Colorado bill would let psychologists prescribe mental health meds

A bill in the Colorado legislature would allow psychologists who complete additional training to prescribe mental health medications such as antidepressants.

Everyone agrees that the best thing that can happen to patients who need mental health care is a spontaneous collaboration between their caregivers, but there is disagreement about whether psychologists should be able to provide advice. will move the state closer to or beyond that ideal.

And, as with all debates over who can afford certain medical services, money is part of it. Psychologists would be able to bill for additional services, while psychiatrists and primary care doctors could lose some business.

Jin Lee, a Denver psychologist who has been pushing to allow prescribing, said the proposal would require an extensive process, including a two-year master’s degree in psychopharmacology, passing an exam, at least one year working under direct supervision and two-year conditional licensure, where the psychologist is required to work with a consulting therapist.

“This is not a weekend course on YouTube,” she said.

The bill, HB23-1071, was introduced Thursday and Sens. Cleve Simpson, R-Alamosa, and Steve Feinberg, D-Boulder, and Reps. Sponsored by Judy Amabile, D-Boulder, and Mary Bradfield, R-Colorado Springs.

Based on other states that allow prescribing, about 10% of Colorado’s roughly 3,000 psychologists could begin the process, Lee said. New Mexico, Louisiana, Idaho, Iowa and Illinois all allow psychologists to prescribe psychotropic drugs, as does the US Department of Defense.

Dr. Jennifer Hagman, a psychiatrist at Children’s Hospital Colorado, said she worries that psychologists will not have the necessary background in body systems and pharmacology to properly prescribe medication. Psychiatrists are required to complete medical school, while psychologists earn a Ph.D.

“The grounds they’re trying to connect are not remotely similar,” she said.

A poll conducted by the nonprofit Healthy Colorado found that 62% of those polled were in favor of allowing psychologists to prescribe after additional training, 26% were opposed and 12% were unsure. However, it did not specify what that training would include, so it is possible that support for the detailed proposal would be more or less. The survey was about 1,060 people likely to vote in the 2022 general election.

Kyle Piccola, vice president of communications and advocacy at Healthier Colorado, said the organization is supporting the bill because it sees a problem with access to care. The wait to see a psychiatrist in Colorado is six to 12 months, he said, and patients’ conditions can worsen in that time.

“We have a system in place right now that clearly isn’t meeting everyone’s needs,” he said. “It’s an additional way we can get people the care they need.”

Hagman said most people who take psychotropic medication get it from their primary care provider, so it would be better to integrate psychologists and other physicians into those practices. They can be especially helpful in working with patients to develop coping skills and to assess how their environment may be contributing to depression or anxiety, she said.

“Sometimes it’s easier to get a prescription than to go to a psychiatrist,” she said.

Studies have found that meditation and medication work equally well for anxiety, and that cognitive behavioral therapy – a treatment that involves asking patients to challenge their negative thoughts – and medication work equally well for depression. was effective. Of course, this doesn’t mean that every patient will get the same benefit from either type of therapy, and some studies have found that a combined approach is best.

Kim Lavoie, chair of behavioral medicine at the University of Quebec in Montreal, wrote a review in 2002 about the lack of evidence for or against prescribing by psychologists, saying there hasn’t been much research since to clarify the picture. Malpractice claims against prescribing psychologists are rare, but head-to-head comparisons of whether their patients are underserved by psychiatrists or primary care doctors have been less frequent.

Levoie said he is skeptical of allowing psychologists to prescribe medication, because they won’t be able to treat the drug’s side effects. Most people who have depression or anxiety also have other health conditions, so they already see a doctor, she said.

“How much does it really streamline the process? I’m not sure,” he said.

Piccola said primary care doctors are not extensively trained in mental health conditions and may not be comfortable prescribing psychiatric drugs, especially for children. They may also be more likely to misinterpret mental health symptoms — misdiagnosing anxiety as attention deficit hyperactivity disorder and prescribing stimulants that make it worse, for example — he said.

While primary care doctors need additional guidance, they have resources, said Dr. Cassie Littler, a pediatrician in Denver. One is the Colorado Pediatric Psychiatry Consultation and Access Program, a publicly funded tool that lets providers call child psychiatrists or psychologists with questions about managing children’s mental health.

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