Guardian Ad Litems Are A Better Choice To Help The Mentally Ill Than Public Defenders - Honolulu Civil Beat

About the Author

Caroline Kunitake

Caroline Kunitake is a member of the American Association of University Women’s Honolulu branch.

I believe that the intent of House Bill 345, Relating to Assisted Community Treatment, is to meet the basic mental health needs of people who suffer from severe mental illness.

This bill will mandate the appointment of a guardian ad litem to represent the best interest of a mentally ill individual in assisted community treatment proceedings and eliminate the requirement for the Office of the Public Defender to participate in the proceedings.

The law needs to be written and interpreted in such a way that the mentally incompetent who refuse necessary medical attention are not allowed to misuse their legal rights to further jeopardize the safety and well-being of themselves and others. Human beings who are misusing their legal rights in this way need immediate medical attention, not a lengthy legal process in court.

Imagine if you lost your mind and all connection to reality. What if you burned all of your bridges with those who cared and loved you? What if you refused all medical care when you were obviously very sick and needed to be admitted to a hospital? If that were you, would you rather have a guardian ad litem appointed to represent you or would you want to meet directly with a public defender to discuss your legal case?

I believe it is unrealistic to expect a public defender to successfully represent a mentally ill person who is incapable of understanding reality. The public defenders do not have the time, training or resources to invest in a mentally incompetent client.

People struggling with severe mental illness may be incapable of even brief, coherent conversations with anyone, let alone an attorney or judge in a court of law. My own personal experiences with a family member struggling with severe mental illness prompted me to submit testimony in support of HB 345 this legislative session.

It was a long, expensive, arduous and painful process to have the Caregiver Foundation (a local nonprofit) assigned to my 80-plus-year-old uncle as a legal guardian. My uncle was a Vietnam veteran who struggled with post-traumatic stress disorder. After he had a mental breakdown, he was uncooperative and very adamant about refusing any medical care to address his paranoia, hallucinations and the “voices” in his head.

My uncle stopped talking to all family members and soon forgot the names of his friends and neighbors that he had known for almost three decades. I continued to visit him at his apartment building, but he refused the groceries that I brought. I pleaded with him numerous times to get medical help, but he would always say, “Caroline, you’re not a doctor. Go away.”

My uncle would not have qualified for the MH-1, Involuntary Application for Mental Health Evaluation, because he didn’t attempt suicide or commit a violent crime. My uncle would also not have requested the MH-2, Emergency Psychiatric Examination, to voluntarily commit himself and have the police transport him to a medical facility.

House members gather on the floor with plastic barriers between members on opening day of the 2021 legislature.
A current bill in the Legislature would change the way in which Hawaii approaches care for the mentally ill. Cory Lum/Civil Beat

Even if my uncle had qualified for the MH-1, the doctors would not have been able to get him to open up and discuss his broken state of mind. I know this because every time he went to the emergency room, he refused to speak to the attending physicians because he didn’t want to be evaluated and committed to a psychiatric ward where he feared that communists from Vietnam would torture or kill him.

Soon my uncle stopped paying his rent and his bills. He could have easily been evicted to aimlessly roam the streets even though he had a full pension from the Air Force, Social Security benefits and owned a parcel of land on a neighbor island.

His sister took over his rent and bills so that he would have a place to live. This went on for a few years until my uncle’s landlord died and the surviving relatives wanted to sell the apartment. At that point, my uncle needed a psychiatric evaluation to determine his competency level since he refused to move out.

Fortunately, it was determined that my uncle was no longer competent. Then the Caregiver Foundation became his legal guardian and tried to relocate him to a new residence. However my uncle repeatedly trespassed to get back to his old apartment and the police were called numerous times to remove him from his old high-rise building.

Eventually the courts ordered monthly injections with a sedative so that his 24-hour caregivers (paid for by his own retirement and assets) could care for him in his new apartment.

If my uncle had met with a public defender, he would have told the public defender to go to hell. Then the public defender would have been required to legally and ethically pursue my uncle’s interests, which would be to refuse all medical care. Legal processes need to change to realistically work and benefit those who suffer from severe mental illness.

Community Voices aims to encourage broad discussion on many topics of community interest. It’s kind of a cross between Letters to the Editor and op-eds. This is your space to talk about important issues or interesting people who are making a difference in our world. Column lengths should be no more than 800 words and we need a photo of the author and a bio. We welcome video commentary and other multimedia formats. Send to The opinions and information expressed in Community Voices are solely those of the authors and not Civil Beat.

Read this next:

Chad Blair: Marriage Equality Advocate Joins State Commission On Fatherhood

Not a subscription

Civil Beat is a small nonprofit newsroom, and we’re committed to a paywall-free website and subscription-free content because we believe in journalism as a public service. That’s why donations from readers like you are essential to our continued existence.

Help keep our journalism free for all readers by becoming a monthly member of Civil Beat today.


About the Author

Caroline Kunitake

Caroline Kunitake is a member of the American Association of University Women’s Honolulu branch.

Latest Comments (0)

Very sorry. Good insight. The PD can do a disservice to one in need who has no insight to his own needs. They need as much training as the police. But in present day reality , even a GAL may not have changed the course of events.Unfortunately, the course of Uncle's illness and  what occurred may not have changed one iota with a GAL in todays mental health use of the ACT law and other laws. In other words, a GAL may not have helped much....uncle didn't listen to relatives or other officials due to his "illness" and having the name "GAL" next to someone's name may not have helped him voluntarily to listen as well.   Uncle needed to get to a court to order the administer of medication a lot quicker.This is one of many major flaws with the  ACT law as administered. Its the mental health system itself. It took months for an application to the court to order the administration of the medication needed. Check in  with or join Mental Health Hawaii and NAMI who deal with this issue on a daily basis. Your voice is needed and the very best to uncle in the future.  It's a long road.

Anson · 8 months ago

Any effort by gov't to grow itself even larger I do not support.

Ranger_MC · 8 months ago

HB345 will benefit not only individuals with severe mental illness , it will help the families whose hands are tied . It will help all facets of the community who actually have to actually deal with the individual . Hopefully there is enough support for this very , very important bill to help people deal with this part of our island community . 

hanawaiman · 8 months ago

Join the conversation


IDEAS is the place you'll find essays, analysis and opinion on every aspect of life and public affairs in Hawaii. We want to showcase smart ideas about the future of Hawaii, from the state's sharpest thinkers, to stretch our collective thinking about a problem or an issue. Email to submit an idea.


You're officially signed up for our daily newsletter, the Morning Beat. A confirmation email will arrive shortly.

In the meantime, we have other newsletters that you might enjoy. Check the boxes for emails you'd like to receive.

  • What's this? Be the first to hear about important news stories with these occasional emails.
  • What's this? You'll hear from us whenever Civil Beat publishes a major project or investigation.
  • What's this? Get our latest environmental news on a monthly basis, including updates on Nathan Eagle's 'Hawaii 2040' series.
  • What's this? Get occasional emails highlighting essays, analysis and opinion from IDEAS, Civil Beat's commentary section.

Inbox overcrowded? Don't worry, you can unsubscribe
or update your preferences at any time.