Restrictive Housing Legislative Working Group

Convening our Restrictive Housing Legislative working group Act 292 working group here at Hawai'i State Capitol. 9:30am Today is two Tuesday, January 13, 2026. Conference room 325 Members. Happy New Year. Let's just jump right into the agenda for a call to order. I will do the roll call of Members. [Roll Call]

Romy Glidewell, Healthcare Division Administrator and place. Director Johnson. Thank you.

[Roll Call]

And Chair. One correction. Michael Hoffman is actually sitting in on the Committee for Director Johnson. Okay, my apologies. I'm sitting in as for the hearing part of it.

Okay, thank you. So, Mr. Hoffman here present on behalf of Mr. Johnson, but Ms. Glidewell is here also to assist with the presentation portion. Okay, Members, moving to the next item on the agenda. Approval, admittance, decoration, December 16, 2025. My apologies.

My staff is still continuing to draft and finalize the minutes for December 16, so we will have that available for our next meeting, which has been slated for January 27, and we'll review those meetings at that time. Rolling into the.

Rolling into the overview and discussion about DCR's 2026 budget request and plans to address population serious mental conditions before we move into that. And it's. It's also related to the section of the minutes my staff is passing out.

Ms. Woodward statement from the last December 16th meeting, as well as administrative segregation stats for 2025 that was provided to the Committee from DCR Ms. Ipopo, who's assistant to the Director. So we want to thank the Director for providing those statistics and that these documents are being passed out as they will inform our discussions.

Again, you should be getting a copy of the administrative Segregation stats for 2025 and Ms. Woodward's statement from the last meeting. Okay, so moving on. The next item on the agenda is the overview and discussion about Department of Correction and Rehabilitation's 2026 budget request. And plans to address population, serious mental conditions Members.

What was distributed as part of the packet was a copy of the Opulento. Settlement.

Experts report as well as the settlement tracker, as these are the documents most relevant to the departments of addressing serious mental health illness and conditions and how there's a lot of intersection with the subject matter that the Act 292 group is supposed to be overseeing. So that has been provided to you and Members.

That's the subject of the discussion as well for today. But for this presentation part, we'll turn it over to either Mr. Hoffman or Ms. Glidewell and we'll let DCR handle that part portion of it. So go ahead.

And my understanding then is that the presentation part of this is what our current status and plans are to identify the mental health population and serve them better in all eight care facilities, is that correct?

It's to talk about the current status. But then what are your budget requests and the plans to address that population? And my understanding is that a lot of it is being driven by the Opulento experts report and the settlement tracker. So it's. If we can have some discussion about those documents. Absolutely.

So the expert reports that we engaged with gave us a generalized ratio of patient to licensed provider that they would recommend in an incarceral setting.

We tabulated what that would look like based off of our SPMI population as well as those who are not considered SPMI but prescribed but are required prescriptive medication because that is part of the workload for our prescribing doctors.

In addition to diagnosing, assessing and prescribing, just like they would in community, the additional workload in a correctional facility is doing suicide risk assessments, clearing for work line clearing for transfer, as well as some other, I wouldn't call them administrative, but policy requirements.

So in a typical day, prescribing doctor or psychiatrist will unfortunately sometimes not get to see what would be like a General population, like medication adjustment patient, because something happened in facility. So our previous allotment for prescribing doctors was extremely shy based on their ratio recommendation. I believe those original recommendations came out of a 2006 settlement.

And a lot has changed in the mental health Department in our population. You guys have all seen the numbers of mental illness skyrocketing, substance use disorder, psychotic syndromes skyrocketing, and we never really got additional providers based off of those community changes.

The one variation that we adjusted for based off of the settlement was Hawaii gives full practice autonomy to nurse practitioners. And you, uh, MNOA has a PMHMP program, which is psychiatric mental health nurse practitioner. They do an additional two years of schooling. They sit for a board, they do clinical rotations specific to mental health and psychiatric disorders.

Their salaries are significantly less like compared to our psychiatrist psychiatrists around 300,000 to 320 a year. The nurse practitioners are 170 to 100. So their original recommendation of closer to like, I guess the numbers would have been closer to 20 psychiatrists, which we did not think that we would be able to procure.

We have a hard time finding those professionals. Everybody does. We parlayed some of those positions into what we call mid level providers. We did have a pilot program where we did hire, I can't remember offhand how many. We had three or four specific PMHMP providers to see how they worked into our system and into our workflow.

It was a good learning experience because we didn't have very clear definitions with the staff, but we were able to develop proper position descriptions and proper workflows with that role because it's kind of a crossover role where there are nurses, but they're working in the medical branch and they're working in the mental health branch.

Previously we were pretty siloed where those branches didn't cross over as much as that one role created. So it allowed us to figure out some problems that we could get ahead of for this next implementation.

So when we had the experts come out and they made the recommendation for that number of staff, we sat down to really identify how can we really get this staff, these positions filled. So we settled on the. I believe it's the seven psychiatrists and the 13 nurse practitioners. Sorry, that's not right.

It's 10 nurse practitioners and seven psychiatrists. And then the RN positions are being requested because we need an RN for each clinic to run, manage and oversee it when the provider puts in orders, essentially. So that's what the budget request for was for.

I believe it's in the governor's package currently, as Director Johnson said at the fiscal hearing, he's requesting that we get partial funding for them so that we can establish the positions. We have to establish the positions within our organizational chart. Then we have to begin recruiting.

It is a bit of a process to get them on board and we don't really want to waste time doing that. We want to get them started as soon as possible.

One of the things that we found from our pilot program with the nurse practitioners was that if we had a nurse practitioner doing an initial intake assessment earlier on in the inmate's journey through our system Essentially at jail intake.

Like if they don't, if they stay over the weekend, and we know they're going to be here a little longer. We were doing earlier assessments and we found that the nurse practitioners were able to get the medical information from Community better than the RNs were. Currently we have RNs doing that.

But as you guys know, like Corrections Healthcare uses a lot of acronyms. There's a lot of diagnostic tests, there's a lot of medications that may show up. And if that RN doesn't know right off the bat what that means, they may miss it as a red flag item in the patient's chart.

We do currently check the Hawaii Health Information Exchange, which has all their ER records, things like that. We really like go through anything we can get our hands on.

So we did find that those inmates who went through intake with the nurse practitioner had a better establishment of care throughout their whole journey, which included mental health, substance use disorder. But the medical piece of.

I know we're not talking about that, but that was one of the things that we found is they screened them much better for these longer care items that we were trying to find. So that's one aspect of the budget request and that's how we differentiated the roles and why we leaned that way.

I think I mentioned at a previous hearing, and it's important that you guys understand that we recently put out one position. We had one APRN position post. We had 18 applicants. Eight of them were qualified for the position. Seven of them were this PMHMP role. They are out there.

They want to come on board, they want to work in corrections. They want to come to work rather than work via telehealth. And that was just our first run at a family practice nurse. We had a significant turnout, so it made us pretty hopeful in this ask that we'll be able to fill the position.

And as I mentioned UH Monoa just launched their program. I want to say they had their first graduating class last year, but they will be producing new grads with these licenses every year if there's jobs here in Hawaii. So. And we want to be part of that solution for the state.

Anything further for you folks to present about this budget topic? Budget requests and plans to address population. That's specific to the budget. Yeah. Okay. And any other plans to address the population with serious mental conditions that you can talk with us?

We're currently still working with DOH on an improved MOA. I think that Director Johnson mentioned before, the previous MOA was specific to OCCC and the reason was for that was OCCC is our primary intake center. So even parole violators went to OCCC first before. Before they went to any of our prisons.

One of the things we changed that during Covid for several reasons. But what we didn't anticipate was that a lot of our deflection efforts, including to DOH, was only through OCCC.

So if somebody came in acutely psychotic, needing support for their mental illness, but they went to Halawa, our MOA didn't support what we call an MH9 transfer, which is directly to DOH. We're working around that.

But we do need it to be very clear in the MOA that we're allowed to transfer from other facilities because of that parole violator change that happened. I can't remember what year might have been 2023ish. So that's one of the things that we're working on updating.

We're also working on updating and streamlining that whole process of how we do transfers and exchanges with DOH. We did send a draft to them. I have not. Again, that's Director to Director. So I'm not completely, completely involved in that.

But I don't do know that Director Johnson sent our first draft to DOH, and I believe we're waiting for their response and edits.

I have a question.

Sure.

Yes. You mentioned MOA with DOH, OCCC. Have they included the Navy island jails as well?

I don't. So one of the things that we do is. And I don't. I can't speak for DOH because I don't know what I think that they only have a facility here. So what we've historically done is if anybody has such a severe.

Is acutely, severely mentally ill at our outer islands, we actually transfer them to OCCC because we don't have suicide cells in a lot of our neighbor islands and we don't necessarily have the staff to support it. So when we.

We do our best to manage them there, especially if they have court dates pending, because obviously flying them back and forth is really challenging on everybody. Something. Sometimes it's hard to even get them on planes. But what we would typically do would be fly them OCCC, try to stabilize them.

And if we still can't stabilize them, then we would. They would still go through the OCCC and the MOA would apply.

Thank you very much. So with the previous information that you gave us, are the neighbor island facilities being considered for the RNs and the physician assistants?

Yes. So even though the Opulento case only really looked at Halawa and OCCC. The Director did ask me to extrapolate that data and pull the SPMI patients and the mental health needs for all islands.

I believe on the form we submitted to the governor's office, it does identify how much, how many of those positions would be allocated for neighbor islands as well. And we'll look at it a little bit closer, but we were really just going with the census and of course our census changes.

But yeah, the other thing as far as the population goes that we're doing right now is I know Director Johnson is working on a.

And again, I'm going to speak kind of loosely and let him fill in the details at another time, is that we are looking at moving our severely mentally ill patients to a facility that's more established as a mental health unit. I don't know where that's going to be. I do know that we've had several meetings on that.

We have identified those patients. Those were specifically identified by Dr. Mexner in the Opulento case as needing a choose my words carefully. So not necessarily a higher level of care in the sense that they're acutely ill because they're actually very stabilized. What he identified, and we concur with, is that that population needs different reentry services.

They need a longer duration of time to support their transition into community. Especially if they've been institutionalized for a length of time. They haven't been required to make their own decisions. One of the things that a long term carceral setting does is we make their decisions for them.

We hand them their medication, we tell them when to do their laundry, we remind them to bathe, those kinds of simple things. When you're talking about releasing somebody to community, our job is to do that. But that doesn't set them up for success when all of a sudden they have all these choices in the world.

They have to figure out how to feed themselves and how to actually just take care of their primary needs. And the mental health population, even if we do a 90 day reentry, the data doesn't support that population being successful at just 90 days.

They actually need to be practicing those behaviors way earlier on because they might not have been very good at them to begin with. For instance, depending on a cognitive impairment.

Can you point out in the expert report where they make this recommendation of moving patients to another mental health unit?

I don't have the report in front of me, but it would be under the halal section, module 1A. He did a good job of identifying them. I would be able to get the page number for you at another time, but. Take a look at it now. Yeah, can you look at it now?

I might be able to take it from my tracker because my tracker did identify the page number.

I could ask a question after yours is worth.

Yes. Can you provide her with a copy of the expert report? And what is the number of patients that we're looking at moving for this. Last look was around 40. So 40 out of?

the census at Hulawa. I don't know what the census is. Do you know Mick, the Census at Halawa?

868,70. That's without actually looking though. No, no. You mean just mental health.

Yeah, because I thought like the experts report, didn't they identify like 60 patients and you guys are moving 40 out of 60 or something like that?

So that sense changes all the time. They came a while ago so I would have to look again.

The other thing, I'm sorry. So look, did you find that in the place so that we can. I want to really point this out, understand where it is in the experts report because this is about moving them to another level of care, right? Yeah, identifying another level of care.

And just for clarity, I think it's. They did not believe that that would be a level of care that they would have to be placed into the state hospital. They weren't that, you know, of that need.

So it would be page eight, paragraph four. And then I believe there's a second page nine, paragraph six. Pete, what was the second page? Page nine, paragraph six.

Okay, we.

And then page nine, paragraph seven identifies the rehabilitative piece that they identify as needing.

And is this plan to move these patients, when is this going to happen?

That depends on the place that we find for them. And if there's a contract that's needed, if there's that. I don't know. I know that Director Johnson did meet with Department of Health Director to kind of like identify if there was any way they could work together on that.

And I'm not part of those meetings, so don't want to misspeak.

Okay.

I think we need a lot. A lot more. We're probably going to need a lot more information about what's happening because this affects. Right. The. Treatment of others. And the whole point of this is that they're not put in restrictive housing. And. It provides space within the current facilities for others to not be placed in restrictive housing.

If I could clarify. So this particular population doesn't typically get put into restrictive housing. So we do have a process, and please speak up if you can, that our mental health staff is called to any administrative segregation hearings to speak on behalf of any of the patients that they're caring for.

And if any concerns come up or if there's any issues with them being put into restrictive housing because of their mental illness, Medical actually has the opportunity to address it right then and there. And historically, we've never gotten any pushback from security.

If we identify a mental health patient that's being put in restrictive housing for an inappropriate reason or for an inappropriate amount of time, they have the opportunity to.

Or even placed in there at all.

Yeah. Yeah. That is a cooperative relationship that Security and Medical currently has with this population. So that particular. Those particular inmates, I can honestly say Halawa was my facility prior to taking my administrative position.

The only time they ended up in restrictive housing would be on suicide watch because they decompensated and were acutely psychotic, which sometimes for this population can last months. Unfortunately, I've never seen people dysregulate for the length of town as I have in these facilities.

If I could chair. There was a section of the report I want to say it might have been under occc. And one of the recommendations was talking about the condition of the suicide safety cells and saying that they were designed for.

There was a specific part of the report to find the page number that said they were designed for two people at best, but some had up to like four to seven patients in them. And so I would consider that restrictive housing. And so could you elaborate a little.

Bit more on that and to be clear, by the definition in Act 292, the restrictive housing is pretty clear.

So OCCC and I believe this has been brought up before and it's one of the reasons why we continue to ask for a new facility at OCCC is you are correct, as far as the square footage goes, the challenge that medical and security is under is If I have 16 patients who are suicidal and I only have seven cells, because the building only has seven cells, I don't really have other options.

So a suicide cell has to have no ligatures. It can't have the sink and the bed that the other cells have. The other issue is that we require direct supervision, direct visual supervision.

So I can't necessarily put them in a cell at a housing unit because there's an ACO stationed there for three shifts all the time until they're released. So we've really had a challenge of adapting our current facilities to the increase in suicidality that's that we're seeing.

And does the budget Bill that the Department presented last week addressed that?

I know there was, I think $2 million requested for kind of like improvement of different facilities with that or anything in the budget request, you know, be able to maybe add more safety cells or make it so that we don't have to have so many people in one suicide safety cell.

That's a institutional.

Well, I. Four in a cell is very rare, if at all anymore. At this point there could be 34. I don't even think you'd have enough mattress space to put it down for them.

Right. The report said they had to arrange themselves like there was a part in the report.

So I know when I've been there, if the numbers start exceeding the actual suicide cells, they'll start putting them in regular cells. But put a one on one ACO with them because it doesn't have all the ligature stuff and the appropriate bedding and whatnot. And I apologize, I do not do the health care requests for budgeting.

And thank you for sharing that information. So if somebody has asked for $2 million, then obviously they're doing more upgrades or they're trying to create more suicide cells. Special beds, special setups. And it costs money to do.

Sure, I think. And I'm sorry, chair if I could, for the 2 million I thought that had been allocated for the perimeter fencing. And then I saw a couple other capital improvement requests for that, but I didn't see anything about the safety cells, so I just wanted to raise that.

So one of the things that we are moving forward with which the 2 million wouldn't necessarily fit would be the consolidated healthcare unit for Halawa, which does expand the amount of beds at Halawa, but not occc. So I'm not exactly sure what that specific one is.

I know that we've also been working with a suicide risk screening tool that is culturally and algorithmically based, which we are right now in kind of a preliminary pilot approach to seeing if it isn't a better screening tool than we currently have.

That's with a group that the Director has been working with and my mental health branch administrator is working with. So again, just kind of finding a tool that's improved so that we can better identify those that are genuinely suicidal. Because one of the things that did come up in the Opulento case is that.

We may be having people on suicide watch and we'll call it restrictive housing for our purposes today who may not actually be suicidal. The challenge that my licensed professional staff has is that onus is on them to decide somebody's not suicidal or suicidal. And they have made mistakes.

In the history of DCR, we have made mistakes and those providers have had to live with those mistakes.

Sorry.

Can I go ahead and Chair? I'd like to go ahead and ask my question. I think it's related to just that previous statement, just regarding the medical intake. I know you had mentioned that.

Was it physician's assistants or nurse practitioners that is recommended rather than RNS, then my question is, would it be, are they, is it for a mental health assessment and would they be done by mental health professionals or is it for an overall medical assessment?

So the initial intake is actually done by intake services center on that screen is red flag questions that automatically refer them to a mental health provider if they say yes. One of the things that we found is that specifically with the mental health population, Sorry, I'm addressing you and addressing you guys.

It's weird, is that they often will say no and they'll deny any mental health history. They don't typically like to be singled out. They don't typically like to be put on their meds. A lot of the time they're back in because they've been off of their meds by choice.

So one of the things that we've found is that if they say no to the questions on the intake screening, which creates the automatic referral to our medical and mental health folks, we're missing a certain level of the population or the severity of the population.

So what we're asking, or we're trying to Implement is having a secondary physical assessment and medical record review done by a nurse practitioner because of the higher level of education and discernment to be able to pick those critical pieces out of their medical records that we have access to.

Can that be done by a mental health professional rather than a nurse practitioner? I mean, would that be a better fit? I guess, for that, if you're trying to screen for mental health issues.

So an intake screening is for every single inmate that comes through our doors. They have to be able to do both. We wouldn't. I mean, that would be a tremendous lift to have every single person go through a mental health professional and a medical professional.

Or that aspect where it gets referred to the nurse practitioner rather than the nurse practitioner making that assessment. Would it make more sense for a mental health professional to make that assessment when it comes to mental health issues? I think is probably how I'd frame.

The question to clarify. The nurse practitioner is a mental health professional.

Okay. Also by certification, I know nurse practitioners have different, you know, different qualifications, but are they also qualified as a mental health professional?

I guess in that regard. So D Herd only acknowledges one type of nurse practitioner, which is the APRN2. However, we are allowed to designate what type of nurse practitioner we're going to hire, but to establish the positions, we can only establish them as APRN2s.

The intention is to hire the PMHNPs, which is the psychiatric mental health nurse practitioners. That's just not part of the request on the form A because it's not an acknowledged position in Vitiheart.

Thank you for the clarification.

And if I could just clarify, even though all inmates come in and they get the review by isc, they still will go into the medical unit as a part of that intake process.

So if somehow, like Romy said, they know they don't want to admit to any mental health illness or whatever when they go into the medical unit. The medical unit people now have another chance to actually assess, look at them, talk to them, and they kind of can sort it out better too.

So there's a secondary part of that where medical does that orientation as well.

And we do do a post admission mental health screen by the mental health providers specifically. I think by policy it has to be done within 14 days. That's the maximum. But our goal is within three to four days, it's another screen.

The screen, even done by a mental health provider really only takes about 15 minutes and it still can yield. One of the things that we've identified, or that Opulento specifically identifies is that our current mental health screen screens about 80% of our population needing services.

That's a tremendous load to then start to like pick out and find our high need inmates. Our mental health branch, I should also clarify, our mental health branch are not licensed professionals. They're behavioral health specialists. So they aren't necessarily clinical or medical.

These positions that I'm asking for will be part of the medical services branch, which are all licensed professionals. We have struggled to get mental health professionals. That is where my vacancy rates are the highest.

Psychologists, social workers and human services professionals, which would be the ones doing those additional screens, are my greatest vacancy rates across the board, which is why we're sort of pivoting and over. I've been in this position for two years and five years on the ground in the facility.

So when I came on board, I recognized that we sort of needed to do, do this differently. And that's why we're trying this out. We're trying to fill other mental health positions rather than continuing to just sort of be frustrated with the vacancies that we have.

Okay, just to clarify, to get the distinction, the mental health branch are behavioral specialists and the positions you're asking for are medical.

Medical services. Yeah. They have a medical license which allows them to assess, diagnose and prescribe medication as well as refer to community and treat at a higher level. The mental health branch is made up of psychologists, which we have a tremendous vacancy for human service professionals and social workers. So more behavioral health SPMI patients.

They need both because they need those prescriptions as well.

But. And the budget request is focusing first on the need to make positions for the medical services.

Correct. And partially because one of the DOH requests was that they get a higher level of care assessment and treatment and referral. Before we make that assessment, they really want to make sure they've gotten everything we can throw at them. So that's like high level psychiatry assessments before we refer to DOH.

Yeah, I have a question relating to the budget bill and the vacancy rate as well. And I understand if this question can't be answered today, but I was looking at a lot of the vacancies. I think there's around 400 and then how long they've been vacant in the current salaries of some of those positions.

And I can understand why, as you mentioned, specifically the, you know, the licensed Clinicians, you might have a higher, a harder time hiring because some of those salaries are pretty low, especially compared to other states. And you know, what these people might be able to find in private practice.

So I know you mentioned with uh, Manoa they have their first graduating class, which is great. But I do worry that, you know, with kind of the lower salaries, maybe that might kind of defer them from going to work for the state or for DCR.

So was there a specific reason that, you know, it wasn't included in this budget request or maybe it's included in a future budget request to increase some of those salary positions just to make them a little more competitive.

So a couple things. I don't have 400 vacancies in health care. So I think that's all. Yeah, I was gonna say I think that that's significant to the security staff. I only have a total of 266 employees like everywhere. So I currently have, and I'm pulling this from, from, from memory.

I have one psychiatry vacancy, I have two MD vacancies and as I mentioned, I had one APRN vacancy that I had more than enough applicants to fill. And I will say I'm very proud to say actually is that all three of those have competitive salaries.

The Director and the medical Director over the last and the previous administrator worked really hard to develop a competitive salary scale which is expensive because they do make a fare in community. As a previous nurse practitioner who worked in community and came on board, we make a respectful salary with the Department and I appreciate the union.

HTA represents us to ensure that. The challenging salary area for my branch specifically, and I won't speak to security is that we currently don't have a comparable salary for licensed social workers. DHRD also, and I apologize if I'm wrong, but I have been through their classifications.

There's no DHRD designation for social worker where the minimum requirement is a license. So there is a social worker 7 which does get them to that level of pay. It's between. I just looked at it. It's between like 88 and 115. I think that the social worker 7 makes it maybe a little bit more.

I apologize if that's not accurate, but I believe that there that would be. The opportunity is to get licensed social workers to fill those positions and those would require a classification change within my unit. Currently the way that the organization is set up is that I don't have any social worker 7 is approved.

The highest position I have is a social worker 6. I have two of those positions which are currently filled but not by licensed social workers. Their salaries are for a non licensed social worker. I actually think their salaries are comparable. The other one is the psychology positions.

The way that the matrix works out for the psychologists is that they are paid based on years of experience and additional certification. We typically get new grad psychologists who don't have a lot of experience and don't have additional certifications.

And so when we do their matrix, it's like in the 80-90 range, which if they go into private practice and are just billing insurance, they're going to make more than that. We start paying. I mean, a psychologist can make up to I think 15170. All of this is on the DHRD website. The LHA2 classification.

It has like a whole matrix of how it's worked out. But DHRD actually sets the salary scale for all of the civil service positions. We don't have the authority to change that.

Yeah. Romey, for clarity, those are psychiatric social workers.

Yeah.

Yes. Yeah. Maybe it's an opportunity for repricing. No.

Okay.

Yes.

Well, it's the same thing with the APRNs. There's only one classification. So if they go to school to get that extra degree, they actually do make money. More money. I would also like an APRN3 for somebody who does have additional certification. There's no upward movement for APRNs within the DHRD system currently.

And then repricing is something that's done with. Between the union and. Or with DHRD.

DHRD has to do the repricing. And I think depends opposed to repricing. But conversation we can have with DHRD.

Just a clarification because I always. We always grew up in the facility calling them psych social workers. So are they different than the regular case managers in terms of the social worker position?

So, and I've been learning this because it's not my specialty, is that there is there historically were psyched social workers. And my understanding was that they needed to broaden because there was such a need and it wasn't being filled necessarily, that they started to include the human services professional and they created those classifications.

You do have to have a social worker degree to be called a social worker. But we do also have these HSP positions. They aren't necessarily clinical. There's different levels, whether it's an AA degree or work experience or a BA and it kind of like goes up from there.

But the psych social, the licensed psych social worker, it's the license part that we don't see. And that requires that extra, like, I think it's 1500 hours of clinical time to get your license. I remember correctly.

I've had friends go through school. Okay, so aside from the qualifications, what is it? I Think the question that Mr. Patterson is asking is what is the psych social nurses providing? What is the care that they're providing that makes it different and better for the people who are experiencing smi.

Right.

I kind of know what I want to hear.

What's going on. Yeah, yeah. I was gonna say you taught me in one of my social work classes at university.

I hope you know some of them. Okay.

So it's about educating all of us. It is. So a licensed psych social worker in the state of Hawaii has the same right to practice as a psychologist. They can assess, diagnose and treat. They also have a significantly more broad approach to clinical care. So building rapport or.

Motivational interviewing where you actually learn how to get those questions answered in a really productive way. They also are allowed to take additional certifications in cognitive behavioral therapy, substance use disorder. And so we kind of followed the centers for Medicaid services. They can bill all the same codes, spend an hour, an hour and a half in treatment. They can.

I believe I could be wrong. The one, the part that they can't do psychologists can do are the testing pieces. But I could be wrong about that. But they really are the counselors, the therapists. We're going to sit down for an hour, we're going to put together a treatment plan.

You're going to, you're going to do these three things before you get like assaulted. They create those behavioral changes and that's why we call it behavioral health versus the medical mental health kind of side.

But so for the treatment part of it, because what I'm hearing is that we really need to have these psychiatric social workers because they're part of the treatment plan. And so that's why it's great.

So give you an example. You know, in the late 80s when they, when the mental health started just pouring into the facilities, we weren't trained.

So one of the key things they did, they brought in the psych social workers, they trained the officers on men mental health so that we were the online we could see and now we begin to understand behavior.

And then we had access to call the psych social worker to come to the housing unit and they, we together, we manage the mental health population in the housing unit.

And so the lack of, the lack of psychiatric social workers over time has now left this gap because the other thing that I saw in the Opulenta report is the fact that there's not enough training for staff. So this is part, this is a fix for both, both treatment as well as training staff.

So what we're not seeing a lot of is we're not seeing a lot of applicants with clinical experience. So the human services professionals that are coming in and the social workers who are not licensed aren't required to have clinical experience.

So the few staff I have with clinical experience and with licensure to train them, it's a pretty heavy lift for. I mean, that's years of training, honestly, to build that up. We hire them because we need them to be our eyes and ears.

And they are supposed to be building rapport with and knowing the thing about the inmates in the mental health population in general and why security is so important and why training for security is so important is when you're living with them, it's these small behavior changes that clue you in, right?

And that's like just medically, like we don't see them enough. We don't know that they normally make this phone call. Why haven't they made this phone call? We don't know that they left a phone call upset because we're not living in that space with them. And those are the pieces.

We're training security and having security as part of the conversation. And then our HSPs, who are really supposed to be spending time in the milieu, in the housing unit similar to the state hospital, you kind of, I mean, I did a rotation of the state hospital. You play cards with everybody. You really sit there.

So these little, little changes in behavior are the things that clue us in and then make you call and say this person needs to be pulled and seen and what he said is accurate.

So pulling on his thread a little bit. If we are not getting the applicants for the psychiatric social workers who have the clinical experience, that's part of the request. You're trying to get more of those, but in the interim, because that's going to take a long time.

In the interim, what has has DCR been doing to shore up this training for the staffing?

So we are currently vetting a training system. So what? And this is part of the Opulenta case as well. One of the. And I have a new mental branch, mental health branch administrator who came on board this summer. So she's been quickly acclimating to us over the last six months.

Her next task is expanding her education into the correctional realm. And as you guys know, we have a couple different governing bodies and there's lots of different opportunities for education, training and certification. My request to her was that we identify a program that suits us, but that's sustainable.

We've done training program before gotten funding but then the second the funding gone, that next round of employees don't get trained. So we need something like these are my rules as the administrator.

I want us to adopt a training system that a is dynamic and evolutionary in the sense that it does adapt to our population but is also sustainable by PCR as it stands today. So we're currently looking at more train the trainer ones. Obviously that comes with a certain amount of cost implementation.

It's not necessarily something that we just throw together and just pick willy nilly. Some of them are very expensive all the way down to free.

So we're working. So what's the timeline for this implementation? Because it's like it's training that the staff need now, Is that correct? Mr.

So I'm going to venture to say, Mick and I may be wrong, that mental health training is part of the academy. It is.

They get mental health and suicidality training. They get 16 hours of training currently as new cadets and they get retraining every year and every two years by policy. And that does happen. The request was that we improve the training and that's part of what we're doing.

And one of the things that we've identified, I mean just even in training in General and in learning in general is a typical didactic course where we just stand there and teach you. It doesn't necessarily reflect back that you've learned anything. So education has changed as well. But we're not necessarily educators.

So we're looking at how are we going to be better educators to train our staff. But the time to train and there is current content and it is relevant to it. So you're looking to improve. We're looking to improve it and we're looking to verify it and to be more successful at it.

It also takes steps, you know.

So when is this improvement in training supposed to occur? So I am sending her so one of the I'm sending her to conferences this year to identify which one she prefers. I'm allowing the mental health branch administrator to determine the program that we're going to engage with. There's four on our short list right now.

But we're really trying to do our diligence. We don't want to jump in. Sure. You know, haphazardly kind of.

There are some easy choices and some hard choices right now. So she this is 2026 is the year you guys are going to identify the program and then hopefully at what point when in 2026 are you going to make a decision?

My goal, because I was hoping to have the decision made by the next budget year. So I wanted to be like nailing it down by June, July so that we could start, start implementation. I will say that the training my staff is one thing, training the security staff is another thing.

And one of the things that we identified with keeping security up to date on training is you guys have already heard this. We're already short staffed. To pull an ACO out to train for two days means that there's a shortage on a shift if we're doing training at.

I think the request from Opulento was that we trained them annually for four hours. I think when Warden show and I had this conversation, he's like, he actually figured out how many positions he would need to request just to accommodate a training schedule.

So that's sort of like the layers. That we get into. If I could just clarify so we don't get lost in that. It's really, we're working very hard to try to fill our uniform vacancies. Tommy's increased training classes at tsd, there's just not a whole lot of takers out there. And there's the problem.

If we had full staffing or at least 85%, 90%, the training wouldn't really be that much of an issue. It's just we're so short. We're upwards in the 28%, 30%. It makes it very difficult to pull people for that. And if you pull them, you might be able to pull one or two people.

You can do that, but it'll take quite a while to get there. Okay, so I'm trying to understand you're going to make a decision on the training in June or July of 2026, that's this year. And at that point that will give you the ability to train your staff? Yes, exactly.

And then parallel to that, the Department is also looking to increase until vacancy so that we can then start the implementation of the training by your staff of the ACO staff, the security staff. So they're already being trained, they're already. Being trained to get, give them better training.

So when is the better training supposed to be implemented? If you're training your people in June, July 2020, when can we expect the better training to start a client?

So my staff, it's actually high level. I only need to have one or two of my staff trained to train the ACOs because those would be the trainers. I have to talk to tsd, because we actually have to certify new staff to be able to train. We've lost a few of our.

So I don't. I don't have to find out when they're. I'm sorry, let me. Let me say this. I'm putting you on the spot, but. And maybe this is something that you need to report back to the group. Yeah.

Because we need to understand these timelines as these affect how people are getting treated and whether or not they're getting treated properly in the restrictive housing setting.

And I. Yeah, and I need to talk to security because they just pull us in. They say, hey, we're having a training. Can you come? I don't actually schedule the security training.

That's something we'll have to get back to you on. All right, so we'll put them. You don't have to answer that because I don't think you can. Perhaps at the next meeting, these kinds of things are more ironed up so that the Committee as a whole understands this implementation.

You know, I mean, your settlement tracker is interweaving all of these things, but we don't understand it until you better. Explain it to us. So that's part of what we're doing. Okay. Sorry. So let's. Any more on this training piece.

Any other questions that. Anything more than anyone else wants to ask about this area in our agenda? Budget requests and plans to address population series.

Yeah, I would just second the chair's request as far as. Yeah, just better understanding of maybe the tracker. And I'll take that, too. I was looking at it over the.

Weekend, but I need to dive in a little bit deeper and I don't know if this is the appropriate time to talk about the numbers that the Department was able to provide as far as how many people are in restrictive housing.

I do appreciate having the numbers and I just wanted to ask for a point of clarification because when I had made the request at the last two meetings and then also in writing to Director Johnson, some of the other specifics of what I had asked for was kind of disaggregation of what are the different categories of restrictive housing, for example, with these numbers, I can't tell how many of these are disciplinary, how many are administrative, so on and so forth.

Is that information that the Department usually keeps track of? I know at the first meeting you had mentioned that if I'm correct, the Department was looking at kind of updating their online data system to better be able to track this kind of information. So I guess, yeah, just asking for a little bit of clarification on these numbers.

I think to the numbers be mindful especially at OCCC, a lot of those numbers, when they do the 24 hour review or 72 hour review, they will be released from that segregation. They then will face an adjustment hearing down the road. They may get lockup time, they may not.

So some of those numbers that you especially see from OCCC, they could be double counted. They would go in for the first 24/72 be released. They can go back in before the end of the month. It's a double count.

Sorting out the admin from disciplinary, we can try to begin to do that. We can try to separate the two. So we can have two logs running. What would be an administrative segregation as opposed to pure D disciplinary segregation.

So that's something that we can look at. Can I follow up on that? Because I actually think that is a very, very important question. You guys have repeatedly said restrictive housing as we've used in the bill covers different things.

And what Ms. Woodward has been trying to drive at is we need to understand what those different categories are. Am I correct, Ms. Woodward?

And so I appreciate that these numbers were given, but if we're going to be developing policies about restrictive housing, disciplinary segregation, we need to understand what the numbers are and then what those definitions are. And I feel like we still don't have a good grasp of what those are. I can give you a short, simple disciplinary.

You put it in writing.

Because this is supposed to be in writing and policies. Correct. Well, disciplinary is due to misconduct. Administrative segregation is purely going to be a safety and security issue, either from. For the individual or for other individuals. So it's not being driven by a misconduct, it's being driven by other factors.

Okay. And that should be in the policy. Yeah. So it's defined. Yeah, yeah. Okay. I mean, and I feel like we've never seen. I know that we probably have to dig more into everything that has been provided us from the Department, but I. My understanding was that that policy was also in flux.

Well, because of the case, we're rewriting it. The restrictive housing.

I forget what it's called. It's called restrictive housing policy. No.

Well, we're dealing with Act 292 now. What is the policy that you're working on? I believe the restrictive housing policy is one of the ones that we're working on. I'm doing the suicide prevention and intervention policy. And that was the only clarification. These numbers don't include suicide safety watch because we don't consider that administrative segregation.

We consider that a medical prescription.

Do we need that? I'm looking at the numbers.

Would you, would you, would we like to have the numbers who are on suicide watch? I would think so. Just because of the conditions identified in the Opulento report. Just so we can determine.

And maybe the question, you know, also is if we don't have the numbers presently of how many do we have in the suicide safety cells, how many are administrative versus disciplinary, then, then the question becomes, you know, what, what does the Department need to make that happen? Just so we can understand at any given time?

Because I would like to know, especially for, you know, the Office of Hawaiian Affairs, you know, 37%, almost 40% of the prison population are native Hawaiian. And so we would like to know, you know, why they're, why they're in restrictive housing, how long they've been in restrictive housing, what are the conditions, conditions of their release.

That way we can better advocate and without that information it's very difficult to do that. So yeah, I guess that would be the request.

If we, if we don't have access to, you know, again, category of placement, length of stay, conditions and criteria for release and any non confidential demographics such as, you know, how many in restrictive housing are native Hawaiian, then what system do we need to put in place or can we put in place to start tracking that information?

I think one thing I would add, and I keep hearing you guys making you miss Glidewell in the prison system making a distinction between what's medical and what's just safety.

But from our perspective, sitting on this working group, the whole reason why serious mental illness was called out is because we are very concerned as the community about the higher levels of suicides. And if these people are in suicide watch or need to be in suicide watch and they're not, that's, that's, that's an issue.

So knowing, knowing this breakout of people who are in what you guys call either administrative or restrictive housing or disciplinary, segregation or suicide, whatever terms you guys are using, we need to understand where the numbers are. To the point of Ms. Woodward, of asking for the demographics. I think that is important.

But we don't even have the categories of where people are at.

So I really think that we need to get better data. Yeah, and this is where it's, I think that we've struggled with the bill in general is piecing all of these things out because it is a much more dynamic system internally.

And even a lot of our suicides are not in suicide watch and not in ad sagr restrictive housing. Like that's the significant data piece that's actually like Not. And it's not even part of this conversation because it's not reflected in the Act 292 either.

The folks that come into Suicide Watch are the ones that we're able to intervene with. The ones who aren't being flagged and aren't being identified are the ones that are being successful in their determination.

And that's actually not accommodated for.

And that would be captured if we had better screening. Suicide is not. Yes, we. Yes, we hope that. But one of the realities of suicide is the person who's determined. Yeah. And they are not going to tell you anything and they're not going to show up.

They're the ones who are behaving well and doing all the things because they want us to turn our back. And that's like the challenging thing. Like when you say, like with someone on Suicide Watch to get off, they need to tell us that they're no longer. They no longer have a plan and they're no longer suicidal.

But also the person who's probably going to do it is exactly going to say that to us, suicide is a really challenging thing to screen and intervene with. And it's something that we're faced with every day.

Chairs, I have a question. Do you folks have numbers on the suicides occurring in restrictive housing and occurring out of restrictive housing?

I think. I think we can. I'm speaking for me, Healthcare doesn't track that, but we may be able.

The housing that people are in. Well, we'd have to begin to set something up to track that data. But I will tell you, the majority, from my experience, it's sad to say, but the majority of the suicides that occur is usually in General public. It's not on Suicide Watch, it's not in segregation, it's not on administrative segregation.

It's in general population. Yeah, that's very accurate.

Chair, the commission is currently.

Currently working on the death report, and we'll have that information.

Anything more? Can I pick up on a thread that Ms. Woodward was talking about? You know, I think we do have to dig more into the settlement tracker and understand piece by piece. I think we were starting to get it with your presentation, Ms. Glidewell, that you guys are doing... You're tracking progress and staffing in training.

But are there other things identified in the Opulento report that don't require as much time and that is more immediate in nature? And I guess one of the things that I was noticing as I was reading through this last night, and I was actually hoping that Mr. Mosier would be here because is he the one that's overseeing most of the implementation of the Opulento pieces?

He was our representation. He's the Deputy Director of Attorney General's Office.

My sense is that there were things in this tracker that you guys actually can move on and are moving on now. And so I don't even know if we touched on all of that here.

No, probably not. And so just to clarify and give you a quick one, the recommendations were dense. You guys saw the report. And so this was really just my way of implementing. This wasn't created to be shared with everybody. However, when I made it and shared it with the Director, it was appropriate.

This is really my way of working with my staff to ensure we were not missing anything. So I went line for line out of the recommendation, which is why I put which line it came from because I wanted to make sure that I had everything written out. To be fair, there's how many? Like 40 something? 47.

We have not had the opportunity to even come up with plans and solutions for every single one. We did try to address things that could be addressed immediately like medication, med pass for the psychiatric meds not happening until 7 o'clock.

We're working with security to ensure all facilities, not just Oahu and OCCC, are doing med pass after 7pm. Things like that. Certain conditions that were identified in one facility different than another facility when people were on suicide and safety watch, those were addressed immediately.

We did try to quickly run through here and see what we could address in the short term. And some of the things do have longer timelines than others, but that was kind of my... And I'm not even sure this the most recent. I might have... I might have a... I'll have to look more closely.

Some of these could probably be updated as we move forward, but that's the idea. And I'll put a date on them so that when you guys get new ones, you understand that there's updates to each item. But it's a lot, you know.

And so the things that have long plans like the staffing, if we start late on the staffing, we're never going to get there. So we tried to kind of move anything that was going to take a long time forward at the same time do all the low hanging fruit early.

There's probably some stuff in the middle that we haven't even had to sit down time to sit down and put a plan together for. One of the other things that's on this tracker was a quality assurance program, which by policy we do have in place. It's not an effective program right now.

I just wrote a five page proposal, I'm actually meeting with my staff I believe today to implement a department wide quality improvement program and a quality assurance program that is part of the Opulento settlement, which will allow gap analysis at each facility. We're doing our first facility audit.

We have a facility audit scheduled for every month this year. We have eight facilities. It takes us a while to audit everybody. We developed our audit tool, and the mental health unit is a significant part of that audit. So this will allow our higher level staff an organized way of going in and identifying gaps in care at every facility. Because they're all a little bit different, they all have different challenges.

It takes that gap analysis, which is going to take us 12 months to do all facilities, to identify ways of solving each one of their problems. So that was one of the more like high level things that we kind of had to do to answer some of these problems. And that is something that we've been working on.

Like I said, we have our first assessment in two weeks at Waiawa, and we've got Big Island next month. So we do a local Oahu and then we go Neighbor Island kind of back balanced it that way to do a proper analysis of what each unit needs. And the gap analysis is based on like policy.

So are they adhering to policy? Why aren't they? How can we help them get there? And then there's actually an improvement plan like, okay, we're going to come back in 3 months, we're going to come back in 6 months, we're going to come back in 12 months and verify it.

It's a pretty heavy lift to do that quality assurance program, but we've identified that that's one of the missing pieces. All the little problems that were identified we realized wouldn't be there if we had kind of pulled back a little bit and said, how can we support each unit in a more organized fashion?

You know, as I'm listening to this, I'm very thankful for all the dedicated work that you guys are doing. It is an additional requirement to analyze all of this from doing what you've been doing just to keep up. Of course, it's for a great purpose and reason why it was passed in the first place.

But as Chair has mentioned, I think it's important for us to get in writing as much information as you're able to present the requirements that are mandated now. And I guess your situation that falls short of that and what you need in order to comply. So something as simple as talking about training the guards.

Right? And you guys are already short, so the work hours is a challenge. That's why you have overtime problems and all of that stuff. But just if you were able to do analysis just on that point, as an example, as far as presenting data to the, to this committee. Showing, like, just to comply with that issue of training.

The number of hours it takes and how many hours you have available by your staff to man your facility properly based on the number of guards at full staffing and, you know, incrementally down. And, you know, we can kind of see where you're at more clearly, I think. And it'll justify your place where you're at in reality and where we need to be and what needs to happen in order for us to get to where we need to be.

Yeah, I appreciate that. And as you guys know, I'm a new administrator. And one of the things that anybody who's worked in the facilities they recognize that most of the time we're tasked with putting out fires. Something's always coming up, and we're dropping our larger programs and our larger goals to go address these little issues that come up. I'm sure Mick can tell you.

And what I've really tasked my staff with is that if we don't step back and start having that macro vision, our policies are actually pretty well aligned with a lot of the standards because they have been being updated. How well are we adhering? How well are we capable of adhering?

Do we have the standards staff to adhere? That's the part that we're missing. There's a lot of structure that's actually decently developed within the department.

It's just that every time we go to implement these things, we get pulled in a thousand directions because of these little things that come up because of the population that we're taking care of. They tend to be a very reactive population. So we are working on that.

And that's what we're recognizing is that we have to just kind of, like, slow down and back up and build better programs that have stronger legs and that could, you know, live beyond my role as administrator, beyond the directors, beyond all, you know what I mean.

These things have to be able to be in place and rooted into the culture and in the foundation of what we're doing. Otherwise, they kind of fall apart when there's little shifts. That's what we're seeing historically.

I appreciate that, and I can empathize with your position because I struggle with the same thing of prioritizing different things and not having enough time in a day.

So even for you to be tasked with that, or you and your staff and your department, you might need help just initially just to do all of that, you know. So, I mean, we're all trying to do as many things as we can, but we're limited to 24 hours and, you know, whatever we can do.

So, you know, I wish I could have more staff. I wish I could have more hours to get all the things that I want to get done. So how does that, you know, I think, you know, not to just... I mean, this is personally where I'm coming from is I want to see you guys succeed. Yeah.

So how do we help you succeed? And I think that that's an important conversation to share with us. What you need to. What help you need even to do all of this, you know, to start with, you know.

Yeah, I appreciate that. And just understanding that it is a big ask. And one of the biggest challenges that we're being asked to, in healthcare we say triage. But we're being asked to triage the priorities of the asks. And there's 47 of them. So we are making our choices.

They might not be the choices everybody agrees on, and we're open to discussing that with Chairs, and I'm open to explaining some of these things or why we chose certain things. I'm happy to share. Our intention is to complete them all and improve on what we're doing.

Okay, I want to come back to one last thing in the Opulento expert report, but I'm also mindful of the time, and we're already coming up to 10 minutes to 11, so I want to try to kind of wrap this up, and then we move to our next steps.

In the experts' report, there's a section on pages 31 to 32 where they specifically talk about the scope of the experts were to review and outline criteria for administrative segregation hearings to include mental health staff to ensure that behavior associated with a known diagnosis does not incur criminal charges to decriminalize mental health disorders within the facility.

So my understanding is Act 292, by trying to carve out and make sure that people who have serious mental illness are not put into restrictive housing, this speaks to that point exactly. And it's interesting to me what the experts wrote about, you know, reviewing COR 11-01. I believe that's the policy that defines what administrative and restrictive housing is. Correct?

But the experts point out the policy does not exclude inmates with a serious and persistent mental illness from being housed in restrictive housing unit that is characterized by being locked down 23 to 24 hours per day. Such an omission is not consistent with the current standard of correctional mental health care.

The standard of mental health care is that inmates with SPMI should be excluded from housing in such RH with very few narrowly defined exceptions. So I guess my question is we're not going to be able to answer it here, but we need to understand and begin to see what is that policy, that new policy. And you're saying that's the policy that's currently under draft.

So just a clarification is the way that Act 292 is written is it does not necessarily support that. So here, here's the difference I think that it's really important. Is currently the way that it works is that mental health does have the opportunity to intervene to make sure that what they did, if it's administrative stag, is not disciplinary.

So an example of that would be, let's say we have an SPMI patient and they scream and bang, almost like a tick. And we have a new ACO and they don't know them and they decide that they, hey, knock it off. The guy doesn't knock it off. Hey, knock it off.

The guy doesn't knock it off. But he doesn't know this patient. He may write him up for not listening to him. When it goes to hearing the staff, our, my staff, medical staff would say, no, that's actually behavioral. It's associated with SPMI. It's not, you know, something that he get...

And this is a really loose, this is not an actual, please forgive me. And they would then remove the charges and he would, he would go back. So that's what currently is in the policy and what Opulento is actually saying in the first half of that statement.

What Act 292 states is that we do a assessment prior to restrictive housing. We currently do assessments prior to restrictive housing to make sure that they're medically cleared. They're two different things. So medical clearance, and this is what Act 292 was getting into, was ACOs do not know patients' diagnosis. They don't even know if they're SPMI.

So what they're doing is they're coming to us and saying, does this patient have a current or chronic medical condition that would disqualify them or make this difficult. Whether it's a respiratory infection or an infection in their legs or an SPMI diagnosis or a history of suicidality. And then my staff would say, no, they're not cleared.

And then security and my staff has to decide someplace else for them to go. But that's different than them their behavior being associated with their illness versus being medically cleared to go in. Does that make sense, the difference? So they're two different things.

They can also keep them out though based on mental illness or a psychiatric issue or concern that they may have.

So let's say it's behavioral. They're yelling and throwing things and whatnot. They'll bring the inmate into medical and to clear them. And I'm going to say this as an ACO who doesn't know anything. Well, actually, that's not necessarily true. We can't always tell what's acute drug use and what's mental illness and what's behavioral.

So the ACOs bring them to the medical unit, the person's yelling and screaming and talking gibberish and being mildly assaultive, possibly. The medical staff then has to designate whether or not this is acute drug use, psychotic issue, or they're genuinely ticked at the staff and want to have this behavioral thing. That's one of the...

We do already do that. And then depending on what decision is made in that moment, that kind of... They may end up on suicide watch, for instance. Sometimes we're like, we may send them to the ER and say, we don't know, but first things first, we're going to do that. But we already do that like 100% of the time.

Yeah. I think most of your mental health patients who are stabilized with meds tend to live in GP. Someone banging doors or whatever, they're probably going to be placed into a mental health module if they're assessed with a mental health disease.

Sometimes organic brain disorder is not treated as a mental health disease, but sometimes the behavior is very similar and most people would think that person has mental illness, but they really don't. So what we're talking about is a special needs population that tends to be grouped and then the services get overlaid in that housing unit.

Most special needs individuals, if they're mentally ill and they're banging doors or whatever, we don't write them up. What are you gonna write them up for? I mean, they're being treated, they're trying to stabilize them at this point in time. And it is the disease itself that is kind of leading them into that type of behavior.

So it's really this special needs population. And I think in the last hearing I had asked, because you can see how complicated this really is. I don't believe health care should be in this law. Healthcare should be separate and apart because it is layers and layers of staffing needs, program needs, special kind of care.

As opposed to saying, if a doctor says this individual is a harm to other people or themselves, they need to be placed into a cell and monitored for a while. That we consider that as restrictive housing. I mean, it's really not per se restrictive housing. It's a clinician saying, this is what this person needs.

And I would think, without knowing, I wish Mr. Linscott came because I could have asked him, what do they do with this same... Because this is the same population in many instances that are actually at the state hospital. What do they do at the state hospital to control people who behave in this manner, that's diagnosed the same way. It's just they're landed in our facility as opposed they landed into the state hospital.

We're starting to go around in circles, and I think we need to understand what's happening because this is also the same population that we earlier talked about, where you guys are looking to move to different facilities. The 40 to 60, isn't it?

No, those...

They're not the SPMIs.

Well, no, they are the SPMIs. They're the stable, non-violent SPMIs.

That might act up and then they might be subject to some restrictive housing policies.

So we also have a different population. And this is where these conversations... I apologize. Really, this is for the benefit of everybody. We're just kind of talking about it. It is a continuum. There are... Mental health is a continuum of mild to very extreme diagnoses.

And as he put, people with cognitive impairments, traumatic brain injuries, low IQs from traumatic events, prefrontal cortex damage, intermittent explosive disorder, none of them are on meds. They tend to have behavioral problems. They tend to be very problematic. They tend to be very assaultive.

They actually aren't being treated with medication, but they do sometimes have behavioral stuff that comes up. All the way to my patients on this end who are acutely homicidal on and off medications, typically have assaulted, if not murdered roommates, are very much SPMI, have got to be housed alone, you know what I mean?

And then I've got all the guys in between. And the challenge with the bills and the policies and everything else is trying to find boxes that accommodates this spectrum. And the challenge we're facing is that the spectrum's getting bigger and the pops are getting in all the different areas.

And we very much understand the spirit of the bill and we're trying to accommodate that while also genuinely figure out how do we help this range of people. The folks that were mentioned in the 40, they're down here where they're SPMI, they're stable, they take their meds, they're very cooperative.

And that's what I did the tour with Dr. Matt and he did that. And he walked into this floor and he said, this is a state hospital floor. Why are they here? That he very much identified. And I've sat with Linscott several times and we've talked about this and we've had meetings.

One of the things that the state hospital and us also need to identify is who are the violent SPMI patients, which unfortunately require what you guys would call a restrictive housing. Because whenever they're out, our mental health units are sometimes our most violent floors. And the reason is because they do have a high propensity to violence dysfunction.

I sat with guys and I said, why did you do that? He was making noise. That's it. He was just making noise. And his roommate is now going to be hospitalized for the rest of his life.

We need to do a better job working with the state hospital where those 40 patients were identified, where they are stable, non-violent, need to be rehabilitated because they have a high chance of getting out. And these guys who are where they're supposed to be because of their propensity to explosive violence.

Can I respond to this? Because I think this is, this is the work of the working group. The people who are in that middle group, if they're somehow at some point getting pulled into restrictive housing that's really meant for the people who are truly assaultive, that's where it's inappropriate.

And so these people are supposed to be being medicated and then put into what I think are these other programs that are more intermediate. Something in between the state hospital and what's at the facilities now.

And that's precisely kind of that program that we need to understand because the more you take care of those people and put them in the non-restrictive intermediate care, that's actually fulfilling Act 292.

Okay, so this is since we've got a visual and we can talk about it, is that so that is what Opulento identified. So if these people who are stable move someplace else, now the GP people could move into that housing unit. We have a limited housing unit. So that's kind of the dance. If we decompress this group now, this group has someplace else to go.

And then they can get better treatment, the screening is better, and then we release the pressure on... Because part of this is that some people are being probably acting up because of the compressed situation. And then the tools that you have left with you is to put them into restrictive housing.

And that's what we're trying to do with Act 292 is reduce restrictive housing because we need these people to be taken care of and not just simply housed. Right. So I guess moving forward, one of the things I'm interested in is what is happening with this population that you guys are saying you're going to move.

What are the policies around that so that they don't get swept up into more restrictive housing. And what do we need to do as a working group to help, as Representative Shimizu said, keep you guys moving in the right direction without... Like I think, you know, your recommendations for the legislation is to kind of gut Act 292.

I want to agree with what Ms. Woodward was saying. When you look at the recommendations and the legislation that's being offered by DCR, stripping out SPMI is basically gutting this. And then we can't have this conversation about overall.

So overall what's happening in the facilities and what needs to happen to move people out so that there's better care in the facilities in general. So my point being with all of this is that we have to move towards our next steps. And I'm again very mindful we've already gone over 11 o'clock.

We have January 27th as identified as another meeting date. Our work plan is still really much in flux. We just spent today talking a little bit about the current plans at SPMI. But in Act 292 we have questions about how are elderly people being treated in under the restrictive housing policies.

We have questions about the application of restrictive housing to those under minors. So we, and then we started to touch on the staffing issues, but we have a lot more to go. So what I would propose is that we have to come up with a further work plan for our next meeting. We're already heading into legislative session.

There will be a bill introduced that basically takes DCR's recommendations. But you know, already in the committee, there's disagreement that that's probably not the right way to go.

So we'll let the legislative process work out what any revisions will be Act 292, but that does not still yet absolve us from doing what we need to do here. So my proposal would be that Chair and I will talk and further discuss maybe how we could map out the rest of 2026 after legislative session.

And that will be the topic of our meeting on January 27th. And then at the same time, we'll see what bills get introduced, what the referrals are at that point, and how we move forward with the legislative, both the legislation and then the ongoing work of this committee, which is kind of parallel tracks of work. Does everyone, is what I'm saying make sense?

I think one of the missing elements though is we would really need to ensure that the funding and departmental requests are also addressed alongside whatever work plan the group wants to come up with. Because I think the fact that we have so many vacancies and we have all of these shortages contributes to what is already untenable situation.

So I think the work plan is also going to have to take into account how do we work with the departments and our budgetary partners to ensure, you know, that implementation can move effectively. Because otherwise we're, you know, imposing a lot of questions upon the group that is also separately undergoing a lot of review.

So I think we need to be kind of mindful of that and look for ways that we can help move forward and assist the department within this budgetary framework. Because this is such a very challenging year that anytime you are dealing with 30% vacancies is really kind of, you know, impossible circumstance.

And to tack onto that, I think what I'm... So what I'm very clear about is the budget request you guys are asking for positions. But just from our conversation, I also am hearing that you might need budget requests for training, and then there's budget requests related to this 40 or so people you might be moving to another facility.

I don't want to misspeak, but I believe the Director has already allotted funds for that. But I'll double check because he would have put it in. We did discuss that.

Okay. But that hasn't been discussed in this group. So we, us as a working group needs to understand all of your budgetary requests and how you're funding all of these things that you're moving and doing to address SMI, SPMI in the facilities.

And then I guess also what I'm hearing is tell us what we need to support in this budget process in this year. So in addition to the legislation we're going to be moving for policy purposes, what are we going to do with Act 292? Because I do think that there's going to have to be some flexibility with timelines and implementation. There has to be. I mean I think we have to confront that.

And then we need to make sure you have the resources, to Chair's point, that maybe our next meeting to be very clear with us and report back to us what exactly the budget request from. And beyond just the budget request for the positions, but for you know. And if it's already covered in budget.

Something that I heard from Director was that you guys have money covered currently to move those people out of facility to more intermediate facilities. But for the next budget year you do not have that. So what is the projected cost for it that we have to advocate for the year.

Madam Chair and Committee. Sorry, this is Mark Linscott. So I'm just here to support Romey and the conversations because we had these prior. Department of Health and Hawaii State Hospital does want to support the right environment for our offenders in this case or our patients that are here at the state hospital.

And so that's why it's important that we're working together because that's the integration point that I think would make benefit for DCR and also the Department of Health.

Thank you. And I appreciate that because that's speaking to the fact that you guys are working, DOH is working with DCR to identify this place for this kind of intermediate facility. Right?

That, and identifying the violent offenders that are SPMI that do belong in a correctional setting versus the non-violent. Or one of the things with schizophrenia is that paranoid delusion can be very specific, which is violence against one single person. And that violent act will then sometimes paint their entire life.

And I've had these folks at my facility, they're just super easy to deal with because that one event based on their mental illness was never repeated because the delusion was very singular.

And this is the best place for them because they're actually, I know it's weird to say they're not violent people, even though it may have been a murder case because that was a paranoid delusion about a specific thing. So Dr. Linscott and I have both kind of discussed that, yes, there's these violent folks.

They do belong here and they are SPMI. And then there's these other folks that may require higher level of rehabilitation and re-entry that would be better suited for the state hospital. But we're both overcrowded and we have to work in partnership on how to manage that.

We're at the point, I feel like we need to wrap this up and move into public questions and comments. And I want to put out there, is there any public questions and comments on anything that we've spoken about on this agenda at this point? Seeing none. We've covered a lot of ground I think. Seeing none.

Our next step is to set up the next meeting for January 27th. I'll go back to take a look at our notes. It seems like there's a couple of things that we're going to need follow up on, and we'll follow up on where the legislation is at that point in time because bills will have already been introduced and then we will move from there. Any questions? No. All right, thank you. I know this...

It may sometimes feel like we're just gathering a lot of information, but that's a really important function, actually, of this working group so that we can understand what we're going to need to do in 2026 leading into 2027. Seeing no other comments or questions. Working Group Members, we are adjourned. Thank you. Thank you for those of you who joined via Zoom.