MASTER’S DEGREE IN HEALTH SCIENCES
175.730 - Professional Practice in Psychology
PRESCRIPTION RIGHTS PROPOSAL FOR PSYCHOLO...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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“Health can be judged by which people t...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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the preliminary negotiations about PxRP...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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under Louisiana law can only write a pr...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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that can be consulted on the internet o...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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required. To become a Clinical Psycholo...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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and graduate degrees that concentrate i...
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appears in the top 100 universities to ...
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approach would be advantageous for stud...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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background, are seen as competent a pr...
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first, in participating hospitals and ...
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more widely available to the populatio...
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Psychologists with prescribing rights....
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prescribing Psychologist's authority, ...
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concerns because of the lack of biomed...
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well, just like the concept that psych...
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REFERENCES
APA [American Psychological...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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rival-powers-to-prescribe-saying-patie...
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Law Commission (2010). Why the availab...
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Muse, M., & McGrath, R.E. (2010). Trai...
175.730.- Professional Practice of Psychology WESTERBERG, V.M.
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Westerberg, V. M. (2012). Early practi...
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Prescription Rights for Psychologists: A critical review

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A critical review of prescribing rights for clinical psychologists.

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Prescription Rights for Psychologists: A critical review

  1. 1. MASTER’S DEGREE IN HEALTH SCIENCES 175.730 - Professional Practice in Psychology PRESCRIPTION RIGHTS PROPOSAL FOR PSYCHOLOGISTS IN NEW ZEALAND: A CRITICAL EVALUATION V.M. Westerberg 15 October 2012
  2. 2. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 2 “Health can be judged by which people take two at a time - pills or stairs” (Welsh, as quoted in Housman, 1994) INTRODUCTION The New Zealand College of Clinical Psychologists (NZCCP) is currently undergoing discussions with Health Workforce New Zealand (HWNZ) and the Ministry of Health (MOH) about granting prescriptions rights for psychologists (PxRP), specifically for clinical psychologists, following on the footsteps of two states in the USA. Health Workforce New Zealand together with its trans-Tasman counterpart, Health Workforce Australia, have been taking the exclusivity of prescribing rights from medical doctors to extend them to other health professionals like nurses, midwives, osteopaths, podiatrists, chiropractors, optometrists, pharmacists. (Australian Psychological Society [APS], 2008). Psychologists appear to be next. Key stakeholders in the PxRP like the Zealand College of Clinical Psychologists (NZCCP) are also the main advocates and proponents of PxRP. Additional stakeholders like the Royal Australian College of General Practitioners (RACGP) (Creswell, 2012), the Royal Australian New Zealand College of Psychiatrists (RANZCP), and the Medical Council of New Zealand (MCNZ) (M. Thorn, personal communication, April 11, 2012) have expressed grave concerns about PxRP per se and about the fact that these medical associations are not being included in
  3. 3. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 3 the preliminary negotiations about PxRP. Conflict of interests, privileges and lobbing issues are at stake. This work will critically address the risks of PxRP so as to raise awareness in the academic and professional clinical psychology community regarding considerations that may not have been taken into account in the midst of a prescription rights euphoria. In the discussion that follows, the background of the PxRP claim will be explored together with facts and suggestions about psychologists competence, training, and educational issues. After public health needs and safety concerns, cultural and ethico-legal considerations will be outlined. All in all, it is the author’s aim to show that psychologists are requesting the right thing, for the wrong reasons, and through the wrong pathway. DISCUSSION The USA was the first country to grant PxRP when in 1985 it passed a Bill allowing Hawaii licensed psychologists working for the US Department of Defence (DOD) to prescribe psychotropics to Government Issues (GIs), that is, military personnel (APS, 2008; Long, 2005). In 1988, the US DOD went on to allow specific medical training for psychologists so that they could prescribe psychotropics under certain circumstances. Guam became the first US territory to approve the PxRP legislation in 1999, followed by New Mexico in 2002, and Louisiana in 2004, where psychologists and PxRP are regulated by the Medical Board authority (APS, 2008), which means that a prescribing psychologist
  4. 4. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 4 under Louisiana law can only write a prescription with the patient’s GP's approval (Long, 2005). Only 5 of the remaining 49 states are currently considering granting medically-trained psychologists prescription rights. Bills keep being turned down, rewritten, and resubmitted (Long, 2005). Worldwide, only one province in Canada (Alberta) and South Africa have PxRP (APS, 2008). Lack of public demand (Lavoie & Barone, 2006) and public safety and satisfaction with the status quo of prescribing rights may explain why no further countries have PxRP. Nevertheless, the NZCCP has taken the initiative of requesting PxRP to HWNZ and the MOH. As mentioned previously, the president of the RACGP, Claire Jackson, the RANZCP, and the MCNZ senior policy advisor, Michael Thorn, wonder how ethical it would be to leave their points of view outside the decision-making process. These organisations are also concerned about PxRP plans because of the potential to divide responsibilities and oversight of patient care and welfare (Creswell, 2012; M. Thorn, personal communication, April 11, 2012). Australian Physiotherapy Association president, Melissa Locke, publicly expressed the enthusiasm of physiotherapists to be allowed to prescribe specialty-relevant medication like the entire range of anti-inflammatory drugs and Botox for the treatment of pain and spasticity in cerebral palsy patients (Creswell, 2012). Opponents to PxRP are concerned about the safety and ethical issues that may arise as a result, like inappropriate prescribing for personal profit, a topic not covered by the HPCA Act (2003). The amount of factors to take into account when prescribing a drug are not just interactions with other drugs (legal and illegal) or substances (foods, nutritional supplements, alcohol)
  5. 5. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 5 that can be consulted on the internet or on a handbook, they include fluent working memory for conditions like liver, renal, respiratory, cardiovascular, immune, and endocrine-metabolic insufficiency; surgical, paediatric, geriatric, and obstetric population idiosyncracies; and the pharmacodynamics of drugs (Brunton, Chabner, & Knollman, 2010). This knowledge is not likely to be acquired with a few semesters of late full-time training, particularly if the individual never had training in biological and medical sciences prior to graduate school. These and further training and safety concerns have been shown by organisations like Psychologists Opposed to Prescribing Privileges (POPP, 2007) integrated by an elite of psychologists from universities across the USA like the University of Nevada, Minnesota, Mississippi, Washington, and Brown, Drexel and Harvard Universities. Looking at training and educational backgrounds now, according to Careers NZ (2012a) and the University of Otago (2012), to become a Psychiatrist in NZ you need to: have an A average in high school, enrol immediately after completing high school, complete the Health Sciences or Bachelor of Science in Biomedical Science First Year programme with a minimum of B+ average, complete the 6- year Bachelor of Medicine and Bachelor of Surgery (BMBS) degree, pass an exam to access internship, work for 2 years as an intern (supervised junior doctor) in a hospital, pass an exam for admission in the Medical Council of NZ, complete another 5 years of specialist training with annual exams, and admission examination to become a Fellow of the Royal Australian and New Zealand College of Psychiatrists, a mandatory requirement for practicing Psychiatrists. A minimum of 14 years of full-time study with top grades is
  6. 6. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 6 required. To become a Clinical Psychologist in NZ you need to: have a Bachelors Degree in Arts, Health Science, or Science (3 years), have a B+ average in your Bachelors Degree to access a Master’s Degree in Psychology (2 years) with an additional Postgraduate Diploma in Clinical Psychology (2 years) or a Doctorate in Clinical Psychology (3 years). A total of 7 years of full-time study is required. (Careers NZ, 2012b; Massey University, 2012). In view of these differences, it could be concluded that, currently, it takes half the effort and half the time to become a Clinical Psychologist than to become a Psychiatrist in NZ, which may be one reason behind the shortage of medical doctors nationwide. Proponents of PxRP claim that medical graduates receive little mental health training during medical school – just 3 years (i.e., 3 double semesters) - (University of Otago, 2012) and that it is GPs, and not Psychiatrists, who prescribe a high percentage of psychotropic medication, sometimes following the recommendations of a Clinical Psychologist (APS, 2008; Long, 2005). On reading this, it would, therefore, be logical that the Clinical Psychologists, exclusively trained in mental health, should have prescription privileges for psychoactive medication and expect similar health outcomes than medical doctors. Indeed, the most prevalent argument against prescription privileges for Psychologists is the significant differences in training and educational background between psychologists and medical doctors (APS, 2008; Muse & McGrath, 2010). While proponents of PxRP refer to the limited prescribing privileges of non-physicians such as dentists, midwives, and nurses, opponents counter with the fact that these prescribing professionals have undergraduate
  7. 7. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 7 and graduate degrees that concentrate in medical and science subjects, whereas Psychologists do not (APS, 2008; Muse & McGrath, 2010; Long, 2005). Because of these differences, opponents of PxRP may claim that Psychologists will require more medical training than currently proposed by the APA (2001) in order to handle the complexities of combining pharmacology with human pathophysiology. The APA's proposed training model is significantly shorter than that required of a GP or a Psychiatrist (APA, 2001) and does not address undergraduate course structure or competences. That said, the APA is right in calling their training model “An Inmodest Proposal” by the APA (2001), and states that Psychologists should feel no shame requesting prescription privileges as they are the professionals with the widest depth and breadth of knowledge of mental health issues. For Psychologists to be safe prescribing professionals, their training should start at undergraduate level, which means a complete restructuring of the qualification / degree. Let us take a look at the current situation: Students can do Psychology as a major in a Bachelor of Arts, a Bachelor of Science or a Bachelor of Health Science degree. They can complete a major in Business Psychology in a Bachelor of Arts, or if they already have an undergraduate degree, they can gain the equivalent of a major in Psychology through a Graduate Diploma in Arts or Sciences. Psychology can be done in internal or distance mode, full or part-time. Honours and Master papers are delivered in 5- day block courses. Unlike medical, nursing, and dentistry students, psychology students have no practicums. Is the academic training of Psychologists too inadequate, diffuse, confusing? Could this be one reason why no NZ University
  8. 8. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 8 appears in the top 100 universities to study Psychology? (Top Universities, 2012). Maybe there is nothing wrong with this pathway for most Psychologists – I/O, forensic, developmental, educational - but maybe it is just not the right one for Clinical Psychologists who seek prescribing right, and they should develop their own. Until the last decades of the 20th century, one had to study Medicine to become a dentist, and in some countries like Finland this is still the case. In most countries today -like France since 1965, Australia and NZ since 1970, Italy since 1980, and Spain since 1986 (Wikipedia, 2012) - students can become dental surgeons by doing the common core first 3 years of medical school fundamental sciences (Biology, Biophysics, Biochemistry, Pharmacology), medical sciences (Anatomy, Histology, Embryology, Physiology, Pathology) and humanities and social sciences. Two more years of specific theoretical and supervised practical training follow. In a total of 5 years, one can become a prescribing dental surgeon in most Western countries. How long does it take to become a Clinical Psychologist in NZ? Around 7 years? How many Clinical Psychologists would be willing to add 2 or 3 more years to their 7-year training to become designated prescribing Psychologists? For those who absolutely want to prescribe, a faster pathway is going to medical school to able to do so on completion of the BMBS. But for Psychologists who veer towards the scientific rather than the philosophical side of the discipline and think they should have prescription rights, advocacy of a new undergraduate pathway should be encouraged, one like that of dentistry, but in the case of Psychologists with supervised practice by a Clinical Psychologist (2 years) and then by a Psychiatrist (2 years). This
  9. 9. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 9 approach would be advantageous for students (a shorter, more robust degree at a fraction of the cost), for governmental bodies (properly trained clinicians), for clinicians (unquestionable background, authorised vs. designated prescription rights) and for patients. With medical-science trained Clinical Psychologists, who would go to a GP or a Psychiatrist when you can get antipsychotics + psychological therapy at half the price at a Clinical Psychologist's office? The cost of mental health services is an additional issue to take into account, just like professional fees. Obviously, prescribing Clinical Psychologists’ wages could be expected to go up considerably because of their added competency and prestige. Given that not all Clinical Psychologists would be willing or interested in becoming prescribers, two categories of clinicians would emerge with the possibility for professional tensions. Again, who would go to a simple Clinical Psychologist when you can get antipsychotics + psychotherapy from the prescribing ones? Maybe only prescribing Psychologists should be referred to as Clinical Psychologists in the new context of PxRP. Maybe health users will end up labelling each one. One thing is clear: prescribing Psychologists may start referring to their health users as patients, and no longer as clients, as a way to proclaim their higher status. This is no laughing matter and an issue to take into account and tackle before frictions lead to sparks. But, does the public have a say in all this? According to NZ due process, public consultation through notification, consultation, and participation is required before any change to current regulations can be made (Legislation, 2012). Pakeha mental health consumers would very possibly have a favourable position about the issue, especially if Psychologists, through a new educational
  10. 10. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 10 background, are seen as competent a prescriber as a medical professional. However, in the context of bicultural NZ, further medicalisation of Psychology could have a negative impact on the Maori population - as health consumers or providers - driving them further away from a biomedical system they consider foreign and alien to their health models (Durie, 2004). Whether the Maori population mental health problems will be better served with a wider availability of psychotropics requires further consideration and study, preferably with Maori stakeholders. The NZCCP instead of promoting Maori health training programmes, promotes a stronger biomedical model which is also rejected by many Psychologists. This is an approach not likely to be highly appreciated by the NZ indigenous population. Moreover, has the NZCCP made any consideration with regard to the approval and impact of PxRP on the Maori population? Society demands competent professionals to meet their needs. Medical students begin their practical work in their second year of undergraduate training, just like nursing, dentistry, and physiotherapy students (University of Otago, 2012; Careers NZ, 2012a). Psychology students have to wait to do a PhD to interact with a client on their own, and, even then, do so under supervision initially (Massey University, 2012). This not only gives rise to additional comparative grievances between medical and psychology students, it is also a waste of time and a misuse of readily available resources to meet the mental health needs of NZ citizens. A proposal has been made for Psychology students to get involved in early practical training (Westerberg, 2012). Just like medical, nursing or physiotherapy students must get involved in practical work, as unpaid trainees
  11. 11. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 11 first, in participating hospitals and clinics as part of their Bachelor’s Degree (Careers NZ, 2012; Carmichael & McCall, 2008), so should Psychology students, in the only context that, like a hospital, provides an unfortunately endless source of not patients but clients, clients in need of forensic, educational and psychological assistance: the correctional facilities (Westerberg, 2012). This approach parallels that of the US Government allowing first military Psychologists to prescribe psychotropics to military personnel in military bases and correctional facilities. That’s where the origin of prescribing Psychologists lies. However, the main rationale that psychological associations like the APA (2001) offer regarding the convenience for PxRP is a duty to better serve societal needs through the provision of mental health care to all citizens, particularly those who reside in remote or deprived areas, given the lack of availability of Physicians and Psychiatrists. Even in large towns, the lengthy waiting times to receive mental care makes the need of having psychologists prescribe psychotropics a matter of importance (Long, 2005). On the other hand, it is doubtful that prescribing Psychologists would really improve health outcomes in rural areas based on “The 2009 Health Needs Assessment Report” (Ministry of Health, 2009). Additionally, professional service availability surveys show that both Psychologists and Psychiatrists often already serve concurrent areas (Long, 2005). There is no evidence that Psychologists will relocate to cater to rural areas not already served by other prescribers, or that psychotropic medication needs are not already adequately being met by the existing medical services. Additionally, making psychotropics
  12. 12. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 12 more widely available to the population in deprived areas, where the Maori population tend to be overrepresented, should be questioned in the context of the current “Alcohol Reform Bill” to reduce the number of alcohol outlets in deprived areas in NZ (Ministry of Justice, 2010). Furthermore, recent studies show the growing concern among GPs regarding psychotropic drug misuse, as they are the drugs of choice for the commission of suicide. (Sheridan, Jones, & Aspden, 2012), which is more prevalent in the context of deprivation and alcohol abuse. Psychotropic abuse is currently regarded as an epidemic in the US, where around 45% of the population are on prescription drugs, and is now second to marijuana abuse (Hernandez & Nelson, 2010). The 2009 Health Needs Assessment (HNA) Report (Ministry of Health, 2009) provides information about the health status of NZ population, how it has varied with regard to previous reports, what health conditions have the greatest relevance in the population, and how each community compares to the rest of NZ. Based on this report, each DHB publishes their respective health reports containing the latest information about key issues like avoidable causes of mortality and hospitalisations. Incidentally, the latest HNA report for the Bay of Plenty was performed by Massey University on behalf of the Ministry of Health. Data regarding Maori vs. non-Maori, male vs. female, children vs. adults vs. elderly across degrees of areas of deprivation are all included. Based on the 2009 HNA report, 4 out of the top 5 main causes of avoidable mortality in NZ are the same across ethnicities and these are, in order of frequency: ischaemic heart disease, lung cancer, diabetes, motor vehicle accidents, and suicide. From these data, it appears that what NZ needs is more medical professionals than
  13. 13. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 13 Psychologists with prescribing rights. Psychologists can and do intervene in suicide prevention, but whether suicide rates can be reduced with a wider availability of psychotropics is an issue that requires ethical consideration and scientific research. Finally, the ethical-legal implications of the PxRP will be discussed. Medical professionals spend a considerable amount of money on professional insurances to cover for all the costs of possible malpractice or negligence suits. If taken to court, prescribing Psychologists could be asked to refer to concepts like standard of care, breach of duty, causation, and injury (Long, 2005). The concept of standard of care should, therefore, be defined for prescribing Psychologists, as it would be expected to differ from that of non-prescribing Psychologist and from that of medical doctors. On the other hand, it would be in the best interest of health service consumers that prescribing Psychologists abode by the same definition of standard of care as GPs and Psychiatrists as it would promote both accountability and protection (Long, 2005). In order to set the elements of a malpractice action, the prosecution usually calls for an expert testimony. A GP or a Psychiatrist may be asked to take the stand to evidence the limitations in knowledge and training of the defendant –the prescribing Psychologist - on whose hands the claimant, the patient - had put his or her health. In this context, the potential liability increase would require prescribing Psychologists to get or vary their malpractice insurance to reflect the greater practice risks, with wider coverage and more expensive premiums (Long, 2005). Additional legal issues to be addressed are the scope of the
  14. 14. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 14 prescribing Psychologist's authority, the requirements to maintain a prescriptive licence, and the drug formulary range (APS, 2008; Long, 2005). In the context of NZ, principle number 1 of the Code of Ethics for Psychologists practising in Aotearoa/NZ (Evans, Rucklidge, & O’Driscoll, 2007), statement 1.3, says that The Treaty of Waitangi “is given priority” in the code. It would be interesting to see if/how this is reflected in the context of the NZCCP proposal for PxRP, that is, how the Maori will participate in the decision-making and how a wider psychotropic availability will be beneficial for Maori welfare and interests. Principle 2 of the Code of Ethics (Evans, Rucklidge, & O’Driscoll, 2007), refers to responsible caring. A proposal for PxRP should explain how making psychotropics more widely available is responsible caring. Statement 2.2 may have to be re-written for prescribing Psychologists and be more specific about the scope of competences, and when a prescribing psychologist should request an expert second opinion and from whom. In view of the literature presented in this work regarding what is viewed as an epidemics of alcohol and drug abuse in NZ, is more psychotropic availability in keeping with principle 4, statement 4.1, about a commitment to promote societal welfare and social justice? If so, how? CONCLUSION The background for PxRP in NZ is based on the US experience, where Psychologists in 2 out of 51 states have limited prescription rights. Bills in other states have not been passed, the main reason being serious competency
  15. 15. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 15 concerns because of the lack of biomedical educational background and training in the Psychology curriculum. In the end, it is GPs, who receive 3 double semesters of mental health training during medical school, who prescribe a considerable amount of psychotropics. This is so because of the extensive biomedical education and training received during the first 3 years of medical school, which is shared by other health professionals, like dental surgeons. Similarly, some other health professionals like nurses, midwives, pharmacists and physiotherapists also have undergraduate and graduate degrees that concentrate in biomedical subjects. This is not the case of Psychologists. For Psychologists to be - and be considered by health professionals and the public- safe prescribers, their training should start at undergraduate level, which means a complete restructure of the Degree in Psychology to accommodate for the new professional scope, and do so in 5 years. Hurried, condensed, late training would be too little, too late, and an additional burden in the form of 2 to 4 years on top of a 7-year training. With the new category of professionals within Clinical Psychology, frictions and prestige issues could be a source of tension among clinicians with prescribers possibly getting more patients (not clients anymore) and having higher wages, but also higher premiums in malpractice insurances. The benefits of PxRP for society, particularly to the Maori population, in the context of lack of public demand and epidemic substance abuse and suicide rates statistics, are doubtful. The claim that more psychotropic availability in deprived areas will be in the best interest of communities is likely not to sell
  16. 16. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 16 well, just like the concept that psychologists would be willing to relocate because there are more of them than GPs or Psychiatrists. Data in the 2009 HNA report show that what NZ needs is more medical professionals and that the area in which Psychologists can contribute, suicide prevention, is not likely to be covered by the administration of psychotropics. Psychologists should focus on freeing the population from the chronic use of medication for psychological problems through the use of talk therapies. Finally, involvement of the Maori population in the PxRP decision-making is required if the NZ Code of Ethics for Psychologists practising in Aotearoa/NZ is to be observed. The code may have to be revised to accommodate prescribing Psychologists competencies. So, NZ Psychologists are requesting the right thing: prescription rights for the experts in mental health, but with no biomedical background the risk outnumber the benefits. The demand is also for the wrong reasons: inexistent societal demand, cater to deprived areas, shortage of GPs/psychiatrists, and through the wrong pathway (late training) instead of undergraduate training. As many journal articles like to conclude: Further research is needed in this regard.
  17. 17. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 17 REFERENCES APA [American Psychological Association] (2001). Prescription privileges: An inmodest proposal. Retrieved from http://www.apa.org/monitor/mar01/sp.aspx Australian Psychological Society (2008). Executive Director’s Report: December, 2008. Retrieved from http://www.psychology.org.au/inpsych/executive_dec08/ Brunton, L., Chabner, B., & Knollman, B. (Eds.) (2010). Goodman and Gilman's the pharmacological basis of therapeutics (12th ed.). Columbus, OH: McGraw-Hill Careers NZ (2012a). Psychiatrist - How to get into this job. Retrieved from http://www.careers.govt.nz/default.aspx?id0=30103&id1=j80099 Careers NZ (2012b). Psychologist - How to get into this job. Retrieved from http://www.careers.govt.nz/default.aspx?id0=30103&id1=j25322 Carmichael, A., & McCall, M. (2008). Medical Deans Australia and New Zealand: Medical training review panel clinical training sub-committee. Sydney: Author. Retrieved from http://www.medicaldeans.org.au/wp- content/uploads/National-Clinical-Training-Review.pdf Creswell, A. (2012, March 5). Doctors fight rival powers to prescribe, saying 'patients put at risk'. The Australian, n.p. Retrieved from http://www.theaustralian.com.au/national-affairs/health/doctors-fight-
  18. 18. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 18 rival-powers-to-prescribe-saying-patients-put-at-risk/story-fn59nokw- 1226288857157 Durie, M. (2004, June). Understanding health and illness: research at the interface between science and indigenous knowledge. International Journal of Epidemiology, 33, 1138-1143. Evans, I. M., Rucklidge, J. J., & O’Driscoll, M. (Eds.) (2007). Professional practice of psychology in Aotearoa New Zealand. Wellington, NZ: New Zealand Psychological Society. Hernandez, S.H., & Nelson, L.S. (2010). Prescription drug abuse: Insight into the epidemic. Clinical Pharmacology Therapy, 88(3), 307-317. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed?term=Hernandez%2C%20S.H.%2 C%20%26%20Nelson%2C%20L.S.%20%282010%29.%20Prescription% 20drug%20abuse%3A%20insight%20into%20the%20epidemic.Clinical %20Pharmacology Housman, A.E. (1994). Shropshire Lad. Cardiff: Michael Raven Publishers HPCA Act [Health Practitioners Competence Assurance Act] (2003). Retrieved from http://www.health.govt.nz/our-work/regulation-health-and- disability-system/health-practitioners-competence-assurance-act Lavoie, K.L., & Barone, S. (2006). Prescription privileges for psychologists: A comprehensive review and critical analysis of current issues and controversies. CHS Drugs, 20, 51-66.
  19. 19. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 19 Law Commission (2010). Why the availability of alcohol matters. Retrieved from http://www.lawcom.govt.nz/sites/default/files/publications/ 2010/04/Publication_154_464_Part_14_Chapter%206%20- %20Why%20the%20availability%20of%20alcohol%20matters.pdf Legislation (2012). Health Act 1956: Public consultation. Retrieved from http://www.legislation.govt.nz/bill/government/2007/0177/latest/DLM 1385800.html?search=qs_act%40bill%40regulation%40deemedreg_publi c+consultation_resel_25_h&p=1&sr=1 Long, J. E. (Fall, 2005). The debate over the prescription privilege for psychologists and the legal issues implicated. Law & Psychology Review 29, 243-260. Retrieved from http://www.nationalregister.org/trr_fall05_long.html Massey University (2012). Doctor of Clinical Psychology (DClinPsych). Retrieved from http://www.massey.ac.nz/massey/learning/programme-course- paper/programme.cfm?prog_id=93334&major_code= Ministry of Health (2009). The 2009 Health Needs Assessment Report. Retrieved from http://www.midcentraldhb.govt.nz/NR/rdonlyres/D9CC8453- F8E0-418C-88D0- 376ADE4813B0/0/2008HealthNeedsAssessmentfinalweb.pdf Ministry of Justice (2010). Alcohol Reform Bill. Retrieved from http://www.justice.govt.nz/policy/crime-prevention/alcohol/alcohol- reform-bill
  20. 20. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 20 Muse, M., & McGrath, R.E. (2010). Training comparison among three professions prescribing psychoactive medications: Psychiatric nurse practitioners, physicians, and pharmacologically trained psychologists. Journal of Clinical Psychology, 66, 96-103. Psychologists Opposed to Prescribing Privileges [POPP], 2007. Retrieved from http://psychologistsopposedtoprescribingbypsychologists.org/?page_id= 60 Sheridan, J., Jones, S., & Aspden, T. (2012). Prescription drug misuse: Quantifying the experiences of New Zealand GPs . Journal of Primary Health Care, 4(2), 106–112. Retrieved from http://www.rnzcgp.org.nz/assets/documents/Publications /JPHC/June-2012/JPHCOSPSheridanJune2012.pdf Top Universities (2012). World university rankings - Psychology. Retrieved from http://www.topuniversities.com/university-rankings/world-university- rankings/2012/subject-rankings/life-science-biomedicine/psychology University of Otago (2012). Bachelor of Medicine and Bachelor of Surgery (MB ChB). A guide to the Otago undergraduate medical degree. Retrieved from http://micn.otago.ac.nz/wp-content/uploads/micn/2008/03/HealthSci- Guide-to-UG-Degrees-web-11.pdf
  21. 21. 175.730.- Professional Practice of Psychology WESTERBERG, V.M. Course Assignment 21 Westerberg, V. M. (2012). Early practice for best practice in clinical and criminal psychology. [Course assignment]. Auckland, New Zealand: Massey University. Wikipedia (2012). Dentistry throughout the world. Retrieved from http://en.wikipedia.org/wiki/Dentistry_throughout_the_world

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