State mental health system finally OK
Citing improvements, a report recommends ending 15 years of federal court oversight
Hawaii's mental health system will be free of federal court oversight after 15 years of costly and sometimes contentious actions.
Dr. Thomas Hester, state Adult Mental Health division chief, insists that the state won't backslide once federal oversight ends. The division will continue to build on improvements in the system, he said in an interview.
"I don't believe the state wants to see things go back to the era where three years in a row we ranked 51st out of 51 states and the District of Columbia" in mental health services, he said.
Hawaii's mental health system has climbed to 11th place, and has received national recognition, Hester said.
U.S. Magistrate Kevin Chang recommended in his 12th and final report to U.S. District Judge David Ezra, filed Monday, that no further action be taken and the case be dismissed on Nov. 30.
The Department of Justice lawsuit originally focused on the Hawaii State Hospital for the mentally ill in Kaneohe, but court oversight was expanded in 2002 to include an "omnibus plan" for community mental health services.
Hester said he did not have current figures, but that more than 10,000 islanders received ongoing mental health services last year and another 2,000 received partial services. "That compares to less than 4,500 before the community plan started," he said.
Commending all involved, Chang said, "The integrated hospital-based and community-based mental health system" envisioned by the omnibus plan "is approaching reality."
In August 2005, the state questioned whether the federal court had exceeded its jurisdiction over the mental health system, which led to the Nov. 30 date to end the lawsuit if certain conditions were met.
Chang, appointed by Ezra in 2001 as special master in the case, said an evaluation team making its seventh and final visit here in June described both "noteworthy progress" and critical deficiencies in completing the community mental health plan.
He said the deficiencies "should not diminish defendants' successes and achievements in other areas of the community plan and the extraordinary efforts being put forth on a daily basis" by all those working in and with the mental health system "to provide quality service to consumers, to develop the system of care and to implement the community plan.
"Momentum certainly is on the defendants' side," Chang said.
It hasn't been smooth-going. Chang has criticized state delays in meeting deadlines for improvements, raised the issue of suicides among mental health clients and pointed to "catastrophic effects" of patient overcrowding recurring at the Kaneohe hospital.
Ezra several times over the years threatened a federal takeover if the state didn't step up efforts to improve mental health services.
The deadline to comply with federal requirements in the community plan was extended to June 30, 2006.
Chang, in his report, said he couldn't say whether the state had achieved substantial compliance with the community plan by that date.
But he said he "can state unequivocally that the amount and level of treatment, care and services available to persons in the community with serious mental illnesses has improved dramatically since the filing of this lawsuit."
Hester said: "We're very close to realizing the type of system that was envisioned by the omnibus plan for the hospital and community."
