Being a state of islands in the middle of the Pacific Ocean carries with it many challenges, and a big one is ensuring access to critical health care services despite limited providers who are often concentrated in Honolulu.

Mental health patients face big obstacles in this regard, particularly those who require medication. The number of psychiatrists practicing in Hawaii has been declining for years. A 40 percent shortfall is projected by 2025, which will only increase the number of patients struggling to get the care and medication they need, especially on neighbor islands.

Fortunately, a solution — some 20 years in the making — is in the works: House Bill 1072, which would extend limited prescribing authority to psychologists who have undergone an extensive program of education, training and certification.

Modeled after successfully implemented laws and policies in New Mexico, Louisiana, Illinois and the U.S. military, the legislation could make a significant difference in Hawaii. The lack of access to mental health services is a major contributor to our statewide homelessness crisis.

Some 1,690 homeless individuals — 22 percent of the statewide population — were identified with serious mental illness in 2015, and nearly 1,200 of them were unsheltered, according to Scott Morishige, the governor’s coordinator on homelessness. Overall, Hawaii ranks last among all states in the percentage of adults with mental illness who receive treatment and in the bottom third for youth who are depressed or attempt suicide.

Allowing “medical psychologists” to play a role in addressing those numbers is an approach supported by a long and growing list of organizations and individuals, including the state Department of Health, the Mental Health Association of America, the National Association of Social Workers’ Hawaii chapter and the Hawaii Association of Professional Nurses.

Indeed, the only serious opposition to the bill seems to come from the American Psychiatric Association and the Hawaii Medical Association, which have a direct financial interest in keeping even limited prescribing authority restricted solely to their members.

Testimony submitted in support of the bill is marked by comments like this:

“We need this option on rural Kauai, where adult psychiatrists are sorely needed,” wrote clinical psychologist Judith White. Dr. Traci Stevenson, a family physician on Molokai, testified, “I see directly, on a daily basis, the absolute necessity for improved access to psychological care and medications for all persons, particularly those living in the community outside of an institutionalized setting.”

“The mental health needs of individuals across our state continue to outweigh the capacity of our mental health system,” wrote psychologist Jill Oliveira Gray, Ph.D., who has worked in rural, medically underserved areas such as Hana, Molokai, Maui and, for the past seven years, Waimanalo.

Suffering Without Care, Medication

The Civil Beat Editorial Board met last week with proponents of the bill, including two individuals who have paid high prices for living on neighbor islands without reliable access to medication. Both diagnosed with bipolar disorder, they collectively endured scores of hospitalizations, in part because of running out of medication and having no access to a psychiatrist who could provide care or prescribe the medicine each needed.

“I was in psychosis and had to fly from Maui over to Oahu. … I couldn’t function,” said Don Lane, who in that incident was admitted to Queens Medical Center. “While I was there, they put together this medication management plan for me, so when I left, all I had to do was get ahold of a psychiatrist to continue to prescribe or continue the medication management plan.”

Back on Maui, he struggled for weeks to find a psychiatrist who would see him. He said many didn’t return his calls; the best-case scenario with others was a two-month wait. “So my medication lapsed,” said Lane, who ended up back in the emergency room twice before he could establish a doctor-patient relationship.

In recovery today and working for a mental health organization, he considers himself one of the lucky ones. “I had someone to advocate for me, but a lot of people don’t have anyone to advocate for them.”

‘What I needed was someone who would listen to me and my whole story and also prescribe the right medication. This is not what I received.’

Kiana Amoncio’s journey into the mental health system began on the Big Island and has included 18 hospitalizations over six years. A former pre-veterinary student at the University of Hawaii Hilo and a leader in her church, her sudden descent transformed her into a tragic figure, sometimes wandering Hawaii’s streets for weeks in psychosis as her mother frantically searched for her.

“What I needed was someone who would listen to me and my whole story and also prescribe the right medication. This is not what I received,” Amoncio said. “What I did get was a psychiatrist, but many times a nurse practitioner who was just trying to get through their rounds.

“Some of them discharged me from the hospital with no medications, wrong medications or made me leave the hospital while I was still in a psychotic state and seriously could have hurt myself or others.”

Amoncio and Lane are among many who could benefit from HB 1072. While providing additional authority for psychologists who complete a postdoctoral Masters of Science in Clinical Psychopharmacology, complete hundreds of clinical training hours under the supervision of a physician and pass a national licensing exam, it would also appropriately limit that authority.

Qualifying psychologists would have to work in partnership with a prescribing physician and would not be allowed to treat severe and persistent mental illness or treat patients under 17 with off-label drugs. They would further be limited to prescribing psychotropic drugs only — no narcotics.

Versions of HB 1072 have passed both the House and Senate, which now must resolve their differences in conference committee. If they are able to do so, the bill is expected to face a positive reception from the governor’s office.

Hawaii is at its best when it draws on existing resources in innovative, creative ways to meet the needs of its people. HB1072 would help some of our most vulnerable — individuals who would continue to struggle mightily without it.

Senate and House conferees should work out their differences as quickly as possible and send the governor a bill that would provide a helping hand to the mentally ill and alleviate real human suffering throughout our islands.