For the past several years, leaders have correctly identified housing as one of Hawai‘i’s most pressing concerns. Understandably, the focus has been on enabling working and middle class residents to remain in Hawai‘i without having to live in squalor. This
For the past several years, leaders have correctly identified housing as one of Hawai‘i’s most pressing concerns. Understandably, the focus has been on enabling working and middle class residents to remain in Hawai‘i without having to live in squalor. This challenge has broad implications, the most important of which is our ability to attract and retain high quality workers. So the legislature, together with the state’s housing arm, Hawai‘i Public Housing Authority, and some nonprofit groups, have built more units. Strategies are in place and funding has been appropriated, and we’re hopeful that these efforts will bear fruit.
But there is another aspect of this equation which is smaller in scale but equivalent in moral urgency. We are doing a shamefully bad job on housing the ambulatory mentally ill in our community. People who suffer from the most severe psychological disorders have their problems made much worse by a lack of housing. It doesn’t take a degree in psychiatry to understand that any kind of illness can be exacerbated by sleeping on the street or in a shelter.
Let me give you an example (this is not a real client, but his situation is common):
John Doe is a local boy who grew up in Kaneohe, O‘ahu, and fought in the first Gulf War. He came home with severe Post Traumatic Stress Disorder and now this has morphed into what is known as Pyschizoeffective disorder. The state mental hospital held him for two weeks but on discharge our ( Helping Hands Hawai‘i ) case managers can’t find any housing for him. There are no apartments that will take him, no beds in the nursing homes, and the group homes are full as well. Our expert spent the better part of three days trying to find shelter for John, but had to settle for a non-private mattress at the Institute for Human Services. Cost to the taxpayers so far:
Two weeks at the state hospital: $10,200
Three days case management: $1,500
After three days at IHS, with no privacy and a relatively high-stress environment, he decompensates, which is a clinical way to say that his mental illness gets worse. Our case manager tries heroically to find John, but to no avail. The next phone call is from the emergency room at the Queens Medical Center. He stays there for two days getting stabilized.
The cost to the taxpayers through Medicaid is $2,000. The total cost of this three-week period is 13,000.
For this, we could have gotten him a nice, clean, quiet apartment, and he likely would have been stable and on the road to recovery. This is no one’s fault. The Adult Mental Health Division of the Department of Health has correctly identified housing as a high priority issue, and they are working hard and well at getting agencies like the prison department and others to work in a more integrated way. But this is really a public policy issue, not one of bureaucratic implementation. It will require legislative and executive leadership, and some additional funding. It’s not financially or morally acceptable to have a system that seems to rotate the same clients in and out of the ERs, state hospitals and other settings. Certain individuals are not getting better under our care, and they cost taxpayers tens of thousands of dollars per year.
The mental health system, under the leadership of Tom Hester, M.D., has made great strides in being more inclusive and more responsive; we’re doing better than many other states. But he needs help, and these clients need help. We don’t have to look too far for excellent models for success. Steadfast Housing, Mental Health Kokua, and other similar groups provide supportive housing for mentally ill adults, and it’s working clinically, and saving money in the long run. These programs can and should be replicated. They will save money, and will save lives.
• Brian Schatz was a state representative for eight years and ran for the U.S. House in 2006. He is currently CEO of Helping Hands Hawai’i, one of O’ahu’s largest social service agencies.
