HOUSE OF REPRESENTATIVES

H.R. NO.

149

TWENTY-EIGHTH LEGISLATURE, 2015

H.D. 1

STATE OF HAWAII

 

 

 

 

 

HOUSE RESOLUTION

 

 

REQUESTING A CONVENING OF A MENTAL HEALTH ACCESS WORKING GROUP.

 

 

 


     WHEREAS, there is a shortage of physicians in the State, with shortages being even more pronounced on the neighbor islands; and

 

     WHEREAS, there appears to be a pronounced shortage of primary care physicians, as well as physicians of all specialties on neighbor islands, including cardiologists, obstetricians and gynecologists, internists, psychiatrists, pediatricians, and neurologists, as well as physician extenders, such as advanced practice registered nurses with prescriptive authority and physician assistants, and allied mental health professionals, such as psychologists, social workers, marriage and family therapists, and other therapists, on the neighbor islands; and

 

     WHEREAS, one proven solution to aid in addressing unmet medical needs on the neighbor islands is telemedicine and, with respect to psychiatric disease, telepsychiatry, which is currently finding increasing success in treating children with psychiatric disease on Hawaii and Maui, and which was supported by Act 159, Session Laws of Hawaii 2014; and

 

     WHEREAS, there has been an increase in the number, complexity, and life-threatening side effects of medications used to treat brain disorders; and

 

     WHEREAS, these side effects, including heart attacks and strokes, are of such concern that the United States Food and Drug Administration ordered "black box warnings" on psychiatric medications; and

 

     WHEREAS, these medications, while effective, can have bothersome, hazardous, and potentially lethal side effects involving both the body and the brain; and

 

     WHEREAS, patients with severe psychiatric illnesses die twenty-five years younger than the rest of our community, not by suicide, but due to medical diseases, including diabetes, heart failure from high blood pressure, lung disease from cigarette smoking, stroke, and heart attacks, all of which can be made worse by medications prescribed to alleviate psychiatric disease; and

 

     WHEREAS, the training and practice of psychiatrists has therefore become increasingly focused on dealing with the bodily consequences of psychiatric disease and the medications used to treat them, including such consequences as smoking, diabetes, stroke, heart attacks, and kidney failure, which are increasingly common in patients afflicted with schizophrenia, bipolar I disorder, and severe depression; and

 

     WHEREAS, physician extenders, such as advanced practice registered nurses with prescriptive authority and physician assistants, by virtue of their biology, chemistry, physiology and medical-based training, are qualified to treat patients, under a physician's supervision, with medications for infections, high blood pressure, and diabetes, as well as the more moderate mood and anxiety disorders; and

 

     WHEREAS, many health and brain disorders can be treated by social workers, family therapists, the clergy, and psychologists, using psychotherapy, including techniques like cognitive-behavioral therapy, and faith-based therapies, as well as a spectrum of other therapies; and

 

     WHEREAS, there are numerous non-physician mental health care professionals trained to deliver psychological and spiritual therapies within the scope of their training and expertise, including doctoral level therapists, such as Ph.D. clinical, counseling, and school psychologists and Psy.D. clinical psychologists, as well as Master's degree level therapists, such as Masters of Social Work, marriage and family therapists, and mental health counselors, as well as other mental health counselors, including pastors, rabbis, Buddhist monks and priests, Shinto priests, and Muslim and other spiritual healers, who, through their non-pharmacological expertise, significantly help to heal psychiatric distress; and

 

     WHEREAS, the training of all non-medically trained mental health care professionals, such as ministers and psychologists, have no overlap with the standard training required of medically trained health care professionals, such as advanced practice registered nurses with prescriptive authority and physician assistants; and

 

     WHEREAS, the standard training required of medically trained health care professionals includes medical school prerequisite-level coursework in chemistry, biology, mathematics, microbiology, and other topics; and

 

     WHEREAS, it has been suggested by proponents of legislation proposing to confer prescriptive authority to clinical psychologists that, under certain conditions, clinical psychologists may be qualified to prescribe medications; and

 

     WHEREAS, this view is unjustified by the fact that psychologists are not required to complete the coursework in biology, chemistry, physiology, medicine, and the other sciences required of all other disciplines qualified to prescribe medication, including primary care physicians, psychiatrists, advanced practice registered nurses, advanced practice psychiatric nurses, and appropriately trained and supervised physician assistants; and

 

     WHEREAS, these competing views need to be carefully examined; and

 

     WHEREAS, it is in the interest of the health, safety, and well-being of the State to consider the appropriateness of conferring prescriptive authority to various health care professionals to treat mental illness in Hawaii; now, therefore,

 

     BE IT RESOLVED by the House of Representatives of the Twenty-eighth Legislature of the State of Hawaii, Regular Session of 2015, that the Department of Psychiatry of the University of Hawaii at Manoa is requested to convene a Mental Health Access Working Group (Working Group) to develop recommendations:

 

     (1)  For the establishment of standards for mental health care in the State, with particular attention to the neighbor islands and rural areas;

 

     (2)  To increase access to all mental health providers; and

 

     (3)  Regarding how telemedicine and physician extenders, and the use of allied mental health care professionals, such as spiritual leaders, social workers, marriage and family therapists, mental health counselors, and psychologists, might improve access to the appropriate level of treatment by the appropriately designated discipline, be it spiritual healing, psychotherapy, or medication; and

 

     BE IT FURTHER RESOLVED that the Legislature requests that the Working Group be assigned to the Department of Psychiatry of the University of Hawaii at Manoa for administrative purposes and make recommendations and propose legislation to improve access to mental health care; and

 

     BE IT FURTHER RESOLVED that the Legislature requests that the Working Group be composed of:

 

     (1)  The Chairperson of the Department of Psychiatry of the University of Hawaii at Manoa, or the Chairperson's designee, who is suggested to serve as the chairperson of the Working Group;

 

     (2)  The Director of Health, or the Director's designee;

 

     (3)  The Director of Human Services, or the Director's designee;

 

     (4)  The Deputy Director of the Corrections Division of the Department of Public Safety, or the Deputy Director's designee;

 

     (5)  A representative of the Insurance Commissioner who is familiar with issues of access to health care;

 

     (6)  The Chairperson of the Senate Committee on Health, or the Chairperson's designee;

 

     (7)  The Chairperson of the House Committee on Health, or the Chairperson's designee;

 

     (8)  The Chairperson of the Senate Committee on Commerce and Consumer Protection, or the Chairperson's designee;

 

     (9)  The Chairperson of the House Committee on Consumer Protection and Commerce, or the Chairperson's designee;

 

    (10)  The Chairperson of the Senate Committee on Higher Education and the Arts, or the Chairperson's designee;

 

    (11)  The Chairperson of the House Committee on Higher Education, or the Chairperson's designee;

 

    (12)  The Chairperson of the Board of Directors of the Hawaii Health Systems Corporation, or the Chairperson's designee;

 

    (13)  The Chief Executive Officer of Hawaii Medical Services Association, or the Chief Executive Officer's designee;

 

    (14)  The President of Kaiser Permanente (Hawaii), or the President's designee;

 

    (15)  A psychopharmacology expert, as designated by the Department of Psychiatry of the University of Hawaii at Manoa;

 

    (16)  A psychology expert, as designated by the Department of Psychology of the University of Hawaii at Manoa;

 

    (17)  A psychiatrist working in a community health center, as designated by the Hawaii Primary Care Association;

 

    (18)  A psychiatrist working in a community mental health center, as designated by the Department of Health;

 

    (19)  A psychiatric nurse practitioner, as designated by the School of Nursing and Dental Hygiene of the University of Hawaii at Manoa;

 

    (20)  A Doctor of Pharmacy, as designated by the Daniel K. Inouye College of Pharmacy at the University of Hawaii at Hilo;

 

    (21)  An expert in telepsychiatry, as designated by the Department of Psychiatry of Tripler Army Medical Center;

 

    (22)  An expert in forensic psychiatry, as designated by the Hawaii Health Systems Corporation;

 

    (23)  A psychiatric physician assistant, as designated by the Hawaii Medical Board;

 

    (24)  A naturopathic physician, as designated by the Board of Naturopathic Medicine;

 

    (25)  A licensed marriage and family therapist, as designated by the Director of Commerce and Consumer Affairs;

 

    (26)  A licensed mental health counselor, as designated by the Department of Psychology of the University of Hawaii at Hilo;

 

    (27)  A psychiatry resident, as designated by the Department of Psychiatry of the University of Hawaii at Manoa;

 

    (28)  A doctoral candidate of the psychology Ph.D. degree program, as designated by the Department of Psychology of the University of Hawaii at Manoa;

 

    (29)  A patient with a diagnosis of schizophrenia for a minimum of five years who is currently receiving treatment, including antipsychotic medication, and residing on the island of Oahu, as designated by the Hawaii Health Systems Corporation;

 

    (30)  A patient with a diagnosis of bipolar disorder for a minimum of five years who is currently receiving treatment, including mood stabilizing medication, such as Lithium, Depakote, or both, and residing on the island of Oahu, as designated by the Hawaii Health Systems Corporation; and

 

    (31)  A patient with a diagnosis of severe depression for a minimum of five years who is currently receiving treatment, including medication, and residing on the island of Oahu, as designated by the Hawaii Health Systems Corporation; and

 

     BE IT FURTHER RESOLVED that the issues to be addressed by the Working Group include:

 

     (1)  An inventory of the mental health professional workforce available in the State;

 

     (2)  The distribution of that workforce, with particular attention to the neighbor islands and rural areas of Hawaii; and

 

     (3)  The means by which access to mental health care by those professionals, including physicians, such as primary care physicians and psychiatrists, physician extenders, such as advanced practice nurse practitioners and physician assistants, allied mental health professionals, such as social workers, marriage and family therapists, mental health counselors, psychologists, and spiritual healers, may be improved; and

 

     BE IT FURTHER RESOLVED that the Working Group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2016; and

 

     BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Commerce and Consumer Affairs, Director of Health, Director of Human Services, Insurance Commissioner, Deputy Director of the Corrections Division of the Department of Public Safety, Chairperson of the Department of Psychology of the University of Hawaii at Manoa, Chairperson of the Department of Psychology of the University of Hawaii at Hilo, Dean of the Daniel K. Inouye College of Pharmacy at the University of Hawaii at Hilo, Dean of the School of Nursing and Dental Hygiene of the University of Hawaii at Manoa, Chairperson of the Senate Committee on Health, Chairperson of the House Committee on Health, Chairperson of the Senate Committee on Commerce and Consumer Protection, Chairperson of the House Committee on Consumer Protection and Commerce, Chairperson of the Senate Committee on Higher Education and the Arts, Chairperson of the House Committee on Higher Education, Chairperson of the Board of Naturopathic Medicine, Chairperson of the Board of Directors of the Hawaii Health Systems Corporation, Chairperson of the Hawaii Medical Board, Chief Executive Officer of Hawaii Medical Services Association, Chairperson of the Board of Directors of the Hawaii Primary Care Association, President of Kaiser Permanente (Hawaii), and Chief of Psychiatry at Tripler Army Medical Center.

Report Title: 

Mental Health Access Working Group