Background offered on MMMC adolescent behavorial health unit

As the psychologist for the interdisciplinary team that developed and opened Maui Memorial Medical Center’s Molokini II in 1996, I am of course saddened at the news of its pending closure.

However, I feel that it is necessary to provide some historical perspective and my own thoughts on what it takes to run an effective adolescent behavioral health unit. I believe that all of us agree that we don’t just want a unit, we want a good one that provides effective treatment.

The climate in 1996 was worlds away from what it is now. The state Department of Health, Child and Adolescent Division provided one or two child psychiatrists to cover their share of calls and to treat their own patients in the hospital. There were up to five private child psychiatrists on island and a child psychiatrist employed by Kaiser who did the same.

The state Department of Education provided a part-time teacher who was an integral part of the team and helped kids stay caught up in school as they healed so that they did not face additional challenges on return to the community. The hospital did not employ any psychiatrists or other physicians in the unit at the time but provided nurses, a psychologist (a position that remains unfilled since my retirement at the end of 2013), a social worker, an occupational therapist and a recreational therapist, as it continues to do.

To the best of my knowledge, the Department of Health has not filled its child psychiatrist position on Maui. Of the five private child psychiatrists, only two remain on Maui. One has his hands quite full trying to fill many needs within community agencies. The Kaiser child psychiatrist is not a member of the hospital medical staff. The Department of Education no longer provides a teacher or even a tutor that was provided for a while.

I agree that the Molokini II unit serves a vital need in our community. However, when supporters approach legislators, it is important to present a full, true picture. The issue of revenue shortfall is serious and presents a threat to overall health care in our community, especially as our population expands and ages. Recruitment of qualified child and adolescent psychiatrists has been problematic for at least 15 to 20 years. This is a huge systemic problem that must be effectively addressed as a whole.

Even if the Legislature approves special funding to keep Molokini II open, we have lost three child psychiatrists in the last year. The hospital has two temporary psychiatrists, only one of whom is child trained. It is untenable for any human to be on call 24/7 or even every other day, especially for such a fragile and volatile patient population.

Hawaii Health Systems Corp.’s Maui Region chief executive officer is not the enemy. He is a good guy who has been extremely supportive of the Behavioral Health Division since I have known him. I know that this decision was painful to reach. Any other administrator would have looked at the numbers and closed Molokini II years ago. The board is also struggling with impossible financial decisions, with its hands largely tied behind its back.

I believe that the issue of closing Molokini II cannot be isolated from several other crucial issues, including the lack of support from other state agencies, the need for an influx of new physicians into the Maui community and the need to free the hospital from the lumbering, restrictive, inefficient state system. It is crucial that the Legislature support exploring partnerships with private, not-for-profit health care organizations, preferably with ties to training institutions to provide a pipeline of potential providers for our community.

I hope that everyone in the community with a personal or professional interest in maintaining acute mental health services for adolescents addresses their concerns with our legislators. I also hope that people will consider the larger context in that discussion.

* R. Susan Rubenstein, Ph.D., has been a practicing Hawaii licensed psychologist since 1996 and has worked at Maui Memorial Medical Center and in private practice.