A Colorado legislative committee advanced a bill Wednesday that would allow licensed psychologists be certified to prescribe and administer psychotropic medications. 

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 House Bill 1071 passes the full legislature, the more than 3,000 psychologists operating in Colorado would soon be eligible to prescribe themselves. In comparison, there are only around 600 psychiatrists currently operating in Colorado.

“Not having access to medication when you need it isn’t just a little bit inconvenient,” said bill sponsor Rep. Judy Amabile, D-Boulder. “It’s life-altering consequences for many people. It could mean a loss of your job, divorce, custody battles, criminal justice involvement, hospitalizations, ER visits and suicide. … Too many people can’t get the care that they need in a timely fashion.”

This effort 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 to 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 bill, at its core, is about expanding access to care, access to life saving medication,” Bradfield said. “Access to mental health treatment is strained in our state and inadequate to meet the rising needs in all four corners of Colorado. The best way to prevent serious mental health emergencies is to ensure that people receive the mental health treatment and services they need, when they need it.” 

The House Public and Behavioral Health and Human Services Committee voted 10-1 in support of the bill Wednesday, advancing it to the full House for consideration. Only Rep. Tammy Story, D-Conifer, voted against the bill. 

While the bill received bipartisan support from legislators, the mental health community is divided. Dozens of psychiatrists and psychologists testified during Wednesday’s committee meeting, arguing for more than four hours about the validity of the bill. 

Opponents in the psychiatric industry 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. “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.”

Under the bill, a psychologist could apply for conditional certification to prescribe medication if they, in part, have a doctorate in psychology, a master’s degree in clinical psychopharmacology, pass the national psychopharmacology exam and hold professional liability insurance. The state’s Board of Psychologist Examiners would determine if they receive certification.

Psychologists would hold conditional certification for two years, during which time they could only prescribe and administer medications under the supervision of a physician or nurse. After two years, the psychologist could apply for full certification and work without supervision, so long as they maintain their license, their insurance and complete at least 20 hours of continuing education annually.

Supporters of the bill pointed out the two-year supervision period for prescribing psychologists – as well as the permanent requirement that they inform a patient’s primary care doctor of what is being prescribed – as making the program safe.

“These psychologists will be able to enhance the care they provide to their patients in a proven, safe manner that will be of tremendous value to the entire state,” said Dr. Brian Beaumund, president of the Colorado Psychological Association.

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.

While bill supporters championed this data as evidence that the program is successful in other states, opponents argued that there only being 250 prescribing psychologists nationwide shows that the program would not meaningfully increase access to prescribers in Colorado.

“This bill does not provide a viable solution to address the complex needs of children and families who are struggling to get the quality behavioral health care they deserve,” said Dr. Cassie Littler, president of the Colorado Chapter of the American Academy of Pediatrics. “It undermines the decades of hard work that we’ve done as a state to provide comprehensive, integrated behavioral health care.”

However, many Coloradans who are struggling to find mental health care testified Wednesday that lawmakers need to do something to improve the current system. 

Amelia Federico, a Denver college student, said she sought care for severe depression in high school, searching for several months before finding a therapist that accepted her insurance, had availability and who she felt safe with. After meeting with the therapist for weeks, she was recommended anti-anxiety medication. She was then told she’d had to restart the process of finding a provider all over again.

While researching psychiatrists, Federico learned that the average copay was around $100, not including the cost of the medication. She said that is the cost of a month’s worth of groceries for her.

“In the end, I could not pay for both a psychiatrist and a therapist, so I was not afforded the luxury of the medication that I desperately needed,” Federico said. “Situations like this are the reality we will continue to live in … if we do not work collectively to pass this bill.”