From your perspective as DOH’s medical director for the crisis continuum, what can be gained by signing Senate Bill 3139?
SB 3139 seeks to expand crisis and diversion services. One way is to establish facilities such as the new Behavioral Health Crisis Center (BHCC) in Iwilei. These facilities benefit the community in several ways.
First, the BHCC is another entry point where people in behavioral crisis can receive timely, patient-centered care. This new resource allows people who may not need psychiatric hospitalization to be diverted from costly emergency rooms at acute care hospitals.
Second, they improve the efficiency of law enforcement bringing people in for emergencies because admission to a BHCC is much quicker than to an acute care emergency department. People with subacute behavioral crises can spend many hours in the emergency room, only to be discharged after being seen by psychiatric staff or social workers. In a BHCC, people will receive immediate assessment and assistance from a multidisciplinary team that includes crisis managers and people with lived experience. SB 3139 amends the law to allow law enforcement to take people under an MH-1 (certification for a person to be taken involuntarily for assessment) to a BHCC instead of an emergency department.
Third, because BHCC is a specialty behavioral health facility with specialized staff, almost every effort is devoted to understanding and helping the person facing a behavioral health crisis.
Additionally, years of experience in places like Arizona show that huge cost savings are realized over time in the health care and law enforcement systems.
What issues are not addressed by SB 3139?
SB 3139 is quite comprehensive. It seems like a good starting point for improving the crisis management system and directing people to more appropriate community care. Since BHCC is a pilot project, we will have a much clearer understanding of how it works over the next year. But BHCC is only one segment of the crisis continuum.
Due to severe workforce shortages across the system, some neighboring island communities are at risk of not having enough crisis stabilization beds. Greater emphasis on mobile crisis teams and improved responsiveness of community behavioral health case management teams to their clients would be helpful.
It is important to note, however, that the critical lack of permanent and affordable housing is a major barrier to addressing behavioural issues among homeless people. Until more housing is available, many vulnerable people will be sleeping rough and at risk of frequent behavioural crises. We have homeless people with diverse needs and we need a wider range of housing options, including supported housing (community housing with case management support), retirement homes, specialist residences and group homes. Supported housing requires extensive collaboration between agencies.
How can Iwilei’s new BHCC be used to maximize its potential?
BHCC can maximize its potential by following national guidelines set by the Substance Abuse and Mental Health Services Administration (SAMHSA). Serving people in real crisis will maximize its value and that of other initiatives, including:
>> Create triage centers for homeless people who are not in crisis
>> Develop close collaboration between BHCC staff and community case managers who already work with clients brought to BHCC.
We continue to work closely with our community partners, particularly the Honolulu Police Department, Queen’s Medical Center, our Crisis Call Center, and our Mobile Crisis Outreach Program. Sharing a common vision with our community partners of what the crisis continuum should look like will foster the success of the BHCC and support funding for future BHCCs.
According to the most recent Point-in-Time Count of Oahu’s homeless population, 33% reported suffering from a mental illness. Can you explain the connection between homelessness and mental health?
The relationship between homelessness and mental illness is quite complex. People with severe brain disorders such as schizophrenia can be very disabled without treatment, leading inevitably to chronic homelessness. People with mental illness and trauma tend to be overrepresented in homeless groups or at risk of homelessness. Living on the streets is extremely dangerous, stressful and traumatic, causing or exacerbating distress and mental illness, or sometimes contributing to substance abuse problems.
We don’t have enough affordable housing. Imagine 10 people playing musical chairs and only three chairs available. Most people won’t have a chair or a safe place to rest. And those who can grab those three chairs tend to be the least vulnerable. That’s one reason why the Supreme Court’s unfortunate decision in City of Grants Pass v. Johnson was a blow to homeless people and homeless advocates.
Finally, the devastating impact of the methamphetamine crisis cannot be overstated. There is not enough treatment at all levels. It is difficult to help someone with an active methamphetamine addiction in assisted living. We need to find a solution to the homeless problem.
You have been involved in treating and advocating for homeless people with mental health issues for over a decade. What drew you to this field?
In fact, it’s been over two decades. During my residency training, I wasn’t exposed to this type of work. One of my first part-time jobs after completing my training was working at the old Safe Haven on Beretania Street. I immediately fell in love with the work.
I wish people could see for a moment what I see when I’m working on the streets. I wish they could see how my amazing teammates interact with these people and how unique, interesting and important each person we meet is. I wish they could see how great some of the police officers are when they work with these people, get to know them and always try to be helpful, as well as some of the amazing people from other community agencies.
Seeing them connect with the homeless who some consider the doormats of our society inspired me to do my part to help people with severe brain disorders who, across the country, have been abandoned by public policy and traditional health service delivery models. And it is my DUTY to continue doing this type of work.
