The yearslong political struggle over whether Hawaii psychologists should be allowed to prescribe powerful medications to mentally ill people is intensifying again at the state Legislature.

Partnership for Access to Safe Care, a group that opposes giving prescriptive authority to psychologists, released a poll last week suggesting that nearly three-quarters of Hawaii residents oppose the idea of allowing psychologists to prescribe drugs for mental illnesses such as schizophrenia and depression.

Currently only New Mexico, Illinois and Louisiana now allow psychologists to prescribe drugs for mental illnesses. Only medical doctors including psychiatrists are allowed to prescribe those drugs. Psychologists, who have doctorate degrees but are not physicians, do not have that prescriptive authority.

Lobbyists for Partnership for Access to Safe Care are presenting the poll findings to state lawmakers in an effort to block House Bill 1072, which if passed would make Hawaii the fourth state to grant prescriptive authority to psychologists. The bill is now pending before its final committee — the Senate Ways and Means Committee — and appears to have a reasonable chance of being passed.

Dr. Julienne Aulwes, president of the Hawaii Psychiatric Medical Association, said in a written statement the poll shows that, like doctors, ordinary Hawaii residents are “alarmed about inadequately trained psychologists prescribing drugs.”

“If HB 1072 passes, some of our most vulnerable patient populations will receive powerful medications from psychologists with very limited clinical training or medical knowledge,” Aulwes said in her written statement.

A lobbyist for psychologists countered that the survey is a biased “push poll” designed to whip up opposition to the bill. Alex Santiago, who owns lobbying firm Health and Human Services Advocates, said the pollsters did not explain to survey participants that many people in rural areas don’t have ready access to a psychiatrist, and therefore might go untreated for mental illnesses.

“This is not about psychiatry versus psychology,” Santiago said. “This is about the consumers and the fact that they cannot get care, and they haven’t been getting care for the last 20 years.”

Opponents of the bill say psychotropic medications are among the most powerful prescription drugs, and many can have serious side effects. Among the 30 most commonly prescribed medications in mental health, 18 carry the FDA’s strongest warning of posing a significant risk of serious or even deadly side effects, opponents of the bill said in their announcement of the poll results.

An estimated 50 percent of patients with mental illness also have other physical illnesses, and mixing prescription medications used to treat mental illness and physical ailments can be dangerous, according to opponents of the bill.

“Without the proper medical training, a prescriber cannot fully understand how these medications can affect patients — especially those with complex medical conditions,” said Dr. Christopher Flanders, executive director of the Hawaii Medical Association. “A prescribing psychologist may erroneously prescribe a drug for what appears to be depression but is actually a thyroid deficiency, a cardiac arrest or even a brain tumor.”

Santiago said the bill has been opposed for years by psychiatrists and physicians, while social workers, consumer advocates, psychologists and others support the bill. Santiago was hired by the Hawaii Psychological Association to make the case for the bill to lawmakers.

Trisha Kajimura, executive director of Mental Health America of Hawaii, said there has been a lack of psychiatrists in rural communities in Hawaii for years, particularly on the neighbor islands, which means many people with mental illnesses go untreated.

“People in acute crisis need medication, and that’s the key, but psychiatrists are not available and we have such a shortage of doctors overall in Hawaii,” Kajimura said. “When you’re starting a crisis, you need intervention right away. The longer it takes to get it, the more severe it’s going to get, which has led to people ending up being in (emergency rooms), being hospitalized, suicide attempts, all of that.”

For Mental Health America the central issue is getting treatment for people, “and we field calls from people looking for help all the time, and are trying to match them up with providers that can meet their needs,” she said.

Psychologists are more readily available in rural communities, she said. “That’s where we’re coming from. We are really trying to provide access to treatment for the people that we are advocating for,” Kajimura said.

The bill would require psychologists to undergo training that is the equivalent of a Master of Science degree in psycho-pharmacology and pass a qualifying exam before they would be able to write prescriptions, she said.

Advocates for the bill predict only a small, select group of psychologists would actually undergo the training to qualify to write prescriptions, but they will improve access to care for the people who need it. “Even in small numbers, trained psychologists can make a difference in the populations that we’re looking at,” Kajimura said.

The Partnership for Access to Safe Care con-tends that a better solution is for psychiatrists to work with primary care physi-cians in rural communities so those doctors are trained and better able to provide help for their mentally ill patients.

Kajimura said she also supports that idea, and also supports expanded use of telemedicine systems as another way to get patients better mental health care.

“All of these things will help, but not one is enough,” she said.