Severely mentally ill prisoners in Hawaiʻi are being cared for in dismal understaffed facilities and receive inadequate treatment, according to a pair of outside experts who inspected two jails under a class-action lawsuit settlement.
The psychiatrists’ grim report on mental health services in Oʻahu Community Correctional Center and Hālawa Correctional Facility — completed earlier this summer but never before made public — identified inmates who were so severely ill they clearly should have been moved to Hawaiʻi State Hospital for treatment.
The inspectors also flagged overuse of pepper spray to control inmates as a problem in an OCCC module for mentally ill prisoners, and reported staff at Hālawa deliberately made inmates on suicide watch endure harsh conditions as a strategy to discourage malingering.
Tommy Johnson, director of the Department of Corrections and Rehabilitation, told Civil Beat on Friday that “we asked for a truthful report, and I believe we got it, and I think now it’s up to us and the policymakers to make certain decisions to address those critical issues.”
The report by Dr. Jeffrey Metzner and Dr. Bhushan Agharkar, nationally known experts on correctional mental health care, becomes public at a time when Hālawa has been the scene of an extraordinary series of six suspected or confirmed suicides in the last 14 months in a facility with a population of fewer than 850 inmates.
By comparison, the overall death rate from suicides for the entire population of nearly 3,800 Hawaiʻi prisoners in eight in-state facilities and a private prison in Arizona averaged less than 2.6 per year from 2007 to 2023, according to data provided by the state Department of Corrections and Rehabilitation.
A Hālawa Correctional Facility inmate sleeps in a cell. Psychiatrist Pablo Stewart said the number of suicides at the prison in the past year is “way off the chart,” leaving the state vulnerable to lawsuits over the lack of mental health services inside. (Cory Lum/Civil Beat)
Many inmates at Hālawa had serious mental illnesses but “accepted mental health treatment modalities are often lacking or being provided by unlicensed clinicians without adequate supervision,” according to the report. “As such, the psychiatric care received is inadequate to address the level of severity present in this population.”
The rash of suicides at Hālawa is “just way off the chart,” said Dr. Pablo Stewart, a longtime correctional psychiatrist and an expert witness in forensic psychiatry. “That’s an emergency. I’m not trying to be hyperbolic on this. That is an emergency.”
That leaves the state vulnerable to new lawsuits, Stewart said, and those lawsuits could finally force Hawaiʻi to improve mental health services and expand its suicide prevention efforts inside.
Hundreds Of Mentally Ill Prisoners
The report by Metzner and Agharkar, who are both psychiatrists, was itself the product of litigation. It was required as part of a settlement in a federal lawsuit that alleged the state provides inadequate mental health services, which led to suicides in Hawaiʻi correctional facilities.
The outside experts were chosen jointly by the state and Honolulu lawyer Eric Seitz, who filed the original lawsuit in 2019. Seitz said in an interview last week that the state agreed to use the report to try to persuade state lawmakers to provide funding for needed improvements in the mental health care system.
Metzner and Agharkar filed their report with the state in late June based on inspections of the two Hawaiʻi facilities earlier that month. It concluded conditions in both Hālawa and OCCC are “very problematic.”
Cathy Levey, a University of Massachusetts Lowell professor who was a supervising psychologist in the Connecticut correctional system for 22 years, called the conditions described in the report as “atrocious.”
“It’s just that you don’t have enough support there to have bare minimum mental health care,” she said. She was particularly concerned about the lack of licensed mental health professionals at the facilities.
According to the report, about 300 inmates at Hālawa were prescribed medications for mental illnesses, but the prison had just one psychiatrist for three half-days each week. Prison staff told the inspectors the psychiatrist would generally assess or treat four to five patients a day.
Five of the six clinical psychologist positions at the prison were vacant, and the mental health section supervisor was expected to leave that position “in the very near future,” according to the report.
OCCC had similar issues to those at Hālawa. Three of the five positions for clinical psychologists at OCCC were vacant along with the section supervisor’s position, according to the report. That facility had three part-time psychiatrists caring for patients in a facility that had 336 inmates being medicated for mental illnesses.
The report also noted the position of statewide director of the correctional mental health system has been vacant for over 10 years.
Suicide Watch And Pepper Spray
The report also raised concerns about harsh conditions in the Hālawa mental health infirmary and on suicide watch, where inmates are to receive one-on-one supervision if there are signs they are contemplating self-harm.
Staff in Hālawa reported “the harsh conditions of confinement within the mental health infirmary were designed to be a disincentive for some inmates” who wanted to get out of the general population because they felt unsafe there.
This was common for inmates who had “safety issues,” according to the report, but there was no efficient mechanism in place for resolving the safety issues while the prisoners were in the infirmary.
“That alone would win you millions of dollars in lawsuits,” Stewart said.
Some prisoners, such as those assigned to gang modules, fear for their lives and claim to be suicidal to get out, he said, but “the better solution is not to make your suicide area terrible, but to increase security and staffing so people don’t feel like they have to say they’re suicidal to get out of a housing assignment.”
Harsh conditions on suicide watch also backfire by discouraging “truly suicidal people from admitting they are suicidal,” Stewart said, “because they don’t want to be placed in these horrible settings.”
The report raised a similar issue for OCCC, where it cited a problem with “inmates remaining on suicide watch for prolonged periods of time due to self-identified safety concerns in contrast to being clinically suicidal.”
Some remained on suicide watch for many months, which the report said was “not acceptable.”
The report also criticized use of pepper spray that was “excessively deployed” in Module 1 of OCCC, including on an aggressive inmate one evening when the experts were touring the facility. That module houses the most acutely mentally ill inmates.
A corrections officer peers out from the Hālawa Correctional Facility infirmary. Experts described the physical plant of the mental health infirmary at the prison as “dismal.” (Cory Lum/Civil Beat 2015)
Another issue raised in the report was a lack of “psychological autopsies” that are supposed to be done whenever an inmate commits suicide. Those psychological autopsies are used to analyze the circumstances surrounding the suicide to head off future deaths.
There were no psychological autopsies done for two recent suicides reviewed by Metzner and Agharkar, according to their report.
Levey said she always saw preventing suicides as the most important part of her job, and was troubled that the prison apparently does not conduct psychological autopsies after each suicide.
Rather than pointing the finger of blame at anyone, Levey said the point of those death reviews is “how can we prevent it from happening again? What can we learn from this?”
Finding The People They Need
Stewart said staff vacancies have been a problem in the system for decades because corrections officers and other employees, including mental health service providers, are not paid particularly well and must cope with poor working conditions.
Johnson said it may cost $4 million to $8 million a year to hire or contract for the additional professional staff that is needed in state prisons and jails, including psychiatrists, psychologists, psychiatric social workers and case managers. He plans to ask Gov. Josh Green’s administration to include funding in the governor’s next budget request.
Johnson also said he believes correctional officers should be paid more, and suggested those who work in units for mentally ill inmates ought to get extra pay for that difficult duty. But that will have to wait until the next round of negotiations with the United Public Workers Union, which represents the officers.
In the meantime the state has launched a recruiting effort and is running extra training classes. The department deployed 43 emergency hires to work in state correctional facilities, but about 24% of its 1,535 authorized correctional officer positions remain vacant.
A graduation ceremony for corrections officer recruits. The state has launched an initiative to step up recruiting and run more training classes, but the Oʻahu jail and Hālawa prison both reported functional vacancy rates of more than 30%. (Cory Lum/Civil Beat 2017)
Metzner and Agharkar said in their report the functional vacancy rate for correctional officers at Hālawa was 34% when officers who are absent on long-term leave were taken into account.
Management at OCCC reported about 32% of the officers there were unavailable on any given day because of vacancies or officers on leave, according to the report.
The staff shortages are so severe at OCCC that the inspectors found that about 20 of the so-called non-essential guard posts are left unstaffed each day, and inmates are generally locked in their cells on weekends. It was also common for housing units to be locked down on weekdays because of short staffing, the report said.
“It’s a well known fact that if you keep the mentally ill locked into the cells all the time and decrease out-of-cell time, their mental illness is going to get worse,” Stewart said. “They’re going to become more psychotic, they’re going to become more assaultive, and they’re going to become more suicidal.”
Deteriorating Facilities
The section of the report focused on Hālawa found “the physical plant within the metal health infirmary was dismal. The conditions of confinement were equally dismal.” Staff explained that a new infirmary for Hālawa has been funded, but construction will not be complete for another two years.
As for OCCC, the report described Module 1 for the most seriously mentally ill as a space where “the decrepit physical plant, overcrowding and restricted out-of-cell time exacerbates many of the inmates’ mental illnesses.”
Tommy Johnson, director of the state Department of Corrections and Rehabilitation, acknowledged shortcomings in treatment of mentally ill inmatges. (Screenshot/2025)
Johnson has been pushing for years for construction of a new jail at Hālawa, but has encountered resistance from critics who say the state should first invest in more community-based mental health and drug treatment programs so people can be diverted from incarceration.
Some of the issues raised in the report are familiar in a haunting way.
Conditions for mentally ill inmates at OCCC became so bad nearly two decades ago the state was placed under a federal court consent degree that forced it to improve services. But those improvements proved to be temporary.
When asked if the state could again become subject to court oversight, Johnson replied: “I think we’re at the point where we need to be concerned about not addressing the overcrowding issue, not addressing the living condition issues, hence we’re trying to get a new OCCC,” Johnson said.
“But more to the point,” he added, “we also need to make sure we provide focused services and treatment to the people in our custody and care, and the report does point out some very glaring deficiencies.”
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