Reports issued last week about Hawai'i State Hospital staff injuries from assaults are disturbing enough. What's more distressing is that these incidents are symptomatic of larger problems faced by the state's mental health system.

The hospital's struggles to meet the demands for mental health services has occupied state officials for years. Federal court supervision of the hospital, spurred by a lawsuit uncovering civil rights abuses at the facility, ended only about a year ago.

Conditions seemingly improved enough for the consent decree to be lifted, but clearly progress is lagging. The demands for mental health services have become even more crushing, signaling another crisis ahead unless the system is shored up to cope with it.

Last week, concerns focused on the number of assaults by patients against staff members. Alarmingly, the tally stands at 112 for the first six months of this year, compared with 187 for all of 2006. State health officials point out that the figure includes minor episodes; of the total, 79 resulted in injury requiring medical attention or involving a workers' compensation claim.

It's not only the staff that's suffering here. The hospital, which is near its 196-bed capacity, is overwhelmed by referrals from court cases. Thomas Hester, head of the Health Department's Adult Mental Health Division, said that more than 95 percent of admissions to the hospital come by court order from the criminal court. These are largely criminal defendants who have been found mentally unfit to stand trial. That has driven the hospital census up from an average of 15 admissions per month to about 20 patients a month since March.

The lack of vacancies means that many patients who need treatment at the hospital are turned away, according to the Mental Health Association and other patient advocates.

Many factors have contributed to that rising census, Hester said, including a shortage of alternative treatment sites for incoming patients and of intermediate "halfway house" accommodations for patients returning to the community.

In addition, Hester said, the crystal methamphetamine epidemic has contributed to the number of patients whose existing mental condition worsened through drug use.

Compounding this problem: The nursing shortage throughout the industry exists at the state hospital, too. Currently, Hester said, 23 registered nurse positions are vacant, as are 48 positions for psychiatric technicians. These are critical weaknesses in the hospital's front-line staff.

There should be action in the next legislative session to address this crisis, action arising from the work of a task force on mental health services, co-chaired by state Sen. Roslyn Baker, D-5th (W. Maui, S. Maui), and state Rep. Josh Green, D-6th (N. Kona, Keauhou, Kailua, Kona).

The task force includes a wide range of mental health professionals and advocates. That's imperative: Every ounce of leadership and education this state can muster must be brought to bear on the problem.

Various approaches that may bring relief are being discussed. One instance: The state needs to find a way to see that the patients in its care can be appropriately medicated. Currently, the conditions under which the court may issue an "order to treat" require imminent danger to the patient or others, and that may be too stringent.

Hawai'i leaders are rightly looking at other state models. In Oregon, for example, if a patient lacks the capacity to make a reasoned decision, the court may issue an order to treat. This issue deserves serious consideration.

The state also needs to find ways of moving patients through its system more efficiently. Stories abound of patients referred to the hospital after arrests on minor infractions, who then remain at the hospital for extended periods. That's disgraceful.

And further improvements are needed in the hospital's physical facilities, which are inefficiently designed.

Cultivating the next generation of nurses and other health professionals to staff the hospital should become a priority. The administration needs to see that there are pay incentives in place, for starters.

The hospital administration and the Health Department officials overseeing the system are aware of these problems, naturally, but the pace of change must accelerate.

In June 2006, the state hospital emerged from three years of oversight by the U.S. Department of Justice, supervision imposed by the court.

Justice has not yet begun hammering on the state's door, but Hawai'i must not wait for that to happen before resolving its deficiencies.

To have the federal government again directing the state's care of its own citizens would be shameful, in the extreme.