Psychology's pursuit of prescriptive authority: Would it meet the goals of Canadian health care reform?

Abstract

Abstract We seek to facilitate reflection on the important issue of prescriptive authority for Canadian psychologists. The present paper contextualizes the discussion of prescriptive authority in the broader context of health care reform in Canada. More specifically, we review pharmacotherapy and psychological services in view of how effectively each of these currently meets three major challenges in health care reform: reducing costs, increasing treatment efficacy, and improving access to treatment. Should Prescriptive Authority be in the Future of Canadian Clinical Psychology? Whether to pursue prescriptive authority is a critically important and controversial issue currently facing psychology. It has the potential to fundamentally change the way the public, other providers, and psychologists themselves view psychological services. Having prescriptive authority would have implications for the very identity of psychology (Dozois & Dobson, 1995) and every aspect of the science and practice of psychology from research (Antonuccio, Danton, & McClanahan, 2003), to training (Dozois & Dobson, 2001), to practice (Hayes, Walser, & Bach, 2002). Passionate arguments for (Deleon, Sammons, & Morgan, 1995; Nussbaum, 2001) and against (Albee, 2002; Bush, 2002) prescriptive authority have been advanced. An issue with such potential to change psychology cannot be taken lightly and must be approached with careful consideration. The intent of this paper is to facilitate such reflection among psychologists in the Canadian context. We argue that to fully reflect on the issue of prescriptive authority, one has to understand the larger current health care context. Further, we assume that in order to remain viable in the long term, any changes within psychology would need to accommodate to the current realities of the Canadian health care system. The Commission on the Future of Health Care in Canada (CFHCC) led by Roy Romanow was spurred by a number of specific problems in Canada's health care system. These include escalating costs, suboptimal quality of care, and lack of timely access to service (see Romanow & Marchildon, 2003 for a discussion of the implications of this review for Canadian psychologists specifically). In the report, Healthy Canadians (Health Canada, 2002), First Ministers developed a framework of indicators of health status, health outcomes, and quality of service. Importantly, these indicators will be used to monitor our health care system's evolution. Quality of service, patient satisfaction with care, and access to service are among the key indicators by which future health care delivery will be judged. Finally, the movement toward EvidenceBased Practice in medicine, emphasizing research evidence, clinical expertise, and patient preferences and values (Dobrow, Goel, & Upshur, 2004; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000), has been suggested as an important model for evaluating and ensuring the influence of psychology (Barlow, 2004; Levant, 2005). As a result of these evolutions in how health care is delivered and evaluated, any change to the practice of psychology, such as obtaining prescriptive authority, will ultimately be judged based on how effectively it addresses key priorities in health care reform such as containing and reducing costs, enhancing treatment efficacy, and increasing treatment access and patient satisfaction with care. Goals of the Present Paper and an Invitation for Reflection The aim of this paper is to stimulate reflection on the question: Would prescriptive authority for psychologists address key priorities in Canadian health care reform? There are undoubtedly other criteria that could be used to explore the broader issue of whether or not psychologists should seek prescriptive authority such as the competence of psychologists to do so, the impact on various professions etc. (see Table 1 for a summary of arguments advanced in this debate to date). …