From your position as Director of Crisis Continuity of Care at the Department of Health, what do you think will be gained by signing Senate Bill 3139 into law?
SB 3139 aims to expand crisis and diversion services, and one of the ways it does this is through facilities like Iwilei’s new Behavioral Health Crisis Center (BHCC), which benefit the community in a variety of ways.
First, the BHCC is another point of entry where individuals in behavioral crisis can receive prompt, patient-centered care. This new resource allows us to divert individuals who may not require psychiatric hospitalization from costly emergency rooms (ERs) at acute care hospitals.
Second, BHCC intake is much quicker than acute care ERs, improving the efficiency of officers bringing individuals in for assistance. Patients in subacute behavioral health crises may spend hours in the ER and be discharged after being seen by psychiatric staff or social workers. At a BHCC, individuals receive immediate assessment and assistance from a multidisciplinary team that includes crisis case managers and lived experience individuals. SB 3139 changes the law to allow law enforcement to bring individuals to a BHCC instead of an ER based on an MH-1 (certificate for persons forcibly taken for evaluation).
Third, because BHCC is a specialized behavioral health facility with specialized staff, nearly all of its efforts are focused on understanding and helping those in a behavioral health crisis.
And years of experience in places like Arizona show that in the long term, it delivers significant cost savings across health care and law enforcement systems.
What issues does SB 3139 not address?
SB 3139 is very comprehensive. It seems like a good starting point to improve the crisis response system and direct individuals to more appropriate community-based care. Because the BHCC is a pilot project, we will have a clearer understanding of how it works over the next year. But the BHCC is only one part of the crisis response continuum.
There is a significant workforce shortage across the system, which may result in a shortage of crisis stabilization beds in neighbor island communities. A focus on crisis response mobile teams and enabling community behavioral health case management teams to respond more quickly to clients would help.
However, it goes without saying that a severe shortage of permanent, affordable housing is a major obstacle to behavioral health care for the homeless. Unless housing is made more available, many vulnerable people will be forced to live on the streets and at risk for frequent behavioral crises. Homeless people have a wide range of needs, and we need to increase the supply of all types of housing options, including supported housing (community housing with case management support), assisted living facilities, skilled residential facilities, and group homes. Supportive housing requires close collaboration between agencies.
How can we utilize Iwilei’s new BHCC to maximize its potential?
BHCCs reach their full potential by following national guidelines set forth by the Substance Abuse and Mental Health Services Administration (SAMHSA): BHCCs maximize their value by serving people who are truly in crisis, along with other efforts such as:
>> Setting up homeless triage centers for homeless people who are not in crisis
>> Develop closer collaboration between BHCC staff and community case managers who already work with clients referred to BHCC.
We continue to work closely with our community partners, including the Honolulu Police Department, Queens Medical Center, the Crisis Call Center, and the Crisis Mobile Outreach Program. Sharing a common vision with our community partners about what the crisis continuum should look like advances the success of the BHCC and supports funding for the BHCC in the future.
The most recent study of homeless people on Oahu reported that 33% suffer from mental illness. Can you explain the relationship between homelessness and mental health?
The relationship between homelessness and mental illness is extremely complex. People with severe brain disorders such as schizophrenia can be extremely disabling if left untreated, which of course leads to chronic homelessness. People with mental illness and trauma tend to be overrepresented in groups who are homeless or at risk of homelessness. Living on the streets can be extremely dangerous, stressful and traumatic, causing or exacerbating mental distress and disability, and sometimes leading to substance use problems.
There isn’t enough affordable housing. Imagine 10 people playing musical chairs, but there are only three available chairs. Most people don’t have a chair, or a safe place to rest. And the people who can grab those three chairs tend not to be the most vulnerable. That’s one reason the Supreme Court decision in City of Grants Pass v. Johnson was such a blow to unhoused people and homeless advocates.
Finally, the devastating impact of the methamphetamine crisis cannot be overstated. There is insufficient treatment at every level. Supportive housing has a hard time serving people with methamphetamine addiction. To make a dent in homelessness, we need to solve this problem.
You’ve been working with homeless people with mental illnesses to treat and support them for over 10 years – what drew you to this field?
In fact, that was over 20 years ago. I had never done anything like this during my medical training. One of the first part-time jobs I got after I finished was working at the old Safe Haven on Beretania Street. I immediately fell in love with the work.
I want people to see a little bit of what I see on the streets. I want people to see how my amazing teammates interact with these people, how unique and interesting and important each person we encounter is. I want people to know that there are great people among our police officers, and great people in other community agencies, who work with these people, get to know them, and are always trying to help.
Watching them interact with homeless people, who are considered the rug of society, inspired me to do my part to help people with severe brain injuries across the country who have not been helped by public policy or traditional health care delivery models, and it is my duty to continue doing this kind of work.