H.C.R. NO.














requesting the Director of Health to convene a working group relating to PATIENTS REQUIRING an emergency mental health EXAMINATION.



     WHEREAS, under section 334-59, Hawaii Revised Statutes, any person who exhibits behavior that is deemed by law enforcement to be an imminent threat to themselves or others shall be transported to a licensed psychiatric facility to receive an emergency mental health examination to determine whether the individual should be hospitalized; and


     WHEREAS, patients transported and examined under this process are referred to as MH-1 patients; and


     WHEREAS, there are currently sixteen facilities that are designated by the Department of Health to receive MH-1 patients, including acute care hospitals and a federally qualified health center; and


     WHEREAS, some facilities designated by the Department of Health receive an outsized number of MH-1 patients and the high volume strains the ability of these facilities to provide care to all residents in the State; and


     WHEREAS, some facilities do not feel they are equipped to care for MH-1 patients because of a lack of adequate infrastructure and fears about patient and staff safety; and


     WHEREAS, some MH-1 patients may benefit from transport to alternative health care services, as not all patients require an emergency psychiatric evaluation or hospital services; and


     WHEREAS, increased support and clearer guidance are needed by law enforcement to ensure that patients are directed to the most appropriate setting of care; and


     WHEREAS, there is a need to determine the state-wide capacity for inpatient and outpatient mental health services, where gaps exist in service availability, and the barriers to getting individuals in crisis to the appropriate setting of care; now, therefore,


     BE IT RESOLVED by the House of Representatives of the Thirtieth Legislature of the State of Hawaii, Regular Session of 2019, the Senate concurring, that the Director of Health is requested to form a working group to evaluate the issue of treating MH-1 patients experiencing a mental health crisis; and


     BE IT FURTHER RESOLVED that the working group:


     (1)  Develop criteria for the Director of Health to designate facilities to transport, examine, and treat MH-1 patients;


     (2)  Review existing laws, law enforcement protocols, and procedures to ensure MH-1 patients are appropriately transported and identify areas that may need clarification to ensure standardized transportation of MH-1 patients in jurisdictions statewide;


     (3)  Develop recommendations for appropriate distribution of transported patients for emergency examination across health care facilities in a given county;


     (4)  Provide an assessment of current law enforcement and health care facility needs and capacities for evaluation and treatment of MH-1 patients, including the availability of beds and services necessary for treating patients experiencing a mental health crisis, preventing crisis situations, and avoiding unnecessary transport of patients;


     (5)  Develop recommendations for building a coordinated system of care with capacity for crisis services, community services, and outpatient and inpatient services to address the needs of persons with mental illness and substance use disorders who are in crisis, including discussions on alternative sites of treatment; and


     (6)  Develop recommendations for reimbursement to support these efforts; and


     BE IT FURTHER RESOLVED that the working group, at the invitation of the Director of the Department of Health, is requested to include:


     (1)  The Deputy Director of Behavioral Health Administration or the Deputy Director's designee, who shall serve as chairperson of the working group;


     (2)  Seven representatives from a hospital or hospital system; provided that at least two representatives shall represent a neighbor island and one shall represent a public hospital;


     (3)  One representative from any federally qualified health center designated to receive MH-1 patients;


     (4)  One representative from a residential mental health or substance abuse treatment facility;


     (5)  One representative from the Healthcare Association of Hawaii;


     (6)  Two representatives from law enforcement, one of which shall represent a neighbor island;


     (7)  One representative from a mental health services provider; and


     (8)  One representative from the Department of Human Services; and


     BE IT FURTHER RESOLVED that the working group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2020; and


     BE IT FURTHER RESOLVED that the working group be dissolved on June 30, 2020; and


     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health, Director of Human Services, and the Healthcare Association of Hawaii.

































Report Title: 

Mental Health Patients; Emergency Hospitalization; Mental Health Crisis; Working Group