More and more, the state is using properties in neighborhoods to house people with mental illnesses as part of an ongoing effort to de-institutionalize services and help patients live independently.

The number of licensed "special treatment facilities" statewide has grown 65 percent since 2000 — when there were 20 — to 33 this year, according to the state Department of Health.

And the number is likely to grow.

The state Department of Health's Adult Mental Health Division is looking at adding more than 20 special treatment facility beds on O'ahu and five beds on Kaua'i by next year, and about 16 more beds on the Big Island by 2009.

The department is currently evaluating proposals for other special treatment facilities — which vary in services as well as the number and type of individuals served — including one that would occupy a two-dwelling lot in Kailua that has drawn the concern of some area residents.

In the case of the Kailua facility — which would replace cottages on the grounds of the Hawai'i State Hospital — some residents raised concerns such as safety risks to both the community and the clients. The Kailua facility also would be near an elementary school.

But officials said community special treatment facilities like the one proposed in Kailua won't house sex offenders or people who have had violent felony charges. They also say most people with mental illnesses do not need to be institutionalized and that such facilities — which have existed in the community for years — are important in helping them live independently.

A NATIONAL MOVEMENT

We need more hospital beds, but we also need places for people who no longer need to be locked up because they're no longer dangerous, their treatment is working, they can't live by themselves, they need a lot of supervision, but they don't need to be in a medical facility,  said Marya Grambs, executive director of Mental Health America of Hawaii.

"Since the 1950s, the national consensus has been to stop warehousing people in state hospitals unless they absolutely require 24-hour medical care in a locked facility, and to place them in the community and have them be integrated in the community because they're human beings and they're not violent," she said.

"If you look at the research, most people with mental illnesses are not dangerous."

This de-institutionalization has continued since the 1980s, said Janice Okubo, spokeswoman for the state Department of Health.

Special treatment facilities provide a combination of housing, supervision and on-site treatment for people — including minors — who are socially or emotionally distressed, mentally ill, suffering from substance abuse or developmentally disabled.

These facilities, one of several types of housing for people with mental illness, are generally in or close to residential communities.

Such facilities, while not new, are important because they allow "people with mental illness to be outside of a hospital setting while having opportunities to be part of a community," state Adult Mental Health Division chief Dr. Thomas Hester said in a statement. "It offers the services needed to help people with mental illness transition to independent living and participate fully in the community."

Special treatment facilities have 24-hour supervision and have a required minimum staffing ratio of one staff member per eight residents.

People referred to the facilities may have criminal backgrounds, but under state Adult Mental Health Division's policy, sex offenders or people with a history of violent felony charges are not placed in community special treatment facilities, the Health Department said.

The state contracts with various providers to operate special treatment facilities. The locations are determined by the providers.

NOT MANY PROBLEMS

Health officials said there have been few problems with special treatment facilities and community group homes, which do not have on-site treatment and may have less supervision.

"There have been few, if any, incidents in the community, and none that I can recall from a (special treatment facility)," Karen Krahn, Adult Mental Health Division clinical operations chief, said in a statement. "These included one to two complaints about group homes that were not substantiated. Every complaint is investigated thoroughly, and if needed or substantiated, acted on immediately."

The need for mental-health services in Hawai'i continues to grow.

The state's Adult Mental Health Division serves more than 13,000 people, and enrollment has grown by up to 150 individuals a month during the past four years, the Health Department said. Thousands are in need of some kind of subsidized housing, Okubo said.

As the number of people served continues to grow, so will the need for more services, including special treatment facilities, she said.

"The need in Hawai'i is really reflected in the rise in the population needing treatment services for mental illness, co-occurring mental and substance abuse issues, and substance abuse/addiction," Okubo said.

Grambs said more community housing facilities are needed to not just serve those who should be getting help in a community setting, but to free up more hospital beds for individuals who need to be in a secured facility.

"We need more hospital beds, but we also need places for people who no longer need to be locked up because they're no longer dangerous, their treatment is working, they can't live by themselves, they need a lot of supervision, but they don't need to be in a medical facility," she said.

The proposed 16-bed facility in Kailua would be operated by the for-profit CARE Hawaii Inc. under contract with the Hawai'i State Hospital at a two-dwelling lot on Kane'ohe Bay Drive. The facility would replace existing 22-bed cottages on the grounds of the Hawai'i State Hospital, which are being converted for use by a separate hospital program.

The proposal drew strong opposition from some Kailua residents who had concerns including community density issues, whether the location compromised the quality of service to clients, and the safety of neighborhood residents.

LOCATION QUESTIONED

Neighborhood Board member Michele Brooks said she is not opposed to a home for the mentally ill in the Kailua community, but doesn't like the proposed facility's location. She said it's close to an elementary school, nursery school and a city park. It's also across from a sewage treatment facility.

"I figure they're in the community whether we're identifying them or not, (and) I'd rather they be in a supportive home, but (CARE Hawaii) couldn't have picked a worse location for it," said Brooks, a psychiatric nurse who has worked at the Hawai'i State Hospital for about seven years.

"It poses some concerns to me for the safety to children in the neighborhood, and it poses some concerns also for the clients in that it's right there on a busy highway," she said.

CARE Hawaii president Tina McLaughlin has said the facility is a voluntary program for people who show they are working toward recovering from mental illness and that it would not house any individuals who pose a risk of violence or sexual offense.

CARE Hawaii also is proposing to convert an existing group home in Salt Lake into a 14-bed special treatment facility providing crisis residential services. That facility would replace CARE Hawaii's crisis shelters in 'Aiea and Pearl City.

CARE Hawaii also wants to convert a group home in Waipahu to a special treatment facility with a crisis program for adults with developmental disabilities.

The state Department of Health has yet to issue licenses for the proposed facilities and decide whether to issue a certificate of need for the Kailua facility.

Reach Lynda Arakawa at larakawa@honoluluadvertiser.com.