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State urged to beef up its mental health services, outreach

By Mary Vorsino


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."

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manakuke wrote:
In times of a real tight budget an urgently needed area.
on December 21,2012 | 04:49AM
sailfish1 wrote:
Are taxpayers going to have to pay for more mental health services? It should be the responsibility of the person's family to provide the needed service or possibly the person's medical insurance.
on December 21,2012 | 05:08AM
kainalu wrote:
A selfish comment pre-ACA. Otherwise, the Affordable Care Act would make your comment more comprehensible.
on December 21,2012 | 05:53AM
sailfish1 wrote:
What's selfish about it? Taxpayers are now paying for all kinds of things including incarcerating people when the courts deem them mentally ill. If we start treating everyone just because someone thinks they are mentally ill, the financial costs will be tremendously high. The federal government has even said that would be impossible to do. Of course, kainalu, if you are a multi-trillionaire, you can pay for it yourself!
on December 21,2012 | 06:46PM
Grimbold wrote:
This comment has been deleted.
on December 21,2012 | 06:17AM
kaiakea wrote:
One answer is that those "crazies" as you call them affect the public at-large, not just the family. Another answer is that it is essentially a civil rights issue, proceeding from the principle called "equal opportunity."
on December 21,2012 | 06:35AM
sailfish1 wrote:
It will be a tremendously huge financial cost to treat everyone who is deemed mentally ill. So, if you treat some of them then it will not be within your principle of "equal opportunity". Tell us how we are going to pay for treating them all since you think you are so smart.
on December 21,2012 | 06:49PM
sjean wrote:
Grimbold, your ignorance speaks crazy loud.
on December 21,2012 | 11:39AM
kaiakea wrote:
A well-written article, but if we want to adress mental health issues before lives are ruined, the DOE needs to change its tune. As a special educator both during the Felix Consent Decree and almost 20 years later in 2012, I see little difference in the assessment of children and youth with suspected mental health issues or in services rendered to those who have problems. Evaluation procedures have become more complicated and time consuming, proper training is not being provided to school-based staff, and the end result is that many keiki are falling through the cracks until they start causing problems as adults. Of course many of those vested in the system will cite increased spending and better statistics, but I don't see much if any improvement. The time is ripe for another class-action; Ivalee, Seitz, Shelby, are you folks still around?
on December 21,2012 | 05:14AM
sjean wrote:
You may be right. Yet, those children will still be Emotionally Disturbed. Blame the DOE yet again.
on December 21,2012 | 11:41AM
kuakini wrote:
I totally agree with Dr. Mee Lee and thank Mary Vorsino for shedding light on this topic. Instead of making sure a mentally ill person is stable, some hospitals send them off to IHS. I realize hospital costs are expensive, but providing more crisis shelters or some kind of tiered care may help the ill before it reaches to violent outcomes. Preventive measures actually help in the long run. Of course, there is no guarantee, but at least the state can say they did their best, instead of only saying "wish we could have done more."
on December 21,2012 | 05:49AM
cojef wrote:
One needs to look at the entire entitlment spending where able bodied indiviuals are receiving benefits whereas, those that cannot help themselves are shunted off to their families who have no means or the wherewithall to cope with a mentally ill individual. In the old days we had mental institutions, but modernist did not take to these facilities as they believed many of the inmates were salvageable and should not be instituionalized. It is tough to grow-up in modern times where all kinds of gadget exist where children do not relate personally with each other. We Tweet, YouTube, and all the blog sites to communicate with each other. There is no personal contact, we are inanimate objects like characters in the violent video games being marketed. there is hardly any personal interaction amongst people. Short tweets, blogs are the way communicate. We don't look into one another eyes and faces when we communicate. Inanimate method of communication makes everyone insensitive how we persceive life itself. Violent video games teaches our children to look at life with indifference. Slay 'em all, bang, bang!
on December 21,2012 | 07:21AM
AndrewWalden wrote:
Connecticut Shooting: Failure of Mental Health System http://www.hawaiifreepress.com/ArticlesMain/tabid/56/articleType/ArticleView/articleId/8435/Connecticut-Shooting-Failure-of-Mental-Health-System.aspx
on December 21,2012 | 10:22AM
retire wrote:
If service in the armed forces was mandatory for all citizens in this country, as it is in Israel, our population would be better prepaired to handle these incidents of terror. In Israel, all the school teachers are armed, which serves two purposes, it helps the teacher to protect themselves from any abberant or violent behavior that may occur among the students, and it provides the means to protect the student body and faculty from persons of harmful or deadly intent. It deals realistically with the issue at hand, you can pass all the legislation you want to ban guns, but its a little to late for that, they are are already out there, so this is a logical way to deal with the problem.
on December 21,2012 | 10:32AM
JohnClark wrote:
My youngest (adult) student son has threatened to kill me. He said I should "go to my grave" and he "won't blink an eye." I want an armed guard placed at the front door of my house. I'm not kidding! In fact, I think there should be armed guards placed at every house in the land where there are kids who express alienation from one or both parents. These days, that's most separated couples. It will also help take care of the high level of unemployment. Soldiers coming home, there's a job they're trained for, waiting for them! Plus, how about Mental Health resources stepping in, and ordering an evaluation in head cases like this? Could be an empty threat, could be not. I know I don't feel safe, and nobody cares.
on December 21,2012 | 10:44AM
retire wrote:
Arm yourself John, you are responsible for your own safety.
on December 21,2012 | 10:59AM
JohnClark wrote:
Thanks. I only know that the University cares more about legal issues of privacy than they do safety. I think safety trumps privacy in view of the horrors of Newtown and the NRA rant.
on December 21,2012 | 11:26AM
st1d wrote:
get a tro. talk to your doctor about getting a mental health order committing your son for observation/treatment. get a dog or two. get a home alarm with camera. if you arm yourself, take lessons and practice. revolvers rarely jam, semiautos carry more rounds.
on December 21,2012 | 09:12PM
JohnClark wrote:
I've decided to go very public with this. Put it on my FB page. I figure to leave a trail. I'm 80, I'd rather go my way than his. Dark deeds thrive in darkness.
on December 22,2012 | 06:37PM
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