99
THE SENATE                           S.R. NO.              S.D. 1
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                    SENATE  RESOLUTION

  REQUESTING THE DEPARTMENT OF HEALTH TO IMPLEMENT THE
    RECOMMENDATIONS OF THE LEGISLATURE'S CONSULTANT ON THE
    PROVISION OF MENTAL HEALTH SERVICES AT THE HAWAII STATE
    HOSPITAL.
 


 1        WHEREAS, in 1991, the United States Department of Justice
 2   filed suit against the State of Hawaii in the United States
 3   District Court for the District of Hawaii for violations of the
 4   constitutional rights of patients at the Hawaii State Hospital
 5   (HSH); and
 6   
 7        WHEREAS, Hawaii entered into a stipulated settlement
 8   agreement and court order with the United States to correct
 9   deficiencies at the HSH; and
10   
11        WHEREAS, the Department of Health (DOH) is in the process
12   of implementing a plan to remedy the alleged deficiencies at
13   the HSH, most notably the provision of appropriate services in
14   the community for HSH patients who do not require hospital-
15   level care; and
16   
17        WHEREAS, the Legislature recently hired its own
18   independent consultant to review the DOH plans for the HSH; and
19   
20        WHEREAS, the consultant is H. Richard Lamb, M.D., a
21   well-known and well-respected psychiatrist and noted expert in
22   the provision of mental health services, who is a professor of
23   Psychiatry at the University of Southern California School of
24   Medicine; and
25   
26        WHEREAS, Dr. Lamb visited the HSH, Institute for Human
27   Services (IHS), Oahu Community Correctional Center (OCCC), Oahu
28   Community Mental Health Services (at Kalihi-Palama Treatment
29   Services), Safe Haven, Hawaii Psychiatric Medical Association,
30   and the Clubhouse (community mental health meeting place); and
31   
32        WHEREAS, Dr. Lamb met with officials from all the visited
33   facilities, including officials of the DOH - Dr. Bruce

 
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                                  S.R. NO.              S.D. 1
                                                        
                                                        

 
 1   Anderson, Director of Health, Anita Swanson, Deputy Director
 2   for Behavioral Health, Dr. Linda Fox, Chief of the Adult Mental
 3   Health Division, Wayne Law, Administrator of HSH, and Ann
 4   Andreas, Deputy Attorney General representing the State in the
 5   litigation; and
 6   
 7        WHEREAS, Dr. Lamb filed a report with the Legislature with
 8   the following comments:
 9   
10        (1)  That the HSH is licensed for 168 beds, but is in the
11             process of downsizing the HSH to 108 beds;
12   
13        (2)  That 85 to 90 percent of the patients are forensic
14             (committed by court order, usually for dangerousness
15             to self or others, or both);
16   
17        (3)  That there are currently an estimated 21 non-forensic
18             patients residing at HSH, or less than two occupied
19             non-forensic beds per 100,000 population (standard of
20             measurement) which is the lowest in the nation;
21   
22        (4)  Reducing the number of beds to 108 leaves no beds for
23             non-forensic patients;
24   
25        (5)  The belief among State mental health officials is
26             that psychiatric hospital beds are not needed if
27             adequate community care is provided;
28   
29        (6)  There is a severe problem with the homeless mentally
30             ill, many of whom use crystal methamphetamine which
31             often causes violent behavior, who are taken to acute
32             care hospitals (usually after an arrest) and are
33             released a few hours later in spite of the opinion of
34             the IHS staff that longer periods of hospitalization
35             are necessary as there is no facility available for
36             this purpose (intermediate care beds);
37   
38        (7)  There is some evidence of inordinate pressure on
39             staff at the HSH to discharge patients, even if
40             discharge is inappropriate or permission has not been
41             granted by the courts in forensic cases;
42   

 
 
 
 
 
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                                  S.R. NO.              S.D. 1
                                                        
                                                        

 
 1        (8)  That committing a crime is becoming the only
 2             practical way of getting admitted to the HSH;
 3   
 4        (9)  There are more than 200 severely mentally ill
 5             patients at OCCC and the neighbor island correctional
 6             facilities, of which at least half of the misdemeanor
 7             offenders should be placed at HSH;
 8   
 9       (10)  100 to 150 additional beds at HSH are needed to
10             permit meaningful diversion from the criminal justice
11             system to the mental health system;
12   
13       (11)  There is a consensus among members of the Hawaii
14             Psychiatric Association that:
15   
16             (A)  It is extremely difficult to admit patients at
17                  HSH, especially for the cohort of severely
18                  mentally ill patients who need a locked, highly
19                  structured facility;
20   
21             (B)  Downsizing of HSH will lead to homelessness and
22                  criminalization;
23   
24             (C)  There is a need for intermediate care
25                  facilities; and
26   
27             (D)  Long-term severely mentally ill patients are
28                  being overcrowded at private hospitals;
29   
30   and
31   
32        WHEREAS, Dr. Lamb further commented as follows:
33   
34        (1)  That the HSH not be downsized and be utilized to its
35             full capacity of 168 licensed beds, which is still an
36             inadequate number for the State's population; and
37   
38        (2)  Downsizing to 108 beds would result in virtually zero
39             non-forensic beds when clinical experience everywhere
40             indicates that there is a core of persons with severe
41             mental illness who need a locked, highly structured
42             care in order to adequately treat them and protect

 
 
 
 
 
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                                  S.R. NO.              S.D. 1
                                                        
                                                        

 
 1             the community;
 2   
 3        (3)  Experience throughout the nation and other countries
 4             indicates that as the amount of highly structured
 5             care decreases, the number of severely mentally ill
 6             persons who become criminalized or homeless
 7             increases;
 8   
 9        (4)  The downsizing of HSH is the basis of the negative
10             comments of the United States Department of Justice
11             experts in their 1999 report, in particular the
12             finding that the downsizing is resulting in patients
13             being prematurely or inappropriately discharged from
14             HSH;
15   
16        (5)  Locked, intermediate care facilities be developed to
17             serve those persons who do not require intensive HSH
18             care, but who do require highly-structured care at a
19             somewhat lower level;
20   
21        (6)  Some patients who are not as severely mentally ill
22             require a locked intermediate care facility, where
23             there is very close medication supervision, a high
24             staff to patient ratio, and there is a very
25             extensive, individually tailored activity program;
26   
27        (7)  A concerted effort be made to identify, evaluate, and
28             provide appropriate services to the more than 200
29             severely mentally ill persons who are incarcerated
30             and the very large numbers of severely mentally ill
31             homeless persons; and
32   
33        (8)  A comprehensive plan be developed by the State to
34             determine how the needs of persons with severe mental
35             illness will be met;
36   
37   and
38   
39        WHEREAS, the Legislature suggests that there should be
40   three levels of treatment for the mentally ill:
41   
42        (1)  The HSH for the forensic and non-forensic patients

 
 
 
 
 
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                                  S.R. NO.              S.D. 1
                                                        
                                                        

 
 1             who need that type of highly structured and secure
 2             setting;
 3   
 4        (2)  Intermediate care facilities for patients who need
 5             confinement in a less structured setting but who are
 6             not ready or not appropriate to be placed in the
 7             community; and
 8   
 9        (3)  Community-based care;
10   
11   and
12   
13        WHEREAS, the Legislature further suggests that the State
14   should address the problems of providing appropriate
15   residential services for the homeless severely mentally ill and
16   the incarcerated severely mentally ill who do not belong in
17   state correctional facilities; now, therefore,
18   
19        BE IT RESOLVED by the Senate of the Twentieth Legislature
20   of the State of Hawaii, Regular Session of 2000, that the DOH
21   is requested to work collaboratively with the Mental Health
22   Association, community-based service providers, hospitals such
23   as Queens Medical Center, and other stakeholders to develop a
24   comprehensive care plan that ensures that appropriate levels
25   are being provided to mentally ill persons using Dr. Lamb's
26   recommendations as a guideline; and
27   
28        BE IT FURTHER RESOLVED that a certified copy of this
29   Resolution be transmitted to the Director of Health.