Hawaii-2023-SB1472-Amended

SECTION 1. The legislature finds that the Hawaii coordinated access resource entry system (CARES) is overseen by the department of health's behavioral health administration and is managed by two separately contracted entities; one specializes in behavioral health crisis response, and the other specializes in substance use disorder treatment referrals. On October 1, 2019, contracts commenced to form a statewide network of service providers that is focused around crisis intervention, substance use disorder treatment, mental health, and other behavioral health services. These service providers are contracted through the administration's three behavioral health divisions: adult mental health division, child and adolescent mental health division, and alcohol and drug abuse division.

Hawaii CARES, through its crisis helpline, a statewide crisis call line open twenty-four hours a day, seven days a week, connects Hawaii residents who are experiencing a mental health crisis with appropriate service providers to reduce unnecessary hospitalizations and arrests, and provides continual care by staying in touch with the individual and providers throughout the duration of treatment. Services provided through Hawaii CARES include:

(1) Suicide crisis hotline services that provide therapeutic support and de-escalation techniques to active suicidal callers and connects them with crisis services;

(2) Crisis support management services, a temporary thirty-day case management service provided when requested by the crisis mobile outreach team, which provides face-to-face contact with each individual within twenty-four hours after receiving a referral and maximum effort to support and assist while linking the individual to additional services;

(3) Crisis mobile outreach services that send out local crisis therapists to callers experiencing a mental health crisis in a variety of community settings to provide them with face-to-face, short term, intensive mental health services; trauma informed care response with initial screening and comprehensive assessment; and assistance in returning to their baseline level of functionality;

(4) Licensed crisis residential shelters offered on a temporary ten-day admission basis for purposes of stabilizing and preventing serious mental health decompensation, psychotic breaks, or hospitalization to individuals in crisis who would continue to be at high risk without the benefit of the twenty-four-hour support services; and

(5) Bed stabilization services, provided to individuals in crisis with mental health concerns or a substance use disorder and in need of a stabilization bed as a bridge or a long-term solution in their continuum of care, with case managers assigned to individuals to ensure wrap-around service as needed.

In addition to receiving calls made directly to its crisis helpline, Hawaii CARES serves as Hawaii's local crisis center for the National Suicide Prevention Lifeline, now known as the 988 Suicide and Crisis Lifeline, a national network of two hundred local crisis centers established by the federal government to assist individuals in suicidal crisis or emotional distress to connect with suicide prevention and mental health support services at any time of the day or night. Calls to the 988 Suicide and Crisis Lifeline, which can be made by dialing "9-8-8" or a ten-digit, toll-free number, 1-800-273-TALK (8255), are routed to a certified local crisis center closest to the caller, as determined by the caller's area code. For Hawaii, calls made from within the State to the 988 Suicide and Crisis Lifeline are routed to the Hawaii CARES crisis helpline.

In 2020, the Hawaii CARES crisis helpline received 138,856 calls, which amounts to more than three hundred thirty calls per day on average. The volume of calls has increased following the transition of the National Suicide Prevention Lifeline's telephone number to a new, easy-to-remember, three-digit dialing code "9‑8‑8" in July 2022.

To accommodate the increased volume of calls and ensure that individuals who access the Hawaii CARES crisis helpline directly or through the 988 Suicide and Crisis Lifeline are provided with appropriate crisis intervention services and crisis care coordination, the behavioral health administration requires funds to improve or establish the necessary technology and infrastructure, retain necessary personnel, and expand and enhance existing services provided by contracted service providers through the Hawaii CARES crisis helpline, including:

(1) Expanding and enhancing suicide crisis hotline and crisis management services by:

(A) Providing high-quality crisis counseling;

(B) Providing in-person intervention by trained mental health professionals as an alternative to law enforcement personnel;

(C) Improving the coordination of linkages for individuals contacting the Hawaii CARES crisis helpline directly or through the 988 Suicide and Crisis Lifeline with ongoing care needs; and

(D) Improving and expanding the use of tele-crisis support technology;

(2) Expanding and enhancing crisis mobile outreach services in each county by:

(A) Adding a registered nurse, emergency medical technician, or paramedic to the crisis mobile outreach teams; and

(B) Establishing preventive youth crisis teams that respond to calls from law enforcement personnel requesting behavioral health assessment, referral, and crisis care for youth who witnessed or participated in potentially traumatic events, to address current behavioral health crises and also prevent future crises;

(3) Expanding licensed crisis residential shelter services by acquiring a sixteen-bed facility to house sub-acute beds to help stabilize youth, improve their condition, and prevent future decompensations, homelessness, hospitalizations, and the involvement of law enforcement agencies; and

(4) Expanding bed stabilization services by adding forty adult stabilization beds across all counties.

The purpose of this Act is to appropriate moneys to accommodate the increase in the volume of calls received by the Hawaii CARES crisis helpline and ensure that individuals who access the Hawaii CARES crisis helpline directly or through the 988 Suicide and Crisis Lifeline are provided with appropriate crisis intervention services and crisis care coordination.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 to fund the expansion and enhancement of the suicide crisis hotline and crisis management services provided by contracted service providers through the Hawaii CARES crisis helpline. The funding shall be used to cover expenses for services, including the provision of high-quality crisis counseling and in-person intervention by trained mental health professionals as an alternative to law enforcement personnel; improvement of coordination with individuals who contact the Hawaii CARES crisis helpline directly or through the 988 Suicide and Crisis Lifeline with ongoing care needs; and enhancement and expansion of the use of tele-crisis support technology.

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the expansion and enhancement of the crisis mobile outreach services provided by contracted service providers through the Hawaii CARES crisis helpline; provided that, of the sums appropriated:

(1) $ shall be expended for the addition of a registered nurse, emergency medical technician, or paramedic to crisis mobile outreach teams; and

(2) $ shall be expended for the establishment of preventive youth crisis teams that respond to calls from law enforcement personnel requesting behavioral health assessment, referral, and crisis care for youth who witnessed or participated in potentially traumatic events.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the expansion of licensed crisis residential shelter services provided by contracted service providers through the Hawaii CARES crisis helpline, by acquiring a facility to house sixteen sub-acute beds to help stabilize youth, improve their condition, and prevent future decompensations, homelessness, hospitalizations, and involvement of law enforcement agencies.

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 to fund the expansion of bed stabilization services provided by contracted service providers through the Hawaii CARES crisis helpline, by adding forty adult stabilization beds across all counties.

SECTION 6. The sums appropriated in sections 2 through 5 of this Act shall be expended by the department of health for the purposes of this Act.

SECTION 7. This Act shall take effect on December 31, 2050.

THE SENATE	S.B. NO.	1472
THIRTY-SECOND LEGISLATURE, 2023		S.D. 2
STATE OF HAWAII