A longstanding need
At least 40% of people in the United States with mental illness cannot access mental health services. Additionally, 61.5% of children with Major Depressive Disorder, and 50% of children with mental illness go untreated. This disconnect between patient and provider has a number of negative consequences, including the concern that many people who need pharmacotherapy are not able to have the necessary medications prescribed. Compounding the problem is that fact that psychiatrists, who are medical doctors (M.D.s), are able to prescribe medications to patients; whereas psychologists—who must earn a Ph.D. or Psy.D. degree to practice—in most cases are not. Currently, just five states – New Mexico, Louisiana, Illinois, Iowa, and Idaho – allow psychologists to prescribe medication under limited circumstances. Psychologists may also prescribe in the US Military and the Indian Health Service. The Illinois law for psychologist prescriptive authority is unique in that it allows for predoctoral education and training in clinical psychopharmacology.
The Chicago School has emphasized the importance of training clinicians in psychopharmacology (the study of the effects of medication on the mind and behavior). In a paper soon to be published in the journal “Experimental and Clinical Pharmacology,” 13 leaders in the field, including nine members of The Chicago School community, advocate for expanding instruction in the discipline and streamlining the credentialing process by offering training toward an M.S. in Clinical Psychopharmacology (MSCP) to doctoral students instead of just to those who have already received their Ph.D. or Psy.D., as is currently the case. The ultimate objective is to streamline the licensing process and expand the number of clinicians able to prescribe medication.
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Gerardo Rodriguez-Menendez, Ph.D., the lead author on the article and chair of the Master of Science in Clinical Psychopharmacology (MSCP) at The Chicago School’s Online Campus, is concerned about a significant problem that limiting prescribing privileges to psychiatrists poses. “Although there are about 50,000 psychiatrists in the nation, at least 40% of them have exclusive fee-for-service practices, meaning cash practices,” he says. “If you are not affluent, you can’t access these services, and that creates even more dire need among underrepresented sectors.”
Dina Glaser, Psy.D., director of the Office of Placement and Training at The Chicago School agrees. “Getting psychiatric services to underserved populations is difficult,” she says. “There are waitlists of patients waiting to get a prescription from a psychiatrist that are months and months long, especially for people living in areas where there are few psychiatrists.” Dr. Glaser also points out that the cost of seeing a psychiatrist is more than a lot of those clients can afford.
In order to be able to prescribe medication, a psychologist must complete an MSCP degree. Although this is a master’s degree, those seeking to receive this certification have traditionally done so after receiving their terminal degree. However, after they were approached by a group of Psy.D. candidates wishing to receive this training while working toward a doctorate, The Chicago School elected to offer this particular training at the pre-doctoral level instead of postdoctoral.
There are several advantages to this action, including reducing the time necessary to receive the required training and therefore decreasing the cost of their education. Most importantly, candidates who follow this course of study are able to enter practice earlier and immediately help those who have difficulties accessing mental health care.
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In Illinois, which passed a law allowing psychologists prescriptive authority in 2014, 60% of its counties do not offer psychiatric services. Nationwide, gaps in coverage are greatest in rural areas and have been exacerbated by the stresses imposed upon the system by the COVID-19 pandemic.
Beth N. Rom-Rymer, Ph.D., one of the co-authors of the paper advocating for allowing doctoral candidates to take coursework toward an MSCP, is regarded as the architect of the Illinois prescriptive authority law for psychologists, which encourages predoctoral training. She and co-author Michele Nealon, Psy.D., president of The Chicago School, provided the vision for the entire program. Therefore, Dr. Rodriguez-Menendez believes that this article charts the clearest path forward and that the institution is well-positioned to deliver on the recommendations in the paper.
Critics stand on tradition
Traditionally, the American Psychiatric Association has opposed granting prescriptive authority to psychologists, but that position is softening. Among the article’s co-authors are two past APA presidents, Patrick DeLeon, Ph.D., and James Bray, Ph.D. According to Dr. Rodriguez-Menendez, Dr. DeLeon is often referred to as the grandfather of clinical psychopharmacology, dating back to when he was the chief of staff to the late Senator Daniel Inouye of Hawaii, who introduced the first legislation to allow psychologists to prescribe.
The argument from psychiatrists has long been that if psychologists wish to prescribe medications, they should attend medical school. However, that dismissive stance belies the level of training required of psychologists before they enter practice. For example, in Illinois, after obtaining the MSCP degree, psychologists must complete 1,620 hours and nine required rotations in emergency medicine, surgery, internal medicine, and family medicine, among others. “They’re taking the same courses that physicians take during pre-med and that nurses take when they’re seeking to become nurse practitioners,” Dr. Rodriguez-Menendez says.
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It is not only psychiatrists who have expressed trepidation. “Historically, psychologists have not been trained to offer this type of service,” Dr. Glaser says. “The idea of integrating prescription privileges is a very far-reaching idea for many in the field.”
However, Dr. Rodriguez-Menendez emphasizes that psychologists are conservative in their use of medication, given that meta-analytic studies have found that the treatment effect is often greater for psychotherapy than for pharmacotherapy. It’s true that in the short term a patient may need relief, and it often takes a number of sessions before you can really see meaningful change in a patient in a therapeutic setting. Therefore, medication should be seen as a supplement to, not a replacement for, one-on-one or group therapy.
The benefits are obvious
Dr. Rodriguez-Menendez sees this innovation in training not merely as meeting a critical need, but it’s also good for the professional prospects of students who embark on this course of instruction because it helps them to “differentiate themselves in their skill sets from those of other graduates,” he says.
For Dr. Glaser, there is also a social justice perspective. “That’s my platform, serving the underserved from a cultural responsiveness perspective,” she says. “Think about how many people we could help who aren’t going to receive services if we had more people who had this capability.”
Ultimately, Dr. Rodriguez-Menendez says that as long as it takes some patients months to get an appointment with a psychiatrist, psychologists can provide a continuum of care to these people. “We have to continue to evolve as a profession,” he insists. “We have to look for ways to expand our scope of practice and keep current with developments in neuroscience to be more viable in the 21st century.”
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