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The Honolulu Advertiser
Posted on: Wednesday, January 31, 2007

Psychiatric treatment needs doctor's care

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When a crisis is at hand, it's tempting to seize the quick fix and hope it buys enough time for a real solution to be in place. That shouldn't be an option when a person's health is at stake, however, and allowing for such quick fixes would distract health officials from making a permanent course correction.

This is the situation with the perennial proposal to give prescriptive authority to psychologists in areas where psychiatrists are not available. The proposal targets a real need in Hawai'i, where there is a serious shortage of psychiatrists to provide mental healthcare, especially on the Neighbor Islands and in rural and poor communities in the state.

This session the proposal takes the form of Senate Bill 1004 and House Bill 1456, neither of which have yet been scheduled for a hearing. They should be heard, so that the discussion of underlying issues might eventually produce better care for all residents.

The bills would allow trained psychologists to prescribe certain drugs — and that may cause more problems in the future than it would solve in the near term.

Many of the professional psychologists who support this measure deal with this crisis head-on, with patients who could benefit both from drugs to stabilize their condition and from a psychologists' behavioral therapy.

Some psychologists working in areas with no resident psychiatrist have pressed physicians to prescribe those drugs but believe their own focus on mental health may, with training, make them better suited to treat a patient with both therapy and medication.

That's a big leap. The drugs at issue can have many medical side effects, and the training being proposed for psychologists falls short of what advanced-practice nurses get in order to be able to prescribe drugs. Psychologists, whose education is based on social sciences rather than medicine, have more ground to cover in their studies than do nurses.

Instead, rural health centers need to hire psychiatrists to handle clinical duties as well as work with doctors and psychologists to keep the body-mind treatment in balance.

Psychiatrists also need to accelerate efforts already under way to bridge the gap through regular telepsychiatry, consulting with patients remotely on follow-up visits.

Progress along these lines should be our lawmakers' goal, not creating a second tier of mental health services for patients in rural communities.