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Psychopharmacology for Psychologists: An International Agenda
By Elaine S. LeVine, PhD
With the support of the Netherlands Psychological Association (NIP), a cadre of Dutch psychologists is seeking prescriptive authority for properly trained psychologists. The initiative is driven, in part, by the lack of sufficient psychiatric care in the more rural areas in the northeastern and southern parts of the country. In the Netherlands, the mental health system, as well as the medical system, is under governmental control. A sufficient number of psychiatrists at some mental health facilities are sometimes lacking. In order to meet these requirements, it has been necessary to hire psychiatrists from the bordering countries of Belgium and Germany, some of whose skills in the Dutch language are often limited.
Advocacy for prescriptive authority by the Dutch psychologists is also driven by quality of care issues. The psychologists in the Netherlands are quite progressive in having developed a specialization of primary care psychologists who work hand-in-hand in clinics with physicians (Derksen, 2008). The interdisciplinary medical, psychological and social work teams triage patients for appropriate inpatient, outpatient and home patient care. Prescriptive authority is a logical extension of the skills for these primary care psychologists. Their careful monitoring of psychotropic medications combined with psychotherapeutic intervention can optimize care. Furthermore, some populations are underserved in the areas of psychiatric care, childcare, elderly care, rehabilitation, forensics, facilities for the mentally and physically handicapped, addiction settings, and migrant minorities.
As the primary step in their RxP political agenda, interested psychologists in the Netherlands are seeking training in psychopharmacology. They have selected the psychopharmacology training program offered by New Mexico State University (Southwestern Institute for the Advancement of Psychotherapy/New Mexico State University postdoctoral Masters Degree in psychopharmacology--acronym, SIAP/NMSU) to complete their studies. By participating in the SIAP/NMSU curriculum practicum, these psychologists will fulfill all of the requirements of the New Mexico Prescribing Authority Act, which allows properly trained psychologists to prescribe psychotropic medications for their patients.
Leaders in mental health in the Netherlands are collaborating to develop a program that best meets the needs of the psychologists in the Netherlands. These include Hans Schutz, PhD, (Chairman of the RxP Task Force of the NIP Netherlands); Jan Derksen, PhD, (primary care psychologist Radboud University in Nijmegen); Huib van Dis, PhD, (Chairman of the Division of Psychology in Health Care of the NIP); and faculty and administrators at New Mexico State University, Elaine S. LeVine, PhD (Training Director of the SIAP/NMSU program, prescribing psychologist); Douglas Hoffman, PhD (psychopharmacologist); Michael Morehead (Acting Dean of Education); and Juanita Mendoza-Hannan, PhD (Dean of Distance Education).
The coursework is divided into four primary units: foundations in psychopharmacology, clinical psychopharmacology, evidenced-based medicine and special topics in psychopharmacology. Each of these units will be introduced with live instruction in the Netherlands by New Mexico State University faculty. The live instruction will be followed by home study and internet material. Students will be provided DVDs for some classes. Other classes are stored in a library through Centra, which is an online voice-over PowerPoint system. In addition, there will be monthly live lectures through the Centra system with direct communication between the faculty in the United States and the psychopharmacologist students in the Netherlands. In the last semester of the two year program, the Dutch psychologists will travel to New Mexico for an executive-tract practicum experience.
In addition to training the psychologists in the Netherlands in psychopharmacology, this joint project between psychologists in the Netherlands and the United States is providing excellent opportunities for professional and cultural exchange. First, designing the coursework by the psychologists in the Netherlands and the United States has illuminated some interesting similarities and differences in the needs of citizens and methods of practice within the two countries. For example, while a lack of sufficient psychiatric care is prompting the RxP movement in both countries, some of the reasons for the insufficient care differ. In the Netherlands, many psychiatrists in the larger cities would prefer to practice only psychotherapy. In the United States, most psychiatrists have adopted a strictly medical model in which they view themselves primarily as managers of the medication regime.
In developing the American psychopharmacology program for another country, a number of unique variables must be taken into consideration. For example, formularies differ across the countries; methods of governmental monitoring of medication (the equivalent of our Food and Drug Administration) also differ. While principles of ethnopsychiatry regarding metabolism of drugs remain the same, the particular ethnic groups to which these principles must be applied vary. The relative differences and emphasis in strengths in training to become a psychologist must also be taken into consideration.
Another aspect of the professional and cultural exchange centers on the practicum experience. It is planned that when the Dutch psychologists come to New Mexico for their practica, they will have an opportunity to meet with the prescribing psychologists and psychologists in prescriptive authority training in New Mexico to further their understanding of the cultural exigencies related to the biopsychosocial model of intervention. In addition, psychology faculty at New Mexico State University are very much looking forward to offering guest lecturers by their colleagues from the Netherlands in their classes.
Twenty-two Dutch psychologists are scheduled to begin the Masters Degree program in psychopharmacology through New Mexico State University in September 2008 and will complete their program in the Fall of 2010. We will keep you apprised of the interesting developments in this program and welcome you to contact Dr. LeVine for further information. Ψ
Derksen, J. (2008) The Identity of the Dutch primary care psychologist after 30 years of development. Submitted to Professional Psychology Theory and Practice, 2008.