The debate about prescription rights ("Prescription rights peer commentary", April 2003) insufficiently addresses the issue of professional influence and power. For example, if clinical psychologists have prescription rights within the NHS should they be paid the same as psychiatrists?

I am a psychiatrist, who has been called more of a psychologist because I take a biopsychological approach to psychiatric practice. I am also a member of the Critical Psychiatry Network ( Such a stance can lead to conflict, for example when working with more biomedically minded GPs, who continue to treat patients in primary care refered to specialists like myself in secondary care.

Under the New Mexico legislation, the prescribing psychologist still has to maintain an ongoing collaborative relationship with the health care practitioner who oversees the patient's general medical care. There also has to be malpractice insurance in place that will cover the practioner as a prescribing psychologist.

Prescribing psychologists are subject to current "best practice" guidelines and in the NHS this would include those produced by the National Institute for Clinical Excellence (NICE) ( I am not necessarily discouraging clinical psychologists from obtaining prescribing rights, but these issues of regulation do need to be addressed.

In psychiatric practice, the other powerful force for medical control, besides medication, is through the Mental Health Act. The current reform of the Mental Health Act (1983) has proposed that the clinical supervisor is normally a consultant psychiatrist, but may also include a consultant psychologist. I wonder how Lucy Johnstone and Jim Orford view this potential extention of clinical psychologists' professional influence.

Personally I am keen to facilitate the increasing role of clinical psychologists in the mental health field, because they tend to identify with my biopsychological approach. If they do take on the responsibilities of psychiatrists, they should also be eligible for the same professional prestige and authority, including salary.

Duncan Double
Norfolk Mental Health Care NHS Trust