The Behavioral Health Crisis Center opened in 2024 across the street from the Institute for Human Services’ men’s shelter in Iwilei and has seen 1,182 people ever since to address issues including substance abuse and mental health, which are considered critical underlying reasons why people end up and remain homeless.
The center opened on Iwilei Road and saw its first patients on March 8, 2024, and continues to take in people like T.J. Utai, 27, who grew up in Kalihi, failed to graduate from Farrington High School and more recently had been living in and out of IHS.
Last week represented Utai’s third visit to the Behavioral Health Crisis Center in two weeks.
He was starting to believe that better things were possible once he kicks his addiction to meth and addresses and stabilizes his mental health issues, which include anxiety.
Now, Utai can see himself possibly getting a job one day and, perhaps, reuniting with his estranged family.
“I fell into a rat hole,” he told the Honolulu Star-Advertiser.
On the street, Utai said, “they told me this was the place. … Now I’m getting the help I need.”
The state-run center operates out of a city building and was the first of three new joint city and state facilities to open within blocks of one another over the past year to help people — many of them homeless — with their medical, behavioral and mental health issues.
They individually represent new models to address the root causes of homelessness in Hawaii and get more people off the street and on to better lives.
Iwilei — home to IHS, which started Hawaii’s original homeless outreach efforts — continues to represent the center of new approaches to addressing homelessness.
Most of the people who have been seen at the Behavioral Health Crisis Center over the past year — 78% —were homeless.
But anyone can walk in and get evaluated and observed over just a few hours.
Or they might involuntarily be brought in by Honolulu Police Department officers and remain upstairs on the mezzanine level for 10 to 14 days before leaving with longer-term case management plans including treatment beds to get additional, stable help.
The center also gives HPD officers a time-efficient alternative to get the people they encounter evaluated, compared with the sometimes hours officers can spend in emergency rooms like The Queen’s Medical Center, said Dr. Chad Koyanagi, the state Health Department’s medical director for crisis continuum, who oversees patient care at the Behavioral Health Crisis Center.
In 2024 the Legislature approved the latest version of Senate Bill 3139, which allows law enforcement to take a person considered dangerous to themselves or others against their will to alternative facilities like the Behavioral Health Crisis Center.
Gov. Josh Green signed the bill into law as Act 86.
Last week two HPD officers brought a man in handcuffs to the behavioral health center whom they encountered in Aiea, got him admitted and were back on their way within minutes to patrol their Aiea district.
The officers were not authorized to speak to the media and said they could not comment to the Star-Advertiser.
In the past, Koyanagi said, HPD officers from across Oahu would have to transport patients as far away as Castle Medical Center in Kailua to get them evaluated.
The number of people seen at the Behavioral Health Crisis Center has steadily grown over the past year, from 62 in March 2024 to a peak of 225 in December to 215 in February.
Most of them — 40% — had mental health issues, including schizophrenia, bipolar disorder and major depression.
They were followed by 24% who suffered from substance abuse and 10% who were having a “housing crisis,” according to Health Department data.
Most — 73% — were men, and a plurality of all patients — 32% — were ages 35 to 44.
The open-air, ground-floor observation room of the Behavioral Health Crisis Center sees clients up to 24 hours — or no more than “23:59” as Dr. Angie Dickson, the center’s director and clinical psychologist, called the time limit.
Some only need to rest in one of 16 oversize chairs, sit in quiet watching television or take a few hours away from life on the street to get reoriented, she said.
“They just need a minute to get away from whatever situation they’re in,” Dickson said.
There are no reasons someone won’t be seen, such as lack of health insurance, she said.
“We take everyone.”
The design of the space — and the focus on a calming approach by health care workers — was based on what Koyanagi saw while visiting similar behavioral health centers in Arizona’s Maricopa County.
Koyanagi thought the same approach would work on Oahu after spending years providing psychiatric care for homeless people through IHS and in the Halawa Correctional Facility, while also teaching at the University of Hawaii’s John A. Burns School of Medicine.
Upstairs in the nine-bed mezzanine level, patients can stay 10 to 14 days while they receive case management designed to improve their situations through substance abuse treatment, mental health medications and longer-term housing and employment goals.
The top three floors of the four-story building will soon open as long-term housing for homeless people — or people at risk of becoming homeless — who also struggle with mental health or substance issues.
Each of the upper floors, accessible from the Sumner Street side of the center, will have nine studio apartments. One will be reserved for a resident manager.
The residents will have to pay rent of 30% of their monthly income, typically through government financial assistance.
The units have been built out, a contract has been executed with Care Hawaii and the first residents will move in after the units are furnished, along with other finishing touches such as the installation of security cameras.
Josten Gutierres, 43, was staying at the Behavioral Health Crisis Center last week after he lost his job on Hawaii island, ended up homeless and came to Oahu hoping for a fresh start, only to end up homeless in Kaneohe, sleeping in Kaneohe District Park at night.
Someone on the street encouraged Gutierres to call 988, which referred him to the Behavioral Health Crisis Center, where he began receiving medications, including mood stabilizers.
He also was working to stay off of meth and alcohol, or what Utai called “relapse prevention.”
“They helping me get clean,” he said. “It is tough.”
But in less than a week of getting help at the center, Gutierres said, “I feel way better.”
By the numbers
1,182
People seen at the Behavioral Health Crisis Center between March 8, 2024, and March 14
78%
Patients who were homeless
40%
Patients with mental health issues, including schizophrenia, bipolar and major depression
24%
Patients with substance abuse issues
Source: State Department of Health
HERE TO SUPPORT
Behavioral Health Crisis Center
>> Opened: March 8, 2024
>> Located: 806 Iwilei Road
>> Facility: Open-air, ground-level observation room for short-term stays of up to 24 hours; Longer-term care and treatment up to 14 days in a nine-bed facility on the mezzanine level.
>> Focus: Observation, assessment, treatment and case management for people who are brought in by police or voluntarily walk in for care.
‘A‘ala Respite
>> Opened: Sept. 16
>> Located: In the former First Hawaiian Bank branch at 445 N. King St.
>> Facility: 62 beds, including 30 indoor hospital-style beds and 30 outdoor, tiny-home kauhale for patients transitioning into more permanent housing.
>> Focus: Long-term medical care for homeless people, including kupuna with dementia and Alzheimer’s; people in need of substance abuse and mental illness treatment, dialysis and diabetes care; and homeless stroke and heart attack victims.
Iwilei Center
Compassionate Housing Kauhale/ Kumu Ola Hou Transitional Center
>> Opened: March 3
>> Located: Kuwili Street
>> Facility: 13 temporary, portable, single-room structures erected inside an air-conditioned building until workforce housing can be developed to coincide with the opening of the planned Iwilei rail station
>> Focus: Treatment for 24 homeless patients at a time with mental health, memory and brain injury issues; on-site health care with a focus on neuroscience
Source: City and County of Honolulu, State of Hawaii
Correction: A photo caption in an earlier version of this story misspelled the last name of Dr. Chad Koyanagi.
