The intent of deinstitutionalization, the decades-long process by which many of those with mental illness were released to community treatment, was to reintegrate those people in society and provide care in the least restrictive setting. For those who achieved that aim, it has been an enormous benefit.
But according patients this freedom has come at a cost. Experts in the field agree that too few of those needing the help will get it, as deinstitutionalization does not ensure patients receive the medication and rehabilitation they need to live in the community.
The result has been evident in Hawaii, especially among the homeless individuals who cycle through the emergency rooms and, far too often, through the criminal justice system.
Fortunately, as Honolulu Star-Advertiser writer Susan Essoyan reported this week, there are new tools in place to disrupt this downward spiral. Authorities must employ them to direct more people to a home environment that’s safer than the streets by getting them care for their illness.
Developments have been encouraging. Improvements this year include more extensive training for police handling these trouble calls, and a more appropriate approach to these cases. More people have been directed to health services through a “jail diversion” program.
In addition, there was the enactment of a new law, Act 231, a refinement of the “assisted community treatment” program first enabled with a bill passed two years ago. The goal was to allow for intervention in cases of mental illness while upholding the civil rights of the patient.
After the 2013 version of the law passed, the only test case was dismissed because of civil rights objections to requests for mental health records. The patient was a woman with a history of mental illness and substance abuse who lay on a Chinatown sidewalk for months.
Senate Bill 961 was then introduced to make the law more constitutionally defensible. For example, the law lays out conditions under which a guardian ad litem, public defender or other court-appointed counsel may be named to assist the subject of a petition for assisted community treatment.
Other “housekeeping” amendments were made — removing a 10-day time limit to set a hearing date and a notification requirement for continuances — to eliminate barriers to the imple- mentation of the assisted community treatment program.
The cases are tough to handle even without the procedural hurdles, so these changes were critical. Health care providers must be persuaded to identify patients now cycling through repeated clashes with law enforcement and emergency care, who could be helped to a more stabilized existence — better for them, and for the community that bears the social costs.
This is no small sector of the workload faced by police. Of the 10,824 arrested in Honolulu in 2013, 5,485 were struggling with severe mental illness or substance intoxication. And that proportion has nearly doubled since 2010, according to data compiled by advanced practice registered nurses working in the cellblock as part of Honolulu Emergency Psychological Services and the Jail Diversion Program.
Multiple studies have shown that intervention makes a tremendous difference, radically cutting the number of days the clients are incarcerated, hospitalized or unsheltered.
Hawaii’s jails are crowded enough without sending them people whose primary shortcoming has been a lack of care. Dealing with them like criminals does not serve as a substitute for medical treatment.
