The lack of access to specialized medical services on the neighbor islands is a real problem for Hawaii, as it is in rural communities across the country.

The shortage of psychiatric care, particularly access to psychotropic medication, is one example recognized by the medical community. In response, the Legislature is considering House Bill 1072, which would allow clinical psychologists to prescribe psychotropic drugs once they get additional training. This authority is usually reserved for medical doctors, including psychiatrists, and certain advanced-practice registered nurses.

The measure awaits a final hearing before the Senate Ways and Means Committee.

However, psychiatrists have legitimate concerns that the proposed training would be insufficient preparation. Medication plans for patients with multiple ailments — physical and mental — can be complex and require advanced medical knowledge. The drugs themselves are extremely powerful.

A better route to a solution that will “do no harm” is a greater investment in technologies that can bridge the gap between patient and the needed medication.

HB 1072 would create a “prescribing psychologist” category in statute, defined as a psychologist who has undergone specialized training in clinical psychopharmacology and has passed a national exam approved by the Hawaii Board of Psychology.

The applicant would need a post-doctoral master’s degree in clinical psychopharmacology. Other requirements would include at least 400 hours of clinical experience and supervision of at least 100 patients. He or she must prescribe “only in consultation and collaboration with a patient’s primary care provider regarding changes to a medication treatment plan,” the bill states.

Among those who find these precautions inadequate is Dr. Saul Levin, the CEO and medical director of the American Psychiatric Association. In written testimony, Levin said the clinical prerequisites fall short of professional standards.

“Consider for a moment that psychiatric resident physicians, who complete a four-year medical residency program following graduation from medical school, will generally see 100 patients in just two weeks,” he wrote.

The two states where such programs have been initiated, New Mexico and Louisiana, have not led to prescribing psychologists relocating to rural areas, Levin contended, suggesting the programs may not address the problem they was designed to solve.

Psychotropic drugs are powerful substances that affect more than the brain, he said, and patients with multiple health conditions may suffer from their combination with other, unrelated prescriptions.

Instead of expanding prescription rights, some in the medical field recommend other ways to bring psychiatrists into more remote communities. These programs are in their infancy in Hawaii and should be ramped up.

Hawaii’s health-care system is especially in need of an active telemedicine component. Psychiatry may be more easily adaptable to this platform, since conversation and observation are the key doctor-patient interactions, and a teleconference can be a suitable means.

There are also ways to leverage the expertise of the psychiatrists through collaborative models. Assignment of case managers who act as intermediaries between psychiatrists and primary-care physicians could enable one approach.

Another program, launched at the start of the year in Hawaii, is called Project ECHO (Extension for Community Healthcare Outcomes). It involves psychiatrists in consultation sessions with other doctors to better prepare them for prescribing the needed mental-health medications — alerting them to potential common drug interactions, for instance.

It’s past time to ramp up these efforts. If doctors want to keep greater control of these drugs, they bear a large share of responsibility for providing the solution.