Help mentally ill help themselves

Across the nation, 41 other states have found a better way than we have to help the most vulnerable of their mentally ill population. Here, many of those in this group, people who are so ill that they’ve lost the ability to care for themselves, also have family or loved ones who can intervene on their behalf.

But there’s also a relatively small group of people who fall between the cracks and find themselves cycling between homelessness, arrest for misdemeanors, involuntary commitment in the state hospital and then back out again. Each pass through this revolving door leaves them weaker and takes a toll on social services and criminal-justice systems, too.

Hawaii can get on the path toward a solution this legislative session, with the passage of Senate Bill 310, which seeks to make it easier to get a court order ensuring that the patient gets "assisted community treatment." The bill is due for a final hearing today by conferees who are trying to find the best way to phase in the law so that mental health treatment providers can have protocols in place.

A workable approach should be possible, given only a few dozen of the most mentally ill would be affected. These people, however, have a disproportionate impact on homelessness and correctional services, so it’s important to arrest their downward spiral.

The bar is set high to protect the patients’ constitutional rights.This bill clarifies criteria for intervention so that the Family Court will be more willing to issue an order. Among these: The person must be deemed by a psychiatrist to be unlikely to live safely in the community without supervision, must have a history of failing to adhere to a medication regimen, and must either have received inpatient treatment or be found an imminent danger to him or herself or others.

Initial resistance to the legislation was based in part on concern that the duty to execute the order by transporting patients to doctors would fall on law enforcement. This, say the advocates, isn’t the usual outcome. For many, seeing a court order provides the incentive they need to take medication themselves.

The plain fact is this fragile population, under the status quo, often deteriorates to the point where their condition culminates in a misdeed; they frequently end up in jail and, worse, then are committed for forced medical treatment.

Research cited in the bill points to declining hospitalization rates in states that have implemented assisted community treatment. The length of hospital stays has been cut by up to 30 days per patient, according to the bill, and arrest rates have declined by up to two-thirds.

Lawmakers should be encouraged by this data and pass SB 310. In the end, it would enable the more humane intervention at an earlier point in the struggles of these patients, and that could provide the road back to the more independent living that they deserve.