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The Honolulu Advertiser
Posted on: Friday, February 26, 2010

State hospital more than locked doors

By Mark Fridovich and Chiyome Leinaala Fukino

Hawaii news photo - The Honolulu Advertiser

The Hawai'i State Hospital is the state's only public mental facility. Many patients are there only because there is no other more suitable place for them in the state.


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We all want a safer community and a safer Hawai'i State Hospital. Unfortunately, the problems identified in a Feb. 15 article are much more complicated than described by The Advertiser.

Hawai'i State Hospital is the only public mental hospital in our state. Admissions come from all islands; individuals hospitalized range in age from 20s to mid-70s.

Most have never been convicted of any crime and have been challenged for much of their lives with serious and persistent mental illness that, unfortunately, could not be helped by conventional treatments. Many also have serious physical health problems, many have had serious substance and alcohol abuse problems, and many are disconnected from families.

Almost all of the patients at the state hospital are so-called forensic commitments, usually because they are unfit to stand trial or because they have not followed court orders. In Hawai'i, a person may be found "not guilty by reason of insanity" when a judge or jury determines that the person did not understand the wrongful nature of their actions or that they lacked the internal controls to stop themselves.

Forensic commitments also include those charged with crimes, but unfit for trial because of mental retardation, cognitive impairment, or physical changes to their central nervous system.

Many come to the hospital, in part, because there is no other more suitable place for them to be in the community; their discharge from the hospital is delayed for the same reason. There are many patients in the state hospital who could be discharged if there was a place where they could go and receive more appropriate treatment.

As a psychiatric hospital we are obligated to offer treatment in the least restrictive setting. We provide care and treatment and we do not incarcerate. The loss of our Public Safety Department partners due to the budget shortfall was regrettable, but their functions were secondary to the operations of the hospital. They did not manage challenging patient behaviors, they did not have arrest powers and they did not monitor access through our security checkpoint.

Working with this population, there will always be some risk of incidents and the presence or absence of public safety officers will not change this. That is why a major component of staff training for everyone at Hawai'i State Hospital is security. Safety is the responsibility of all, not one group.

Many people, families and programs in our state are suffering because of the current economic downturn. As Hawai'i State Hospital works to address how to carry out our core functions with limited resources, we cannot afford to be distracted from focusing on real measures that would help.

Among them are these three steps:

•  Bad economic times will not last forever. It is important to begin talking now about how to finance and build a new facility for the about 80 patients who live in a 60-year-old building poorly designed for safe or effective treatment.

•  Provide political, social and financial support for the development of appropriate community options for those patients who do not need hospital-level clinical support. This will be more cost-effective and permit the state hospital to focus on patients who clinically require inpatient treatment.

•  Open our hearts and minds to the human predicament of individuals with serious mental illness, to regard them with compassion and to challenge discrimination against them.