The Colorado legislature is seeking ways to address Coloradans’ lack of access to mental health services amidst a national mental health shortage. On February 9, the Colorado House of Representatives voted 56–6 to pass HB1071. The bill creates a new category of mental health specialists called Prescribing Psychologists, or RxPs.
States require clinical psychologists to have a doctoral degree (either Ph.D. or PsyD), which takes roughly 5 to 6 years to obtain after getting an undergraduate degree. Most states then require that they do at least one year of postgraduate clinical training and pass a standardized test.
In Colorado, as in most states, clinical psychologists must refer patients who need medication to licensed prescribers—usually psychiatrists. But nowadays, roughly 50% of psychiatrists don’t take insurance, and it can be difficult and costly for patients to see psychiatrists. And many small or rural communities don’t have psychiatrists. Psychologists can also refer their patients to primary care practitioners or even general surgeons like myself (even though it’s been years since I had any training or experience with psych meds) if a psychiatrist is unavailable.
More than 30 years ago, the Department of Defense (DOD) trained clinical psychologists to prescribe psych meds to increase the workforce of prescribing psychotherapists. The American College of Neuropsychopharmacology reviewed the program for the DOD and concluded:
“It seems clear that a 2‑year program—one year didactic, one‐year clinical practicum that includes at least a 6‑month inpatient rotation—can transform licensed clinical psychologists into prescribing psychologists who can function effectively and safely…and expand the delivery of mental health treatment to a variety of patients in a cost‐effective way.”
A Government Accounting Office review of the program concurred.
Today, RxPs practice in several federal agencies, New Mexico, Louisiana, Idaho, Illinois, Iowa, and the territory of Guam. Most jurisdictions require RxPs to obtain a master’s degree in clinical psychopharmacology, pass the national standardized Psychopharmacology Examination for Psychologists (PEP), and do 1 to 2 years of supervised clinical rotations before granting a license. In some cases, RxPs must contract to collaborate with a licensed prescribing health care practitioner for 1 or 2 years before their license is unrestricted.
You can read more about this in a Cato policy brief I wrote last October. On Wednesday, February 1, I testified before the Colorado House Public & Behavioral Health & Human Services Committee on HB1071. You can hear that testimony here. The Committee passed the bill by a 10–1 vote, with one abstaining.
Similar RxP legislation is pending in other states, including Arizona, Hawaii, and Washington.
Colorado lawmakers can help increase access to medically assisted mental health services by licensing prescribing psychologists without expending taxpayer dollars.
