March 15, 2002 -- New Mexico is the first state to let psychologists prescribe mental-health drugs. It's supposed to make things better for patients. Will it? That depends on whom you ask.
This new law applies only to psychologists with a PhD in the science of clinical psychology. In order to prescribe drugs, these psychologists would need to take hundreds of hours of training in pharmacology, physiology, and drug interactions -- after finishing their PhD.
Psychiatrists say that psychologists may have PhDs and extra training, but that doesn't make them medical doctors. Only physicians, they say, have the medical training to understand the complex effects of powerful drugs. Richard Harding, MD, is president of the American Psychiatric Association.
"We are talking about prescribing medicines that have great potential for harm or good, and about who should be allowed to do that," Harding tells WebMD. "It should not be a matter of legislation but of training. Physicians are set up to do this in ways that will have not even entered the mind of psychologists when they have finished their training program. The idea that a brief course will let them bypass that whole process built up over a number of years -- well, it is not the way I would like to see my family treated."
Psychologists say that there are too few psychiatrists to go around. They note that family doctors -- not psychiatrists -- now write eight out of 10 prescriptions for mental-health drugs. Psychologist Elaine LeVine, PhD, chairs the task force on prescriptive authority for the New Mexico Psychological Association.
"Psychologists are better trained in determining which [mental-health] medication might be best for a particular patient's mental-health condition, because that is what we work with every day," LeVine tells WebMD. "When psychologists work hand-in-hand with family doctors, patients are going to get better care. We spend the time it takes with the patient to really know about their psychological functioning."
Harding says that this isn't the issue.
"Let's say I'm a psychologist and I decide to prescribe for an individual with depression," Harding says. "The patient also has diabetes and heart disease. What should I know about that? Is it important? They are saying they're just dealing with the mind. But psychotropic medications are very complicated things. They affect many body systems. That is what is so scary. They don't recognize what they are getting into. Some of the medications we are dealing with now have a high potential for problems. The side effects and interactions with other drugs can be very serious if not lethal."
Family practitioner Dino W. Ramzi, MD, teaches family medicine at Atlanta's Emory University. He agrees with Harding that prescribing medicine is something that requires a doctor's supervision.
"Psychologists can get into a lot of trouble, but if they keep open lines of communication with a physician, I've got no problem with them prescribing," he tells WebMD.
Russ Newman, PhD, JD, is the executive director of professional practice for the American Psychological Association. He says that psychiatrists' dire predictions are nothing new.
"The idea that psychologists would put patients at risk is an old argument that psychiatry first brought up in the 1960s, when psychologists were licensed to practice independently," Newman says. "Now every state licenses psychologists and those fears have been put to rest. In the 1980s when psychologists were being licensed to practice unsupervised in hospitals, psychiatrists said patients would be at risk. Now they do and there is no risk. Here in the 21st century we are hearing the very same argument that if you let psychologists do something different, somehow patient safety will be put at risk. There is no data that shows that is the case."
Psychologist Vincent J. Giannetti, PhD, is a professor of pharmaceutical administration at the Duquesne University School of Pharmacy in Pittsburgh. He doesn't oppose prescribing by psychologists -- but like Harding, he wonders if psychologists know what they are getting into. One of his principal worries is that psychologists will forget that drugs don't cure most mental illness.
"I can say unequivocally there is no antidepressant that cures depression. There is no anti-anxiety medicine that cures anxiety," Giannetti tells WebMD. "I think we always need a strong and consistent voice -- while not anti-medicine -- for the psychotherapeutic approach. That opens the possibility for long-term cure with some disorders."
Which side is right? Family doctor Ramzi says that's not the point.
"I trust psychologists to cooperate closely with physicians," he says. "In that environment, there isn't a problem. The only problem is when psychologists and psychiatrists fight over the issue instead of focusing on the patients' health."