EXCLUSIVE: Mentally ill headed to four more Oahu emergency rooms

EXCLUSIVE: Mentally ill headed to four more Oahu emergency rooms
Published: Nov. 29, 2012 at 10:39 PM HST|Updated: Nov. 30, 2012 at 5:07 AM HST
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State Health Director Loretta Fuddy
State Health Director Loretta Fuddy
Dr. Stephen Bradley
Dr. Stephen Bradley

HONOLULU (HawaiiNewsNow) - Starting Saturday, the State Health Department will allow Honolulu police officers to take people an HPD psychologist believes may be suffering from mental illness to four Oahu hospitals that do not have in-patient psychiatric wards.  It's a move the health department delayed by one month because of concern from the hospitals that they lacked staff, facilities and procedures to handle potentially dangerous mental patients in their emergency departments.

The state has previously allowed HPD to transport potential mental patients only to Queens, Castle and Tripler medical centers, since all three have in-patient psychiatric wards.

In the last five years, HPD said the number of psychiatric patients its officers have taken to those hospitals has risen by more than 300 percent, to nearly 3,000 a year.

"In addition to increased need, we were also alerted that we were going to have decreased capacity," said State Health Director Loretta Fuddy.

Queens plans to decrease its adult mental health beds by 25 percent and Castle is renovating, causing a temporary drop in psych beds there, state health officials said.

So the state is allowing police to take mental patients to emergency departments at four other medical facilities: Kaiser Moanalua, Straub Clinic and Hospital, Waianae Coast Comprehensive Health Center and Wahiawa General Hospital.

"We will not overwhelm the new hospitals.  We know that we need to build this up incrementally. But we need to begin somewhere," Fuddy said. "This is going to be a good thing for the system overall.  We will provide services sooner and closer to where the client lives."

Fuddy said police will still take the most severe, potentially violent mental patients to the three hospitals with in-patient psychiatric units, Queens, Castle and Tripler.

The emergency department at Waianae Coast Comprehensive Health Center has just nine rooms and its chief medical officer said the facility has not been asked to handle combative, violent mental patients. Waianae Comp is not a hospital and does not have in-patient beds.

"These are patients that we're talking about at a much lower-level of intensity but obviously of great distress to the patient.  And that is our obligation as a community health center is to take these patients in and take care of them," said Waianae's Dr. Stephen Bradley.  He said the ER has one room that could be used to isolate a mental patient, but it's in the middle of a crowded and busy facility.

HPD has pledged to have officers stay with a potentially-dangerous mental patient for an hour or two in the ER.

"HPD that brings the patient in, will remain with the patient, with us, to assure that there is adequate safety measures being taken," Bradley said.

The state health department has a crisis mobile team of counselors available around the clock seven days a week to respond to emergency rooms and help provide services to psychiatric patients, Fuddy said.

But officials at some hospitals said that team can take up to an hour or two to arrive.

The hospitals can expect to receive one or two distressed mental patients brought in by police officers a week, according to Michael Christopher, a psychologist who coordinates HPD's Emergency Psychological Service and Jail Diversion Program.

"It will help a little by providing a little more flexibility," Christopher said, adding that officers won't have to travel as far to a small number of hospitals to get people treatment and patients will more often get help closer to their neighborhoods near family and friends.

Fuddy said she will support the Wahiawa and Waianae facilities' requests for money from the state legislature to build new emergency facilities that can more safely handle psychiatric patients.  Waianae Comp plans to build a much larger two-story emergency department in the next two years, which will allow for design of separate facilities for the mentally ill.

Fuddy said her department first met with the hospitals over the summer to discuss the change and pushed the planned start date to the change back by one month from Nov. 1 to Dec. 1, after hospitals raised concerns.

"The increasing need for emergency mental health services is a community problem and as such needs to be resolved collaboratively," said Laura Lott, director of public relations for Kaiser Permanente Hawaii. "Because we are not a licensed psychiatric hospital and have limited space appropriate for such patients, we are limited in the type and amount of assistance we can offer."

Lott said Kaiser has one isolation room that could be used for mental patients who pose a potential danger to themselves or others, "although it is not optimal."

Christopher said up until now, about 80 percent of mental patients taken to ERs by HPD went to Queens, the other 15 percent went to Castle and about five percent were sent to Tripler.  Christopher said the reason the number of potential mental patients taken into custody by HPD has risen in recent years is twofold: because officers have received more training about recognizing mental problems and since "more people are falling through the cracks," because of cuts in social programs, unemployment and the tough economy.

Karen Schultz, vice president for patient care at The Queen's Medical Center released a statement that said, "We will be working towards reducing the size of the Kekela (psychiatric) unit from 16 beds to 12 beds, but expanding day treatment services for this patient population, focusing more on outpatient services rather than inpatient services which is a national trend."

"We are also increasing our child and adolescent beds from 20 to 24, where we found a significant need.  There is no specific timetable at the moment but we are working with our community collaborators to make sure all patient care needs are met," Schultz said. 

Said Waianae's Bradley, "They are not trying to shove something down our throats or impose something on us.  They're saying we have to accommodate these patients due to a number of unforeseen circumstances and we say, you know, these are our patients, our community, we do want to help and we do want to take care of them."

"The majority of these individuals do not require hospitalization.  What they do require is some stabilization, some calming down and looking at appropriate resources in the community," Fuddy said.

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