Across Hawaiʻi, particularly on the neighbor islands, many residents wait months for psychiatric care. For many families, that wait is not measured only in weeks or months. It is measured in sleepless nights, missed work, worsening depression, panic attacks, continued uncertainty, and the daily fear that a loved one may deteriorate before help becomes available.

Senate Bill 847 responds to that shortage by establishing a limited three-year program on Kauaʻi and Hawaiʻi Island to evaluate how appropriately trained prescribing psychologists, under regulatory oversight and a well-defined scope of practice, can safely and effectively expand access to mental health treatment in underserved communities.

Debates about prescriptive authority for psychologists often begin with an important concern: psychiatric medications are powerful interventions that require careful training and oversight.

On that point, we agree. No responsible clinician believes psychotropic medications should be prescribed casually or without appropriate education or training.

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The question facing Hawaiʻi is not whether psychiatrists receive extensive medical training. They do. The question is whether appropriately trained psychologists working within clearly defined safeguards can help expand safe and appropriate access in communities where patients often have no realistic option but to wait.

Psychologists bring a distinct and complementary approach to mental health care. Their training emphasizes comprehensive diagnostic evaluation, psychological assessment, and psychotherapy, and many spend extended time with patients, integrating multiple aspects of care into a cohesive treatment plan.

\When one clinician is responsible for both psychotherapy and medication management, treatment decisions can be informed by a more complete understanding of the patient’s progress, functioning, and goals within a single, continuous course of care.

When psychotherapy and medication management are divided among multiple providers, care can become more fragmented and burdensome for patients. In practical terms, that may mean a patient retelling painful trauma to multiple providers, repeating the same intake paperwork, juggling separate appointments, and waiting weeks or even months between visits while symptoms continue to worsen.

Allowing appropriately trained psychologists to prescribe medication could improve continuity of care and reduce barriers to treatment.

These challenges are especially evident on Hawaiʻi’s neighbor islands, where provider shortages, appointment availability, insurance participation, and geography often combine to delay treatment. Psychiatrist Daniel Carlat — who has written extensively about psychopharmacology and quality psychiatric care — has noted that psychologists already possess deep expertise in mental health diagnosis and treatment and, with additional psychopharmacology training, could help safely expand access to medication management.

Importantly, Kauaʻi Mayor Derek Kawakami has emphasized that this approach is not expected to solve every workforce challenge but rather serves as one practical step toward increasing access within a carefully regulated system.

Regulatory Frameworks Provided

Additionally, prescribing psychologists are not a new or untested model of care. Prescriptive authority for appropriately trained psychologists already exists in several states and within federal health systems, including the U.S. military, where they have practiced safely for decades under structured training and oversight.

These programs operate within regulatory frameworks that include additional education, supervised training, and clearly defined safeguards. This mirrors how prescriptive authority has been established for other non-physician prescribers, such as nurse practitioners and physician assistants, based on training and defined scopes of practice.

These examples reflect a broader principle in health care: safe clinical practice is determined not by professional title alone, but by education, specialized training, clinical judgment, and practice within a clearly defined scope.

Prescribing psychology illustrates this principle. Doctoral training in psychology emphasizes psychological assessment, comprehensive diagnostic evaluation, and clinical case formulation — the foundation upon which effective mental health treatment for complex clinical presentations and co-occurring psychological and medical conditions is built.

With additional specialized education in clinical medicine and psychopharmacology, followed by supervised clinical training with physicians, prescribing psychologists can safely and effectively integrate psychotherapy, behavioral interventions, and medication management within a unified treatment plan.

Senate Bill 847, which is expected to become law soon, proposes a limited program to generate Hawaiʻi-specific data before any broader expansion is considered. The goal is not to elevate one profession over another, but to strengthen Hawaiʻi’s mental health system in communities where the current system often falls short.

The program does not attempt to solve every challenge within the system. Instead, it offers a practical opportunity to improve continuity of care and expand timely access through a carefully designed program grounded in training, oversight, and evidence. When someone is struggling with severe depression, suicidal thoughts, or debilitating anxiety, delayed treatment is not a minor inconvenience — it can be devastating and life-altering.

The question is not which profession provides that care. For patients waiting months for treatment, the central question is simple: will safe, timely care be available when they need it?