Nolan Espinda, the director of the Hawaii Department of Public Safety, was facing a crisis.

Earlier this year, Espinda learned that, under his watch, the department’s mental health branch was falling into disarray, leaving many of the hundreds of mentally ill inmates in Hawaii to go without adequate care.

About This Project Civil Beat is examining how the state manages its troubled, overcrowded prison system, which includes four prisons and four jails in Hawaii, and a contract private prison in Arizona. This story is the first in a series that looks into the state of mental health care.

For Espinda, that was an all-too-familiar predicament: In 2008, the U.S. Justice Department sued the department over a similar condition, which stemmed from “deliberate indifference to the mental health needs” of inmates at the Oahu Community Correctional Center — where he was the warden at the time.

The lawsuit led to a court-sanctioned settlement agreement, which kept the department under federal oversight until it could raise the level of care at OCCC up to Justice Department standards — a process that took more than six years.

Now, the old problems are coming back to haunt Espinda.

Cory Lum/Civil Beat

To hear him tell it, Espinda took immediate action, putting a new team in charge and setting the mental health branch on a path to correcting the “significant deterioration” he saw in the level of care.

“I’m not trying to claim at this point in time that we’re a shining star. But we definitely have gone from a downward line to an upward line,” Espinda said in a recent interview. “I’m satisfied that the level of care has risen dramatically back to where it should be.”

But a Civil Beat investigation over the past few months found that the mental health branch is still a far cry from where it was two years ago when the department emerged from federal oversight.

In fact, the investigation — based on a series of documents obtained from within the department, as well as interviews with current and former Health Care Division employees — found that the mental health branch is failing to provide some of the most basic care, let alone meet the clinical standards once demanded by the Justice Department.

Among the findings:

• Not all mentally ill inmates are properly assessed and provided with full treatment plans that can help guide them to safe release from custody.

• The mental health branch is so understaffed that it doesn’t have the needed manpower to offer enough rehabilitative services to inmates.

• The department is also so cash-strapped that, to avoid overtime expenses, it has banned mental health employees from making rounds on the weekends and holidays, including for daily clinical monitoring of inmates on suicide watch.

Critics also say Espinda’s decision to part ways with key employees has had the opposite of its intended effect, exacerbating the mental health branch’s woes and causing morale problems for employees.

Russell Van Vleet, who oversaw the settlement agreement as one of the court-appointed monitors, says Civil Beat’s findings demonstrate that the department has abandoned its commitment to abide by the spirit of the settlement agreement.

“You had the best minds in the country come in and spend years providing a blueprint for how to provide the care and, as soon as the settlement agreement expires, you throw it away. That makes no sense at all,” Van Vleet said. “It is truly unconscionable and astonishing that anybody in the position of leadership would allow this to happen.

Lack Of Effective Treatment

Civil Beat’s investigation found that the mental health branch has a long way to go to raise the level of care back to what was once demanded by the Justice Department.

The investigation found:

• The mental health branch is falling short on one of the key clinical standards: to prepare “comprehensive treatment plans” for at least 90 percent of all mentally ill inmates.

Several Health Care Division employees, who would agree to be interviewed only if Civil Beat granted them anonymity to protect them from reprisals, say that the treatment plans are being prepared for only about 50 percent of inmates.

But the employees say the pressure is now being put on to bump up the number by using a simplified form — instead of taking time to properly assess each inmate and provide a full treatment plan that details the rehabilitative steps that should be taken.

The form “is short and superficial — more like a checklist rather than a plan. It’s not meaningful,” one employee said.

Cory Lum/Civil Beat

• The mental health branch is also struggling with another clinical standard: to offer 20 hours of rehabilitative services to each mentally ill inmate per week — with 10 hours spent on recreational activities, such as exercising and watching TV, and another 10 hours on “therapeutic” sessions, such as stress management and “social/relationship” workshops.

In an interview with Civil Beat last week, Espinda acknowledged that, in recent months, the amount of rehabilitative services had dropped to as low as 5 hours.

Still, Espinda said, the new team in charge of the mental health branch has since sorted out the issue. “Our treatment hours … are back up to the level that we should be at,” he said.

But several employees say the mental health branch has been artificially bumping up the amount of therapeutic hours by including “worksheet activities” — which consist of nothing but doing word-association exercises and coloring animals on pieces of paper — and improperly labeling them as therapeutic sessions.

The employees also point out that, even though therapeutic sessions are supposed to be led by psychologists and other qualified employees, the mental health branch is relying on “para-medical assistants” — who have no proper credential — to conduct “worksheet activities.”

Espinda acknowledged that “a color-crayon program” shouldn’t be labeled as a therapeutic session. But he denied that the mental health branch is engaging in the practice.

“I would dispute that we in any way rely on a color-crayon program for therapeutic hours,” he said. “That’s not what we do.”

But documents obtained by Civil Beat that keep track of the amount of rehabilitative services at OCCC show otherwise.

According to the documents, the mental health branch began heavily relying on “worksheet activities” in mid-August.

During the first week of August, for instance, the documents show that only an hour of therapeutic, “coping skills” session was held in Module 1, which is reserved for inmates suffering from acute mental illness. But the amount of therapeutic sessions shot up to 10.25 hours two weeks later, thanks to 8.5 hours of “worksheet activities.”

In all, the documents show that, in August and during the first three weeks of September, “worksheet activities” made up nearly two-thirds of the 63.75 hours of therapeutic sessions held in Module 1.

• On Aug. 8 — barely a month into the state’s fiscal year — Gavin Takenaka, the mental health branch’s acting administrator, distributed a memo to announce that, because of “budget constraints,” the use of overtime is banned “effective immediately.”

In an email exchange with mental health employees, Takenaka later confirmed the memo’s implication: The daily clinical monitoring of inmates on suicide watch — required under a department policy — has to be stopped on the weekends and holidays.

Espinda told Civil Beat that he wasn’t aware of Takenaka’s memo. “To the best of my knowledge, (the weekend and holiday coverage) is happening right now,” he said. “I can’t confirm or dispute what you’re saying, but we certainly will be looking into it immediately.”

Cory Lum/Civil Beat

Staffing Concerns

Mark Mitchell, whose contract as the mental health branch’s administrator wasn’t renewed at the end of June, says the deficiencies of the mental health branch primarily stem from severe staff shortages in the Health Care Division — a problem that has long plagued the Department of Public Safety.

The problem is particularly serious in the mental health branch, according to a database of the Health Care Division employees.

An analysis of the database shows:

• The mental health branch has 61 budgeted positions, but 25 of them — or 40 percent — were vacant as of Friday.

• At OCCC, 12 of the 34 budgeted positions weren’t filled — a 35 percent vacancy rate. Among the 20 positions reserved for psychologists and other qualified employees, only 10 were filled, leaving the mental health branch with only half of the manpower needed to hold therapeutic sessions.

• At the state’s seven other correctional facilities and in the administrative office, the vacancy rate stood at 48 percent — with 13 out of the 27 budgeted positions sitting vacant.

• Despite the staff shortages, the department didn’t renew the contracts of three key employees — Mitchell; Victor Yee, who managed OCCC’s mental health section; and Jackie Lee, a nurse who was in charge of Module 1 — after it was free of federal oversight.

Espinda declined to talk about why the contracts weren’t renewed, citing personnel rules. He noted that the mental health division is now being headed by a new administrator, Takenaka.

“As the director, I did notice a significant deterioration in the level of services, so we made some decisions — we’ve moved around some people; we’ve hired some new people — and reinvigorated the existing staff who may have not been as satisfied or as enthusiastic about performing their job,” Espinda said.

But Van Vleet, the former federal monitor, says the staffing changes are counterproductive.

“These three people he let go — they were the only people who could provide the supervision necessary to comply with the settlement agreement, and there was nobody else that could have done that,” Van Vleet said. “So the termination of those people alone indicates to me that the state has actually no commitment to following through and complying with the standards established by the settlement agreement.”

Cory Lum/Civil Beat

Several Health Care Division employees told Civil Beat that they can barely keep OCCC’s services functioning now.

“If anyone calls in sick or has a vacation or somebody quits, we’re not going to have enough staff to run our operations because we’re literally at the bare bones,” one employee said. “Our morale is definitely down because everybody is overworked and stressed out.”

Shouldn’t Have Had A Money Problem

But the staff shortages in the Health Care Division aren’t rooted in the lack of funding — in fact, the department has received the Legislature’s support every time it has asked for additional funds to bulk up the mental health branch.

In 2008, for instance, the Legislature agreed to increase the Health Care Division’s budget by nearly $900,000 to pay for 24 new positions — all mental health employees. In 2014, the department again received an increase of about $785,000 to fund 20 additional positions.

Still, despite additional funding by the Legislature, Mitchell says the Health Care Division has never filled key positions under the management of its administrator, Wesley Mun. He adds that Espinda wasn’t proactive in stepping in to fast-track the hiring, either.

Espinda told Civil Beat that hiring in his department, including mental health positions, is a cumbersome process.

Earlier this year, Mitchell says he was told by the department’s personnel office that filling vacancies in the mental health branch was taking a back seat to the recruitment of correctional officers and hiring in the Law Enforcement Division, which includes the sheriff’s office.

Civil Beat reached out to Mun with the details of Mitchell’s accounts, but he declined our request for comment. Instead, Espinda agreed to sit down for the interview, saying he was the most appropriate official in the department to address the questions.

State Rep. Gregg Takayama says he has been talking to Mun about the staff shortages but declined to share the details of those conversations. He says he’ll give the department until the end of the year to make progress on filling the vacancies.

“At least by the end of the year, we’ll ask the department to fill us in on the progress that they’ve made. If it’s unsatisfactory, then I’ll talk to my counterpart in the Senate to see if oversight hearings might be in order,” said Takayama, who chairs the House Public Safety Committee.

“The important thing, to me, is that we not backslide on the conditions of the (settlement agreement) that we were able to meet at OCCC,” Takayama said. “It’s important because the consequences are severe if DOJ ever has to come back and find us in violation again.”

Cory Lum/Civil Beat

Return Of The Feds?

There are signs that the Justice Department is showing interest, possibly as part of a broader inquiry spurred by a complaint filed in January by the American Civil Liberties Union of Hawaii.

The Justice Department declined to comment for this story. But Mitchell told Civil Beat that he and Mateo Caballero, legal director of the ACLU of Hawaii, recently had a conference call with federal investigators, who asked them a number of questions about the state of mental health care.

Still, Honolulu attorney Eric Seitz, who partnered with the ACLU of Hawaii in the 1980s to bring a class-action lawsuit that led to a consent decree to reduce overcrowding at OCCC and the Women’s Community Correctional Center, says he’s not counting on the Justice Department to come intervene again.

“They don’t have enough resources, so they have to pick and choose the cases where they think they can make the greatest impact,” Seitz said. “And Hawaii is just not a place that’s particularly impactful.”

Seitz thinks the Legislature should give the responsibility of providing medical care to the Hawaii Department of Health. “They’ll probably do a more consistent and better job,” he said.

“They need to own the problem they’ve got in their prisons — that’s what they’re in the business of doing.” — State Sen. Rosalyn Baker

But state Sen. Rosalyn Baker, who chairs the Senate Health Committee, isn’t convinced that handing the responsibility to the health department.

“Even if the Department of Health were to take it over, the services will still have to be delivered in prisons in a culture that doesn’t care very much about whether inmates are rehabilitated or whether they’re getting decent care,” Baker said. “That’s the basic problem — you’ve got to have a culture change.”

Besides, Baker says, the Department of Public Safety shouldn’t be let off the hook so easily.

“They need to look inside and figure out how they’re going to make a commitment to the people that are in their care and actually help them,” Baker said. “They need to own the problem they’ve got in their prisons — that’s what they’re in the business of doing.”

Caballero says there has to be a sense of urgency in resolving the issue — no matter who’s in charge.

“The reason we all should care is that these folks will eventually come out, so it’s a public safety matter if they are not receiving adequate care,” Caballero said. “If they do not come out better than they went in, then of course they’re going to reoffend. At that point, it’s not only their responsibility, but also the state’s responsibility for not doing a better job of rehabilitating them.”

Seitz says he intends to prepare a class-action lawsuit on behalf of mentally ill inmates in an effort to force lawmakers to take the problem more seriously.

“In the next couple of months leading up to the next legislative session, I’ll put together a draft lawsuit and send it over and inform the Legislature that it’s coming and what it’s going to cost the state unless they take some immediate action,” Seitz said. “I would hope that the Legislature would stand up and listen and see that there are ways to avoid that by intervening at an earlier stage.”