Tuesday, March 13, 2001
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Posted on: Tuesday, March 13, 2001

Needs of mentally ill unmet, report says

By David Waite
Advertiser Staff Writer

With help from the Legislature and the federal government, the state Department of Health hopes to double within four years the amount spent each year on services for seriously mentally ill adults in Hawaii.

About $62 million a year is being spent to provide services to about 4,500 adults who need treatment for various mental health problems, state Health director Bruce Anderson said yesterday.

But proposals contained in a report titled "Adult Mental Health Statewide Needs Assessment," which was done by North Carolina-based Technical Assistance Collaborative Inc. and the Human Services Research Institute, call for the amount to climb to $122 million a year by 2006.

That’s the amount necessary to tend to the needs of mental health patients discharged by the Hawaii State Hospital in Kaneohe and those patients diverted from the hospital into community based treatment programs, according to the report.

And to fully meet the needs of all acutely ill mental health patients who turn to the state for services, not just those treated at the state hospital or diverted to community programs, the current level of funding needs to be increased by about $88.3 million within four years, according to the newly released report.

Martha Knisley, senior consultant for Technical Assistance Collaborative, said the additional money would give Hawaii a "fully comprehensive system" to meet the needs of mentally ill adults.

Anderson said the report’s completion is a "major step forward" in the state’s efforts to meet the needs of mentally ill adults.

"There are no states fully meeting the needs of seriously mentally ill adults although a few states are approaching that level," Knisley said.

Efforts over the past decade to correct the problems at the state hospital have put Hawaii in a good position to provide the comprehensive program that the report calls for, Knisley said.

"With proper funding, we could look forward to lifting the weight of federal oversight and eventually addressing the settlement agreement issues," Anderson said.

The U.S. Department of Justice sued the state in 1991 over conditions at the Hawaii State Hospital, a state-run facility for treating adults with serious mental health problems. Later that year, state health officials agreed to a settlement or "consent decree" in which they promised to make a series of improvements to the facility.

From 1991 to 1996, state officials worked primarily on improving health and safety conditions at the hospital, Anderson said. Since then, the focus has been on treatment and discharge of patients at the hospital, which has space now for 168 patients. As of yesterday, 160 patients were housed at the hospital.

The hospital receives about $27.4 million, or about 44 percent of the annual mental health services budget, to provide inpatient services. Under the plan released yesterday, that amount would shrink to about $11 million four years from now.

At the same time, amounts allocated for "community living" for services such as halfway houses and monitored independent housing would be increased from about $7.5 million now to more than $23 million.

Anderson said a $60 million increase would enable the state to provide one of the best care systems in the country for adults with serious mental health problems. However, he added that at least $24 million must be spent "over the next several years" so the state can abide by its agreement with the federal government to improve mental health services for adults.

He said leaders in the state House of Representatives have been briefed on the plan and have pledged support for adding the requested $8 million increase for adult mental health services to next year’s budget. The plan will be presented to state Senate leaders shortly.

State health officials estimate that about 21,000 seriously mentally ill people are in Hawaii, and that only about one-third of them turn to the state for assistance. On any given day, the state provides services to about 4,500 adult mental health patients, mostly through community-based programs, Anderson said.

About 58 percent of the patients the state services suffer from schizophrenia while another 29 percent suffer from mood disorders such as manic depression.

Anderson said he is optimistic that as much as 40 percent of the proposed spending increase might be provided by the federal government.

Meanwhile yesterday, Leland Chang, a court-appointed monitor of the hospital’s progress under the consent decree, told state lawmakers that while the report’s completion signifies progress for the hospital, "there’s still quite a ways they need to go yet."

Chang said the Legislature needs to comply with the report’s call for additional money if more community support programs are to be developed.

The Knisley report was prepared in response to Chang’s findings in January that the hospital still needs to make more changes to comply with the consent decree.

"One of the problems with the hospital is that, for decades, it’s really been the only source for seriously mentally ill people," said Chang, who made a presentation to the House Health Committee. "You can’t be all things to all people, and yet they’ve been forced into that position. As there are more appropriate placements and services in the community, the challenge of the hospital to finally bring itself up to the standards of the (court) order will be somewhat easier."

Chang said he also was concerned that hospital staff work overtime to meet the staff-patient ratios set by the court order.

He said he also would like to see an increase in the amount of time patients spend in various hospital programs.

"Money is the essential piece here," Chang said. "The last part of the equation is for the Legislature to stake out a plan. ... It all comes down to what happens here."

Committee Chairman Dennis Arakaki said despite the budget demands at the Legislature this session, lawmakers must fund the Adult Mental Health Division of the Department of Health.

"We really don’t have a choice," said Arakaki, D-28th (Kalihi Valley, Kamehameha Heights). "There’s a lot of pressing needs that we need to take care of. Everything seems to hinge on collective bargaining, but this is something we have to fund."

Anderson said Department of Health officials are scheduled to meet with U.S. District Judge David Ezra in May.

Knisley also urged lawmakers to seek federal money to help pay for developing community housing for the mentally ill.

Many other states have received federal money for similar programs, she said.

"You as a state should not be paying for this alone," Knisley said. "Without adequate community care, people will need some kind of confinement and institutional care.

"We actually create disability. When we don’t give people an opportunity for community care, they become more and more dependent on us (the state hospital)."

Advertiser Capitol Bureau reporter Ronna Bolante contributed to this report.

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