The recent suggestion by federal Judge David Ezra that the state's mental health programs might require a federal takeover ignores the dramatic progress that the state has made in improving those programs.

While there are many areas where improvements must still be made, the state is committed to making those improvements, and the extraordinary step of ordering a federal takeover is simply not warranted.

In 1984, 1988 and 1990, the National Alliance of Mental Health, the nation's largest grass-roots mental health organization, ranked Hawai'i dead last (or tied for last) among states in providing mental health services. In NAMI's first comprehensive report in 15 years, released one month ago, Hawai'i was tied for 10th.

The facts bear out this assessment. There has been a huge increase in access to state mental health services in Hawai'i in recent years. Our ACCESS crisis line call center opened in 2002, when we received 21,842 calls. In 2005, we received 129,749.

In 2002, there were 203 assessments statewide to determine eligibility for adult mental health services in Hawai'i. In 2005, there were 2,486 completed assessments. Those who received mental health services beyond assessment or crisis services increased from 4,741 in 2002 to 11,844 in 2005.

The number of housing units for Adult Mental Health Division (AMHD) clients has increased from 1,204 in 2003 to 1,676 in 2005, and likely 2,284 in 2006 based on expected legislative funding. Those served with case management services have risen from 4,063 in 2002 to 6,284 in 2005.

Consumer involvement in the day-to-day operations of AMHD has increased markedly. Consumers serve on nearly every AMHD committee and are partners in design and oversight of the system of care. Consumer satisfaction is very high — a 2005 survey demonstrated a statewide positive response of 80 percent for access to services, 83 percent for appropriateness of services, 78 percent for participation in recovery planning, 69 percent for improved outcomes from services, and 84 percent for overall satisfaction.

AMHD certifies peer-review specialists to assist consumers at every level. Over 70 peer-review specialists have been certified during the last three years — prior to that time, there were none.

New services also include crisis mobile outreach teams for consumers in emergencies, dual diagnosis services for people suffering from mental illness and co-occurring substance-abuse disorders, 30-day crisis support management services for consumers who may not even be eligible for services, and an annual statewide mental health plan that originates in the counties, with local input from Service Area Boards.

Of course, going from almost no community services to the expanded services we are now providing was difficult, and there have been serious problems along the way. And we fully recognize that we could have done better than we have. But the claim that all the good is so outweighed by the problems, and that the system is so failing that we are on the brink of a federal takeover, is just not so.

Judge Ezra's comments were based in part on the findings of a recent evaluation of the system by court experts. But even those experts, while noting the existence of some serious problems, also saw great strides and dedication. Dr. Kenneth Minkoff wrote of the possibility of achieving substantial compliance by June 30 with the "Community Plan" for non-institutionalized people: "(M)y observation is that there is willingness, capability and motivation to achieve this goal."

This hardly sounds like a system that has so failed that it is on the brink of a federal takeover.

The suggestion that the system is in disarray is also belied by prior findings of the court. In December 2004, in approving dismissal of most of the 13-year-old lawsuit by the U.S. Department of Justice regarding the Hawai'i State Hospital, Judge Ezra described the state's progress as "astonishing." The head of Justice's Civil Rights arm stated: "When a state accomplishes meaningful reforms for those persons it has accepted responsibility to protect from harm, we must recognize and applaud those efforts."

Last Oct. 26, Judge Ezra ordered the final and permanent dismissal of the rest of the case, dealing with non-institutionalized people, no later than Nov. 30, 2006. It is noteworthy that when that order was entered, all of the parties recognized that the state would likely not be able to meet existing deadlines regarding the "Community Plan" for non-institutionalized people. It was just five weeks later that the evaluation team conducted its visit.

It is difficult to see how conditions could have turned so dramatically for the worse in just five weeks, and indeed, they did not.

We recognize and appreciate the true public service Judge Ezra has performed over the last 15 years relating to mental health services in Hawai'i. We also acknowledge and accept the state's duty to diligently address the shortcomings raised by the evaluation team, as well as the concerns raised by Judge Ezra and Magistrate Judge Kevin Chang.

But the suggestion that a federal takeover is warranted is simply not supported by the facts and does a disservice to the many state employees who are working tirelessly to overcome years of neglect and to ensure that the state provide high-quality mental health services.

Mark Bennett is the state attorney general; Chiyome Fukino, M.D., is the director of the state Department of Health; Tom Hester, M.D., is chief of the Adult Mental Health Division. They wrote this commentary for The Advertiser.