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Re: [psychiatry-research] People with mental illness are not guinea pigs -- please help now

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  • John Winston Bush
    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
    Message 1 of 7 , Mar 4, 2002
      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
      considered.

      Benchmarks:

      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
      first place?

      ------------------\
    • David Schneider
      ... Well, the issue is whether all that training adds up to much. To be sure psychiatrists can tell lots of stories about the importance of their medical
      Message 2 of 7 , Mar 4, 2002
        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 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 first place?

        Well, the issue is whether all that training adds up to much. To be sure
        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.

        Dave Schneider


        David J. Schneider

        Psychology Department MS-25
        Rice University
        Box 1892
        Houston, TX 77251

        713-348-5144 (voice)
        713-348-5221 (fax)
        sch@...

        http://www.ruf.rice.edu/~sch
      • Jim Goodwin
        ... Ditto! 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
        Message 3 of 7 , Mar 4, 2002
          --- David Schneider <sch@...> wrote:
          > I am a psychologist (academic and not clinical) and
          > 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.
          >
          >etc.,etc.


          Ditto!

          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
          customer please.


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        • John Winston Bush
          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
          Message 4 of 7 , Mar 6, 2002
            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
            nurses prescribing?
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