State hospital makes use of community services


POSTED: Sunday, March 08, 2009

The Hawaii State Hospital for the mentally ill in Kaneohe appears to have solved an overcrowding problem by shifting patients to community-based services.

The monthly population, which hit 197 in May, has averaged in the 160s or 170s since November, said administrator Mark A. Fridovich.

Designed for 168 to 178 patients, the facility was operated under federal court oversight from 1991 to December 2004 because of unconstitutional conditions and overcrowding.

A task force convened by the governor last year recommended legal and other changes to address the patient overload. Community-based services were encouraged to reduce the largely court-ordered hospital population.

Sen. Rosalyn Baker (D, Honokohau-Makena), who headed the task force, said another one may be needed to review the effects of recent Health Department cuts to community programs. “;Any time you've got a system that's underfunded and under stress, there's going to be potential issues,”; she said.

“;My ultimate concern is, with an influx of folks coming back from two wars, we're going to see more people who are going to need more services and services may not be available,”; Baker said.

A Mental Health Transformation group is studying the entire mental health system under a five-year federal grant of about $11 million.

Fridovich said the hospital is working with the Adult Mental Health Division staff and community agencies to manage its population and expand discharge options for patients and he's “;quite pleased it's working as well as it has.”;

Discharged patients are going to community-based programs or families, some to prison if court-ordered, or to substance treatment programs, group homes or nursing facilities. Placements for people with psychiatric and physical problems are most challenging, he said.

A specialized residential program is being operated on the hospital grounds for eight patients as “;one small step out of the hospital,”; he said.

The hospital was reaccredited for three years after a four-day unannounced visit by a Joint Commission for Accreditation of Healthcare panel, Fridovich said. Only two areas were identified for improvement — patient safety monitoring and making sure expired licenses are renewed for clinical professionals, he said.

Safety is closely monitored, he said, noting “;a small number of patients who engage in violence. ... We do have incidents of staff and patients being assaulted.”; He said he believes the assault rate is “;lower than sometimes in the past.”;