In keeping with its mission to "bring together experts in all areas
of science and technology to address critical national issues," the
National Academy of Sciences last month sponsored the debate "A Bitter
Pill: Should Psychologists Have Prescriptive
Eric Steckler, M.D. (left), representing APA, makes a critical point
about monitoring and treating psychotropic drug side effects during a debate
on psychologist prescribing sponsored by the National Academy of Sciences.
Navy Cmdr. Morgan Sammons (right), a clinical psychologist, spoke on behalf of
the American Psychological Association. See story on page 8.
The debate featured Eric Steckler, M.D., president of the Northern Virginia
chapter of the Washington Psychiatric Society on behalf of APA, and Cmdr.
Morgan Sammons, deputy director for clinical operations at the U.S. Navy
Bureau of Medicine and Surgery. Sammons is a doctoral-level psychologist on
active duty in the Naval Medical Corps. He noted he was speaking on behalf of
the American Psychological Association as a private citizen, not in his
capacity as a naval officer.
Speaking first, Sammons, a graduate of the first class of the Department of
Defense's Psychopharmacology Demonstration Project—a pilot project begun
in 1988 to train psychologists to prescribe—characterized the issue as"
part of an enormous transformation of our health care
The move to grant psychologists prescriptive authority, Sammons said,"
takes place in the context of a vast transformation in American health
care, an extraordinary rate of change in the scope of practice of any
Sammons went on to note that "our mental health system, as Dr.
Steckler will talk about in a few moments, is so badly broken. We believe that
prescriptive authority will help to rectify this really tragic situation for
Sammons suggested that prescribing psychologists would be better equipped
to offer integrated and comprehensive care combining the best psychological
interventions with pharmacotherapy. Sammons added that he believes
psychiatrists are mourning the loss of their ability to provide
psychotherapeutic interventions in today's managed care environment of
mandated med checks.
Sammons detailed the highlights of the American Psychological Association's
model curriculum for training psychologists to prescribe and the requirements
of the New Mexico and Louisiana statutes. Sammons is on the faculty of at
least three institutions offering psychopharmacology training programs
designed to meet these requirements (see related article on page 1).
At one point in his remarks, Sammons suggested that prescribing
psychologists would give superior care to patients compared with primary care
physicians, noting that primary care physicians write the majority of
prescriptions today for antidepressants, while providing little or no
"It used to be just antidepressants," Sammons argued,"
but now many pharmaceutical firms market their antipsychotics to
primary care physicians, and I think at least one area where we can reach some
common ground is that we don't believe that this is the most effective use of
these medications for complex and severe, persistent mental
Sammons finished his allotted time by declaring that "the
patient-safety argument just isn't an issue." He emphasized, "If
any nonphysician health care provider with prescriptive authority was harming
patients, you can bet they would be stopped immediately."
Steckler, a child and adolescent psychiatrist in private practice in
McLean, Va., met Sammons head on by first noting that he doesn't know any
psychiatrists in mourning for psychotherapy.
"I do therapy in my office every day," Steckler said,"
and just about everyone I know does." He agreed with Sammons that
the system is, indeed, badly broken. But the solution is not to grant a legal
right to prescribe to individuals "ill prepared to accept the
Steckler detailed the very different pathways leading to prescribing
privileges for physicians compared with those contained in the two state laws
allowing psychologists to prescribe.
"A psychiatrist has nine years of biomedical education under his or
her belt," Steckler emphasized. "A psychologist may have a great
deal of psychosocial and behavioral education, but would need only one year of
biomedical education to meet the requirements in New Mexico or
Psychologists, Steckler added, have provided great contributions and
advances to the treatment of mental illness, including effective psychosocial
interventions and tools that greatly aid the diagnosis and ongoing assessment
of patients. But giving psychologists prescriptive authority is not the answer
to increasing access to mental health care, Steckler said.
"Psychologists are no more likely to practice in underserved areas
than psychiatrists," he said. "We all practice in the same areas
now, just down the street from each other. That isn't going to
Granting prescribing privileges to psychologists will lead only to a
decrease in the quality of care and raise significant patient safety issues,
Steckler's arguments became more pointed during the question-and-answer
period following the two speakers' presentations.
In response to a question from the audience asking Sammons whether he could
describe a patient that he would be uncomfortable treating, he replied that he
would not treat a patient who presented with serotonin syndrome in his office;
he would refer the person. The questioner then asked Steckler how he would
deal with a patient with serotonin syndrome.
"I'd continue to treat [the patient]," Steckler replied, adding
he would watch the patient and make any necessary adjustments in
Sammons interjected, "What if [the patient had] a severe or
complicated [case of] serotonin syndrome?," appearing surprised that
Steckler would adopt such a "watch and wait" stance.
"My patients wouldn't be in that position in the first place,"
Steckler concluded. ▪