The Hawaiʻi State Hospital is struggling to manage an influx of patients, following the enactment of Act 26, a law designed to expedite mental health care for non-violent offenders. Since its implementation in 2020, the number of individuals admitted under this law has surged by nearly 2,000%, raising concerns about the effectiveness of the system meant to provide urgent treatment.
On September 3, 2025, a 61-year-old homeless man appeared via Zoom in Honolulu’s First District Court, where a judge informed him that he was found mentally unfit and would be released from custody. This man, who has been admitted to the state hospital 22 times in five years, illustrates the challenges faced by the system. While the judge expressed hope that he would engage with mental health services, his record suggests otherwise, as he was arrested again just days after his release.
Act 26 was initially celebrated for its intention to transform the criminal justice system by diverting individuals with mental health issues away from jails and into community-based treatment. Prior to its enactment, many found themselves in jails serving as de facto mental health facilities, where they waited for assessments for weeks, or even months. The law aimed to shorten these wait times significantly, allowing for expedited mental health evaluations and quicker releases for those deemed unfit to stand trial.
Despite early successes, including a reduction in jail time for low-level offenders and estimated savings of over $7 million in the first year, recent data has revealed a troubling pattern. The Department of Health reported that many individuals continue to cycle through the state hospital without receiving adequate treatment. The hospital, which is the only state-run facility for psychiatric care in Hawaiʻi, has seen its admissions increase dramatically, with crowding leading to a waiver of licensing standards to accommodate additional patients.
Many individuals released from the hospital are homeless and struggle with ongoing mental health issues and addiction. According to Connie Mitchell, executive director of the Institute for Human Services, the system is failing to provide the necessary support to ensure successful reintegration into society. “They are often released in the same state they were admitted, struggling with psychosis or substance abuse,” she noted.
The challenges have been exacerbated by the law’s restrictions on the duration of hospital stays for treatment. Initially set at one week, this period has now been extended to two weeks, yet many patients still do not receive meaningful care during this timeframe. Experts argue that this is insufficient for individuals with severe mental health conditions, leading to their rapid return to the streets and, ultimately, back into the hospital.
Moreover, the lack of community services for individuals transitioning out of the hospital has created a significant gap in care. While the hospital staff attempts to connect patients with organizations like the Institute for Human Services, limited resources hinder effective follow-up. Many patients, once discharged, do not remain in the community services provided.
As the situation continues to unfold, the cycle of re-arrest and readmission highlights the urgent need for a comprehensive approach to mental health care that addresses the root causes of these issues. “We need to meet people where they’re at,” stated Mark Linscott, the hospital’s current administrator. “Sending them to the highest level of care may not be the right direction.”
The story of the 61-year-old man reflects broader systemic failures that require immediate attention. As the number of individuals entering the state hospital increases, it has become evident that Act 26, while well-intentioned, is not achieving its aims. Without adequate resources and a more effective treatment strategy, many will continue to fall through the cracks of the system, perpetuating a cycle of mental health crises, homelessness, and incarceration.
