STAR-BULLETIN / 2000 The admissions and stabilization unit of the Hawaii State Hospital in Kaneohe.

Groups work on State Hospital plan

Patient overcrowding continues to plague the Hawaii State Hospital in Kaneohe for the mentally ill as two groups seek solutions through the mental-health and court systems.

"We are working with the courts to try and close the front door and develop services in the community so we can appropriately move people out," state Health Director Chiyome Fukino recently told lawmakers.

The hospital, designed for 168 to 178 patients, struggles with a high population because most are forensic patients sent there by the court.

The population hit 202 in August, the highest since 1994. It was about 194 this week.

This is within the licensed capacity but "still is much higher than ideal," said Dr. Thomas Hester, chief of the Health Department's Adult Mental Health Division. "It presents a lot of challenging staffing and space problems."

Fukino said the mental-health system is providing services to more than 14,500 residents, compared with "barely 4,000" in 2003.

"Fortunately, the administration and staff worked very well together, and we have not seen a spike in injuries to the staff or other patients as a result of assaults," Hester added.

The hospital was operated under federal court oversight from 1991 until December 2004 because of overcrowding and unconstitutional conditions. Significant changes were made, but assaults against staff and patients, some with serious injuries, drew legislative attention in 2006.

The governor convened a task force at the Legislature's request to recommend possible changes to reduce the hospital's population and encourage community-based services for forensic patients.

The task force, led by Sen. Rosalyn Baker (D, Kapalua-Kaanapali-Lahaina-Maalaea-Kihei-Makena), has completed a 61-page report with detailed procedural, legal and policy recommendations.

"I think we were able to move a number of issues forward that are contributing to overcrowding at the state hospital," Baker said. More than 40 government and private organization representatives met every month for more than a year and "really did a good job," she said.

The entire system is under study by a Mental Health Transformation group organized under a federal grant of nearly $11 million for five years.

The group is holding statewide community meetings to gather information for a comprehensive mental-health plan to transform what Fukino calls a "court-driven system."

The group is working with consumers to determine the greatest needs for a complete system, she said.

Hester said the Adult Mental Health Division has implemented jail diversion programs and made other changes to address problems and improve services. More changes are expected as an outgrowth of the task force, he said.

Baker introduced Senate Bill 2160 with some of the group's recommendations "to continue discussion and see how much we can accomplish." Other bills will be in the administration's legislative package, she said.

"The recommendations all are important if we're going to make sure that somebody who is mentally ill and interacts with criminal justice is appropriately dealt with," Baker said. "Folks that don't need to be at the State Hospital can be dealt with in another setting," she said, stressing the need for "appropriate placements."

Looking at what other states do, she said the task force found "we had restrictive policies and procedures with regard to how long people can be held, how soon they get re-evaluated and conditional release.

"Just a lot of things are impeding the system, and we're trying to look at how you make sure you're protecting the person who is mentally ill, as well as society, if there have been some bad acts."

With the courts filling up the small hospital in Kaneohe with forensic patients, she said, "Anybody in the community who needs that kind of hospital care really can't get it. It is a shame. It was not designed to be a forensic facility.

"We need to try to really put facilities and programs in place that address those needs in the community, because they spill over into the larger community."