Saturday, November 28, 2015         


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Patients before policymakers


During periods of budgetary distress, preserving the social safety net becomes government's primary concern. There is room for debate over which people, at a minimum, this net must catch. Tough and painful decisions are necessary, and state government officials have made many of them since the recession stripped away every bit of budgetary surplus.

Now it seems clear that the state took a wrong turn by thinning out too radically the mental-health services section of the net. A loud outcry came from mental health advocates last week, with more comments being taken through today (see box). But the first signal that the state had seriously lapsed in its public duty came in June when the Hawaii Disability Rights Center filed a suit alleging that the state had changed its criteria for delivering services "by administrative fiat" rather than taking required rule-changing steps, a process that calls for public hearings.

In an effort to address this charge, rule amendments were drafted and public testimony was taken last week. The belated hearing drew complaints that the changes would aim to slash the state Adult Mental Health Division client list from about 16,000 to about 4,000, according to the rights center attorney Louis Erteschik. The cuts would produce savings that Erteschik said are illusory: Untreated mental illness compounds homelessness and other social costs and can leave the state vulnerable to litigation. In addition, The Queen's Medical Center testified that the cutback in case-management services for outpatients with mental health problems has led to a higher rate of readmission of patients to the hospital, not a workable solution.


Written testimony will be received until 4:30 p.m. today at the Adult Mental Health Division, HAR 11-175, 1250 Punchbowl St., Room 256, Honolulu 96813. There is an e-mail form on the division's website:

Beyond that broad picture, the proposed rule specifics should give everyone pause. For example: Some categorical changes would be made to halt treatment of new patients for several mental-health problems, such as post-traumatic stress disorder. This is a disturbing prospect, considering that the demand for PTSD treatment can only be on the rise with the frequent deployments of military personnel to war zones.

Further, one rule change seeks to make the process of further reductions relatively painless -- not for the patients, but for state policymakers. "In the event of budget restrictions, reductions in force or similar measures limiting the department's available resources, the director may change or reduce community mental health services." Changes in services should be transparent to the taxpaying public through the hearings process, not merely enabled by administrative order.

The Lingle administration certainly acted from the unenviable position of needing to make short-term cuts quickly to balance the budget. And although revenue projections have improved, Hawaii is far from out of the fiscal woods. The incoming Abercrombie administration has pledged to reorient government services to achieve efficiencies and cover what's most important, rather than blithely raising taxes. The mental-health crisis before it presents a formidable challenge of this resolve.

In March, lawmakers took testimony under oath from Dr. Tina McLaughlin, one of the top executives of the private mental health agency Care Hawaii Inc. Dr. McLaughlin told legislators that she compiled data of the number of deaths among mental patients that resulted from curbs on their access to care and follow-up, data that showed a 36 percent increase over the 2008 death count. At last week's hearing, Eileen Uchima of the National Alliance on Mental Illness' Hawaii office cited that "deplorable statistic" and urged legislators "not to make these changes on the backs of extremely vulnerable people."

If anyone is truly in need of a safety net, it would be people whose condition erects a barrier between themselves and self-sufficiency. It is for these people that a robust mental-health delivery system is so critical.

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