Should psychologists prescribe medication? Consultation.

[NeurotrashWarrior]

This might be something we may have varying opinions about.

www.bps.org.uk/news-and-policy/should-some-psychologists-have-option-prescribe-medication

I would worry about the potential for hormones and blockers to be prescribed if this was a decision that was taken

The thing is that I'm also trying to think of other situations where women might find it helpful to be prescribed something by a psychologist. For example A friend is having intensive therapy for ptsd due to CSA.

I'd imagine anyone who's been referred to a psychologist has probably been through a Gp pathway? Or could it be via CAHMs and other pathways?

My son was referred to a psychologist through CAMHS.

My daughter (and me) were referred through PICU (I’m not sure how common this is but it was introduced at RMCH in the immediate aftermath of the Manchester Arena bomb and they found it so helpful they continued it for all PICU patients and their families).

I’m hesitant on this - I can see it could be a good, practical way to deal with some of the staff shortages within the NHS but there is a big difference between a medical degree plus specialism and an undergraduate degree in psychology.

I suppose those that wanted the ability to prescribe would do some kind of specialist training and join a regulatory body the way nurse prescribers do? We’ve had good experiences with both the prescribing nurses we’ve seen (one a supplementary prescriber attached to CAMHS and one an independent prescriber at our GP) so with careful oversight and limited scope I very cautiously think it could be a good thing?

Hell no. Mental-health medication is already disgustingly overprescribed without psychologists dishing it out too

My understanding is that hormones and blockers are usually prescribed by medics/endocrinologists, not psychiatrists, anyway. They work together in a multidisciplinary team.

So a psychologist would likely be restricted to specific antidepressants, anxiolytics, sleeping tablets that kind of thing. Just like the emergency nurse practitioners at the minor injuries unit can prescribe certain antibiotics and painkillers etc.

That’s only my impression anyway. Given how bloody difficult it can be getting a psych appointment, I support CPNs, psychologists etc having prescribing privileges (with suitable qualifications/training). There aren’t enough psych docs to go around.

@DuMondeB you need more than an undergrad degree to be a psychologist.

Sorry, I meant my brain meant masters and my fingers typed undergrad - I blame posting on an AIBU thread about my student son at the same time.

It’s still far less training than a psychiatrist, who are the professionals prescribing these medications currently.

If Nurse Practioners can prescribe certain medication I see no reason Psychologists can’t.

Psychologists don't have any medical training though.

Psychiatrists diagnosing gender dysphoria can currently provide bridging prescriptions for cross sex hormones whilst waiting for an endocrinologist, psychologists can make the diagnosis only.

Example - Gendercare - Lorimer, Dundas and Lenihan can all diagnose but only Lorimer can issue a bridging script:

gendercare.co.uk/

NHS pathway is Psych diagnosis, referral to endocrinologist, endo recommendation to GP, GP issues prescriptions.

Psychology and psychiatry exist in parallel for a reason. They are founded on different fundamental beliefs about the root causes of mental illness.

The type of training and study is totally different. This is a strength of the MH system not a weakness. Having different perspectives on the same problem is helpful to the patient. Some patients benefit more from one approach than the other.

What's the point in a psychologist dishing out drugs? It's not what they're trained to do and rightly so.

I have no knowledge of this area so
Thank you For perspectives.

My impression is that there are more 'types' of psychologists with different methods and approaches so wrt GD I'd worry about this. However it seems it's already possible as mentioned-up thread.

It’s definitely interesting how different disciplines/specialisms approach the same conditions - as an example, occupational therapists tackle ADHD in a completely different way to psychiatrists.

OT is massively underrated, in my opinion. We need lots more of them!

I think preggasaurus touches on the issue here. (I'm a psychologist working in the NHS). Psychology and psychiatry are very different trainings and produce quite distinct and diverse ways of viewing "mental illness". I think a lot of psychologists, myself included, would actually not want to prescribe medications even if we were medically trained and supported to do so. To make my own position clear, whilst I have come to understand that for some people certain medications can be helpful in the short term I also have worries about how this locates 'mental illness' as being a purely biologically-mediated problem within a person. It can stop us from asking what has happened to people and viewing difficulties as very understandable human responses to difficult (and sometimes traumatic) situations. Therefore I would never wish to have psychiatric medications as a string to me professional bow, if I did I may have chosen to persue a career in psychiatry. Hope that makes sense! :)

Also just to clarify for @DuMondeB, to be a clinical psychologist in the UK you need to have studied psychology at undergrad and then completed a clinical doctorate (so a minimum of 6 years training/education although many who complete the doctorate course will also have a Masters degree before getting a place on training). Therefore the time spent before qualifying is often equivalent to psychiatrists but as a previous poster points out although we hold a Dr title we are not medically trained. (This also reflects the difference in how psychologists view mental distress versus traditional psychiatry).

Absolutely not, they have no medical training, no idea about interactions or medical contraindications. What is the patient is taking other drugs for other conditions? What if it is the same drug, different name, for other conditions? What if the medical consequences exacerbate another condition the patient has? What ability has a psychologist to monitor eg blood pressure, side effects, take bloods etc ? Absolutely crazy idea. Doctors and pharmacists are trained for a reason.

mummabubs Psychiatrists do a medical degree (5 years), foundation years (two years), then a minimum of 3 years of specialist training.

Yup am aware of the pathway Birds, but thank you for sharing it for others. 😊 I think the issue of whether psychologists view medication as the best way to respond to difficulties is probably the crux of the issue here as opposed to who has had more years of training under their belt. (But just to acknowledge your point... As mentioned earlier our core training may be shorter, but many have additional years of psychological qualification- I have 10 for example and were I to do the next level of qualification in the field I work in that would be an additional 2/3 years).

No, absolutely not. Medications are complicated.

I have had dealings with both in my long battle with poor mental health. In my experience psychiatrists favour a drug based approach and not much else and psychologists favour other therapeutic approaches. In my case I needed both but it was the psychologist that helped me the most and helped me not to rely on drugs but to try to get well holistically.

I do not think that anyone else needs to be dishing out drugs especially in this bonkers time of transing children.

No.

They are not qualified in the right area to prescribe.

They have a completely different approach to treatment which isn't part of a biomedical model

It wouldn't interfere with rapport and therapeutic aims as psychology isn't about fixing it's about exploring

As pp said they are already massively over prescribed especially by people who don't really understand what they are for (like a lot of GPs)

OT is massively underrated, in my opinion. We need lots more of them!

Absolutely, and yes I've seen OTs work wonders with ADHD. And also speech therapists and teachers trained to teach children with autism.

I'm on a bit of a crusade at the moment at work around OT support.

No. Just no.

That is truly worrying if a cross-sex hormones bridging prescription can be given to a child by someone not trained in prescribing- Du Monde is that what is happening?

How does informed consent possible work when the prescriber themselves doesn’t understand the full set of issues that the patient needs to take into account??

That would be an awful failure of care.
What are the GMC or whoever regulates these professionals doing about this, if so? Really hope I have misunderstood..

I’m assuming there would be a clinical prescribing training program and limitations on prescribing or a supplementary prescribing system in partnership with a specialist. All other clinical professionals that are allowed prescribing privileges have undergone the relevant training to do so.

I very much doubt it’s a case of ‘just crack on, prescribe whatever you want’.

But nurses are medically trained too before they even start training to become nurse prescribers. Not to the same extent as doctors maybe, but certainly a lot more than psychologists. For a start, let us consider how BPS distinguishes between men and women...

And you certainly can’t compare them to the prescribing by pharmacists!