Should psychologists prescribe medications?

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Supporters of a bill to allow psychologists to prescribe medications in Hawaii gathered Tuesday at the state capitol to plead with lawmakers to hear the measure.

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Supporters of a bill to allow psychologists to prescribe medications in Hawaii gathered Tuesday at the state capitol to plead with lawmakers to hear the measure.

House Bill 1072 is an attempt to address the severe shortage of psychiatric health care in Hawaii, specifically in rural areas such as Hawaii Island, said Dr. Judi Steinman, program coordinator of the Master of Science in Clinical Psychopharmacology program at University of Hawaii at Hilo’s College of Pharmacy.

“We just don’t have enough providers,” she said Tuesday.

On Hawaii Island, 23 psychiatrists are needed to serve the population, according to a January report from the Hawaii Physician Workforce Assessment Project. But only 14 currently are available, representing a shortage of 39 percent. Meanwhile, a November 2014 study by Mental Health America found Hawaii ranked last in the nation when it came to the percentage of adults with any mental illness who had received treatment.

As licensed physicians, psychiatrists can prescribe medications for their patients, but psychologists are limited to other forms of therapy. That means patients with illnesses that must be treated with medications are sorely limited in where they can find treatment.

By allowing some psychologists to receive advanced training in psychopharmacology and then giving them the ability to prescribe, Hawaii can lessen the burden on psychiatrists while opening up a new avenue for residents in need of mental health care, Steinman said.

New Mexico, Louisiana and Illinois adopted the proposed model of prescriptive authority, she said, and “even more states are currently considering similar legislation, including Florida, Idaho, Oregon, New York, New Jersey, North Dakota, Tennessee and Texas.”

“This is a proven model of success within the military and in those states in which prescriptive authority has been in existence for a decade or more,” she wrote in testimony provided to the Legislature.

“Patients are better served by clinical psychologists with prescriptive authority.”

In a phone interview Wednesday, Waikoloa resident Cathy Klarin said she has spent more than a decade trying to find help for her 30-year-old son, Robinson, who only recently was diagnosed with schizophrenia.

“I know the trouble and heartache I’ve been through fighting for my son,” she said. “He wasn’t properly diagnosed until two years ago. We’ve been trying to get a proper diagnosis for 11 years. It’s meant having to wait to find a psychiatrist that can treat him. It’s meant misdiagnoses. He started to get into trouble. He’s been in and out of jail. Now, he’s back in court again. … But he’s not a criminal. He has severe mental problems that were undiagnosed.”

In the last year and a half, her son’s behavior has stabilized following his diagnosis, but it’s been an uphill battle.

His condition requires visits with psychologists and psychiatrists, Klarin said, and allowing a psychologist to prescribe drugs for her son could prevent splitting the focus of his treatment.

However, people opposed to the bill say psychologists simply aren’t trained well enough to make the right decisions when it comes to prescribing drugs.

The Hawaii Medical Association provided testimony in which it said it would oppose HB 1072 unless the bill placed psychologists under the direct control of psychiatrists.

“These medications are powerful and complex and can cause serious cardiac and neurological side effects,” the association said. “By virtue of their education and training, physicians are able to weigh multiple factors, including the patient’s underlying medical condition, before prescribing medications. They are also able to recognize the adverse effects and side effects that may occur without warning.

“… This bill will cause more harm than good to an extremely vulnerable patient population.”

Even among psychologists, the issue is a debate.

Testimony provided by the group Psychologists Opposed to Prescription Privileges for Psychologists said the proposed bill would create “unnecessary risks to the public.”

Despite making important contributions to human health and well-being, “there are limits to the practices that psychologists can undertake responsibly as professionals. We believe that prescribing medications goes beyond psychologists’ competence … even if they obtain the additional training advocated by the American Psychological Association,” reads a petition submitted as testimony that was signed by dozens of psychologists, including University of Hawaii at Manoa psychology professor Frank Floyd.

State Sen. Josh Green, D-Kona, an emergency room physician and chairman of the Senate Committee on Health, said Wednesday he has long been a supporter of the psychology community, but the timing on HB 1072 just isn’t right.

He has not called for a hearing on the bill because there are other issues that take precedence this session, he said.

Also, he said, “if I had held the hearing, and then there was massive testimony against it, which I know there would have been, I would have had to defer the bill. Then, we’d have to start over from scratch next year. And that would have held it up further.”

Green says that ultimately physicians will be responsible for the care of any mental health patients who end up in hospitals because of issues such as medication reactions, and therefore the physician community’s input and participation is necessary.

“I am considering hearing and potentially passing this bill next session,” he said. “In the run up to the deadline, I put top psychology leaders in touch with top medical physician leaders in the hope that they’d have some consensus. … They have to have a meeting of the minds. … I will be encouraging both communities to meet each other halfway, but that was not accomplished yet.”

Steinman, however, says the time to act is now.

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“Why this bill is not scheduled to be heard is inexplicable. How many more suicides do we need in Hawaii before this bill can move forward? How many more task forces and studies need to be done at taxpayers’ expense before this bill can move forward?” she said.

Email Colin M. Stewart at cstewart@hawaiitribune-herald.com.

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