Psychologists write illegal prescriptions

Medications are being illegally prescribed by psychologists who are unlicensed and unqualified to do so.

The illegal prescription of drugs can lead to misdiagnosis, which can seriously hurt or kill a patient.

ABU DHABI // Psychologists are illegally prescribing medications to their customers despite being unlicensed and unqualified to do so, an investigation has found. The practice has led to warnings from doctors that real mental health issues are not being addressed, and could have potentially fatal consequences.

The area of psychology has limited regulations and, unlike medical doctors or psychiatrists, psychologists are not qualified to prescribe medicines. According to one clinician, who did not want to be named, the practice is routine at some clinics. "There are places in the Emirates, big medical centres, where psychologists who have no training in the medical field act as psychiatrists," he said. "The psychologist will do the assessment and if the patient is depressed, for example, the psychologist who is not authorised to prescribe will tell a primary physician to write a prescription."

Medications for conditions such as depression, anxiety and other psychological problems are among those handed out. The National visited three psychologists in Abu Dhabi. One professional, practising as a clinical psychologist, prescribed antidepressants using a blank pad already signed by another doctor. A second said she would prescribe medication in different circumstances and only one offered counselling.

The psychologist, working at a hospital in Abu Dhabi, gave a month's supply of Cipralex, an antidepressant, within minutes of the consultation. The prescription was written on a blank pad which had already been signed by a general medical doctor, who did not meet the patient. The assessment took less than 20 minutes and there was no discussion of possible conflicts with other medication or instructions on the correct dosage to take.

The woman, who charges up to Dh400 (US$109) for an hour's consultation, later denied prescribing medication and admitted that it would be "totally unprofessional" to do so. Dr Sana Hawamdeh, assistant professor of mental health and behavioural sciences at Sharjah University, said: "Under no circumstances should psychologists prescribe medication." Another doctor warned of the serious dangers involved.

Dr Youssef Abou Allaban, a psychiatrist who works in the UAE, said that proper understanding of the interactions of medications was essential for people who prescribe. "A misdiagnosis could lead to death," Dr Allaban said. "One common type of antidepressant can lead to cardiac effects or liver problems." He added that some psychiatric conditions could be the result of underlying medical conditions.

"If you have someone who just focuses on the fact that the patient is depressed without going through a detailed history, the patient is paying the price." According to guidelines issued by the Health Authority Abu Dhabi, "a clinical psychologist is required to have a master's degree in clinical psychology, as well as hold a national licence. Their experience should not be less than three years as a clinical psychologist."

Regulations governing psychology and other areas differ. A psychiatrist must also obtain a licence to practise, but anyone can set up a psychotherapy clinic and start seeing patients with potentially complex mental health problems. Even within the field of psychology, the lines are blurred. "In the field we see a lot of people who aren't well trained. There are psychologists who have bachelor degrees and go and do therapy," said a mental health expert.

At the Hopital Franco Emirien in Abu Dhabi, people asking for a psychologist are directed to Virginie Rivere, who offers "psychotherapie". While her staff call her "Dr Virginie", she has only a bachelor's degree in psychology and admitted that she was not a qualified or trained psychotherapist, instead calling herself a "life coach". "I restrict the work I do. I work with depression, mood disorder, anxiety, but I don't work with schizophrenia or bipolar [manic depression]," she said. "Once I get my master's [degree], I'll take care of the rest."

Ms Riviere, however, criticised doctors for over-prescribing medication without taking the benefits of counselling into account. She said many "give it out like candy" despite having a lack of knowledge of psychology. Part of the trouble, say members of the mental health community, is a lack of understanding about what a psychologist does. "The problem in the private sector is that there is no system for giving licences to people," Dr Hawamdeh said. "It is mixed up, there is no clear line between psychologist and psychiatrist."

Psychiatrists are medically trained doctors who have chosen to specialise in treating mental disorders. Some have undergone extra training in therapy. A psychologist has a degree in psychology. A higher doctorate qualifies a psychologist as a clinical psychologist or counselling psychologist. However, they are doctors of psychology, and not medicine. The health authority said it investigates any breaches of the regulations regarding prescriptions. It recommended that cases of psychologists prescribing medications be reported to its Health System Compliance Division for investigation.

[e-mail] * With reporting by Karen Attwood