“I don’t typically get awards,” says Dr. Steven Curtis, a faculty member at Antioch Seattle who just received the Washington Psychological Association’s Distinguished Service Award. As he says, “I always look at myself as a part of the machine, rather than an outlier.” But this modesty, and Dr. Curtis’s comfort in working behind the scenes, understates the big effects that his work is having on his students, his clients, and even on the laws that govern his profession.
Today, Curtis is busily working on this legislative effort—HB 1863, which would amend Washington State law to expand who can prescribe psychotropic medications. And he’s doing this while at the same time teaching his students and maintaining a private practice working as a therapist with children who have Attention Deficit/Hyperactivity Disorder and other neurodevelopmental challenges. Amidst all of this, Curtis will on May 6th be offering a day-long, six-credit course for Antioch’s Continuing Education program, titled Fundamentals and Updates in Pediatric Psychopharmacology.
We caught up with him earlier this month to talk about his career, the joy of winning this award, his legislative activism, and his passion for training psychology professionals.
Necessary Changes to Prescribing Laws
In 2021, Washington State had the second-highest rate of youth experiencing major depressive episodes, but fewer than half of these youth received mental health services. And during the COVID-19 pandemic, mental health professionals have seen increased depression and anxiety across all populations. At the same time, there is a decreased availability of psychiatric prescribers—in part because psychiatrists are becoming increasingly scarce. Psychiatric nurse practitioners help fill the gap, but more mental health prescribers are desperately needed. Most psychotropic medications are prescribed by primary health care professionals, which requires increased quality of collaboration between therapist and primary care provider as well.
This is why Dr. Curtis is working to pass House Bill 1863, a bill in Washington State that would allow specially trained psychologists to have prescribing privileges. This bill will expand patients’ access to life-saving psychotropic medication in a timely basis. And it will allow psychologists who are interested and willing to undergo special training the opportunity to add a powerful tool in their goal of helping patients. That is, if the bill passes and gets signed into law. Currently, the bill has been introduced to the chamber. The bill has a long way to go before making its way to the governor’s desk for a signature. Which is why Dr. Curtis continues his advocacy.
Beginnings and Psychopharmacology
But Dr. Curtis wasn’t always this interested in psychopharmacology. When he first started out on his career in psychology, Dr. Curtis was primarily interested in treating children with ADHD and autism with psychological interventions. This began during his undergraduate days at UCLA, where he majored in psychology. He then earned his PhD at Utah State University and completed a pre-doctoral internship and post-doctoral fellowship in Child Clinical Psychology at the University of Washington School of Medicine.
Psychopharmacology piqued Dr. Curtis’s interest when he ran into obstacles during his first job as a Child Clinical Psychologist at the South East Alaska Regional Health Consortium. Part of his job there was to do assessments and interventions with kids with autism, ADHD, and other neurodevelopmental challenges. But he found that they weren’t getting the care they needed, because of the amounts of bureaucratic red tape and referrals to other professionals required by law. And he came to see that these laws were in place all across the country—continuing to this day.
“If a child needs medication, I need to refer to another provider,” he says. “That referral piece can be extremely frustrating because anywhere in America, it’s really hard to access quality psychiatric services unless you’re well off.” As he ran into these barriers again and again with his clients, he became frustrated with the whole process.
It was this very frustration that led him to complete a postdoctoral Master of Science in Clinical Psychopharmacology at Alliant University in San Francisco. If his clients had trouble accessing the medicine that would help, he wanted to learn about those drugs himself and work to be able to prescribe them directly to those who needed them. Once he finished his program, Dr. Curtis became a full prescriber in New Mexico. He completed a Conditional Prescribing Psychologist Fellowship at Memorial Medical Center in Las Cruces, New Mexico in 2021.
Dr. Curtis also wrote the book Understanding Your Child’s Puzzling Behavior. This guide offers parents guidance for when they should seek professional help for their children’s behavioral, social, or learning challenges—giving key guidance through the often-complex process of treating a child’s problems.
Finding a Calling as a Teacher of Other Psychologists
Dr. Curtis still practices part-time in New Mexico, primarily serving youth with Medicaid, but today he lives on Bainbridge Island, near Seattle, and he teaches part-time at Antioch Seattle. At Antioch, he has embraced not just teaching psychologists-in-training but also leading continuing education classes for experienced psychologists who need to remain current on the latest advances in their professions. This is why in May he is offering the one-day course Fundamentals and Updates in Pediatric Psychopharmacology.
Psychopharmacology, the use of medication for the psyche, is a field that has been around in its modern form since the 1950’s. But traditionally, prescribing psychotropics has been the province of psychiatrists, primary care physicians, nurse practitioners, and physician assistants—meanwhile psychologists were expected to intervene primarily through talk therapies. But that is slowly changing. As of today, RxP, prescriptive authority for psychologists, is legal in just five states: New Mexico, Louisiana, Illinois, Iowa, and Idaho. It’s also permitted within the Department of Defense, the US Public Health Service, and the Indian Health Service. There are over 200 prescribing psychologists overall.
Appropriately trained prescribing psychologists are well-situated to be the ones prescribing medications, in part because they need five years of mental health training before they can go into psychopharmacology. They often have the chance over many sessions to work on understanding a patient, before prescribing medications.
This is the logic underpinning Dr. Curtis’s work to pass House Bill 1863, which allows appropriately trained psychologists to prescribe medications for mental health challenges. Dr. Curtis is clear that this won’t give psychologists a blank check to prescribe all sorts of medication. In the bill, there are specific terms of what training is required, and what medications prescribing psychologists can prescribe. Additionally, all prescribing must occur in collaboration with a primary health care provider. But ultimately, this increased number of prescribing psychologists will enable many patients currently shut out of the science of pharmacological intervention to get the care they need. That’s why Dr. Curtis and others on the Washington State Psychological Association RxP Task Force are working so hard to get this bill passed.
Bigger Ambitions for Changing the System
In the long run, Dr. Curtis hopes after the bill is passed he can help to set up a training program similar to the psychopharmacology training program he went through at Alliant University. He hopes that this work will center the needs of underserved populations.
Additionally, he sees a need for more public-facing education about medication and how it’s used, focused partly on debunking negative stereotypes people have around these medicines. “I think there’s a lot of stigma about medication,” Dr. Curtis says. “It probably comes from people being silenced or not treated correctly.”
At the same time, Dr. Curtis thinks there needs to be a focus on taking people off medication. He sees an opening for psychology training programs to look at prescribing in a different way than the mainstream medical and nursing schools. “It’s important to have trained people that can understand people’s problems,” says Dr. Curtis. “As prescribing psychologists, we are psychologists first, and prescribers second. We have the power not only to prescribe, but to not prescribe, or de-prescribe as well. In contrast to other prescribers, we mastered the art of psychotherapy first. If medications are not effective, our fall back position is to provide talk therapy services as well.”
To these ends, he’s building his own expertise. “It takes a while to help certain people,” he says. “Not all people with mental health challenges can be helped with an eight week treatment program.” Many patients need someone on a regular basis to keep helping them long term rather than short term, especially with cases that are severe. In many ways—through advocacy of the Washington State legislature, by leading this one-day course in Fundamentals and Updates in Pediatric Psychopharmacology, through his ongoing teaching work at Antioch, and through his private practice—Dr. Curtis is working every day to make that change.