Hawaii Lawmakers Push for Better Mental Health Treatment Options

Bill aims to expand access to court-ordered assisted outpatient treatment, but challenges remain in implementation

Published on Mar. 3, 2026

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A deepening clash between state lawmakers, community providers, and the Hawaii Department of Health is putting renewed scrutiny on how the state handles defendants with serious mental illness. At the center of the debate is House Bill 2505, which could streamline assisted community treatment (ACT) and clarify that community mental health outpatient programs can prepare court certificates required to place someone in treatment. However, even when defendants are repeatedly found unfit to stand trial, few are being placed into court-ordered treatment, raising concerns about a 'revolving door' between jail, the Hawaii State Hospital, and the streets.

Why it matters

This issue highlights the challenges Hawaii faces in providing adequate mental health treatment options, especially for those involved in the criminal justice system. Gaps in the system are leading to a costly cycle of repeat hospitalizations and homelessness, putting strain on both public resources and community safety. Addressing these systemic issues could improve outcomes for individuals with mental illness and the broader community.

The details

House Bill 2505 aims to address part of the breakdown by clarifying that community mental health outpatient programs that agree to provide services under an ACT order may prepare the required certificate for the court. This would speed up access to care, particularly for those who are not in a mental state to seek treatment on their own. However, data shows that even when defendants are found unfit to stand trial, few are being placed into court-ordered treatment due to limited resources and a narrow interpretation of the eligibility criteria. Community providers say this leads to a 'revolving door' where individuals cycle back into the community untreated, only to be picked up by police again.

  • From July 1, 2024 to Sept. 30, 2025, there were 298 admissions to the Hawaii State Hospital where a defendant's fitness to proceed remained unresolved.
  • During that period, only 5 defendants were found to meet criteria for involuntary hospitalization, with 4 petitions granted and 1 withdrawn. No ACT petitions were filed.

The players

House Bill 2505

A bill that could streamline assisted community treatment (ACT) and clarify that community mental health outpatient programs can prepare court certificates required to place someone in treatment.

Hawaii Department of Health

The state agency responsible for overseeing mental health treatment programs and determining eligibility for court-ordered treatment.

State Rep. Adrian Tam

The representative who introduced House Bill 2505 to address gaps in the mental health treatment system.

Senate Judiciary Chair Karl Rhoads

A state senator who has expressed alarm at the low number of ACT petitions being filed, calling it a "completely unbelievable" figure.

Institute for Human Services Community Relations Manager Angie Knight

A community provider who has been tracking the "revolving door" of low-level defendants cycling between the criminal justice system and the streets without receiving adequate treatment.

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What they’re saying

“When they're left to their own devices, they become threats to themselves. We have doctors in the state hospital who are saying these individuals don't qualify for ACT when we believe they are … Is it going to take one of these people to assault someone, have a serious crime on their hands, and then, clearly, they're harmful to others?”

— Della Au Belatti, House Health and Human Services Chair (Honolulu Star-Advertiser)

“There has been very little, if any, people found eligible for court-mandated treatment, which different stakeholders are confused by. Some people have over 50 counts of being unfit to proceed with criminal meetings, yet they don't meet eligibility for their evaluation.”

— Angie Knight, Community Relations Manager, Institute for Human Services (Honolulu Star-Advertiser)

What’s next

The Hawaii Department of Health is working to partner with the state Judiciary to expedite ACT hearings and strengthen community supports, including a dedicated ACT team and streamlined petition forms.

The takeaway

This case highlights the need for a more comprehensive and effective mental health treatment system in Hawaii, particularly for those involved in the criminal justice system. Addressing the gaps and barriers to court-ordered treatment could help break the costly 'revolving door' cycle and improve outcomes for individuals with serious mental illness as well as community safety.