From your vantage point as DOH medical director for crisis continuum, what can be gained by signing Senate Bill 3139 into law?

SB 3139 aims to expand crisis and diversion services. One way is through facilities like the new Behavioral Health Crisis Center (BHCC) in Iwilei. They benefit the community in many ways.

First, the BHCC is another entry point where individuals in behavioral crisis can receive expedient and patient-centered care. This new resource allows individuals who may not need psychiatric hospitalization to be diverted from expensive emergency rooms (ERs) at acute-care hospitals.

Second, they improve efficiency for law enforcement officers who bring in individuals for assistance, as the BHCC intake is much quicker than in an acute-care ER. People with sub-acute behavioral health crises may spend many hours in an ER, only to be discharged after being seen by psychiatric staff or social workers. At a BHCC, individuals will receive immediate assessment and assistance by a multi-disciplinary team that includes crisis case managers and people with lived experience. SB 3139 changes the statute to allow law enforcement to take individuals under an MH-1 (certification for someone to be taken involuntarily for an evaluation) to the BHCC instead of an ER.

Third, because the BHCC is a specialized behavioral health facility with specialized staff, almost all efforts are dedicated to understanding and helping the person with their behavioral health crisis.

Also, years of experience in places like Arizona show huge cost-savings across the health care and law enforcement systems over time.

What issues are not addressed by SB 3139?

SB 3139 is quite comprehensive. It seems to be a good starting point for improving the crisis delivery system and diverting individuals into more appropriate community-based care. As the BHCC is a pilot project, over the next year we will have a much clearer understanding of how it is functioning. But the BHCC is just one segment of the crisis continuum.

With a severe workforce shortage across the system, some neighbor island communities may not have enough crisis stabilization beds. More focus on Crisis Mobile Teams and improved responsiveness by community behavior health case management teams for their clients would help.

However, it must be stated that the severe lack of permanent, affordable housing is a major impediment to behavioral health care for the homeless. Until more housing is available, a large number of vulnerable individuals will be sleeping rough and at risk of frequent behavioral crises. We have homeless individuals with various needs, and we need a deeper supply of the full range of housing options, including supported housing (community housing with case management support), care homes, specialized residential facilities, and group homes. Supported housing requires copious collaboration among agencies.

How can the new BHCC in Iwilei be utilized to maximize its potential?

The BHCC can maximize its potential by following the national guidelines outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA). Having BHCC serve people truly in crisis will maximize its value along with other initiatives, including:

>> Creating homeless triage centers for homeless individuals not in crisis

>> Developing close collaboration between BHCC staff and community case managers already working with the clients brought to the BHCC.

We continue to work closely with our community partners, especially the Honolulu Police Department, the Queen’s Medical Center, our Crisis Call Center and Crisis Mobile Outreach program. Sharing a common vision with our community partners of what the crisis continuum should look like will foster success of the BHCC and support the funding of future BHCCs.

In the latest Point in Time Count of Oahu’s homeless, 33% reported a mental illness. Can you explain the nexus between homelessness and mental health?

The relationship between homelessness and mental illness is quite complex. Those with serious brain disorders like schizophrenia can be highly incapacitated without treatment, predictably leading to chronic homelessness. Individuals with mental illness and trauma tend to be overrepresented in groups experiencing homelessness or at risk of becoming homeless. Living on the streets is extremely dangerous, stressful and traumatic, causing or exacerbating mental distress and disorders, or sometimes contributing to substance use issues.

We do not have enough affordable housing. Imagine 10 people playing musical chairs, and only three chairs available. Most people will not have a chair, or a safe place to rest. And the ones who able to grab those three chairs tend to have the fewest vulnerabilities. This is one reason why the unfortunate Supreme Court ruling in City of Grants Pass v. Johnson was a big blow to unsheltered people and homeless advocates.

Finally, one cannot overstate the devastating impact of the methamphetamine crisis. There is not enough treatment at all levels. Supporting someone with an active meth addiction in supported housing is challenging. We have to figure this out in order to make a dent in the homeless problem.

You have been involved in the treatment of and advocacy for mentally ill homeless for more than a decade. What drew you to this field?

Actually, it’s been more than two decades. Going through my residency training, I was not exposed to this type of work. One of my first part-time jobs when I completed my training was working at the former Safe Haven on Beretania Street. I instantly fell in love with the work.

I wish that people could for a moment see what I see when I do my street work. I wish they could see how my amazing teammates connect with these people, and how each person we meet is so unique, interesting, and important. I wish they could see how some of the police officers are so great working with these people, getting to know them and always trying to be helpful, and some of the other incredible people from other community agencies.

Seeing them connect with houseless people who some regard as the doormats of our society inspired me to do my part in helping people with serious brain disorders who nationwide have been failed by public policy and traditional health service delivery models. And it is my DUTY to continue doing this type of work.