View Point
View Point
I am very concerned about the state Health Department's plan to reduce the number of beds at the Hawaii State Hospital from 168 to 108. If this reduction is completed, Hawaii will have the fewest number of hospital beds per capita for the mentally ill of any state in the nation. Downsizing state
hospital spells disasterThis reduction will mean that more persons, especially among our young people, will be homeless or in prison, and we will have more violence in our streets. That prediction isn't only my opinion. It is shared by two of the nation's foremost experts in mental illness and community psychiatry with whom I recently spoke - Dr. Richard Lamb, professor of psychiatry at the University of Southern California, and Dr. E. Fuller Torrey, professor of psychiatry at the Uniformed Services University of the Health Sciences in Washington, D.C. They said increased violence, crime and homelessness has been the pattern across the country as other states have reduced their capacity to care for the severely mentally ill.
This downsizing trend came to a dramatic end in New York recently when Gov. George Pataki stopped the planned closing of state hospital beds because of a series of high-visibility homicides by mental patients. The most publicized death was that of Kendra Webdale, a young woman who was pushed in front of a speeding subway train by a man who had been unable to find psychiatric treatment after repeated attempts to admit himself to several hospitals. As a result of the governor's action, New York will continue to retain 30 state hospital beds for each 100,000 residents.
On average, the United States today has 22 state hospital beds per 100,000 people. With our population of 1.2 million, Hawaii would need 264 beds to be at the national average. We now have 168 beds at Hawaii State Hospital. If we reduce the number of beds to the Health Department's projected 108 by next summer, Hawaii will have only nine beds per 100,000 - the fewest in the nation.
Why do we need so many beds? Two in 100 people in our islands (24,000 individuals) have a serious mental illness, most commonly either schizophrenia or manic-depressive disorder. These brain diseases are often a source of despair, which is demonstrated by the fact that one in 10 individuals with schizophrenia and one in five with manic-depressive disorder commits suicide.
Both diseases are caused by a chemical imbalance in the brain that grossly impairs reality-based thinking, and they usually have their onset in young adulthood. Schizophrenia and manic-depression are genetic diseases about which people have no more choice than the color of their eyes. Medicine has no cure for these disorders. We can, however, help about 70 to 80 percent of those who suffer from these illnesses by reducing their symtoms with medications.
BUT when they don't receive treatment, a life of homelessness, drug and alcohol use and prison is increasingly the norm. The National Law Center on Homelessness and Poverty estimates that at least 25 percent of the nearly 1 million homeless persons in our nation suffer from some form mental illness and another 30 to 35 percent are abusing drugs or alcohol. Young people with mental illnesses often use alcohol and other substances to self-medicate their symptoms, behavior which frequently leads to prison. There are now far more mentally ill in the nation's prisons (200,000 to 250,000) than in state hospitals (57,716).
Historically, Hawaii State Hospital has served as the place of last resort for those who could not find adequate treatment in the community or private sector. It is imperative that we take deliberative care in any plan to downsize the hospital. We must have a full public debate to make certain that we continue to give the best care possible to the seriously mentally ill of Hawaii.
Dr. Andrew J. Weaver is a clinical psychologist at
Hawaii State Hospital who has written several books and
numerous articles on mental health care. He is also an
ordained Methodist minister.