Committee hears testimony on H237 to let doctoral psychologists prescribe to expand access to mental health care

A legislative committee on Thursday heard testimony on H237, a bill that would amend Title 26 to allow licensed doctoral-level psychologists to obtain a prescribing specialty to prescribe medications for mental-health conditions after completing specialized coursework, supervised clinical practice and a national certifying exam.

Supporters said the change aims to reduce long waits for psychiatric care in Vermont and improve access in rural and under-resourced areas, while regulators and some committee members pressed for clearer training standards, statutory language and limits on what drugs would be permitted.

The bill would add a new section to the state psychology chapter (referred to in committee as Section 3,019) authorizing the Board of Psychological Examiners to create a prescribing specialty for doctoral psychologists. Under the draft language discussed, an applicant must hold a current doctoral-level psychology license in Vermont, complete a postdoctoral program in psychopharmacology accredited or designated by an appropriate authority, complete at least two years of supervised clinical practice of not less than 20 hours per week, and pass a national certifying examination as determined by rule. The board would adopt rules specifying educational prerequisites, length and settings of clinical rotations, and collaborative-practitioner qualifications.

The draft also would require a written collaborative agreement with a collaborating practitioner (a physician or other prescribing provider approved by the board), filed with the board, and would limit prescriptive authority to mental-health conditions the collaborating practitioner generally treats. The bill as drafted would bar prescribing for patients younger than 18, patients 80 years of age or older and patients during pregnancy; it would require Schedule II–V controlled substances to be identified by name and would prohibit prescribing or administering controlled substances by injection under the collaborating agreement.

Dr. Brandon Campbell, a Vermont clinical and neuropsychologist who does evaluations and therapy, told the committee he supports the proposal to “bridge that gap to access,” describing patients who wait six months or more to see a psychiatrist and sometimes wind up in emergency departments. "I am in support of this scope for many reasons," Campbell said, adding that psychologists who provide medication management typically see patients weekly and can monitor side effects and adjust treatment promptly.

Dr. Philip Hughes, a health-services researcher at UNC Chapel Hill, cited peer-reviewed comparative data from New Mexico and Louisiana and summarized his findings to the committee: "Compared to patients treated by psychiatrists, prescribing psychologists patients had a 24 percent lower rate of adverse drug events and a 20 percent lower rate of using multiple psychotropic medications," Hughes said, and he told members his modeling estimated H237 could reduce Vermont's mental-health prescriber shortage by about 8 percent. Hughes also cited studies linking prescriptive authority for psychologists to modest reductions in suicide rates and improved cost-effectiveness in some analyses.

Sarah Hastings, a psychology professor at Saint Michael's College who trains master's-level clinicians, said psychiatric appointment wait times are long and unevenly distributed: "The average wait time to see a psychiatrist is 54 days," she told the committee, citing a 2022 Agency of Human Services report, and argued that the bill balances access and patient safety by adding minimum training, supervised practice and an examination.

Officials from the Office of Professional Regulation (OPR) and the deputy secretary of state urged changes to the bill's draft language and timing. Lauren Hibbert, Deputy Secretary of State, said OPR supports the concept but requested statutory clarifications and additional specificity in training requirements. OPR staff suggested replacing wording that creates what the bill calls a separate "license" with a "specialty" or "endorsement" stacked on the existing psychology license, and they recommended substituting the word "designated" for "accredited" where the bill refers to postdoctoral psychopharmacology programs because the American Psychological Association does not grant the type of accreditation implied in the draft.

OPR also recommended a more prescriptive clinical-rotation model modeled on Illinois, in which applicants complete a defined set of rotations (for example, psychiatry, pediatrics, geriatrics, family medicine, internal medicine, emergency medicine, obstetrics and gynecology, surgery and one elective) over a 14-month clinical rotation rather than an unfettered two-year agreement set by the collaborating practitioner and applicant. OPR asked for rulemaking authority to limit certain drug classes (for example, opioids and other narcotics) and recommended a longer implementation runway so rulemaking for this new specialty can align with OPR's broader mental-health licensure modernization work. OPR told the committee it would prefer an effective date in 2028 to allow coordinated rulemaking and program setup.

Committee members pressed on practical details: how many Vermont doctoral psychologists might seek the specialty (OPR's survey response suggested roughly 580 licensed doctoral psychologists statewide, with a small survey response indicating about half of respondents might pursue training, implying perhaps a few dozen potential candidates), how continuity of care would work if patients moved between states, and which controlled substances or age groups prescribing psychologists should be allowed to treat. Supporters pointed to Colorado's 2023 experience and to national data showing many prescribing psychologists treat underserved patients in rural and Medicaid populations.

No formal committee vote was recorded during the hearing. Committee members directed staff to work with OPR and legislative counsel on drafting clarifications; OPR offered to propose statutory edits and to participate in rulemaking if the bill advances.

If advanced, H237 would require subsequent rulemaking by the Board of Psychological Examiners to define the precise educational, supervised-practice and collaborative-agreement standards, the panel heard. The board and OPR told members that additional funding for startup and administration of the specialty program may be requested if the bill proceeds.

The committee recessed for a short break and planned to reconvene to continue the discussion and consider possible language amendments.