Psychiatric News 1-16-1998 -Reply

[HARRIET PALMER-WILLIS]

** For Your Eyes Only **

Hi: 
Re: your request for responses:

(I am a psychiatric clinical specialist, currently working in the field of
public health as a nursing consultant.  Have had extensive clinical
experience in psych/mental health, and have worked with many
multi-disciplinary teams.)

The message could be a little confusing to the non-mental health clinician,
because there seem to be several levels of concern.  Two major issues
are the potential for prescribing by psychologists and the prescribing by
non-psychiatric-prepared individuals, including advanced practitioners of
nursing who do not have psych experience.  The "article" or "summary"
seems to have been written (originally) by the APA (which I think means
by psychiatrists, e.g. MDs) who do have valid concerns about anyone
who prescribes medications for psychiatric patients/clients.  For many
reasons, psychiatrists as a rule do not favor psychologists (or many
nurses) prescribing medications for such clients.  

Because mental health diagnosis is often so inexact, and because
psychopathology can be easily obscured by physiological conditions
(and vice versa), prescribing psychotropic medications poses unique
problems best addressed by clinicians who have  the pathophysiological,
pharmacological, and clinical understandings of the manifestations of
various disorders.  It is doubtful that most prescribers of medications,
indeed most psychotherapists, have all of those knowledge bases.

I personally do not think psychologists or non-mental health experienced
nurse practitioners should prescribe psychotropic medications; it is also
my personal opinion that advanced practice (psych) nurses should have
some method to have collaboration with a practicing psychiatrist so that
those conditions which can and often do present as psychiatric when
they are organic (or vice versa) are not missed.  I do think the issue is a
public health issue, furthermore. 

It sounds as if the APA (?American Psychiatric Association) is
concerned when nurses get prescriptive privileges, and then (the
psychiatrists believe) the door may be opened for psychologists to get
legislation passed which allows them to prescribe psychotropic
medications.  It may be that each state's nursing association should
carefully monitor proposed legislation which is being developed which
denotes which professionals may prescribe.  (The Colorado Nurses
Association does monitor such legislation, and ensures that
psych/mental health nurse clinicians recommend appropriate positions
and lobby their legislators.)