EDITORIAL: Mentally ill need more attention

July 14--Some of Hawaii's social problems can be held at bay for a time -- and when taxpayer money runs short, government tries to do that. The sad case of Richard Nelson exemplifies the tragic consequences of letting funding constraints define the way the public is served on an ongoing basis.

It provides a crucial reality check on the investment truly required for state mental health services. And beyond the halls of the state Department of Health, the case illustrates just how much Hawaii needs to refocus attention on early diagnosis and treatment of mental illness, as part of basic health care and interventions.

Nelson was killed in a police shooting last year in Waikiki that, experts said, stemmed from the failure to get a mental health evaluation on a timely basis. In the incident, which started as a traffic stop, police said he did not heed a command to get out of the car and almost struck the officer, who ultimately shot and killed him.

The victim had been due for the evaluation for months. The tests were ordered to gauge his capacity to stand trial for misdemeanor offenses. And had they been done right away, he could have been treated and thus have been less likely to be provocative, according to police.

The evaluation was delayed because of unfilled positions for forensic psychologists, which meant the ones on the job were swamped with a backlog of cases. DOH officials are painfully aware of the problem but said the positions are not funded at the appropriate levels of pay to make them competitive, and to make it easier to fill the jobs. That plainly needs correcting in the state's budgeting process.

The overworked staffers themselves, who are abundantly clear about the impact of this shortage, have filed an internal complaint within the DOH Courts and Corrections Branch. One department forensic psychologist, Daryl Matthews, also has filed a separate complaint with the U.S. Department of Justice contending that delayed evaluations for defendants constitute a civil rights violation.

Such official grievances often are what drive government finally to address critical shortcomings and, in fact, similar cases of chronic understaffing problems have arisen elsewhere in the state bureaucracy. But the sub-par treatment of mental illness is an issue that goes even deeper and has serious repercussions that are visible today.

Virginia Pressler, DOH director, has rightly placed a priority on improvements to the behavioral health aspect of state services, which includes the mental health divisions for adults and minors alike, as well as substance abuse programs. In a recent interview with the Honolulu Star-Advertiser, the director said she's "trying to get behavioral health integrated into primary care, so there's screening for depression and substance abuse ... because there are effective treatments now."

These are the kinds of services that too often have borne the brunt of budget cuts in community-based preventive care and need to be rebuilt. A patient's primary care needs to include screenings for mental health at the entry point to the system.

Postponing that step in health care may save money immediately, Pressler said, but a lapse eventually results in patients cycling through emergency rooms and, frequently, falling into homelessness and even criminal behavior.

The state is beginning to make a gradual turnaround. The imminent development of a new, state-of-the-art forensic in-patient facility at the Hawaii State Hospital represents a welcome effort to increase state capacity to care for its mentally ill.

But improving mental health services is a long-term project. If Hawaii wants to ensure that failures such as what led to the death of Richard Nelson don't become routine, decision-makers must commit to see it through.

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