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The Honolulu Advertiser
Posted on: Wednesday, October 25, 2006

Mental health watch lifted

By Ken Kobayashi
Advertiser Courts Writer

FEDERAL OVERSIGHT

On Nov. 30, federal oversight over the state Department of Health's mental health division will end. Key dates in the case:

1991 — The U. S. Justice Department files a lawsuit alleging violations of constitutional rights of patients at the Hawai'i State Hospital. The state agrees to make improvements and be placed under federal jurisdiction as part of a consent decree.

2003 — As part of the oversight, the state helps develop a community mental health plan for treating patients who aren't at the hospital. Ezra approves the plan. It's now estimated that they number 11,000 residents.

December 2004 — Ezra lifts the oversight over the hospital but retains oversight over state compliance with the community plan. The judge postpones the deadline for compliance from January 2005 to June 2006.

September 2005 — After the state raises concerns about whether the federal oversight could continue beyond June 30, Justice agrees the federal court's jurisdiction would end Nov. 30 even if the June 30 deadline is not met.

August 2006 — In his final report to Ezra, U.S. Magistrate Judge Kevin Chang said the state made progress in complying with the plan but fell short in other areas. He reported he could not say the state met the June 30 deadline. But he recommended oversight be lifted Nov. 30 as agreed on by the lawyers.

Yesterday — Ezra approves Chang's report. Oversight will end Nov. 30.

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After 15 years, federal court oversight over the state Department of Health's mental health services will come to an end on Nov. 30.

U.S. District Judge David Ezra yesterday approved a recommendation that will lift federal jurisdiction over the state's community mental health plan aimed at providing services and treatment to the estimated 11,000 Hawai'i residents suffering from severe mental illness.

Ezra said the state has reached a point where it can be "proud" of its mental health services.

State Attorney General Mark Bennett acknowledged that more work has to be done to implement the plan but promised that the state will continue its efforts even after the oversight is lifted. "We will keep our noses to the grindstone," he told the judge.

Verlin Deerinwater, the Justice Department lawyer handling the case, said the state fell short of complying with key parts of the plan by a June 30 deadline. But in recommending the end to the oversight, he said the state did make progress on the plan and is committed to implementing it.

Federal oversight and the state's efforts have been closely monitored by many of the state's mentally ill residents and their families.

Steve Kishimoto, a 54-year old Kalihi resident who takes medication for depression and who works under contract with the health department to help the mentally ill with their finances, said he's hopeful about the state providing the services.

He said he's seen "phenomenal" improvements this year but fears that without federal oversight, it may be a matter of time before the state's commitment might be undermined by lack of funding.

"I also realize when money gets tight, then it won't be there, and many programs might be put on the shelf," he said.

He guesses that funding might last another two years. "Then, it's scary," he said.

The lifting of the oversight would be a milestone for state health officials, state and Justice Department lawyers and the federal courts grappling for 15 years with providing adequate treatment and services for the mentally ill.

"I think this is really a great day for the Department of Health and the people of Hawai'i," Michelle Hill, deputy health director in charge of behavior health administration, said after the hearing.

The oversight started with the Hawai'i State Hospital in Kane'ohe with 1991 after the Justice Department filed a lawsuit alleging that conditions at the facility were so bad that the patients' constitutional rights were being violated.

The oversight expanded in 2003 after the state agreed to implement a community plan for the mentally ill who lived in the community.

Oversight was lifted for the hospital in 2004, but Ezra retained jurisdiction over state efforts to implement the plan.

U.S. Magistrate Judge Kevin Chang, appointed by Ezra to monitor the state's progress and report to him, filed scathing reports in an effort to prod state health officials to comply with the plan. He said the state wasn't doing enough in addressing suicides and deaths among the mentally ill, and that the lack of progress was leading to overcrowding at the state hospital.

In his last report on Aug. 28, Chang said the state made progress but still did not comply with key parts of the plan. He said he could not report that the state complied with the June 30 deadline, but still he recommended the lifting of the federal oversight on Nov. 30 that the Justice Department and state lawyers had agreed upon.

Deerinwater declined to comment on why Justice agreed to the Nov. 30 date, but Bennett said there had been discussions about whether the federal court could continue jurisdiction over the community plan.

He said the Justice Department's lawsuit was based on a federal law dealing with civil rights of "institutionalized" people, but the oversight dealt with those who weren't in institutions.

The state had agreed to be under the federal courts through June 30 and could have argued that oversight should end at that time, but the state agreed to an extension until Nov. 30 as the final date when the federal jurisdiction would end, Bennett said.

Thomas Hester, head of the health department's adult mental health division, said the state still must meet goals under the plan that include managing services for the mentally ill and improving on developing teams that include psychiatrists, nurses, rehabilitation specialists and others to provide individualized mental health services.

He said the state was able to meet goals related to providing the mentally ill with access to services and providing housing. Hester said housing units for the mentally ill increased from 687 in 2002 to 2,292 in July.

Hester said there have been "tremendous improvements" in mental health services, but the adult mental health division will continue to work "hard, if not harder" to further improve them.

Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com.