Construction of a new forensic patient facility — replacing a dilapidated 70-year-old building — is expected to wrap up on Hawaii State Hospital (HSH) grounds in Kaneohe by late 2020, with staff and patients moving in the next year.
In addition to upgrading the therapeutic environment and addressing safety concerns, the four-story building — designed and built with $160.5 million in state funding — will help ease long-standing overcrowded conditions, said Run Heidelberg, HSH’s new administrator.
The sole public psychiatric hospital in the islands, HSH was initially built to serve as a 178-bed facility. However, in recent years its count of court-ordered patients has routinely topped 200.
Among the features slated to be included in the upgrade: a courtroom, and spaces for “fitness restoration” for individuals found unfit to stand trial; occupational and recreational therapy areas; and several group therapy rooms for classes to address issues such as anger management, substance use and social skills training.
“By containing all these elements within the new building’s perimeter, this prevents the need for patients to travel across the campus, and creates a more secure and safer area for treatment activities,” said Heidelberg, who has worked at HSH since the mid-1990s.
The Gulfport, Miss., native holds a master’s degree in psychiatric mental health nursing from the University of Hawaii and a doctorate degree of nursing practice from Brandman University in California.
His career in health care started at age 16, when his mother, a longtime intensive-care unit nurse, encouraged him to pursue a nurse’s aide certificate. In addition, he earned pharmacy technician and telemetry technician certificates. Heidelberg moved to Hawaii in 1990, as a member of the military assigned to Schofield Barracks, where he worked as an air-assault trained expert field medic.
Question: Your first name, Run, is unusual. Is there a story attached to it?
Answer: I’m part Native American on my mother’s side, and I used to love running. My actual name is Ronald, which slowly morphed into Tiger Run then to Run. And, I was told, when I get older they’ll simply call me “Ran.”
Q: As the state hospital’s leader, what are your top short-term and long-term goals?
A: I’ve had the rare opportunity to having been directly supervised by the last three hospital administrators, and each has shared a wealth of knowledge in regard to organizational goal-setting. With that in mind, my first goal is to ensure that all HSH staff know and understand the hospital’s mission and vision. That, coupled with clear lines of communication, create better organizational outcomes.
Among the long-term: Establish HSH as the No. 1 psychiatric treatment facility in Hawaii. This would mean expanding our capacity to include short-term civil patients. My goal is to also spearhead the use of transitional housing to improve patient recovery and increase their safe reintegration into the community. HSH is just one part of a larger safety net for mental health in Hawaii, and it plays a small, but key role among a vast network of partners.
Q: All (or nearly all) of the state hospital’s patients are there because of criminal charges? How long has that been the case?
A: It’s been like this for longer than I think anyone is comfortable with. That’s why we are really working to balance that out, so we can serve a broader spectrum of needs in our community. The fact that so many stakeholders continue to step up and work on these issues makes me very proud, and was one of the main reasons I took this job on.
Currently, we are only able to accommodate persons who have been committed to the custody of the Director of Health through a criminal court order.
Q: What are your thoughts on how to most effectively treat Hawaii’s homeless individuals contending with mental illness?
A: I really see it as a trifecta of issues we need to address: homelessness, mental health and substance use. I think we are on the verge of really moving the needle because of the way so many folks are coming together to coordinate our response; and I’m excited to be able to work with everyone who is so committed to the idea of coordinated care. It includes providing outreach to those homeless individuals dealing with a mental illness and educating folks on how to handle homeless individuals with mental illness to avoid having to go through the criminal court system.
Q: Over the years, there have been news stories regarding claims of an unsafe work environment resulting from patient attacks on workers. What are your thoughts on the level of safety in your workplace?
A: In recent years, HSH adopted the “IMUA” concept (interaction, mindful documentation, unconditional positive regard, being available), which advocates for hourly interactions with each patient. We saw a significant decline in the severity of assaults on staff by patients after implementation. … The severity of assaults measured by lost work days has decreased by 27% from 2014. Also, we have also increased our staffing levels … and patients who are high risk for violence are placed on 1-to-1 staffing with clinical safety plans.
In addition, we can now petition the courts for Orders to Treat with psychotropic medications more quickly — within an average 14 days. … In the past, this court process normally had taken as long as 21 to 28 days. Patients who fail to respond to these interventions and continue to … threaten the safety of staff and other patients are referred to an out-of-state facility that offers a higher level of care than HSH.
Q: In June, the hospital started replacing 25-year-old surveillance systems, some of which were not operational, with new digital equipment to bring the facility up to date. How’s that effort going?
A: The main problem with our aging camera system had more to do with the Matrix (the camera hub) and not so much the cameras. In other words, the cameras were working but the signals were not being transmitted to the monitors. Now that the Matrix and monitors have been installed, the original cameras are transmitting their signals to the monitors. HSH will be installing additional cameras in the near future.
HSH also uses a redundant system of extra staff to cover (camera) unit blind spots. Security guards patrol the perimeter … and man cameras from central control. Every staffer is required to carry a panic button that, when engaged, shows their location. The staff member’s name and their location is then announced on the hospital-wide PA system for support safety.
Q: Randall Saito’s escape is now approaching the mark of two years in the rear view mirror (November 2017). What are your takeaway thoughts on that incident?
A: Obviously, the incident pointed out areas that needed improvement and policies and procedures that needed to be reviewed and revised. We assessed the weaknesses and took corrective actions in order to maintain a safe environment, not only for the patients and staff at HSH, but also the entire community of Hawaii.
Q: The hospital now has a staff of 600, and you’re looking to add about 200 more staffers by 2020?
A: We are actively participating in career fairs and other events to showcase the Hawaii State Hospital as a great place to work and pursue a career in health care. We also pride ourselves as being a teaching hospital where students can get hands-on training and education.
HSH recently partnered with Windward Community College, and I’m proud to announce that we are in the final stages of creating three behavioral health certificate pathways for HSH workers and Windward CC students. We are also interfacing and collaborating with local businesses on the Windward side in an effort to attract and develop qualified workers.
Q: In your decades of experience, what health care industry-related changes are most striking?
A: The effective use of electronic, automated and robotic systems integrated across the health-care industry has increased efficiency, productivity and patient/staff safety.
I was amazed 20 years ago when I first saw a robotic pharmacy technician delivering medication in the hospital setting; it looked like R2D2 from “Star Wars.” Now the technology has advanced to Bluetooth blood pressure machines; and when patients need assistance, their call light will ring their assigned nurse’s cell phone.