South African Prescribers’ Opinions about Specialist Psychopharmacology Trained Clinical Psychologists as Non-medical Prescribers at PHC level

Objectives
Prescribers working in South Africa’s (SA) public rural primary healthcare (PRPHC) facilities opinions’ about specialist
psychopharmacologically trained clinical psychologists as non-medical mental health (MH) prescribers at PRPHC
facilities were investigated.
Setting
Over 17 million rural South Africans are dependent on PRPHC facilities for their MH care. In this setting, there is a dire
shortage of specialist MH prescribers with a psychiatrist to population ratio of 0.03 to 100 000. SA has adopted the World
Health Organization’s task shifting principle in an effort to alleviate medical workforce shortages. One task-shifting
consideration is to train clinical psychologists, employed at eleven times the rate of psychiatrists in PRPHC areas, more
comprehensively in physical assessments and psychopharmacology in order to become non-medical MH prescribers in
psychiatrically underserved settings.
Methodology
In this cross-sectional survey, the data was collected by means of telephonic interviews and electronic questionnaires.
The participants included a random sample of 60 prescribers consisting of medical officers, clinical managers and
psychiatric nurses employed at PRPHC facilities. A descriptive statistical analysis of the completed questionnaires was
carried out.
Results
The results indicate that the vast majority of PRPHC prescribers in this sample are in favour of clinical psychologists
receiving specialized training enabling them to prescribe psychotropic medication at PRPHC level.
Conclusion
This study suggests that the current prescribers of psychotropic medication at PHC level support the evidence-based
practice of task-shifting in terms of extending appropriately trained clinical psychologists’ roles in PRPHC settings to that
of non-medical MH prescribers.
References
Bruckner TA, Scheffler RM, Shen G, et al. The mental health workforce gap in low- and middle-income countries: a
needs-based approach. Bulletin of the World Health Organization. 2011;89(3):184-194.
Lund C, Flisher AJ. Norms for mental health services in South Africa. Soc Psychiat Epidemiol. 2006;41(7):587-594