Hawaii homeless with mental issues could be assessed involuntarily

Homeless people displaying mental health issues could be taken off the street against their will and brought in for assessment at a 3-month-old behavioral center in Iwilei if a new bill becomes law.

The new approach would apply to homeless people who draw both concern and scorn for their behavior, which could include wandering in traffic, yelling in public, hurling threats and generally exhibiting signs of distress, said Dr. Chad Koyanagi, the state Health Department’s medical director for crisis continuum, who oversees patient care at the new Behavioral Health Crisis Center on Iwilei Road.

Senate Bill 3139, which sits on Gov. Josh Green’s desk, is designed to allow law enforcement officers to spend less time with homeless patients waiting for them to be seen in emergency rooms such as The Queen’s Medical Center that are disproportionately used by homeless people.

Instead, officers would take homeless people directly to the new Behavioral Health Crisis Center in a process that would take five to seven minutes, Koyanagi said.

The center sits in the middle of a growing complex of buildings and programs intended to help reduce homelessness by providing a wide range of services.

The physical setting, atmosphere and approach by the staff at the crisis center are all intended to make the experience less stressful for patients — and, ideally more willing for them to accept help, even for those who arrive in handcuffs, Koyanagi said.

The state Departments of Attorney General and Budget and Finance are reviewing SB 3139 before Green decides how to proceed, his office said.

Koyanagi has spent years providing psychiatric serv­ices dealing with homeless people on the street for the Institute for Human Services and in Halawa Correctional Facility, while also teaching at the University of Hawaii’s John A. Burns School of Medicine.

He was impressed by the calm setting and approach he saw during a November trip to Arizona’s Maricopa County, where he watched Arizona’s approach play out in real time.

Homeless children and working adults who cannot afford housing tend to generate sympathy from the public, which, in general, has grown otherwise frustrated by the inability to get large segments of Hawaii’s homeless population with apparent mental health issues off the street.

In the latest Point in Time Count of Oahu’s homeless, 33% — or 2,433 out of a total homeless population of 4,494 — reported a mental illness, compared with 26% who reported a substance abuse disorder.

SB 3139 would allow law enforcement officers to involuntarily take anyone exhibiting signs of distress to the Behavioral Health Crisis Center, which opened in March, and could become a model to be replicated statewide if it’s successful, state Health Director Dr. Kenneth Fink told the Honolulu Star-Advertiser inside the center last week.

The goal would be to connect case managers and health care workers to homeless patients who could stay in nine short-term “stabilization beds” for a week or so on the center’s mezzanine level. The upper two stories are designed for long-term, permanent housing.

The airy, open space of the ground level and approach by the staff are all intended to “be more conducive to settling someone down,” Fink said.

Out of 112 people who have been admitted to the center since March, 56 of them — or half — have gone into some form of housing, such as a substance abuse treatment program, clean-and-sober home or homeless shelter, according to the Health Department.

The Hawaii Supreme Court in March ruled in favor of a American Civil Liberties Union of Hawai‘i lawsuit against Maui County over a 2021 county sweep of a homeless encampment. The ACLU also has a pending lawsuit over Honolulu’s homeless policies in addition to concerns about taking homeless people off the street against their will.

“Allowing a police officer to gain control over a person because of a perceived mental disability, even if that disability poses a risk to oneself or others, may plausibly violate the Fourth Amendment and pose other infringements on liberty, due process, and privacy,” ACLU Executive Director Salmah Rizvi wrote in an email to the Star-Advertiser. “While Senate Bill 3139 attempts to create community solutions, the Bill inherently contravenes principles of human dignity and autonomy. Research has shown that police presence can exacerbate one’s mental health state and negatively impact our vulnerable neighbors, already suffering from houselessness, poverty, and trauma. Those in need of support are best served when offered consent, empathy, and a calm, safe environment for rehabilitation. Lastly, I oppose efforts to funnel persons with disabilities and neurodivergence into jails and mental health facilities simply to hide them from the public view to satiate tourists and property owners.”

Sharmane Botelho, 54, who lives on the street across from the Iwilei Salvation Army, last week made her second voluntary visit this month to the Behavioral Health Crisis Center after she was initially referred by case managers at the nearby Punawai Rest Stop homeless hygiene center, medical clinic and general “navigation center.”

She’s been depressed and despondent and having thoughts of suicide, in part, over the deaths of her three sons.

Her oldest son, Bryson Kainoa Botelho-Kalima, 27, was stabbed to death in February 2022 nearby in Iwilei.

Botelho-Kalima had been living at the Institute for Human Services’ men’s shelter, and his mother was staying at IHS’ women’s shelter when she was awakened and told about her son’s death.

She was born on Hawaii island, the oldest of eight, grew up in Kalihi and never graduated from McKinley High School because of poor attendance.

But while in school, Botelho said, “I had big dreams, a lot of dreams.”

Now Botelho has a long list of medical problems including diabetes, sleep apnea, high blood pressure and congestive heart failure, and said she used to smoke methamphetamine.

Lately, she said, life in general “was just too much for me. I felt so broken down, so broken, so lost. I felt like quitting and throwing in the towel.”

The first time she was told about the crisis center earlier this month, Botelho said, “I knew nothing about this place. I thought, ‘Why not? I need help right now.’ I couldn’t be more happy.”

She spent the night before sleeping on the mezzanine level and spoke to the Star- Advertiser at a table in the open ground-floor level, saying she appreciated the care she’s received.

“It’s a beautiful building, and I’ve come to love this place,” Botelho said. “It helped me. When you need help, why not reach out?”

Through her case managers at Punawai Rest Stop, Botelho now has a housing voucher and looking forward to moving off of the street and into a permanent home.

She hopes the crisis center will help homeless people with mental health issues, even if it means bringing them in against their will.

Living with them out on the street, Botelho said, “can be very dangerous. Not only for a woman, it’s not safe and anything can happen.”

But mostly, she said, “To see people who really need that help, it tears me apart.”