There is little doubt that the Hawaii State Hospital is in dire need of more capacity and beds, plus improved conditions to optimize safety for staffers and others who deal with its mentally troubled — and sometimes violent — patients.
So it’s easy to root for the Kaneohe campus’ updated plan unveiled Tuesday that aims to increase overall capacity to 516 beds from 178, a move needed to deal with the sharp increase in people being committed to the complex.
Not so easily forthcoming, however, will be the $160 million for a new 144-bed, maximum-security facility envisioned at the core of the campus overhaul.
Health and hospital officials will face a heavy lift before state lawmakers next session to justify this worthy request over myriad others. But there are many selling points, including:
>> Serious safety issues.
The state Health Department reported 327 assaults or attempted assaults on HSH staff over the past 2.5 years.
Last year, hospital staff filed a class-action lawsuit against the state claiming the attacks were fostered by an unsafe work environment.
A state Senate committee also launched an investigation, and its final report warned that the ongoing assaults could end in a fatality if safety problems weren’t quickly addressed.
Clearly, the proposed maximum-security hospital is warranted. To replace the old and unusable Goddard Building, a new $160 million facility ringed by a security fence would separate high-risk patients in a modern building with direct line-of-sight monitoring and other needed features, improving safety for all.
>> A spike in court-ordered referrals.
Built in the 1930s for up to 168 patients, the hospital daily gets 25-30 above that number. Another 40 beds are contracted with a private psychiatric hospital, but there is high likelihood of more overflow needs. Virtually all hospital admissions are forensic mental health patients committed there by the state courts.
>> As Hawaii’s homeless population has grown, it’s become visibly apparent that a certain segment suffers from severe mental illness.
Arrests of mentally ill homeless have contributed to the State Hospital’s overcrowding because detainees often arrive in court unfit to proceed and are sent there for assessment. More capacity is needed to enable appropriate treatment more readily for those who urgently need it.
With so many deficiencies at the hospital — resulting from years of deferred attention — a purposeful strategy must emerge. Four months ago, there was much buzz about another portion of the HSH complex: a proposal to replace the deteriorated Bishop Building with a new 150-bed skilled-nursing, long-term care home under a public-private partnership.
Work on that needs to continue apace. About 50 beds would be set aside for patients discharged from HSH who have complex, long-term care needs, freeing up crucial space at the over-capacity hospital; the 100 other beds would be open to the community for those in need of complex care.
Plans to overhaul the State Hospital have languished for at least a decade. A critical mass of need has been reached, and state Health Director Virginia Pressler calls it the department’s “No. 1 priority.”
No doubt the $160 million, high-security “Goddard Building” proposal will be picked apart — as it should be in legislative hearings next year: Is that price tag justified, or could the new facility be built more efficiently and economically? What are the safeguards against cost overruns and budgetary ballooning?
At the core of all the questions, though, is this basic one: Is upgrading the State Hospital a need, or a want?
Given the chronic and growing demands of caring for our society’s most mentally ill members, substantial improvement of the hospital is a need.
