At a recent legislative hearing, two voices illustrated what delayed mental health care means for Hawaiʻi families — especially on the neighbor islands.

In testimony before lawmakers, a community member described the loss of two cousins to suicide. She emphasized that neither was able to access care in time, pointing to delays many families in Hawaiʻi know too well — long waits, limited access to prescribers, and missed opportunities for early intervention. She did not claim that a single policy change would prevent every tragedy, but she made one thing clear: when access is delayed, the consequences can be lasting.

Mayor Derek Kawakami of Kauaʻi, who also testified, spoke from years of public service and personal loss. He shared that he had lost numerous friends and family members to suicide and mental health crises. Notably, Mayor Kawakami acknowledged that he had not supported prescriptive authority for psychologists in the past. His testimony reflected a shift rooted in the realities of the communities he represents — places where psychiatric prescribers are scarce and timely access to care is limited.

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He was also clear that the proposal is not a cure-all, but that areas with persistent shortages must be allowed to consider realistic solutions. That is why allowing specially trained psychologists to prescribe medications — as part of comprehensive mental health care — is one practical option now being discussed.

Those stories are not isolated. They reflect broader challenges in Hawaiʻi’s mental health system. The state faces persistent shortages of psychiatric prescribers, a reality felt most acutely on the neighbor islands and in rural, isolated communities. Even on Oʻahu, demand consistently outpaces the availability of psychiatric prescribers, resulting in long wait times for medication evaluations and follow-up, delays in starting or adjusting treatment, and increased reliance on overburdened primary care providers, emergency departments, and inpatient services.

For many residents, this isn’t an abstract problem. It’s visible in shelters, emergency rooms, and on streets like Ala Moana Boulevard, where untreated mental illness is often on full display.

Geographic isolation limits the effectiveness of short-term recruitment and temporary staffing solutions. Telehealth has expanded access for many Hawaiʻi residents, but it has not been sufficient on its own to meet the state’s ongoing need for timely, continuous care.

Hawaiʻi already has doctoral-level psychologists working across public and integrated healthcare systems. These psychologists routinely diagnose and treat complex mental health conditions, provide long-term follow up, and manage high-risk and high-acuity patients. However, current law prevents psychologists — even those with advanced training — from addressing medication needs when psychiatric prescribers are unavailable or overextended.

These delays aren’t about specialization or expertise. They stem from regulatory constraints that limit Hawaiʻi’s ability to fully utilize — and grow — its mental health workforce.

In Hawaiʻi, the problem is not a lack of mental health expertise — it is a mismatch between the care people need and how the system allows clinicians to respond. In practice, this means that even when qualified providers are available, regulatory limitations can interrupt continuity, force additional referrals, and delay treatment at moments when time matters most.

Closing these gaps requires better use of the clinicians already serving Hawaiʻi’s communities, stronger continuity of care, and fewer unnecessary barriers between patients and treatment. Recruitment and retention efforts remain important, but they have not been enough on their own. That’s why allowing specially trained psychologists to prescribe medications is now on the table.

Many delays in treatment are not caused by medication complexity, but by gaps in evaluation and follow-up. Psychologists already work in these spaces, providing assessment, diagnosis, and ongoing treatment for individuals with complex needs. Prescriptive authority would allow medication decisions to occur within established care relationships, instead of adding another layer of delay.

Psychologists approach medication as one component of treatment. Specifically, prescribing psychologists are trained to integrate medication decisions into a broader psychosocial context — alongside psychotherapy, functioning, behavior, and environment — and to reassess those decisions regularly over time. This approach emphasizes careful use, close follow-up, and thoughtful consideration of when medication is — or is not — necessary.

Prescriptive authority for psychologists requires additional postdoctoral education and supervised clinical training. In a geographically constrained state like Hawaiʻi — where reliance on traveling or short-term prescribers is common — allowing these psychologists to integrate medication management into existing therapeutic relationships supports continuity by allowing care to remain with clinicians they already know and trust.

As with any change in healthcare policy, questions are inevitable. Some in psychiatry have expressed concerns about whether psychologists have sufficient medical training to prescribe safely, whether patient safety could be compromised, and whether professional boundaries could blur. Others argue these challenges should instead be addressed by expanding psychiatry itself.

Those concerns deserve to be taken seriously. Prescriptive authority proposals for psychologists address these concerns through defined scopes of practice, required postdoctoral medical education, supervised clinical training, and collaborative care models. The intent is not to replace existing psychiatric prescribers, but to expand access for patients who are already waiting for care.

Prescriptive authority for psychologists is about access, safety, and modernizing care. It reflects how healthcare already works — through collaboration, shared responsibility, and patient-centered care.
Denying prescriptive authority for appropriately trained psychologists is no longer a neutral stance. It perpetuates shortages, delays care, and harms patients. Continuing to wait has real consequences for patients and families — especially in communities already struggling to access care. The people of Hawaiʻi deserve timely, accessible mental health care.