Lawmakers are expressing concern that a law meant to keep people with mental illness accused of minor crimes from languishing in jail is instead trapping some people in a revolving door at the Hawaiʻi State Hospital without meaningful treatment.
In a letter sent earlier this month to state Department of Health Director Kenneth Fink, 11 senators cited Civil Beat’s reporting on the law and asked the department for detailed information on how Act 26 has been implemented and whether it is actually helping people get lasting help. They also ask the department to consider whether changes to the law are needed to prevent people from being readmitted over and over again.
The senators, who include Health and Human Services Chair Joy San Buenaventura and Judiciary Chair Karl Rhoads, expressed support for programs meant to improve outcomes for people with mental illness in the criminal justice system, but questioned whether this five-year-old law has been effective.
“One example from the article is a 61-year old man described as homeless who had been sent to the state hospital for a determination of his mental fitness a staggering twenty-two times in a five-year period,” the letter says.
When there are concerns that a defendant doesn’t understand what it means to face charges well enough to aid in their own defense, they are sent to the state hospital. People facing non-violent petty misdemeanors can be held for 14 days, at which point, if they still aren’t capable of standing trial, they are released and their case dropped. (Kevin Fujii/Civil Beat/2025)
Introduced in 2020, Act 26 started out as part of a broader effort to reform the way jails had become de facto mental health treatment centers and to get mentally ill residents accused of petty crimes into community treatment programs. By the time it passed, however, the measure focused primarily on the process for determining whether people with mental illness arrested for low-level crimes have the mental capacity to stand trial.
In the past, the process dragged on so long that people were held at the state hospital for longer than the maximum sentence for the charges they faced, which for a petty misdemeanor, is 30 days. Act 26 shortened this timeline from three months to seven days, although lawmakers increased that to 14 days last year.
If people facing non-violent petty misdemeanor charges can’t be deemed fit to stand trial within two weeks, they are discharged from the hospital and their case is dropped.
More than 150 people were readmitted to the state hospital on petty misdemeanor charges between July 2024 and June 2025, with some admitted half a dozen or more times. About half of those readmitted were back in the hospital within four months, Civil Beat found.
In the letter, lawmakers asked the health department to provide detailed information about nearly a dozen areas of concern, including whether patients could be held in less restrictive facilities, what happens when someone is discharged from the state hospital after being found mentally unfit and whether the hospital takes steps to ensure they continue to receive medical care once they leave.
Lawmakers also asked health officials to explain whether the state hospital can obtain a court or administrative order for treatment over a patient’s objections and provide data on the number of people who are evaluated for involuntary treatment programs that would enable the hospital to hold them longer.
“If they’re not fit to proceed, the court cases drop. And that’s the end of it. And that’s why I think you have the revolving door, because these people are mentally ill, they go back out and do the same thing again, surprise, surprise, and then they come back,” Rhoads said.
The Department of Health will respond to senators “as soon as possible,” department spokesman Adam LeFebvre said in an email.
‘It’s About Time We Started Looking At It Again’
Generally, Act 26 has had a positive impact, state hospital administrator Mark Linscott told lawmakers at a Health and Human Services Committee briefing in October. But he said patients cycling in and out of the hospital is a persistent challenge.
“It’s about time we start looking at it again,” San Buenaventura said during the briefing. “The revolving door referred to by the Civil Beat article may continue unless hopefully we could have some solutions going forward.”
The mandate to release people within 14 days has led to people being discharged without having received much treatment, according to experts at the state hospital and service providers working with people with mental illness.
Many patients also struggle with addiction, and the short stays may not be enough to detox. In the letter sent to the health department director, lawmakers are asking whether the current timeline is sufficient to provide people with meaningful treatment. People leaving the hospital are often met with few resources and insufficient options for community-based treatment.
It’s not just Act 26 that needs to be reexamined, San Buenaventura said. She wants to take a closer look at other factors, like whether the broader strategy of jail diversion for people with mental illness is working.
“I don’t think that it’s Act 26 by itself that is causing this revolving door,” she said. It’s about “ensuring that there is stabilizing treatment that’s out in the community.”
Sen. Joy San Buenaventura at an informational briefing with leadership from the Hawaiʻi State Hospital in October to discuss the high number of people with petty misdemeanor charges cycling in and out of the facility.
Lawmakers also want to know whether the health department is fully utilizing programs that would allow them to take a more forceful approach. The hospital can’t hold someone involuntarily without a court or administrative order if they are not deemed a danger to themselves or others, nor can doctors medicate a patient against their will.
But there are initiatives like Assisted Community Treatment, which allows someone to obtain a court order to force a person who is refusing medication into treatment. The program is controversial because it involves people being medicated against their will. Proponents, however, say that it is key to interrupting the revolving door at the state hospital, and lawmakers want to know whether it’s a viable option that the state hospital uses.
Even then, there’s the problem of bedspace and a lack of alternatives. Hawaiʻi is heavily reliant on its state hospital for patients with mental illness who are facing charges.
“That, I think, is the next big problem: where we put people,” Rhoads said. The health department needs to expand other less acute options, “as opposed to funneling all these guys into the state hospital.”
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