We are considering a very dangerous bill that would jeopardize safe mental health care for Hawaii’s rural area patients. House Bill 1072, if passed, would allow psychologists to prescribe medications without a medical degree. Psychologists would be allowed to take a psychopharmacology crash course equivalent to an 11-week full time course, most of it online.

This program falls woefully short of adequately training psychologists to prescribe potentially dangerous psychotropic medications. Despite the recommendation from the National Alliance on Mental Illness that the health care professionals allowed to prescribe psychotropic medication should have significant medical training, the psychopharmacology program does not even require science or biology classes as part of its prerequisite requirements.

A review of the prerequisite requirements and the proposed curriculum ought to raise red flags for my colleagues. However, some legislators are simply buying into the rhetoric of the bill proponents who say that this bill will increase access to mental health care in rural areas. But what about safety? Shouldn’t the safety of our citizens be our foremost concern?

Patients suffering from mental illness
Patients suffering from mental illness sometimes need powerful medications. Those prescribing them must understand the effects of medication on the brain, kidney, heart, liver, skin and other organs. By Marco Castellani - Flickr: Schizophrenia, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=15538220

Consider this: bio-science classes are not required as prerequisites for psychologists to enter the psychopharmacology program. In contrast, bio-science classes are required for the pharmacy program. How can the bio-science requirement be less rigorous for psychologists will be prescribing powerful medications than for pharmacists who will be dispensing the medications?

The proponents of the psychopharmacology program insist that bio-science classes are not necessary to prescribe medications, and that psychologists will be “exposed” to these areas through the program. However, they cannot specify how the program will teach psychologists to screen for or manage diseases that can manifest themselves with mental health symptoms.

This is a critical issue since about half of the patients with mental illness also have other serious medical conditions requiring other medications. Symptoms that appear to derive from mental illness may actually be symptoms of infection, cancer or other serious medical conditions. Because of the lack of medical training and education, psychologists cannot determine whether symptoms may be a result of mental illness or a medical condition.

If this bill passes, psychologists can prescribe powerful medications only after completing about 10 percent of the training required for psychiatrists and about 20 percent of the required training for advanced nurse practitioners.

Psychologists are also not trained to understand the effects of medications on the brain, kidney, heart, liver, skin and other organs of the human body. Psychologists will learn only to treat the symptoms of mental illnesses through medication without understanding how these medications will affect the patient as a person.

Because of their extensive medical school and specialty training, psychiatrists are trained to determine whether a patient’s symptoms are either an untreated medical problem or the result of a psychiatric illness. This crucial distinction can mean the difference between life or death for patients.

If this bill passes, psychologists can prescribe powerful medications only after completing about 10 percent of the training required for psychiatrists and about 20 percent of the required training for advanced nurse practitioners. And the bill allows psychologists to take these courses online. These significant differences in training guarantees sub-optimal care.

There is a reason that similar bills have failed at least 183 times in 26 states in the past 20 years. In Hawaii, similar bills have failed 11 times. And it should fail again in our state if the legislators are listening to their constituents. Psychiatrists, community members, mental health community and legislators all over the country and in our own state are concerned about the safety issue.

Turning out ill-prepared psychologists into our community would unnecessarily increase the risks to patients without addressing the root of the problem: access to mental health care. In fact, according to distribution studies performed by the American Medical Association, the prescriptive psychologists in New Mexico and Louisiana (the two states that allow psychologists to prescribe) did not move to the areas with an underserved mental health population, but rather moved to the same areas currently served by psychiatrist and primary care physicians.

There is no way this current bill restricts those who might receive this privilege to rural areas, and it is very likely they will go where the money is, which is sadly not the rural areas.

Given the lack of proper medical training, psychologists should not be given prescriptive authority. I hope that my colleagues will join me in standing up for safe access and guaranteeing that our rural patient are not subject to sub-optimal care. I hope that they will promote and encourage the safer alternatives already in place, such as Project ECHO, collaborative care, and telepsychiatry. Passing this bill may seem on the surface to help with an access problem, but it will put our communities in harm’s way.

About the Author

  • Richard Creagan
    Richard Creagan, M.D., is a state representative from the Big Island. He was board certified and worked in Emergency Medicine in California and on the Big Island at Kona Hospital, where he was vice chief of staff. He left that specialty to retrain as a psychotherapist and received his B.A. in Psychology with Highest Honors from UH Hilo in 2009. He currently serves on the House Committee on Ocean, Marine Resources and Hawaiian Affairs and the Public Safety Committee.