THE SENATE                           S.C.R. NO.            210
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                    SENATE  CONCURRENT
                        RESOLUTION

  REQUESTING THE DEPARTMENT OF HEALTH TO IMPLEMENT THE
    RECOMMENDATIONS OF THE LEGISLATURE'S CONSULTANT ON THE
    PROVISION OF MENTAL HEALTH SERVICES AT THE HAWAII STATE
    HOSPITAL.
 


 1        WHEREAS, in 1991, the United States Department of Justice
 2   filed suit against the State of Hawaii in the United States
 3   District Court for the District of Hawaii for violations of the
 4   constitutional rights of patients at the Hawaii State Hospital
 5   (HSH); and
 6   
 7        WHEREAS, Hawaii entered into a stipulated settlement
 8   agreement and court order with the United States to correct
 9   deficiencies at the HSH; and
10   
11        WHEREAS, in 1995, the court found the State in contempt of
12   that agreement and order; and
13   
14        WHEREAS, the Department of Health (DOH) is in the process
15   of implementing a plan to remedy the deficiencies at the HSH,
16   most notably the provision of appropriate services in the
17   community for HSH patients who do not require hospital-level
18   care; and
19   
20        WHEREAS, the Legislature recently hired its own
21   independent consultant to review the DOH plans for the HSH; and
22   
23        WHEREAS, the consultant is H. Richard Lamb, M.D., a well-
24   known and well-respected psychiatrist and noted expert in the
25   provision of mental health services, who is a professor of
26   Psychiatry at the University of Southern California School of
27   Medicine; and
28   
29        WHEREAS, Dr. Lamb visited the HSH, Institute for Human
30   Services (IHS), Oahu Community Correctional Center (OCCC), Oahu
31   Community Mental Health Services (at Kalihi-Palama Treatment
32   Services), Safe Haven, Hawaii Psychiatric Medical Association,
33   and the Clubhouse (community mental health meeting place); and

 
Page 2                                                     
                                  S.C.R. NO.            210
                                                        
                                                        

 
 1   
 2        WHEREAS, Dr. Lamb met with officials from all the visited
 3   facilities, including officials of the DOH - Dr. Bruce
 4   Anderson, Director of Health, Anita Swanson, Deputy Director
 5   for Behavioral Health, Dr. Linda Fox, Chief of the Adult Mental
 6   Health Division, Wayne Law, Administrator of HSH, and Ann
 7   Andreas, Deputy Attorney General representing the State in the
 8   litigation; and
 9   
10        WHEREAS, Dr. Lamb filed a report with the Legislature with
11   the following findings, among others:
12   
13        (1)  That the HSH is licensed for 168 beds, but is in the
14             process of downsizing the HSH to 108 beds;
15   
16        (2)  That 85 to 90 percent of the patients are forensic
17             (committed by court order, usually for dangerousness
18             to self or others, or both);
19   
20        (3)  That there are currently an estimated 21 non-forensic
21             patients residing at HSH, or less than two occupied
22             non-forensic beds per 100,000 population (standard of
23             measurement) which is the lowest in the nation;
24   
25        (4)  Reducing the number of beds to 108 leaves no beds for
26             non-forensic patients;
27   
28        (5)  The belief among State mental health officials is
29             that psychiatric hospital beds are not needed if
30             adequate community care is provided;
31   
32        (6)  There is a severe problem with the homeless mentally
33             ill, many of whom use crystal methamphetamine which
34             often causes violent behavior, who are taken to acute
35             care hospitals (usually after an arrest) and are
36             released a few hours later in spite of the opinion of
37             the IHS staff that longer periods of hospitalization
38             are necessary as there is no facility available for
39             this purpose (intermediate care beds);
40   
41        (7)  There is some evidence of inordinate pressure on
42             staff at the HSH to discharge patients, even if

 
 
 
 
 
Page 3                                                     
                                  S.C.R. NO.            210
                                                        
                                                        

 
 1             discharge is inappropriate or permission has not been
 2             granted by the courts in forensic cases;
 3   
 4        (8)  That committing a crime is becoming the only
 5             practical way of getting admitted to the HSH;
 6   
 7        (9)  There are more than 200 severely mentally ill
 8             patients at OCCC and the neighbor island correctional
 9             facilities, of which at least half of the misdemeanor
10             offenders should be placed at HSH;
11   
12       (10)  100 to 150 additional beds at HSH are needed to
13             permit meaningful diversion from the criminal justice
14             system to the mental health system;
15   
16       (11)  There is a consensus among members of the Hawaii
17             Psychiatric Association that:
18   
19             (A)  It is extremely difficult to admit patients at
20                  HSH, especially for the cohort of severely
21                  mentally ill patients who need a locked, highly
22                  structured facility;
23   
24             (B)  Downsizing of HSH will lead to homelessness and
25                  criminalization;
26   
27             (C)  There is a need for intermediate care
28                  facilities; and
29   
30             (D)  Long-term severely mentally ill patients are
31                  being overcrowded at private hospitals;
32   
33   and
34   
35        WHEREAS, the recommendations and conclusions of Dr. Lamb
36   were, among others, as follows:
37   
38        (1)  That the HSH not be downsized and be utilized to its
39             full capacity of 168 licensed beds, which is still an
40             inadequate number for the State's population; and
41   
42        (2)  Downsizing to 108 beds would result in virtually zero

 
 
 
 
 
Page 4                                                     
                                  S.C.R. NO.            210
                                                        
                                                        

 
 1             non-forensic beds when clinical experience everywhere
 2             indicates that there is a core of persons with severe
 3             mental illness who need a locked, highly structured
 4             care in order to adequately treat them and protect
 5             the community;
 6   
 7        (3)  Experience throughout the nation and other countries
 8             indicates that as the amount of highly structured
 9             care decreases, the number of severely mentally ill
10             persons who become criminalized or homeless
11             increases;
12   
13        (4)  The downsizing of HSH is the basis of the negative
14             comments of the United States Department of Justice
15             experts in their 1999 report, in particular the
16             finding that the downsizing is resulting in patients
17             being prematurely or inappropriately discharged from
18             HSH;
19   
20        (5)  Locked, intermediate care facilities be developed to
21             serve those persons who do not require intensive HSH
22             care, but who do require highly-structured care at a
23             somewhat lower level;
24   
25        (6)  Some patients who are not as severely mentally ill
26             require a locked intermediate care facility, where
27             there is very close medication supervision, a high
28             staff to patient ratio, and there is a very
29             extensive, individually tailored activity program;
30   
31        (7)  A concerted effort be made to identify, evaluate, and
32             provide appropriate services to the more than 200
33             severely mentally ill persons who are incarcerated
34             and the very large numbers of severely mentally ill
35             homeless persons; and
36   
37        (8)  A comprehensive plan be developed by the State to
38             determine how the needs of persons with severe mental
39             illness will be met;
40   
41   and
42   

 
 
 
 
 
Page 5                                                     
                                  S.C.R. NO.            210
                                                        
                                                        

 
 1        WHEREAS, the June, 1999, United States Supreme Court case
 2   of Olmstead v. L.C., held essentially that states cannot force
 3   psychiatric patients to live in hospitals if it is more
 4   appropriate for the patients to receive care in a community-
 5   placement program, which is resulting in states providing
 6   better access to small community facilities rather than large
 7   state-run hospitals; and
 8   
 9        WHEREAS, increasing the number of beds at HSH or providing
10   secured intermediate care facilities does not violate Olmstead
11   because these patients are not appropriate for community-based
12   care, and because the Olmstead case involved patients who were
13   recommended by their psychiatrists for treatment in community-
14   based care; and
15   
16        WHEREAS, the Legislature finds that there should be three
17   levels of treatment for the mentally ill:
18   
19        (1)  The HSH for the forensic and non-forensic patients
20             who need that type of highly structured and secure
21             setting;
22   
23        (2)  Intermediate care facilities for patients who need
24             confinement in a less structured setting but who are
25             not ready or not appropriate to be placed in the
26             community; and
27   
28        (3)  Community-based care;
29   
30   and
31   
32        WHEREAS, the Legislature further finds that the State
33   should address the problems of providing appropriate
34   residential services for the homeless severely mentally ill and
35   the incarcerated severely mentally ill who do not belong in
36   state correctional facilities; now, therefore,
37   
38        BE IT RESOLVED by the Senate of the Twentieth Legislature
39   of the State of Hawaii, Regular Session of 2000, the House of
40   Representatives concurring, that the DOH is requested to work
41   collaboratively with the Mental Health Association, community-
42   based service providers, hospitals such as Queens Medical

 
 
 
 
 
Page 6                                                     
                                  S.C.R. NO.            210
                                                        
                                                        

 
 1   Center, and other stakeholders to develop a comprehensive care
 2   plan that ensures that appropriate levels are being provided to
 3   mentally ill persons using Dr. Lamb's recommendations as a
 4   guideline; and
 5   
 6        BE IT FURTHER RESOLVED that a certified copy of this
 7   Concurrent Resolution be transmitted to the Director of Health.
 8 
 9 
10 
11                         OFFERED BY:  ____________________________