Homeless need alternative to hospitals for health care needs

Hospitals treated homeless patients 15,900 times last year, up from roughly 14,900 times in 2014, according to the Hawaii Health Information Corporation (HHIC). The Queen’s Medical Center tended to homeless patients 10,126 times in 2015, racking up gross charges of $89.3 million, HHIC data shows.

We do not know how much law enforcement, the Judiciary and other government, private and nonprofit entities spend each year managing our homeless population. But we know the number of homeless living on Oahu has increased every year since 2009 and with it, the cost of caring for them.

Honolulu service providers estimate that more than 30 percent of people living on the street are battling mental illness, substance abuse or both.

According to the U.S. Interagency Council on Homelessness, costs associated with the chronically homeless ranged from $35,000 to $150,000 per person annually in 2014 while the annual cost of the alternative, permanent supportive housing, ranges from $13,000 to $25,000 per person.

More importantly, we realize that we need a viable alternative to the revolving door of ER visits, arrests and other interactions that do not result in a person receiving the care they need or the home they seek.

The Honolulu Star-Advertiser’s editorial, “Outreach to homeless needed to cut ER costs” (Our View, Sept. 11), touched upon the frustrating trend of rising costs associated with Hawaii having the highest per capita homeless population in the country.

We have been working on the issue of homelessness, in one capacity or another, for more than 10 years.

We now seek to establish a program modeled upon Seattle’s successful Crisis Solutions Center that we visited this summer.

This summer we toured the facilities of Seattle’s Downtown Emergency Service Center (DESC) Crisis Solutions Center (CSC). The CSC gives Seattle’s first responders options instead of jail and hospitalization when they encounter a homeless individual having a behavioral or substance abuse-driven episode.

The CSC is designed to stabilize and support an individual in a non-confrontational setting while identifying and linking that person to services.

They serve any adult 18 or older experiencing an emotional and/or behavioral disturbance who agrees to accept help.

A mobile crisis response team, short-term diversion facility, and shelter services work together to manage incidents involving homeless. Participation is voluntary and the CSC is offered as an alternative to arrest or an emergency room visit.

In Seattle, the program cost per night of care amount to staggering savings for the community. It is $29 per night of DESC care, compared to $130 for jail, $2,000 for a psychiatric hospital, and $4,000 for an acute care hospital.

What we have discovered is that comparable parts of such a model in Honolulu are fragmented and working within their own silos.

For example, the state Department of Health operates licensed crisis residential services for up to three weeks. It also fields mobile crisis response teams whose primary focus is on individuals with mental health issues. Some providers and hospitals are evaluating other diversion and treatment approaches for varying lengths of housing and treatment.

We don’t have a comprehensive solution yet.

We must look at individual programs and find ways to weave them into a single, coordinated, multijurisdictional safety net of responses and services like the Crisis Solutions Center. We need the public, private and nonprofit communities to come together in favor of a comprehensive approach like what is being done in Seattle and San Francisco.

A Crisis Solutions Center in every county would provide considerable savings and bring benefits to the homeless individuals it serves, to the health care industry and to the public whose business operations or residential neighborhoods are often disrupted by homeless dealing with mental health and substance abuse challenges.

Carol Fukunaga, Ann Kobayashi and Ron Menor are members of the Honolulu City Council.