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Plans are quickly, thankfully taking shape that would expand capacity at the long-troubled Hawaii State Hospital in Kaneohe — the state mental health hospital — by nearly 300 beds and upgrade its facilities with specialized care capacities and better equipment.

The timing is welcome. Overcrowding and its effects on staff safety, other facilities and homeless populations are deeply troubling and growing worse. Clearly, we need a better path forward.

State Health Department Director Virginia Pressler — who previously served as deputy health director under Gov. Ben Cayetano and is a longtime Honolulu physician — is working on a plan that would build a new forensics facility at the state hospital, expanding capacity by a desperately needed 144 beds.

The state-of-the-art facility would care for mental patients sent there by the courts and would take shape on the site of the hospital campus’s Goddard Building, currently in the midst of a demolition expected to cost nearly $5 million.

Pressler is also creating a plan to replace the long-vacant Bishop Building, also on the state hospital campus, with a new 150-bed residential facility, mostly for the elderly mentally ill who have long-term care needs. The venture proposed is a public-private partnership with Utah-based Avalon Health Care, which has two nursing homes in Hawaii.

Avalon would build the facility, essentially a 150-bed nursing home. A third of it would go to long-term care for some of the State Hospital patients who don’t need that high of a level of inpatient psychiatric treatment, and the rest would be available for others in the community. The state would still be liable for as-yet-undetermined operating costs that would enable Avalon to pay for the facility’s construction incrementally, but spreading those expenses over time may well be a convenience that makes good fiscal sense for Hawaii, both now and in the long term.

The combined capacity of the new facilities at the Goddard and Bishop sites would address multiple pressing challenges at the state hospital, some of them nearing crisis level:

• Overcrowding. The existing hospital was built for 178 beds but is licensed for 202. The budget is based on 168 patients staying there. Earlier this week, 203 patients were there, plus 42 in overflow units at Kahi Mohala Behavioral Health. And all of those patients are there by order of a court, meaning that no capacity exists at the state mental health hospital for its original purpose – a treatment facility for members of the public with mental illness. Increasing capacity from a top limit of 202 to nearly 500 will ensure many more individuals get the care they need, and fewer mentally ill wind up sleeping on our streets.
• Staff safety. The overcrowded hospital has been a danger for those who work there for years. It has been the site of hundreds of assaults on staff, and given its court-ordered population, courts, safety concerns are serious. “If we don’t build a new forensic state hospital like right away, we are going to have another crisis. I want to prevent that,” Pressler told Civil Beat.
• Making better use of the Kaneohe campus. One of the most attractive aspects of Pressler’s proposal is that it makes productive use of state property for exactly the use that was originally intended. The properties that the new facilities will replace were built in the 1930s; Goddard has been closed since the early ‘90s, Bishop also for years. Replacing them with new facilities on the same land negates site acquisition costs and ensures the redeveloped mental health campus will be an acceptable neighbor in the area it calls home.

Costs for the new forensic facility are estimated at $165 million, and Pressler, no stranger to the legislative process, is already working with Sen. Josh Green, also a physician, on legislation for general obligation bonds that would cover the construction.

Senate Ways and Means Chair Jill Tokuda seems to be working toward support, calling the facility, “such an important public need. I don’t think we can push this down the road.”

The Avalon facility would ostensibly be built with little or no taxpayer outlay. Pressler says only “loose ends” need to be tied up on the matter and anticipates making an announcement on the project “soon.”

Resolving an overcrowding issue that has been allowed to persist for two decades with significant upgrades in safety and care — at a fraction of the price those issues might be addressed under less advantageous circumstances — represents a benefit to taxpayers and to the health and welfare of Hawaii.

The most recent impetus for these changes came from a state Senate investigation last year into the state hospital, which culminated in a 93-page report that called for new facilities and other reforms, some of which Pressler is already making.

Shortly after Gov. David Ige nominated her to lead the Health Department last fall, that among the first “urgent issues” she planned to address was “follow-up from the state Senate investigative report on the Hawaii State Hospital, particularly related to employee and patient safety and census management.” She remained focused on those issues in conversation with Civil Beat, calling the new forensic facility in particular one of her “top priorities.”

Pressler’s commitment on these major state needs should be applauded, including the framework of a plan that so far has multiple offices within the legislative and executive branches of state government working toward its fruition.

Resolving an overcrowding issue that has been allowed to persist for two decades with significant upgrades in safety and care — at a fraction of the price those issues might be addressed under less advantageous circumstances — represents a real benefit to taxpayers and to the health and welfare of our state.

The Legislature and Gov. Ige should complete their oversight work on these matters quickly in the first half of 2016 and allow work to proceed apace on new beginnings for the old Bishop and Goddard sites.