State defends
mental health plan

A report responds to scathing
criticism by a federal judge over
state-funded services

The state is questioning whether the federal court has exceeded its jurisdiction in supervising development of a community plan for mental health services.

The state raised the issue in response to a blistering report last month from U.S. Magistrate Kevin Chang, who criticized the Adult Mental Health Division's lack of leadership and progress in developing a system of care.

In a report filed in federal court yesterday, state attorneys pointed out: "Hawaii is unique among the states in that it may be the only state in the United States that is developing a statewide community based mental health system under the supervision of the United States District Court in a CRIPA (Civil Rights of Institutionalized Persons Act of 1980) case."

The federal court has supervised improvements ordered in Hawaii's mental health system since the U.S. Justice Department filed a lawsuit against the state in 1991 over allegedly unconstitutional conditions at Hawaii State Hospital in Kaneohe.

U.S. District Judge David Ezra appointed Chang special master in the case in 2001.

The federal court in 2002 ordered an omnibus plan to ensure continued mental health care in the community for patients leaving Hawaii State Hospital.

The hospital was released from court oversight in December after implementing a remedial plan and the state Health Department was given a one-year extension to June 30, 2006, to complete a community mental health system.

"Has the community plan, originally ordered to facilitate discharges from HSH, and thereby supplement the court's enforcement of the 1991 settlement agreement in this case, gone far beyond that mission, thereby falling outside the subject matter jurisdiction of the United States District Court?" state attorneys asked.

In his 10th report to the court, Chang said 16 people receiving mental health services died from mid-February to mid-April, including six suicides.

He focused on the apparent suicide of Jane Doe, saying the division's failure to make her death a high priority, along with a cluster of suicide deaths, "and treat it accordingly is appalling and reflects a serious lapse in judgment and questionable leadership."

Jane Doe's death initially was believed to be a suicide but she actually died of an undetermined cause, the state reported.

"However sad the death of any consumer is to every member of the mental health community, the state defendants point out that there is little if any evidence to link the death of this consumer with any absence of leadership by anyone in AMHD (Adult Mental Health Division)."

The number of residents receiving state-funded mental health services has jumped from about 4,500 four years ago to 8,500 or 9,000, while the death rate has dropped from about 11.33 percent to 7.8 to 8.24 percent, the state reported.

Five suicides of mental health consumers, none in the target population for the community plan, occurred in the past fiscal year, all in a two-month period, the state said.

"As unfortunate as the five suicides are, there is nothing in the record that suggests that any of these incidents of suicide were connected either to each other or to AMHD leadership," it said.

Chang's last report presents a "glass half empty" view rather than half full because it "downplays accomplishments" noted by an evaluation team in June, the state attorneys said.

The Health Department adopted a new functional organizational chart for the division July 29 and it is trying to fill vacancies to help meet the goals, the state said, acknowledging much remains to be done.

The Justice Department, in a separate report, said it shares Chang's concerns about the state's lack of significant progress in some areas, gaps in services and a high patient population at the state hospital and Kahi Mohala, preventing seriously mentally ill people in the community from being admitted for treatment.

Ezra will hold a status hearing Sept. 22.

The state attorneys are asking Ezra to accept Chang's report as a status report on the litigation rather than adopting the findings, which include recommendations of the three-member evaluation team. They said the recommendations exceed the scope of the community plan's requirements.