As a community pediatrician, I see and treat children daily who struggle with behavioral health needs and lack access to mental health resources. Like our elected officials, pediatricians are committed to finding the right solutions to address Colorado’s pediatric mental health crisis, and as physicians, we are guided by the Hippocratic Oath to “first, do no harm.”
When it comes to what’s safest for Colorado kids, the clear risks and consequences of the recently introduced House Bill 1071 — which would allow psychologists to prescribe powerful psychiatric medications — mean it’s not the right solution for children, adolescents and young adults.
Currently, only medically trained professionals — physicians, psychiatrists, nurse practitioners or
physician assistants, for example — can prescribe these medications. If HB 1071 passed,
psychologists would be the only non-medically trained prescribers in Colorado.
HB 1071 moves Colorado away from collaborative care models where physicians and psychologists each take a lead role to support kids and families. This would silo behavioral health care, separating a child’s medical and behavioral health needs. This is contrary to years of work by pediatric professionals to integrate the physical and mental health care needs of patients.
Pediatricians have great respect and reliance on our psychologist colleagues’ expertise and counsel. In fact, they lead the care team around the diagnosis of behavioral health disorders and therapeutic interventions. However, the many medical considerations for prescribing and treating a child on psychiatric medications — weight, blood pressure, metabolic panels, organ systems, side effects, and interactions with other medications — are most safely monitored and assessed by medically trained professionals.
Therefore, prescribing powerful psychiatric medications to children, which impact both the mind and body, should be done within the context of the “medical home,” an evidence-based approach where a full picture of a child’s health is known, considered, and evaluated.
Pediatricians are very comfortable prescribing and managing medications for diagnoses like anxiety, depression, sleep disorders, and ADHD. For more complicated medication needs, pediatricians refer patients to local child psychiatrists or utilize programs like the Colorado Pediatric Psychiatry Access and Consultation Program, which exist to support medical practices seeking expert child psychiatric consultation for medication management, both in moments of crisis and for long-term patient care.
Instead, families struggle to access counseling and therapy, especially in underserved areas.
Prescriptive authority is the last privilege granted to a physician. It is the culmination of the understanding of the human body, the application of medicine to each individual, and the balance of beneficence and nonmaleficence within clinical decision-making.
Even with the training requirements listed in the bill, a prescribing psychologist would be the least-trained professional with prescriptive authority in Colorado, including any physician, nurse practitioner, or physician assistant. Psychologists lack the comprehensive medical training and expertise to appropriately care for the complicated nuances of side effects and adverse reactions that accompany prescribing and de-prescribing medication to children.
Addressing the pediatric mental health crisis requires access to more mental health professionals and therapeutic interventions, not more prescribers. In fact, adding more prescribers could mean fewer mental health professionals available to offer the counseling, assessments, and therapeutic supports that work in tandem with medications. More prescribers accepting cash-only payments also won’t help patients who lack the means to pay out of pocket for care, worsening existing inequities among children needing mental health care.
For 30 years, policymakers across the country have rejected over 200 bills to allow psychologists to prescribe psychiatric medications. Today, only five states allow such practice, demonstrating that this proposal does not meaningfully increase access to care.
We can’t just medicate our way out of the mental health crisis we are facing, especially for our youth, and I ask Colorado’s state legislature to reject HB 1071.
Instead, we need to ensure statewide, timely and affordable access to mental health professionals who offer therapeutic support, expand existing integrated behavioral health programs and invest in solutions we know make a real difference for kids.
Cassie Littler, MD, FAAP, is the president of the American Academy of Pediatrics — Colorado Chapter, which represents nearly 800 pediatric professionals across the state.
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