State fails to improve key parts of mental-health plan
By Ken Kobayashi
Advertiser Courts Writer
By Ken Kobayashi
State health officials did not meet the deadline to show they had moved ahead substantially with key parts of a community mental-health plan to serve an estimated 11,000 seriously ill Hawai'i residents, a federal magistrate reported yesterday.
The state made progress in certain areas of providing services, treatment and housing to the mentally ill living in the community, but U.S. Magistrate Judge Kevin Chang said he could not say the state met a June 30 deadline to show that it was in "substantial compliance" with its plan.
Chang said he could not ignore the "shortcomings" in "critical" parts of the plan.
Nonetheless, Chang recommended that federal oversight of the mental-health plan be lifted on Nov. 30, the date that state and Justice Department lawyers had agreed oversight would end.
Attorney General Mark Bennett said he was pleased with Chang's conclusions.
"We are glad this case is going to be ending at the end of November," he said.
U.S. Justice Department lawyers could not be reached for comment yesterday.
Costly and lengthy litigation over mental-health care in Hawai'i began in 1991 with a Justice Department lawsuit alleging civil-rights violations against patients at the Hawai'i State Hospital.
Federal oversight of the Kane'ohe facility was lifted in late 2004, but U.S. District Judge David Ezra retained oversight of the community health plan to ensure that the mentally ill who did not live in the facility were receiving adequate services and treatment.
Chang was appointed by Ezra to file regular reports on the state's efforts.
Chang's 26-page report relied on the findings of the seventh and final visit by three mental-health experts appointed to help the court evaluate the state's efforts. The three are Kenneth Minkoff of Acton, Mass.; Gail Hanson-Mayer of Lexington, Mass.; and Paul Gorman of Lebanon, N.H.
Chang said the evaluation team found many areas in which the state achieved compliance, including providing access to state mental-health resources, housing, psychosocial rehabilitation services, crisis services and mental-illness and substance-abuse services.
But the team also found "shortcomings" in providing forensic services, treatment planning, inpatient discharge oversight, case management services and individual, group and family therapy at the state's community health centers.
As an example of lack of forensic services, Chang said the first conditional release program for former hospital patients opened in March, but the programs were still not completed.
In terms of treatment or recovery planning for the mentally ill, one of the evaluators found that of the 36 plans he reviewed, more than 30 had deficiencies, Chang said.
But Chang said the evaluators found that state health officials made "significant progress" in the past six months, especially in April, May and June.
"The evaluation team noted that in many areas the defendants (state health officials) were headed in the right direction and encouraged defendants to continue their efforts through Nov. 30, 2006," Chang said.
The state's efforts to comply with the plan have been closely followed by advocates for mentally ill residents who face the difficult task of coping with their disabilities.
Some are skeptical about whether state officials will follow through without the federal oversight, especially given Chang's findings that he could not say the state met the June 30 deadline.
"It sounds contradictory to me," said Mike Pablin, 59, a Salt Lake resident who suffers from depression and also is an advocate for the seriously mentally ill.
He said that from his viewpoint, the state has improved providing the mentally ill with access to services, but has not met goals in providing appropriate services tailored to individual needs and providing continuity to ensure that the individual continues to progress and does not fall through gaps in the system.
"You have to wonder if the state by Nov. 30 is able to sustain its progress," he said.
As early as February 2005, Chang warned that the state wasn't moving quickly enough. He submitted other reports highly critical of the lack of progress.
But attorneys for the state and the Justice Department reached an agreement in September that federal oversight would end in November.
The agreement was reached after state lawyers had questioned whether the federal courts could retain jurisdiction over the community plan when the underlying Justice Department lawsuit was based on the federal law dealing with the civil rights of "institutionalized" individuals.
Bennett yesterday said it was anticipated when the agreement was reached that the state would not be in full compliance by June 30.
"But everyone agreed we had come a long way, that we could indeed come a long way by June 30, and the case would conclude Nov. 30," he said.
Bennett said he could not say where the state would be on Nov. 30 in terms of compliance.
"But we are committed to meeting our statutory and constitutional obligations and providing the best community services we can," he said.
Reach Ken Kobayashi at firstname.lastname@example.org.
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Correction: Although the state of Hawai'i failed to show it had made substantial progress in key parts of a community mental- health plan, it did make progress in certain areas. The headline on a previous version of this story suggested no progress had been made.