Two similar bills that would grant Hawaiian psycholog ists prescribing
privileges have advanced in the Hawaii state legislature, despite their
inclusion of lower training standards than previous bills.
Bills were passed in March by the Hawaii House of Representatives (HB 1456)
and Senate (SB 1004) that would establish a system to train, license and
credential, and supervise psychologists to prescribe "a limited
formulary of psychotropic medications for the treatment of mental
The legislation calls for training for psychologists that would include a
two-year postdoctoral program of at least 450 hours of classroom instruction.
Legislation approved by the Hawaii House last year had required 500 hours of
classroom instruction. The bills also would require a one-year supervised
practicum in which at least 100 patients are treated under the supervision of
a "licensed health care provider who is experienced in the provision of
"It should be a no-brainer that you can't replace 11 years of
[medical] training with 11 weeks of class and a year of supervision,"
said Jeffrey Akaka, M.D., a Hawaii psychiatrist and speaker-elect of the APA
The Hawaii Psychiatric Medical Association (HPMA) strongly opposes the
measures arguing that psychologists lack comprehensive medical training,
accreditation standards, and clinical supervision. District branch members
have been active in lobbying against the proposal.
Both bills have passed the chambers in which they were introduced but are
different enough to require further legislative approval by the opposite
chamber. Among the differences are more limited geographic areas where
psychologists could prescribe and stronger physician supervision in the Senate
The bill's supporters, including the Hawaii Psychological Association and
Hawaii Primary Care Association—composed of directors of the state's
community health centers—said it would benefit patients at rural
community health centers who can wait from six weeks to three months to see a
Psychiatrists dispute the claim that community-based mental health needs
are not being met due to lack of psychiatrists. They report that there are
17.4 psychiatrists in Hawaii per 100,000 residents, significantly higher than
the national average of 11.2 physicians per 100,000 residents.
The problem, according to HPMA, is that Hawaii's uninsured and underinsured
residents have insufficient access to psychiatrists through the state's
community mental health centers. Several of the centers have taken on the
additional paperwork needed to obtain federal funding for staff psychiatrists,
but most centers have chosen not to do this, Akaka said. "The main
barrier is funding," he said.
The legislative push for psychologist-prescribing privileges in Hawaii has
been under way for more than 20 years, but this year's bills have moved
further than previous ones. Similar legislation was approved by the House last
year, but the Senate put off approval pending further study.
Although the governor has taken no formal position on the legislation,
objections raised by the Hawaii State Department of Health suggest to
psychiatrists that Gov. Linda Lingle (R) is unlikely to sign such a measure,
according to opponents of the prescribing bills.
During the current legislative session, APA has again provided personnel,
financial, and strategic support to Hawaii psychiatrists.
"Every year it has been hard fighting this in Hawaii, and this year
is no different," said Paula Johnson, deputy director of APA's
Department of Government Relations.
A January review of data concerning psychologist prescribing by the Hawaii
Legislative Reference Bureau concluded that if the legislature were to approve
a psychologist-prescribing program, it should include a training model with
classroom and clinical training requirements at least as rigorous as a
Department of Defense (DoD) pilot psycholog ist prescript ive training program
in the 1990s. The DoD program, the Psychopharmacology Demonstration Project
(PDP), included at least one year of full-time classroom training at the
Uniformed Services University of the Health Sciences and one year of full-time
clinical training supervised by a psychiatrist. After privileges were granted,
psychologists remained under the supervision of a psychiatrist for two
Akaka and other opponents of the prescribing bills pointed out that in many
areas the proposed training courses fall far short of the DoD program, which
required an 11 times longer supervised practicum and supervision by
psychiatrists, not "a licensed health care provider who is experienced
As legislators assess the prescribing bills, psychiatrists plan to
emphasize alternative ways the state could address alleged shortcomings that
prescribing advocates say drives their bill.
In addition to several suggested approaches to fund psychiatric services at
the state's federally funded health clinics, psychiatrists have urged
legislators to support the use of telepsychiatry. Eighteen states have
implemented some type of telepsychiatry program to provide services to
otherwise underserved areas.
In 2006 telepsychiatry became available in Hawaii through the Community
Clinic of Maui and the Molokai General Hospital. Psychiatrists go to each site
once each month and provide additional visits through telepsychiatry. The
program also trains psychiatry residents in the use of telepsychiatry.
A growing base of trained psychiatrists may eventually expand
telepsychiatry services to schools, other community health centers, and
prisons, according to testimony from the Hawaii Psychiatric Medical