The Right to Prescribe Movement Gains Momentum Across States, Improving Access to Mental Health Treatment

Recently, the Colorado Legislature approved HB 1071, which allows licensed clinical psychologists with additional training to prescribe psychiatric medications to their mental health patients. Colorado is now the sixth state to allow patients access to prescribing psychologists. Similar legislation is also progressing in several states, including Arizona, Hawaii, and Washington. 

Colorado passed this legislation to help mitigate the growing difficulties people with mental health problems encounter seeking mental health services. Mental Health America’s 2022 State of Mental Health in America report found that Colorado has the highest prevalence of adult mental illness among the 50 states and the District of Columbia. 

This legislation is part of a larger right-to-prescribe movement (RxP movement) that has been around since the 1990s when prescribing psychologists or RxPs, provided medication-assisted psychotherapy and talk therapy to people with mental health problems in the military and other federal agencies. Since then, Guam, New Mexico, Louisiana, Iowa, Illinois, and Idaho have taken similar action.

Currently, in most states without RxP laws, clinical psychologists with doctorate degrees must refer patients who need medication to licensed prescribers, usually psychiatrists. Unfortunately, this system has drawbacks. Such scope of practice laws limit psychologists from being able to most effectively assist those with mental health disorders. Specifically, these restrictive laws are placing a large burden on the mentally ill instead of assisting them.

By removing barriers to psychologist prescribing, states can increase the workforce of mental health professionals who can integrate pharmacotherapy with talk therapy, thus increasing access and reducing cost and inconvenience for people seeking mental health care. Additional benefits include: 

• increased collaboration and coordination of care. In a model where prescribing psychologists work alongside other mental health providers, such as therapists and counselors, there could be increased collaboration and coordination of care. This could help ensure that patients receive comprehensive and integrated care that addresses both their psychological and pharmacological needs.
• greater flexibility and patient-centered care. Prescribing psychologists may be better positioned to provide patient-centered care that takes into account the unique needs and preferences of each individual patient. Because psychologists are trained to consider the biopsychosocial factors that contribute to mental health conditions, they may be able to take a more holistic approach to medication management that considers not only the pharmacological effects of the medication but also the patient’s psychological and social context.
• improved outcomes. Prescribing psychologists may be able to offer more personalized and nuanced medication management that takes into account the individual patient’s needs and preferences, potentially leading to improved outcomes.
• reduced stigma. In some cases, patients may be hesitant to see a psychiatrist for medication management due to stigma or fear of being labeled with a mental health diagnosis. Seeing a prescribing psychologist, who may be perceived as less stigmatized or more accessible, could help reduce this barrier and encourage more people to seek the care they need.

There is also evidence showing that prescribing psychologists prescribe safely, and possibly more conservatively, than psychiatrists. 

Clearly, efforts to allow patients access to prescribing psychologists are gaining momentum as America’s mental health problems continue to mount.

Such legislation is not asking for a large expansion to scope of practice laws. Utah has already made similar changes. In fact, during the 2021 legislative session, Utah State Sen. Curt Bramble and Rep. Doug Welton saw legislation passed that increased medical professionals’ scope of practice by expanding the ability for non-physicians to write prescriptions. These non-physicians, such as nurse practitioners, receive less training in clinical pharmacology, therapeutics, and psychopharmacology than many clinical psychologists.

With states already adopting laws to allow psychologists to prescribe medication and Utah’s elected officials lessening scope of practice laws, it only makes sense for this law to come to fruition.