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Officials describe assisted community treatment program expansion and new legal tools to reach people who cannot consent to care
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Summary
Department presenters outlined assisted community treatment (ACT) criteria, recent statutory changes that broaden "dangerousness" to permit earlier intervention, program outcomes to date (82 medicated, 25 ACT petitions granted, 21 pending, 13 guardianships), and steps the Attorney General’s office will take to help families file petitions.
Connie Mitchell, presenting for the Department, told the council that assisted community treatment (ACT) is a targeted intervention for people with severe mental illness who cannot or will not consent to needed care. "ACT is almost like the last resort," she said, describing criteria used to petition the court: evidence of mental illness or substance abuse, inability to live safely without supervision, refusal of necessary services, and a mental state that impairs decision‑making.
Mitchell said the department uses repeated outreach and documentation—including psychiatric evaluations, medical and legal records, and family contacts—before filing petitions. She described common clinical examples (self‑neglect, untreated wounds leading to sepsis, psychotic behaviors in public) and the use of long‑acting injectable antipsychotics where appropriate. "We've been able to medicate 82 people," she said, adding that 25 ACT petitions were granted, 21 were pending at the time of the meeting and 13 guardianship orders had been successfully obtained.
Connie emphasized the program’s broader objective is to help people accept treatment and re‑engage with services: many of those who were medicated did so after assertive outreach rather than court orders. She described outcomes in individual cases—people who moved into housing and found employment after treatment—and recommended more training and provider participation for street psychiatry and mobile evaluations.
Ian Suda from the Attorney General’s Office explained the AG’s role in ACT filings: limited‑scope representation for petitioners and assistance throughout the court process. He noted a 2024 statutory change (referred to in the meeting as HB2159) clarified responsibilities and that the AG office is preparing public guidance and a webpage to help families and providers understand the materials needed to pursue a petition. He encouraged the council to submit ideas for statutory improvements under Chapter 334 of the Hawaii Revised Statutes.
Council members asked about safeguards, court scheduling, and how to avoid increasing pressure on the Hawaii State Hospital. Mitchell recommended a faster guardian ad litem appointment and suggested judges and hospital staff coordinate to avoid unnecessary inpatient admissions; one member said a judge had agreed verbally that not all ACT orders required hospital stays.
The presenters also discussed logistics: the need for more street‑ready psychiatrists to perform evaluations, the importance of guardian ad litem in‑person assessments, and the role of new behavioral health crisis centers as alternative transport destinations for police under recent law changes. The AG’s office said it would post contact information and a forthcoming website to reduce friction for families seeking help.
