Health officials are considering a 12-bed inpatient facility at the old Kona courthouse in an effort to help address mental health and substance abuse issues in the community.
The initiative is very tentative and preliminary at this point, however, the Department of Health is discussing possible funding with the state Legislature on the concept of developing capacity for mental health service at the Keakealani Building in Kealakekua.
“We have taken some steps to explore the possibilities and we are working with other relevant stakeholders such as the Legislature to determine the when and how,” said Janice Okubo, spokeswoman for Department of Health. “We are looking at 12 beds to be used for post-acute services which includes the component as part of a broader plan.”
Although details regarding the proposal have not been worked out, West Hawaii legislators are hoping funding to retrofit the old courthouse will be included in the budget currently making its way through the Legislature.
Rep. Nicole Lowen, D-North Kona, said securing $750,000 for the project is her No. 1 priority for the capital improvement project budget.
“It makes a lot of sense,” Lowen said. “The community needs this. And it couldn’t be in a better location.”
Sen. Dru Kanuha, D-Kona, Ka‘u, is also giving the project important consideration.
“As one of the leading causes of homelessness, providing more resources to support transitional treatment facilities like the old Kona courthouse, for those suffering from drug addiction and/or behavioral health issues, in our community is definitely a high priority of mine this legislative session,” Kanuha said in an emailed response. “I look forward to working with Representative Lowen and the DOH on this proposed transition.”
The courthouse was the original home to Kona Hospital until 1975, when Kona Community Hospital opened just mauka of the facility. It served as a courthouse for more than three decades until the new Keahuolu Courthouse opened in Kailua-Kona.
Originally designed as a hospital, being a state owned building, along with proximity to the current hospital makes the location a perfect fit for an inpatient facility, Lowen said.
Okubo outlined the Department of Health’s Behavioral Health Administration’s plan for rebuilding a coordinated mental health system through subacute stabilization in Hawaii. Subacute stabilization is a 24-hour facility for the treatment of psychiatric disorders or addictions which is more restrictive than a supervised group living facility and less restrictive than an inpatient facility such as the state hospital.
Lt. Gov. Josh Green agrees there is a need in the community for this facility.
“We need space very badly in West Hawaii to help people who are mentally ill, homeless or in transition with chronic disease,” Green said. “This space is a priority for us to address the crisis we are facing with those who are suffering on our streets. It can be repaired and retrofitted easily and will be a great addition to our health care system on the Big Island.”
The DOH plan, based on state data, says it’s estimated that a significant portion of individuals experiencing a crisis have needs that align better with services delivered within a subacute level of care facility. Subacute residential stabilization services have been a missing component of the Department of Health’s envisioned comprehensive continuum of care, which would bridge the gap between acute hospitalization and lower level residential and community resources.
Communities that lack a comprehensive service continuum and coordinated resources are often burdened with public safety issues, law enforcement having to engage in crisis situations, increased expenses due to incarceration, and elevated health care resources spent on behavioral health crisis care. More importantly, it negatively impacts the quality of life for individuals who are affected by behavioral health challenges in the community.
Hawaii Police Department Community Policing Officer Wyatt Nahale can attest to the need for such a facility based on his daily encounters with “behaviorally challenged” individuals.
“This would be huge for us. Chronic homeless who suffer from substance abuse and mental health issues are the ones we worry about,” he said, noting it is that population of homeless individuals that creates most of the issues that need to be addressed in Kona.
Nahale said they need the proper diagnosis and treatment to stop cycling through the system. It is frustrating for the police to take an individual to the hospital for mental observation just to see them back on the streets a few hours later.
Nahale questioned if the program would be voluntary or mandated either by the court or hospital.
“If it’s voluntary, it’s not going to work,” he said. “The biggest problem we have on the streets are the ones who refuse treatment. We will continue to deal with the same people on the street. How do we target those broken down, cycling through the system who are unwilling to get help?”
While a myriad of programs and services exist to support individuals who suffer from behavioral health disorders, it is DOH’s position that the absence of residential stabilization represents a significant gap in the continuum of care that results in higher relapse rates and lower than desired success rates for a small, but high utilizing segment of the focus population.
The DOH plan seeks expand short term crisis care in Kona and Hilo in order to decrease the burden on the emergency room system and allow individuals to obtain psychiatric crisis care in an appropriate setting. In addition to decreasing the burden at the ERs, it will allow individuals to be linked to care, and for those not needing acute psychiatric hospital level of care be diverted to subacute stabilization or other residential or outpatient programming.
Sharon Hirota, Mayor Harry Kim’s executive assistant assigned to homelessness, acknowledged the importance of having a stabilization facility.
“There is a need for services locally and community alliance partners who address homelessness are supporting all legislation funding those type of services,” Hirota said.
Johnny Fox, LCSW, a mental health professional in Kona, also realizes the need for such a facility.
“There is no cure-all that makes everything better, but anything that would benefit people in need would benefit the whole community,” he said. “Any opportunity the community has to get help…I’m all for it.”
“This would be a major game-changer,” Nahale said.
