Re: [psychiatry-research] People with mental illness are not guinea pigs -- please help now
- The New Mexico bill calls for psychopharmacology training of (a) 450 classroom
hours, equivalent to seven or eight months of full-time study, plus (b) less
than three months' worth of supervised clinical praticum.
Previous bills in NM and other states have required 300 classroom hours and
about seven months of clinical practicum. Not much change, all things
1. The Defense Department project that is said to have demonstrated the safety
and efficacy of psychologist prescribing required (a) 712 classroom hours in
the first year and (b) a full year of clinical practicum. The 10 psychologists
graduating from this program were allowed to treat only adults 65 and under; no
kids, no elderly. They worked in military team-practice settings where
psychiatric and other medical consultation was readily available. And they
treated a population that had been pre-screened by enlistment and discharge
criteria for better than average health.
2. The Blue Ribbon Panel organized by the California Psychological Association
and the California School of Professional Psychology (Los Angeles) with the
backing of the American Psychological Association recommended 395 to 570 hours
of classroom work plus 18 months of supervised practicum.
3. Board-certified psychiatrists spend four years in medical school and from
three to five years in psychiatric residency.
The above are the only benchmarks that exist.
It is true that many psychiatrists do a slapdash job and in effect waste a good
deal of the medical training they have received. But is this a reason to put Rx
pads in the hands of people who've never received adequate training in the
- At 12:07 PM 3/4/02 -0500, John Winston Bush wrote:
>It is true that many psychiatrists do a slapdash job and in effect waste aWell, the issue is whether all that training adds up to much. To be sure
>good deal of the medical training they have received. But is this a
>reason to put Rx pads in the hands of people who've never received
>adequate training in the first place?
psychiatrists can tell lots of stories about the importance of their
medical training to the issues, but then psychologists can tell lots of
stories about times when psychiatrists failed and psychologists bailed them
out. Exchanging or even counting stories doesn't get us very far. If anyone
can provide evidence that medically trained people actually catch serious
side effects or various organic causes better than non medically trained
people I'd be pleased to see it. Despite my criticisms I am not dogmatic
about this issue nor do I have any vested interest in the outcome. To the
best of my knowledge no such research has been done, perhaps for the
obvious reasons that no one is willing to let psychologists prescribe drugs
-- an essential condition of the test. Until we have more definitive
evidence I am highly suspicious of the claims of those who are threatened
by the prospective change. What I'd like to see is a clean debate devoid of
motives to get more of the lucrative action (psychologists) and those
designed to protect financial privilege (psychiatrists). I'm certainly not
saying that all participants in this debate have financially based biases.
But enough do to make the rest of us wary of the legitimacy of arguments on
both sides. Let's have some data please.
I'm certainly sympathetic to the idea that bad training or practice for one
profession doesn't justify the same for another. There's plenty of bad
practice to go around in all professions, including mine. But the challenge
is this: If psychologists can provide equally good care at a cheaper price
why not let them? In the context of managed health care it seems to me the
burden of proof is on those who claim their care is not equal. The truth of
the matter is that in this context prescription privileges for
psychologists is inevitable. For those who care I'd focus my attention on
making sure that what training they get is adequate.
Actually in most of these debates I usually come down on the side of not
granting prescription privileges to psychologists. As I have said privately
to others who responded to my original criticism, I'm afraid that
psychologists will then become more like psychiatrists -- handing out
prescriptions rather than therapy. Surely we need both, and psychologists
generally get better training in the arts of therapy. I'm highly respectful
of the legitimate advances both in psychopharmacology and therapy that the
medical profession and psychiatry have provided. I just don't like to see
arguments on this issue rest on puffed up and largely unsubstantiated
claims on behalf of the sacred training of psychiatrists. When more of them
start using it appropriately, then I'll listen more.
David J. Schneider
Psychology Department MS-25
Houston, TX 77251
- --- David Schneider <sch@...> wrote:
> I am a psychologist (academic and not clinical) andDitto!
> I have mixed feelings
> about this and other such bills for reasons other
> than those mentioned
> here. But the criticisms of Dr. Schulman are
> misleading, I fear.
Jim Goodwin, Psy.D.
Clinical Psychologist in pvt practice
WA State, USA
PS As I see it, the greatest danger is that American
Psychology may end up as American Psychiatry; after 3
minutes (a Rand Corp study in the '90's) the
prescription pad is out, a few questions about side
effects and then after a total of 10-15 minutes next
Do You Yahoo!?
Try FREE Yahoo! Mail - the world's greatest free email!
- It varies from state to state, depending on what organized nursing has been
able to accomplish legislatively. I know that my daughter, a psych APRN in NJ,
had to complete an MSN program before she could write scripts. Even now, she
has to prescribe under the supervision of a psychiatrist. There are also a few
states where APRNs have independent prescriptive authority, and there are a
good many others where they cannot prescribe even under medical supervision.
I would have no great objection to RxP for psychologists who had been trained
on a par with APRNs, at least in the more demanding states, and especially if
continuing medical supervision were required. The problem is that nothing even
approaching this degree of rigor has been advocated by organized psychology.
How many hours of training do APRNs receive? Are there objections to these