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Mental health counselors'' perceptions regarding psychopharmacological prescriptive privileges. (Research).

Article Excerpt
The perceptions of mental health counselors about securing psychopharmacological privileges and requisite training have not been studied. A survey was sent to a national random sample of 1,000 members of the American Mental Health Counselors Association to which 410 members responded. The purposes were to elicit AMHCA members' perceptions regarding obtaining independent and dependent prescriptive privileges for psychopharmacological agents and requisite training needs. Forty-one percent of the respondents agreed that independent prescription privilege should be attained; 64 percent agreed that the mental health counselor should obtain dependent prescription privilege. More than 90% of the participants agreed that psychopharmacological training should be a required part of their curriculum. The most significant characteristics relative to agreement with dependent and/or independent prescriptive privilege were respondents' age and years of experience.

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Mental health counselors, one of the nonmedical mental health professionals (NMMHPs), are faced more than ever with a continually challenging client population. Psychotropic medications for the treatment of certain types of mental disorders have been improved, recognized, and accepted by medical and nonmedical mental health care providers. Often, the mental health counselor is more familiar with the client and the client's clinical issues than the prescribing physician. Therefore, the demand for mental health professionals to understand these medications' effects on patients with whom they work has become of paramount importance (Buelow & Hebert, 1995; Diamond, 1998; Hayes, 1997; Preston, O'Neal, & Talaga, 1997).

Ronald Koshes, a board-certified psychiatrist, believed that a cooperative approach to prescribing psychotropic medications would be in the best interests of the client (cited in Hayes, 1997, p. 8). He felt that most counselors were knowledgeable about their client's issues, including the possible benefits clients might receive from psychotropic medications. Legally and ethically, mental health counselors cannot prescribe medications, but they are often the ones to hear from their clients about the effects of medications.

Buelow and Hebert (1995) questioned whether it was ethical for the counselor to work with clients utilizing only counseling methods when pairing counseling with psychopharmacological interventions may be a more beneficial and efficient approach. Counselors need to be both educated and careful in their decisions to treat and refer clients who are in need of psychiatric medications. "The liability incurred in not referring a client for evaluation who needs psychiatric medication is certainly much higher than of referring a client who does not. Good faith referral of clients is the responsibility of counselors"(p. 107). Buelow and Hebert (1995) also indicated that mental health counselors are not receiving the training required to perform the collaborative work expected of them in clinical or hospital settings. They stated that many counselors are not prepared in psychopharmacology.

After examining the available literature relative to the current research, we did not find any existing survey of mental health counselors' perceptions about prescription privileges and requisite psychopharmacological training. Nevertheless, it was apparent from a review of the literature that the needs for further training and more involvement in the prescriptive process were emerging concerns. Therefore, a survey was developed to ascertain the perceptions of American Mental Health Counselors Association (AMHCA) members regarding their views of attaining independent and/or dependent privileges. The survey also addressed their perceptions about training needs and the extent of training they have already received.

There are several references related to training. From 1973-1986, Mount Zion Hospital in San Francisco, California, offered a doctorate in mental health that was intended to modify the shortcomings in the training of psychiatrists and psychologists to be able to work therapeutically and psychotropically with their patients (Wallerstein, 1992). A Prototype Educational Model for Training Psychologist Prescribers was developed in 1991 by the Department of Defense. This program initially offered post-doctoral training in psychopharmacology to clinical and counseling psychologists on active duty in the armed services (Sammons, Seton, & Meredith, 1996). Lott and Koshes (1997) developed a home-study program that was delivered through the American Counseling Association's (ACA) publications office. This program was to provide mental health professionals with information on the clinical use of psychoactive medications. The first specific information about requiring training for counselors was found in the 2001 draft of Standards for Accreditation submitted by the Council on Accreditation of Counseling and Related Educational Programs (CACREP). The two options that require didactic training in psychopharmacology were in Mental Health Counseling and Gerontological Counseling (ACA, 1999).

The...