to those faced by general clinical psychologists or other health psychologists, they are often made more complex by the multidisciplinary nature of pain management and by the psychologists' relationships to third-party payers (health maintenance organizations, workers' compensation), attorneys, or other agencies. An open forum exploring ethical issues is needed. This article outlines major ethical considerations faced by pain management psychologists, including patient autonomy and informed consent, confidentiality, reimbursement and dual relationships, patient abandonment, assessment for medical procedures, clinical research, and the interface of psychology and medicine. American Psychological Association ethical principles and principles of biomedical ethics need to be considered in ethical decision making. Further exploration and discussion of ethics for pain management psychologists are recommended.

Journal Article↗
PubMed2002

Reductionism in the comments and autobiographical accounts of prominent psychologists.

Many of the researchers in the field of psychological science use strategies and methods in which human actions and experiences are reduced to behavioral contingencies, statistical regularities, neurophysiological states and processes, and computational functions and models. However, many psychologists talk readily and easily about how their research might assist human agents to solve problems, cope, make decisions, self-regulate, and more generally "make a difference" and "take control." The authors considered informally selected comments by several eminent psychologists, and more formally, 73 autobiographical accounts of prominent psychologists to see what could be learned about the attitudes of these psychologists toward reductionism in their own work and in the field of psychology in general. In interpreting these comments and accounts, the authors posit a gap between many psychologists' contemplation of their work and their actual research practices. The authors also suggest that such a gap may be related to psychologists' educational experiences and their scholarly and professional socialization, as well as to their subdisciplinary attachments and contexts.

Autobiographies as Topic↗
PubMedDate not supplied

An ethical dilemma: clinical psychologists prescribing psychotropic medications.

The use of psychotropic medication to treat psychiatric disorders has surged in recent years, and while commonly prescribed, the question of who should be allowed to prescribe such medication has become an increasingly important issue to nurses. Psychologists have historically functioned in roles such as psychotherapy and psychological testing, but as standards of care for psychiatric disorders incorporate medication, reimbursement for psychotherapy is declining. Medication prescription and management have not been traditionally seen as the role of the psychologist, however, many clinical psychologists have begun to advocate for prescription authority as a legally sanctioned role for their profession. This article addresses the issues of clinical psychologists seeking prescriptive privilege. It will be argued that the current paradigm of psychology rejects the neurobiological basis of mental illness and that psychologists prescribing medication presents an ethical dilemma for nurses. It is the contention of the author that nurses have an ethical responsibility to advocate against the extension of the psychologist's role into the prescription of medications.

Drug Prescriptions↗
PubMed1998

Medicare program; scope of Medicare benefits and application of the outpatient mental health treatment limitation to clinical psychologist and clinical social worker services--HCFA. Final rule.

This rule addresses requirements for Medicare coverage of services furnished by a clinical psychologist or as an incident to the services of a clinical psychologist and for services furnished by a clinical social worker. The requirements are based on section 6113 of the Omnibus Budget Reconciliation Act of 1989, section 4157 of the Omnibus Budget Reconciliation Act of 1990, and section 147(b) of the Social Security Act Amendments of 1994 (SSA '94). This rule also addresses the outpatient mental health treatment limitation as it applies to clinical psychologist and clinical social worker services. This final rule also conforms our regulations to section 104 of the Social Security Act Amendments of 1994. Section 104 provides that a Medicare patient in a Medicare-participating hospital who is receiving qualified psychologist services may be under the care of a clinical psychologist with respect to those services, to the extent permitted under State law. In addition, this final rule requires that clinical psychologists and clinical social workers use appropriate diagnostic coding when submitting Medicare Part B claims.

Ambulatory Care↗
PubMed2000

The psychologist's role in the Garrison mission of combat stress control units.

Active duty psychologists frequently are called upon to provide services that extend beyond the model of direct patient care. Army psychologists in combat stress control teams or division mental health services, Navy psychologists deployed to surgical companies, and Air Force psychologists deployed with air-transportable hospitals or mental health rapid response teams may find themselves acting as organizational consultants as well as clinicians. Psychologists assigned to hospitals and clinics also have opportunities to make contact with their units for purposes of consultation and education. Organizational consultations that offer interventions for improving unit readiness and/or increasing combat effectiveness are often welcomed by commanders and provide a mechanism for the application of training and experience directly to military populations. Transferring skills from patient care to performance enhancement may not be a clear progression for many clinicians. This article describes the strategies and materials developed as part of a combat stress control garrison mission at Fort Lewis, Washington, as an example of one approach to working with combat units. The article also calls for the development of a formal mechanism to train psychologists for such roles and for the maintenance and dissemination of research materials to support organizational interventions.

Combat Disorders↗
PubMedDate not supplied

Physician and psychologist beliefs influencing referral of patients for psychotherapy.

A majority of patients with mental or emotional problems are seen in the general medical sector first, but physicians often report that they do not have the time or skills for dealing with these patients. This study focuses on physicians' and psychologists' beliefs about the components of making a successful referral. Interviews with family physicians and psychologists revealed that physician visits before and after referrals, good communication between the physician and the psychologist, physician knowledge about psychotherapy, third-party insurance coverage, and a holistic approach to the patient were considered important components of a successful referral. Physicians believed that patients' income and psychologist experience were less important than did psychologists, but physicians felt that involving the family was more important than psychologists. Both groups generally agreed about specific problems and their relationships to a successful referral. This survey identified issues useful to providers attempting to care for patients with psychological problems by the referral process.

Attitude of Health Personnel↗
PubMed1989

A market analysis comparing the practices of psychiatrists and psychologists.

Data are analyzed that describe the clinical work of representative samples of psychiatrists and clinical psychologists who practiced in one of 62 markets for mental health services in the United States during 1982 and 1983. For psychiatrists, intensity of treatment (ie, mean face-to-face treatment minutes per patient per month) varied from 107 to 368 minutes vs 124 to 283 minutes for psychologists. Multiple regression models explain these variations somewhat differently for each provider group. Whereas the patient's severity or stage of illness is explanatory for both psychiatrists and psychologists, only psychologists appear to alter intensity of treatment in response to local economic conditions. Psychiatrists have large diversified practices, whereas psychologists tend to treat fewer persons and the bulk of these have less severe mental and emotional conditions. Neither practitioner group appeared to provide services in excess of their perceptions of patient need. These and other important similarities and differences are explored, and the advantages of local market focus for examining relevant public policy issues are discussed.

Female↗
PubMed1995

The impact of expertise and sufficient information on psychologists' ability to detect malingering.

Twenty-two forensic diplomates and 22 general clinical psychologists were asked to review a variety of psychological data from one of four cases (two cases of malingering and two cases of legal insanity) to determine whether data suggested malingering or insanity. Of the 44 psychologists who reviewed cases, 86.4% accurately determined whether their protocol was from a malingerer or an insane person. Forensic diplomates and clinical psychologists were equally accurate in their determinations; only three subjects from each group misidentified their case. In spite of their success, confidence levels for both groups were reported as moderate. These results contradict previous studies that have found psychologists to not only be poor detectors of malingering, but also overconfident in their ability to detect it. It is believed that the success of psychologists in this study compared to previous studies was due to improved methodology.

Adult↗
PubMed2002

Responding to society's needs: prescription privileges for psychologists.

The health care revolution has contributed to the natural evolution of the role of psychologists. This has led to the necessity for future psychologists to have the authority to prescribe psychotropic medications in order to offer the best-available, comprehensive treatment to the public. Psychologists' training gives them a unique role in addressing the psychosocial aspects of medical problems, in collaboration with primary-care physicians. Prescribing psychologists are cost-effective, many practice in rural areas where people have no other access to mental health care, and they will be able to treat other underserved populations such as the poor, the elderly, the chronically mentally ill, children, and prisoners in the criminal justice system. Prescribing psychologists will have an increasingly prominent role in future health care policy decisions and practice.

Drug Prescriptions↗