Psychiatrists, not psychologists, should prescribe medications

Imagine someone who has never set foot in medical school writing prescriptions for powerful medications.

Unfortunately that’s not far-fetched, as there is a years-long effort by some psychologists in Hawaii to obtain prescribing privileges. So far, our lawmakers have wisely rejected such a proposal, as it would lead to substandard mental health care for Hawaii people.

Psychologists are an important part of mental health, but they have no medical training. Under the proposal that some of them championed to the Legislature again this year, a psychologist with no medical training could take 400 hours of instruction — often online — and pass a test administered by other psychologists, who also lack medical training. Then they could start prescribing to children, seniors, pregnant women and people with serious and complicating medical conditions, such as heart disease, cancer and diabetes.

One’s role in providing health care should be limited by one’s training. But as they say, "You don’t know what you don’t know." What we learned during our residency training under the watchful eye of senior, experienced physicians and what we learned in our practices with patients can’t be taught in front of a computer. It can’t be taught in 400 hours.

Just imagine all of the issues with side effects, drug-to-drug interactions, physical illnesses that masquerade as mental illnesses and so forth. Medications affect all systems in the body, and do not start or stop at a patient’s brain. By definition, medications enter the digestive system and blood stream, and interact with other organs like the liver and kidneys. Those who prescribe need to understand the total patient.

This is why, if approved, the psychologist-prescribing bill would result in a two-level system of care: some patients would receive their care from highly trained medical doctors while others would be cared for by providers with insufficient training and knowledge. The patients we treat and all Hawaii people with mental illness deserve to be treated by someone with the proper medical training.

According to the National Institutes of Health, more than half of all patients with mental illness also have an underlying physical illness.

Understanding these major physical and mental illnesses and the complex interactions between the medications used to treat them requires extensive medical and pharmacological training, training that cannot be obtained in a crash course online. Also, psychotropic medications are highly effective in treating serious mental illness, but if not appropriately prescribed and monitored, they can result in serious consequences, such as seizures and irregular heart rhythms.

Proponents of the psychologist prescribing bill argue that there is a shortage of prescribing professionals — but that is simply not the case. They overlook primary care physicians, internists, pediatricians, OB/GYNs, nurse practitioners and others who regularly treat patients’ needs.

The needs of underserved areas can be better met by building on the mental health training of general physicians and other medically trained practitioners who are more widely distributed than psychologists. The expanded use of telepsychiatry also helps.

Medication is not the solution for every patient. Hawaii patients don’t need psychologists with prescription pads. We need psychologists to practice what they’re trained to do: evidence-based psychotherapy. We need proven programs that are high quality and don’t create a substandard system of care for some.

That is what the Hawaii Psychiatric Medical Association will push for and what our patients deserve.