The first is that the current economic crisis is traumatically impacting Hawai'i's families. Job and income loss, defaulting mortgages, layoffs and government cutbacks are prime drivers for family disorder and mental health problems such as depression, anxiety, or other mental illnesses, substance abuse, and family violence. This negative social spiral is happening already to our friends, neighbors, and families.

Compounding this is the trauma undergone by military families caused by deployments to Iraq and Afghanistan and the often difficult return to civilian life; Hawai'i having one of the highest proportions of military in its population. That's why Mental Health America of Hawai'i has launched a program to develop action plans for support of returning National Guard/Reserves and their families.

The second principle is that cutbacks in mental health services to save money actually save us no money at all. Indeed, they cost us in the long term. Radically slicing case management hours, limiting eligibility rules, reducing already inadequate day treatment facilities and housing and putting more strain on a state mental hospital filled beyond its licensed capacity will reverse years of progress in Hawai'i. And the costs tomorrow will be greater than the dollar savings today.

Starkly put, without these less expensive support services, some mentally ill people who are managing now will end up in homeless shelters, emergency rooms, hospitals, or prisons, at far higher costs to taxpayers.

O'ahu is hit hard. Neighbor Islands are hit even harder. At a recent state Senate hearing, our Maui branch director, Colleen O'Shea Wallace, described conditions which have been worsening for more than a year.

"Without adequate case management, people end up missing out on mental health treatment, going to the hospital, going to jail, and living on our streets and beaches," she said.

So what should guide us going forward?

First, the state must make budgetary decisions with full transparency. Specifically, this means that the impact of our choices should be understood and weighed openly. We cannot pretend to save money by letting important health services slip between cracks, which is exactly what will happen if decisions are made behind closed doors. And those who are providing the services must be free to voice their concerns without fear of retribution.

Second, we must keep consistent measurements of Hawai'i's mental wellness in place. MHA will collect baseline data on the impact of the mental health cuts on other systems (psychiatric E.R. visits and inpatient beds, arrest and incarceration trends, rates of mentally ill homeless, suicides, etc.), because no one else is earnestly collecting such data. We will share and publish these data because denying these realities solves nothing.

Third, given the decline in support and services to those with mental illnesses, we must redouble our advocacy on their behalf. In the past, the state's failure to meet minimum standards has led to court-ordered services.

And last, everyone out there can make the extra effort to help people and families they know who are dealing with mental illness. Friendship and compassion go a long way, especially when stress is on the rise.