The purpose of the Hawaii application for the SAMHSA Emergency COVID-19 funding opportunity is to bring critical mental health services directly to individuals statewide across the islands, both in person and through telehealth, amidst a pandemic. The Hawaii Department of Health (DOH) will address the increased behavioral health challenges posed by COVID-19 by tailoring responses to the needs of the three different groups: adults with severe mental illness (SMI) or co-occurring SMI and substance use disorders (SUD), homeless individuals with less severe mental illness, and healthcare practitioners requiring mental health care as a result of COVID-19. Of particular urgency is the expansion to Hawaii island of a highly promising recovery program piloted on Oahu for co-occurring SMI/SUD individuals at risk for decompensation and hospitalization at a time when hospital beds, both psychiatric and medical, may not be available, when entering a hospital facility poses a serious health risk, and when air travel to the only state psychiatric facility on Oahu entails a 14-day quarantine and jeopardizes the health of healthcare workers and other SMI patients at the locked facility. The co-occurrence of SUD among severely mentally ill individuals is very common in the state: According to the clinical judgement of their providers, 7 in 10 SMI adults served by the DOH also have SUD. Hawaii island has the highest statewide per capita rates of opioid-related poisonings, methamphetamine-related drug convictions, as well as DOH SMI consumers, making it critical for the specialized co-occurring recovery model to be brought directly to that island, particularly during this time when travel needs to minimized and currently there is no such programming available on island.
The goal of the expansion is to improve the community tenure of these high-need individuals by providing intensive, evidence-based therapy and case management strategies within a cohort model. By January 31, 2021, 75 percent of the first Hawaii island cohort is expected to graduate into a lower level of care, and by June 21, 2021, 75 percent of the second cohort. Other initiatives proposed include: 1) Increasing telepsychiatry services to SMI individuals statewide through collaboration with the Department of Psychiatry at the University of Hawaii (UH) School of Medicine; 2) Increasing access to behavioral health services by homeless individuals with less severe mental illness through expanded access to homeless case management; and 3) Improving the mental well-being of healthcare professionals requiring care due to COVID-19 by partnering with the UH Department of Psychiatry to provide peer-developed and peer-implemented supports. Hawaii expects to serve approximately 650 individuals over the lifetime of the project and can leverage existing vendor agreements to begin the Hawaii island co-occurring recovery program within the first 3 months of the grant award.