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Part 3: Prescription process
Who can prescribe psychiatric medications?
There are four groups of people who can prescribe psychiatric medications: (1) psychiatrists, (2) primary care doctors or any physician with a valid medical license, (3) physician's assistants (PAs), and (4) nurse practitioners (NPs) (Note: Most states do not allow psychologists to prescribe medications, but there are exceptions, e.g., Illinois, Louisiana, and New Mexico.). 
Psychiatric patient work flow
The flowchart below shows the internal process of how healthcare systems handle incoming patients. There are three processing points where psychiatric medications can be prescribed: (1) initial assessment, (2) in-patient assessment, and (3) out-patient assessment.
In-patient and out-patient assessments are typically done by psychiatric specialists, while initial assessments are often done by primary care or urgent care physicians. It is unknown how well primary care physicians are trained in psychiatric evaluations. A recent report shows that 80% of antidepressants were prescribed by non-psychiatric specialists without any accompanying psychiatric diagnosis. 
Before prescribing medications, your doctor should perform a thorough psychiatric evaluation. According to the guidelines published by the American Psychiatric Association, evaluations are complex, time-consuming, and "involve a systematic consideration of the broad domains described in the guideline and vary in scope and intensity."  The domains described in the guideline are listed below, illustrating the complexity and resource-intensive nature of psychiatric assessment.
- Reason for the evaluation
- History of the present illness
- Past psychiatric history
- History of alcohol and other substance use
- General medical history
- Developmental, psychosocial, and sociocultural history
- Occupational and military history
- Legal history
- Family history
- Review of systems
- Physical examination
- Mental status examination
12.1 Appearance and general behavior
12.2. Motor activity
12.4. Mood and affect
12.5. Thought processes
12.6. Thought content
12.7. Perceptual disturbances
12.8. Sensorium and cognition
Use your doctor as your support system
People often talk about support systems. They are typically referring to friends and family members who stand behind and help them by understanding their special circumstances. Because your doctor is the one who understands the biomedical aspects of your health and may advise you to take medications and/or supplements, your doctor is a big part of your support system.
In order to maximize the value and minimize the risks of medications, work with your doctor to:
- discuss options other than medications—for example, therapies or self-help,
- set clear, reasonable expectations for outcomes and the risks of using medications, and
- stay connected and informed of any changes or developments in the medications you take.
 Types of Mental Health Professionals. Mental Health America. Retrieved on May 13, 2016. Link
 Mojtabai R. Olfson M. Proportion Of Antidepressants Prescribed Without A Psychiatric Diagnosis Is Growing. Health Affairs. 2011;30(8):1434-1442. Link
 Practice Guideline for the Psychiatric Evaluation of Adults. Second Edition. American Psychiatric Association. June 2006. Link