As the psychologist for the interdisciplinary team that developed and opened Molokini II originally in 1996, I am of course saddened at the news of its pending closure. However, I feel that it is necessary to provide some historical perspective and my own thoughts on what it takes to run an effective adolescent behavioral health unit. I believe that all of us agree that we don't just want a unit--we want a good one that provides effective treatment.
The climate in 1996 was worlds away from what it is now. The state Department of Health Child and Adolescent Division provided one or two child psychiatrists to cover their share of call and to treat their own patients in the hospital. There were up to five private child psychiatrists on island who did the same. The state Department of Education [DOE] provided a part-time teacher, an integral part of the team who helped kids stay caught up in school as they healed so that they did not face additional challenges on return to the community. The hospital did not employ any psychiatrists or other physicians at the time, but provided nurses, a psychologist, a social worker, an occupational therapist and a recreational therapist, as it continues to do. To the best of my knowledge, the state Department of Health has not filled their child psychiatrist position on Maui. Of the five private child psychiatrists, only two remain on Maui. One has his hands quite full trying to fill many needs within community agencies (thank you, Dr. Arensdorf). The other has expressed a reluctance to take call. The DOE no longer provides a teacher or even the tutor it provided for a while.
I agree that the Molokini II unit serves a vital need in our community. However, when you approach legislators, it is important to present a full, true picture. The issue of revenue shortfall is serious and presents a threat to overall healthcare in our community, especially as our population expands and ages. Recruitment of qualified child and adolescent psychiatrists has been problematic for at least the last 15 to 20 years. This is a huge systemic problem that must be effectively addressed as a whole. Even if the legislature approves special funding to keep Molokini II open, we have lost two child psychiatrists in the last year and a third is leaving now. The hospital has two locum (temporary) psychiatrists, only one of whom is child trained. It is untenable for any human to be on call 24/7 or even every other day, especially for such a fragile and volatile patient population.
Wes Lo is not the enemy. He is a good guy who has been extremely supportive of the Behavioral Health Division since I have known him. I know that this decision was painful to reach. Any other administrator would have looked at the numbers and closed Molokini II years ago. The board is also struggling with impossible financial decisions, with their hands largely tied behind their backs. I believe that the issue of closing Molokini II cannot be isolated from several other crucial issues, including the lack of support from other state agencies, the need for an influx of new physicians into the Maui community and the need to free the hospital from the lumbering, restrictive, inefficient state system. It is crucial that the legislature support exploring partnerships with private not-for-profit health care organizations, preferably with ties to training institutions to provide a pipeline of potential providers for our community.
Please consider my comments when you approach our legislators.