On Monday, a Circuit Court judge ordered that 85-year-old Beverly Shimabukuro, a Liliha resident charged with first-degree arson, be transferred from an Oahu Community Correctional Center jail cell to the Hawaii State Hospital for a mental health examination. Family members said this was a “good outcome,” trusting in the capacity of the State Hospital to provide care and treatment. That’s a reflection of the absolute need that the hospital fulfills.
The likelihood that a State Hospital patient will receive the quality care and treatment required, however, is threatened by the facility’s continuing struggle to adequately staff and deal with chronic overcrowding. As the Legislature considers budget requests for the coming year, it must prioritize funding to address these problems.
Overcrowding threatens security at the State Hospital, putting both staff and patients in danger. On Nov. 13, a patient who had transitioned to a residential program on hospital grounds stabbed and killed a nurse, prompting public concern and bringing staff criticism of safety procedures into the open. The state Department of Health (DOH), which oversees the facility, has rightly tightened security and increased staff-to-patient ratios, and also conducted a safety analysis at both sites.
Other recommendations include adding a safety and operations administrator and committee, and more security personnel, including a rapid response team. These actions must be fully implemented, using emergency or redirected funds, if necessary, and provided for in the DOH budget going forward.
Crucially, the DOH evaluation also calls for increasing the number of certified court examiners (CCEs), who assess whether a person referred by the courts is fit to proceed with trial and sentencing. A current increase in criminal court referrals to the State Hospital for mental health evaluations continues to worsen the overcrowding problem. The hospital has an unacceptable shortage of available CCEs, who are primarily psychiatrists or licensed psychologists, and may include physicians in felony cases, which require three examiners’ reports. Administrators must refine and intensify efforts to fill this need, which has been a problem for at least a decade.
Also critically important is bolstering the bed count outside of the State Hospital’s high-security setting for those in need of crisis intervention and mental health treatment. As has been recommended in previous studies, increasing rates for contracted service providers that can house and treat nonviolent patients outside of the State Hospital can ease the facility’s overcrowding, as can adding community-based kauhale providing mental health services; the state must move forward on both counts.
Gov. Josh Green has acknowledged the value of crisis centers in helping divert those with mental health needs from the court system. The partial opening of a Behavioral Health Crisis Center in a city-owned Iwilei building last week was a step in the right direction. But DOH administrators say legislation is required to allow crisis centers such as this to serve more clients and reach full potential; public pressure is on to get it done.
Senate Bill 2885 and partner House Bill 2309 would establish a state-run Homeless Triage Center that provides case management, behavioral health services and substance abuse treatment. The Legislature must reconcile the bills to position a center for maximum federal support and move this much-needed development forward.
As Shimabukuro’s story shows, the State Hospital is called upon to serve people from varied backgrounds, old and young, including those who have not been convicted of any crime, or assessed officially as mentally ill. To ensure safety and quality of care, legislators must fund critical behavioral health programs, and support necessary staffing and security measures. The $42.5 million in capital improvement funding proposed by the House for a mental health crisis unit at the State Hospital is a positive step; the ball is now in the Senate’s court.
