Encountering homeless people on the street with apparent mental health problems is commonplace, but there’s no clear consensus on what to do to help them.

Even the Mental Health America of Hawaii organization is conflicted.

“What we’re running into is the system problem, the bigger problem, which is that our current rules and laws are not set up to force people into treatment who are too sick to understand that they need help,” said Trisha Kaji­mura, executive director of Mental Health America of Hawaii.

“There’s a conflict between civil rights and that humanitarian desire to help someone who is too sick to help themselves. Our organization doesn’t have a strong position on what to do because we as a community haven’t decided what to do because we don’t want to go back to institutionalization.”

It’s clear that people should call 911 if they see someone who poses an immediate threat to themselves or someone else.

But the next steps are more complicated when trying to help someone who does not pose an immediate threat but refuses offers of help, shelter or a mental health assessment.

Kajimura was one of the many people who read about “Bus Stop Mary” on Facebook, calling her situation “really sad.” Kajimura, however, had no direct knowledge of the woman who turned out to be Natalie Thiel, who before her death this month was a fixture at the bus stop fronting the headquarters of the commander of the U.S Pacific Fleet off Nimitz Highway.

In general, Kajimura recommends people concerned about a specific homeless person track down the social service agency that has the homeless outreach contract for a particular area of Oahu. Outreach workers have developed a “by-name” list of Oahu’s homeless and regularly share information between agencies.

“Even though it’s really hard to see, the professionals are working on it,” Kajimura said.

While little can be done to force someone off the street and into treatment, there’s plenty of work that can happen long before someone becomes homeless.

Early assessments

In general, Kajimura said more emphasis needs to be placed on getting mental health assessments as early as childhood to prevent bigger problems later in life.

“We need to make sure treatment is accessible and affordable,” Kajimura said. “We need more mental health screening and depression screening to identify issues earlier and get help. Early treatment can give them a better chance to manage their symptoms.”

The first steps toward assessments can start with family members, teachers and pediatricians, she said.

By the time mental health or substance abuse issues lead a person to become homeless, Kajimura said, “they’ve burned through so many bridges and people have given up on them. They’re past that point where they don’t recognize they’re too sick to accept help.”