CNS Drugs 2006; 20 (1): 51-66

REVIEW ARTICLE 1172-7047/06/0001-0051/$39.95/0

© 2006 Adis Data Information BV. All rights reserved.

Prescription Privileges
for Psychologists
A Comprehensive Review and Critical Analysis of Current
Issues and Controversies
Kim L. Lavoie1,2,3 and Silvana Barone1,3
1 Division of Chest Medicine, Research Center, Hôpital du Sacré-Coeur de Montreal, Montreal,
Quebec, Canada
2 Department of Psychology, University of Quebec at Montreal (UQAM), Montreal,
Quebec, Canada
3 Department of Psychology, McGill University, Montreal, Quebec, Canada

Contents
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
1. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2. Historical Antecedents and Forces Driving the Prescription Privileges for Psychologists Debate . . . 53
2.1 The Origins of Clinical Psychology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
2.2 The Origins of Modern Psychopharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
2.3 Forces Driving the Prescription Privilege Movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
3. Who Can Legally Prescribe? International Prescribing Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
4. Major Milestones Achieved by the Prescription Privileges for Psychologists Movement . . . . . . . . . . . 54
4.1 Recommended Curriculum for Psychopharmacology Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.2 The Current Status of the Debate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5. Major Arguments For and Against Prescription Privileges for Psychologists: A Critical Analysis . . . . . 57
5.1 Major Arguments for Granting Prescription Privileges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
5.2 Major Arguments Against Prescription Privileges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
5.3 Critical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
6. Desirability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
7. Feasibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
8. Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
9. Cost Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
10. Conclusions and Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Abstract The debate over whether clinical psychologists should be granted the right to
prescribe psychoactive medications has received considerable attention over the
past 2 decades in North America and, more recently, in the UK. Proponents of
granting prescription privileges to clinical psychologists argue that mental health-
care services are in crisis and that the mental health needs of society are not being
met. They attribute this crisis primarily to the inappropriate prescribing practices
of general practitioners and a persistent shortage of psychiatrists. It is believed
that, as they would increase the scope of the practice of psychology, prescription
privileges for psychologists would enhance mental health services by increasing
52 Lavoie & Barone

public access to qualified professionals who are able to prescribe. The profession
of psychology remains divided on the issue, and opponents have been equally
outspoken in their arguments.
The purpose of the present article is to place the pursuit of prescription
privileges for psychologists in context by discussing the historical antecedents and
major forces driving the debate. The major arguments put forth for and against
prescription privileges for psychologists are presented, followed by a critical
analysis of the validity and coherence of those arguments. Through this analysis,
the following question is addressed. Is there currently sufficient empirical support
for the desirability, feasibility, safety and cost effectiveness of granting prescrip-
tion privileges to psychologists?
Although proponents of granting prescription privileges to psychologists pre-
sent several compelling arguments in favour of this practice, there remains a
consistent lack of empirical evidence for the desirability, feasibility, safety and
cost effectiveness of this proposal. More research is needed before we can
conclude that prescription privileges for psychologists are a safe and logical
solution to the problems facing the mental healthcare system.

1. Background profession of psychology remain divided on this

Over the last 2 decades, an important debate has
emerged within professional psychology about
whether clinical psychologists should be granted the
legal right to prescribe psychotropic medications.
The major argument from individuals in favour of
prescription privileges for psychologists is that
mental healthcare services are in crisis, and as a
result, the mental health needs of society are not
being met.[1-4] The major proponents of granting
prescription privileges to psychologists, who in-
clude the American Psychological Association
(APA)[4] and the American Society for the Advance-
ment of Pharmacotherapy (ASAP, Division 55 of
the APA), attribute this crisis to the often inappro-
priate prescribing practices of general practitioners
and a persistent shortage in the number of available
psychiatrists.[1,3] It is believed that by increasing
psychology’s scope of practice, prescription privi-
leges would enhance mental health services by in-
creasing public access to qualified professionals
who can prescribe. Despite important advancements
in the pursuit of prescription privileges, those in the
issue, and opponents have been equally outspoken
in their arguments against the proposal.[5-12]
Throughout the course of this review, we attempt
to put the debate into context by presenting the
historical antecedents and current forces driving it.
We present the major arguments for and against
granting prescription privileges to psychologists,
followed by a critical analysis of the validity and
coherence of those arguments. Through this analy-
sis, we hope to answer the following question. Is
there currently sufficient empirical support for the
desirability, feasibility, safety, and cost effective-
ness of granting prescription privileges to psycholo-
gists?
We conducted a literature search of relevant arti-
cles published from 1980 to 2005 appearing in the
PsychInfo, MEDLINE, EMBASE and Cochrane
databases, using ‘prescription privileges’ and
‘psycholog*’ as search terms. We also searched
relevant popular and professional media publica-
tions using Google.

© 2006 Adis Data Information BV. All rights reserved. CNS Drugs 2006; 20 (1)
Prescription Privileges for Psychologists
2. Historical Antecedents and Forces
Driving the Prescription Privileges for
Psychologists Debate
2.1 The Origins of Clinical Psychology
The profession of ‘clinical psychology’ was orig-
inally founded in the late 19th century by Lightner
Witmer, who established the first American psy-
chology clinic.[13] At that time, the practice of
clinical psychology was conceptualised as the appli-
cation of psychological techniques to the study of
the individual.[14] Although clinical psychology has
evolved to become a largely (though not exclusive-
ly) practice-based profession, the PhD in clinical
psychology was originally developed as a research
or academic degree. In fact, the APA’s Committee
on Training in Clinical Psychology (CTCP) did not
consider psychotherapy a central activity of clinical
psychologists[15] until after World War II, when the
demand for mental health services increased sharp-
ly, due to the need to treat the victims of war. A
shortage in the number of psychiatrists led the Vet-
eran’s Administration (VA) in the US to expand the
role of clinical psychologists to include many prac-
tice-based activities including psychometrics, diag-
nostic interviewing and ultimately, psychothera-
py.[16,17] Although psychiatrists were initially op-
posed to psychologists providing psychotherapy,
claiming that they lacked proper training, psycho-
therapy had emerged as a major activity of clinical
psychologists by the end of the 1950s,[18] and has
continued to be one of their central activities to this
day.
2.2 The Origins of
Modern Psychopharmacology
Interestingly, at about the time clinical psycholo-
gists were becoming important psychotherapy ser-
vice providers alongside psychiatrists, psychophar-
macology emerged as a major force in the mental
healthcare arena. Many of the psychotropic medica-
tions in use today, such as benzodiazepines, chlor-
promazine and TCAs were introduced between
1950 and 1960, when Freudian psychotherapy was
© 2006 Adis Data Information BV. All rights reserved.
53
dominant. This introduction led to a major shift in
the conceptualisation of mental illness as a psycho-
logical disorder to an emphasis on the medical
model.[19,20] Since then, the field of psychopharma-
cology has made considerable progress as both a
basic science and clinical treatment modality for
several mental disorders.[21] In the early 1980s, the
SSRIs were introduced and they revolutionised
modern psychopharmacology. Although they were
of comparable effectiveness to the older classes of
antidepressants (e.g. TCAs and MAOIs), SSRIs had
a more favourable adverse effect profile, making
them easier to tolerate and a relatively safer pharma-
cological alternative for the treatment of many mood
and anxiety disorders.[22-26] Their relative safety and
perceived ease of administration has also made them
more likely to be prescribed by general practition-
ers,[23,27-29] who are currently responsible for pre-
scribing over 80% of all psychoactive medica-
tions.[3,30,31]
2.3 Forces Driving the Prescription
Privilege Movement
Since the inception of this debate approximately
20 years ago, many have asked: why prescription
privileges for psychologists, and why now? Under-
standing the nature and timing of the prescription
privileges debate involves the recognition that it is
occurring within a larger context of change within
and around the practice of clinical psychology. Per-
haps the most obvious force driving the current
debate is economics, or more specifically, an over-
supply of doctoral-level (PhD and PsyD) psycho-
therapists, who charge more than their master’s-
level counterparts, and a concurrent increase in the
demand for less costly psychotherapeutic ser-
vices.[10,17] Research shows that, in most circum-
stances, psychotherapy may be effectively delivered
by non-doctoral-level psychologists, including mas-
ter’s-level psychologists, social workers, counsel-
lors, nurses, and sex therapists.[17,32,33] The concur-
rent rise of managed care and health maintenance
organisations (HMOs) in the US and a need to
reduce healthcare costs in Canada’s public health
system are increasingly leading to the replacement
CNS Drugs 2006; 20 (1)
54
of doctoral-level psychologists with less costly psy-
chotherapists, whenever possible.[34,35] The result:
many clinical psychologists are facing the possibili-
ty that they are no longer needed to fulfill their
psychotherapeutic role, an activity in which they
have dominated since the 1950s.
An additional force driving the movement for
prescription privileges for psychologists involves
the rising pharmaceutical company interest in ex-
panding the number of professionals who can pre-
scribe.[10] Drug companies are increasingly sponsor-
ing psychological symposia and providing research
and education grants to clinical psychologists “with
a strong psychopharmacology emphasis”.[36] Psy-
chotropic medications now occupy a significant pro-
portion of the drug portfolios of the major pharma-
ceutical giants. In fact, in 2001, the largest increases
in drug sales were seen for psychotropic medica-
tions.[37] According to IMS Health, a major global
healthcare information company, drugs affecting the
CNS underwent a sales growth of 16%, to $US45.3
billion in the 12 months prior to May 2002.[37]
Moreover, sales of antidepressants experienced 18%
growth, to total $US13.4 billion, which accounted
for 4.2% of all global pharmaceutical sales. Fluoxe-
tine was the most successful product amongst the
drugs affecting the CNS, demonstrating a market
share of 21.5%. North America was the highest user
of psychoactive drugs, accounting for 74.6% of
sales, amounting to a 19% growth rate. It is notewor-
thy that in Europe, sales fell by 1%, while Africa/
Asia/Australia and Latin America reported only
4.5% and 2.4% increases in sales, respectively. Giv-
en the growth and sales records of psychoactive
medications in the US, it is perhaps not surprising
that the prescription privilege movement is so strong
there, relative to other countries (e.g. Canada, the
UK).[37]
3. Who Can Legally Prescribe?
International Prescribing Practices
In order to appreciate the complexities of ob-
taining prescriptive authority, it is helpful to under-
stand how prescription privileges are legislated in
different countries. In the US, the Food, Drug and
© 2006 Adis Data Information BV. All rights reserved.
Lavoie & Barone
Cosmetic Act is responsible for defining whether a
drug may be sold over the counter or by prescription
only.[2] However, through their respective pharmacy
and medical practice acts, individual states deter-
mine which professions are authorised to pre-
scribe.[38] In Canada, the Federal Bureau of Human
Prescription Drugs decides how drugs are sold, and
provincial and territorial governments are responsi-
ble for regulating the practice of medicine and phar-
macy, often through their colleges or registrars of
physicians and/or pharmacists.[39] In the UK, pre-
scribing is regulated by the Medicines and Health-
care products Regulatory Agency (MHRA), an ex-
ecutive agency of the Department of Health.[40]
A two-factor classification scheme for prescrip-
tion privileges was established to specify the degree
of prescriptive authority held by a particular profes-
sion. The first dimension (independent vs depen-
dent) involves whether physician supervision is re-
quired for the individual to be able to prescribe. The
second dimension (limited vs unlimited) concerns
which categories of drugs may be prescribed.[41]
Only physicians have independent and unlimited
prescription privileges in the US, but in Canada and
the UK, both physicians and dentists have indepen-
dent and unlimited privileges (table I).
Over the years, various non-physician profes-
sions, such as dentists, optometrists, and podiatrists,
have been granted limited prescription privileges in
the US. Prescriptive authority for these professions
is limited typically to medications that affect the
body systems in their area of practice.[2] The APA is
currently advocating for independent privileges,
which would be limited to prescribing psychoactive
medications. For a summary of professions with
various levels of prescriptive authority in the US,
Canada, and the UK, see table I.
4. Major Milestones Achieved by the
Prescription Privileges for
Psychologists Movement
When we wrote our first review on the prescrip-
tion privileges for psychologists debate,[42] we re-
ceived a letter stating that advancing prescription
privileges for psychologists was “untenable…[and
CNS Drugs 2006; 20 (1)
© 2006 Adis Data Information BV. All rights reserved.

Prescription Privileges for Psychologists

Table I. Summary of professions with various degrees of prescriptive authority in the US, Canada and the UK

Health professional US Canada UK

independent unlimited limited independent unlimited limited independent unlimited limited
Physician Yes Yes No Yes Yes No Yes Yes Yes

Dentist Yes No Yes Yes Yes No Yes Yes Yes

Physician assistant No No Yesa No No Yes NAb NAb NAb

Pharmacist No No Yesc No No No No No Yes

Nurse/nurse practitioner Yesd No Yes No No No No No Yes

Health visitor NA NA NA NA NA NA No No Yes

Nurse midwife No No No No No No No No Yes

Optometrist No No Yes No No No No No Yes

Podiatrist/chiropodist No No Yes No No Yese No No Yes

Physiotherapist No No No No No No No No Yes

Radiographer No No No No No No No No Yes

Psychologist No No Yesf No No No No No No

a In 40 US states.

b Physician assistants do not exist in the UK.

c In eight US states.

d In 26 US states.
CNS Drugs 2006; 20 (1)

e In Alberta, Canada only.

f In the US military, New Mexico and Louisiana only.

NA = not applicable.

55
56 Lavoie & Barone

that it] appears somewhat ludicrous that an article of
this nature would grace the pages of the Canadian
Psychiatric Association’s journal.”[43] Since its in-
ception, the movement to gain prescription privi-
leges for psychologists, at least in the US, has shown
considerable progress, despite the opinions of those
who thought it impossible. For a summary of the
major milestones achieved by the movement, see
table II.
4.1 Recommended Curriculum for
Psychopharmacology Training
Both New Mexico and Louisiana have granted
limited, independent prescriptive authority to prop-
erly trained psychologists, based on training guide-
lines developed and approved by the APA’s Com-
mittee for the Advancement of Professional Practice
(CAPP) and the APA College of Professional Psy-
chology (a subsidiary of CAPP). In order to undergo
training to prescribe, psychologists must have a
doctoral degree in psychology, hold a current, valid
state license as a psychologist, and have at least 5
years experience as a ‘health service provider’ psy-
chologist as defined by state law or by the APA.[44]
The actual psychopharmacology training pro-
gramme includes a minimum of 450 hours of didac-
tic training in five core content areas: (i) neuros-
cience; (ii) clinical and research pharmacology and
psychopharmacology; (iii) physiology and patho-
physiology; (iv) physical and laboratory assessment;
and (v) clinical pharmacotherapeutics. Psychologist
trainees must also complete a joint board-approved
80-hour supervised practicum in clinical assessment
and pathophysiology and an additional 400-hour
practicum treating at least 100 patients with mental
disorders. The 400-hour practicum also requires re-
ceiving 2 hours of weekly individual supervision,
which is reportedly more than physicians receive.[44]
To receive certification, trainees must pass a nation-
al certification exam, which will grant them a 2-year
license to prescribe under the supervision of a physi-
cian. At the end of the 2 years, subject to supervisory
approval, the psychologist can apply to prescribe
independently.[44]
4.2 The Current Status of the Debate
As of April 2005, prescription privilege legisla-
tion has been introduced to study the prescription
privilege issue and/or enact laws enabling psycholo-
gists to prescribe in at least 20 US states.[4,44,45,54,55]

Table II. Summary of major milestones achieved by advocates of prescription privileges for psychologists in the US[44-53]
Date Event
November 1984 US Senator Daniel K Inouye (Hawaii) calls for psychologists to seek prescriptive authority to help improve
availability of quality mental healthcare
1985 Hawaii State Legislature considers legislation to study the issue of prescription privileges for psychologists
1989 Congress orders DoD to develop pilot training programme in psychopharmacology (training began in 1991)
1990 APA approves the establishment of ad hoc Task Force on Psychopharmacology to study the desirability and
feasibility of granting prescription privileges to psychologists
1992 Task Force issues report concluding psychologists could be properly trained to prescribe
1994 DoD training programme graduates its first two prescribing psychologists
1995 APA formally announces endorsement of pursuing prescription privileges for psychologists
1996 APA Council of Representatives formally adopts model prescription bill and training curriculum
1997 APAGS formally announces endorsement of pursuing prescription privileges for psychologists; authorises
College of Professional Psychology to develop suitable psychopharmacology exam to be used by state
licensing boards
1998 Legislation regarding prescription privileges for psychologists about to be introduced or pending in seven
states (California, Florida, Georgia, Hawaii, Louisiana, Missouri, Tennessee)
1999 US Territory of Guam approves legislation allowing psychologists to prescribe in collaboration with physicians
March 2002 New Mexico becomes the first state authorising properly trained psychologists to prescribe
May 2004 Louisiana becomes the second state authorising properly trained psychologists to prescribe
APA = American Psychological Association; APAGS = American Psychological Association of Graduate Students; DoD = Department of
Defense.

© 2006 Adis Data Information BV. All rights reserved. CNS Drugs 2006; 20 (1)
Prescription Privileges for Psychologists
Nearly half of all the State Psychological Associa-
tions have developed a Task Force to address pre-
scription privilege issues in their respective states,
and specific training programmes based on the De-
partment of Defense (DoD) training model have
been introduced or are being offered in 12 states.[44]
Although efforts to obtain prescription privileges
for psychologists appear to be moving forward,
whether or not psychologists should gain prescrip-
tion privileges remains hotly debated both within
and around professional psychology. The following
sections summarise the major arguments presented
for and against the movement, followed by a critical
analysis of those arguments based on the extent to
which they demonstrate the desirability, feasibility,
safety, and cost effectiveness of granting prescrip-
tion privileges for psychologists.
5. Major Arguments For and Against
Prescription Privileges for Psychologists:
A Critical Analysis
5.1 Major Arguments for Granting
Prescription Privileges
First, the most popular argument put forth by
advocates of prescription privileges for psycholo-
gists is that there are important public mental health
needs that are not being met under the current
healthcare system, and that increasing the number of
mental health professionals who can prescribe will
improve public access to the needed quality mental
healthcare.[1-3] Secondly, proponents argue that
properly trained clinical psychologists will offer the
public a superior quality of mental healthcare ser-
vices than that currently being delivered by the
majority non-psychiatrist physicians (i.e. general
practitioners [GPs]) who can prescribe).[1-3] Thirdly,
proponents argue that clinical psychologists are
highly trained mental health professionals, and that
granting them prescription privileges is both a logi-
cal extension of their current practice and that it
would help circumvent their impending marginal-
isation in the face of the oversupply in the number of
professionals who conduct psychotherapy.[2,56] Fi-
nally, proponents argue that granting psychologists
© 2006 Adis Data Information BV. All rights reserved.
57
prescriptive authority would provide greater con-
tinuity of care and would be less disruptive and more
cost effective than having to consult two profession-
als (a psychologist and a physician) with potentially
contrasting views on how to direct patient care.[57-59]
5.2 Major Arguments Against
Prescription Privileges
Firstly, the most common argument put forth by
opponents of granting prescription privileges to psy-
chologists is that psychologists are simply not quali-
fied to prescribe medication.[60,61] Secondly, oppo-
nents claim that there is no societal need to grant
psychologists prescriptive authority, nor would psy-
chologists be geographically better situated to serve
rural populations than other medical profession-
als.[60] Thirdly, it has been argued that psychologists
have not adequately demonstrated their competence
to prescribe psychoactive medication, which may
pose an important threat to patient safety.[42,59,62]
Fourthly, opponents have pointed to a lack of con-
sensus within professional psychology as to whether
prescription privileges should even be pursued,
which they claim calls into question the desirability
of redefining the practice of psychology to include
prescription privileges.[42,60,63,64] Finally, opponents
raise concerns about how granting prescription priv-
ileges to psychologists would drastically alter the
psychological content of graduate and post-graduate
training programmes, and how that would negative-
ly impact the future direction of professional psy-
chology.[10,12,38,41]
5.3 Critical Analysis
The questions we seek to answer through this
critical analysis are the extent to which the current
literature has amply demonstrated the desirability,
feasibility, safety and cost effectiveness of granting
prescription privileges to psychologists. Our goal is
to present an updated and balanced critical analysis
of both sides of the argument from the perspective of
a scientist-clinical psychology practitioner, in order
to assist readers in drawing informed conclusions
about this controversial issue.
CNS Drugs 2006; 20 (1)
58
6. Desirability
The most popular argument in favour of granting
prescription privileges to psychologists is that there
is a societal need for greater access to mental health
professionals who can prescribe, and that granting
psychologists prescriptive authority would serve the
public interest by helping to reduce society’s mental
health burden; this is a highly desirable goal. Advo-
cates appear to be correct on two counts: (i) that the
mental health burden of industrialised nations is
extensive; and (ii) that there may be increasingly
limited public access to mental health professionals
(i.e. psychiatrists) who can prescribe.
According to the National Institute of Mental
Health (NIMH), 44.3 million Americans suffer from
a diagnosable mental disorder.[65] Left untreated,
mental disorders can cause significant psychological
and functional impairment leading to absenteeism
and lost productivity, which total nearly $US312
billion annually in the US alone.[63] The acute
shortage in the number of available psychiatrists has
been documented by both the Surgeon General’s
Report on Mental Health[66] and the President’s New
Freedom Commission on Mental Health.[67] Advo-
cates point out that fewer and fewer psychiatrists are
being trained,[1] and there was a 7.4% drop in the
number of graduates entering new psychiatry resi-
dencies between 1997 and 1998.[68] This shortage is
expected to increase, with demographic projections
predicting that there will be a shortage of over
22 000 adult and 28 000 child and adolescent psy-
chiatrists by 2007.[69] This is particularly true in
rural areas, where access to quality mental health-
care is particularly limited. For example, the APA
reported that there are only 18 psychiatrists serving
the 72% of New Mexicans who live outside the
major city centres of Santa Fe and Albuquerque, and
that up to 75% of those with a treatable mental
disorder are not receiving treatment and must endure
waiting times of as long as 6 months.[46]
However, what proponents have not adequately
demonstrated is that there is actual societal demand
for psychologists to be the ones to meet their mental
health needs, rather than increasing access to prop-
erly trained physicians who can prescribe. The fact
© 2006 Adis Data Information BV. All rights reserved.
Lavoie & Barone
remains that it is the APA and a group of psycholo-
gists who are advocating granting prescription privi-
leges to psychologists, not the general public. With
the exception of one small study, which showed that
consumer demand for psychologists obtaining pre-
scription privileges was quite low,[70] we are una-
ware of any representative surveys of the general
population’s views on this matter.
It has also been argued that maintaining a class of
mental health professionals who can offer an alter-
native to medication can better serve the public
interest than adding psychologists to the list of pro-
fessions who can prescribe.[12] There is also no
evidence to suggest that psychologists would be
better geographically situated to serve rural popula-
tions, as they are generally located in the same areas
as physicians, psychiatrists, and other health profes-
sionals who have some degree of prescriptive au-
thority (e.g. nurse practitioners). We have not seen
any published study presenting data on: (i) the ratio
of psychologists to ‘other prescribing health profes-
sionals’ in rural areas; (ii) the number of psycholo-
gists currently situated in these areas who would be
willing (or able) to undergo the extensive training
required to prescribe; or (iii) the number of psychol-
ogists in urban areas who would be willing to relo-
cate to serve these populations. Interestingly, the
profession of ‘physician assistant’ was created to
help meet the healthcare needs of underserved (e.g.
rural) populations, but only 3% of all physician
assistants actually do.[71] As of 1997, there were
over 160 000 advanced nurse practitioners who
were either prescribing or administering psycho-
tropic medication in all 50 states.[44] This number
rivals the 152 500 members of the APA (2000), a
fraction of whom would likely undergo training to
prescribe.[63]
Proponents have argued for the desirability of
granting prescription privileges to psychologists by
stating that psychologists would provide superior
mental health (and pharmacotherapy) services than
those that are currently being delivered by the ma-
jority of non-psychiatrist physicians (i.e. GPs) who
can prescribe. Advocates are correct to be concerned
about the prescribing practices of many GPs. With
CNS Drugs 2006; 20 (1)
Prescription Privileges for Psychologists
the advent of the newer and relatively safer classes
of antidepressants (SSRIs and serotonin-
norepinephrine [noradrenaline] reuptake inhibitors),
GPs have become the largest prescribers of
psychoactive medication. Between 60% and 83% of
all prescriptions written for psychotropic medica-
tions are now written by GPs, who often have <4–8
weeks of training in psychiatry and mental
health.[3,31,72] US medical schools typically devote
only about 115 hours of classroom teaching to phar-
macology (without a particular emphasis on
psychopharmacology).[73] In addition, there is evi-
dence to suggest that many patients seen by GPs are
misdiagnosed, prescribed inappropriate medication
or prescribed medication unnecessarily.[3,74,75] Re-
search shows that, in women alone, depression is
misdiagnosed on 30–50% of occasions, and that
when antidepressants are prescribed patients are oft-
en improperly monitored.[74] Finally, a recent study
by De Las Cuevas and Sanz[76] demonstrated an
important disparity between the knowledge of GPs
and psychiatrists with regards to how to appropriate-
ly prescribe benzodiazepines. Less than 43% of GPs
(vs 82% of psychiatrists) knew that abrupt cessation
of benzodiazepines could cause serious harm.[77]
Given these data, proponents of granting prescrip-
tion privileges to psychologists argue that appropri-
ately trained psychologists would be more qualified
to properly diagnose, treat, and monitor the
behavioural effects of psychoactive medication than
would other non-psychiatrist practitioners.[4]
While no one would argue against the necessity
and desirability of providing a higher standard of
care to patients with mental disorders, proponents
have yet to demonstrate how prescription privileges
for psychologists are the logical solution to what
appears to be a training issue for GPs. Given that
GPs are, and will remain, the front-line service
providers under most international healthcare sys-
tems, it is unclear how prescription privileges for
psychologists would significantly alter the health-
care-seeking behaviour of patients or the number of
prescriptions written by GPs (unless, of course, GPs
decided to systematically refer their patients to psy-
chologists for pharmacological treatment). Moreo-
© 2006 Adis Data Information BV. All rights reserved.
59
ver, it is important not to dismiss the extensive basic
science, medical and pharmacological training these
physicians undergo in preparation to prescribe,
which is a minimum of 9–12 years.[78,79] Rather than
adding psychologists to the list of professionals who
can prescribe, a more logical solution may be to
provide greater mental health training to GPs and
help promote greater collaboration between GPs and
psychologists.[42] Interestingly, the MHRA in the
UK recently issued a list of treatment guidelines for
GPs on the proper administration of antidepressant
therapy, including specific recommendations about
dosages, patient communication, and when to use
psychotherapy as a first-line therapy.[80] Although
this is not necessarily a substitute for additional
training, it is an encouraging start.
Proponents have argued for the desirability of
granting prescription privileges to psychologists by
stating that clinical psychologists are highly trained
mental health professionals, and granting them pre-
scription privileges would be a logical extension of
their current practice. In fact, clinical psychologists
do undergo extensive training in multiple areas of
mental health and illness, including psychometrics,
psycho-diagnostics, neuroscience, psychological
and behavioural interventions, basic and clinical
research on the aetiology and epidemiology of
mental disorders, and even psychopharmacolo-
gy.[2,44,58,81] Typical graduate programmes last ap-
proximately 7 years and many go on to complete
more specialised post-doctoral training, which in
most states is a requirement for licensure.[2,44,58]
However, this debate is not about whether clinical
psychologists should be allowed to acquire the cre-
dentials to prescribe psychoactive medication. In
fact, as it has been previously argued, clinical psy-
chologists who want to obtain prescription privi-
leges can already do so through existing channels.
Under existing laws in both North America and the
UK, any psychologist who wants to prescribe medi-
cations can do so by earning an appropriate qualify-
ing degree in medicine or a related health profession
(e.g. nurse practitioner, physician assistant).[6] It re-
mains unclear why the practice of psychology needs
to be overhauled for psychologists to obtain pre-
CNS Drugs 2006; 20 (1)
60
scription privileges. One possible explanation is that
the majority of psychologists simply do not have the
basic science background that is required for admis-
sion into many of these professional training
programmes.[10] Nonetheless, proponents of pre-
scription privileges have not adequately justified
why psychology should be exempt from the prereq-
uisite training that has been necessary for all other
prescribing professions. Although several proposals
have been made with regards to providing psycholo-
gists with comparable basic science training, this
has raised several issues related to feasibility, which
are discussed in section 7.
Finally, proponents argue that there is a general
consensus within professional psychology in favour
of pursuing prescription privileges for psycholo-
gists, indicating that the majority view it as a worth-
while and desirable goal.[2,3,82] Although it has been
repeatedly argued that support for granting prescrip-
tion privileges to psychologists is widespread and
increasing, relatively few studies have actually been
published on the issue.[63] A recent meta-analysis of
opinion data from practicing psychologists, trainees,
and training directors in the US shows that the
results of only 17 surveys have been published in
over 20 years of debate.[83] Moreover, an examina-
tion of this report by Walters actually reveals an
important division within professional psychology,
as his analysis concluded that the absolute level of
in-principal support for obtaining prescription privi-
leges is only around 50%. Since this report, only two
additional surveys on this issue have been pub-
lished.[84,85] One reported that more than two-thirds
of graduate students were in favour of gaining pre-
scription privileges, although less than half would
personally undergo training.[84] A more recent sur-
vey of psychologists and trainees in Canada also
suggests general support for obtaining prescription
privileges, although less than half of those surveyed
had plans to personally seek training.[85] We are
unaware of any survey data from British psycholo-
gists, but individual opinions about gaining pre-
scription privileges in the UK appear less favourable
compared with the opinions in the US and Cana-
da.[86-88]
© 2006 Adis Data Information BV. All rights reserved.
Lavoie & Barone
7. Feasibility
The major argument of individuals in favour of
the feasibility of the prescription privileges for psy-
chologists proposal is that training programmes (e.g.
the DoD programme) have already successfully
graduated several (n = 10) prescribing psycholo-
gists.[47,89] However, whether or not a few military
psychologists can be trained to prescribe is not the
issue, but rather, the extent to which prescription
privilege training can be offered and undertaken by
psychologists on a national level without seriously
compromising the integrity of psychological train-
ing. Opponents have consistently argued that the
training required to adequately prepare psycholo-
gists to prescribe would have a significant impact on
the academic structure and teaching of psychology,
and therefore would not be feasible without sacrific-
ing both the substance and quality of current clinical
psychology programmes.[6,10,12] To prevent this, cur-
rent training programmes are proposed to be post-
graduate programmes, and would only be offered to
licensed psychologists with at least 5 years of expe-
rience.[44] Although this proposal appears to protect
the psychological basis of graduate or pre-doctoral
training, these proposals fail to specify who will
incur the financial burden of this additional training,
which may include costs to students, training sites,
internship settings, tax payers, individual clinicians,
and consumers.[90]
The Louisiana Psychological Association’s
model curriculum (which includes over 450 hours of
didactic coursework and nearly 500 hours of super-
vised practicum training) amounts to approximately
nine courses offered over least three semesters. To
put the costs into perspective, Wagner[90] published
a report illustrating how 2 years of extra training in
psychopharmacology for approximately ten students
per programme, per school in Louisiana (n = 2002
students), would end up costing over $US232 mil-
lion for the university and professional school
programmes combined. When a 2-year delay in
earning potential for those undergoing training is
factored in, this would amount to an additional
income (and tax) loss of over $US180 million. Un-
fortunately, proponents have failed to demonstrate
CNS Drugs 2006; 20 (1)
Prescription Privileges for Psychologists
exactly who would bear this financial burden and if
there is government support for such an investment.
Until these issues are resolved and there is a firm
financial commitment on the part of government
and/or training facilities, the feasibility of the grant-
ing prescription privileges to psychologists remains
questionable.
Also related to feasibility is the extent to which
proponents have successfully enlisted the support of
the medical community, who would remain impor-
tant providers of patient care and, in most cases, be
the ones to refer patients to prescribing psycholo-
gists. The American Psychiatric Association has
repeatedly stated its firm opposition to granting pre-
scription privileges to psychologists,[60,91] and pro-
ponents have failed to produce data demonstrating
support or willingness to collaborate from non-psy-
chiatrist physicians (e.g. GPs). In fact, one national
survey of family physicians in the US revealed that
the majority did not favour granting prescription
privileges to psychologists and would not refer pa-
tients to these practitioners for psychopharmaco-
logical treatment if such privileges were ob-
tained.[77] Until proponents of granting prescription
privileges to psychologists can demonstrate that the
medical community will be active and willing col-
laborators, their efforts are unlikely to succeed.
8. Safety
Proponents assert that with the proper training,
psychologists could prescribe both safely and effec-
tively. This is generally accepted.[6,10,86] Evidence
emanating from both the DoD and Indian Health
Service (HIS) pilot training projects suggests that
psychologists have already been trained to prescribe
safely.[47,89,92] At least two independent reviews of
the DoD programme have suggested that the ten
graduates “performed with excellence”[93] and
demonstrated “good quality of care”.[94] Additional
evidence demonstrating the safety of non-physician
prescribers comes from at least one study showing
comparable prescribing outcomes in both physician
and non-physician prescribers.[95] Advocates of
granting prescription privileges to psychologists
claim that because there is no evidence that non-
© 2006 Adis Data Information BV. All rights reserved.
61
physician prescribers are less safe than physician
prescribers, there is no reason to believe prescribing
psychologists would be any different.[92]
However, when evaluating the success of the
psychopharmacology training programmes, it is im-
portant to note that the ten psychologists trained
under the DoD programme prescribed under the
close supervision of psychiatrists in a military facili-
ty.[94] Moreover, a review of the programme by the
American College of Neuropharmacology (ACNP)
pointed out that psychologists trained under the pro-
gramme were limited to treating active military per-
sonnel between the ages of 18–65 years with ‘un-
complicated’ cases, and only after the patients had
received full medical evaluations.[93] This suggests
that the conditions under which the programme was
judged to be ‘successful’ may not be representative
of the prescribing conditions under which most psy-
chologists would be legislated to prescribe. It is also
noteworthy that when the US Government Account-
ing Office audited the programme in April 1997,
they recommended it be discontinued unless psy-
chologists practiced under psychiatrist supervi-
sion.[94] They were also highly critical of the pro-
gramme, claiming the military health system had
“no demonstrated need” for prescribing psycholo-
gists, and that the benefits of training psychologists
to prescribe had still not been established.
Though there is some evidence documenting psy-
chologists’ ability to prescribe safely, it is extremely
difficult to draw any firm conclusions from so little
data. To date, the results of only one American study
(the DoD Project)[47] has been published, and we are
unaware of any planned trials based in Canada or the
UK. Moreover, the sample size (n = 10) upon which
conclusions concerning safety have been drawn is
extremely small. Clearly, more research is needed
before concluding that psychologists are capable of
prescribing psychoactive medication safely and ef-
fectively, particularly considering the potential risks
involved. Some of the major safety concerns put
forth by opponents of granting prescription privi-
leges for psychologists include whether psycholo-
gists would know enough to be aware of the gaps in
their knowledge and the need to refer the patient to
CNS Drugs 2006; 20 (1)
62
an appropriate physician.[62] This may be especially
true when dealing with complex drug interactions,
where recognising the limits of one’s expertise
would be crucial to ensure patient health and safety.
Of particular concern is the extent to which psy-
chologists can be relied upon to provide evidence-
based treatment, when a significant number contin-
ue to use unproven or non-empirically validated
methods of psychotherapy.[6,64] If psychologists
were granted prescription privileges, they would be
obliged to follow the strict prescription guidelines
mandatory for all prescribing professions. The fact
that so many psychologists continue to dismiss em-
pirically based psychological methods as superfi-
cial, inflexible, simplistic and irrelevant[96] is indeed
troubling. Resolving this issue seems to be a more
pressing matter for clinical psychology than the
pursuit of prescription privileges.
9. Cost Effectiveness
Proponents of prescription privileges for psy-
chologists have argued that granting psychologists
prescriptive authority would provide greater con-
tinuity of care, which would be less disruptive and
more cost effective than having to consult multiple
professionals. Advocates argue that under the cur-
rent system, patients may be forced into ‘divided
loyalties’ when treatment providers do not agree
about how to direct patient care.[57,58,66] The result is
inefficient treatment dissemination and, ultimately,
diminished treatment efficacy. Proponents add that
granting prescriptive authority to psychologists
would also result in decreased healthcare costs be-
cause psychologists charge an average of 14% less
than do psychiatrists for the same service, and be-
cause patients would be able to meet all their mental
health needs in a single visit (to a psychologist).[95]
As such, proponents believe granting prescription
privileges for psychologists would facilitate both
treatment and recovery at a lower cost.
The vast majority of psychologists conducting
psychotherapy do not practice in the same office, or
in close proximity to, the physicians who provide
medications.[97] Effective communication and col-
laboration between providers can be a major chal-
© 2006 Adis Data Information BV. All rights reserved.
Lavoie & Barone
lenge with this type of arrangement, but this does
not preclude it from being the appropriate mode of
mental healthcare delivery. Even if psychologists
were granted prescription privileges, their limited
prescriptive authority would require them to refer
patients back to their primary physician for treat-
ment of any co-morbid medical conditions (which
affect approximately 50% of patients with mental
illness).[5] The same would be true for the treatment
of many of the adverse effects of psychoactive med-
ication (e.g. nausea, constipation, sexual dysfunc-
tion, abnormal heart rhythms, orthostatic hypoten-
sion and hypertension).[98] For example, a male pa-
tient taking paroxetine may request a prescription
for sildenafil for the treatment of sexual dysfunc-
tion, which would fall outside the prescriptive au-
thority of the psychologist and require referral to a
physician. Finally, a closer look at the current pre-
scription privilege legislation in Louisiana reveals a
major weakness in the continuity of care argument.
According to the Louisiana House Bill 1426, psy-
chologists with prescription privileges are mandated
to collaborate with physicians on all matters related
to prescribing.[99] Specifically, the law states that
medical psychologists are “required to work col-
laboratively with the patient’s physician when pre-
scribing medication”. This condition appears to fly
in the face of the continuity of care argument, as
even prescribing psychologists are required to do
what they have effectively been doing for years:
collaborating with the patient’s physician on matters
related to medication.
The assertion that granting prescription privi-
leges to psychologists would be more cost effective
than current prescribing practices appears unsup-
ported by the current literature. First, proponents
have not provided evidence that psychologists
would do a better or more cost-effective job of
prescribing psychoactive medication than their phy-
sician-counterparts (although without psychologists
being granted some degree of prescription privi-
leges, it would be impossible to conduct such trials).
Secondly, the costs of training psychologists to pre-
scribe are likely to be great. For example, the actual
cost of training the ten psychologists to prescribe
CNS Drugs 2006; 20 (1)
Prescription Privileges for Psychologists
under the DoD programme totaled $US6 mil-
lion.[5,94] As previously mentioned, the costs of
training in psychopharmacology alone were estimat-
ed to reach over $US232 million for just 2 years of
extra training.[90] These estimates do not include the
costs of delayed earnings, licensure, and profession-
al liability insurance. For example, it was estimated
that a licensure increase of only $US50 would cost
the 40 000 American licensed psychologists $US2
million. Similarly, if prescribing psychologists paid
the same for liability insurance as psychiatrists, psy-
chologists in California would experience a premi-
um increase of over $US10 000 per year.[90] These
added costs for training, licensure, insurance, and
delayed earnings would likely encourage psycholo-
gists to increase their fees, which would ultimately
result in greater costs to consumers and/or third-
party payers.
Another consideration regarding the cost-effec-
tiveness argument is the myth that drug treatment is
more effective and less expensive than psychothera-
py. A recent cost analysis of the relative costs of
cognitive behavioral therapy versus medication for
the treatment of depression determined that the costs
of cognitive behavioural therapy alone were signifi-
cantly lower than for medication alone or combina-
tion therapy ($US6809 vs $US12 737 and
$US14 572, respectively).[100] This analysis consid-
ered all costs related to third-party payments, pro-
vider charges and medication costs. More impor-
tantly, there is evidence to suggest that many psy-
chological interventions, particularly cognitive
behavioural therapy, are at least as effective as med-
ication for the treatment of both mood[101-103] and
anxiety disorders,[104] and that the effects of cogni-
tive behavioural therapy are more likely to be main-
tained over the long-term.[105,106] This suggests that
for certain disorders, not only are psychological
interventions less expensive, but that they may also
be more effective (and longer lasting) than medica-
tions. This begs the question: why the push for
prescription privileges for psychologists?
© 2006 Adis Data Information BV. All rights reserved.
63
10. Conclusions and Future Directions
The debate about whether psychologists should
be granted prescription privileges is still in its infan-
cy, particularly outside North America. However,
there does not appear to be compelling evidence of
the desirability of granting prescription privileges
for psychologists. Pilot projects relating to the feasi-
bility, safety, and cost effectiveness of prescription
privileges for psychologists are either sparse or un-
available. Although proponents present several
compelling arguments in favour of granting pre-
scription privileges for psychologists, more research
is needed before we can conclude that prescription
privileges for psychologists are a safe and logical
solution to the problems affecting the mental health-
care system.
In the meantime, psychologists should concen-
trate their efforts on improving both the professional
and public dissemination of the services they al-
ready provide. In particular, they could work on
improving collaboration with GPs and psychiatrists
to ensure that medicated patients are properly moni-
tored and advised of available psychotherapy op-
tions. Psychologists need not go beyond the bounda-
ries of psychological practice to expand into new
treatment areas. There have already been important
advances in the areas of health psychology and
behavioural medicine, where psychologists have
demonstrated success in improving treatment adher-
ence, health behaviours and disease outcome in can-
cer patients,[107-109] obese patients,[110] coronary ar-
tery disease patients[111,112] and patients with
HIV.[113] Expanding the quality and scope of these
interventions may represent a more desirable, feasi-
ble, safe and cost-effective goal than the pursuit of
prescription privileges at this time.
Acknowledgements
The authors acknowledge the support of their work by the
Canadian Institutes of Health Research (CIHR) and the Auger
Research Foundation at Hôpital du Sacré-Coeur de Montréal.
The authors have no conflicts of interest that are directly
relevant to the content of this review.
CNS Drugs 2006; 20 (1)
64
References
1. Norfleet MA. Responding to society’s needs: prescription privi-
leges for psychologists. J Clin Psychol 2002; 58 (6): 599-610
2. DeLeon PH, Fox RE, Graham SR. Prescription privileges:
psychology’s next frontier. Am Psychol 1991 Apr; 46 (4):
384-93
3. DeLeon PH, Wiggins Jr JG. Prescription privileges for psychol-
ogists. Am Psychol 1996; 51 (3): 225-9
4. DeLeon PH, Sammons MT, Sexton JL. Focusing on society’s
real needs: responsibility and prescription privileges? Am
Psychol 1995; 50: 1022-32
5. Scope of practice: psychologist prescribing legislation. Ameri-
can Psychiatric Association. 2003 May [online]. Available
from URL: http://www.psych.org/advocacy_policy/leg_is-
sues/prescribing_issues/rxfactsheetam43003.pdf [Accessed
2005 Apr 22]
6. McFall RM. Training for prescriptions vs. prescriptions for
training: where are we now? Where should we be? How do we
get there? J Clin Psychol 2002; 58 (6): 659-76
7. Albee GW. Just say no to psychotropic drugs! J Clin Psychol
2002; 58: 635-48
8. Hayes SC, Walser RD, Bach P. Prescription privileges for
psychologists: constituencies and conflicts. J Clin Psychol
2002; 58 (6): 697-708
9. Hayes SC, Blackledge JT. Creating an alternative to prescription
privileges in the era of managed care. In: Hayes SC, Heiby
EM, editors. Prescription privileges for psychologists: a criti-
cal appraisal. Reno (NV): Context Press, 1998: 261-78
10. Hayes SC, Heiby EM. Psychology’s drug problem: do we need
a fix or should we just say no? Am Psychol 1996; 51: 198-206
11. Hayes SC, Heiby EM, editors. Prescription privileges for psy-
chologists: a critical appraisal. Reno (NV): Context Press,
1998
12. DeNelsky GY. Prescription privileges for psychologists: the
case against. Prof Psychol Res Pr 1991; 22 (3): 188-93
13. McReynolds P. Lightner Witmer: a centennial tribute. Am
Psychol 1996; 51: 237-40
14. Reisman JM. A history of clinical psychology. 2nd ed. New
York: Hemisphere, 1991
15. Committee on Training in Clinical Psychology. Recommended
graduate training program in clinical psychology. Am Psychol
1947; 2: 539-58
16. Miller JG. Clinical psychology in the Veterans Administration.
Am Psychol 1946; 1: 181-9
17. Humphreys K. Clinical psychologists as psychotherapists: his-
tory, future, and alternatives. Am Psychol 1996; 51: 190-7
18. Gilgen AR. American psychology since World War II: a profile
of the discipline. Westport (CT): Greenwood Press, 1982
19. Rosenbaum JF. Attitudes toward benzodiazepines over the
years. J Clin Psychiatry 2005; 66 Suppl. 2: 4-8
20. Alford GS. Pharmacotherpay. In: Hersen M, Kazdin AE, Bel-
lack AS, editors. The clinical psychology handbook. New
York: Pergamon Press, 1983: 631-56
21. Bloom FE, Kupfer DJ, editors. Psychopharmacology: the fourth
generation of progress. New York: Raven Press, 1995
22. Guaiana G, Barbui C, Hotopf M. Amitriptyline versus other
types of pharmacotherapy for depression. Cochrane Database
Syst Rev 2003; (2): CD004186
23. MacGillivray S, Arroll B, Hatcher S, et al. Efficacy and tolera-
bility of selective serotonin reuptake inhibitors compared with
tricyclic antidepressants in depression treated in primary care:
systematic review and meta-analysis. BMJ 2003; 326: 1014
© 2006 Adis Data Information BV. All rights reserved.
Lavoie & Barone
24. Nutt DJ. Overview of diagnosis and drug treatments of anxiety
disorders. CNS Spectr 2005 Jan; 10 (1): 49-56
25. Ham P, Waters DB, Oliver MN. Treatment of panic disorder.
Am Fam Physician 2005 Feb 15; 71 (4): 733-9
26. Katzman M. Venlafaxine in the treatment of anxiety disorders.
Med Sci Monit 2004 Jul; 10 (7): CR288-93. Epub 2004 Jun 29
27. Lapid MI, Rummans TA. Evaluation and management of geriat-
ric depression in primary care. Mayo Clin Proc 2003; 78:
1423-9
28. Manning JS. Difficult-to-treat depressions: a primary care per-
spective. J Clin Psychiatry 2003; 64 Suppl. 1: 24-31
29. Remick RA. Diagnosis and management of depression in prima-
ry care: a clinical update and review. CMAJ 2002 Nov; 167
(11): 1253-60
30. Hansen DG, Vach W, Rosholm JU, et al. Early discontinuation
of antidepressants in general practice: association with patient
and prescriber characteristics. Fam Pract 2004 Dec; 21 (6):
623-9
31. Zimmerman MA, Wienckowski LA. Revisiting health and
mental health linkages: a policy whose time has come…again.
J Public Health Policy 1991; 12: 510-24
32. Christiansen A, Jacobson NS. Who (or what) can do psychother-
apy: the status and challenge of nonprofessional therapies.
Psychol Sci 1994; 5: 8-14
33. Dawes RM. House of cards. New York: Free Press, 1994
34. Cummings NA. Impact of managed care on employment and
training: a primer for survival. Prof Psychol Res Pr 1995; 26:
10-5
35. Chiefetz DI, Salloway JC. Patterns of mental health services
provided by HMOs. Am Psychol 1984; 39: 495-502
36. Egli D. Psychopharmacology in independent practice: prescrip-
tion privileges [letter]. The Independent Practitioner 1994b;
14: 218
37. Drug sales globally continue to increase. IMS Health; 2002 Aug
[online]. Available from URL: http://www.chiropractichelps/
com/drgsalesgctoinc.html [Accessed 2005 May 7]
38. Brentar J, McNamara JR. Prescription privileges for psycholo-
gists: the next step in its evolution as a profession. Prof
Psychol Res Pr 1991; 22: 194-5
39. Health Canada. The regulation of prescription drugs: roles and
responsibilities. Health Canada Online; 2004 May [online].
Available from URL: http://www.hc-sc.gc.ca/english/media/
releases/2004/internet_pharmacybk1.htm [Accessed 2005 Apr
22]
40. National Health Service Modernisation Agency, Department of
Health. Medicines matters: a guide to current mechanisms for
the prescribing, supply and administration of medicines [on-
line]. Available from URL: http://www.content.modern.nh-
s.uk/cmsWISE/Workforce+Themes/Using_Task_Skills_Ef-
fectively/workingsafely/prescribing/prescribing.htm [Ac-
cessed 2005 Apr 22]
41. Dozois DJ, Dobson KS. Should Canadian psychologists follow
the APA trend and seek prescription privileges? A reexamina-
tion of the (r)evolution. Can J Psychol 1995 Nov; 36 (4):
288-304
42. Lavoie KL, Fleet RP. Should psychologists be granted prescrip-
tion privileges? A review of the prescription privilege debate
for psychiatrists. Can J Psychiatry 2002 Jun; 47 (5): 443-9
43. Sussman S. Re: should psychologists be granted prescription
privileges? A review of the prescription privilege debate for
psychiatrists [letter]. Can J Psychiatry 2003 Aug; 48 (7): 497-8
44. Williams-Nickelson C. Prescription privileges fact sheet: what
students should know about the APA’s pursuit of prescription
CNS Drugs 2006; 20 (1)
Prescription Privileges for Psychologists
privileges for psychologists (RxP). APA Practice Directorate,
APA Monitor 2002
45. Sammons MT, Olmedo E. The prescription privileges agenda in
1997: forward progress, future goals. Prof Psychol Res Pr 1997
Dec; 28 (6): 507-8
46. Americal Psychological Association – Practice Directorate.
New Mexico governor signs landmark law on prescription
privileges for psychologists. APA Practice Directorate. In:
The APA/Division Dialogue 2002 May/Jun [online]. Availa-
ble from URL: http://www.apa.org/about/division/prac-
ticemay02.html [Accessed 2005 Apr 11]
47. Sammons MT, Brown AB. The department of defense
psychopharmacology demonstration project: an evolving pro-
gram for postdoctoral education in psychology. Prof Psychol
Res Pr 1997 Apr; 28 (2): 107-12
48. Murray B. A brief history of RxP. APA Monitor 2003; 34: 66
49. Daw Holloway J. Psychologists persevere in the states. APA
Monitor 2003; 34: 28
50. Holloway J. New Mexico becomes first state to gain Rx privi-
leges. APA Monitor 2002; 33: 1
51. Daw Holloway J. Louisiana grants psychologists prescriptive
authority. APA Monitor 2004; 35: 1
52. Dittman M. Psychology’s first prescribers. APA Monitor 2003;
34: 36
53. Daw Holloway J. Steady and strong progress in the push for Rx
privileges. APA Monitor 2002; 33: 1
54. Ax RK, Forbes MR, Thompson D. Prescription privileges for
psychologists: a survey of predoctoral interns and directors of
training. Prof Psychol Res Pr 1997 Dec; 28 (6): 509-14
55. Cullen EA, Newman R. In pursuit of prescription privileges.
Prof Psychol Res Prac 1997 Apr; 28 (2): 101-6
56. Fox RE. Prescription privileges: their implications for the prac-
tice of psychology. Psychotherapy 1988; 25: 501-7
57. Fisher K, Buie J. Prescription privilege points, counterpoints
debated at convention. APA Monitor 1987; 11: 6-7
58. Wiggins JG. The care for prescription privileges for psycholo-
gists. Psychotherapy in Private Practice 1992; 11: 3-8
59. Welsh RS. To medicate or not to medicate: let us be honest
about why we should [letter]. Am Psychol 1992; 47: 1678
60. American Psychiatric Association. Scope of practice: psy-
chologist prescribing legislation American Psychiatric As-
sociation 2003 May [online]. Available from URL: http://
www.psych.org/advocacy_policy/leg_issues/prescribing_is-
sues/rxfactsheetam43003.pdf [Accessed 2005 Apr 6]
61. Hausman K. Nurse practitioners in NY allowed to diagnose,
prescribe. Psychiatr News 1988; 9: 11-2
62. Lazarus JA. Implications for medication errors and patient safe-
ty. Psychiatr Serv 2004 Dec; 55 (12): 1423-4
63. Dobson KS, Dozois DJA. Professional psychology and the
prescription debate: still not ready to go to the altar. Can J
Psychol 2001 May; 42 (2): 131-5
64. Plante TG, Boccaccini M, Andersen E. Attitudes concerning
professional issues impacting psychotherapy practice among
members of the American Board of Professional Psychology.
Psychotherapy: Theory, Research, and Practice 1998; 35 (1):
34-42
65. Narrow WE. One-year prevalence of mental disorders, exclud-
ing substance use disorders, in the US: NIMH ECA prospec-
tive data. Population estimates based on US Census estimated
residential population age 18 and over on July 1, 1998. (Data
on file)
© 2006 Adis Data Information BV. All rights reserved.
65
66. US Department of Health and Human Services. Mental health: a
report of the surgeon general. Rockville (MD): US Department
of Health and Human Services, 1999
67. US Department of Health and Human Services. The President’s
new freedom commission on mental health: achieving the
promise: transforming mental health care in America. Rock-
ville (MD): US Department of Health and Human Services,
2003
68. American Psychiatric Association. Resident matching numbers
appear to have plateaued. Psychiatr News, 1998 Apr 3
69. Marra T. Should clinical psychologists have prescription privi-
leges in California [letter]? Psychiatric Times 1994 Feb 20; 3:
20
70. Fulgieri MD. Prescription privileges for psychologists: an ex-
amination of the development of consumer attitudes [disserta-
tion]. Dissertation Abstract International: Section B: The Sci-
ences & Engineering, 2000 Aug; 62 (2-B): 1080
71. Staff. Nurses, other professional want bigger share. Bigger
Roles 1993 Apr; 3, 7, 8, 23
72. DeLeon PH. Prescription privileges: evolutions within the APA
governance. National Register for Archives and Manuscripts
1993; 1-10
73. Pimental PA, Stout CE, Hoover MS, et al. Changing psycholo-
gists’ opinions about prescriptive authority: a little information
goes a long way. Prof Psychol Res Pr 1997; 28: 123-7
74. McGrath E, Keita GP, Strickland BR, et al., editors. Women and
depression: risk factors and treatment issues: final report of
APA national task force on women and depression. Washing-
ton, DC: American Psychological Association, 1990
75. Moran M, Thompson T, Nies A. Sleep disorders in the elderly.
Am J Psychiatry 1988; 145: 1369-78
76. De Las Cuevas C, Sanz EJ. Controversial issues associated with
the prescription of benzodiazepines by general practitioners
and psychiatrists. Med Sci Monit 2004; 10 (7): 288-93
77. Bell PF, Digman Jr RH, McKenna JP. Should psychologists
obtain prescribing privileges? A survey of family physicians.
Prof Psychol Res Pr 1995; 26 (4): 371-6
78. McGill Faculty of Medicine [online]. Available from URL:
http://www.medicine.mcgill.ca/ [Accessed 2005 Apr 22]
79. University of Toronto Faculty of Medicine [online]. Available
from URL: http://www.facmed.utoronto.ca/scripts/index_.asp
[Accessed 2005 Apr 22]
80. GPs get new anti-depressant rules. BBC News UK edition; 2004
Dec [online]. Available from URL: http://news.bbc.co.uk/1/hi/
health/4071145.stm [Accessed 2004 Dec 6]
81. Sweet JJ, Rozensky RH, Tovian SM, editors. Handbook of
clinical psychology in medical settings. New York: Plenum,
1992
82. Smith BS. Attitudes toward prescribing privileges among
clinical graduate students. Terre Haute (IN): Indiana State
University, 1992. (Data on file)
83. Walters GD. A meta-analysis of opinion data on the prescription
privilege debate. Can Psychol 2001 May; 42 (2): 119-25
84. deMayo RA. Academic interests and experiences of doctoral
students in clinical psychology: implications for prescription
privilege training. Prof Psychol Res Pr 2002; 33 (5): 499-501
85. St-Pierre ES, Melnyk WT. The prescription privilege debate in
Canada: the voices of today’s and tomorrow’s psychologists.
Can J Psychol 2004; 45 (4): 284-92
86. Kinderman P. Prescription rights: are we ready for change?
[letter]. Psychologist 2003 Jun; 16 (6): 287-8
87. Orford J. Prescription rights peer commentary: don’t go there
[letter]. Psychologist 2003 Apr; 16 (4): 189
CNS Drugs 2006; 20 (1)
66
88. Johnston L. Prescription rights: peer commentary: back to
basics [letter]. Psychologist 2003 Apr; 16 (4): 186
89. Gutierrez PM, Silk KR. Precription privileges for psychologists:
a review of the psychological literature. Prof Psychol Res Pr
1998; 29: 213-22
90. Wagner MK. The high cost of prescription privileges. J Clin
Psychol 2002; 58 (6): 677-80
91. Weiner J. Editorial. Psychiatric News 1995; 30: 5
92. Yates DF. Should psychologists have prescribing authority? A
psychologist’s perspective. Psychiatr Serv 2004 Dec; 55 (12):
1420-1
93. DoD Prescribing Psychologists: external analysis, monitoring,
and evaluation of the program and its participants. Nashville
(TN): American College of Neuropsychopharmacology, 1998
94. Prescribing Psychologists: DoD demonstration: participants
perform well but have little effect on readiness or costs. Pub
GAO/HEHS-99-98. Washington, DC: US General Accounting
Office, 1999
95. Buie J. Practice priorities: Medicare amendments, hospital priv-
ileges, HMO reforms, prescription privileges. APA Monitor
1988; 1: 14-5
96. Peterson DR. Making psychology indispensable. Appl Prev
Psychol 1996; 5: 1-8
97. Caccavale J. Opposition to prescriptive authority: is this a case
of the tail wagging the dog? J Clin Psychol 2002; 58 (6):
623-33
98. Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry. 8th ed.
Maryland: Williams and Wilkens, 1998
99. Dittmann M. State Leadership Conference. Prescriptive authori-
ty: DoD-trained psychologists spoke about how prescribing
has changed clinical practice. APA Monitor 2004 May; 35: 5
100. Antonuccio DO, Thomas M, Danton WG. A cost-effectiveness
model: is pharmacotherapy really less expensive than psycho-
therapy for depression. In: Hayes SC, Heiby EM, editors.
Prescription privileges for psychologists: a critical appraisal.
Reno (NV): Context Press, 1998
101. DeRubeis RJ, Hollon SD, Amsterdam JD, et al. Cognitive
therapy vs medications in the treatment of moderate to severe
depression. Arch Gen Psychiatry 2005 Apr; 62 (4): 409-16
102. Antonuccio DO, Danton WG, DeNelsky GY, et al. Raising
questions about antidepressants. Psychother Psychosom 1999;
68: 3-14
103. Antonuccio DO, Danton WG, DeNelsky GY. Psychotherapy
versus medication for depression: challenging the convention-
al wisdom with data. Prof Psychol Res Pr 1995; 26 (6): 574-85
© 2006 Adis Data Information BV. All rights reserved.
Lavoie & Barone
104. DeRubeis RD, Crits-Christoph P. Empirically supported indi-
vidual and group psychological treatments for adult mental
disorders. Consult Clin Psychol 1998 Feb; 66 (1): 37-52
105. Hollon SD, DeRubeis RJ, Shelton RC, et al. Prevention of
relapse following cognitive therapy vs medications in moder-
ate to severe depression. Arch Gen Psychiatry 2005 Apr; 62
(4): 417-22
106. Evans MS, Hollon SD, DeRubeis RJ, et al. Differential relapse
following cognitive therapy and pharmacotherapy for depres-
sion. Arch Gen Psychiatry 1992 Oct; 49 (10): 802-8
107. Anderson BL. Biobehavioral outcomes following psychological
interventions for cancer patients. J Consult Clin Psychol 2002;
70 (3): 590-610
108. Fawzy FI, Kemeney ME, Fawzy NW, et al. A structured psychi-
atric intervention for cancer patients. Arch Gen Psychiatry
1990; 47: 729-35
109. Halley FM. Self-regulation of the immune system through bi-
obehavioural strategies. Biofeedback Self Regul 1999; 16:
55-73
110. Berkowitz RI, Wadden T, Tershakovec AM, et al. Behavior
therapy and sibutramine for the treatment of adolescent obesi-
ty: a randomized controlled trial. JAMA 2003 Apr 9; 289 (14):
1805-12
111. Linden W, Stossel C, Maurice J. Psychosocial interventions for
patients with coronary artery disease: a meta-analysis. Arch
Intern Med 1996; 156: 745-52
112. Guiry E, Conroy RM, Hickey N, et al. Psychological response to
an acute coronary event and its effect on subsequent rehabilita-
tion and lifestyle change. Clin Cardiol 1987; 10: 256-60
113. Kelly JA, Kalichman SC. Behavioral research in HIV/AIDS
primary and secondary prevention: recent advances and future
directions. J Consult Clin Psychol 2002; 70 (3): 626-39
Correspondence and offprints: Dr Kim L. Lavoie, Division of
Chest Medicine, Research Center, Hôpital du Sacré-Coeur
de Montreal, 5400 Gouin W, Montreal, Quebec H4J 1C5,
Canada.
E-mail: kiml_lavoie@yahoo.ca
CNS Drugs 2006; 20 (1)