State cuts could hurt mentally ill


POSTED: Sunday, March 08, 2009

State Health Department cuts in mental health services to offset an anticipated $25 million budget shortfall this year will jeopardize safety of the clients and public, service providers and advocates warn.

“;People with mental illnesses are no more violent than people in the general population,”; emphasized Marya Grambs, Mental Health America of Hawaii executive director. However, many mentally ill people no longer are getting adequate services and “;a very small minority of them, when untreated, can become a danger,”; she said.

“;They (health officials) have made cuts they had to make,”; she said. “;It's now up to the governor and the Legislature to figure out whether these people are a priority or not.”;

Tina McLaughlin, chief executive of CARE Hawaii (Child and Adolescent Resources for Education), said, “;We can no longer state that the level of services we provide ensures public safety or keeps our consumers safe.”;

Some psychiatrists are refusing to take patients “;because the support system is drifting away,”; she said.

CARE Hawaii serves about 3,000 people in the case-management program and another 1,000 or more in a crisis program.

Case management involves linking patients to psychiatric services and helping them with medications, housing, health and other issues.

“;These are people who have health symptoms, are hearing voices or confused, and we teach them how to blend in and interact with the public in a way their mental illness does not become an issue,”; McLaughlin said.

The health department last fall disbanded Assertive Community Treatment (ACT) teams that provided specialized services to seriously mentally ill people and transferred them to community-based case-management programs, McLaughlin said.

In January, the DOH, which serves about 16,000 residents in the mental health system, limited case-management services to 3.5 hours per patient per month. It also is moving an estimated 300 to 500 privately insured patients out of state-supported services.

A savings of $10 million to $12 million is projected — still leaving a $15 million deficit in the health budget for the fiscal year ending June 30, said Michelle Hill, deputy director for behavioral health and acting chief of the Adult Mental Health Division.

She said the department wanted to maintain the quality of services while containing out-of-control expenditures. Data showed use of case-management services varied and “;more money being spent did not equate to better outcomes,”; she said.

Providers in December billed the department about $7.5 million and January billings so far are under $4 million, she said.

Reports of sentinel events, such as death, harm to an individual, suicide or an act of violence, “;were consistently the same,”; Hill said. She said she hasn't noticed an increase in such events since January but that it's too early to see a trend.

“;Sometimes we get sidetracked by one event that is really tragic,”; Hill said, such as the stabbing of Waianae High teacher Asa Yamashita on Feb. 27 at the Ewa Town Center. Tittleman Fauatea, 25, was indicted Wednesday on charges of second-degree murder.

Fauatea, diagnosed with schizophrenia, had been hospitalized several times in Hawaii and California for mental illness. “;He definitely needs treatment and supervision,”; said his attorney, Dean Young.

“;We have come so far; we cannot force people to do things,”; Hill said. “;That is not the system we've built. ... We want people to focus on how we can figure out where there might be shortcomings we can better address or shore up and still be mindful that most of our population are the most vulnerable.”;

Hill said a procedure was established to authorize more services for clients if needed, but McLaughlin said it is so complicated that she doubts there have been many authorizations.

Hawaii's mental health system was designed under federal court order in recent years to keep mentally ill people out of hospitals and jails with community-based services, Grambs and McLaughlin pointed out.

“;Now, instead of redesigning the system to address the needs, they're throwing out the core of the system,”; McLaughlin said.