Social work and psychotropic medication.(LETTERS)(Letter to the editor)

I read with great interest the article on psychiatric medication by Bentley, Walsh, and Farmer appearing in the October 2005 issue of Social Work.

I have more than 30 years of clinical experience with the various classes of psychotropics. In courses that I teach of aspiring psychologists and clinical social workers, I spend a great deal of time educating them about the benefits and risks of these medications, and this includes discussion of therapeutic indexes, onset of action, and dosing ranges.

I agree heartily with the authors that medication issues are very pertinent to clinical social workers. In the public sector, which has been the majority of my experience, four out of five clients are prescribed psychotropic agents, often in combination. This includes adults and youth clients. And it is quite common to have these agents prescribed for "off label" purposes.

I regard medication as a more invasive intervention than psychotherapy, and a strategy that should always be used in conjunction with psychosocial interventions. I have attended numerous psychiatric consultations with my clients. In my experience it is rare for the prescriber to ask the client if they are allergic to any of these agents, and they rarely discuss side effects and adverse events.

I believe that best practice is to fully inform clients about the medication and treatment. Informed consent, I believe, should be obtained in writing especially when neuroleptics such as Haldol, Risperdal, and the like are about to be ...