Psychologists & medications: sabotaging mental health?

Imagine a gleaming and piercing scalpel slices through your body to fix a malady. You wake up in the middle of the surgery screaming with utter disbelief and pain. Your family, waiting with bated breath, discovers that the “folks” performing a procedure on their kid are not designated surgeons and anesthesiologists.

Whom would you blame? The “folks” performing the procedure assuming that they knew their job, or the policymakers who allow such “folks” to masquerade as doctors.

Something like this might happen with respect to mental health when Iowa becomes the fourth state to implement a law allowing psychologists to prescribe psychotropic medications. In 2002, New Mexico became the first state to enact such a law. However, it hasn’t done wonders for it, as the average suicide rate is more than the 50 percent higher than the nation’s average. Louisiana was the next state, but here, too, the suicide rate is above the national average.

On the other hand, the states of California and New York have the highest number of psychiatrists and the suicide rates are among the lowest in the country. Can this be just a random coincidence?

Supporting this anomaly, American Psychological Association  commends substituting psychiatrists with “properly trained psychologists,” while leaving to our imagination the definition of “properly trained.” The supposed rationale behind that is the shortage of trained psychiatrists. The main reason we have a scarcity of psychiatrists is the perception of low salaries among medical students. The average salary of psychiatrists is below that of general practitioners and significantly less than that of surgeons.

With towering student loans, few students choose psychiatry as their ultimate field of specialization. Not surprisingly, lawmakers and psychologists have been shush about advocating increase in funding for training psychiatrists, which indubitably would be the ultimate solution to the aforementioned problem.

Another problem being cited is that patients have to wait for six months to see a psychiatrist. But the solution does not lie in giving under-trained Ph.D. graduates the reins of an already suffering medical branch. The solution rests in looking for a way in the field of medicine. For instance, we can turn to primary-care residents. As of now, such residents do not have any mandatory training in psychiatry. Consequently, the psychiatry department receives myriad bogus consultations, which take up valuable time and resources that can be used to treat other more sick patients. It is imperative that the primary-care physicians become the first line of patient care, not psychologists. Interestingly, there is reluctance on the part of primary-care physicians to prescribe psychiatric medications, because they do not feel comfortable prescribing psychiatric medications laden with perilous side effects. This calls to question the judgment and logic behind allowing psychologists to prescribe these medications.

The most important principle of a patient-physician relationship is the obligation of primum non nocere or to “first do no harm.” As undertrained psychologists authorized to prescribe medications, this first principle of the Hippocratic Oath will be the first to be compromised. With this new law in the offing, profound harm will be done to people who deserve nothing but the best of health care. This is not only a travesty of justice but also a breach of trust of patients.  

Pravesh Sharma, M.D., is a chief resident in the Department of Psychiatry at Texas Tech University Health Sciences Center, Lubbock, Texas.