Relief in sight for state hospital

Two years ago, the Hawaii State Hospital was contending with an all-time record patient count, with 218 court-ordered individuals packed into a mental hospital initially designed to accommodate 170. Overcrowding in the aging facility threatened to compromise patient care and put the safety of hospital employees at risk. Conditions were rightly tagged by the state as a clear-cut crisis.

Fast forward to this week — and finally, cause for optimism against that crisis. Architects, designers and state health officials on Wednesday unveiled artist renderings for a four-story, 144-bed, 170,000-square-foot, $140 million building to be situated mauka of the current hospital. Part of a master plan to upgrade and expand the Kaneohe campus, it’s designed to increase the hospital’s total capacity to 252 patients from 202, and will replace the nearly 70-year-old Goddard Building.

More elbow-room for patients and revamped security measures slated for the new building promise much-needed progress in helping the hospital fulfill its mission of providing excellent inpatient psychiatric services within a safe and therapeutic environment. However, the capacity figures prompt questions as to whether overcrowding concerns could resurface soon after the building opens in January 2021.

First built in 1932 when it was known as the Territorial Hospital, the facility is the only one in the state where psychiatric patients are admitted and discharged according to judicial order. Limiting the number of patients admitted is not an option.

In the past decade, administrators have attempted to make do by converting conference rooms into places for beds. Also, the state now maintains an overflow contract for about 40 beds with Kahi Mohala, a private-sector mental health facility. The state Department of Health’s master plan’s intent is to house all patients on the state hospital campus. But unless the flow of court orders slows, that might be a challenge.

What’s more, the increased capacity is crucial as concerns swirl over homelessness, and appropriate housing and treatment for street people with mental illness. Should the hospital get tapped to help in that effort, more beds could be needed.

State officials are stressing that the campus overhaul will result in a more secure and safer site for patients, staff and neighbors, who for years have expressed uneasiness about proximity to violent patients. Such worry escalated in mid-November when killer Randall Saito slipped away from the hospital, with his escape unreported for eight to 10 hours.

Bill May, administrator for the hospital, has declared: “What happened in November will not happen with this facility”; and persuasively backs that up with a roster of 17 policies and procedures under review following Saito’s escape. An attorney general’s report into that escape, now expected in a few weeks, is eagerly awaited.

The new building’s layout should also prompt community confidence. It aims to deter potential trouble by enabling a staffer to monitor an entire floor, thereby freeing up others to focus on treatment. As an an added layer of protection, a 16-foot, “anti-climb fence” that curves inward will surround the rear of the building.

In the aftermath of Saito’s escape, the Honolulu City Council granted a Plan Review Use permit to the state for the hospital’s 2015 master plan, which is expected to meet the facility’s needs through 2050. However, the approval required DOH to ask the Legislature for funds necessary to transition its facilities into a “fully secure hospital facility.”

State lawmakers denied a request for perimeter fencing, estimated at $17 million, but DOH was still able to secure its permit. In February, a $350,000 interior fencing upgrade — recommended after a public safety review — was put in place at the hospital.

Development of the hospital’s master plan started well over a decade ago. After years of grappling with crisis-level conditions, the state is finally poised to break ground on long-overdue improvements.