By Victoria Budiono
The Honolulu Star-Advertiser
HONOLULU — Honolulu officials are expanding a program that allows emergency responders and law enforcement to involuntarily take people experiencing severe mental illness or substance abuse to receive care, saying the approach is helping people who have repeatedly fallen through gaps in the social service system.
Honolulu EMS Director Jim Ireland said Tuesday that the program, known as MH3, has conducted about 150 involuntary interventions since its launch under a new state law. Those interventions involved about 120 people, meaning roughly 80% of the cases involved people who were encountered only once.
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The program grew out of the city’s Community Outreach Response and Engagement, or CORE, initiative, which was created to connect people experiencing homelessness with services and shelter.
But Ireland said outreach alone was not enough for people who were so severely affected by mental illness or substance abuse that they became a danger to themselves or others while not recognizing that they needed help.
“What we learned was that it wasn’t enough,” Ireland said. “We had contact with individuals who were so unwell with mental illness, with substance abuse, that they continued to be a danger to themselves and others, but didn’t recognize that they needed the help.”
The state Legislature’s passage of Act 219 last year, which was signed into law by Gov. Josh Green , gave health care providers and law enforcement another tool to intervene when a person meets the legal threshold for involuntary care.
Ireland said the MH3 process brings together a health care provider, such as a physician or nurse practitioner, with EMTs, CORE community health workers and law enforcement officers. The team assesses people in the field after receiving reports through 911 calls, police officers or other observations.
If the person meets the threshold for involuntary detention, the health care provider directs a law enforcement officer to detain the person and transport them for further evaluation.
Ireland emphasized that the intervention is not intended as a criminal arrest.
“We tell them: You’re not in trouble. You didn’t do anything wrong. You’re not under arrest. We’re not going to court,” Ireland said. “This is a pathway to help you.”
Although the intervention is involuntary, Ireland said about 90% of the people encountered voluntarily get into the ambulance after responders explain the process.
Most are transported to the Behavioral Health Crisis Center, while others have been taken to facilities including The Queen’s Medical Center, Castle Medical Center or Tripler Army Medical Center for further assessment.
Doctors and other providers at those facilities determine whether a person needs a longer involuntary hold under other provisions of state law.
Ireland said some of the people encountered by the program have been experiencing psychotic episodes associated with methamphetamine use or conditions such as schizophrenia. Some have been found running in traffic or swinging sticks at people.
“These are the people,” Ireland said. “They are a danger to themselves, but they are a danger to others because they often hurt other people, and they do it because they don’t know what they’re doing.”
The city says the program is beginning to produce longer-term outcomes. Ireland estimated that at least 20% of the people who have gone through MH3 interventions are now permanently off the streets, including people living in medical respite programs, the state hospital or foster care, as well as some who have returned to the mainland.
He said the city ultimately wants to use its medical respite system as a pathway for people who need significant medical care. Another federally funded medical respite facility is being developed at Leahi Hospital, with a potential capacity of about 50 beds.
For people who have gone through the MH3 process multiple times, Ireland said responders need to develop more individualized long-term plans rather than repeatedly intervening without addressing the underlying problem.
Honolulu Police Chief David Lazar said HPD is committed to expanding its role in the program across Oahu.
“Jail is not the answer always,” Lazar said. “It’s really how we can help people get out of the situations that they’re in if they’re suffering from a mental health crisis.”
Lazar said HPD’s Crisis Intervention Team has grown from four officers when he became chief to eight officers. He said the department plans to expand the team further.
The officers receive 40 hours of specialized crisis intervention training covering de-escalation, creating time and distance, mental illness, substance abuse and interacting with people experiencing a crisis.
Lazar said he has also asked the department to double the number of officers receiving the training each quarter, with the eventual goal of having all patrol officers trained.
The department has developed a public policy governing how officers respond to these situations, Lazar said. “We want to use the least amount of force and least amount of restraint as possible,” Lazar said. “We also think that transportation, by way of medical ambulance, is a better way.”
Honolulu Mayor Rick Blangiardi said the city’s approach to homelessness has evolved from simply moving people from one location to another toward trying to address the underlying problems contributing to homelessness.
He said the city estimates there are about 4,600 people experiencing homelessness on Oahu, with roughly half sheltered. Of the remaining unsheltered population, he estimated at least half may be experiencing severe mental health conditions.
Blangiardi said the people targeted by the MH3 program are among those suffering the most on the streets.
“These are the people who are hurting the most. These are the people who most need it,” Blangiardi said.
He said the city encounters people with conditions including post-traumatic stress disorder, depression, bipolar disorder and schizophrenia, noting that some people who in previous generations might have received institutional care are now living on the streets.
Blangiardi said the city intends to be aggressive in addressing that population, but stressed that the interventions are intended to be humane.
“It’s been a game changer to be able to pick them up involuntarily,” Blangiardi said. “I want to just say it out loud one time: This is not ICE. We’re not doing ICE raids. What we’re doing here is very humane.”
Blangiardi said the city’s goal is to intervene with people who are suffering in public and connect them with a place where they can receive care and, ultimately, regain greater stability and freedom.
“We want to be able to get people off the street who literally suffer before our eyes, to be able to put them somewhere we can hopefully give them freedom,” he said.
The mayor acknowledged that involuntary intervention is difficult for everyone involved, including the people being taken into care and the responders carrying out the interventions, but said it is necessary to protect people experiencing severe crisis as well as the broader community.
Officials said the MH3 program represents an evolving partnership between healthcare providers, CORE workers, EMS and law enforcement, with the goal of intervening before people in severe crisis repeatedly cycle through 911 calls, hospital visits or encounters with police.
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