State tries to show health reforms
State health officials say they were stunned by a threatened federal takeover of Hawaii's mental health system.
They feel they've made significant improvements in the system since the U.S. Justice Department filed a lawsuit in 1991 alleging unconstitutional treatment of Hawaii's mentally ill.
"We obviously have to do a better job articulating what we are doing so the court can see it and understand it," said state Health Director Chiyome Fukino.
U.S. District Judge David Ezra at a hearing Thursday gave the state until April 30 to make substantial progress in providing mental health services.
"We see backsliding on all fronts. We see a lack of dedication to getting the job done by some, and we have that specter of substantial sanctions by the court as a result," Ezra said.
Michelle Hill, deputy director for behavioral health administration, responded Friday by saying, "at this time, we don't know what that means."
Ezra instructed attorneys for the state and U.S. Department of Justice to meet and agree on what needs to be accomplished by April 30.
Dr. Thomas Hester, chief of the Adult Mental Health Division, said he was encouraged by discussions with Justice Department attorneys Friday.
"We will be working quickly with the court and DOJ to come to agreement on particular benchmarks," he said.
Activities will be documented to demonstrate that the Health Department is making "reasonable best effort" to achieve the benchmarks under a plan for community mental health services, he said.
Justice Department attorneys asked Ezra to impose sanctions on the Adult Mental Health Division, arguing that the state has failed to use "reasonable best efforts" to do what it said it would do.
Fukino said the problem of suicides of people with mental illness, raised by U.S. Magistrate Kevin Chang last year, was brought up again but the Health Department has "aggressively addressed" that issue. "We don't know why those activities are not recognized," she said.
The Justice Department request for sanctions was based on a critical status report submitted to the court Feb. 10 by Chang, appointed by Ezra as special master in the case.
Chang expressed concern about Hawaii State Hospital's rising, overcrowded population and the mental health system's lack of forensic services.
The hospital was released from federal oversight in December 2004 but the court still oversees community planning for mental health services.
The state last year was given a year's extension, until June 30, to complete the community plan. But federal and state officials agreed planning could continue until Nov. 30 if necessary.
Hester said Justice Department attorneys said they were responding to Chang's use of the word "egregious" in describing deficiencies in state efforts to develop community mental health services. "They felt they had no choice but to request sanctions from a legal standpoint."
Hester said more documentation is needed to inform the court and evaluators of accomplishments in improving the system.
Organization of the Adult Mental Health Division was one of three major issues and it has been completed, he said.
Others are the hospital population and development of forensic services, he said.
The hospital population, which had been running over 190, has been reduced to about 183, he said. The facility is licensed for 190 but budgeted for 168 patients.