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

COMMENTARY
Current policy has left state in a crisis

By Ricardo C. Custodio

The Legislature recently passed SB 1004, a bill allowing appropriately trained psychologists working in federally designated healthcare centers to prescribe a limited number of medications for the treatment of mental health disorders when working with the patient's primary care physician.

This bill is a responsible and compassionate response to a critical shortage of psychiatric care in the rural areas of our state. This shortage has been called a "crisis" in both local and national media. It is the direct result of a long-standing national and statewide shortage of psychiatrists. Like most problems, this shortage hits rural areas at hardest.

This crisis means that in a state where suicide kills more people than homicide each year, patients with major depression and substance abuse issues wait months to see a psychiatrist. It means that patients in rural areas, where the risk of suicide is highest, need to be psychotic before they become a priority for a psychiatric appointment.

It means more 911 calls, more police involvement and more reliance on the ER. No mental-health policy should have to rely upon the patient to become psychotic, calling the police and burdening hospital emergency rooms for psychiatric care.

Because of this recognized crisis, the bill is championed by many, including: the Hawai'i Primary Care Association; the state affiliate of Mental Health America; HMSA; a number of medical doctors serving the rural community, including the majority of the medical directors of the clinics that will be served; rural Hawaiian kupuna of the state; and the Hawai'i Psychological Association.

The bill passed through the Legislature over the opposition of psychiatrists and medical doctors who are closely affiliated with the state medical association. These are the same associations that opposed sharing the prescription pad with dentists, optometrists, advanced nurse practitioners and physician assistants.

Each time, these associations have given the same warnings of dire and dangerous consequences if anyone but medical doctors were allowed to prescribe medication. However, contrary to what their scare tactics imply, the evidence is overwhelming that when non-medical doctors receive prescriptive authority based on training appropriate to their professional skills and scope of practice, healthcare improves, in both access and quality of care.

The bill now waiting on the governor's desk is a conservative, well-crafted piece of legislation that has more safeguards, and requires more training, than the current standards for any of the jurisdictions where psychologists are already prescribing safely and effectively.

It is an excellent opportunity for Gov. Linda Lingle to continue her long-standing support of improving mental-health care in Hawai'i. It's time for the critical mental-health needs of our people to trump the vested interests of a few medical doctors. It is time for the governor to sign SB 1004 into law.

Dr. Ricardo C. Custodio is medical director of the Wai'anae Coast Comprehensive Health Center. This commentary, co-written by Marya Grambs, executive director of Mental Health America of Hawai'i, was written for The Advertiser.