The Pros and Cons of Prescribing Privileges for Psychologists

There is a bill before the Illinois Senate these days granting the privilege of writing prescriptions for psychiatric (psychotropic) medications to Clinical Psychologists licensed in the state of Illinois.

Several states, as well as the United States military, already have granted this privilege to doctorate-level psychologists. This idea is to address a shortage of psychiatric coverage in under-served communities. Several professions, including my own (clinical social work) have weighed in on the topic. I do not speak for anyone or any profession. The pros and cons speak for themselves.

Licensed Clinical Psychologists (LCPs) would have advanced, specialized training in clinical psychopharmacology and continuing supervision by a medical doctor or a doctor of osteopathy. They ideally would be available in areas where there simply are not enough psychiatrists to meet the local need.

American Sign Language Telehealth

They would also serve under-represented populations. For example, I work with people who are Deaf or Hard-of-Hearing. There is currently, in Illinois, only one psychiatrist who is skilled in American Sign Language, in the far northern corner of Illinois.

Few psychiatrists provide ASL interpreters in their clinics. There are, however, a few LCPs who are skilled in ASL. (There are also other licensed mental health professionals, myself included, who are skilled in ASL, who do not prescribe.) A supervised LCP in downstate Illinois would be able to address a serious service gap, which, by the way, is projected to grow more severe over the next 10 years.

On the con side of this debate, there are several arguments; again, I am not stating facts, just postulates: It has been presented that, no matter how well-trained the LCP is, that person is still not a physician, and cannot have the fund of knowledge that a licensed MD or DO would have in terms of side effects and drug interactions in persons with more than one medical condition.

The LCP would still be supervised by that professional, who might not always be available in a timely fashion. The LCP would personally and professionally face the financial challenges of much higher malpractice insurance premiums.

And because many of the service areas involved would include services to Medicaid and Medicare recipients, whose insurance pays providers at a lower rate than private insurance, the LCPs may see themselves actually losing money in their practices. This last is a practical consideration that I have seen discussed in online forums; I do not know it to be likely, but it is a concern.

Conclusion

The larger concern for me as a behavioral healthcare provider is, there could be a rush to prescribe where psychotherapeutic intervention may be more appropriate.

We may also see that, even where psychotherapy is indicated, in these lesser-served areas, there are also not enough of us non-prescribers as it is. Psychopharmacology has been shown to work best where psychotherapy is also presented. Prescription privileges for LCPs is a beginning, possibly, but it is not a solution. One would prefer to see the data on rates of recovery in behavioral healthcare in the areas where LCPs are already prescribing before taking sides in this debate.