Editorial: Repair safety net for mental health

Everyone agrees that there is a looming crisis: The state’s safety net fails to meet needs for behavioral health and substance abuse treatment, especially for those living in dire conditions.

In 2021, the latest official response to the recognized deficit in care was for the Legislature to pass a law mandating the state Department of Health (DOH) take over an Oahu regional hospital management agency’s operations of two aging facilities.

The idea initially had the strong support of state health officials and the agency’s Oahu governing board as a means of expanding capacity. But at a recent legislative briefing, the new Health Department administration told the House Finance Committee that the mandate should be repealed, maintaining that this solution is inelegant and expensive.

While a persuasive case was made that the fix would be cumbersome and incur avoidable costs, health-care officials now need to present at least the framework of a plan to upgrade the hospitals and make significant improvements in service.

The two facilities — Leahi Hospital and Maluhia, a nursing home — largely serve skilled-nursing patients, under the Oahu region of the Hawaii Health Systems Corp. The HHSC’s principal function on Oahu is nursing care; by contrast, the mental health and substance- abuse programs are part of the DOH mission.

The tide of official opinion about the facilities’ transfer from HHSC to DOH had actually begun to turn late in the 2021 legislative session, before Senate Bill 628, enacted as Act 212, became law. After leadership changes at DOH, the department had testified to the House Finance Committee that the DOH “respectfully withdraws support” from the measure and requested more time to deliver “comprehensive recommendations.” The bill was approved into law anyway.

Ultimately, those recommendations emerged in a recent report from a working group authorized in Act 212 and charged to “develop a comprehensive business plan and transfer framework to govern and manage the additional steps necessary to complete the transfer of the Oahu region into the Department of Health.”

The 24-page report outlines some eye-popping cost figures. The transfer itself is estimated to cost $4.1 million to carry out, and it would trigger ongoing additional costs projected at $3.7 million in the 2023 fiscal year, rising to $6.6 million in 2026.

That’s more than enough to produce sticker shock, to be sure. Marian Tsuji, DOH deputy director of behavioral health, said the costs arise from, for example, settling with unions over contracts of public workers being shifted from HHSC to DOH.

Units now working under contracts with lower wages and benefits would have contracts reconciled with those in corresponding units in the other agency, she said, which invariably means overall increases.

Other identified cost centers include adding operational staff. Tsuji also underscored regulations that would make mixing the populations in facilities a nonstarter.

Another argument raised: Creation of a new administration of HHSC functions within DOH would be an unneeded duplication of costs.

The report proposed that instead, the HHSC’s Oahu region be set up as an “independent quasi- agency of the DOH,” calculating that this transition would cost $1.7 million to execute, followed by annual additional costs of $1.3 million thereafter. A substantial capital improvements funding infusion for the deteriorating facilities also would be needed.

This sounds better but lacks the necessary details: What does DOH hope to accomplish, and how will the facilities be used?

These blanks must be filled in before Act 212 is rescinded and another strategy is launched, if the goal of better health treatment for Hawaii is to be reached.