Senate Bill 847 Advances, Would Let Psychologists Prescribe Medications in Kauai Pilot

A state Senate committee cleared legislation last Monday that would make Kauai the testing ground for allowing qualified psychologists to prescribe psychotropic medications, marking a significant shift in how mental health care could be delivered on the island.

The Senate Health and Human Services Committee approved Senate Bill 847 despite fierce resistance from psychiatrists, moving forward a three-year pilot program that would operate at a federally qualified health center on Kauai. The State Health Planning and Development Agency would administer the pilot in partnership with the Board of Psychology, and the bill requires a formal report to the Legislature evaluating whether the program should be expanded statewide, made permanent, or discontinued.

Supporters of the measure argue it directly addresses a crisis that Kauai residents already know too well: a critical shortage of psychiatrists that forces patients to wait three months or more just to get an appointment for medications treating conditions such as anxiety, depression, and post-traumatic stress disorder. Kawakami, who spoke in support of the bill, framed the stakes in personal terms. "I am not saying that this measure would have saved them, but all I am saying is that for rural communities, Kauai being the smallest community in the state of Hawaii, something like this I have to believe would help," Kawakami said.

The bill was introduced by state Sen. Dru Kanuha (D, Naalehu-Kailua-Kona) and represents a significant narrowing of earlier proposals. In past years, advocates pushed to grant all licensed psychologists statewide prescribing authority. This year's companion measure, House Bill 2169, was never even scheduled for a hearing. The Senate bill had previously focused on federally qualified health centers serving rural communities across multiple islands, including the Waianae Coast Comprehensive Health Center, Waikiki Health, and Bay Clinic on Hawaii island, before being narrowed specifically to a Kauai pilot.

Lichton, a supporter of the legislation, acknowledged the scaled-back scope but said the group still backs the Kauai pilot as a path toward eventual statewide adoption. The bill's safeguards include a requirement that prescribing psychologists receive significant additional training and operate under psychiatrist supervision. Dr. Jack Lewin, the governor's senior advisor on health care, supported that structure. "That supervision creates what I think is a healthy thing, which is a team led by a psychiatrist to manage the psychologists who want to do this," Lewin said.

Opposition from the psychiatric community has been substantial. The health committee received more than 150 pages of testimony on the bill, much of it from psychiatrists arguing the supplemental training falls short. Dr. Doreen Fukushima, a Pearl City psychiatrist, put the concern bluntly: "Would you trust your loved one to go get that crash course medication or from one of us that has done this for years?" Dr. Piimauna Kackley, president of the Hawaii Psychiatric Medical Association, argued that telehealth expansion, reduced medical paperwork, better insurance coverage, and incentives to recruit and train more psychiatrists represent a more reliable path forward. "There are other proven solutions to address the mental crisis in this state," Kackley said.

A survey cited in support of the bill found that roughly one-third of psychologist members said they would pursue prescribing qualifications if the option became available, and some Hawaii psychologists already hold the required training. The pilot's outcome on Kauai, if the bill becomes law, will ultimately shape whether the rest of the state follows.