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Other Views
THE suggestion that all those with serious mental illness in Hawaii should be hospitalized in a psychiatric hospital -- put forth in your Oct. 17 editorial -- was disturbing in its misguided simplicity. The editorial was inaccurate because of its reliance on an ill-conceived Oct. 14 Insight article by Andrew J. Weaver and the Rev. Barbara Grace Ripple. Mental health
needs being metIt is naive to think that we have a large homeless population and our prisons are full because we lack beds in a state mental health hospital. Equally off-base is the suggestion that the policies of the Department of Health are the cause.
Since 1991, Hawaii has been reforming its system of care for public mental health services in accordance with the settlement agreement that the state signed with the U.S. Department of Justice in the federal lawsuit that challenged conditions at Hawaii State Hospital.
We've worked to create a comprehensive system of care where appropriate interventions and programs are coordinated to provide continuous care for the seriously mentally ill.
Providing psychiatric hospital-based treatment for those who need that level of care is an essential element.
In 1996, it became evident that the efforts to help transition in-patients successfully to the community would require the extensive development of community-based treatment, housing and vocational opportunities.
At that time, the independent consulting firm known as Technical Assistance Collaborative Inc. (TAC) was designated by the federal court as an independent expert to provide assistance in developing this system.
TAC continues to advise DOH on the array of community-based services needed for a fully developed system of care.
Clearly, the issue is much more complicated than simply counting the number of beds in the State Hospital and comparing it to "average" psychiatric bed counts. Your editorial did not consider the beds in the Hawaii Health Systems Corporation hospital system and private hospitals.
Further, most states have not developed appropriate "best practice" systems of care. Best practice is to develop a continuum that provides for both in-patient psychiatric care and community-based treatment, housing and vocational opportunities to meet patients' needs.
In recognition of the need to develop a system of care to meet the treatment and rehabilitation needs of the seriously mentally ill, the Legislature last year supported our efforts in its approval of our request for an additional $14 million to expand community treatment programs.
With this support, we are well on our way to developing a comprehensive and coordinated system of care to meet the needs of the seriously mentally ill in Hawaii.
The problem of homelessness among mentally ill and the related prevalence of mental illness in prison populations are not problems unique to this state.
WE are well aware of the need for mental health services for a significant proportion of our homeless population, as well as a large number of convicted prisoners who are serving sentences in Hawaii jails and prisons.
But we disagree that more beds at the State Hospital will solve either of these complex problems.
Simply banishing people to an institution will not solve the problem. In compliance with the federal court order that most recently appointed a special monitor, we commissioned a report on Hawaii's mental health needs.
The report will assist us in making both short-term and long-term plans to continue to develop Hawaii's public mental health system. Let's work together towards this goal.
Bruce S. Anderson is director of the
state Department of Health.