NAMI Hawaii’s executive director, Kumi Macdonald, says the most common calls she receives at the local chapter of the National Alliance on Mental Illness come from worried family members.

“The majority of the calls are parents saying, ‘My son or daughter has a mental illness, but they don’t want to get help. What do I do?’” said Macdonald, who fielded a surge in such calls Tuesday. “We hear that over and over.”

The question of how to handle people who don’t recognize they need help is reverberating locally after Jerry Hanel, a 69-year-old man with signs of paranoia, wreaked havoc on his neighborhood Sunday. He allegedly stabbed a neighbor with a garden tool, beat and possibly killed his landlord, Lois Cain, and fatally shot two police officers before he set a fire that consumed Cain’s house and several others.

Cain, who moved to evict Hanel last week, had been trying to get him mental health treatment, but he wasn’t interested, according to a neighbor, Rebecca Atkinson. Hanel’s attorney, Jonathan Burge, said, “The bottom line is he didn’t think he had any problems.”

Macdonald stressed that people with mental illness are usually the vulnerable ones and that early intervention can ward off problems, if approached properly.

“We want to emphasize that most people with mental illness are not dangerous,” she said in an interview. “It’s a rare, rare, rare case that this happens. The majority of people with mental illness are victims of violence, not perpetrators of violence.”

NAMI Hawaii’s approach focuses on teaching family members and friends how to communicate with their loved ones and also get help for themselves.

“The family is the front line, and the communication is the key that unlocks this dilemma,” Macdonald said. “What we try to do is teach families, empower families, get support for families so that they know how to appropriately respond to their family member in crisis, what to say and what not to say.”

It’s a delicate path because people can balk when they feel like they are being coerced, she said.

“The more you push, the more you try to force someone, the more they’re going to run,” said Macdonald. “What we do is educate our family members or caregivers to encourage the patient to want to get help on their own.”

When someone is in a mental health crisis that could pose a danger to self or others, it’s best to call police, authorities say.

“Absolutely, call 911, and if it’s a mental health-related crisis, ask for a CIT officer,” Macdonald said.

CIT stands for Crisis Intervention Team, a national model launched late last year in Honolulu to help authorities and others better respond to such crises. It brings together the Honolulu Police Department, mental health providers, hospitals and people and families with mental illness.

The program gives officers more tools to use to respond to such emergencies and connect people with resources. Data from other states shows it has reduced injuries to police officers while also helping people get needed mental health treatment.

So far, 58 Honolulu officers have been trained, and another 18 are due to begin training Monday, Macdonald said.

Under HPD policy, police consult with mental health emergency workers designated by the Department of Health, including psychologists, to determine appropriate steps. If a person is imminently dangerous to self or others, steps can include sending the individual to a hospital for an involuntary mental health evaluation.

Emergency rooms are overloaded, however, and patients are often released after being stabilized.

“The regular hospital setting cannot accommodate all the clients or patients with mental health issues, so we will be working with the Department of Health to ensure there is space for civil commitments (court- ordered treatment),” state Rep. Sylvia Luke (D, Punchbowl-Pauoa-Nuuanu) said Tuesday.