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Eliminating Barriers to the Treatment of Mental Illness -- HRS Evaluated Law by Law
By News Release @ 11:57 AM :: 1128 Views :: Health Care, Law Enforcement, Drugs

Eliminating Barriers to the Treatment of Mental Illness

Hawaii State Report Card

From Treatment Advocacy Center, Last Updated: June 14, 2019

Method and Scoring: State involuntary civil commitment laws are evaluated using a 100-point grading scale. The scoring criteria is in accordance with the Treatment Advocacy Center’s values and policy preferences.

Up to 50 points are awarded to a state based on the quality of its inpatient commitment law and up to 50 points are awarded based on the state’s assisted outpatient treatment law.

Final letter grades are computed using the following scale:

97 or above      A+
93-96               A
90-92               A-
87-89               B+
83-86               B
80-82               B-
77-79               C+
73-76               C
70-72               C-
67-69               D+
63-66               D
62-60               D
59 or below               F


PART ONE: Inpatient Commitment Statute (up to 50 points)
Criterion Citation Specifications Points
1. Citizen access to court, emergency evaluation (5 pts) Haw. Rev. Stat. § 334-59(a) ​☐Authorizes family/enumerated adults (3 pts)
☐Authorizes any responsible adult (2 pts)

Designated professionals, designated medical professionals, and law enforcement officers
2. Quality of emergency petition process (5 pts) Haw. Rev. Stat. § 334-59 ☒Process specified and reasonable (2 pts)
☐Timelines specified and reasonable (2 pts)
☒Responsible entities identified (1 pt)
☐Requires certification by more than one professional (-2 pts)
☐Emergency evaluation criteria inconsistent with inpatient commitment criteria (-5 pts)
3. Emergency hold duration (5 pts) Haw. Rev. Stat. § 334-59(e) ​☒At least 48-hour hold allowed (3 pts)
☐At least 72-hour hold allowed (2 pts)
4. Citizen access to court, inpatient petition (5 pts) Haw. Rev. Stat. § 334-60.3(a) ☒Authorizes family/enumerated adults (3 pts)
☒Authorizes any responsible adult (2 pts)
5. Quality of criteria for harm or violence to self or others (up to 10 pts) Haw. Rev. Stat. §§ 334-1, 334-60.2(2) ​☒Contains explicit criteria (10 pts)
☐Language is vague/ambiguous (-3 pts)
☒Harm must be imminent (-3 pts)
6. Quality of criteria for grave disability/basic needs (up to 10 pts) Haw. Rev. Stat. §§ 334-1, 334-60.2(2) ☒Contains explicit criteria (10 pts)
☐Language is vague/ambiguous (-3 pts)
☒Endangerment must be imminent (-3 pts)
☐Criteria require family to turn person out of home to receive treatment (-3 pts)
​☐Unreasonably high risk of harm (-3 pts)
7. Quality of criteria for psychiatric deterioration (up to 10 pts)  Haw. Rev. Stat. §§ 334-1, 334-60.2(2) Contains explicit criteria (10 pts)
☐Language is vague/ambiguous (-3 pts)

(See comments below)
SUBTOTAL                   35 
PART ONE: Extra Credit
1. Specifies in which court a petition for inpatient commitment shall be filed (1 pt)      
Extra Credit                   0
PART ONE TOTAL         35 


PART TWO: Outpatient Commitment Statute (up to 50 points)
Criterion Citation   Specifications  Points
1. AOT explicitly authorized (5 pts) Haw. Rev. Stat. § 334-121 ☐Requires local government to adopt (-3 pts)
2. Citizen access to court for AOT (5 pts) Haw. Rev. Stat. § 334-123 ☒Authorizes family/enumerated adults (3 pts)
☒Authorizes any responsible adult (2 pts)
☐Authorizes citizen petition to mental health system only (-2 pts)
3. Criteria sufficiently broad to provide actual access (up to 10 pts)   Evaluate applicable provision only:
☐If inpatient/outpatient criteria are the same: 
☐Inpatient criteria include psychiatric deterioration standard (10 pts) or
☐No psychiatric deterioration standard, adequate grave disability standard (5 pts)
☒If outpatient criteria are distinct from inpatient criteria:
☒Allows consideration of length of treatment history ≥ 36 months (2 pts)
☐Does not exclude periods of incarceration or hospitalization (-1 pt)
☒Does not limit application to those currently dangerous or unstable (4 pts)
☒Does not limit application to those refusing service or currently lacking insight (4 pts)
4. Authorizes AOT directly from community (5 pts) Haw. Rev. Stat. § 334-123  
5. Procedures sufficiently detailed to guide practitioners (up to 5 pts) Haw. Rev. Stat. §§ 334-121, 334-133 ☒Process specified and reasonable (1 pt)
☒Timelines specified and reasonable (1 pt)
☒Responsible entities identified (1 pt)
☐Periodic reporting to court required (1 pt)
☒Renewal process expressly specified (1 pt)
6. Procedures require the treatment plan to be shared with the court (5 pts) Haw. Rev. Stat. § 334-126(h)  
7. Specifies procedures and consequences for nonadherence (5 pts) Haw. Rev. Stat. § 334-129  
8. Duration of initial order (5pts) Haw. Rev. Stat. § 334-127(b) ☐=90 days (2 pts) or
☒>90 days (5 pts)

One year
9. Duration of continued order (5pts) Haw. Rev. Stat. § 334-133 ☐=180 days (2 pts) or
☒>180 days (5 pts)

One year
SUBTOTAL                   49 
PART TWO: Extra Credit
1. Specifies court for AOT (1 pt) Haw. Rev. Stat. § 334-121 Family court
2. Court monitoring of voluntary settlement agreements (5 pts)      
Extra Credit                   1
PART TWO TOTAL         50 


TOTAL      85 
GRADE      B 



In 2013, Hawaii passed amendments to inpatient criteria that removed 'gravely disabled' and 'obviously ill' from the language and criteria. The removal harmed the efficacy of the grave disability standard, and the standard no longer contains psychiatric deterioration criteria.

In 2019, Hawaii's legislature expressly re-incorporated failure to obtain needed treatment for mental illness to prevent serious physical debilitation or disease into its definition of 'dangerous to self.' 

2018 Report Card:  Hawaii Grade C for Involuntary Psychiatric Treatment Laws


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