Mental health
services faulted

A magistrate assails the state's
"troubling" lack of progress

Even after getting an 18-month extension to bring its community mental health services up to federal standards, the state of Hawaii continues to fall behind, according to the most recent report from a court-appointed special master.

In his report submitted in U.S. District Court here yesterday, the special master, U.S. Magistrate Judge Kevin Chang, said, "That (the state) had failed to make meaningful progress with regard to system of care development is disappointing and troubling.

"At best, (the state's) system development and compliance with the Community Plan has been delayed unnecessarily. At worse, time and resource have been probably wasted and the delivery of community-based mental health services to consumers may have been compromised," Chang wrote.

The contents of the report are not a surprise, and the state does not intend to file an objection to the report, said Michelle Hill, deputy health director for behavioral health administration.

However, Hill believes the state will develop a system of care for mental health patients outside the Hawaii State Hospital that will meet federal standards.

The report is based on site visits in December by three health-care professionals who make up the master's evaluation team. According to the report, the evaluation team is critical of the state for failing to develop the infrastructure to support a community-based system of care for Hawaii's mentally ill adult population.

Dr. Thomas Hester, state Adult Mental Health Division chief, agrees that the focus of the state's effort should be in developing such an infrastructure. But he said the state has been hampered by a more than 50 percent increase in the number of people entering the system.

In 2003 the state was providing community mental health care to about 4,500 patients, Hester said. Today, the state is providing care to more than 7,000 patients, he said.

"That's been one of the challenges," Hester said.

The reason for the increase is because the number of new services the court ordered the state to provide has opened the system to more people and keeping them in longer, he said.

Chang was appointed special master to oversee the state's progress in improving its system of care for mental health patients after the U.S. Department of Justice sued the state in 1991.

U.S. District Judge David Ezra released the Hawaii State Hospital from the lawsuit in December after Chang reported dramatic improvement at the Kaneohe facility, which was plagued with overcrowded, unsafe and unsanitary conditions when the federal lawsuit was filed.

Ezra also extended the deadline for the state to complete the requirements of the community plan to June 30, 2006, from Jan. 23, 2005.