RxP goes international

By The National Psychologist Editor
November 1, 2008



Amidst the many concerns Americans face in the world today, it is exciting to know that the prescriptive authority movement for psychologists is having a positive impact internationally.

Psychologists in the Netherlands have been carefully monitoring the progress of the prescribing/medical psychologists in the United States. They are now focusing their efforts to pass a law that allows prescriptive authority for properly trained psychologists.

Like psychologists in the United States, the Netherlands psychologists seek prescriptive authority to improve access to care as well as to develop a more integrated, biopsychosocial model of care.

However, while the overarching goals are similar, the specific sociocultural factors engendering the needs are different. For example, in many of the more rural areas in the northern and southern parts of the Netherlands, there are insufficient numbers of psychiatrists to staff health facilities.

The mental health system is regulated by the government, which determines the number of psychiatrists required per patient. It has been necessary to hire psychiatrists from the bordering countries of Germany and Belgium, although at times these psychiatrists are not fluent in Dutch. Even in the cities, there is sometimes a shortage of psychiatrists willing to integrate psychopharmacology into their practice.

These phenomena apparently began about 40 years ago when the standard of care for mental illness in the country was psychoanalytically based. Many of the older psychiatrists obtained training in psychoanalytic psychotherapy and do not want to prescribe medications.

The Dutch psychologists, through their professional organization, Nederlands Instituut van Psychologen (NIP), have selected the psychopharmacology training program offered by New Mexico State University (Southwestern Institute for the Advancement of Psychotherapy/New Mexico State University post doctoral Masters in psychopharmacology (acronym, SIAP/NMSU) to complete their studies.

By completing the New Mexico State University curriculum, these psychologists will fulfill all of the requirements of the New Mexico Prescribing Authority Act, which allows properly trained psychologists to prescribe psychotropic medications.

Leaders in mental health in the Netherlands, Hans Schutz, Ph.D., (chairman of the RxP Task Force of the NIP); Jan Derksen, Ph.D., (primary care psychologist Radboud University in Nijmegen); Huib van Dis, Ph.D., (chairman of the Division of Psychology in Health Care of the NIP); and faculty and administrators at New Mexico State University, Elaine S. LeVine, Ph.D. (training director of the SIAP/NMSU program and a prescribing psychologist); Douglas Hoffman, Ph.D. (education director of the SIAP/NMSU program psychopharmacologist); Michael Morehead (associate dean of education) and Juanita Mendoza-Hannan, Ph.D. (dean of distance education), collaborated to develop a psychopharmacology program that best meets the needs of the psychologists in the Netherlands.

The coursework is divided into four primary units: foundations in psychopharmacology, clinical psychopharmacology, evidenced-based medicine and special topics in psychopharmacology. Each of these units will be introduced in the Netherlands by New Mexico State University faculty.

The live introduction of each unit will be followed by home study, DVDs, and Internet classes. In the last semester of the two-year program, the Dutch psychologists will travel to New Mexico for an executive-track practicum experience.

There are many challenges in developing a program that is relevant for the Netherlands psychologists. For example, like psychopharmacology students in the United States, they need to learn about ethnopsychiatry; however, the preponderance of their ethnic groups and issues of those groups are quite different than in the United States.

In addition, some psychotropics are unique to Europe while others are identical chemical formulations to those prescribed in the United States but have different names. Of course, their means of regulating drug use differs from that in the United States. Also, because mental health care is monitored at the national level, the venues through which services are provided are different.

In this latter respect, there is organizational development within the Netherlands that offers much promise for prescribing/ medical psychologists. The psychologists in the Netherlands are quite progressive in having developed a specialization of primary care psychologists who work hand-in-hand with physicians in clinics.

The interdisciplinary medical, psychological and social work teams triage patients for appropriate inpatient, outpatient and home patient care. Prescriptive authority is a logical extension of the skills for these primary care psychologists. Their careful monitoring of psychotropic medications combined with psychotherapeutic intervention can optimize care.

Twenty-one Dutch psychologists began the masters in psychopharmacology through New Mexico State University in September 2008 and will complete their program in the summer of 2010. In addition to training the psychologists in the Netherlands in psychopharmacology, this joint project between psychologists in the Netherlands and the United States is providing excellent opportunities for professional and cultural exchange.

Thus, of even broader significance than in the prescriptive authority movement, this joint effort is a step toward psychologists uniting internationally to provide better mental health care for those in need.

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