Posted on: Sunday, September 2, 2001

Editorial
State hospital mess: back to the future?

Faced three years ago with the almost impossible task of satisfying a federal court's demand for improvements at the Hawai'i State Hospital on time, state Health Director Bruce Anderson came up with an intriguing solution:

He redefined the problem.

Rather than get the Kaneohe facility up to federal standards, Anderson said, why not simply close it?

No, he didn't mean throwing the patients out in the street and dusting off his hands. Rather, he said Hawai'i should get in step with the latest philosophy for handling the institutionalized mentally ill in use across the country. This philosophy, in essence, puts individuals in community-based facilities with treatment programs tailored to their particular needs.

Our sense was that Anderson was on the right track. But there's been a serious difference between his theory and the practice that has ensued in the last three years.

First, patients have not been moved into the community with the speed envisioned, and perhaps there are those who ultimately can't be moved. Now the hospital is overcrowded, caring for about 168 patients in space designed for 108.

Second, so-called "forensic" patients, those referred by the courts, have been walking away from poorly secured facilities with alarming regularity. While Anderson insists that these are patients, not prisoners, they remain dangerous and must be secured.

The high-risk patients at one time were housed in the aging Gunsberg Building, which was shut down in March. It strikes us as a product of poor management that no replacement facility was ever contemplated, even though the Gunsberg Building had been deteriorating for years.

It may be that the closing of that building was as much about getting the state out of the mental hospital business as it was about the building's physical deterioration.

At one time, Anderson said plaintively that forensic patients didn't belong in the hospital at all; that they belonged in segregated quarters within a prison.

That may be correct, but the state's present prison facilities have no space for such an addition, and thus might be a decade away from realization. A secure facility was needed in time for the shutdown of the Gunsberg Building.

Now Anderson suggests that a quick rehab of the Gunsberg Building can be an interim measure for overcrowding. Perhaps it can also be used once more to keep forensic patients secured.

That's an interim measure that we wish had been planned a year or more ago. Anderson now visualizes a new unit, probably designed for high-risk patients, with complete fencing, which suggests that Anderson and his boss, Gov. Ben Cayetano, have taken a new look at the need for secure facilities and retreated from the dream of closing the hospital.

All this continues to add to the state's embarrassment over its operation of this facility, which has been under the supervision of the federal court for years now. It is a quandary that needs high-priority attention and a clear solution.