Advocates, families face overwhelming barriers to help homeless with severe mental illness

HONOLULU (HawaiiNewsNow) - For homeless people incapacitated by mental illness in Hawaii, years go by and ― for many ― nothing changes.

They’re trapped.

And their families struggle to get them help, despite a law passed five years ago that was supposed to offer a way out.

Cheryl Sasaki knows firsthand how hard it is to see a loved one on the streets ― and be able to do nothing about it.

Her younger sister, Jeanette Serikaku, was homeless for decades. For 35 years, she was lost in a disease that manipulates how she thinks, feels and acts.

“I’d see her at the K-Mart. By 7-11 on Dillingham,” said Sasaki. “I’d always stop by to see how she’s doing. And it was never an eye contact. She’d always look away from me.”

Sasaki says the signs of her sister’s sickness first appeared when she was just a girl.

“I noticed when she was actually in intermediate. She was very passive and timid,” said Sasaki. “I just remember a lot of the time she was just always sad. Friends were a hard thing for her to get.”

As time passed, her condition manifested. Doctors diagnosed Serikaku with bipolar disorder shortly after graduating from Kalani High School.

Sasaki said the whole family went to see the state psychiatrist for help. That was in the 1970s.

And he had a discouraging message: “He couldn’t do anything because she was not hurting herself and she’s not hurting anybody,” Sasaki said.

Mental health advocates say despite changes in the law since then, that same explanation has kept Serikaku ― and others like her ― trapped on the streets.

It used to be the only way a person could be forced to take psychiatric medication in Hawaii is if they committed a crime or had a legal guardian.

But in 2014, the state Legislature passed a law called Assisted Community Treatment.

It allows the courts to order a person to take medication if they’re proven to be an imminent danger to themselves or others.

The problem: That threshold is so high the majority of Hawaii’s homeless suffering from mental illness don’t reach it, despite advocates and family members petitioning the court in a number of cases.

“As I work with many of these people, you don’t think that they have any family involved. Or any family who have tried to help. But it’s actually quite the opposite,” said Dr. Chad Koyanagi, who heads up the Institute for Human Services’ psychiatric street medicine team.

He’s the only psychiatrist in the state who goes into homeless camps to engage and treat patients.

“Many of these folks have families who have tried for years," he said. "They eventually just give up.”

It was Koyanagi who diagnosed Serikaku with schizophrenia, a chronic and severe mental disorder that can include hallucinations, delusions and extremely disordered thinking.

The doctor started trying to convince Serikaku to accept treatment when he first encountered her ― as a student in medical school.

“She’s probably the only person I can think of in my 20-plus year career that hasn’t improved,” said Koyanagi, earlier this year. “Other people who have been untreated and homeless that long usually have ended up passing away.”

So for years, without ever knowing the other existed, a sister and a psychiatrist spent decades attempting to rescue Serikaku from the symptoms of her mental illness.

Both were rendered powerless by the law.

You see them every day in communities across Hawaii. On sidewalks. At the bus stop. In the park.

It’s estimated there are up to 600 homeless people who suffer from severe mental illness statewide.

And most, said Institute for Human Services Executive Director Connie Mitchell, “don’t even realize they’re mentally ill. They don’t understand what circumstances they’re living with.”

In February, emergency room doctor and Lt. Gov. Josh Green joined the IHS street medicine team on an outreach trip. He wanted to see firsthand the law’s impact on the ability to provide treatment.

One of the first people the group encountered was Shatonya Tyler.

She’s a fixture at the bus stop outside Harris United Methodist Church. Wrapped in a blanket stained in feces, Tyler responded to the team’s questions about her health in gibberish.

Koyanagi, the street medicine psychiatrist, diagnosed her with schizophrenia.

It’s also believed she’s suffering from severe sores on her legs that limit her ability to move.

The team has been visiting her every week for the past eight months. Despite repeated offers of medication and other treatment, it’s a concept that’s never really sunken in.

“Normally folks don’t accept treatment services in the street,” said outreach team member Justin Phillips. “Usually people say, ‘No, I’m fine. I’ll do it later.’”

Incapable of understanding or even truly communicating, it’s blatantly obvious Tyler is severely impaired both physically and mentally.

But since she is adamant she’s OK, there’s nothing anyone can do because she’s not suicidal or threatening to hurt anyone else.

“Right now, our laws focus more on civil rights than protecting their access to treatment,” Phillips said.

On average, it takes a year’s worth of these weekly visits to convince someone suffering from mental illness to start taking medication.

In order to the speed up the process and make any kind of noticeable difference on the streets, mental health advocates say the law needs to change.

Specifically, they say, the definition of what it means to be an imminent danger to self or others needs to be expanded.

That’s why IHS is now backing a proposal at the state Legislature that would make it legal to force treatment not just on people who pose a harm to themselves or others, but on those whose health status is so compromised that if nothing is done they are at risk of serious medical illness or death.

Phillips said the change just makes sense.

Homeless people with severe mental illness are showing up at ERs with serious wounds and rampant infections.

“We end up having to have them hospitalized or amputations because of the degree they’re decompensating in the community. This could all be avoided,” he said.

Since the Assisted Community Treatment law went into effect in 2014, it’s helped just two people a year. Green said that’s two more people a year getting key services.

But, he added, “if we don’t improve this program, we won’t be able to get to the tough cases.”

Advocates also point out that the medication that’s used to treat the severely mentally ill has greatly improved from what it used to be.

A few decades ago, psychiatric medicine left many patients feeling drugged and not like themselves.

“The medication comes in a shot now. It’s called Invega Sustena,” said Koyanagi. “It’s one of the newer generation, anti-psychotic medications used for conditions like schizophrenia.”

The injection is administered just once a month.

And Koyanagi said, it’s a game changer.

Ben Taparra knows that all too well. He was diagnosed with schizophrenia and lived on the streets of Kapahulu for 10 years. Two and a half months after his first injection, he moved into a shelter.

He’s been living in his own apartment going on two years and has been reunited with his family.

"I want to thank the people for helping me," said Taparra.

He’s not alone. Since IHS launched it’s psychiatric street medicine program in 2017, it’s been able to treat 60 people.

So far, 40 of those have gotten into housing and the others are expected to be off the streets in the next few months.

"You don't have to give up hope on people," said Mitchell. "There is a way for them to find their way back and in many cases find their way back to their families."

For Jeanette Serikaku, it was chance that initiated an opportunity for change.

In 2017, she was featured in the Hawaii News Now documentary Prescribing Hope. The profile helped connected Koyanagi and Serikaku’s sister.

"I was just kind of running in circles, said Sasaki. “I didn’t know where to find help. When I saw ‘Prescribing Hope’ on television. It was like my missing link.”

She immediately tracked down the doctor. He returned her call that night.

Koyanagi brought up the option of obtaining legal guardianship. Getting that court order would allow Sasaki to make healthcare decisions for her sister.

“I said, well I’ve gone this far. I’m not going to give up. If this is going to be the only way then this is going to be the only way,” Sasaki said.

Together, they worked through the process.

“Oh, it took a while. The courts didn’t have room,” she said. "You know they only do these court cases once a week.

Time is only part of it. The costs are staggering. Sasaki said she dished out almost $10,000 as part of the process. She also needed her sister’s permission.

“So during the course of that time I had to talk to her and I said, ‘You know, I’m here for you. I’m going to help you,’” said Sasaki. “I told her I’m going to court and I had to serve her papers. I kind of just explained it to her. And then she signed it.”

It took six months for a judge to approve the petition.

But after all the paperwork was in order, Sasaki finally had the power to make a real difference in her sister’s life. So she gave the doctor the go-ahead to start treatment.

“After I saw the documentary I knew it had to be that,” Sasaki said.

With help from Honolulu police, the IHS street medicine team was able to have Serikaku admitted into Castle Medical Center.

“We knew it was going to be a painful emotional experience for her,” said Koyanagi. “We cringe when we have to do that because even though we know it’s the right thing to do ― at the moment she’s begging us not to take her to the ER.”

Serikaku was hospitalized for a week.

In addition to psychiatric treatment, doctors cleaned and dressed severe wounds on both of her legs. After her release, she spent about a month at Tutu Bert’s, a shelter for people who are medically frail.

“Her hostility went down. Her ability to have a conversation increased. Her hygiene increased. She became less fixated on collecting trash,” Koyanagi said.

For more than a year and a half, Hawaii News Now documented Serikaku’s journey from afar because of her paranoia with cameras.

Eventually, that too changed.

“Yes, I feel more comfortable now,” Serikaku said, when HNN caught up with her on Alakea Street.

She talked about spending time with her sister and her plans to get a permanent place to stay.

“I would rather be at Safe Haven,” Serikaku said, referring to a shelter for those with mental illnesses. “If there’s a space, I’m going to jump in as soon as possible.”

Five days later, she moved in.

After her first dose of schizophrenia medication, she was no longer resistant to taking the shot. She even agreed to come into a clinic, something she had been against for decades.

Soon, she started smiling more often and began offering others a glimpse into who she really is.

She also showed ambition, eager to work in the kitchen at her new home ― Safe Haven.

“If they offered me a job during the daytime I would help them cook,” Serikaku said.

Now the 56-year-old’s life includes standing dates with her sister. They meet up twice a week. She calls it cruising.

“This has been an incredible year,” said Sasaki. “I’m thankful to have Jeanette back in my life. In our whole family’s life, actually.”

On a recent day, they’ were headed to the park for a picnic.

“We go to eat lunch places. Before she would just sit in the car,” said Sasaki. “She ordered her own food today. She did her own purchase.”

Some old memories are also coming back.

"She remembers all the old eating places," said Sasaki. "But they're not around anymore so I have to say they closed down."

Not long ago, Sasaki had lost all hope that days like this would ever come.

To be sure, there are still times when not everything her sister says makes sense. It’s to be expected in this stage of her recovery.

Still, Sasaki is proud to say her sister has improved “1000%” compared to a year ago.

“A thousand percent meaning she has medication. She has housing,” said Sasaki.

“Mentally-wise I think she’s better. She smiles. She says thank you. She’s starting to take care of herself too. It’s good to see her back in society."

It took 35 years, but Serikaku is finally free ― no longer a hostage of her paranoia but a survivor who managed to escape the filth of the street.

She’ll tell you how it happened: “Help is inside that needle,” she said.

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