Hawaii has urgent mental health needs. Too many people wait too long for care, and some cannot get it at all. But Senate Bill 847 is the wrong answer. It asks patients, especially rural patients and those with complex needs, to accept a lower standard of medical safety. The bill would authorize a pilot allowing psychologists to prescribe psychotropic medications to adults, and it amends controlled-substance law to let them prescribe and dispense these powerful drugs. Psychotropic medications can be lifesaving. They can also be dangerous when mismanaged, and shortcuts are not the answer.
Psychiatrists complete medical school and then four years of supervised residency. They log more than 12,000 hours of clinical training to prescribe safely. Psychiatry residency is four additional years of training focused on these questions: when psychiatric medications help, when they become dangerous, and when they must be tapered or stopped. A brief psychopharmacology program for psychologists, however well-intended, is not a substitute for that training.
Knowing who can start a patient on medication is only half the question. The prescriber also has to recognize when a medication is no longer appropriate and how to taper and stop it safely. Psychotropic medications affect the whole person. Pregnancy, heart disease, seizure disorders, liver or kidney disease, substance use disorders, and medications from other clinicians all demand a careful, individualized approach. The wrong drug interaction can be deadly.
Mental health medications are not interchangeable. Mismanaged, some cause insomnia, dependence, relapse, seizures, cardiovascular complications or dangerous interactions. Psychiatrists manage these nuances every day. We are trained to judge not only whether a medication may help, but whether the diagnosis is right, whether a medical illness is driving symptoms, whether another drug is the cause, whether the risks outweigh the benefits, and whether a patient needs tapering, monitoring, hospitalization, a different therapy or no medication at all.
SB 847 also lacks supervisory standards. To keep patients safe, no prescription should be written until a licensed psychiatrist has seen the patient and agreed on the diagnosis and treatment plan. The bill builds in no such safeguard.
The lack of safeguards are especially concerning when controlled substances are involved. SB 847 opens the door for psychologists to prescribe dangerous habit-forming drugs such as amphetamines and opioids, and it does so in communities already struggling with substance abuse.
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None of this diminishes clinicians who already prescribe within appropriate medical standards. Rather, it underscores the central concern: psychotropic prescribing should occur within a framework of rigorous medical training, psychiatrist collaboration and patient-safety safeguards. SB 847 fails to ensure such a framework. SB 847 is billed as a three-year pilot; however, it creates a trial that could become permanent and expanded statewide.
Rural residents should not be asked to participate in an experiment in lower standards. The psychology shortage is also severe. Creating a new category of prescribers does not fix the underlying access problem. There is a better path. Expand the Collaborative Care Model, telemedicine and effective case management to connect patients with the appropriate mental health professionals. The Collaborative Care Model delivers evidence- based, patient-centered behavioral health care inside primary care settings. More than 100 randomized controlled studies show it improves access and outcomes in both rural and urban settings while preserving physician-led medical oversight.
We urgently and respectfully call on Gov. Josh Green to veto SB 847.
Mark Rapaport, M.D., is president of the American Psychological Association; Kyung Moo Kim, M.D., is president of the Hawaii Psychiatric Medical Association (HPMA); Jeffrey Akaka, M.D., is past president of HPMA.