EDPS604: LT3 Handout Brady, Campbell, & O’Neill

Ethical Issues Regarding Prescription Privileges for Psychologists

In 2007, the Canadian Psychological Association formed a Task Force on Prescription Authority for Psychologists
in Canada. In the USA, five states allow prescriptive authority for psychologists with specific doctoral
certifications (American Psychological Association, 2011), but no province in Canada.

Arguments Supporting Prescriptive Authority Adapted from the Canadian Psychological Association, 2010
 Psychological – Behavioural Model: Psychologists prescribe medication using a psychological-behavioural
model rather than a medical-disease model. Integrating psychological and pharmacological interventions would
improve continuity of care and provide a more holistic approach.
 Public Welfare: Psychologists with prescription authority would improve access to underserved populations
(e.g., rural areas). Increasing access to appropriate prescriptions, in combination with psychotherapy.
 Professional Consideration: Prescriptive authority may increase the government’s interest in psychology;
enhancing funding and competitive viability of psychologists.

Arguments Against Prescriptive Authority DeNelsky, 1996; Greenberg, 2010

DeNelsky (1996), “there is a powerful seductiveness about medications” (p. 207).
 Professional Identity and Integrity: It is easier and faster to prescribe medications for mental health concerns,
however, there is evidence medications interfere with the patient acquiring more adaptive thinking/behaviour
and that psychotherapy is at least as effective as medications and produces lower relapse rates. Furthermore,
prescriptive authority may lead to conflicting interprofessional relationships and increase the influence of
lobbying and pharmaceutical companies within the profession.
 Training and Educational Concerns: Current training does not provide the biochemical and medical emphasis
required for prescriptive authority, raising safety concerns. Enhancing training could detract from the
behavioural and psychological interventions that psychologists are experts in.
 Legal Ramifications: Prescribing psychologists would be more legally and medically responsible for their
actions, as well as incur more insurance costs.

Relevant Ethical Principles and Values

Ethical issues of public good and safety are central issues (Canadian Psychological Association, 2010)
 Principle II: Responsible Caring to Society:
A basic ethical expectation of any discipline is that its activities will benefit members of society.
Ethical Standards: 2.1; 2.2; 2.6; 2.8; 2.18; 2.33
 Principle III: Integrity in Relationships:
Avoid not only clear conflicts of interest, but also situations that would present an appearance of a
conflict of interest: Ethical Standards: 3.4; 3.33 - 3.35
EDPS604: LT3 Handout Brady, Campbell, & O’Neill

 Principle IV: Responsibility to Society:

Psychologists need to acknowledge and deal with their role and influence as a discipline in society.
Ethical Standards: 4.3; 4.4; 4.12; 4.20

Canadian Psychological Task Force Recommendations

The CPA Task Force on Prescriptive Authority made the following recommendations:
1) Basic psychopharmacology knowledge should be established as a curriculum requirement and all
psychologists should have a rudimentary understanding best-practice use of psychopharmacology
2) Psychological regulatory bodies should actively promote psychopharmacological continuing education
for licensees relevant to their areas of practice.
3) Professional training programs need to explore training curriculums that better prepare students for
biopsychosocial collaborative interprofessional practice models.

College of Alberta Psychologists

A review of the College of Alberta Psychologists states psychologists may:

1) Discuss medication with a client in general terms and may suggest consultation
2) Acknowledge a client on medication that symptoms may be attributable to medication and may
suggest consultation
3) If a client is considering medication, suggest consultation
4) Observe changing in clients cognitive, behavioural, and emotional function and share/consult with the
treating physician/psychiatrist
5) Enhance treatment outcomes by developing consultative relationships with physicians and
psychiatrists and use referral forms allowing direct referral to a psychiatrist
Psychologists should refrain from making definitive statements regarding: need for medication; information on
specific medications; dosage; how a psychiatrist should prescribe; and specific side effects. Psychologist should not
prescribe medications.

Food for Thought

 Do the benefits outweigh the potential harms?
 Beliefs about a holistic approach to treatment compared to the dominant medical-disease model.
 When we already have different areas of specialization (i.e., psychologists, psychiatrists, medical doctors, etc.)
can we not find a better way to collaborate with other professions?
EDPS604: LT3 Handout Brady, Campbell, & O’Neill

References

American Psychological Association (2011). Practice guidelines regarding psychologists' involvement in

pharmacological issues. American Psychologist, 66(9), 835-849. doi: 10.1037/a0025890

Canadian Psychological Association (2017). Canadian Code of Ethics for Psychologists (4th ed.) Ottawa:

ON: Canadian Psychological Association. Retrieved from:

https://www.cpa.ca/docs/File/Ethics/CPA_Code_2017_4thEd.pdf

Canadian Psychological Assocation (2010). CPA Task Force on Prescriptive Authority for Psychologists in

Canada. Ottawa, ON: Canadian Psychological Association. Retrieved from:

https://cpa.ca/docs/File/Task_Forces/CPA_RxPTaskForce_FinalReport_Dec2010_RevJ17.pdf

DeLeon, P., & Wiggins, J. (1996). Prescription privileges for psychologists. American Psychologist, 51(3), 225-

229.

DeNelsky, G. Y. (1996) The case against prescription privileges for psychologists. American Psychologist, 51(3),

207-212.

Greenberg, R. P. (2010). Prescriptive authority in the face of research revelations. American Psychologist, 65(2),

136-137. doi: 10.1037/a0018051

Heiby, E. M. (2010). Concerns about substandard training for prescription privileges for psychologists. Journal of

Clinical Psychology, 66(1), 104-111. Retrieved from:

https://doi-org.ezproxy.lib.ucalgary.ca/10.1002/jclp.20650

Sammons, M. T. & Newman, R. (2010). Effects of an uncertain literature on all facets of clinical decision making.

American Psychologist, 65(2), 137-138. doi: 10.1037/a0018494