State health officials will cite evidence of Hawaii State Hospital improvements from a national organization at a hearing Monday before U.S. District Judge David Ezra.
But while progress has been made in developing better services at the hospital, support is lacking for thousands of people needing mental health services, advocates say.
Ezra set a deadline this month for the state to show substantial compliance with court-ordered improvements at the hospital and facilities providing state child and adolescent mental health services.
He warned last summer that the state had to "move forward" if it wanted to maintain control of the mental health system. It is being operated by the state Health Department under a federal court agreement resulting from a U.S. Department of Justice lawsuit against the state.
Anita Swanson, special assistant to Health Director Bruce Anderson, pointed out that the hospital recently was awarded accreditation for three years by the Joint Commission for Accreditation of Health Care Organizations, which looks at 500 ìindicators
"I'm very confident that we have made tremendous progress at the hospital," she said. Certain things might be challenged, she said, but "The accrediting organization says we are responding to patients' needs; they are receiving excellent care."
She said 25 beds have been closed at the hospital and the population has been reduced to 145 from 167 last February by transferring patients to more appropriate acute hospital or community settings.
"We were managing 60 patients in the hospital that did not meet the criteria for inpatient psychiatric care," she said. "We're in the process of moving them out."
The Legislature approved a department plan to change the State Hospital gradually to a rehabilitation facility with 108 beds, Swanson noted.
"We're continuing with the effort we started in the spring to respond to what the needs of patients at the hospital are,"she said. "We have made tremendous efforts in that regard,"she said. "We're concentrating efforts on appropriate treatment planning and appropriate discharges in community settings."
Patients needing acute mental or physical care are being transferred to The Queens Medical Center or Castle Medical Center and the DOH is using money from its budget to expand community-based mental health programs, Swanson said.
The department is drawing funds for the fourth quarter of the fiscal year to finance community mental health services, said DOH spokesman Patrick Johnston. The Legislature will be asked for emergency funding to make up any shortfall in the last quarter, he said.
It looked as though Mental Help Hawaii would lose about $300,000 last July, which would have meant closing some residential resources for clients, said Joanne Lundstrom, executive director.
She said the programs were reorganized to keep them open while working with DOH on how to sustain some level of service for people who are not in the State Hospital.
Greg Farstrup, executive director of the Mental Health Association of Hawaii, said the DOH "has made some good progress." But if it's done at the expense of those currently receiving community mental health services, he said, "They're not going forward; they're just going sideways."
With no additional money provided by the Legislature for community services, Farstrup said the DOH is reducing some services and increasing others "rather than keeping the base of services and building on it."
"They're taking the wood from one house and building another house so the people in the first house don't have anything to keep the rain off them.
"It doesn't seem fair to solve things at the hospital for people that are there," Farstrup said, "and have people whose lives are more stable in the community have their lives disrupted so they may have to go into the hospital, to say nothing about the people in prison and jails. A lot of (mentally ill) people are misplaced in prison."
About 80 percent of patients at Hawaii State Hospital are criminal commitments, sent there by the court, and some of them are minor offenders who also are misplaced, Farstrup said.
One person in five is estimated to have some kind of mental health problem, he said, which amounts to about 200,000 in Hawaii. About 2.8 percent of the adults, or about 23,000, have serious disabling mental illnesses, he said, adding, "The state says they help maybe 3,000 to 5,000 people."
Lundstrom said the DOH is ìnot focusing dollars on people who have not made it to the State Hospital.
"If you can divert people from having to go into the hospital, that's a plus. Under the way the system is set up now, the dollars follow you from Hawaii State Hospital," Lundstrom said.
