The death rate among Hawai'i's mentally ill has been dropping and is the lowest in the past few years, state officials said yesterday in response to a federal magistrate's scathing report on the state's efforts to implement a community mental-health plan.

The state also said there's no indication that five suicides in the past year were connected to the leadership of the state adult mental-health department.

In a 35-page report by the attorney general's office, the state said it did not want to minimize the impact of any death, but said "the numbers are relevant."

The state also gave a different view of three cases cited by the report by U.S. Magistrate Kevin Chang. The cases involved the deaths of two mentally ill residents and a stabbing.

Meanwhile, the Justice Department yesterday filed a sympathetic response to Chang's findings, saying it "echoes" the magistrate's concerns that state adult mental-health officials weren't making "significant and timely progress."

The responses and Chang's report will go to U.S. District Judge David Ezra, who will hold a hearing Sept. 22 to evaluate the state's progress. The judge is overseeing the state's compliance with a mandate to develop a community mental-health plan by June 30 next year.

The mandate is an offshoot of a 1991 Justice Department lawsuit based on the federal Civil Rights of Institutionalized Persons Act that alleges violations of the civil rights of Hawai'i State Hospital patients.

As part of the case, the state Department of Health agreed to come up with the plan for Hawai'i's mentally ill, estimated by the state to be as many as 9,000.

In his 50-page report issued July 20, Chang cited the deaths of 16 mentally ill residents, including suicides, during a two-month span this year. He said the failure by health officials to place a high priority on addressing those deaths reflected a "serious lack of judgment and questionable leadership."

He called the failure "appalling," saying the state's lack of progress on developing the plan could be a life-or-death situation for the mentally ill the state is supposed to serve.

The state's response agreed that "much remains to be done" by June 30, but it pointed out that Hawai'i may be the only state that must develop a statewide community mental-health plan while under the jurisdiction of the federal courts.

The state lawyers also questioned whether the plan, which they said originally was meant to cover former state hospital patients only, has "gone far beyond that mission, thereby falling outside the subject matter jurisdiction of the United States District Court."

In addition, state Attorney General Mark Bennett and special Deputy Attorney General Paul Aucoin tried to defuse some of the harsh criticism, saying Chang downplayed accomplishments in suggesting a glass is "half empty" instead of "half full."

The lawyers said they welcome Chang's directive that a doctor and his special monitor review all deaths among the mentally ill this year, but they also said the rate of death has dropped as the number of residents receiving mental-health services from the state has increased.

"As unfortunate as the five suicides are, there is nothing in the record that suggests that any of these incidents of suicide were connected, either to each other or to (adult mental-health division) leadership," they said.

SUICIDES DISPUTED

In one of the three cases cited by Chang, the magistrate cited an "apparent suicide" of a woman who had earlier called her treatment facility's "hotline" to say she took an overdose of medication. In its response, the state said the woman did not commit suicide.

"As it turns out, 'the apparent suicide' was not a suicide at all, but a death due to undetermined cause," the lawyers said, citing the autopsy report.

In a second case, the state lawyers said a man accused of stabbing his mother in the chest three times had been released from the state hospital six years earlier.

Chang had said the man was on "temporary conditional release" from the hospital, but his case manager apparently did not know about his past history of violence toward family members or a prohibition that he was not supposed to see them.

The state said the man appeared to be "treatment compliant" and no "causal relationship" has been established between any failure of treatment and his illegal act.

The man has been identified by family members as Rueben A. Ortiz, who has been charged with stabbing his mother on April 13.

In the third case, Chang reported that a former state hospital patient who had a history of drug use was given a large sum of money by his case manager, and was later found dead from an apparent drug overdose. The state said the former patient was given a community placement check of $500, but left his supervised housing and treatment program the next day, bought crystal methamphetamine and accidentally overdosed.

The state said once a patient is well enough to leave the hospital, there is no guarantee that the former patient will rely on the support provided him.

The case "represents a sad example of just how challenging it is to treat forensic mental-health patients with a history of substance abuse," the state lawyers said.

FORMAL FILING TODAY

The state submitted its response in a receptacle at the federal courthouse late yesterday afternoon after the court closed. The document will be formally filed today.

The Justice Department filed a six-page response that also agreed with Chang that the adult mental-health division has not established an internal organizational structure to support clinical services.

"The emphasis that (Chang) places on the harm that has befallen certain consumers and their families due to gaps of service within the (adult mental-health division) system highlights the United States' concern in this area," Justice Department attorneys said.

Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com.