HONOLULU (HawaiiNewsNow) - The chief of psychiatry at the state's largest acute in-patient psychiatric hospital told Hawaii News Now some major gaps in mental health care result in a lack of services for the mentally ill once they get out of the hospital.
"There's no place to send her," said Melinda Dallass, whose 30-year-old sister Crystal has been in and out of the Queens Medical Center psychiatric unit about eight times in recent years, because she's severely mentally ill and is addicted to crystal methamphetamine.
But Melinda is unable to find a facility for her to be treated once she's stabilized, so Crystal remains homeless, living most recently at the Kakaako homeless camps.
"It goes from emergency care facility to outpatient clinic. There's just no place in the middle. There's no inpatient rehab facility, there's no inpatient psychiatric facility that's not a hospital, so it's just ridiculous to find her a place to go," Melinda Dallass said.
State health officials admit they need another 200 beds for in-patient mental services at the State Hospital in Kaneohe, but those could take eight years to build.
Dr. Barry Carlton, the chief of psychiatry at Queens Medical Center said, "I think the largest gaps have to do with both intensive case management services as well as residential-type services."
Carlton said without proper care, the severely mentally ill keep getting re-admitted to emergency departments and to behavioral health units at Queens and Castle Medical Center on Oahu.
"The families suffer when they see the people they care about not have access to care or their social functioning deteriorate or they become increasingly psychotic or whatever," Carlton said.
Carlton said Queens loses millions of dollars a year in its psychiatric services, partly because government medical coverage for the poor and disabled reimburses hospitals for only about half as much as money as people with privately-funded insurance.
Carlton said the hospital is need-blind in making the medical decisions about the type of care and length of hospital stays for mental patients, in spite of the heavy financial losses it faces from many of the poorest patients who require psychiatric care.
Queens has 52 beds for inpatient psychiatric care: 32 beds for adults and a separate 20-bed unit for children and adolescents. The Queens emergency department is also staffed 24 hours a day with psychiatry services, a Queens spokeswoman said.
Once poor or disabled patients leave the hospital, they find that many psychiatrists who are able to prescribe anti-psychotic drugs don't take low-income patients.
"If you're low income, and you're on Medicare or you're on Medicaid, Quest, and you want to see a psychiatrist, you're out of luck," said Marya Grambs of Mental Health America of Hawaii. "Psychiatrists cannot get their expenses covered by the reimbursements that Medicare and Medicaid pay out and they would have to spend 50 percent of their time doing paperwork."
Grambs agreed that a lack of follow-up services often dooms the poorest mentally ill people into a cycle of arrests and emergency room visits or forced hospitalizations when police take them to Queens.
"They would have to continue on their medication and they would need supervision, they would need therapy, they would need help getting housing. And it's called case management. And often, that doesn't exist, or it's not possible to find it," Grambs added.
Carlton, from Queens, said one solution is public-private partnerships for new psychiatric facilities and programs, but all of those will take millions of dollars to build and operate.
Kimo Carvalho, a spokesman for the Institute for Human Services, Oahu's largest homeless shelter, said, "What we're trying to do is prevent clients from just being discharged (from a psychiatric unit) after three days and up right back on the streets where homeless service providers have to pick them up and they're actually refusing care from homeless service providers. And they're just harassing the public and general community."