Cuts planned at Hilo Medical Center could make an already bad situation even worse for Hawaii Island residents facing limited options in mental health services, some experts say.
Cuts planned at Hilo Medical Center could make an already bad situation even worse for Hawaii Island residents facing limited options in mental health services, some experts say.
“We already have a crisis as it is,” said Judi Steinman, program coordinator of the University of Hawaii at Hilo’s masters program in clinical psychopharmacology. “Right now, we have 20 to 40 percent fewer psychiatrists than we need.”
Wrestling with a $7 million budget shortfall, the East Hawaii Region of the state’s public health care network, Hawaii Health Systems Corp., announced last week a plan to lay off 87 employees and cut some services at HMC, Ka‘u Hospital and Hale Hoola Hamakua.
As part of that plan, HMC will close one of two wings in its Behavioral Health facility. Administrators say the closure was necessary after the state Legislature failed to provide more funding for the ailing hospital system.
While the HHSC’s board did not want to make the cut, it was viewed as one of the least disruptive options available, said HHSC East Hawaii Region Interim CEO Dan Brinkman.
“Closing the rarely utilized 8-bed Maile Wing of our Behavioral Health facility will eliminate our excess capacity which has been useful when the numbers of psychiatric patients briefly spike,” he explained in a Wednesday letter to mental health care providers. “Unfortunately, we can no longer afford to sustain this additional capacity. As these spikes in patient numbers rarely happen, we anticipate minimal impact to the overall care delivered to the inpatient psychiatric population in East Hawaii. While our community is understandably alarmed at any reduction in psychiatric services, we will continue to provide excellent behavioral health care in our Emergency Department and inpatient facility.”
Steinman said she can’t fault HHSC for trying to balance its books, but she fears that making any further cuts to mental health care will compound the issues being dealt with by some of the community’s most vulnerable members.
“How do you separate homelessness, drug and alcohol abuse, and mental health disorders?” she said. “That’s going to be your biggest population of problems. … Those are the people we’re most concerned about, because they have the least resources for themselves.”
Dr. Hannah Preston-Pita, CEO of the Big Island Substance Abuse Council, said the hospital’s Behavioral Health facility serves as the “front line” for mental health care on the island, admitting patients in the throes of serious psychological events that can’t be dealt with on an outpatient basis, such as someone feeling suicidal, coming down off of drugs or alcohol, or dealing with a psychotic break, hallucinations, delusions and more.
In response to those concerns, Brinkman says that despite the loss of the beds, the hospital considers “acute inpatient psych services essential and part of our safety net mission.” When no more beds are available in the Behavioral Health unit, Brinkman says those patients will continue to be cared for in the Emergency Room until alternative options can be found, either through other mental health care providers on island, or at larger facilities on Oahu.
“In spite of this difficult and challenging situation, we know that our employees and medical staff will continue to deliver the high quality care our community has come to expect,” he said.
Even so, the cuts represent another loss in an ongoing pattern in which mental health is paid short shrift, argues Marya Grambs, executive director of Mental Health America of Hawaii, a nonprofit mental health advocacy organization.
Mental health issues carry with them an undeniable stigma in our society, she said, while mental health services often find themselves on the chopping block when hospitals look to cut costs. High associated costs and low reimbursements compared with other specialties make mental health an appealing target. Meanwhile, there are some who think that some mental health issues can’t be treated successfully.
“Every mental illness can be treated,” Grambs said. “It’s not a lost cause, and I think some people think that’s the case. … It’s so much not a lost cause, and it can be treated, if given adequate treatment. But we’re not providing adequate treatment. We’re not. I think we’re kind of abandoning people, basically.”
Between 2009 and 2012, states cut $4.35 billion from mental health services, she said, even as 10 percent more people sought care during that period.
“Overall in this state, we don’t have enough psychiatric beds, and this is very clear,” Grambs said. “So, we’re concerned whenever we lose any.”
Email Colin M. Stewart at cstewart@hawaiitribune-herald.com.