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An inmate leaves after appearing in court on Zoom from Oahu Community Correctional Center. Many cases for mental health patients are heard virtually. (Kevin Fujii\/Civil Beat\/2025)<\/p>\nThe goal was to get help faster to non-violent offenders with mental illness. Instead, they are showing up again and again at the state hospital.<\/p>\n
Moments after a state hospital employee knocked on the door and told him to put on a shirt, the 61-year-old stared wide-eyed at a small smart phone screen transmitting his image into courtroom 7D of Honolulu\u2019s First District Court.<\/p>\n
The homeless man with salt and pepper hair watched attentively as a judge explained that he had been found mentally unfit and couldn\u2019t be prosecuted for the trespassing charge he\u2019d been arrested for in August.\u00a0<\/p>\n
\u201cYou\u2019ll be released today,\u201d the judge said on Sept. 3. \u201cI hope that you will take advantage of the services that you\u2019re being directed to, so that hopefully we don\u2019t see you back under these circumstances.\u201d<\/p>\n
The man nodded, but even a cursory glance at his record shows how thin that hope was.\u00a0<\/p>\n
Five years ago, Hawai\u02bbi enacted a law meant to keep people with mental illness who commit nonviolent petty misdemeanors out of jail and get them help faster. Too often, officials noted at the time, jails were serving as de facto mental health treatment facilities \u2014 a costly, ineffective and unfair system.\u00a0<\/p>\n
An inmate leaves after appearing in court on Zoom from Oahu Community Correctional Center. Many cases for mental health patients are heard virtually. (Kevin Fujii\/Civil Beat\/2025)<\/p>\n
Though initially envisioned as a dramatic transformation of the state\u2019s criminal justice system, one of Act 26\u2019s biggest changes was significantly shortening the amount of time mentally ill people arrested for low-level crimes can be held in jail or at the state hospital waiting for doctors to determine whether they are competent to stand trial. If they can\u2019t be restored to mental fitness, they are to be released, with their charges dismissed, and referred to community-based treatment.\u00a0<\/p>\n
In the beginning, the new law was lauded as a great success, saving the state millions of dollars and dramatically decreasing the time people were sitting in jail waiting for a mental health assessment. But five years later, longer-term data is painting a very different picture.\u00a0<\/p>\n
The number of people admitted to the state hospital with petty misdemeanor charges under Act 26 has soared by almost 2,000% since the act took effect in 2020, further straining the already overwhelmed facility. More troubling, experts say the approach is failing to get people the help they need. Diverting people into treatment can mean simply dropping people off at a shelter run by the Institute for Human Services, where they often walk away.<\/p>\n
\u201cIt has not eliminated the revolving door.\u201d<\/p>\n
Kori Weinberger, former Big Island prosecutor<\/p>\n
The act\u2019s shorter deadline for determining mental fitness \u2014 a week at the start, recently increased to two \u2014 also means people aren\u2019t being held long enough to receive meaningful treatment during their stay at the state hospital. They are frequently released in the throes of psychosis or addiction, particularly to meth, and there hasn\u2019t been a sufficient increase in community-based services to catch them. Most are homeless and end up right back on the street.<\/p>\n
\u201cIs it better for them to be in state hospital than in the jail? Like, yeah, I guess,\u201d said Kori Weinberger, a former prosecutor on the Big Island. \u201cBut \u2026 it has not eliminated the revolving door.\u201d<\/p>\n
The 61-year-old released by the judge on Sept. 3 has been sent to the state hospital 22 times in five years. Sometimes, he\u2019s discharged only to be arrested again just a few days later. About a week after his Sept. 3 court appearance, that\u2019s exactly what happened: He was arrested for another petty crime, a misdemeanor for theft and trespassing.<\/p>\n
An Auspicious Start<\/p>\n
Act 26 grew out of a national conversation about how to prevent people with mental illness from cycling between jails, hospitals and the courts. Nationwide, people with mental illness were 19 times more likely to end up in jail than in a psychiatric facility.\u00a0<\/p>\n
To be prosecuted for a crime, the defendant has to understand what\u2019s going on in court and be able to aid in their own defense. Those with acute mental illness, significant developmental disabilities or serious substance use may not fully understand the role of the judge or what it means to face charges, and may not be able to provide their defense attorney with alibis or witnesses.\u00a0<\/p>\n
In Hawai\u02bbi, people facing low-level charges were spending weeks \u2014 even months \u2014 waiting in jail or sitting at the state hospital while doctors tried to restore them to fitness.\u00a0<\/p>\n
They could be held in jail for 30 days waiting for an evaluation to be completed. Often, that deadline wasn\u2019t met. In 2017 and 2018, about 275 people facing misdemeanor charges spent more than 12,000 days in jail pre-trial waiting for access to mental health treatment at the state hospital, according to Hawai\u02bbi Supreme Court Chief Justice Mark Recktenwald.\u00a0<\/p>\n
Defense attorneys were sometimes reluctant to challenge their clients\u2019 ability to stand trial because it essentially equated to receiving the maximum sentence before they had even been found guilty.<\/p>\n
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A man appears in Honolulu District Court for his case on Sept. 12. (Kevin Fujii\/Civil Beat\/2025)<\/p>\n
Those who made it to the state hospital were later released without sufficient follow-up services in the community.\u00a0<\/p>\n
\u201cIn too many instances these same defendants are arrested again for a petty misdemeanor or misdemeanor and the cycle restarts,\u201d said a 2020 report by the state\u2019s Hawai\u2019i Mental Health Core Steering Committee, a group of judges, mental health experts and law enforcement officials that had come together to try to figure out how to improve the system.<\/p>\n
To address this, the Legislature passed Act 26 in September 2020. The goal was two-fold: First, divert non-violent low-level offenders with mental illness out of the criminal justice system and into community treatment in days rather than months. And second, prevent people from being held in custody waiting to get a mental health evaluation longer than the maximum sentence for their charge, which for a petty misdemeanor is 30 days.\u00a0<\/p>\n
The new law expedited the process for determining whether someone was \u201cfit to proceed\u201d in court. People facing non-violent petty misdemeanors like trespassing, sleeping in a park or low-level theft have to be evaluated either at the jail or the state hospital within a matter of days.\u00a0<\/p>\n
It also shortened the amount of time people could be held at the state hospital while receiving treatment, medication and therapy to restore the cognitive ability needed for the case to go forward. Previously, doctors had up to three months to do so. Now, it\u2019s two weeks.\u00a0<\/p>\n
If at the end of that stay they are determined to still be unfit, the case is dismissed and the person is discharged from the state hospital.<\/p>\n
Act 26 got off to a slow start. It was enacted in the early days of the pandemic when the Hawai\u02bbi Supreme Court had ordered all defendants charged with petty misdemeanors released from custody.\u00a0<\/p>\n
Only one person was evaluated for fitness in the first couple months of the program. But within the first full year, the volume of people with petty misdemeanor charges admitted to the state hospital for a fitness evaluation increased five-fold.\u00a0<\/p>\n
Within the last three years, the number of people entering the state hospital as a result of Act 26 has skyrocketed. Between June 2024 and July 2025, total admissions under the program reached 228.<\/p>\n
At first, Act 26 was considered a success. About two-thirds of those who received an expedited fitness evaluation in roughly the first year of the program had their cases dropped, were discharged and linked with services on the outside. People picked up on petty misdemeanors spent less time in jail, which resulted in more than $1 million in savings for the Oahu Community Correctional Center. The state hospital also saved more than $7 million in approximately the first year of the program because of shorter patient stays, according to a report by the judiciary in December 2022.<\/p>\n
\u201cThe positive impact of Act 26 is clear and profound,\u201d the report read. \u201cPreventing non-violent offenders who suffer from a mental illness from serving extended terms of incarceration provides the best opportunity to extend case management and peer specialist support.\u201d<\/p>\n
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Hawaii State Hospital has seen skyrocketing numbers of admissions since the passage of Act 26. (Cory Lum\/Civil Beat\/2015)<\/p>\n
A Disturbing Pattern Emerges<\/p>\n
There\u2019s a pattern that plays out three times a week in Courtroom 7D in the Honolulu District Court, where fitness to proceed cases are heard. A state hospital employee patched in via Zoom walks down the sterile white hallways of the state hospital wrangling everyone who has a court hearing that day. The cases are heard rapid-fire, and they almost always go the same way.<\/p>\n
Of the roughly half-dozen defendants in Act 26 cases that had hearings on two days in August and September, several had been to the state hospital before, some more than half a dozen times. None were found fit, and the judge ordered them to be discharged, their cases dismissed.<\/p>\n
Under Act 26, it\u2019s incredibly rare that people are stable and mentally competent enough to stand trial at the end of their two-week state hospital stay. Some refuse treatment at the hospital, and doctors can\u2019t forcibly medicate them. It also takes some time for psychiatric drugs to take effect. Heavy meth use can alter the brain to the degree that it\u2019s not going to snap back when someone stops using.\u00a0<\/p>\n
Patients can\u2019t stay longer unless they are found to be a danger to themselves or others, or someone files a petition to involuntarily commit them through a program called Assisted Community Treatment.\u00a0<\/p>\n
Instead, the vast majority are released because doctors determine they can\u2019t be restored to fitness before the clock on their short-lived stay at the state hospital has run out. Most return to the community in about the same mental state as they were before, many still struggling with psychosis or addiction.<\/p>\n
\u201cIt\u2019s enough time to determine whether the person is fit to proceed, they can participate in their defense,\u201d said Connie Mitchell, executive director of the Institute for Human Services. \u201cBut it\u2019s not enough time to actually treat someone.\u201d<\/p>\n
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The Hawaii State Hospital in K\u0101ne\u02bbohe where crowding has forced the Department of Health to waive licensing standards to allow an additional 123 beds. (Cory Lum\/Civil Beat\/2015)<\/p>\n
It\u2019s especially difficult if the person is coming to the hospital off the street, which is happening more and more frequently as the number of people admitted on charges like trespassing and unauthorized lying in a park has gone up.<\/p>\n
When Mitchell thinks about whether Act 26 has been successful, she thinks of a woman who has been in and out of the state hospital for more than two decades. A number of years ago, before the law changed, that things were going well for her. She was receiving treatment, and she\u2019d finally gotten stable enough to be released into the community.\u00a0<\/p>\n
That was before Act 26. In the last five years, the woman, now 61, has cycled through the state hospital more than two dozen times, mostly on low-level theft and trespassing charges.\u00a0<\/p>\n
\u201cShe doesn\u2019t have treatment that lasts long enough for her to be able to benefit from it, and then she\u2019s homeless most of the time now,\u201d Mitchell said. \u201cI don\u2019t think you can expect much more. I feel like she\u2019s a victim of the system.\u201d\u00a0<\/p>\n
With longer-term medication and support with daily living, Mitchell thinks things might be different for the woman. But she\u2019s not getting those services now. At the end of August, she was arrested again for criminal trespassing and minor theft from a Cajun restaurant in Waik\u012bk\u012b. Once again, she went to the state hospital for about a week.\u00a0<\/p>\n
\u201cShe\u2019s going to go through the same thing again,\u201d Mitchell said. \u201cShe won\u2019t come out fully medicated and treated, and we\u2019re going to have to chase her and figure out how to engage with her so that maybe she\u2019ll take some medications.\u201d\u00a0<\/p>\n
The number of people returning to the state hospital has gone up, too. More than 150 people were readmitted to the state hospital on petty misdemeanor charges between July 2024 and June 2025, according to the Department of Health.<\/p>\n
\u201cFor the longest time the Hawaii State Hospital has been that one size fits all and it doesn\u2019t work any longer.\u201d<\/p>\n
Dr. Michael Champion, senior advisor to the governor on mental health and the justice system, told lawmakers last year.<\/p>\n
Previously, people would still come in and out of the state hospital, but it was less common and it took longer for them to reappear. Now, people are cycling through more quickly. About 7% of all admissions to the state hospital were in a hospital room just a month before. About half of those readmitted under Act 26 are back in the hospital within four months, according to the Department of Health.\u00a0\u00a0<\/p>\n
Although the hospital\u2019s current administrator, Mark Linscott, said the staff tries their best to treat these \u201cfrequent fliers,\u201d that\u2019s hard to do on a rapid turnaround when someone has serious mental health or addiction issues.\u00a0<\/p>\n
\u201cIf we get repeat offenders, then something\u2019s not working right,\u201d he said.\u00a0<\/p>\n
The frequent churn is also hard on the state hospital, which is the only state-run inpatient treatment center for psychiatric hospitalization in Hawai\u02bbi and is supposed to be reserved for the highest need and highest-risk patients. Instead, it\u2019s filling up with people who even the hospital\u2019s own leadership and other experts say could be better served in a less intensive setting.<\/p>\n
Only about a quarter of people at the state hospital medically need to be there, the hospital\u2019s then- administrator Dr. Kenneth Luke told lawmakers last February.\u00a0<\/p>\n
\u201cSomething is wrong. The continuum is too heavily focused on the hospital,\u201d he said.<\/p>\n
On a single day in August, 386 patients were being held at the state hospital, which is only licensed to hold 292. That crowding has forced the health department to waive licensing standards to allow an additional 123 beds. Act 26 has increased the annual patient count by 20%, Linscott told lawmakers in August.\u00a0<\/p>\n
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A homeless encampment at Ulehawa Beach Park in Wai\u02bbanae. (Kevin Fujii\/Civil Beat\/2025)<\/p>\n
About three-quarters of admissions are homeless, a proportion that rose in July 2022 along with the number of Act 26 cases, according to data from the Department of Health. Many face non-violent misdemeanors related to living on the streets, like trespassing or low-level theft. In places with a more robust array of community-based services, those people probably wouldn\u2019t be hospitalized.<\/p>\n
Act 26 didn\u2019t come with a funding stream to expand community-based services for people leaving the hospital. While the hospital staff do their best to take care of the patients, Linscott and Mitchell agree, the handoff to services in the community is lacking.\u00a0<\/p>\n
\u201cThe bottom line is we need to meet people where they\u2019re at. Sending them to the highest level of care in this community may not be the right direction,\u201d Linscott said. \u201cBut unfortunately, there isn\u2019t alternatives built in the system structure to do it in a different way.\u201d\u00a0<\/p>\n
Social workers at the hospital try to connect people to groups like the Institute for Human Services, which offers case management for people with severe mental illness, many of whom are experiencing homelessness. But their capacity is limited, and not everyone wants to participate. Even if a person gets dropped off at the IHS shelter when they\u2019re discharged, they don\u2019t always stay for long.\u00a0<\/p>\n
\u201cIdeally, they come out, we get the meds, we can basically help them continue taking the medication, and we can start working on them really getting back into housing and connecting them with a rehabilitation program,\u201d Mitchell said.\u00a0<\/p>\n
Instead, Mitchell said, people are trapped in a cycle: \u201cIt\u2019s almost like they\u2019re stuck in this Groundhog Day thing.\u201d<\/p>\n
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