Expanding access to mental health aid and boosting existing homeless services in Hawaii are some of the top priorities homeless service providers and outreach workers want state lawmakers to address this year.

Gov. Josh Green has promised to prioritize the issue and included a request for more than $25 million to build housing and improve services in his budget proposal submitted to the 2023 Legislature, which will convene next week.

Advocates hope lawmakers will also tackle issues that address chronic homelessness, or people living on the streets for decades who suffer from substance abuse and mental health issues.

Tents and shopping cars located along Iwilei Road near the Institute of Human Services.
While homelessness has decreased by nearly 11%, people living on the streets have slightly went up. Cory Lum/Civil Beat/2022

Sen. Joy San Buenaventura, who chairs the Health and Human Services Committee, said she plans to reintroduce a bill allowing psychologists to prescribe drugs to make up for a shortage in psychiatrists.

“In order to address chronic homelessness, you’ve got to increase mental health access,” San Buenaventura said. “Not just those who are diagnosed with mental illness but those with addiction disorders like alcoholism, drug disorders and behavioral health issues.”

State lawmakers also will consider Green’s budget proposals relating to homelessness, such as funding Ohana Zones aimed at helping people transition into permanent housing, positions for the state Office of Housing and Homelessness and support for other service programs.

On the campaign trail, Green promised to reduce homelessness in the state by more than half in the next four years and “effectively eliminate” chronic homelessness by 2030. He proposed a 10-point plan to provide more health care, social services and housing for people who are chronically homeless.

His administration has asked lawmakers for $10.8 million to support family assessment centers,  homeless outreach and civil legal services, the Housing First Program and the rapid re-housing program. It also wants an additional $15 million to fund Ohana Zones, which provide services like health care and transportation to homeless people. 

But the new governor also faced a quick turnaround after his election in November.

His point man on homelessness, James Koshiba, who co-founded the nonprofit housing advocacy group Hui Aloha started work last week but said he’s still meeting with stakeholders and city and state government to come up with new homelessness strategies.

Homelessness is one of Hawaii’s most intractable problems despite many initiatives to get people off the streets. 

Last year, the number of homeless people decreased by nearly 11% overall but went slightly up among those living on the streets, according to the annual statewide Point-In-Time count. The new count is scheduled for Jan. 23 and the results will be released in May, according to Laura Thielen, executive director of Partners in Care, which coordinates with homeless services. 

Thielen said one solution would be the allocation of permanent funding for homeless programs.

“Each year, we have to go back and request funding that actually runs all of our state programs on homelessness,” Thielen said, adding that the programs are jointly allowed up to $10.9 million. “So we’re going to be pushing for a significant increase in those core services so that we can increase outreach and increase the number of available services.”

One of the biggest challenges is a statewide psychiatrist shortage as many patients wait several months to receive appointments and prescription drugs.

IHS Outreach Navigation Program Coordinator David Warman, Dr. Chad Koyanagi and right, IHS Assistant Outreach Navigation Program Coordinator Shona Cobb stop to assist a man that said he felt sick and needed help.
Many service providers and outreach workers work with people who have been homeless for years. Cory Lum/Civil Beat/2022

Connie Mitchell, executive director of the nonprofit Institute for Human Services, said her clients wait up to six weeks for a first appointment with a psychiatrist. 

“A lot of psychiatrists aren’t even taking new clients,” Mitchell said. “You have to call them and see who is willing to see somebody. So we default to using some of our own providers, but we don’t have much capacity, and they’re stretched thin as a result.”

Mitchell said IHS has homeless clients with bipolar disorder, schizophrenia and depression. 

“These are all serious diseases that put people at risk,” she added. 

The bill introduced by San Buenaventura last year would allow psychologists to prescribe drugs as long as they meet specific education, training and registration requirements. The measure also would require the state Board of Psychology to accept applications for prescriptive authority privilege by June 7, 2023.

The measure never got a hearing, but San Buenaventura said she’s said hopeful it may advance this year because of the growing need for mental health services.

However, lawmakers have debated the idea of extending prescription powers to psychologists since the 1980s. A bill was closest to becoming law in 2007, but it was vetoed by then-Gov. Linda Lingle.

IHS Institute of Human Services bunk beds for women located on the second floor of the facility located at 546 Kaaahi Street in Iwilei.
Advocates say there’s a need for shelter space and beds for people with mental health issues. Cory Lum/Civil Beat/2022

Homeless service providers are also grappling with a lack of shelter space and stabilization beds – a short-term housing option for people who are chronically homeless who can receive resources for mental health or housing services.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said the problem is especially acute for homeless people with mental health issues who need specialized facilities.

“There is a category called residential care,” Raethel said in an email. “However, Hawaii’s hospitals do not have this level of care.” 

Oahu has only three inpatient psychiatric facilities on Oahu, including The Queen’s Medical Center, Adventist Health Castle and Kahi Mohala

San Buenaventura said lawmakers would have to wait and see how Green’s administration will implement its ideas on homelessness.

“I think the major key is implementation,” she said. 

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