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High mortality among Hono­lulu’s homeless reported by Christopher Happy, chief city medical examiner, is a sobering testament to the deadly toll of life on the streets. Read more

High mortality among Hono­lulu’s homeless reported by Christopher Happy, chief city medical examiner, is a sobering testament to the deadly toll of life on the streets.

He found that 373 homeless people died on Oahu between 2014 and 2018 from various combinations of drugs, alcohol, street violence, bad physical and mental health, poor sanitation and lack of medical attention.

Most shocking was that the average age of death among those studied was 53, some 30 years less than the average life expectancy in the broader community.

It gives impetus to calls by Lt. Gov. Josh Green and homeless care providers to more aggressively treat mental illness and drug addiction on the streets, even if help must sometimes be forced.

Inflexible civil liberties arguments to “live and let live” can translate in reality to “live and let die.”

A balance of these interests must be carefully constructed, but it’s simply inhumane to allow premature deaths of this magnitude to continue when there are effective treatments to prevent them.

Green, an emergency room physician by profession, has spent much time on the streets in his scrubs since being tapped by Gov. David Ige to help spearhead the state’s efforts to solve homelessness.

His impulse as a doctor is to treat mental or physical illness without delay, but he’s expressed frustration at legal barriers to helping homeless without consent — even when they’re insufficiently coherent to understand they are ill or make an informed decision on treatment.

Green told Hawaii News Now, “We’re passively depriving people of their civil rights because they’re so sick, their mental illness — usually schizophrenia, sometimes drug influence — is so severe they can’t make decisions any longer for their own well-being. … They have no idea they are profoundly schizophrenic and have been there for months or years.”

Green said there are effective medications for many forms of mental illness and drug addiction, and treatment is often clinically uncomplicated; the complications are with the law.

“We’ve seen some individuals get just a little bit of care … and they’re returning almost to normal,” he said. “They’re able to function. They’re able to say, ‘Yes, I want a home. I don’t want to be homeless.’“

But Hawaii’s assisted community treatment law has been so restrictive on the side of civil liberties that there have been fewer than 10 cases of court-ordered treatment for mental illness in the last five years.

The Legislature this year amended the community treatment law to give judges, doctors and agencies more legal options for treating incapacitated homeless, but likely only a few will end up being helped after lawmakers removed key funding for intervention efforts.

The medical examiner’s disturbing analysis starkly highlights the need to move more urgently and compassionately on this front as many Hawaii homeless needlessly suffer.

Reach David Shapiro at volcanicash@gmail.com.