Legislature considers prescriptive authority for psychologists, again

On March 16th, the House Committee on Health considers SB384, which would provide prescriptive authority for psychologists.  This is a practice approved in the Dept. of Defense health system and at least four other states. In Hawaii, prescribing psychologists would complete rigorous educational requirements (a post-doctoral master’s degree in psychopharmacology), pass a national board exam in psychopharmacology, work with a limited formulary, and collaborate with a patient’s primary care provider or with the Dept. of Health. The bill’s preamble cites a long list of reasons to authorize prescribing authority, including the large number of Hawaii residents in need of behavioral health care, a troubling suicide rate, and long waits for care due to a critical shortage of accessible psychiatrists.

Psychologist prescriptive authority, or RxP, has a history here going back to 1985 when the Legislature called for a study of the practice.  A second study was requested of the Legislative Reference Bureau in 2006, which was followed by the Legislature approving the measure in 2007 only to have it vetoed by then-Governor Linda Lingle.  The legislative archives show that RxP legislation was introduced and considered annually since 2003 (I couldn’t find information on the Capitol website for earlier years but legislation was certainly being proposed).  From 2003-2013, proposed legislation would have restricted the practice to federally-qualified health centers or mental health shortage areas with a variation in 2014 that would have created a 4-year pilot project at a single health center. The bills in 2015 and 2016 restricted the practice to rural counties.  This year’s bill doesn’t currently limit practice sites.

Since the issue has been around for a long time, both supporters and detractors were prepared with their arguments. When heard in Senate CPH, about 50 people supported, 15 opposed, and multi-signature petitions were submitted for both sides.  RxP support came from at least one MD, APRN, and pharmacist besides Mental Health America, the social service advocacy network PHOCUSED, and the Roman Catholic Conference.  Opposition came largely from psychiatrists, other physicians, and some psychologists.  Arguments boiled down to needs that can’t be met by current or foreseeable physician resources vs. the capacity of psychologists to prescribe effectively and safely.

I don’t know whether this will be the year for passage–the Senate is poised to support it but the vote in the House is dubious–but I do believe that passage of RxP is as inevitable as the hard-fought success of prescriptive authority for nurse practitioners and physician assistants in previous decades.