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The Honolulu Advertiser
Posted on: Friday, May 25, 2007

COMMENTARY
Bill not the answer to mental health access

By Gale R. Beardsley

The president of Hawai'i Psychological Association, Robin Miyamoto, was quoted in a recent Advertiser article stating that a shortcut program for psychologists to become prescribers of powerful psychotropic medications was needed because "our capacity to see these (mental health) patients hasn't increased."

Quite the contrary. Six years ago the Department of Health's Adult Mental Health Division was able to serve approximately 3,400 patients per year. In the past year it was able to provide services to almost 13,000 patients with serious mental illness.

Ten years ago, Hawai'i was rated 51st in the nation for its mental-health system, coming in behind Puerto Rico. In 2006, Hawai'i was ranked 11th. Part of that ranking was due to the higher number of psychiatrists in Hawai'i compared with the national average: ninth overall for numbers of psychiatrists per 100,000 persons, and second for child psychiatrists.

Access to services on Neighbor Islands is related not just to mental health but all medical specialists. The problem with access to mental-health services is about distribution barriers, not about the number of providers.

Some psychologists, in an effort to expand their scope of practice, have seized upon rural access issues to further their personal agenda. Instead of addressing real system barriers to retaining specialty care on the Neighbor Islands, they are offering a self-serving solution instead.

Psychologists, who have had no prior medical training, are proposing 660 hours, or 16 weeks, of training as adequate to prescribe powerful, dangerous drugs. Physicians receive more than 8,000 hours of training. Even cosmetologists are required to have more training (1,200 hours) to do hair than the amount of training as is being proposed in SB 1004.

It is misleading to regard the 15-year-old Department of Defense Psychopharmacology Demonstration Project as comparable to SB 1004. What is proposed in SB 1004 is a very poor rendition of the far more rigorous and thorough Department of Defense project.

According to the official evaluation report of the Department of Defense PDP by the American College of Neuropsychopharmacology under contract with Department of Defense:

  • The training was conducted at the military's medical school, the training was full time (no other jobs permitted; not just 660 hours).

  • The course content was dictated by psychiatrists (not any prescribing physician).

  • The year of supervised clinical practice was a full-time year (not just 400 hours supervised by any licensed mental health provider, as is required in SB 1004).

  • All supervision was by psychiatrists.

    The governor should veto this bill. There are several alternative ways in which the needs of some of the mentally ill in under-served areas are being met, and efforts are under way to meet the needs of others with quality healthcare.

    Dr. Gale R. Beardsley is chairman of the Hawai'i Psychiatric Medical Association's Policy Committee. He wrote this commentary for The Advertiser.