Hawaii received a C grade for its adult mental-health care system on the latest report card of the National Alliance on Mental Illness.

It is the same grade the state received in 2006 after two decades of improvement, NAMI said, adding, “;The state is now at risk of sliding backward.”;

The national average was a D. No state received an A. There were six Bs, 18 Cs, 21 Ds and six Fs.

“;Mental health care in America is in crisis,”; NAMI Executive Director Michael J. Fitzpatrick said in a news release. “;Even states that have worked hard to build lifesaving, recovery-oriented systems of care stand to see their progress wiped out.”;

The report cites these factors contributing to improvements in Hawaii's system in the past 20 years:

“;U.S. Department of Justice oversight, new money, a governor who spoke openly about the experience of having a family member with a mental illness, steady agency leadership and the embarrassment that came from falling behind other states - resulting in clarity in defining issues.

“;Unfortunately, all of these variables are under stress or no longer applicable.”;

Marion Poirier, Hawaii executive director of NAMI, said Hawaii probably would have improved and earned a B if not for all the budget cuts.

The report also suggests Hawaii could do a better job “;connecting the dots from one branch of government to another and from the private to public sector,”; she said.

“;Most people go along nicely with the system, then all of a sudden something happens and there's a break. They seek out a service or need a certain medication or can't get a doctor's appointment and something happens, and the population is so fragile. If something doesn't come to them at the time they need it, they can decompensate.”;

NAMI said efforts to address housing needs and outreach to the homeless are critical in Hawaii. It said the state's decision to end specialized Assertive Community Treatment teams and put resources into case management services “;is a step backwards.”; The system's problems “;are compounded by imminent transitions and the state's budget crisis,”; with all hiring frozen and many unfilled positions.

“;Hawaii's challenge is to build more momentum to protect the gains made in the past two decades and to keep moving forward as the true test of its progress,”; the alliance concluded.