Mental health safety net reform

Everyone agrees that a crisis is looming: the government’s safety net is failing to meet the behavioral health and substance abuse treatment needs, especially for those in squalid circumstances.

In 2021, the latest official response to recognized deficits in care is for the legislature to pass a law mandating the state Department of Health (DOH) to take over the operations of the Oahu Regional Hospital Management Agency for two aging facilities.

The idea initially had strong support from state health officials and the Oahu Board of Directors as a way to expand capacity. But in a recent legislative briefing, the new Health Department administration told the House Finance Committee that the mandate should be revoked, arguing that such a solution is inelegant and expensive.

While a convincing case has been made that reform would be cumbersome and have avoidable costs, health care officials now need to provide at least a framework for a plan to upgrade hospitals and make significant service improvements.

The two facilities — Leahi Hospital and Maluhia, a nursing home — largely serve skilled nursing patients, in Hawaii Health Systems Corp.’s Oahu region. The primary function of the HHSC on Oahu is nursing care. By contrast, mental health and substance abuse programs are part of the Ministry of Health’s mission.

The stream of official opinion on moving facilities from HHSC to DOH began to lag at the end of the 2021 legislative session, before Senate Bill 628, enacted as Act 212, became law. After changes of leadership at the Department of Health, the administration testified to the House Finance Committee that the Department of Health was “respectfully withdrawing support” from the measure and asked for more time to make “comprehensive recommendations.” The bill was approved into law anyway.

Ultimately, these recommendations emerged in a recent report from a work group authorized by Act 212 tasked with “developing a comprehensive action plan and transferring the framework for managing and administering the additional steps needed to complete the transfer of the Territory of Oahu to the Department of Health.” “

The 24-page report summarizes some eye-catching cost figures. The conversion itself is estimated to cost $4.1 million, and will result in projected additional ongoing costs of $3.7 million in fiscal year 2023, rising to $6.6 million in 2026.

That’s more than enough to cause sticker shock, to be sure. Costs arise, for example, from settling with unions over the transfer of public servant contracts from HHSC to DOH, said Marian Tsuji, deputy director of behavioral health at the DOH.

She said units now operating under contracts with lower wages and benefits will have contracts settled with those of corresponding units at the other agency, which always means overall increases.

Other identified cost centers include the addition of operational staff. Tsuji also stressed regulations that would make it ineffective for residents to mix in facilities.

Another argument was raised: creating a new management of the HHSC functions within the Ministry of Health would be an unnecessary duplication of costs.

The report suggested instead creating the HHSC’s Oahu District as a “semi-independent agency of the Department of Health,” calculating that this transition would cost $1.7 million to implement, followed by $1.3 million in additional annual costs thereafter. Significant capital improvements in financing deteriorating facilities will also be required.

This sounds better but lacks the necessary detail: What does the Department of Health hope to achieve, and how will the facilities be used?

These voids must be filled before Law 212 is repealed and another strategy launched, if better health treatment in Hawaii is to be reached.