A bill to certify psychologists to prescribe and administer psychotropic medications passed the Colorado legislature Thursday, now only needing the governor's approval to go into law.
Currently, if a psychologist providing therapy or counseling decides their patient needs medication such as antidepressants, they must refer the patient to a psychiatrist or medical doctor to get a prescription. But due to a lack of prescribers in Colorado, this process can take months to complete and forces patients to pay for care twice.
House Bill 1071 would make the more than 3,000 licensed psychologists operating in Colorado eligible to apply to prescribe themselves. In comparison, there are only around 600 psychiatrists currently operating in Colorado.
"At the core, this bill is about mental health," said Senate President Steve Fenberg, D-Boulder, who sponsored the bill. "We can do better and we need to do better, and this bill is part of that conversation."
The state Senate unanimously passed the bill on Thursday, following the House's 56-6 approval earlier this month. The bill will now be sent back to the House to confirm changes made by the Senate, and then to Gov. Jared Polis for final consideration.
The bill's passage comes after several weeks of debate among lawmakers and mental health professionals regarding whether letting psychologists prescribe medications would lower the standards of mental health care.
To become a prescriber under the bill, a Ph.D.-holding psychologist would have to get a master’s degree in clinical psychopharmacology, pass a national psychopharmacology exam, complete 750 hours of prescribing practice under a supervising physician, be approved by the state boards of psychology and medicine, and complete 40 hours of continuing education in psychopharmacology every two years. In addition, the psychologist would have to maintain their current psychology license, malpractice insurance and psychology-based continuing education.
Despite these requirements, opponents raised concerns about allowing non-medically trained psychologists to prescribe medications, saying they do not understand how medications impact the body or how physical illnesses can manifest as mental health issues.
“Psychiatric medications affect all of the body’s systems,” said Dr. Nadia Haddad with the Colorado Psychiatric Society while testifying against the bill. "The mind does not exist in a vacuum. … Psychiatric medications can cause fatal heart arrhythmias, diabetes, high blood pressure, thyroid problems, liver and kidney issues."
Numerous medical organizations oppose the bill, including the American Academy of Pediatrics, Colorado Medical Society, Colorado Psychiatric Society, Colorado Chapter College of Emergency Physicians, Colorado Radiological Society, Denver Health and Kaiser Permanente.
The bill is backed by the Colorado Psychological Association, Colorado Counseling Association, National Association of Social Workers, Colorado Center on Law and Policy, Colorado Consumer Health Initiative, Colorado Cross-Disability Coalition, AARP and Healthier Colorado.
Proponents defended the qualifications of prescribing psychologists and emphasized that they would be required to collaborate with a patient’s primary physician regarding any medications prescribed, and wouldn’t be allowed to prescribe high-level drugs such as opioids. The Senate also amended the bill to clarify that the physician and psychologist would have to explicitly agree that the prescription is appropriate before it is administered to the patient.
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The House previously amended the bill to increase the required hours of supervised training, require 250 of the 750 hours to be under specialty providers for psychologists working with special populations like children, and require prescribing psychologists to disclose to patients that they are not medical doctors.
"We know that we don't have enough providers on the market, but we also recognize that physicians bring a certain level of expertise and psychologists bring a level of expertise," said Sen. Kyle Mullica, D-Thornton, who brought forward many of the Senate amendments. "We were able to find those solutions and make sure that both entities are marching forward together."
Psychologists can already prescribe mental health medication in five states — New Mexico, Louisiana, Illinois, Iowa and Idaho — as well as in the U.S. military. In New Mexico and Louisiana, deaths by suicide were reduced by between 5% and 7% since psychologists were granted prescriptive authority, according to Healthier Colorado.
Nationally, there are around 250 prescribing psychologists currently operating. From 2005 to 2021, there were only 14 board complaints against prescribing psychologists — half of which were dismissed and only two of which resulted in payments to the plaintiffs, according to Trust Risk Management Services, which provides liability insurance for psychologists.
Bill supporters championed this data as evidence that the program is safe and successful in other states, and likely won’t result in the massive tidal wave of prescribers that opponents fear. And while it might not drastically increase the number of prescribers in the state, Republican supporters emphasized that even one prescriber would make all the difference in rural areas that have none.
"It's really about expanding access to care," said bill sponsor Sen. Cleave Simpson, R-Alamosa. "We struggle to meet the rising need in all four corners of the state. ... This is just another key aspect of improving outcomes for constituents across Colorado, but in particular in rural Colorado."
This bill comes as the 2022 State of Mental Health in America report ranked Colorado as the worst state in the country for adult mental health. The year before, Children’s Hospital Colorado declared a state of emergency for youth mental health, as suicide became the leading cause of death for Colorado children ages 14-19.
In Denver, the city with the highest concentration of psychiatrists in the state, wait times for prescribers are upwards of six months, said the bill’s other sponsor Rep. Mary Bradfield, R-Colorado Springs.
In addition, Bradfield said, in Colorado only 12% of patients who are sent to another office for mental health care complete their treatment, compared to 77% of patients offered the same care in their current office.
“The kids I serve are the winners today,” said Dr. Jin Lee, a licensed clinical psychologist, in response to the bill's passage. “Whether I can start them on life-saving medication or take them off medications that are not helping, I know my young patients will be safer and healthier because of this law."
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