Hawaii mental health advocates say the shooting rampage at a Connecticut elementary school underscores the need for a robust mental health safety net and for improved efforts to provide resources and support to individuals early — at the first signs of worrisome behavior.
They also say that while the state is making progress toward rebuilding its network of mental health services, after years of budget cuts, there is still much work to do.
"We did have cutbacks to some crucial services," said Dr. Denis Mee-Lee, chairman of the Department of Psychiatry at Castle Medical Center and a member of the National Alliance on Mental Illness-Hawaii chapter’s board.
Mee-Lee added one area in great need of improvement is mental health outreach, which allows providers to "intervene very early when we might see things that are a little worrying."
While the massacre at Sandy Hook Elementary in Newtown, Conn., has spurred a debate locally and nationally over gun control, it is also generating a discussion over what can be done to improve mental health care — and help communities, educators and health care professionals spot the difference between someone who needs serious help and a person who may just be a little different.
It is still not known whether shooter Adam Lanza suffered from a diagnosed mental health disorder.
Lanza, 20, killed his mother in her home Dec. 14 before driving to Sandy Hook Elementary and fatally shooting 20 children and six adults before killing himself.
Marya Grambs, executive director of Mental Health America of Hawaii, said in the wake of the Newtown shooting rampage and others like it in recent years, it’s important to note that most people with mental illness are not violent — and the vast majority of violent crimes are committed by people who are not mentally ill.
"We don’t want these (violent) episodes to stereotype mental illnesses," she said. "This is a tiny, tiny minority, but we do have to be equipped."
Being equipped, she said, means bolstering mental health services, streamlining the system of care and having a frank conversation about how to offer assistance to severely mentally ill individuals, some of whom might not want it.
"We have to recognize the symptoms, and then we have to find out how to get them help," she said.
But she said getting someone help is often a complicated, draining and difficult process. "The tragedy is there is not always a way to get them help," she said.
The Hawaii State Hospital in Kaneohe, the only state-run psychiatric hospital in the islands, almost exclusively admits those who have been ordered there by the courts after committing a crime.
Grambs said that means that someone who may need inpatient treatment but who has not been arrested has a dearth of options available to them.
Families are often left struggling to secure services for a loved one suffering from a mental illness, she said.
In the coming legislative session, mental health advocates plan to support changes to the state’s involuntary outpatient psychiatric treatment law that would clarify who should be ordered by the court to receive mandatory care.
Advocates say the law is rarely used in large part because it’s not clear who qualifies for involuntary outpatient treatment.
Meanwhile, state officials say they’re working to rebuild and improve Hawaii’s mental health network.
The Department of Health, for example, has restored some adult mental health services that had been cut during the economic downturn, including for crisis support and case management, and is looking to bring back more.
In a statement, DOH Director Loretta J. Fuddy said her department will hold community forums in the new year to solicit "input to help us prioritize the services we will expand in 2013."
Also in the new year, the state plans to kick off an effort to streamline the delivery of mental health services to thousands of low-income adults who are elderly or disabled.
Dr. Kenneth Fink, administrator for the Med-Quest Division at the state Department of Human Services, said patients will go to a single program for all of their behavioral health services, rather than having to navigate what can sometimes be a bureaucratic maze.
"I think we can do a better job of serving these individuals," he said, adding the change will improve the quality of care and "reduce the fragmentation of the system."
As part of the discussion about mental health care in the wake of the Newtown shooting, Louis Erteschik, executive director of the Hawaii Disability Rights Center, said it’s also important to be realistic: Changes to the law and improved mental health systems are far from fail-safe protections against future tragedies.
"In terms of who commits these horrific crimes, would these people even be covered (by mental health services)?" he said. "It’s terrifying to think that there may be a lot less that we could do about these things than we would like."
