Hawaii’s prison system confronts ‘a huge mental health crisis’

[October 10, 2024] 

Chaylvin Oliveira-Kalama called his family almost every day from Halawa prison, and before he died he told his mother the voices he heard in his head were getting worse.

The 30-year-old inmate had been diagnosed with schizophrenia and depression. Sometimes the voices that only he could hear advised him that if he killed himself, his mother and her husband would be “safe.”

His mother Jonnie Oliveira said she tried to reassure him by saying: “We are good, and we don’t want you to believe what you’re hearing.” But on June 18 Chaylvin hanged himself in his cell, she said.

It was at least the seventh suicide in the state correctional system since 2022 as confirmed by Civil Beat. The state Department of Corrections and Rehabilitation rarely specifies the cause of any death in custody.

The suicides are a symptom of what officials, staff and experts described as a mental health system in trouble again, nearly two decades after the U.S. Department of Justice sued the state for alleged “deliberate indifference” to mental health needs at the largest jail on Oahu.

Current and former employees identified at least nine clinical psychologists and psychologists-in-training who have left the correctional system since 2022, an alarming rate of departure that has left facilities short-handed. The department’s mental health branch administrator position also has been vacant since early this year.

“There is a huge mental health crisis in corrections right now. It’s massive,” said Kevan Kamisato, mental health section administrator at the Hilo jail. “We have aging facilities, populations which exceed the maximum counts, and a large population of inmates with mental health issues who are coming in and require extraordinary amounts of care.”

Experts say the system must cope with people suffering from severe mental illness, and staff are being stretched to the limit.

Tommy Johnson, director of the state Department of Corrections and Rehabilitation, said the department is pivoting to new strategies to cope with mental health problems in Hawaii prisons and jails. But he said too many mentally ill people are being routed into Hawaii’s jails for petty crimes and misdemeanors.

“A lot of the folks that we have don’t belong in our custody,” he said Tuesday in a telephone interview. “Their needs can be better met in the community.”

Johnson and Corrections Health Care Administrator Director Romey Glidewell said the system has been relying more heavily on contract nurses, psychologists and psychiatrists because it is difficult to hire full-time permanent staff with those credentials. But they said the system never had any huge staff shortage.

‘A Very Serious Backlog’

Others disagree. The shortage of psychologists left five inmates stranded on suicide watch at the women’s prison in Kailua in August, according to a recent report by the Hawaii Correctional System Oversight Commission.

Commission members were told the Women’s Community Correctional Center had lost its only staff psychologist this year, which Glidewell confirmed. “This has caused a very serious backlog of individuals on suicide watch who otherwise would have been removed,” the report said.

The commission was asked to intervene on behalf of one woman who had been on suicide watch for a month, with staff saying she no longer needed to be there.

Prison staff believed some women were stuck on suicide watch because two doctors who used videoconferencing to see patients were “hesitant to release individuals from suicide watch due to potential liability,” the report added.

Suicide watch is a highly restrictive status that requires constant one-on-one supervision. It involves isolation in a cell as well as loss of phone privileges, visits, mail, activities and even bedding and articles of clothing that could be used for self-harm.

Normally prisoners would be placed on suicide watch for “a few days to a week, depending on their needs and psychological assessment,” the commission said it had been told. “However, since losing the psych doctor, individuals are left to remain on suicide watch for weeks to months with no indication of when they will be removed.”

But Glidewell said Tuesday there were multiple people at the prison who could have moved those women out of suicide watch if that had been appropriate. She said the facility lost a psychiatrist and a psychologist this year, but the psychiatrist was replaced.

Seeking New Strategies

Glidewell said she would need to review the specifics of each of the women’s cases to know more, but said the women were not detained on suicide watch because of a staffing shortage. She said two psychiatrists and two nurse practitioners were available to release the women.

The correctional system is pivoting away from using psychologists for mental health assessment and treatment by relying more on psychiatrists and psychiatric mental health nurse practitioners who can prescribe medication, she said.

“We’re seeing more mentally ill and substance abuse patients, and they’re needing prescriptions sooner, so we’re changing the way that we’re doing everything,” she said.

The system has four of those nurse practitioners, she said, although one is leaving this month.

The potential risks associated with inadequate mental health care were also underscored by the death of Oliveira-Kalama, who was serving a 10-year sentence for robbery.

Jonnie Oliveira said her son had been repeatedly placed on suicide watch at the prison, meaning it was well known he was at risk for self-harm.

When Oliveira urged her son to seek assistance from the medical staff at Halawa, he dismissed her advice in a way that suggested he had little hope he would receive help for his illness. “Mom, this not school,” he would say.

“The whole vibe I got from him is that they’re not taking care of him,” she said. “This is all the things that I want them to be accountable for, because we lost a life, and I’m sure my son is not the only one who was affected by this kind of lack of the state providing services.”

Data for Maui Community Correctional Center shows at least six suicides at that jail in the last four years, and in two of those cases MCCC jail staff reported to the governor’s office there was an urgent need for additional mental health services for prisoners there.

The state has been sued repeatedly in recent years in connection with suicides in correctional facilities, including in the death of Joey O’Malley at Halawa in 2017. A judge awarded $1.375 million in that case.

Johnson said suicides in custody are a growing problem across the country because many mentally ill people are being deposited in prisons and jails who don’t belong there.

“Any suicide is tragic — don’t get me wrong — and we do what we can to protect the lives of the folks in our custody and care. But I can tell you this, if someone is determined to kill themselves, they’re going to try, and keep trying,” he said. “Our job is to identify them and try to get them to care and the treatment they need at the appropriate level.”

“Jails and correctional facilities have become de facto mental health institutions because across the country a lot of those facilities have closed down,” he added.

“We are now housing them in an environment that is the least productive, and that is the most expensive and it’s not appropriate for them, because if it wasn’t for their mental health issues, some of them wouldn’t be in our custody,” he said.

Federal Oversight

The state also is the target of a federal class-action lawsuit over mental health services in the correctional system in a case that is scheduled to go to trial next summer.

That lawsuit filed by Honolulu lawyer Eric Seitz claims that “at least 26 inmates have committed suicide in Hawaii prisons and jails since 2010.” The state Attorney General’s Office denied those claims in its reply to the lawsuit.

Seitz’s lawsuit seeks the appointment of a special master “to oversee the implementation of already existing policies and protocols requiring mental health treatment for state prison inmates,” according to federal court filings.

If the correctional mental health system is put under outside oversight, it would be the second time in recent state history that has happened.

The U.S. Department of Justice sued the state Department of Public Safety in 2008, alleging it exhibited “deliberate indifference” to the mental health needs of prisoners at the Oahu Community Correctional Center, which is the state’s largest jail with nearly 1,100 inmates.

A settlement reached in that case required reforms in some 40 areas, from increasing staffing levels to mandating programs for the mentally ill and improving screening at intake, according to Mark Mitchell, a psychologist hired by the state to implement the settlement.

Mitchell said his contract with the state was not renewed after the DOJ ended its supervision of OCCC in 2015, and by 2020 half of the mental health positions at the facility were vacant. He said lack of staffing made it impossible for the facility to comply with the terms of the DOJ settlement.

Mitchell recalled that a series of suicides occurred at OCCC after he left, and he later became an expert witness in the lawsuit filed by Seitz over more recent issues with mental health care in state correctional facilities.

Mitchell said there needs to be a “commitment to quality” and improvement in mental health care by the corrections leadership, or psychologists and other mental health professionals will continue to leave.

Pablo Stewart, a correctional psychiatric expert who has worked as an attending psychiatrist at OCCC for years, said part of the problem is that people with the proper credentials can find more inviting places to work.

“Quite frankly, no one wants to work in the jail,” said Stewart. “It’s an oppressive setting, the patients are really sick — I can see people would rather work anywhere else than work in the jail, because the conditions are so bad.”

Jails are some of the biggest providers of mental health care, both in Hawaii and across the country, he said, noting many inmates have chronic mental illness and problems with drug abuse.

“So, these are the very complicated patients who need a lot of care, and if you don’t have staff to take care of them, then bad things happen,” he said.

Kamisato said his experience as a clinical psychologist at the Hawaii Community Correctional Center in Hilo has been “like the whole facility is constantly on fire.”

The system is struggling to adapt to the growing numbers of inmates with mental illness, he said. Kamisato has worked at HCCC, WCCC, Halawa Correctional Facility and OCCC, but he is planning to take a new job at the state Department of Health.

“It’s really not about the money, he said. “It’s just that the facilities and the system are so unequipped to deal with this, and at some point it’s too much to put on any individual or group of people to be in charge of this much risk, liability, this many lives. It’s too much.”

“I hope that they can find their way to address these issues, but right now, it’s difficult,” he said.

A Celebration Of Life

At one time Chaylvin Oliveira-Kalama’s family hoped that if he went to jail, he would finally get the help he never got in school or from the scant drug treatment and mental health services available on Maui. But that didn’t happen, his mother said.

Oliveira-Kalama told his family he attended some group therapy sessions at Halawa Correctional Facility, but his mother does not believe he received medication regularly.

She would call and email the Oahu prison to seek help for her son, but only a few of those efforts were even acknowledged, she said. After Chaylvin’s death, she demanded her son’s medical and other records but said she has received no reply from the prison.

Hundreds of people attended Chaylvin’s celebration of life event in Hana last month and friends and family staged a parade through town with motorcycles and ATVs to mark his death.

His mother said she trusted that the state “should be at least helping. We have people getting paid to do it, but yet I don’t see it.”

“I want all this to be brought to light,” Jonnie Oliveira said. “That’s the only way things are going to get solved, if we talk about it.”

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

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