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The parents of a Maui woman whose youth mental health services were severed when she turned 18 are suing the state Department of Human Services and the state Department of Health over allegations that their daughter’s condition worsened when she wasn’t able to access the services she needed.
According to the federal court complaint, the young woman, Soleil “Kela” Feinberg, “cycled in and out of the Molokini psychiatric ward on Maui for over a year, receiving no long-term treatment,” upon losing mental health services due to her age.
The case, the lawsuit alleges, is a striking example of Hawaii’s policy of revoking mental health treatment from young people once they turn 18 even though federal law requires that services be provided until age 21.
Lawyers for Feinberg, who is now 21, say they believe her case is not isolated.
“Although the law is clear that the state has to provide services until age 21, the state is routinely ending mental health services after age 18,” said Victor Geminiani, executive director of Lawyers for Equal Justice, a nonprofit law firm that advocates for low income Hawaii residents and is litigating Feinberg’s case.
“We believe that there are dozens or hundreds of other young people in Hawaii who are suffering because the state simply isn’t doing what the law requires,” Geminiani added.
Hawaii Health Department spokesperson Janice Okubo said the state does not terminate mental health services for eligible youth on Medicaid at the age of 18. But she said the DOH cannot comment on pending litigation. The DHS also decline to comment on pending litigation.
On Monday, Lawyers for Equal Justice also published a report documenting what it calls a systemic failure by Hawaii’s public schools and state health regulators to fulfill federal mandates to screen juveniles for mental illnesses and provide adequate treatment.
The system, the report claims, is starved for resources and lacks quality control safeguards to ensure that kids and adolescents in Hawaii who face mental illness are receiving sufficient support.
“I think that we need a significant overhaul of the system,” said Tom Helper, the Feinberg family’s lawyer. “I would hope that the state and the legislature and the Department of Health and the Department of Human services would take a hard look at the system and start the crucial reforms without having to be threatened with federal court litigation.
“It shouldn’t take a federal case for the changes to be made to take care of the keiki of Hawaii.”
For Feinberg, mental illness in the form of a schizoaffective disorder began to disrupt her life around the time of her 16th birthday. She was admitted to the state Health Department’s Child and Adolescent Mental Health Division in 2014. In 2016, she commenced a year of treatment at a residential mental health treatment facility in Arkansas because Hawaii could not offer her the intensive level of treatment she needed.
Feinberg was terminated from the Arkansas program and returned to Hawaii in June of 2017 with a recommendation that CAMHD place her in an adult residential program or, at minimum, an “all day intensive outpatient services and medication management (program),” according to the lawsuit.
But when Feinberg arrived in Hawaii in June 2017, the complaint claims that CAMHD unilaterally transferred her to the Adult Mental Health Division over the protests of her parents. AMHD did not offer Feinberg residential nor intensive outpatient mental health services. Rather, it reduced her treatment to just a few hours per week of in-home therapy, according to the lawsuit.
“We knew that there were deep problems within the Hawaii mental health system,” said David Feinberg, Kela’s father. “We felt that there was something deeply wrong and almost criminal about it.”
Due to this rollback of services, Feinberg’s condition deteriorated to the point where no treatment program would take her and in 2018 she twice assaulted staff members at Molokini due to her psychosis, the lawsuit claims. In December 2018, Feinberg was committed to the Hawaii State Hospital, where she remains following a judge’s determination that she is incapable of participating in court proceedings.
“The doctors that we’ve talked to are convinced that when she came home in the summer of 2017 she was fragile, but with the appropriate services she could have had a much, much better outcome than what she has today,” said Tom Helper, director of litigation at Lawyers for Equal Justice.
“And it was the state’s failure to provide the services that is the central cause of her condition today and her institutionalization at the State Hospital, an institutionalization that at this point has no end in sight.”
Kela’s mother Victoria Feinberg said the entire family’s mental, physical and emotional health has suffered due to the trauma of five years spent trying to navigate a state mental health system so starved for resources.
“If Kela had gotten the treatment she needed, none of this would have happened,” said Kela’s mother Victoria Feinberg. “The state basically ignored me and all the warning signs.”
The Lawyers for Justice report, titled “Young Minds At Risk,” is based on first-hand accounts from more than a dozen youth and their families, multiple interviews with state-contracted service providers, comments from former and current state officials and a review of thousands of pages of state policy documents and procedural manuals.
It cites a problem identified in 2013 by a statewide Juvenile Justice Working Group that found an “urgent need for enhanced access to mental health and substance abuse treatments.” It’s a problem the report claims has still not been solved.
The report identifies numerous contributing factors: delays in access to treatment, a shortage of mental health services providers, disagreements within the system over the criteria students must meet to receive treatment and a tendency to overlook more concealed mental health symptoms of disorders including anxiety or depression in which youth tend to display fewer external warning signs.
“The DOE’s systematic failure to identify students with mental health care needs seems to be the primary reason that the number of youth registered with CAMHD is lower than it should be,” the report concludes.
The issue of adolescents “aging out” of CAMHD at age 18 is just the tip of an iceberg of problems that need to be addressed within the greater system, Geminiani said.
“We are committed to making a change slowly but surely and our decision to bring this lawsuit on behalf of one particular client is just an indication to the state that we are there for the long haul,” Geminiani said. “We will continue as clients come forward to tell us their horror stories to deal with those horror stories and they will be confronted with lawsuit after lawsuit after lawsuit.”
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