In the United States, the majority of mental health services are provided by non-medical therapists. Likewise, the majority of prescriptions for psychotropic medications are written by family practice and primary care physicians. Thus, even though psychiatrists represent the branch of medicine that specializes in psychopharmacology, they are directly responsible for providing only a fraction of professional services to the mentally ill. Consequently, it is becoming increasingly important for all mental health clinicians to have a basic familiarity with psychiatric medication treatment.
Many non-medical psychotherapists are or will become strongly and rather directly involved in medication treatment. In some settings, psychologists and social workers assume a major role in monitoring patient responses to psychotropic medications.
As primary therapist, these practitioners are in most frequent contact with patients and are in the best position to observe symptom improvement, side-effect problems, and issues involving medication compliance. When consulting with primary care physicians, or as a staff member in some HMO settings, non-medical therapists who are well-versed in the use of psychiatric medications can play an active (albeit collaborative) role in recommending particular medications and dosage adjustments.
In addition, the Department of Defense, in response to an inadequate number of psychiatrists available in the military, implemented a program in the early 1990s to train a small number of psychologists so that they could prescribe a limited formulary of psychiatric medications. Although this program was eventually discontinued, it paved the way for appropriately trained psychologists to prescribe psychotropic medications in the military today.
Currently, the United States Army, Navy, and Air Force have specific guidelines for credentialing psychologists in psychopharmacology and it’s estimated that at least one dozen psychologists are actively prescribing in the Department of Defense.
Prescribing Psychologists Available in Military, Few States
Psychologists are also prescribing in the Indian Health Services (another federal institution) and in New Mexico and Louisiana. State laws allowing psychologists to prescribe have also been passed in Illinois, Iowa, and Idaho. These various activities reflect quite direct involvement in medication treatment by non-medical therapists.
In contrast, many non-medical therapists have little to do with drug treatment. In some cases, this may be because of the nature of their position in a particular treatment setting; in others it may have more to do with their own preferences and biases, such as opposition to medication treatment.
However, we believe that, regardless of the degree of involvement and interest in medication treatment, it is increasingly important that all mental health therapists become acquainted with some basic notions regarding psychopharmacology.
Convincing evidence now exists that certain mental disorders are either caused or accompanied by neurochemical abnormalities. The failure to appropriately diagnose and medically treat such conditions can result in the use of ineffective or only partially effective treatments and hence in prolonged suffering.
Furthermore, many serious mental illnesses are progressive in nature. As a result, inadequate treatment may lead to worsening of a condition to the point where pharmacological and psychological interventions will have little to no effect in later stages of the illness.
Aside from the obvious cost in human terms, prolonged inappropriate treatment results in excessive financial burdens for clients, their families, and the health care system.
Successful Malpractice Suits Brought Against Therapists
In addition, to date, there have been successful malpractice suits brought against therapists who failed to treat or refer for treatment patients suffering from particular disorders known to be generally responsive to medication.
All mental health professionals must be able to, at the very least, diagnose mental disorders that require psychotropic medication treatment so that appropriate referrals can be made.
In many cases, clients may not choose to see a psychiatrist, even when told by their therapists that medication treatment is indicated. This reluctance may be because of financial concerns or to the negative stigma some people believe is attached to psychiatric treatment.
A viable alternative, in some cases, is referral to the family practice doctor. Many people suffering from emotional distress see their family physician first. This doctor may begin treatment with psychotropic medications and may also refer the patient for psychotherapy.
In such cases, the non-medical therapist may be in a key position to supply information regarding diagnosis and treatment response. Increasingly, family practice physicians and non-medical therapists become partners collaborating on the treatment of many patients—especially those suffering from fairly uncomplicated depressive and anxiety disorders.
Mental health treatment has moved increasingly toward greater acceptance of multidisciplinary and integrated treatment modalities. As sophistication in the diagnosis and medical treatment of mental disorders continues to develop, it will be important that mental health professionals not take a step backward.
The polarization of models and professional “turf battles” of the 1960s and 1970s may have sparked useful and lively debate, but they also often resulted in a fragmentation of care. Ongoing knowledge of and respect for diverse models and collaborative involvement hold promise for increasingly effective efforts in treating mental illness.
*This article is based on Dr. Moore’s latest book “Handbook of Clinical Psychopharmacology for Therapists” published by New Harbinger Press and coauthored by John Preston, John O’Neal, and Mary Talaga.
Preston, J., O’Neal, J., Talaga, M., & Moore, B. A. (in press). Handbook of Clinical Psychopharmacology for Therapists-Ninth Edition. Oakland, CA: New Harbinger Press.