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The Honolulu Advertiser
Posted on: Thursday, April 13, 2006

Judge sets goals for helping mentally ill

By Ken Kobayashi
Advertiser Courts Writer

BENCHMARKS

Here are some of the benchmarks state health officials must meet by April 30 to avoid a federal takeover of the community mental-health plan.

  • Develop discharge procedures for patients acquitted of crimes by reason of insanity. The procedures must spell out the responsibilities of the patients, treatment teams, community case managers, probation officers and others. Focus should clarify what communication should occur among these people for a smooth transition for the patients into the community.

  • Develop written procedures for patients acquitted of crimes by reason of insanity who have been released, but who face recommitment to the hospital. They should include the responsibilities of the patients, community case managers, probation officers and others.

  • Issue a directive on the availability of the Health Department's clinical consultations for helping treatment teams manage "challenging" clinical cases.

  • Implement monitoring of calls to the Health Department's access line.

  • Develop and distribute a recovery planning resource guide.

  • Review the Health Department's policies and procedures for overseeing the planning for discharging patients at Hawai'i State Hospital and Kahi Mohala, a private mental-health institution under contract with the state to provide bed space for patients.

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    A judge's report filed this week outlines a dozen goals that state health officials must strive to achieve by April 30 to avoid a possible contempt-of-court citation and a federal takeover of the state's community mental-health plan.

    Federal Magistrate Judge Kevin Chang issued the dozen "benchmarks" involving procedures related to patients acquitted of crimes who are released from the Hawai'i State Hospital, the management of cases of the mentally ill, monitoring of the mental-health access telephone line and treatment planning.

    Chang submitted the report to U.S. District Judge David Ezra, who said last month that it didn't appear state officials were making reasonable "best efforts" to comply with developing the plan, but he was giving the state a final chance to meet its obligations.

    Ezra warned that if the state doesn't step up its efforts, he would find it in contempt and place the programs under federal receivership.

    The judge directed the state and federal Justice Department lawyers to determine what must be done by April 30 to show that the state is trying to implement a plan to serve an estimated 11,000 of Hawai'i's mentally ill residents. The state is under a June 30 deadline to implement the plan.

    Chang's report said a meeting with the lawyers was "productive" in setting the benchmarks, but the attorneys were unable to agree, which resulted in his recommendations. If the goals are met, it would show the state officials are giving their "reasonable best efforts" to develop the plan and it would also have a "positive impact" on the mentally ill and the public.

    At a hearing this week, U.S. Justice Department lawyers and state attorneys did not object to Chang's proposal setting the dozen benchmarks.

    But state Attorney General Mark Bennett said he was not waiving the possibility of a challenge to a contempt finding or federal takeover.

    Bennett later said it is his hope that the benchmarks will be reached by the April 30 deadline.

    "We will certainly utilize good-faith efforts to do so," he said.

    Assistant U.S. Attorney Harry Yee said it's up to the state to meet those goals. "We're always hopeful that the state will meet its obligations," he said.

    The community mental-health plan is an offshoot of a federal consent decree that stemmed from a Justice Department lawsuit over conditions at the Hawai'i State Hospital. The hospital emerged from the consent decree in late 2004, but the federal court retained oversight over the development of a community mental-health plan.

    The plan was supposed to be implemented in January 2005, but the state fell behind and the deadline was postponed until June 30.

    Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com.