Posted on: Thursday, February 10, 2005

Service for state's mentally ill 'slow'

By Ken Kobayashi
Advertiser Courts Writer

The state isn't doing enough to implement a court-mandated plan to serve thousands of Hawai'i's mentally ill living in the community, a federal magistrate said yesterday.

The Department of Health's pace is "slow and not remarkable," said Magistrate Kevin Chang, who is overseeing the state's efforts to implement the plan by June 30 next year.

Chang said health officials have not yet identified the people who would be served, a critical first step.

State health officials said they weren't surprised since a court-appointed evaluation team that Chang relied on shared its findings in December. The officials praised Chang's report for providing them with some direction and said they won't object to it.

"We're confident as we move forward that we're going to get this job done," said Michelle Hill, the health department's deputy director in charge of behavioral health administration. "We're determined and committed to doing it."

The plan is an offshoot of the Justice Department's lawsuit alleging civil-rights violations at the Hawai'i State Hospital in Kane'ohe. In December, Chief U.S. District Judge David Ezra lifted 13 years of federal oversight at the facility, calling the improvements there "astonishing."

But as part of an overall strategy to treat Hawai'i's mentally ill, the federal court retained oversight on the state's efforts to treat the noninstitutionalized mentally ill. Ezra still retains oversight on the state's efforts to implement the plan, and he appointed Chang to provide recommendations and status reports.

"Now is not the time for defendants (the state health officials) to relax and rest on their accomplishments with the Hawai'i State Hospital," Chang said in his 26-page report.

The community plan was approved by the court two years ago.

"At best, defendants' system development and compliance with the community plan has been delayed unnecessarily," Chang wrote. "At worst, time and resources have probably been wasted and the delivery of community based mental health services to consumers may have been compromised."

Dr. Thomas Hester, chief of the adult mental-health division for the state Health Department, said the plan calls for a "major transformation" in the way the mentally ill are treated as well as the decentralization of the planning process.

But he said some aspects of the plan present challenges that may not be readily apparent, such as identifying the target population since it entails tracking down patients discharged from the hospital since 1991.

He said progress has been made in developing a 24-hour crisis line for people to call to get help and the development of a mobile crisis team to go into the community and help the mentally ill.

The target population to be served by the plan is also growing, he said.

When the plan was adopted, it was estimated at fewer than 4,500 people, but now, it's estimated at 7,000 and the number is likely to grow, Hester said.

The estimated cost of the plan is $12 million a year, assuming the population remains at 7,000, but health officials hope the federal government will pay $9 million yearly, Hester said.

Chang recommended that the evaluation team and a special court-appointed monitor conduct monthly telephone conferences with Hester. The magistrate also recommended that health officials prepare periodic reports on the development of an integrated system for mental health services.

He asked that Ezra schedule a hearing to listen to any objections to the report. Hester said they do not plan to object.

Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com or 525-8030.