Psychiatric care
expands in Ewa

Kahi Mohala holds an open house
at its new 88-bed facility

Kahi Mohala Behavioral Health, located on 14 acres on the Ewa Plain, is expanding psychiatric services to accommodate growing outpatient needs.

The 88-bed residential facility held an open house Friday to introduce two new programs: an electroconvulsive therapy suite and a telepsychiatry program planned with Hilo Medical Center.

Dr. Mark Mitchell, chief executive officer of Hawaii's only licensed psychiatry center, said it has begun to expand outpatient services for therapy because so many residents in the area work during the day.

"Most of the therapy is done in the evenings and weekends," he said.

Mitchell said the demand for services spurred efforts to consolidate and expand outpatient care at the facility and develop programs such as anger management, individual therapy and Women's Circle.

An $83,000 grant from Sutter Healthcare, nonprofit provider of health-care services based in Northern California, enabled affiliate Kahi Mohala to establish the electroconvulsive therapy suite.

Electroconvulsive therapy, used for people with severe depression, involves small electrodes attached to a person's temples. Low-voltage electrical currents are applied that stimulate nerve endings and elevate mood, Mitchell said.

The treatment was administered in the past with higher voltages and no anesthesia, and it was controversial, but it has a long record of safety and efficacy, Mitchell said.

"In today's world it is very, very different. People are administered a kind of twilight anesthesia, and the whole procedure takes about three seconds. A small shock is administered."

A course of treatments is required in stages over about six months, he said.

The only other place in Hawaii to get electroconvulsive therapy is at the Queen's Medical Center, and it is offered at inconvenient hours, particularly for neighbor islanders, Mitchell said. "We believe it's underutilized as a treatment on this island."

It is one of the best practices for people who have depression that does not respond to more traditional interventions, such as medication and therapy, Mitchell said.

It can be lifesaving and life-restoring if the patient, for example, is in a catatonic depression and not eating, he said.

In the second major development, Kahi Mohala is working with Hilo Medical Center to establish psychiatric evaluations from the Ewa facility for Hilo patients.

Mitchell said Kahi Mohala has a long relationship with the Hilo emergency room. "We used to go over all the time and deliver training to folks.

"They came to us and said they were really having difficulty getting assessments for children in ER; they sit there for five to seven days before anyone sees them."

Another issue for Hilo's ER is getting kids medevaced off the Big Island to Oahu, he said. "They end up stuck with kids a long time inappropriately, not even having assessments."

Mitchell said the first televideo unit was installed a few weeks ago in Kahi Mohala's conference room, and the facility borrowed two televideo units from Kapiolani Medical Center for Women & Children.

One stayed at Kahi Mohala, and the other went to the Hilo emergency room where patients can be evaluated by mental health professionals on Oahu.

Mitchell said the two facilities will work out the kinks and develop the service during the next six months or so.

He said other hospitals and the Department of Education are interested in working with Kahi Mohala for televideo services, but it depends on availability of psychiatrists. "We have to staff up more."

Telepsychiatry is used a lot on the mainland, Mitchell said, noting studies have shown whether people are receiving evaluations, therapy or medical monitoring through a televideo system, satisfaction rates are as high if not higher.

The system is particularly effective in rural areas with limited access to medical or psychiatric specialties, Mitchell pointed out.