Military health care providers' views on prescribing privileges for psychologists.

Selected military psychologists have been trained and privileged to independently prescribe psychotropic medications. To explore the attitudes of health care professionals toward prescribing authority, a survey of 395 military psychiatrists, psychologists, primary care physicians, and social workers was conducted. Psychologists, physicians, and social workers supported prescribing privileges and continuation of the training programs. Results suggested that support by physicians and social workers is based on improving access to comprehensive mental health care for their patients. Psychologists advocating prescribing privileges at the state level need to pursue the training and licensing authority to prescribe independently. The opposition of organized psychiatry seems assured. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is psychologists' involvement in the prescribing of psychotropic medication really a new activity?

How involved in the process of prescribing psychotropic drugs is the average practicing professional psychologist today? The answer is "far more than most people realize." Five hundred ninety-six practicing psychologists responded to a survey reporting the types of professional activities in which they regularly engage. Virtually all responding psychologists reported they were involved in making recommendations for medication evaluations, consulting with physicians about which medications to use with specific patients, and discussing medication-related issues with patients. A generally agreed-on model of psychopharmacology training for professional psychologists should emerge over the next 5 to 10 years. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychotropics, Consultation, and Psychology.

The status of psychology in national health insurance is clouded in the minds of some Washington planners because the independent practice of psychology is identified with fee-for-service payment mechanisms, active treatment is identified with drug therapy rather than psychotherapy, and planners are unfamiliar with the nature and the scope of the practice of psychologists. Also, some feel that psychology is not equivalent in practice to psychiatry because psychologists are not integrated into the medical community and because psychologists do not prescribe drugs. These criticisms seem unfounded, since physicians and psychologists have regular consultations and psychologists see many patients who have previously been treated with psychotropic medications. Further, clinical experience indicates frequent therapeutic success by reducing or discontinuing medication rather than placing patients on psychotropics. Accordingly, a questionnaire was sent to the 87 members of the Cleveland Academy of Consulting Psychologists (CACP), requesting information concerning the prescribing of psychotropics and records of interprofessional consultations. The results are provided here. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moving toward a broader model of health care.

This article looks at how we can move toward a broader model of health care. It discusses advances in U.S. health care, the issue of health care coverage for all Americans, the need for a biopsychosocial model of health care, and the impact that psychologists can make in improving health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A training model for psychologists with prescription privileges: Clinical pharmacopsychologists.

Presents a training model for prescribing psychologists. Training for independent psychology practitioners is modeled after a training program drafted by the International Neuropsychological Society-Division 40 Task Force for Neuropsychology. In the proposed model, the prescribing psychologist is trained as a specialist within clinical psychology. The term used to describe this specialist, clinical pharmacopsychologist, emphasizes psychology as the underlying field and is homologous with clinical neuropsychologist. Not all clinical psychologists will have this privilege because it is a specialty in its own right, which requires specific didactic and experiential training. During the transition period before the appearance of clinical pharmacopsychologists on clinical psychology faculties, prospective prescribing psychologists will obtain specialty training primarily in medical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology can be indispensable to health care reform and the patient-centered medical home.

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March 2010, making health care reform a reality. Perhaps the most well-developed model of primary care that aligns with the PPACA's agenda is the patient-centered medical home (PCMH). Integrated care, as defined by collaborative care between mental health and primary care providers and systems, will undoubtedly play a critical role in the success of the PCMH. The role of psychology and integrated care in the PCMH as well as training implications for psychologists are discussed. This article is intended to challenge our discipline to embrace psychology as a health care profession that must prepare for and solidify its added value in the health care delivery models of the future. Requisite skill sets for primary care psychologists and existing training opportunities are presented. Finally, possible mechanisms for training psychologists in integrated care and the professional roles primary care psychologists can expect to fill are proposed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Should psychologists obtain prescribing privileges? A survey of family physicians.

The question of whether psychologists should be granted prescribing privileges has generated considerable interest and debate. Family physicians' views are important because of their growing role as gatekeepers to specialty services and the frequency with which they encounter patients with mental health treatment needs. A national sample of family physicians was sent a questionnaire that assessed their current collaborative practices with psychologists and psychiatrists and their views about granting prescribing privileges to psychologists. The response rate was 40% (N?=?397). High rates of communication and collaboration were reported. Most respondents opposed prescribing privileges for psychologists. Subgroups of physicians differed, and certain medications (antidepressants, anxiolytics) appeared more acceptable than others for psychologists to prescribe. These results could provide impetus to those psychologists seeking prescribing privileges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Basic science training in psychopharmacology: How much is enough?

Training psychologists to administer psychotropic medication will require acquisition of a unique knowledge base and set of skills that are generally not components of graduate education in psychology. Nevertheless, the current level of basic science training in graduate education in psychology is substantial and should, with minor modification, allow adequate preparation for students to enter into specialized training to prescribe. The direct provision of psychopharmacology requires psychologists to demonstrate competencies in addition to those required in the general provision of psychological services. Such competencies are perhaps best taught at the postdoctoral level. The authors argue that all curricula training professional psychologists should be able to train psychologists capable of practicing as independent, full-fledged health care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing suicide risk in primary care: Practice recommendations for behavioral health consultants.

Psychologists working in primary care clinics can have a significant positive impact on preventing suicide. For psychologists working within the behavioral health consultant (BHC) model in primary care, however, the issue of how to appropriately manage suicide risk within this model has yet to be adequately addressed. Given the time-limited and focused nature of the BHC model, it is important to establish a framework for psychologists to provide adequate care that is practical within this model of health care. This article offers 26 empirically supported recommendations for suicide screening, accurate and time-efficient risk assessment, and effective risk management strategies, as well as suggestions for consultation with primary care physicians, all of which are consistent with the BHC model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaboration between psychologists and family physicians: Implementing the biopsychosocial model.

Training in primary care medicine in the past decade has included more attention to the psychosocial issues of patients. With this shift, psychologists have new opportunities to collaborate with medical providers to provide comprehensive health care to medical patients and their families. Systems theory and biopsychosocial medicine provide compatible theories to underpin this collaboration. Suggestions are made for overcoming the considerable barriers to implementation of this model, and examples of creative collaboration are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective serotonin reuptake inhibitors and atypical antidepressants: A review and update for psychologists.

Psychologists are increasingly being required to care for patients who are concurrently undergoing pharmacological treatment, particularly when patients suffer from mood disorders, such as major depression. In addition, nonpsychiatric physicians are prescribing antidepressant medications with greater frequency, thereby increasing the likelihood that the physician with which the psychologist must collaborate will have a limited understanding of psychiatric illnesses. As independent mental health professionals, psychologists have a right and a responsibility to be actively engaged in all aspects of their patients' treatment, including pharmacotherapy. A prerequisite for providing this level of professional care is a solid grounding in the principles and actions of pharmacological agents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What every psychologist should know about the Food and Drug Administration’s black box warning label for antidepressants.

In 2004, the Food and Drug Administration released a black box warning label for all antidepressants, indicating an increased risk for suicidality in children and adolescents. The label was subsequently updated in 2007 to include those up to 24 years of age. Data have since emerged to indicate changes in clinical practice patterns of nonspecialists (i.e., nonpsychiatrists) prescribing medications. Among the changes reported in practice patterns are an increased likelihood of referral and a decreased willingness to prescribe antidepressants. Findings also indicate marked reductions in ambulatory visits for depression among children and adolescents, lower rates of diagnosis of depression in this age group, a spillover effect to adults, inaccurate understanding of the actual risk communicated on the warning label (on the part of primary care practitioners), and increased suicide rates among children and adolescents. Recent findings have important implications for practicing psychologists, and specific recommendations are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An introduction to psychologists treating medically ill patients: Competent practice and seeking credentials in organized health care settings for routine or incidental practice.

Psychology has been recognized as a health care science and profession, and psychologists have been working clinically with medically ill patients and within organized health care settings and hospitals for decades. The potentially daunting environment of organized health care should be seen by psychology as an opportunity to further develop and expand its scope of practice. With knowledge of that environment's rules, regulations, ethics, bylaws, and traditions, the clinically competent psychologist who is first seeking to practice in hospitals should succeed alongside psychologists with busy practices who are already exclusively or occasionally within an organized health care setting or medical facility. This article reviews issues of competency, credentialing, privileges, bylaws, and practice expansion to guide psychologists toward a successful hospital practice with medically ill patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)