Four years ago, the Hawaii State Hospital made international headlines after patient Randall Saito walked out of the psychiatric facility, caught a taxi and flew to Maui and then California before he was even reported missing.

His escape underscored that the state’s only psychiatric facility wasn’t built for patients like Saito, who were committed to the hospital by the courts.

Gov. David Ige’s administration unveiled a new facility on Wednesday that was designed to solve that problem and house patients who are subject to court-ordered psychiatric care.

The new $160.5 million facility has room for 144 patients and sits below H-3 highway in the shadow of the Koolau Mountains overlooking glittering Kaneohe Bay.

Sen. Jarrett Keohokalole gestures to the lower campus of the Hawaii State Hospital on a tour of the new facility on May 26, 2021. Anita Hofschneider/Civil Beat/2021

State legislators and news media on Wednesday toured the facility, which will start to accept patients in August.

“This building is in my mind critical infrastructure to deal with the most extreme patients,” said Hawaii Senate Health Committee Chairman Jarrett Keohokalole. “But the real challenge that we have … are the folks that just cycle in and out of the system.”

There’s a lot more that needs to be done to strengthen the continuum of care, he said, while crediting state officials for their work in completing the new facility. 

“This isn’t a silver bullet certainly but for a long time, the major concern for the State Hospital has been safety for the most acute patients,” he said.

Run Heidelberg, administrator of the State Hospital, said the new facility will be safer for both patients and staff. Hawaii State Hospital staff previously have raised concerns about injuries sustained from violent attacks by patients.

The new Hawaii State Hospital building is complete with electric car charging stations in the parking lot, a metal detector at the entrance and even machines that can detect if someone is carrying a pen. Anita Hofschneider/Civil Beat/2021

Heidelberg said the new facility has hundreds of cameras — many more than existing facilities — and is designed in a way to minimize staff blind spots and enable them to see more patients at once.

Hospital sections — called units — hold a maximum of 24 patients at once, compared to nearly twice that number in existing facilities.

“That makes it much, much more safe,” he said.

Staffers will also be equipped with buttons they can press if needed that will alert security to their location. Heidelberg said he anticipates that the new facility will mean fewer employee injuries.

“We do anticipate a decrease … in assaults because of the configuration and less blind spots,” Heidelberg said. “With our reorganization of patients, I think it will be much better as well.”

The state is also on a hiring spree and anticipates adding more than 100 new staffers, from janitors to nurses.

New Features

The new facility overlooks the existing state hospital campus, made up of several buildings divided by criss-crossing fences.

Heidelberg said some fences were erected in response to patient escapes, but the fences also make it hard for staff who need to urgently respond to situations to get from one part of the facility to another.

Kurt Fevella presses on the rubber wall in the rubber room in the Hawaii State Hospital on a tour on May 26, 2021. Anita Hofschneider/Civil Beat/2021

The new building enables employees to more easily traverse between sections. Security is managed by central control and some elevators include separated areas for particularly violent patients.

The new facility also has a single entry and exit point for patients, and a sally-port to prevent escapes. Heidelberg said the design was partially inspired by the design of Hawaii jails.

The design prioritized clear sight lines for staff. A staffer sitting in a nursing station can simultaneously view patients who are playing volleyball, gardening and walking down a hallway to their rooms.

The new facility also has therapy rooms, classrooms, gardens, volleyball courts, a computer lab, a gym and other areas to help patients improve. There are even two pickleball courts.

“It’s therapeutic. It’s a very different model, it’s treating the person as a human being and maybe that’s what it takes,” Sen. Sharon Moriwaki said after the tour. “It’s very hopeful.”

In some Hawaii State Hospital facilities, the state has converted classrooms into bunk rooms due to demand for space. Existing facilities used to have therapy rooms but those have been converted to bedrooms too.

Moriwaki asked state officials to collect data to see if the new facility is effective in improving patient outcomes and whether parts of it should be replicated elsewhere and possibly expanded to people who are not just receiving court-ordered care.

Hawaii State Hospital Administrator Run Heidelberg stands on the roof of the building in 2021. Anita Hofschneider/Civil Beat/2021

The new building has sick bay rooms that enable patients to get medical care without being transported to other hospitals. There’s a courtroom where patients can practice for court appearances and also participate in court proceedings via video conferencing.

The facility also has rubber rooms to hold patients that are particularly volatile, another first for the Hawaii State Hospital.

In patients’ bedrooms, beds and desks are fixed to the ground and the doors are designed to prevent patients from barricading themselves inside. The doorknobs, too, are designed to prevent suicides.

Decade-Long Effort

Keohokalole credited former Sen. Jill Tokuda for pushing for the funding for the new building. Tokuda said in a phone interview that she remembers walking through the abandoned Goddard building before it was torn down to be replaced by the new facility.

By the time it was destroyed in 2016, the old building had been empty for years due to an asbestos problem. But it still had old machines for electric therapy and former surgery rooms. Patients’ drawings were still on the walls.

She got involved in part due to community concern about the frequency of patient escapes.

“I had constituents who would tell me every time they heard a helicopter they’d look around and think, ‘Who escaped now?’” she said. It was that or another hiker stuck on the Stairway to Heaven, she said. 

One of the aging Hawaii State Hospital buildings as seen from above. Anita Hofschneider/Civil Beat/2021

Tokuda says one of her continuing concerns is the quality of the other Hawaii State Hospital buildings. The hospital is certified to hold 203 patients and thus not all of them will fit into the new facility.

Heidelberg said patients will enter the facility in phases and noted on average patients who are committed to the facility stay for just three to six months. But he also estimated about 50 patients have stayed for years.

Tokuda said long-term care for patients who are there into their old age is another concern for her Kaneohe community.

At least 90% of the Hawaii State Hospital patients have substance abuse problems and about 70% are homeless, Heidelberg said. He said it’s often hard to tell which came first, substance abuse problems or behavioral problems.

A survey found 63% of the facility’s patients used meth compared with 1% of the state population.

Longer patient stays give the state more of an opportunity to gain the trust of patients and help them work on the trauma that’s often at the root of their substance abuse problems, Heidelberg said. The facility also prioritizes connecting patients with other services when they leave.

That’s important, says Moriwaki, noting that strengthening connections between state services is a priority.

“I was really pleased to see, even though it cost a lot, that it’s well worth it for us to treat these mentally ill with respect and really try to work with them to get them off the street,” she said.

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