HB1831 SD1

PART I

SECTION 1. The legislature finds that thousands of people in Hawaii are cited or arrested each year for offenses such as drinking liquor in public, loitering in public parks after hours, and camping on sidewalks, beaches, and other restricted public places. Most of these people suffer from issues relating to drugs, alcohol, or mental illness. Many of those cited do not appear in court, leading courts to issue bench warrants for their arrests. Time and resources are expended bringing people to court, and the court system, prosecutors, and police are caught in a never-ending revolving door situation. In response to this situation, mental health service providers have been working with appropriate law enforcement agencies and the criminal justice system to implement a crisis intervention program on the island of Oahu.

Accordingly, the purpose of this part is to establish a behavioral health crisis center pilot program in the department of health to redirect persons experiencing a mental health crisis who are involved with, or at risk for involvement with, the criminal justice system to the appropriate health care system and services.

SECTION 2. (a) There is established a behavioral health crisis center pilot program within the adult mental health division of the department of health to redirect persons experiencing a mental health or substance use disorder crisis who are involved with, or are at risk for involvement with, the criminal justice system to the appropriate health care system and services.

(b) The pilot program shall establish two behavioral health crisis centers from which to treat and direct patients pursuant to the pilot program, one to be located in Honolulu and a second to be located on Oahu or on a neighbor island. The department of health shall determine the most appropriate sites for the behavioral health crisis centers. The department of health may lease or acquire property for the establishment of these behavioral health crisis centers.

(1) Address mental health and substance use disorder crisis issues;

(2) Screen, assess, admit for stabilization, and redirect a client to ongoing care in the most appropriate and least restrictive community setting available, consistent with the client's needs;

(3) Provide services twenty-four hours a day, seven days a week;

(4) Provide services regardless of the client's ability to pay, subject to subsection (d);

(5) Offer a dedicated first responder drop-off area;

(6) Not require medical clearance before admission of the client but rather provide assessment and support for the client's medical stability while at the behavioral health crisis center;

(7) Have the capacity to assess physical health needs and deliver care for most minor physical health challenges;

(8) Be staffed at all times with a multidisciplinary team capable of meeting the needs of clients experiencing all levels of mental health or substance use disorder crises; and

(9) Screen clients for suicide or violence risk and complete more comprehensive risk assessments and planning when clinically indicated.

(d) No person shall be denied services at a behavioral health crisis center operated under the pilot program because of inability to pay; provided that subject to section 334-6, Hawaii Revised Statutes, the behavioral health crisis center shall make every reasonable effort to collect appropriate reimbursement for the cost of providing services to persons with the ability to pay for services, including insurance or third-party payments.

(e) The department of health shall collaborate with law enforcement agencies, courts, mental health providers, and community stakeholders for the execution and implementation of the pilot program.

(f) The adult mental health division of the department of health shall submit a report on the behavioral health crisis center pilot program to the legislature no later than twenty days prior to the convening of the regular sessions of 2025 and 2026. Each report shall include progress updates on the establishment of the behavioral health crisis centers, contracting of crisis intervention services and diversion activities, actual delivery and utilization of crisis intervention services, outcomes of services and diversion activities at the behavioral health crisis centers, and collection of reimbursements for the cost of providing treatment or services, including reimbursements from insurance or third-party payments.

(g) The behavioral health crisis center pilot program shall cease on December 31, 2026.

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2024-2025 for the establishment of the behavioral health crisis center pilot program, including the leasing or acquisition of property and contracting for crisis intervention and diversion services, pursuant to this part.

The sum appropriated shall be expended by the department of health for the purposes of this part.

SECTION 4. In accordance with section 9 of article VII of the Hawaii State Constitution and sections 37‑91 and 37‑93, Hawaii Revised Statutes, the legislature has determined that the appropriations contained in H.B. No. , will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. In addition, the appropriation contained in this Act will cause the general fund expenditure ceiling for fiscal year 2024‑2025 to be further exceeded by $ or per cent. The combined total amount of general fund appropriations contained in only these two Acts will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. The reasons for exceeding the general fund expenditure ceiling are that:

(1) The appropriation made in this Act is necessary to serve the public interest; and

(2) The appropriation made in this Act meets the needs addressed by this Act.

PART II

SECTION 5. Chapter 334, Hawaii Revised Statutes, is amended by adding a new section to part I to be appropriately designated and to read as follows:

"§334- Behavioral health crisis centers. Pursuant to the authority and functions established under sections 334‑2.5(a)(3)(B) and 334-3(a)(5), the director may establish or contract with behavioral health crisis centers in each county of the State to provide care, diagnosis, or treatment for persons experiencing a mental illness or substance use disorder crisis."

SECTION 6. Section 334-59, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (a) to read:

"(a) Initiation of proceedings. An emergency admission may be initiated as follows:

(1) If a law enforcement officer has reason to believe that a person is imminently dangerous to self or others, the officer shall call for assistance from [~~the~~] a mental health emergency [~~workers~~] worker designated by the director. Upon determination by the mental health emergency [~~workers~~] worker that the person is imminently dangerous to self or others, the person shall be transported by ambulance or other suitable means[,] to a licensed psychiatric facility or other facility designated by the director for further evaluation and possible emergency hospitalization. A law enforcement officer may also take into custody and transport to any facility designated by the director any person threatening or attempting suicide. The officer shall make application for the examination, observation, and diagnosis of the person in custody. The application shall state or shall be accompanied by a statement of the circumstances under which the person was taken into custody and the reasons therefor which shall be transmitted with the person to a physician, advanced practice registered nurse, or psychologist at the facility.

(2) Upon written or oral application of any licensed physician, advanced practice registered nurse, psychologist, attorney, member of the clergy, health or social service professional, or any state or county employee in the course of employment, a judge may issue an ex parte order orally, but shall reduce the order to writing by the close of the next court day following the application, stating that there is probable cause to believe the person is mentally ill or suffering from substance abuse, is imminently dangerous to self or others and in need of care or treatment, or both, giving the findings upon which the conclusion is based. The order shall direct that a law enforcement officer or other suitable individual take the person into custody and deliver the person to a designated mental health program, if subject to an assisted community treatment order issued pursuant to part VIII of this chapter, or to the nearest facility designated by the director for emergency examination and treatment, or both. The ex parte order shall be made a part of the patient's clinical record. If the application is oral, the person making the application shall reduce the application to writing and shall submit the same by noon of the next court day to the judge who issued the oral ex parte order. The written application shall be executed subject to the penalties of perjury but need not be sworn to before a notary public.

(3) Any licensed physician, advanced practice registered nurse, physician assistant, or psychologist who has examined a person and has reason to believe the person is:

(A) Mentally ill or suffering from substance abuse;

(B) Imminently dangerous to self or others; and

may direct transportation, by ambulance or other suitable means, to a licensed psychiatric facility or other facility designated by the director for further evaluation and possible emergency hospitalization. A licensed physician, an advanced practice registered nurse, or physician assistant may administer treatment as is medically necessary, for the person's safe transportation. A licensed psychologist may administer treatment as is psychologically necessary."

2. By amending subsections (d) and (e) to read:

"(d) Emergency hospitalization. If the psychiatrist or advanced practice registered nurse with prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization who performs the emergency examination has reason to believe that the patient is:

(1) Mentally ill or suffering from substance abuse;

(2) Imminently dangerous to self or others; and

(3) In need of care or treatment, or both;

the psychiatrist or advanced practice registered nurse with prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization shall direct that the patient be hospitalized on an emergency basis or cause the patient to be transferred to another psychiatric facility or other facility designated by the director for emergency hospitalization, or both. The patient shall have the right immediately upon admission to telephone the patient's guardian or a family member including a reciprocal beneficiary, or an adult friend and an attorney. If the patient declines to exercise that right, the staff of the facility shall inform the adult patient of the right to waive notification to the family, including a reciprocal beneficiary, and shall make reasonable efforts to ensure that the patient's guardian or family, including a reciprocal beneficiary, is notified of the emergency admission but the patient's family, including a reciprocal beneficiary, need not be notified if the patient is an adult and requests that there be no notification. The patient shall be allowed to confer with an attorney in private.

(e) Release from emergency hospitalization. If at any time during the period of emergency hospitalization the treating physician determines that the patient no longer meets the criteria for emergency hospitalization and the examination pursuant to section 334-121.5 has been completed, the physician shall expediently discharge the patient. If the patient is under criminal charges, the patient shall be returned to the custody of a law enforcement officer. In any event, the patient shall be released within forty-eight hours of the patient's admission to a psychiatric facility[,] or other facility designated by the director, unless the patient voluntarily agrees to further hospitalization, or a proceeding for court-ordered evaluation or hospitalization, or both, is initiated as provided in section 334-60.3. If that time expires on a Saturday, Sunday, or holiday, the time for initiation is extended to the close of the next court day. Upon initiation of the proceedings, the facility shall be authorized to detain the patient until further order of the court."

PART III

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect upon its approval.

HOUSE OF REPRESENTATIVES	H.B. NO.	1831
THIRTY-SECOND LEGISLATURE, 2024		H.D. 1
STATE OF HAWAII		S.D. 1