Psychologists closer to prescribing drugs

Advocates for legislation that would allow psychologists to prescribe powerful medications argue the change is badly needed because there are too few psychiatrists on the neighbor islands.

Tina Marshall, whose daughter suffers from bipolar disorder with psychotic features, lives in Lahaina and knows about the struggles of living in an area where psychiatrists are not readily available.

“There are a lack of services, especially on Maui, and people are being killed and the suicide rate is rising exponentially,” said Marshall, 57, in a telephone interview. “Because of this, people are self-medicating with drugs and alcohol. This bill will provide some kind of care, and it’ll be better than no care at all.”

House Bill 1072 would grant prescriptive authority to psychologists under certain conditions, including mandatory consultation with primary care providers. Hawaii would become the fourth state to allow prescribing psychologists, joining New Mexico, Louisiana and Illinois.

The Senate passed the bill with amendments last week, but the House objected to certain changes.

On Monday Reps. Della Au Belatti (D, Moiliili- Makiki-Tantalus), Angus McKelvey (D, Lahaina- Kaanapali-Honokohau), Bert Kobayashi (D, Diamond Head-Kaimuki-Kapahulu) and Joy San Buenaventura (D, Hawaiian Acres-Pahoa-Kalapana) were named to make the House’s case in conference.

The Senate conferees have not been named.

The points of contention were not specified on the Legislature’s website.

In addition to consulting and collaborating with a patient’s physician, psychologists who want to write prescriptions would have to hold a postdoctoral master’s degree in clinical psychopharmacology and have at least 400 hours of clinical experience.

Individuals who suffer from mental disorders currently can get prescriptions from psychiatrists, who are also medical doctors trained in the possible reactions caused by various drugs. Advanced-practice registered nurses and primary care physicians can also prescribe drugs for mental disorders.

But those who support the bill say it will help address the shortage of psychiatrists, particularly in rural communities.

THE number of psychiatrists per capita across the country is dwindling as the nation’s population increases. To make matters worse, a recent survey by the Association of American Medical Colleges found that 59 percent of psychiatrists are 55 or older, signaling that many could soon be retiring.

Lambert Kong, 38, who lives in Wailuku and also suffers from a bipolar disorder, has experienced what it feels like to have a shortage of medication.

“I’ve been in that situation a few times, and by the time you can get the help, you’re already in crisis,” he said. “When I get in my manic episodes or my depression, I’m a different person. I’m more angry all the time, and I’m hard to deal with.”

Some psychiatrists argue that psychologists aren’t adequately trained to prescribe drugs, said Bob Toyofuku, a lobbyist for the Hawaii Psychiatric Medical Association.

Andy Martorana, M.D., who is a psychiatrist in the Chicago area, disagrees that psychologists do not have enough training.

“There’s psychologists with prescribing privileges across the country that didn’t go to medical school, but there’s a significant amount of training needed for a psychologist to prescribe.

“It’s a concern, but that’s balanced by the remarkable shortages of psychiatrists across the country. We really don’t have a lot of alternatives at this point.”

BUT not all mental health consumers are in favor of HB 1072.

Bud Bowles, 68, of Makiki has been suffering from depression since 1968 and is against the measure. He would rather have the role of a psychiatrist and psychologist be separate, and have them work together to help the patient.

“I want someone who understands chemistry as a chemical problem and has taken chemistry and is scientific. As with a psychologist, I want someone who specializes in behavior and thinking,” he said. “(There) needs to be balance for good mental health. I think of them as two different types of people, and I would like them to work in tandem.”

One of the psychologists in Hawaii who would pursue prescribing rights if HB 1072 is passed is Kelly Harnick, who has already obtained her postdoctoral master’s degree.

“I actually started that degree because I was practicing in Hana, which is obviously one of the most rural areas in the state,” said Harnick. “Being a provider in the community and serving rural areas is why I would pursue licensure, because people need help and they need access to care.”

Toyofuku, however, contends that the majority of prescribing psychologists would not go out into rural areas because there is already a lack of specialists such as neurosurgeons and cardiologists in these communities.

“I think the health community or the providers, they have to look at access across the board. It’s not only mental health. In the rural areas there is a shortage of specialists.

“There’s not enough business, so to speak, to make a living, so that’s a problem in rural areas.”