Interview With Robert McGrath About Pharmacotherapy for Psychologists

Interviewer [female voice]: In your book, Pharmacotherapy for Psychologists, you discuss how pharmacotherapy for mental health conditions has traditionally been the domain of psychiatrists and other MDs. What has changed in recent years?

Robert McGrath: Well, in recent years, the public has become very aware of mental disorders — things like depression, anxiety. And so, you've had this real explosion of people who are looking for help with these kinds of problems. And because of that, they've really overwhelmed the available resources.

So, you have more and more people who are getting treated for their mental disorders by primary care physicians and nurse practitioners who are very well-trained professionals, but they're not trained in mental disorders specifically. So because of that, you're seeing more and more people who are being treated exclusively with medication. And so, the numbers are very clear about that; that fewer and fewer people or smaller and smaller group proportion to population gets treated with psychotherapy. More and more people are getting treated with medications.

And so, that's something that we as psychologists are very concerned about. We're very committed to the value of both medications and psychotherapy as treatments for mental disorders, and so we want to participate in that process.

Interviewer: What are some of the key arguments for giving prescription privileges to psychologists?

Robert McGrath: Well, it comes down to two issues, and those are safety and access. And it's those two words that really sum it up. So, in terms of access, there's simply not enough people who are trained in both psychotherapy and medications to meet the need; to really do an evaluation of what's going to be the best treatment for this person who's having this kind of problem. And so, what we're really trying to do is increase access to people who are specially trained in mental disorders.

And the second issue is safety. Because obviously if psychologists aren't going to be safe prescribers, then psychologists shouldn't prescribe. But, at this point, psychologists have been prescribing in the military for 20 years, and they have been prescribing in two states for about ten years — Louisiana and New Mexico. In that time, there has not been one complaint ever registered against as a psychologist as a prescriber, either by a physician or by a member of the public. And that says to me that psychologists are safe prescribers.

So in terms of access and in terms of safety, I think there's a great case for giving psychologists the authority to prescribe.

Interviewer: Are there any risks or downsides for psychologists who take on this new role? If so, what are they?

Robert McGrath: Well, I think the biggest of all is that there is going to be pressure to become someone who just hands out medications and doesn't think about it in the way that psychologists were trained to think about these disorders. So, we really value doing a full evaluation of the person looking at the context, trying to figure out what's going on in the person's life, why it is that they're not functioning effectively, and using that as part of the treatment plan. It's awfully easy to just give out medications, and there is a lot of pressure just to give out medications. But we, as psychologists, are aware of these issues, and we're really struggling to make sure that psychologists don't fall into that trap.

Interviewer: What would you say to a psychotherapist who expresses reservations about the increased role of pharmacotherapy in mental health care?

Robert McGrath: My answer to that is: I agree with you. And I agree with you because I do think that medications are being overused. Sometimes they are underused too. There are lots of people in the population who are suffering from anxiety and depression who never get any kind of treatment. So, it's really finding the people who need it and then deciding the best course of treatment.

I think one of the advantages of having psychologists prescribe is because we do know about psychotherapy and we know about medications, that we're in a good position to say, "This isn't a really good use of medication." And because of that, a lot of the psychologists who prescribe will talk about the many times that they've actually reduced the amount of medication people are taking. So, I think this is really consistent with our wanting to play a role in keeping medications from being used too much.