Eighty-five percent of people arrested in the State of Hawai‘i have a problem with drugs or alcohol. One in two arrestees have a mental problem. At least 20 percent of the people currently sitting in jails around the state have severe and persistent mental illness,
For Maui police officers, these numbers—which come from the state Public Safety Department Mental Health Branch Administrator—are staggering. When the cops arrest someone who’s breaking a law—trespassing, a public nuisance, whatever—they have a couple choices. They can cuff ‘em and stuff ‘em, as they usually do. But if they decide the person they’re arresting might suffer from a mental illness, the officers can call the Access Line.
This goes to Oahu; they, in turn, call a Maui crisis outreach worker to assess the arrested person and maybe help calm him or her down. Sometimes, the Access Line has a history of the person in question and what the problem might be.
The next step—a warning, trip to the hospital or detox—depends on the situation. But a high percentage of those mentally ill people arrested just end up in jail.
According to a letter written by two Chicago Psychiatry professors and published in the Journal of the American Psychiatric Association in 2006, “this country [is] the world leader in per capita incarceration –with rates five to ten times those of comparable industrialized nations… American incarcerations for drug offenses exceed incarcerations for all offenses combined in the European Union, which has 100 million more people than the United States.”
In 2005, the PBS program Frontline aired a documentary called “The New Asylums.” It detailed the trend in this country to give mentally ill people treatment once they landed in prison, as opposed to the time before they committed whatever offense got them in trouble in the first place. Put simply, the program illustrates how our jails have become our nation’s new mental asylums.
When the Maui Police Department picks up someone with mental illness, two worlds collide. There’s the law enforcement world—Maui Community Correctional Center (MCCC), judges and juries—and then there’s the mental health ward at Maui Memorial Memorial Center, rehabilitation and drug therapy. Both have similar goals and interact on a regular basis. But both worlds are very different and have different jobs to perform.
The police need to keep the streets safe. The Adult Mental Health Department needs to treat people who are sick. It’s a case of the Department of Health versus the Public Safety Department.
There is nothing easy about dealing with mentally ill people who run afoul of the law. Say a mentally ill man is convicted of trespassing at 7-11: he does his time and pays his fine, and it comes time to release him back to society. He’s still mentally ill—still more than capable of getting into trouble again.
Now say that same person is picked up again, this time for loitering. But instead of paying a fine, a judge orders him to stay in jail until he undergoes a mental health evaluation. Sounds wonderful, until you find out that it currently takes months to get such an evaluation completed.
“The cases we’re having are things like someone standing in an alley throwing things at people,” Maui Police Lt. Tivoli Faaumu said. “What are we gonna do with this guy? Maybe we can work with the Department of Health, instead of hook him up, throw them in a cellblock, then to court, and then back on the street. Maybe the person can’t pay for their medication. Maybe they can’t get transportation to the pharmacy.”
Another option would be simply to keep the mentally ill criminal in jail. On Dec. 17, 2007, National Public Radio reported the story of Jonathan Ramos in St. Thomas. He has schizophrenia and took someone’s bike from the front of Wal-Mart without permission. Though charges were subsequently dropped, he couldn’t be released because he’d been deemed a danger to himself and others. So he’s stayed in jail for the last five years. This may be an extreme example, but similar scenarios have happened on Maui.
Clearly the action taken depends on the severity of the crime. But there are other options besides having the police continually lock people up. There are transitional programs, reentry programs, rehabilitation programs, group homes, minimum-security prisons and mental wards. They are run on Maui by the state, Maui Economic Opportunity and by private firms like Mental Health Kokua, Aloha House, Care Hawaii and a host of others. And what’s more, many of these options cost less then jailing a person.
But at MCCC, treatment options are extremely limited. The psychiatrist visits inmates just twice a month. And the Maui Memorial mental health ward (known as the Molokini Ward) is chronically full. If inmates are in a serious crisis, they’re usually transferred to either the State Hospital in Kaneohe or the Oahu Community Correctional Center (OCCC).
OCCC has some additional resources for mentally ill people, but it’s also over-crowded. Making matters worse, the U.S. Department of Justice has monitored OCCC for years due to its poor treatment of mentally ill inmates. In 2005, the department found prison officials restraining and isolating inmates to the point of violating their constitutional rights.
The State Hospital in Oahu is also overcrowded; 95 percent of its patients are court ordered to be there. There were so many assaults there last year that the Hawai‘i Government Employees Union filed a grievance with the state alleging unsafe working conditions. One of the nurses apparently suffered facial fractures and bruising after one of more than 100 incidents in 12 months.
“The hospital is a rehabilitative facility but is also needs cells when safety becomes an issue,” Dr. Michael Chang, a psychiatrist at the State Hospital said in an August 2007 Honolulu Advertiser story. Nurse manager Grace Pakele agreed, saying that, “Our programs become ineffective because we just end up housing patients [instead of treating them].”
The state has taken steps to lessen the pressure in the existing facilities. It’s tried to contract more interim and minimum security housing for patients who don’t actually belong in jail. While a positive move, this brings a new host of problems. For example, when a group home was proposed in Kailua the neighbors were able to block it, saying such a place wasn’t appropriate for their residential area. The state has proposed a number of minimum-security facilities at various locations throughout the Islands, but none have yet been built.
Ultimately, if and when overcrowding becomes critical in the State Hospital, officials are left with a hard choice: send their patients to jail or let them out early. Since letting mentally ill criminals loose on the streets doesn’t go over too well with the media, communities or victims, more often than not the inmates stay in jail.
Is there a way Maui can deal with its own mentally ill citizens without flying them to Oahu or paying to keep them in jail? And at the same time, can we prevent Maui from facing the same problems that plague Oahu?
Reneau Kennedy has some ideas. She worked in the Attorney General’s office but switched over to the Mental Health Branch Administrator in the Public Safety Department (PSD).
“I’m a rainmaker,” she said. “I love making things happen.”
Kennedy has studied the situation with mentally ill inmates on Oahu. She believes Maui can create a model the rest of the state could one day follow.
“Maui is small enough,” she said. “The people are capable enough. We could put together a program, do model work and attract federal funds. Now there are [people charged with] pretrial misdemeanors who are waiting seven months for [psychological] evaluations. Are we violating constitutional guarantees? Are we wasting taxpayer dollars?
“Take a trespasser,” she continued. “Usually that would be a fine. But if that person can’t plead guilty because they’re too unstable, then they’re in a system of judicial process that keeps people off the streets. There’s no facility for people who need hospital level treatment in prison or jail. And the State Hospital and Maui Memorial is too full to take PSD people in.”
The first solution, she contends, is to get people talking. Following that logic, she organized regular round table discussions and put many of those involved in a room together.
“The Judiciary doesn’t ever talk to anybody, because they’re the law,” she said. “Prosecution and defense have their own jobs. Then there’s the mental health department, parole department and public safety who capture these people and hold them. It’s all one milk shake. There’s a process needed.”
Lucas Bruno, a new MCCC psychiatric social worker and former probation officer, agrees. “We’re all talking to each other,” he said. “That’s headlines. People are all meeting at the same table. For years, Hawai‘i departments have worked within their own silos.”
Officials within the police department and MCCC who requested anonymity confirmed that they’ve begun to run more crossover programs lately, even though they haven’t yet been officially sanctioned. The programs are active, but work “under the radar” until the Departments of Health and the Public Safety can adjust their internal systems enough to work together on an official basis.
Dr. Tom Harding, a Forensic Coordinator with the Maui Community Mental Health Center is part of the roundtable discussions. Of his many job responsibilities, one is to monitor and track patients who are in need of mental health services and are going through the legal system. He says that Maui’s doing pretty well, but he does have a couple concerns.
“While tracking and monitoring people through the system, with so many different agencies, it’s easier for a puka to appear,” he said. “We need to be able to hand off the baton—better communication.”
One way Harding sees to address the problem is by getting mental health staff positions in the MPD. That’s actually easy when compared to another problem Harding sees on the horizon.
“Another problem is dementia,” he said. “It’s on the rise in the community. A ‘Silver Tsunami’ is coming and Maui must be ready to deal with it.”
Harding was referring to the aging baby boomer generation, poised to swell the ranks of the elderly in the community. He cited cases where an elderly person becomes confused or makes a scene, prompting others to call the police.
Often the person’s family lives off-island. The question then becomes what to do with these elderly people. Right now, beyond letting them languish in jail, there aren’t many options. Harding said we clearly need more supervised housing and geriatric programs to deal with them.
In the meantime, there’s a brand-new $100 million, 800-bed, prison in the early planning stages for Pu‘unene. It will be larger and more modern than the current MCCC. How such a facility will handle the island’s mentally ill individuals who fall within its walls is unknown. MTW