Hawaii State Hospital (HSH) employees are valued and are valuable.
Twenty-four hours a day, seven days a week, they provide support, nursing, guidance and monitoring for Hawaii citizens in our care.
Our employees are mental health workers, not correctional officers; our facility is a hospital, not a prison; those in our care are patients, not prisoners.
The staff’s job is challenging and carries the risk of danger. At times, their efforts are heroic. Due to them, lives are saved. Recovery happens. Many who were hopeless find healing, and safely re-enter society.
In recent weeks, some of our employees have publicly shared their experiences. The response has been significant. We’d like to share some information on the situation.
HSH has been on Oahu more than 100 years. The original "Territorial Insane Asylum" was in Kalihi. Around 1930, it was moved to Kaneohe. In the 1960s the facility, renamed the Hawaii State Hospital, housed more than 1,000 people. It was designed to treat those with severe mental illness; good hygiene was the mainstay of treatment. Psychiatric medications were new and limited in their effectiveness.
John F. Kenne-dy’s 1963 Community Mental Health Care Act resulted in the de-institutionalization of state hospitals. His death and the subsequent change of national priorities did not finish his vision of expansion of community mental health services to offset the reductions of inpatient beds. HSH’s population shrank from more than 1,000 in 1966 to around 200 in 1986. Hospital buildings built in the 1950s became outdated. New medications and treatments came. The movement to de-institutionalize individuals and help them re-enter the community grew. It seemed possible that state hospitals would no longer be needed.
In the late 1980s, the old buildings were razed. The current facility, opened in 1992, was built for a patient census of 178. After opening, the rate of admissions began to exceed the rate of discharges. Previously, individuals committed had "only" mental illness.
Unexpectedly, three new trends emerged that increased admissions and discharges. First, individuals in the legal system began to be committed in increasing numbers; second, crystal methamphetamine became a scourge that caused criminal actions, violence and brain damage for users; and, third, the population of Hawaii grew significantly.
As a result, the number of court commitments to the hospital increased and pressured the licensed capacity of the facility. Some buildings, previously condemned, were reopened to house the expanding numbers. The U.S. Department of Justice filed suit against the state, alleging violation of the civil rights of institutionalized persons, including patient abuse and neglect, overcrowding and lack of active treatment. Before the suit was resolved, more staffers were hired, programs were expanded and capacity was contracted at other facilities.
Today, virtually all admissions are by a judge’s order. Each person has been charged with a crime and been considered dangerous and/or not penally responsible due to mental disease, disorder or defect. One-third of those committed also have methamphetamine abuse or dependence.
The hospital invests large amounts of time and finance to orient, train and support our staff to successfully manage our patients. Our goal is to have zero incidents of violence, assaults and injuries. As can be seen from recent reports in the media, that goal is not being met.
The state Senate plans to conduct hearings on this matter. We look forward to participating as we plan for improvements to HSH staff, funding, programs and facilities.
