Chelsea Gorniewicz 1

Professor Sloggie-Pierce
ENG 211C
10/22/2016
Part C
The ability of non-psychiatric health care providers to prescribe
psychotropic medications is an ongoing debate in todays world. Some health care
providers that have not been provided an extensive knowledge and education in mental or
behavioral health have the legal ability to prescribe these medications. Nurse
practitioners, general practitioners, primary care physicians, nurse anesthetists,
physicians assistants, and internists are just some of these examples. (Rutkow et al.)
A team of professors, doctors, and educators from Johns Hopkins
Bloomberg School of Public Health and the Sandra Day OConnor College of Law at
Arizona State University investigated whether the current regulations on the advanced
practices nurses and health care professionals was, in fact, too strict. The onset of mental
illness, especially depression can be rapid. There are three main risk factors associated
with the prevalence of depression, one of which is major life changes, trauma, or stress.
(U.S. Department of Health and Human Services, 2016) When analyzing the ability of
these professionals in emergency situations, they realized that the health care providers
are legally allowed to prescribe psychotropic medications to a certain degree. However,
in the event that the emergency concluded, the patients to whom these health care
professionals prescribed can no longer seek them for care. Dr. Lainie Rutkow and team
argue that these medical professionals have more than equipped knowledge to prescribe
in all situations, never mind emergency situations. The overwhelming demand sought
after psychiatrists if these advanced practice nurses cannot provide prescriptions for
psychotropic medications would be far too overwhelming to meet the needs. (Rutkow et
al.)

Chelsea Gorniewicz 2
Professor Sloggie-Pierce
ENG 211C
10/22/2016
The argument that advanced practice nurses obtain an adequate level of
knowledge regarding pharmacology and psychiatry is presented as the American
Association of Colleges of Nursing are transitioning to doctoral-level education being
implemented into current advanced practice nursing programs which currently rest at the
masters-level. (OGrady, 2008) By providing this all-encompassing, extensive level of
education to all health care providers, the degree of variation between actively
prescribing professionals is significantly minimized. Thus, eliminating the presumption
that a health care provider of the above designations is less capable of effectively treating
a broad spectrum of diagnoses. While progressing from a comparatively more
competitive, independent system to a coordinated arrangement of procedures, the system
provides an environment favorable of occupational overlay and collaboration between
healthcare professionals where incidence of problematic tension was indicated. The
developmental interdependency between health care providers, through the reallocation
of scholastic resources, will subsequently improve the quality of patient care. This
increase in recognition of proficiency and respect amongst working counterparts and
decrease in incidence of situational tension solved the problem of power over turf
regarding the prescription of psychotropic drugs.
However, Dr. Jory Goodman makes a claim that neither power nor money
has anything to do with the issue at hand. Alongside his colleagues, Dr. Goodman
investigates the administration of prescription psychotropic medications with his peer
psychopharmacologists. He acknowledges that primary care physicians are briefed on
psychiatry due to the mandatory rotations done in medical school, but is concerned with
that minimal 7-week basis of knowledge and its ability to provide for educated, quality

Chelsea Gorniewicz 3
Professor Sloggie-Pierce
ENG 211C
10/22/2016
patient care in mental health patients, especially in comparison to the extensive study that
psychiatrists complete. (Goodman, 2011)
Also, when general practitioners, primary care physicians, or advanced
practice nurses provide care and for mental or behavioral health instead of referring the
patient to a psychiatrist, the patient is actually not receiving adequate care. Brendan
Smith describes that the effectiveness of mental health treatment via psychotropic drugs
is the most successful in conjunction with therapy. When patients are not referred to a
mental health professional they are not given an opportunity to receive full treatment.
(Smith, 36)
According to a study in Health Affairs, the proportion of non-psychiatrist doctor
visits where antidepressants were prescribed without a documented psychiatric diagnosis
increased from 59.5% to 72.7% between 1996 and 2007. (Mann, 2016) Psychiatrists are
trained not only in the human brain and its functions but also to detect even the simplest
of behavioral changes that may be indicative of an adverse reaction, contraindication, or
side effect. These behavioral changes may otherwise go unnoticed in non-specialized
health care professionals. Psychiatrists spend 4 years in postgraduate school studying for
their degree and this have the ability to detect these initial signs and signals. (Caccavale
et al.) Failure to detect these signs can lead to sudden psychotic outbreaks. Untreated
depression can lead to increased chance of risky behaviors such as alcoholism, drug
addiction, or suicide. (Mayo Clinic Staff, 2016) The NAPPP Executive Committee
considered the statistics regarding suicide recorded by the US Center for Disease Control,
and noticed the significant increased risk of suicide in patients being treated with
psychotropic drugs prescribed by practitioners other than professionals in the mental

Chelsea Gorniewicz 4
Professor Sloggie-Pierce
ENG 211C
10/22/2016
health fields was directly correlated with maltreatment via medication choice and
misdiagnosis. (Caccavale et al.)
A direct example herself, Dr. Suzanne Koven explains why she is not
comfortable prescribing psychotropic drugs but often feels obligated in instances where
her patients are unable to seek psychiatric help. The problem that she is getting to is that
she is not properly educated to make accurately informed decisions when it comes to
psychiatrics. She poses the reason that so many primary care physicians treating mental
health cases such as depression is due to a lack of psychiatrists while increase in need.
While she is unable and unequipped to make decisions on behalf of her patients mental
health, she has worked in conjunction with mental care professionals to ensure the patient
receives the best quality care possible. (Koven, 2013)

Chelsea Gorniewicz 5
Professor Sloggie-Pierce
ENG 211C
10/22/2016
Works Cited
Caccavale, John L., Ph.D., ABMB, Nicholas Cummings, Ph.D., Sc.D, Jerry Morris,
Psy.D., ABPP, ABMP, Dave Reinhardt, Ph.D., ABMP, Howard Rubin, Ph.D.,
ABPP, and Jack Wiggins, Ph.D., ABPP. Failure To Serve: A White Paper on The
Use of Medications As A First Line Treatment And Misuse In Behavioral
Interventions. Garden Grove: National Alliance of Professional Psychology
Providers, 29 Jan. 2008. PDF.
Goodman, Jory, M.D. "Hints for the Prescription of Psychotropic Drugs by NonPsychiatrists." Psychology Today. Sussex Publishers, LLC, 04 Dec. 2011. Web. 29
Sept. 2016.
Koven, Suzanne, MD. "Should Mental Health Be A Primary-Care Doctor's Job?" The
New Yorker. Conde Nast., 21 Oct. 2013. Web. 10 Oct. 2016.
Mann, Denise. "Antidepressants Prescribed Without Psychiatric Diagnosis."
WebMD. WebMD, 2016. Web. 12 Oct. 2016.
Mayo Clinic Staff. "Depression (Major Depressive Disorder)." Antidepressants:
Selecting One That's Right for You - Mayo Clinic. Mayo Foundation for
Medical Education and Research, 2016. Web. 18 Oct. 2016.
O'Grady, Eileen T., Ph.D., R.N., N.P. "Chapter 43: Advanced Practice Registered Nurses:
The Impact on Patient Safety and Quality." Patient Safety and Quality: An
Evidence-Based Handbook for Nurses. Ed. Ronda G. Hughes. Rockville: Agency
for Healthcare Research and Quality, U.S. Dept. of Health and Human Services,
2008 Apr. National Center for Biotechnology Information. Web. 18 Oct. 2016.

Chelsea Gorniewicz 6
Professor Sloggie-Pierce
ENG 211C
10/22/2016
Rutkow, Lainie, J.D., Ph.D., M.P.H., Jon S. Vernick, J.D., M.P.H., Lawrence S. Wissow,
M.D, M.P.H., Christopher N. Kaufmann, M.H.S., and James G. Hodge, Jr. J.D.,
LL.M. "Prescribing Authority During Emergencies." Journal of Legal Medicine
32.3 (2011): 249-60. EBSCOhost. Taylor & Francis Group, LLC, 1 July 2011.
Web. 02 Oct. 2016.
Smith, Brendan L. "Inappropriate Prescribing." American Psychological Association 43.6
(2012): 36. Print.
U.S. Department of Health and Human Services. "NIMH Depression." U.S
National Library of Medicine. U.S. National Library of Medicine, Oct. 2016.
Web. 15 Oct. 2016.