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Allow psychologists to prescribe medication.

Byline: Timothy Forester for The Register-Guard

The guest viewpoint by Jim Lace, M.D., and his co-authors in the June 24 Register-Guard reminded me of articles written in the 1950s and '60s rejecting government involvement in health care, including Medicare.

Lace and his co-signers, writing as politicians and lobbyists opposing state legislation to allow psychologists to prescribe drugs, present themselves as those who embrace half-stories - a tactic frequented by politicians and the right-wing and left-wing media. A half-story deliberately ignores facts and embellishes the teller's opinion with filtering, catastrophizing and the old standby, reductionism.

The guest viewpoint argues that House Bill 3355, which would allow psychologists to prescribe medications, should be rejected because psychologists lack scientific training. Non-physician prescribers currently include dentists, nurse practitioners, podiatrists and physician assistants, all who have basic college science courses yet not medical-school intensive training.

Most clinical psychologists, including myself, have taken basic undergraduate science courses including neuropsychology, human physiology and chemistry.

The training required for a prescribing clinical psychologist includes intense training culminating in passing a national exam written by psychiatrists with medical degrees. Most clinical psychologists already consult on a regular basis with primary care physicians to advise on psychotropic choices for depression, anxiety and other mental health challenges.

Prescribing psychotropics usually involves trials of different medications until the most effective one is accepted by the patient, because all have side effects that need to be tolerated and each drug has "cousins" that can be more effective.

Has an independent psychology prescription program been successfully implemented in the United States? Yes! The Department of Defense Psychopharmacology Demonstration Project has been functioning for several years, with superior service to our military men and women.

As an intern in training in California's San Quentin State Prison with a psychiatrist, I found that more than half of the 4,000 inmates had significant psychological diagnosed disabilities. Mental health services are so inadequate in America that when I referred a friend to local psychiatrists for medication, he was told there was a one-year wait list for the first appointment. Since primary care physicians prescribe 80 percent of psychotropics in America, the prescriptions are being written by many medical doctors who feel uncomfortable with mental health issues - so the risk for the patient is higher.

Most clinical psychologists do not want prescribing privileges, yet the ones who are interested and highly competent should have the opportunity to sit for a national exam to be a medical psychologist. People who are underserved, those legally at risk and rural Americans need services that could reduce the overall high cost of our penal system and increase productivity in the workplace. At any one time, 10 percent of the workforce is experiencing sufficient stress (anxiety or depression) to reduce their effectiveness by 30 percent to 40 percent.

Given that psychoactive medications can create more complex drug interactions, an inclusive national exam would test for these issues - and that is included in HB 3355, the proposal in the Oregon Legislature that Dr. Lace and his co-authors oppose.

Historically, medical doctors have been very protective of their turf - as most of us are in each individual craft. In 1950 the American Medical Association was primarily ruled by a protection paradigm. Now a paradigm shift needs to be supported.

Timothy Forester, Ph.D., is a retired board-certified psychologist in Eugene.
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Title Annotation:Guest Viewpoint
Publication:The Register-Guard (Eugene, OR)
Date:Jun 28, 2017
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