Hawaii and Vermont Widen Psychologist Mental Health Prescribing

Hawaii and Vermont have moved to let specially trained psychologists prescribe medications, a change with direct consequences for folks managing a mental health condition alongside addiction. While these states sit on opposite geographic ends of the country, lawmakers in Hawaii and Vermont saw fit to expand the number of those prescribing to increase access to medications for vulnerable groups.

Hawaii’s law, SB847, took effect on July 15, 2026, authorizing qualified doctoral-level psychologists to prescribe certain mental health medications. Governor Josh Green signed the measure in May. Vermont, which already permits psychologist prescribing, adopted the standardized national examination used to qualify prescribers.

The Hawaiian Law

Expanding the number of prescribers reflects the shortage of mental health providers across the country. However, the authority is conditional and narrower than the headline suggests.

To qualify, a psychologist must hold a doctoral degree, complete a master’s degree in clinical psychopharmacology, accumulate at least two years of clinical experience treating a diverse patient population, pass a national examination and practice under the supervision of a medical physician. 

The prescriptive authority begins as a conditional certificate and is limited to patients at federally qualified health centers. Federally qualified health centers serve medically underserved areas and treat patients regardless of ability to pay. That way, residents in areas with few psychiatrists can still receive care. Some regions even allow nurse practitioners to prescribe medications under specific circumstances.

The national examination is the Psychopharmacology Examination for Psychologists, administered by the Association of State and Provincial Psychology Boards. Hawaii became the ninth jurisdiction to adopt it, joining Vermont, Colorado, Idaho, Illinois, Iowa, Louisiana, New Mexico and Utah. Agencies such as the Department of Defense, the Public Health Service and the Indian Health Service also use the same standards.

This Matters for Dual Diagnosis Treatment

Co-occurring disorders, also called dual diagnosis, describe the presence of a mental health condition and a substance use disorder together. This is common rather than exceptional. Depression, anxiety, PTSD, and bipolar disorder frequently accompany addiction, and each condition tends to worsen the other when only one is treated.

Integrated treatment addresses both at once. Evidence favors this approach over treating them sequentially or in separate systems. The obstacle is usually structural. Therapy and prescribing often sit with different clinicians in different organizations with the patient connecting them.

That coordination burden falls hardest on the people least equipped to carry it. Oftentimes, minority groups, like Pacific Islanders in Hawaii, face additional obstacles to care. Someone in early recovery, managing withdrawal or unstable housing, has the burden to synchronize appointments across two systems that don’t share records.

A prescriber who’s also the therapist collapses that gap. Supporters of prescriptive authority argue this is the central benefit, particularly in rural areas where the nearest psychiatrist may be hours away.

Supporters and Opponents Disagree

This is a genuinely contested policy question, and the disagreement is substantive rather than territorial.

The American Psychological Association supports prescriptive authority for trained psychologists. They argue it expands access, shortens waits and integrates therapy with medication management. Supporters note that Hawaii’s requirements include a psychopharmacology master’s degree, a national exam, and physician supervision. Governor Green’s senior health care advisor supported the bill on those grounds.

The American Medical Association and the American Psychiatric Association oppose it, citing patient safety. They argue that psychopharmacology coursework doesn’t replace medical training in clinical pharmacology, drug interactions and recognizing physical and psychiatric symptoms. That concern centers on addiction medicine, where patients often have co-occurring effects or withdrawal states that complicate prescribing.

Both positions describe real risks. Access gaps harm people who cannot get mental health treatment at all. Prescribing errors harm people who do get treatment. Where the balance falls is the question states are answering differently.

Mental Health Treatment Options Alongside Addiction Care

Regardless of who prescribes, the levels of mental health treatment available are the same. Residential treatment centers provide 24-hour structured care for folks who need stabilization or whose home environment undermines recovery. Outpatient care delivers substantial weekly clinical hours while a person continues living at home and who have stable circumstances and lower acuity.

Evidence-based therapies include behavioral group therapy for restructuring the emotions and thoughts that drive both mood symptoms and substance use and trauma-focused approaches such as EMDR and cognitive processing therapy. Medication management runs alongside these rather than replacing them.

Comprehensive Treatment in Any State

When evaluating behavioral treatment centers, look into mental health conditions and addiction together. Inquire into the specialists’ backgrounds and approaches. Pay special attention to aftercare follow-ups, since the transition out of a program is where treatment most often lapses.

Confirm insurance and Medicaid participation before admission. For people in underserved areas, federally qualified health centers are worth checking directly, since they provide behavioral health services on a sliding scale.

Our online directory lists mental health, behavioral health, and dual diagnosis treatment programs by location and level of care. You can also dial 800-908-4823 (Sponsored) for free and confidential services. Don’t forget that the 988 Suicide and Crisis Lifeline is available around the clock.

Author

Eric Owens

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Eric Owens has been a writer and editor for various businesses as well as his own successful websites. He has extensive experience creating content in the health and wellness space and the sustainability space. He holds a bachelor degree in Philosophy which helped him with presenting complex information in a simple way that all audiences can understand.

Editor

Peter Lee, PhD

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Peter W.Y. Lee is a writer and historian of American history during the Cold War. His primary focus is the relationship between youth and popular culture and its impact on U.S. society during the twentieth century. He has published widely on how the public has used popular culture as a mechanism to address political and social shifts throughout time