The state still lags significantly in providing services to mentally ill residents, resulting in overcrowding at the Hawai'i State Hospital and millions of taxpayer dollars being spent to send patients to a private facility, a federal magistrate reported yesterday.

In addition, the overcrowding prevents individuals who need hospital services from being admitted to the only state-run mental institution in Hawai'i, according to the magistrate's report — the latest among highly critical assessments of the state's efforts.

U.S. Magistrate Kevin Chang said state officials are so far behind, it appears "unlikely" they will meet the June 30 deadline to be in substantial compliance with a community mental health plan to provide services for an estimated 9,000 seriously mental ill Hawai'i residents.

"Some progress has been made but much more work needs to be done," Chang said.

The judge's 27-page report is the latest assessment of the efforts by state Department of Health officials who have agreed to the June 30 deadline.

The plan is part of a consent decree that resulted from the U.S. Justice Department's 1991 lawsuit alleging constitutional violations against patients at the state hospital in Kane'ohe. The decree gives the federal courts oversight of the state's efforts to provide mental health services.

The hospital emerged from the decree and federal oversight in 2004, but the court retained authority over the state's providing community services to the mentally ill.

CONTINUING TO NOV. 30

Under an agreement between the state and Justice Department lawyers in September, the federal oversight will be lifted on Nov. 30, which would end 15 years of the federal court's scrutiny.

State health officials suggested yesterday that they still believe they can meet the June 30 deadline.

"The judge promised that he was going to hold our feet to the fire to keep us in forward motion, so we appreciate his comments," state Health Director Chiyome Fukino said.

She said the state has made progress since a visit in December by three Mainland mental health experts appointed by the court to evaluate the state's efforts.

On the issue of overcrowding, Fukino said they have set up two cottages on hospital grounds to provide 24-hour supervised residential care for patients released from the hospital. The cottages will be open in March or earlier for about 16 people, according to Fukino.

"We believe that we've made some additional forward strides and that we can accomplish what we need to in June," she said.

But at least some others in the mental health community aren't so sure and agree with Chang.

Bud Bowles, executive director of United Self Help, a nonprofit group that assists the mentally ill, said he wasn't surprised by Chang's findings.

Bowles said that there are simply not enough resources and that case managers for discharged patients are overworked.

"It seems when someone gets out of the hospital, it should be easy to find housing," he said. "It's not."

Chang issued a blistering report in July 2005 saying he was troubled by 16 deaths last year, including suicides, of mentally ill residents. He said it was "appalling" that health officials failed to place a high priority on addressing conditions that led to the deaths.

'EGREGIOUS' FAILURE

His report yesterday focused on the lack of adequate community services that are necessary for the release of patients committed to the hospital because of their criminal cases.

Such services would be to monitor, house and treat the patients to protect public safety. The failure to provide those services, the judge said, was "egregious."

In one case, Chang said, a former patient disappeared within 90 days of his release from the hospital.

He said health officials, including the leadership of the department's adult mental health division, knew they had to provide the services in 2002, but "have little to show for the past four years."

Chang noted that he warned the state in his July report that the increasing number of patients at the 168-bed state hospital showed health officials' lack of progress in developing the services.

The numbers, reflecting a "disturbing trend," continue to increase, he said. The daily average number of patients rose to 193 in January this year, Chang said.

"Little has changed since July 2005 when the census began routinely topping 180," he said.

Chang said health officials began contracting Kahi Mohala to deal with the overcrowding. The annual cost last year of sending 40 patients there was about $10 million a year.

It's gotten worse, Chang said.

Health officials recently have contracted for the maximum 42 beds at Kahi Mohala, he said.

The overcrowding at the hospital has "adversely affected the quantity and quality" of treatment for the patients, according to Chang.

In December, some patients had to sleep on mattresses on the floors in conference or activity rooms, he said. In one unit, 20 or more male patients had two showers and three toilets, Chang said.

He said the lack of progress "threatens to reverse" the achievements that resulted in the hospital's emerging from the federal oversight.

'CATASTROPHIC EFFECT'

The agreement reached last year calling for the end of federal oversight on Nov. 30 requires the state to continue to implement the plan even after June 30, Chang said.

He said health officials must comply with the community mental health plan to provide the programs and services that would enable the hospital to safely release patients.

The inability by health officials to make progress on the plan and their failure to deal with the overcrowding could have the "catastrophic effect" of undoing the work achieved by the hospital that enabled it to emerge from federal oversight, Chang said.

"What is required now is focused action by (the health department adult mental health division)," the judge said.

Chang's report goes to U.S. District Judge David Ezra, who will hold a hearing to give lawyers for the state and Justice Department an opportunity to file comments or challenge any of the findings.

If no one objects, Ezra may approve the report without a hearing.

Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com.