On the 2nd October, 2019, the British Psychological Society (BPS) – the professional body for all practising psychologists in the United Kingdom – announced the start of an internal consultation about the merits of giving psychologists the rights to prescribe drugs. In the previous month, the BPS published a ‘discussion paper‘ about the same issue, highlighting anticipated benefits of the proposed change and posing questions that were worded in a way that suggested that the decision to give psychologists prescribing rights had already been taken – a fait accompli. This is very troubling.
If this proposal is given the go-ahead, most psychologist prescribing is likely to take place in the mental health sector. Based upon my experiences gleaned from 26 years as a clinical psychologist in NHS psychiatric services, I am struggling to see how such a shift in practice would benefit service users (or, for that matter, the psychology professions).
Equipping psychologists with prescription pads will:
- COLLUDE WITH THE GROSS OVER-PRESCRIBING OF PSYCHIATRIC DRUGS
There is already a psychiatric-drug epidemic across the Western world. Around 1-in-6 of the adult population are ingesting ‘antidepressants’. We routinely sedate both our agitated elderly, and disaffected youth, with toxic ‘antipsychotics’. The drugging of our children with amphetamines is becoming commonplace. All this despite the recognition that psychiatric drugs are (at best) only modestly effective, are often addictive, and are associated with a range of serious negative consequences for our physical health. Why do we need another profession dispensing psychiatric drugs? In over 30 years of working in mental health services, I don’t recall hearing many service users complain about being unable to access a prescriber?
- GIVE CREDIBILITY TO THE INSIDIOUS DIAGNOSTIC SYSTEM
It is clear from the discussion paper that drug prescribing by psychologists would be diagnostically driven. Within mental health services this would mean that stigmatising, pseudoscientific labels (invented by a few blokes around a committee-room table), that possess neither explanatory value about cause nor predictive power regarding the likely course of the problem, would determine whether drugs are offered. At a time when psychologists are at the forefront of promoting alternative frameworks for making sense of human distress (the Power Threat Meaning Framework, for example) do they really wish to collude with, and give credibility to, a nefarious diagnostic system?
- STRENGTHEN THE UNHELPFUL ‘ILLNESS LIKE ANY OTHER’ APPROACH TO HUMAN DISTRESS
Construing the various forms of human distress as ‘illnesses’, no different from established physical problems such as a chest infection or kidney stones, fuels much of what is currently wrong with psychiatric services. By seeking drug-prescribing rights, the psychology profession would be colluding with the myth of biological causation, that the primary reason for human distress and overwhelm is a biological abnormality that typically requires a chemical cure to restore balance. By further strengthening this ‘illness like any other’ myth, psychologists would be supporting an explanatory model that is associated with a number of negative consequences for service users, including: more stigma; greater passivity; the overuse of psychiatric drugs; and greater pessimism and risk aversion within services.
- DENY SERVICE USERS A SAFE, DRUG-FREE SPACE TO EXPLORE THEIR DIFFICULTIES
Anyone seeking help for emotional distress currently has no choice but to enter a GP surgery or psychiatric outpatient clinic, clinical environments where drug treatments are typically recommended. A small percentage will subsequently access talking therapies, a milieu unsullied by pill pushing. By granting clinical psychologists prescribing rights, service users will be denied access to a rare, drug-free space in which they can make sense of their difficulties while safe in the knowledge that their distress will not be medicalised.
- UNDERMINE THE IMPORTANCE OF PSYCHO-SOCIAL FORMULATION
Exploring the unique past and present circumstances of a person’s distress, elucidating how life experiences have influenced the development and maintenance of current difficulties, is one of the most helpful approaches offered by clinical psychologists. Giving psychologists the option of ‘formulation-informed prescribing’ risks replacing the encouragement of therapeutic storytelling, the exploration of the multi-layered personal stories of each individual, with simplistic, diagnostically-driven drug recommendations.
- CONFIRM BIOLOGICAL PSYCHIATRISTS AS THE ULTIMATE EXPERTS IN THE MULTI-DSICIPLINARY TEAMS
Psychologists with prescribing rights would – appropriately – be supervised by medically-trained psychiatrists, a process that risks further strengthening the existing misperception that consultant psychiatrists are appropriate leaders of multi-disciplinary teams. If we are to realise the much-needed paradigm shift away from the currently-dominant bio-medical approach to distress, non-medical professionals will require more power to agitate for change. Subordinating psychologists (in at least part of their role) to the direction of medical experts would, therefore, be a retrograde step, further enhancing existing power imbalances and tightening biological psychiatry’s grip on how we make sense of, and respond to, human suffering.
Based on these six negative consequences, I strongly urge psychologists to reject the proposal to grant them prescribing rights.
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Ketrin StockFreeImages & Dreamstime and David Castillo Dominici at FreeDigitalPhotos.net