Scope of Psychological Authority
As we explore the power held by the doctorate among psychologists in the United States, we can turn to the formal power and authority associated with the title “Doctor.” The formal power that is assigned in the United States can be identified by asking several fundamental questions concerning authority: who can prescribe medications, commit someone to a mental health facility, conduct psychological testing, and offer psychotherapy services.
Medications
First, who can order medications? This is a granting of authority that cuts deeply into the medical profession. The traditional answer is that only physicians (and perhaps physician assistants and nurse practitioners) can prescribe. However, there is a growing trend to allow some psychologists with significant knowledge and training in the area of psychopharmacology to prescribe. This trend arises from recognition that some psychologists are knowledgeable about medications (and their impact on human functioning) than are primary care physicians (who do most of the prescribing). It is not usual for a psychologist to offer advice regarding prescriptions to the physician working with one of the psychologist’s clients/patients.
As in the case of all important matters of authority, the grading of prescription privileges is determined at the state level in the United States. New Mexico was the first state to pass a law extending prescriptive authority to psychologists in 2002, followed by Louisiana, then Illinois, Iowa, and Idaho more than a decade later. Other states, such as California, support the notion that knowledgeable psychologists can serve as important consultants to physicians regarding prescriptions (especially regarding psychoactive drugs) – but still reserve prescription rights to physicians.
Commitment
There is a second medically related question regarding authority: Who can commit patients? An important distinction must be made between involuntary commitment and voluntary commitment. Typically, a medical professional must ultimately authorize the involuntary commitment of someone to a mental hospital or psychiatric ward of a general hospital. This commitment often requires judicial approval in a court, and evidence must be provided of a severe mental disorder.
This “disorder” is often identified –and warrants protective commitment–as a result of some actions taken that could hurt this person or other people. Suicidal behavior (enacted or seriously threatened) could be the triggering event, as could the observation or “legitimate” reporting of behavior that is bizarre, “non-normal,” and considered in some way to be dangerous. Psychologists and other mental health providers can recommend the commitment, but a medical professional must sign the papers. “Doctor” has no valence in this setting.
Voluntary commitment is much more common than involuntary. Mental health challenges such as severe depression, suicidal thoughts, manic episodes, and recurrent psychiatric episodes (e.g., hearing voices) can lead one to seek inpatient treatment at a hospital. While there is no need for a professional mental health worker to sign any commitment papers, a psychiatric evaluation will inevitably be done when a “patient” first enters the hospital. This evaluation will usually be done by a psychiatrist or other physician with mental health credentials.
