Editorial: Mentally ill need more than jail

The overlapping issues of mental illness, substance abuse and homelessness present complex problems in Hawaii, which has the highest rate per capita of homelessness in the nation — with nearly one-third of homeless adults on Oahu reporting they suffer from a serious mental illness.

The problem of arrests touching off counterproductive jail-hospital cycles was addressed at last week’s inaugural Hawaii Summit on Improving the Governmental Response to Community Mental Illness, where judicial, law enforcement and health care officials focused on the need to improve pre-arrest and pre-court diversion routes.

Progress is in the works through programs such as this year’s launch of Crisis Intervention Team (CIT) training — a Honolulu Police Department partnership with the National Alliance on Mental Illness Hawaii and other community partners; and the city’s social services-focused city Law Enforcement Assisted Diversion (LEAD) program, which recently wrapped up its first year.

Both CIT and LEAD are part of nationwide initiatives effecting positive changes — improving the lives of individuals who have bounced from criminal justice system detention and hospital care to living on the streets, and, in some cases, chronic homelessness.

Still, there’s much evidence that more front-end innovation and training in judicial, law enforcement and health care fields, along with effective public policy, are in order. Currently, the path to getting mental health treatment while jailed for a misdemeanor offense can be slow going.

Hawaii Supreme Court Chief Justice Mark Recktenwald, who spoke at the summit about how collaboration among government and private-sector organizations can improve public safety, pointed out that in recent years, state Department of Public Safety pretrial detainees with mental illness spent a cumulative several thousand days at DPS facilities before transfer to Hawaii State Hospital (HSH).

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 exceeded 200. And all (or nearly all) of the patients are there because of criminal charges.

Construction of a new forensic patient facility — replacing a dilapidated building — is expected to be completed by late 2020. It can’t come soon enough. In addition to upgrading the therapeutic environment, the facility will help ease overcrowded conditions. HSH, which has some 600 staffers but hopes to hire 200 more, will play a key role in coordinating optimal care.

Elsewhere in the community, Joint Outreach Centers in Chinatown and Kaneohe hold potential to help break incarceration-related cycles by bringing together health care, law enforcement and social services resources to help homeless clients.

The summit’s keynote speaker, Judge Steve Leifman of Miami-Dade County, said Florida officials held a similar state agency summit nearly two decades ago. At that time, he said: “No one was looking at the entire system, when in fact this population was utilizing the resources of everyone in that room and then some.”

Post-summit there, several thousand law enforcers in three dozen agencies underwent training, and pre-adjudicatory diversion systems were created. Subsequently, arrests of mentally ill suspects have dropped by more than 50%. What’s more, diverting defendants from the courts and into treatment lowered the recidivism rate, from 75% to 20%.

Hawaii’s summit attendees should aspire to follow suit. That starts by committing to a community-wide network based on the assertion that while, in most cases, mental illness does not need to be tethered to criminal justice issues, it’s always a community issue.