State lawmakers are poised to vote Tuesday on a pair of bills that would strengthen the court’s ability to order a person with serious mental illness to undergo intensive psychiatric treatment while remaining in the community.

If the measures are approved they would go to Gov. David Ige for his consideration.

The legislation strengthens Hawaii’s Assisted Community Treatment Act, which provides court-ordered psychiatric treatment to people with serious mental illness who may be homeless or cycling through the emergency medicine or criminal justice systems. Often these people do not seek out psychiatric treatment of their own volition because their illness prevents them from knowing they are sick.

The law has been difficult to implement because mental health advocates who have taken the lead in petitioning for court-ordered treatment on behalf of people with mental illness don’t have enough funding or resources to fulfill the requirements.

To that end, Senate Bill 567 would provide state health regulators with up to $100,000 for legal assistance with ACT petitions and related court proceedings.

Elderly couple embrace after packing up some of their belongings along Hotel Street.
A third of homeless adults on Oahu have a debilitating mental disorder. Cory Lum/Civil Beat/2018


In recent years, advocacy groups have taken on the task of trying to secure pro bono lawyers to represent ACT petitioners in court.

Last summer, the Institute for Human Services successfully petitioned to get a person into the program who has been arrested more than 30 times. The nonprofit next took up the fight for outpatient treatment for someone who has been arrested on more than 80 occasions.

But the petition process is lengthy and onerous, and IHS doesn’t have adequate staff or funding to take on more cases.

“There’s a lot that goes into a successful ACT petition — paying for the psychiatrists to do the assessment, educating the lawyers who represent the client, gathering all the research and documents to build a case with evidence that shows the court that this is a person that has a history of serious mental illness and it’s in their best interest to have access to this treatment,” said IHS spokesman Kimo Carvalho.

“We don’t have the funding to do this level of intervention.”

This lack of resources is partly why fewer than 10 people have received outpatient treatment through the program since the law passed in 2013.

Better Evaluations

Also up for a final vote Tuesday is Senate Bill 1124, which directs hospitals to evaluate patients who receive emergency psychiatric treatment to determine whether they are a viable candidate for the ACT program before releasing them from hospital care.

The bill would funnel people who meet the criteria for long-term outpatient mental health treatment into the ACT program, thereby reducing instances where people with serious mental illness fall into a cycle of costly short-term emergency hospitalizations.

The bill also clarifies some of the language in the ACT law to make it easier to use.

For example, the bill would more clearly define what it means for a person to be “dangerous to self” — an important requirement for a successful petition. The term is re-defined as a person who has threatened or attempted suicide or bodily harm, or behaved in a manner that indicates they are unable to provide themselves with food, shelter and medical care — including treatment for a mental illness.

The bill similarly clarifies other criteria and processes to improve the law’s potential to help people with serious mental illness obtain appropriate treatment that is in their best interest.

Carvalho called the bills a huge victory for the state’s mental health and homelessness systems. But he emphasized a need for other vital support — such as a shelter for homeless ACT petitioners to stay in at the onset of their treatment when their psychiatric symptoms are still pronounced.

“If this is still our community’s number one complaint, the legislature needs to really build some political will to help serve this population,” he said. “Because it takes a lot of resources to get someone stabilized and off the street.”

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