With training, clinicians can help the mentally ill
Community health centers across the state and the Hawaii Primary Care Association strongly endorse Senate Bill 1004 and House Bill 1456, which address prescriptive authority for certain psychologists. We believe that the requirements outlined in these bills regarding psychopharmacological training, supervised practice, standardized testing, board review and authorization, restrictions on what drugs can be prescribed, and practice only within community health center settings will ensure that patients will be well served rather than jeopardized.
As primary care providers, community health centers are best able serve the primary behavioral health needs of patients. Ideally, this care would be provided in an integrated manner by a team of professionals. This team would include the primary medical care clinician, who could refer to a licensed clinical social worker or psychologist for behavioral needs. By "integrated" we mean that medical and behavioral health clinicians work from the same set of orders and refer patients back and forth as appropriate, and freely communicate with each other about their care and management. The team would be supported by consultation with a psychiatrist on treatment decisions who also would be available to provide direct clinical care to patients who are seriously mentally ill.
Why do we think this is the best plan of action for Hawaii?
» Significant needs. Hawaii's 13 nonprofit community health centers on all islands in both urban and rural areas care for about 100,000 people who are at risk for not getting the health care they need because of poverty, lack of insurance, language and cultural gaps, or just because they live in areas where few doctors practice. Increasingly, community health centers -- in both rural and urban areas -- are the providers of behavioral health care in at-risk communities because their patients, who typically have a number of social, educational, economic and health problems, are more likely to suffer from depression, anxiety and other mental disorders. At the same time, they are much less likely to have access to any behavioral health care providers other than those who work at the health center.
» Training fits needs. The psychologists who would be affected by these bills go through a well-documented training program that addresses physiology and the drugs they are allowed to prescribe. The psychologists also are trained to be part of the primary care treatment team at community health centers. As such, they understand the needs of the patients, the resources of the health center and their role as part of the clinical team.
» Workforce availability. While this legislation affects a relatively small number of psychologists, their number and availability to community health centers is roughly equivalent to the demand for their services. There is a shortage of psychiatrists available even to serve privately insured patients living in urban areas, so their long-term availability to staff community health centers is questionable.
» Appropriate to needs. Psychologists are well suited both to the needs of community health centers and to their financial resources. Psychiatrists are scarce, command high salaries and are necessary to health centers primarily as consulting specialists on a limited basis. It makes a lot more sense to us to get the most from our psychologists. Moreover, it isn't fair to unnecessarily take up the time of psychiatrists, who are in such short supply, when others really need them.
We believe the thousands of underserved patients all over Hawaii who are cared for by community health centers will appreciate this legislation.
Paul Strauss is chairman of the board of the Hawaii Primary Care Association and executive director of the Waikiki Health Center. Beth Giesting is CEO of the Hawaii Primary Care Association.