PART III: Team has seen results with hardest homeless cases. Now, they want to expand

THERE ARE MORE THAN 200 people living on Oahu streets with severe mental illness.

As the Institute for Human Services' psychiatric street medicine team knows all too well, they are often the hardest to house. Because they need to be convinced that they need help — and convinced that they should take medications.

And that can take years.

"Whenever you're trying to help someone who is mentally ill, who doesn't want help, you pretty much aren't going to be able to help them," said IHS Executive Director Connie Mitchell.

"Our laws here definitely protect people's rights, but they do not promote access to mental health treatment very well for someone who is mentally ill and doesn't know that they are mentally ill."

And so, the nonprofit's psychiatric team relies on persistence to get through to those in need of help.

Week after week, month after month, year after year, IHS outreach workers try to convince people who don't believe they're ill to take a psychiatric medication that could change their lives.

The street medicine team, launched in January, has a powerful weapon in their arsenal: Invega Sustenna, a once-a-month shot.

A few decades ago, psychiatric medication left many patients feeling drugged. But today, the medications have fewer side effects and are more effective.

Some psychiatrists believe Invega Sustenna should be reserved for only the most violent patients. But Dr. Chad Koyanagi, a psychiatrist with IHS, believes the shot should be a first-line therapy, calling it one of the most effective treatments available.

"You can sometimes see the positive results within a few weeks of getting the loading doses of the shot," he said.

Over the last 10 months, the psychiatric street medicine program hasbeen able to treat a total of 20 people through donations. So far 17 have gotten into housing. The other three are expected to be off the street in the next few months.

Now, IHS says if their work is going to make any kind of noticeable impact in the community, it needs help.

The goal is to have a psychiatrist working with an outreach team in all four regions on Oahu.

"It's going to take more personnel. It's going to take more cooperation and coordination with the community and other service providers to really make it happen," Mitchell said.

It's also going to take more money: An estimated $4 million a year to expand islandwide. That would cover the cost of staffing and medication. Shots for uninsured patients run close to $800 per dose.

Koyanagi calls it an investment.

"In terms of improvement to ones functioning and reduction of health care costs because of other health care conditions that don't get treated or frequent ER visits or arrests, to me the cost of these shots for these patients is well worth it," he said.

Meanwhile, the cost of caring for those high-needs homeless patients continues to grow.

The Queen's Medical Center provided over $16 million of care last year to treat homeless people who are mentally ill. That's about two and a half times what it was in 2011. While the hospital is partially reimbursed by insurance companies – it's forced to absorb much of the cost.

"We understand that medication is the key to this process," said IHS outreach worker Justin Phillips.

"We can go out and give somebody who is homeless on the streets all of the social security benefits they want, But if we're not giving them medication and housing we're not really helping them."

INDEX TO SERIES: Prescribing Hope: How a small Hawaii team is helping the hardest to house SLIDESHOW: A street medicine team transforms lives

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