Police shot Chance Narvaes in the hand at Roosevelt High School in Honolulu on Jan. 28, 2014, after he pulled a knife on them. Officers had wanted to take him into custody for being a runaway. Instead, he ended up facing three counts of attempted murder.

At the time, Narvaes, who was 17, suffered from schizophrenia and other symptoms of severe psychosis, according to his mother, Shereen Narvaes. She said he was a troubled teen, who heard voices and would frequently run away from home.

“It’s not that he’s a criminal,” she told Civil Beat. “He’s mentally ill.”

Like with many Hawaii teenagers, it was a struggle to find a facility that would treat Narvaes. His mother said he escaped from multiple adolescent psychiatric wards – there are no secure residential treatment facilities for teens in the state.

Narvaes was eventually sent to the mainland to get treatment, not an uncommon fate for severally ill teens.

There’s long been a lack of bed space at hospitals for mentally ill teens on the islands. Treatment options are limited, and the problem is only getting worse.

“We’re not taking care of the most vulnerable people in our community.” — Marya Grambs, Mental Health America of Hawaii

Hawaii is in the midst of a mental health care crisis, with youths waiting for hospital beds or entering the criminal justice system. Meanwhile, hospitals across the islands are facing severe financial cutbacks.

Last year, Maui’s only adolescent facility, Molokini II, closed because of budget cuts.

From 2009 to 2011, the state lost 12 percent of its mental health budget, one of the largest such cutbacks in the country, according to the National Alliance on Mental Illness.

Even on Oahu, bed space for mentally ill teens is often hard to come by. The island’s two adolescent psychiatric wards are frequently full, leaving teens waiting in emergency rooms before getting treatment.

“We’re not taking care of the most vulnerable people in our community,” said Marya Grambs, executive director of Mental Health America of Hawaii. “That’s obviously a crisis.”

An estimated 12,000 teens in Hawaii suffer from mental illness, ranging from depression to psychosis, according to the organization.

Yet there are only two mental health facilities in the state — Queen’s Medical Center and Kahi Mohala Behavioral Health — specifically designed to treat teens suffering from mental illness. The two facilities, both on Oahu, have a total of fewer than 50 beds for mentally ill teens.

If the adolescent psychiatric units are full, many teens are forced to wait days in hospital emergency rooms until bed space is available.

Justin Oliver, a social worker at Queen’s, says that his hospital has two to six youths waiting for residential treatment on any given day.

“We pretty much have a wait list all the time,” Oliver said. “It seems like in the last few years it’s been (busier) than usual and it probably coincides with the cuts in funding around the state.”

Neighbor island youths have it worse, according to Tina Boteilho, a therapist at Aloha House, a nonprofit dedicated to mental health and addiction treatment on Maui.

If there isn’t any bed space at the Oahu facilities, Boteilho says, the youths are out of luck. They get sent home or must spend the night in an ER hoping for a spot to open up, she said.

“We don’t have any other options,” Boteilho said. “Parents are at their wits’ end.”

Locked in a School Bathroom

Hawaii’s problem isn’t a recent development.

In 1993, a Honolulu attorney filed a lawsuit that alleged the state failed to provide services required by the federal Individuals with Disabilities Education Act to treat people with disabilities and mental illnesses.

The case was filed on behalf of Jennifer Felix, a disabled high school student who spent nearly every day locked in a school bathroom because her teachers didn’t how to manage her behavior.

The U.S. District Court found that Hawaii’s child and adolescent residential treatment programs weren’t in compliance with federal laws, and placed the state under a consent decree to improve services for mentally ill students.

One solution was to send kids to the mainland for treatment if they couldn’t get it here.

Hawaii’s youths in mainland placements cost the state about $375 each day, according to DOH data. Many teens are in treatment from three to six months, and programs for treatment of severe conditions can last up to a year.

Under the consent decree, Hawaii Department of Health data shows the state sent as many as 38 teens to the mainland each year for mental health treatment from 1995 to 2005.

The number started to decline in the early 2000s because of increased services within the state, officials say. By the time the consent decree was lifted in 2005, five to 10 patients were sent to out-of-state facilities each year.

Back to the Mainland

Over the past two years, the number of Hawaii youths sent out of state has climbed back nearly to the levels seen after the Felix ruling.

In 2014, the number of teens sent to the mainland for treatment skyrocketed to 22, up from an average of six in previous years.

State officials don’t know why there’s been a sudden increase. Daniel Ulrich, the medical director of the DOH’s Child and Adolescent Mental Health Division, says he’s launched a task force to try to figure it out, and he has some hunches.

Ulrich said more youths are entering the system in part because officials are getting better at identifying cases.

A court diversion program for mentally ill juveniles, established by law in 2014, might also be a contributing factor.

“Kids were being incarcerated in situations that did not need incarceration,” Ulrich said. “The majority of kids that end up in a facility like (the Hawaii Youth Correction Facility) are victims themselves.”

But Ulrich said the lack of mental health treatment programs in the state could also be partially to blame.

“Kids were being incarcerated in situations that did not need incarceration.” —  Daniel Ulrich, DOH Child and Adolescent Mental Health Division

The task force is currently identifying gaps in the state’s array of mental health services for teens. Once it has found what it thinks the state needs – for instance, a secure residential psychiatric facility – Ulrich plans to get feedback from the community.

He hopes to use the task force’s findings to negotiate contracts with mental health service providers by 2018, when the DOH is set to release a new manual on Hawaii’s available mental health services.

Collaboration with other government agencies, especially the Department of Education, will be key to helping Hawaii’s teens with mental illness, Ulrich said. Compared to the years during the Felix era, the DOE isn’t referring as many teens to the DOH for mental health treatment, he added.

“I think there’s been a degradation in school-based (services),” Ulrich said. “If those services were more robust, more effective … kids wouldn’t be necessarily getting as bad.”

Early intervention could prevent teens from needing to be sent to the mainland for more intensive treatment, he said.

Police were still patrolling the grounds of Roosevelt High School on Jan. 29, 2014, the day after Chance Narvaes was shot.

Gene Park/Civil Beat

Even when Hawaii youths are sent to the mainland for treatment, it’s a struggle for them to get the services they need when they come back.

That doesn’t change once they turn 18, because Hawaii’s adult mental health system is equally troubled.

Shereen Narvaes said her son was doing well in a secure residential facility on the mainland. But after Chance Narvaes returned to Oahu, he was placed in a community home without the necessary services to treat his mental illness, she said.

Now, she said, he’s homeless and was recently caught stealing food from a grocery store. Shereen Narvaes doesn’t think her son can survive unless he goes to the Hawaii State Hospital.

Yet because of perpetual overcrowding at the hospital in Kaneohe, her son’s only chance of getting in is by court order.

“They’ve got to come out with a better solution,” Narvaes said. “I don’t know how he’s going to survive out there.”