Psychologists can help relieve crisis in rural Hawaii
THERE IS a quiet crisis in rural Hawaii. It's not a secret. But even though it kills more people each year than traffic accidents, people don't much like to talk about it.
This crisis is a lack of adequate psychiatric care. As with most problems, when there's not enough to go around, it's the rural areas that go without. In rural Hawaii, it can take months to see a psychiatrist. In fact, you must be diagnosed as psychotic before you become a priority for getting an appointment.
Some have suggested that the solution is simple: hire more psychiatrists. The truth is that despite the admirable efforts of the Department of Health and the numerous unfulfilled promises of the psychiatric association, the problem is not likely to improve anytime soon. Nationally, one-third of all psychiatric training slots go to foreign doctors while still others go begging. Locally, each year the John Burns School of Medicine consistently produces new psychiatrists in the single digits -- hardly enough to replace those who are retiring or leaving the state.
The good news is, the Legislature has taken action. It passed Senate Bill 1004, allowing psychologists to obtain appropriate training to prescribe medications in federally designated health centers serving rural and underserved areas of the state. Psychologists, who already are experts in the diagnosis and treatment of mental disorders, will go through an additional four years of training and supervision, pass a national exam and then prescribe only medications relating to the kinds of mental health problems for which they already are treating patients.
The bill was passed over vigorous objections from the psychiatric association and the medical association. These are the same groups that opposed sharing the prescription pad when dentists, optometrists, nurse practitioners and physician assistants sought (and won) similar prescriptive authority -- with the same warning of tragic consequences if anyone but MDs were allowed to prescribe. Yet each time health care professionals have been allowed to receive appropriate training, access and quality of care improved.
The bill is supported by a broad coalition of citizens and groups, including the Hawaii Primary Care Association; Mental Health America in Hawaii (formerly the Mental Health Association); medical doctors serving rural Hawaii, including most of the medical directors of the health clinics that will be affected by the law; kupuna from rural areas of the state; Hawaii Medical Services Association; and the Hawaii Psychological Association.
The bill now is awaiting signature on Gov. Linda Lingle's desk. Meanwhile, for those patients in rural Hawaii who are suffering from panic attacks that send them to the emergency room, from major clinical depression that leads them to suicidal thoughts and actions, from substance abuse problems that tear at the very fabric of family and community, it is time to speak out. It is time to ask the governor to continue her courageous advocacy for improved mental health care and sign SB 1004 into law.