PSYCHOLOGISTS

PRESCRIPTIVE AUTHORITY ISSUE SHOULD GO AWAY

The issue of psychologists' prescriptive privileges has been extant for a few decades; and when defeated, it seems to rise from the legislative ashes.

It should go away, but legislators, such as Dr. Josh Green, who have little psychopharmacologic expertise, continue to advocate for psychologists to prescribe.

I am a practicing psychiatrist in Kona; I am also a doctoral- level clinical psychologist. And, I am quite as proud to be one as the other. I received my psychiatric residency training and later my clinical psychology training at the same institution, the University of Minnesota.

As one who trained in both psychiatry and psychology disciplines within the same university, I can say there is little cross-over between these applied sciences.

Except on a purely elective basis, there is no more requirement for future clinical psychologists to study biochemistry, neuro- and medical physiology, and pharmacology than there is for psychiatry residents to study the administration and interpretation of psychological testing.

Each rests at the very core of its respective discipline.

Hence, the psychology doctoral candidate or practicing psychologist can no more learn competent, knowledgeable psycholopharmacology than can the psychiatry resident or practicing psychiatrist perform neuropsychological or intellectual assessments by simply taking a few relevant courses. Those who would argue otherwise are confounding necessity with sufficiency.

Psychologists cannot become practicing psychopharmacologists by merely augmenting their skills and field of knowledge short of first becoming fully-fledged medical doctors.

PRESCRIPTIVE AUTHORITY: MORE ACCESS TO CARE

There was a time when only medical doctors prescribed medications. They also made house calls.

But healthcare has changed. Today, many kinds of healthcare professionals prescribe safely and effectively in order to provide appropriate care to their patients.

Dentists, optometrists, advanced nurse practitioners, physician assistants and psychologists — yes, psychologists — have been safely prescribing for years.

About a decade ago, the Department of Defense conducted a demonstration project that clearly established that appropriately trained psychologists prescribe safely and effectively.

More recently, New Mexico and Louisiana have passed laws allowing psychologists to prescribe. And what has been the result? More patients are getting better access to quality mental health care. Why is this important?

In Hawai'i there is a shortage of psychiatrists, especially in the rural communities. A recent issue of Psychiatric News referred to the lack of rural psychiatric care in the United States as the "crisis in the country."

The bill in the Legislature to allow appropriately trained psychologists to prescribe has more extensive training requirements and safeguards than the current requirements anywhere else in the country, including the Department of Defense.

What is truly unsafe is to continue to allow thousands of our rural neighbors to go without adequate mental health care. It is time to allow appropriately trained psychologists to prescribe.

NEIGHBORHOODS

CARE HOME REGULATIONS WOULD MITIGATE IMPACT

With the looming increase in the number of frail elderly who need care, there is a need for residential care homes.

However, these facilities also impact neighborhoods.

In recent years, many residential care homes have been built in Foster Village. These homes are enormous, dwarfing neighboring single-family homes.

Cars owned by proprietors and their staff clog street parking.

Sirens blare at least twice a week as medics race to aid patients.

Regulations to control the concentration and impact of residential care homes on surrounding communities are needed, along with continued oversight of quality care to patients residing in these facilities by the state Department of Health.

COST, TIMETABLE

PUBLIC HAS LITTLE FAITH IN CITY'S TRANSIT NUMBERS

There are few people who will argue against the need for a rapid-transit system, but the recent $35 million bus-yard debacle by the Harris administration reveals much of the opposition to the rail project. Can you name anything our local governments do well or efficiently?

Whatever costs and timetable are put on the project, you can rest assured both will be run significantly over.

Consequently, much of the public have no faith in the numbers that are being tossed around, and are at the mercy of whatever delays and cost overruns the project incurs.

The city's record of maintenance speaks for itself.

A reliable track record would certainly help the city convince its citizens their money will be well-spent.

INTERISLAND

PUGET SOUND SHOWS MERIT OF FERRY SYSTEM

As a lifetime resident of the Puget Sound area of Washington state and a 20-year part-time resident of Hawai'i, I am amazed at the negative attitude of some people here toward the new interisland ferry.

The Puget Sound area would be virtually paralyzed without its ferries. Even our smallest islands have service. Our service to Canada has existed for years and is essential to our economy.

The vintage interisland freight system has served us well and is essential for heavy-lift items.

Stop the petty infighting and let the ferry people show us what they can do as they have done on Puget Sound.