Survey gives isles a 'C' for mental health care
But is an improvement when compared to 1990, the report says
Hawaii's mental health system has risen from last in national ratings to potentially one of the best, according to a survey of all public mental health systems.
Sixteen years ago there was little hope for Hawaii's mental health system, the National Alliance on Mental Illness said. "Everything about the situation was dire -- an abysmal state hospital with disgraceful conditions, poor outpatient care, poor vocational supports and poor housing."
With "hard work and federal pressure" since 1990, however, Hawaii has moved from "dead last" to one of the top 15 states for mental health services, the alliance said.
"We are actually very pleased with the report," said Dr. Chiyome Fukino, director of the state Health Department.
"Grading the States: A Report on America's Health Care System for Serious Mental Illnesses," confirms what President Bush's New Freedom Commission on Mental Health called a "fragmented system in shambles," the national organization said.
The system nationally received a D grade; no state received an A overall.
Hawaii's overall grade was a C, but it scored an A on mental health recovery supports. In other areas, Hawaii's system received a C-plus for services, a C-minus for infrastructure and a D for information access.
"We know it's not a perfect ranking," Fukino said, but eight states failed the ratings and only five received a B overall.
She said the department is looking into criteria for some areas where the mental-health system had some zeros. One was a health disparities program. "I'm not sure exactly what they mean," she said. "We have a cultural sensitivities program."
Another concerned "a written mandate ensuring family and consumer input" in treatment plans, she said. This was surprising because Dr. Thomas Hester, Adult Mental Health Division chief, has been a strong advocate of consumer involvement in treatment and other division activities, she said.
Also drawing a zero was workforce development, which the department is addressing through the University of Hawaii to interest young people in the profession, Fukino said.
The report commended Hawaii for an action plan to build a community mental health system, "reinvention" of the Hawaii State Hospital, Hester's "leadership to turn around a failing system," and additional funds to build and stabilize a community system.
The report also noted Gov. Linda Lingle's discussion of her mother's mental illness, which "has helped debunk stigma in the state during this important transition time for the mental health system."
Improvements in Hawaii's system followed a 1991 Department of Justice lawsuit alleging civil rights violations of patients at the state hospital. The hospital was released from federal monitoring in December 2004. Planning for a community system is still under way with federal oversight.
The system is on the right track but "change also takes money," the alliance said, noting the Legislature increased funds from fiscal year 2003 to 2005 to almost $35 million. A $10 million emergency appropriation has been requested this session.
The report also pointed to recent problems in the mental health system: a high population at the hospital and a community system that still lacks resources to provide appropriate services for discharged patients.