A mixed bag of diverse views on psychologists prescribing

Dr Rebecca Courtney-Walker on recent debate.

Can I start by saying a massive thank you to those who responded to our prescribing rights for psychologists discussion paper consultation as well as to those who wrote following our letter in the March issue. We had over 120 responses from across the Society membership and beyond, from psychologists (both academic and practitioner), professional organisations, other professionals and service users.

We had a mix of responses from people who had read the document and commented explicitly on the questions but also from people who were offering comment on the topic but not as a specific response to the document itself. I will summarise some of the themes from the consultation here.

Responses varied from ‘Please hurry up and get this proposal approved’ to ‘Please stop this project’, and so I have set out some of the dominant themes below and have also compiled some FAQs (as many similar concerns and queries were repeated across responses).

Some themes were seen as either a benefit or a concern, dependent on the respondent’s viewpoint:

  • The value of the therapeutic relationship between the psychologist and the service user. Some perceived that prescribing rights could damage the therapeutic relationship and that psychologists currently offer a clear alternative to a diagnostically driven medicalised model. Some perceived that prescribing rights could allow a psychologist to collaboratively work with service users to develop their psychological assessment/interventions that may include relevant medication, rather than having to see different professionals who may not understand them with the same depth.
  • Current problems with over medicalisation in general and over prescription of, for example, anti-psychotic medication. Some people felt concern that prescribing rights would mean psychologists may become more medicalised, posing a potential threat to their identity and practice as a profession. Some people felt psychologists with prescribing rights would be able to deprescribe medications alongside offering psychological interventions, thereby potentially reducing the use of medication. This was seen as potentially relevant in some specific contexts such as pain management and health psychology services, older persons services, Intellectual Disability services and addiction services.

Some themes reflected concerns about psychologist prescribers:

  • Links to diagnosis and the medical model with regards to the psychological profession working towards influencing the use of more formulation-informed frameworks/discourses, particularly in mental health contexts. The need to use the current diagnostic categorical frameworks which inform the prescription of medications for specific ‘diagnoses’, rather than symptoms, was seen as at odds with this.
  • Inadequacy of appropriate training to enable safe prescribing. Some respondents believed that psychologists should not prescribe because they haven’t had medical training and therefore lack the necessary competencies, particularly with regards to physical health conditions. However, some respondents believed that psychologist prescribers should be given the same opportunities as other non-medical prescribers to complete specialised training to achieve these competencies.

Some of the other main themes reflected the potential benefits of psychologist prescribers:

  • The next progression for the psychological profession; especially as other professions have evolved and now routinely practice as psychological therapists, which was previously one of our unique selling points. Similarly, psychologists have already successfully undertaken the Mental Health Act Approved Clinician role, a role previously reserved for medical doctors.
  • Improvements in the speed or timeliness of interventions. Some responses reflected potential benefits of service users being seen and treated more quickly, as other professionals may not need to be involved. Psychologist prescribers were also seen as potentially being able to help support service users to reduce medication if they wish during psychological work.

Responses showed considerable passion around whether psychologists should or should not have the right to train and practice as prescribers. It is clear that it is not for everyone, just as with the option to train and practice as a Mental Health Act Approved Clinician. I would like to stress that whatever position the Society adopts regarding prescribing for psychologists, ultimately it is not in the BPS’s gift to make the final decision, since this is a process that would rest in legislation. The Commission on Human Medicines, who advise the government, keep the potential benefits and disadvantages for service users at the heart of their decision making in this area and they would undertake their own consultation. The purpose of the BPS consultation is therefore to assess whether psychologists would wish to be considered for prescribing rights.

As for next steps, the consultation responses suggest there is enough support for us to engage further with experts by experience as well as with organisations such as the Royal Pharmaceutical Society and the Health and Care Professions Council. The outcome would be to produce a further document which would cover additional details of practicalities along with considering whether it is possible to address some of the concerns we are hearing, particularly around what a potential curriculum could look like to address current educational requirements. There will be more opportunity for comment from members and others once this is produced.

We now have a webpage on the Society’s site (www.bps.org.uk/prescribingrights) where you can find the discussion paper, other relevant information, the FAQs and details of how to contribute to the project.

As ever we are happy for anyone to get in touch and contribute – please do contact [email protected] and get involved.

Dr Rebecca Courtney-Walker
Chair, Prescribing Rights Task & Finish Group

Illustration: Tim Sanders

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