Psychiatrists who inspected state facilities cited problems ranging from overuse of pepper spray to intentionally harsh conditions on suicide watch. <\/p>\n
Severely mentally ill prisoners in Hawai\u02bbi 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.<\/p>\n
The psychiatrists\u2019 grim report on mental health services in O\u02bbahu Community Correctional Center and H\u0101lawa Correctional Facility \u2014 completed earlier this summer but never before made public \u2014 identified inmates who were so severely ill they clearly should have been moved to Hawai\u02bbi State Hospital for treatment.<\/p>\n
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 H\u0101lawa deliberately made inmates on suicide watch endure harsh conditions as a strategy to discourage malingering.<\/p>\n
Tommy Johnson, director of the Department of Corrections and Rehabilitation, told Civil Beat on Friday that \u201cwe asked for a truthful report, and I believe we got it, and I think now it\u2019s up to us and the policymakers to make certain decisions to address those critical issues.\u201d<\/p>\n
The report by Dr. Jeffrey Metzner and Dr. Bhushan Agharkar, nationally known experts on correctional mental health care, becomes public at a time when H\u0101lawa 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.<\/p>\n
By comparison, the overall death rate from suicides for the entire population of nearly 3,800 Hawai\u02bbi 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.<\/p>\n
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A H\u0101lawa Correctional Facility inmate sleeps in a cell. Psychiatrist Pablo Stewart said the number of suicides at the prison in the past year is \u201cway off the chart,\u201d leaving the state vulnerable to lawsuits over the lack of mental health services inside. (Cory Lum\/Civil Beat)<\/p>\n
Many inmates at H\u0101lawa had serious mental illnesses but \u201caccepted mental health treatment modalities are often lacking or being provided by unlicensed clinicians without adequate supervision,\u201d according to the report. \u201cAs such, the psychiatric care received is inadequate to address the level of severity present in this population.\u201d<\/p>\n
The rash of suicides at H\u0101lawa is \u201cjust way off the chart,\u201d said Dr. Pablo Stewart, a longtime correctional psychiatrist and an expert witness in forensic psychiatry. \u201cThat\u2019s an emergency. I\u2019m not trying to be hyperbolic on this. That is an emergency.\u201d<\/p>\n
That leaves the state vulnerable to new lawsuits, Stewart said, and those lawsuits could finally force Hawai\u02bbi to improve mental health services and expand its suicide prevention efforts inside.<\/p>\n
Hundreds Of Mentally Ill Prisoners<\/p>\n
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<\/a> that alleged the state provides inadequate mental health services, which led to suicides in Hawai\u02bbi correctional facilities.<\/p>\n The outside experts were chosen jointly by the state and Honolulu lawyer Eric Seitz, who filed the original lawsuit in 2019.<\/a> 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.<\/p>\n Metzner and Agharkar filed their report with the state in late June based on inspections of the two Hawai\u02bbi facilities earlier that month. It concluded conditions in both H\u0101lawa and OCCC are \u201cvery problematic.\u201d<\/p>\n 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 \u201catrocious.\u201d<\/p>\n \u201cIt\u2019s just that you don\u2019t have enough support there to have bare minimum mental health care,\u201d she said. She was particularly concerned about the lack of licensed mental health professionals at the facilities.<\/p>\n According to the report, about 300 inmates at H\u0101lawa 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.<\/p>\n Five of the six clinical psychologist positions at the prison were vacant, and the mental health section supervisor was expected to leave that position \u201cin the very near future,\u201d according to the report.<\/p>\n OCCC had similar issues to those at H\u0101lawa. Three of the five positions for clinical psychologists at OCCC were vacant along with the section supervisor\u2019s 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.<\/p>\n The report also noted the position of statewide director of the correctional mental health system has been vacant for over 10 years.<\/p>\n Suicide Watch And Pepper Spray<\/p>\n The report also raised concerns about harsh conditions in the H\u0101lawa 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.<\/p>\n Staff in H\u0101lawa reported \u201cthe harsh conditions of confinement within the mental health infirmary were designed to be a disincentive for some inmates\u201d who wanted to get out of the general population because they felt unsafe there.<\/p>\n This was common for inmates who had \u201csafety issues,\u201d according to the report, but there was no efficient mechanism in place for resolving the safety issues while the prisoners were in the infirmary.<\/p>\n \u201cThat alone would win you millions of dollars in lawsuits,\u201d Stewart said.<\/p>\n Some prisoners, such as those assigned to gang modules, fear for their lives and claim to be suicidal to get out, he said, but \u201cthe better solution is not to make your suicide area terrible, but to increase security and staffing so people don\u2019t feel like they have to say they\u2019re suicidal to get out of a housing assignment.\u201d<\/p>\n Harsh conditions on suicide watch also backfire by discouraging \u201ctruly suicidal people from admitting they are suicidal,\u201d Stewart said, \u201cbecause they don\u2019t want to be placed in these horrible settings.\u201d<\/p>\n The report raised a similar issue for OCCC, where it cited a problem with \u201cinmates remaining on suicide watch for prolonged periods of time due to self-identified safety concerns in contrast to being clinically suicidal.\u201d <\/p>\n Some remained on suicide watch for many months, which the report said was \u201cnot acceptable.\u201d<\/p>\n The report also criticized use of pepper spray that was \u201cexcessively deployed\u201d 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.<\/p>\n Another issue raised in the report was a lack of \u201cpsychological autopsies\u201d 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.<\/p>\n There were no psychological autopsies done for two recent suicides reviewed by Metzner and Agharkar, according to their report.<\/p>\n 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.<\/p>\n Rather than pointing the finger of blame at anyone, Levey said the point of those death reviews is \u201chow can we prevent it from happening again? What can we learn from this?\u201d<\/p>\n Finding The People They Need<\/p>\n 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.<\/p>\n 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\u2019s administration to include funding in the governor\u2019s next budget request.<\/p>\n 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.<\/p>\n 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.<\/p>\n Metzner and Agharkar said in their report the functional vacancy rate for correctional officers at H\u0101lawa was 34% when officers who are absent on long-term leave were taken into account.<\/p>\n 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.<\/p>\n 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.<\/p>\n \u201cIt\u2019s 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,\u201d Stewart said. \u201cThey\u2019re going to become more psychotic, they\u2019re going to become more assaultive, and they\u2019re going to become more suicidal.\u201d<\/p>\n Deteriorating Facilities<\/p>\n The section of the report focused on H\u0101lawa found \u201cthe physical plant within the metal health infirmary was dismal. The conditions of confinement were equally dismal.\u201d Staff explained that a new infirmary for H\u0101lawa has been funded, but construction will not be complete for another two years.<\/p>\n As for OCCC, the report described Module 1 for the most seriously mentally ill as a space where \u201cthe decrepit physical plant, overcrowding and restricted out-of-cell time exacerbates many of the inmates\u2019 mental illnesses.\u201d<\/p>\n Johnson has been pushing for years<\/a> for construction of a new jail at H\u0101lawa, but has encountered resistance from critics<\/a> who say the state should first invest in more community-based mental health and drug treatment programs so people can be diverted from incarceration.<\/p>\n Some of the issues raised in the report are familiar in a haunting way.<\/p>\n Conditions for mentally ill inmates at OCCC became so bad nearly two decades ago the state was placed under a federal court consent degree<\/a> that forced it to improve services. But those improvements proved to be temporary. <\/p>\n When asked if the state could again become subject to court oversight, Johnson replied: \u201cI think we\u2019re at the point where we need to be concerned about not addressing the overcrowding issue, not addressing the living condition issues, hence we\u2019re trying to get a new OCCC,\u201d Johnson said. <\/p>\n \u201cBut more to the point,\u201d he added, \u201cwe 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.\u201d<\/p>\n![\"Halawa](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/09\/Halawa-Prison-Infirmary-Guard1-1024x592.jpg\")
A corrections officer peers out from the H\u0101lawa Correctional Facility infirmary. Experts described the physical plant of the mental health infirmary at the prison as \u201cdismal.\u201d (Cory Lum\/Civil Beat 2015)<\/p>\n![\"Basic](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/09\/Basic-Corrections-Recruit-Class-17-01-graduation-ceremony-Halekoa-hotel8-1024x683.jpg\")
A graduation ceremony for corrections officer recruits. The state has launched an initiative to step up recruiting and run more training classes, but the O\u02bbahu jail and H\u0101lawa prison both reported functional vacancy rates of more than 30%. (Cory Lum\/Civil Beat 2017)<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/09\/Tommy-Johnson-staff-survey-300x196.png\")
Tommy Johnson, director of the state Department of Corrections and Rehabilitation, acknowledged shortcomings in treatment of mentally ill inmatges. (Screenshot\/2025) <\/p>\n
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