An effort to certify psychologists to prescribe and administer psychotropic medications took a major step forward Thursday, receiving approval from the Colorado House of Representatives.
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.
If approved by the state Senate and governor, 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.
Bill sponsor Rep. Judy Amabile, D-Boulder, said she has experienced the ineffectiveness of the current system firsthand. During the bill’s House debate, Amabile said her adult son suffers with serious mental illness and was forced to wait eight weeks for his first psychiatric appointment. Feeling unable to wait, he went to a primary care doctor who was unaware of his diagnosis and was prescribed the wrong medication, causing him to end up in the hospital.
“We’ve spent the last 12 years navigating a completely broken mental health care system,” Amabile said. “This process is convoluted, it’s too long, it’s too expensive and we have families all over this state that cannot get care for their loved ones in the timeframe that they need it.”
House lawmakers passed the bill Thursday in a 56-6 vote. Though the bill received broad bipartisan support, it also faced bipartisan opposition from lawmakers who argued that it 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 clinician, 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.
“Nurse practitioners, psychiatrists, pediatricians are receiving between 12,000 and in some cases 16,000 hours of training and practice in this area before they’re given the authority and licensing capacity to prescribe medications,” said Rep. Shannon Bird, D-Westminster, who voted against the bill. “There’s always a balance to be had that, as we expand access, we are maintaining quality care.”
Proponents defended the bill, pointing out that prescribing psychologists would be required to collaborate with a patient’s primary care provider regarding any medications prescribed, and wouldn’t be allowed to prescribe high-level drugs such as opioids.
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.
“This just gives a path to the people who are the best of the best,” said Rep. Matt Soper, R-Delta, who voted in favor of the bill. “I appreciate that for rural Colorado and for being able to remove barriers to accessing specialists.”
Other lawmakers disapproved of psychologists being able to prescribe medications to minors, attempting to pass an unsuccessful amendment to the bill that would have prohibited this practice.
Rep. Scott Bottom, R-Colorado Springs, pointed to the numerous medical organizations that 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.
"Psychiatrists are against this. Psychologists are definitely in favor of it because it broadens their horizon and broadens their financial horizons. They’re going to make a lot more money with this, but they are not trained,” Bottoms said. “Even with all these additions … they’re still not even close to having the training they need for even basic psychotropic drugs.”
Rep. Serena Gonzales-Gutierrez, D-Denver, countered, arguing that psychologists often know their patients' needs better than psychiatrists.
Gonzales-Gutierrez said she worked with kids in the child welfare and juvenile justice systems for nearly 20 years, many of whom received therapy and were prescribed mental health medications. While these kids met with psychologists for therapy weekly and for at least an hour at a time, Gonzales-Gutierrez said the appointments with psychiatrists were only 15 minutes long and happened only every one or two months.
“That psychologist has more contact with the child, understanding what is going on with them, how the medications might be impacting them and affecting them,” Gonzales-Gutierrez said. “This bill is incredibly important to making sure kids are getting what they need when they need it.”
In an attempt to ease the worries of opponents, bill sponsors amended the bill to, in part, 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.
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.
“This bill is not a quick fix, but will produce long lasting, positive change for the people of Colorado,” Bradfield said. “I am so glad that I can be a part of a significant effort in bettering our state’s mental and behavioral health care.”
