Prescribing Psychology Gets a Boost

LT Marcus VanSickle, prescribing psychologist, discusses a shared patient with Behavioral Health Technician, HN Corey Bryan.

Source: U.S. Navy LT Marcus VanSickle, used with permission

The military is known for pioneering advances which go on to benefit all of society. Technical and medical advances frequently start out as military initiatives before going on to be publicly adopted. Military psychology is no different. Such innovations as intelligence and personnel testing and strategies to address severe stress have their origins in the military.

One such military innovation, which has been slowly making its way into mainstream society, took a giant step forward last week when the American Psychological Association’s Council of Representatives adopted clinical psychopharmacology, better known as prescribing psychology, as a specialty in professional psychology. This officially recognizes prescribing psychology in the same light that the psychology profession views such specialties as neuropsychology, child psychology, industrial-organizational psychology, forensic psychology, and so on.

Psychology specialties are highly defined, requiring specific advanced knowledge and skills, and have distinct education and training components. Clinical psychopharmacology requires a Master’s degree (on top of the already required doctoral degree), an examination (i.e., Psychopharmacology Examination for Psychologists), and supervised clinical training before a psychologist can gain prescription privileges.

Military psychologists first achieved prescriptive authority via a pilot program conducted jointly at the Uniformed Services University of Health Sciences (USUHS) and Walter Reed Army Medical Center (WRAMC) in 1994, and since then, military psychologists have continued to gain these privileges. Despite the long history of prescribing within the military, however, it has taken a while for both military medicine and the overall system to adapt.

Part of the problem was the need for an education and training infrastructure, which in the 1990s existed only at USUHS and WRAMC. However, this initial pilot program ended in 1997, resulting in the need to create training programs at military treatment facilities. These programs were relatively short-lived and the military ultimately transitioned from in-house training to using civilian programs, as the number and accessibility of these programs began to grow. Masters of Science programs in clinical psychopharmacology started to appear within various U.S. universities in the early 2000s, and accreditation of these academic programs started in 2010. These formal programs, which continue to expand, have increased the realistic implementation of this training and consequent practice.

Five states currently have laws granting prescriptive authority to psychologists: New Mexico, Louisiana, Illinois, Iowa, and Idaho, and several states have current legislation pending. Additionally, Guam has a law allowing prescriptive authority for psychologists. The Department of Defense, including the U.S. Air Force, U.S. Army, and U.S. Navy, as well as the Public Health Service and Indian Health Service, continue to integrate prescribing psychologists within primary care, specialty care, and expeditionary units.

With the formal recognition of clinical psychopharmacology as a specialty in professional psychology, the groundwork is laid for board certification through the American Board of Professional Psychology. This would then bring prescribing psychology in line with the longer-standing clinical specialties and allow prescribers to attain the highest credential in the field. Additionally, with this recognition, ongoing legislative changes, increased training programs, and a heightened focus on the provision of mental health care to underserved communities, it is anticipated that the number of prescribing psychologists will begin to grow more quickly.