Hawaii plan to trim state hospital stays by mentally ill accused of minor crimes is a revolving door

By CAITLIN THOMPSON/Honolulu Civil Beat undefined

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 smartphone screen transmitting his image into courtroom 7D of Honolulu’s First District Court.

The homeless man with salt and pepper hair watched attentively as a judge explained that he had been found mentally unfit and couldn’t be prosecuted for the trespassing charge he had been arrested for in August.

“You’ll be released today,” the judge said on Sept. 3. “I hope that you will take advantage of the services that you’re being directed to, so that hopefully we don’t see you back under these circumstances.”

The man nodded, but even a cursory glance at his record shows how thin that hope was.

Five years ago, Hawaii 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 — a costly, ineffective and unfair system.

Though initially envisioned as a dramatic transformation of the state’s criminal justice system, one of Act 26’s 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’t be restored to mental fitness, they are to be released, with their charges dismissed, and referred to community-based treatment.

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.

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.

The act’s shorter deadline for determining mental fitness — a week at the start, recently increased to two — also means people aren’t 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’t been a sufficient increase in community-based services to catch them. Most are homeless and end up right back on the street.

“Is it better for them to be in state hospital than in the jail? Like, yeah, I guess,” said Kori Weinberger, a former prosecutor on the Big Island. “But … it has not eliminated the revolving door.”

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’s discharged only to be arrested again just a few days later. About a week after his Sept. 3 court appearance, that’s exactly what happened: He was arrested for another petty crime, a misdemeanor for theft and trespassing.

An auspicious start

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.

To be prosecuted for a crime, the defendant has to understand what’s 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.

In Hawaii, people facing low-level charges were spending weeks — even months — waiting in jail or sitting at the state hospital while doctors tried to restore them to fitness.

They could be held in jail for 30 days waiting for an evaluation to be completed. Often, that deadline wasn’t met. In 2017 and 2018, about 275 people facing misdemeanor charges spent more than 12,000 days in jail pretrial waiting for access to mental health treatment at the state hospital, according to Hawaii Supreme Court Chief Justice Mark Recktenwald.

Defense attorneys were sometimes reluctant to challenge their clients’ ability to stand trial because it essentially equated to receiving the maximum sentence before they had even been found guilty.

Those who made it to the state hospital were later released without sufficient follow-up services in the community.

“In too many instances these same defendants are arrested again for a petty misdemeanor or misdemeanor and the cycle restarts,” said a 2020 report by the state’s Hawaii 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.

To address this, the Legislature passed Act 26 in September 2020. The goal was twofold: 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.

The new law expedited the process for determining whether someone was “fit to proceed” 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.

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’s two weeks.

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.

Act 26 got off to a slow start. It was enacted in the early days of the pandemic when the Hawaii Supreme Court had ordered all defendants charged with petty misdemeanors released from custody.

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.

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.

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.

“The positive impact of Act 26 is clear and profound,” the report read. “Preventing 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.”

A disturbing pattern emerges

There’s 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.

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.

Under Act 26, it’s 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’t 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’s not going to snap back when someone stops using.

Patients can’t 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.

Instead, the vast majority are released because doctors determine they can’t 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.

“It’s enough time to determine whether the person is fit to proceed, they can participate in their defense,” said Connie Mitchell, executive director of the Institute for Human Services. “But it’s not enough time to actually treat someone.”

It’s 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.

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, things were going well for her. She was receiving treatment, and she’d finally gotten stable enough to be released into the community.

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.

“She doesn’t have treatment that lasts long enough for her to be able to benefit from it, and then she’s homeless most of the time now,” Mitchell said. “I don’t think you can expect much more. I feel like she’s a victim of the system.”

With longer-term medication and support with daily living, Mitchell thinks things might be different for the woman. But she’s 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 Waikiki. Once again, she went to the state hospital for about a week.

“She’s going to go through the same thing again,” Mitchell said. “She won’t come out fully medicated and treated, and we’re going to have to chase her and figure out how to engage with her so that maybe she’ll take some medications.”

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.

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.

Although the hospital’s current administrator, Mark Linscott, said the staff tries their best to treat these “frequent flyers,” that’s hard to do on a rapid turnaround when someone has serious mental health or addiction issues.

“If we get repeat offenders, then something’s not working right,” he said.

The frequent churn is also hard on the state hospital, which is the only state-run inpatient treatment center for psychiatric hospitalization in Hawaii and is supposed to be reserved for the highest need and highest-risk patients. Instead, it’s filling up with people who even the hospital’s own leadership and other experts say could be better served in a less intensive setting.

Only about a quarter of people at the state hospital medically need to be there, the hospital’s then- administrator Dr. Kenneth Luke told lawmakers last February.

“Something is wrong. The continuum is too heavily focused on the hospital,” he said.

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.

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’t be hospitalized.

Act 26 didn’t 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.

“The bottom line is we need to meet people where they’re at. Sending them to the highest level of care in this community may not be the right direction,” Linscott said. “But unfortunately, there isn’t alternatives built in the system structure to do it in a different way.”

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’re discharged, they don’t always stay for long.

“Ideally, 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,” Mitchell said.

Instead, Mitchell said, people are trapped in a cycle: “It’s almost like they’re stuck in this Groundhog Day thing.”

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This story was originally published by the Honolulu Civil Beat and distributed through a partnership with The Associated Press.