Should Canadian psychologists follow the APA trend and seek prescription privileges?: A reexamination of the (R)evolution.

Abstract

AbstractThis paper critically examines three key issues surrounding the prescription debate (quality of care, marketability, and psychology's heritage) and demonstrates that, with respect to professional psychology as a whole, obtaining prescription privileges may not be the optimal way to enhance its practice. A second purpose is to place these developments within the context of Canadian psychology. Although American gains in professional autonomy have usually followed in Canada (Dobson et al., 1993), Canadian psychologists face far more impediments to seeking prescription privileges than their southern colleagues. Despite the fact that such obstacles do not preclude our profession from determining its own destiny and advocating for this privilege, we argue at both a practical and conceptual level; 1) that the benefit is not worth the battle and, 2) that obtaining prescription privileges may have austere ramifications for the basic identity and core philosophy of professional psychology in Canada.A major issue facing both American and Canadian psychology today pertains to how we should evolve as a profession (Brentar & McNamara, 1991b). Although professional psychology has, over the past decade, considerably expanded its scope of practice, there remain numerous restrictions placed on its autonomy (Boswell & Litwin, 1992; Dobson, Dobson, & Ritchie, 1993). Increasing the scope of psychology's practice has been deemed the profession's challenge for the 1990s (Enright, Resnick, Ludwigsen, & DeLeon, 1993, p. 135). Recently, in an attempt to broaden the boundaries of professional practice, some United States psychologists have begun to advocate for prescription privileges (e.g., Burns, DeLeon, Chemtob, Welch, & Samuels, 1988; DeLeon, Fox, & Graham, 1991; Fox, Schwelitz, & Barclay, 1992). Canadian psychologists, on the other hand, have been virtually silent on the issue. There are compelling arguments both for and against psychologists obtaining this privilege. Unfortunately, the debates surrounding this issue have not been empirically based or rationally disputed, but rather have been highly emotional, confrontational, and, above all, lacking in specifics (DeLeon, Fox, & Graham, 1991, p. 385). From within psychology, few arguments against prescription privileges exist in the literature (see DeNelsky, 1991 for an exception). The lack of contention against prescription privileges is unfortunate given that many psychologists oppose attaining this clinical responsibility (Frederick/Schneiders, 1990).This paper will present arguments both for and against prescription privileges as they pertain to the profession of psychology in general.(f.1) Following the presentation of this debate, obstacles that our American counterparts face, and further impediments that Canadian psychologists would confront, should they wish to pursue prescription privileges, will be described.DIVIDED VIEWSThere is clearly a divided view within psychology itself about whether psychologists should seek prescription privileges (American Psychological Association [APA], Division 29, 1993; Aronoff & DeFries, 1992; Boswell & Litwin, 1992; Burns et al., 1988; DeLeon, Folen, Jennings, Willis, & Wright, 1991; DeLeon, Fox & Graham, 1991). A representative example of this division comes from some earlier developments in Hawaii. In 1984, when Senator Daniel Inouye beseeched the members of the Hawaii Psychological Association (HPA) to seek statutory authority to prescribe psychoactive medication,(f.2) he received little support (DeLeon et al., 1991). In fact, the University of Hawaii was rather hostile about the proposal (Burns et al., 1988). The results of a 1989 opinion poll of the HPA revealed a strong split (34% supported the proposal and 27% strongly opposed). More recently, the APA Practice Directorate commissioned Frederick/Schneiders, Inc. (1990) to conduct an independent telephone interview of 1505 APA members. …