To prescribe or not to prescribe: Clinical Psychologists’ opinions on task-shifting for PHC practitioners.

The aim of this study was to explore clinical psychologists’ opinions about limited prescription authority (LPA) for psycho pharmacologically trained clinical psychologists working in South Africa’s public rural primary healthcare (PRPHC) settings. In PRPHC settings, a severe shortage of mental healthcare (MHC) professionals is experienced with a psychiatrist-to-population ration of about 0.03 to 100 000 people. Clinical psychologists are employed in this setting at 11 times the rate of psychiatrists. Clinical psychologists and psychiatrists share a treatment aim of alleviating their patients’ suffering caused by psychopathology, and the question is posed whether LPA for additionally psycho-pharmacologically trained clinical psychologists might enhance MHC at a PRPHC level. The study design was a crosssectional survey where telephonic interviews and electronic questionnaires were used to obtain data. The participants included two samples: a random sample of 30 clinical psychologists employed at PRPHC facilities, and a convenience sample of 49 clinical psychologists practicing in settings other than PRPHC facilities. The participants completed the questionnaires consisting of 11 Likert-type statements relating to opinions about the competence of current non-specialist prescribers, the legitimacy and possible usefulness of non-medical prescribers, the availability of MH human resources in PRHPC settings and the possible endorsement of further psychopharmacological training for clinical psychologists leading to LPA in PRPHC settings. The results indicate a consensus of support for the idea of clinical psychologists receiving extra training, to be employed as non-medical MHC prescribers in order to alleviate the medical workforce shortages and improve access to care in PRPHC areas.