New $160 million Hawaii State Hospital facility set to accept patients in August

A long-awaited 144-bed psychiatric facility at the Hawaii State Hospital, which for decades has been plagued by overcrowding and assaults on staff by patients, is set to begin housing its first patients in August.

The new building on the Kaneohe campus provides state-of-the-art security with hundreds of digital cameras, clear lines of sight, design features to prevent suicides, elevators with separate compartments for staff and patients and rooms where unstable patients can be constrained or confined to a space made out of rubber to prevent self-injury. Single rooms designed for patients with high-risk behavioral problems have their own bathrooms and windows where staff can peak in to check that they are breathing during the night without disturbing them.

The forensic facility, functions somewhat like a jail — nearly all patients at the state hospital have been ordered there by the courts after committing minor or serious crimes. Many are awaiting evaluations on whether they are fit to stand trial.

But the new building’s design also recognizes the hospital’s mission to provide therapy, healing and rehabilitation to some of Hawaii’s most troubled and high-needs residents. The Koolau mountains form a stunning backdrop to the facility that looks out on expansive views of Kaneohe and Kailua Bays. The new facility contains outdoor areas where patients can relax, tennis and basketball courts, a game room and an open dining area designed to foster a communal environment and draw patients out of isolation. Classrooms are set up for therapy and anger management sessions. A separate room is designed for virtual court hearings that doubles as a mock courtroom, where patients can practice going before a judge to ease their anxiety.

The majority of patients at the facility at any given time are homeless and more than 90% are suffering from substance abuse problems on top of their mental health needs, said Run Heidelberg, the hospital’s administrator, who led a media tour of the new building on Wednesday. Many are struggling with major trauma from experiences in childhood or being homeless.

“They self medicate because of the trauma, and that is what we really try to get down to, to see is it the trauma or what is going on with the person,” said Heidelberg. He said it can take several months to a year just to get a patient to a point where they are stable enough to begin accepting programs that will help them. He said a lot of it comes down to earning their trust.

The hospital is licensed for 202 beds, but with waivers has held as many as 238 patients throughout several buildings, said Heidelberg. The crowding has reduced classroom space and the ability to focus on therapy.

The new $160 million building has been in the works for years. In 2005, the Hawaii Department of Health commissioned a master plan to revamp the facility, which is the only publicly-funded psychiatric hospital in the state. However, the plan, which included a new 136-bed facility was never funded.

In 2014, the state Senate convened a special committee to investigate the hospital, conducting 10 hearings and reviewing thousands of pages of documents that were turned over in response to subpoenas. A final report warned that ongoing assaults at the facility could eventually result in a fatality if safety problems weren’t addressed.

In the 2013 and 2014 fiscal years, there had been 215 assaults at the hospital, 26 of which required outside medical treatment.

In 2015, former Health Department Director Virginia Pressler revamped the master plan and made construction of a new forensic facility that would provide a safer environment a top priority. The plan calls for eventually increasing the campus’ patient capacity to 516 as other buildings are renovated and creating a better continuum of care. Ultimately, hospital officials hope to curb patients from cycling in and out of jail, the streets and the state hospital.

The hospital has also gotten approval from the Legislature to hire 127 additional staff and is currently recruiting.

“There’s been a lot of interest,” said Heidelberg.

The psychiatric hospital has been in the news recently because of the dramatic escape and recapture of one of its most infamous patients.

Randall Saito was sent to the hospital in 1981 after he was acquitted of murder by reason of insanity in the 1979 killing of Sandra Yamashiro. Saito walked out of the hospital in November 2017, called a taxi that took him to the airport, boarded a chartered flight to Maui, then a commercial flight to the Northern California city of San Jose. He was eventually caught and earlier this month was sentenced to five years in prison for the escape.