The state Department of Health will soon expand its care options to include a behavioral health crisis center for people suffering from severe mental illness.
The crisis center is meant to help people suffering from a mental health crisis for up to 24 hours and to alleviate pressure on emergency responders.
Department of Health Adult Mental Health Division Medical Director for Crisis Continuum Dr. Chad Koyanagi explained that the center allows law enforcement to have a place where they can quickly drop someone off in an emergency. They will also know that the facility and staff are enthusiastic about wanting to receive the patient.
“You end up saving the system a lot by saving a lot of police time, including folks who maybe overutilize the system from going to the ER very often,” he said.
“Some of them tend to just get kind of boarded in the ER and spend long hours in the ER and are not even admitted. Some of them get admitted when maybe a lesser, more, cost-efficient modality of care like the [Behavioral Health Crisis Center] would have sufficed or even provided more desirable care for the patient.”
People who suffer from mental illness only make up about 4% of the general population, but 17% of people in jail have serious mental illness. Over 70% of those with serious mental illness in jail also have substance abuse issues.
During a hearing last week, Queen’s Health System Director of Government Relations Jacce Mikulanec said that the emergency department sees 400 visits related to behavioral health every year.
Currently, if a law enforcement officer finds someone on the street suffering from an acute mental health crisis, they can contact the on-call mental health emergency worker for an evaluation. That worker is contracted by Queen’s Medical Center and directs law enforcement to take them to the hospital, if necessary.
The Behavioral Health Crisis Center now becomes another option.
It’s a model adopted from Arizona that has seen some success. Law enforcement officers in Phoenix have a guaranteed drop-off time at a crisis center of 10 minutes.
The center opening in Iwilei next month would have eight seats and would provide services to people for up to 24 hours. It is meant to be more of a home-environment setting versus a hospital, but still provide recovery care with trauma-informed specialists including an onsite nurse, psychiatric providers and caseworkers.
After they receive care at the Behavioral Health Crisis Center, they would be then discharged to community resources such as further treatment or housing services.
The state is leasing the city’s Iwilei Resource Center for the facility. The Department of Health has contracted with the service provider CARES Hawaiʻi.
The crisis center will first focus on taking in suicidal patients who are brought in by police or call the 988 CARES crisis helpline. However, it could scale up from there to accepting walk-ins and helping with other mental illness issues.
Koyanagi hopes it will eventually grow to become a no-wrong-door facility where anyone can come for help, like many of the centers in Arizona.
“As we see how things progress when we open the facility, the volume of patients, how long they take, tend to stay and the percentage capacity that we're using, if we find out we're doing much better can service a greater cross-section of patients, then we'll expand the eligibility criteria to other populations,” Koyanagi said.
Oʻahu has the highest number of people the DOH’s adult mental health division serves statewide. Hawaiʻi County is the second highest, followed by Maui and Kauaʻi.
Because of this, Oʻahu also has the highest need for crisis receiving chairs that the new Behavioral Health Crisis Center would provide. Although the new center would provide eight chairs, the DOH estimates that Oʻahu would need 54.
A bill to fund these centers failed in the Legislature last session, but the DOH used a little over $2 million in federal American Rescue Plan Funding to open the Iwilei location.
Gov. Josh Green this year has also requested an additional $6.7 million from the Legislature to continue to fund the Behavioral Health Crisis Center and other supporting housing services.
Lawmakers are closely watching the progress of the Iwilei Center because they want the results of the project to inform how they build more. They are also hearing a bill this session, which is part of the House majority's legislative package, that would fund two more of these centers.
The locations of the centers will be based on need, likely either in West Oʻahu or a neighbor island.
The House Health and Homelessness committee will decide on whether to advance the bill on Wednesday.
