Prescription for better mental health care
WITH the stroke of a pen, Hawaii lawmakers have the power to improve access to mental health care for tens of thousands of people -- an estimated 55,000 -- served by nonprofit community health centers in our state's poorest and most underserved rural areas.
Their need is dire, and the situation is getting worse.
The solution is the Hawaii Primary Care Association's House Bill 2589, which will allow appropriately trained licensed psychologists working at community health centers to prescribe and adjust medication to treat mental health issues.
These patients now wait from six weeks to three months to see a psychiatrist. On the neighbor islands, where the shortage of psychiatrists is most acute, many patients can't get an appointment at all. In 2005, only five new psychiatrists finished their training in Hawaii, compared to 34 new psychologists. In 2004, there were only six psychiatrists serving three of Hawaii's 13 community health centers, compared to 10 psychologists serving nine of the centers.
THE primary opposition to this bill comes from the state psychiatric association. This issue is not new to the Legislature. For more than a decade, psychiatrists have fought giving psychologists the authority to prescribe drugs by promising to improve care in rural areas, yet the situation remains dismal. There are simply not enough psychiatrists to go around, and as with many things in life, the poor and needy go without.
This bill is widely supported by medical directors and administrators of community health centers and by the Hawaii Nurses Association, HMSA and the Hawaii Psychological Association. Indeed, the bill was drafted by Rep. Josh Green, vice chairman of the House Health Committee and a Big Island physician who provides emergency room care in a rural setting.
In written testimony supporting the bill, HMSA states that this "could have a large impact for individuals in need of these services."
But is it safe?
Absolutely. Non-medical doctors, including dentists and optometrists, have safely pre- scribed medication within their areas of expertise for years. In Hawaii, advanced practice nurses and physician assistants also prescribe medication.
Moreover, psychologists are already prescribing in New Mexico, Louisiana, and within the Department of Defense. In Louisiana, psychologists have written more than 10,000 prescriptions without incident. In fact, there is no record of a patient being harmed by a prescribing psychologist in any of these settings. Elaine Orabano Mantell, a DOD prescribing psychologist since 1997, reports:
"I have never had a single adverse outcome. I have never had a single complaint leveled against me with regard to any of my clinical work including my use of medications. On the contrary, I continue to receive more referrals than any one individual can handle because the need for treatment is so great."
HB 2589 will require doctorate-level psychologists to undergo 4.5 years of intensive supervised training prior to prescribing a limited number of medications for our neediest individuals. This is in addition to the seven years of doctoral training in the diagnosis, assessment and treatment of mental and emotional disorders already required to become a licensed psychologist.
This advanced curriculum is based on the recommendations of a blue-ribbon panel, which included input from psychiatry, pharmacology and psychology. And just as dentists and optometrists only prescribe medications related to their expertise, appropriately trained psychologists would only prescribe medi-cines relating to mental health.
But most importantly, this bill will improve the safety of the people of Hawaii by increasing access to high quality mental health care in underserved rural areas.
But can we afford it?
The bill will cost the taxpayer nothing. Psychologists are already working in the rural health clinics. The cost of additional training will be borne by the individual psychologists. The real question is, can we afford not do this?
We have nothing to lose but the artificial roadblocks that prevent our most under-served populations from getting the care they need.
Beth Giesting is executive director of the Hawaii Primary Care Association.