Let’s not repeat folly of drug-treatment center

A little less than two years ago, I was writing a story on how Kaua‘i, which had managed to lag behind the opioid crisis that has so decimated mainland communities, was finally experiencing inevitable incursions of drugs like Fentanyl and Oxycontin.

A year or so before that, I’d done a piece for this newspaper on how Kaua‘i was undergoing a sharp — and unexplained — spike in its number of suicides. It is no secret that rates of drug abuse are linked — at least indirectly — to suicide.

By the time I was writing the story on drug abuse trends here, the Adolescent Treatment and Healing Center was already under construction. I spoke with the contractor who was building it. He told me he had been given a very strict timeline to follow because the county believed the project was incredibly urgent.

It had become an island-wide theology, I think, that the arguments in favor of opening the center were airtight. Since at least 2003, there had been steady pressure on county leaders to create such a facility so young people with drug problems would not have to be sent off the island for inpatient treatment.

At the same time, it was also irrefutably true — and remains so today — that there were almost insoluble challenges driven by the small inventory of hospital beds for psychiatric emergencies. Doctors are so overwhelmed with mental-health emergencies that they are often unable to keep even the most severely ill patients in the hospital for more than 48 or 72 hours.

With eight beds, the adolescent treatment center was expected, among other things, to take pressure off Kaua‘i’s existing inpatient psych capacity and make mental-health services more available for the most-severe cases.

But then, earlier this month, news emerged that the contractor the county thought would operate the facility had not been able to deliver on its promises and that the contract had been canceled. More than that, it came out at a County Council meeting last Wednesday that the building had been taken over as a potential temporary COVID-19 isolation facility at the start of the pandemic in March.

Not only that, but the county has developed an interim — though apparently indefinite — plan to relocate some functions of the office of county Prosecuting Attorney Justin Kollar to the new, and-as-yet unused, building. Kollar’s office was in the process of planning to move its victim/witness program, along with five employees and, eventually, some prosecuting attorneys, into the space. There was also talk of “co-locating” programs like Teen Court and the prosecutor’s tobacco cessation and anti-vaping programs.

It was pointed out that the adolescent treatment center had been located intentionally in a comparatively isolated place to make it more difficult for outside influences to intrude. That very isolation will work against the success of most of the programs Kollar intends to move into the facility. There is no public transit available, so anyone without a car or motorcycle would be hard-pressed to use any services provided there.

Kollar — and others in the county hierarchy I’ve spoken with — made clear that the adolescent treatment center concept is still alive, though on life support. “The dream is not dead,” Kollar said.

Since I first heard about the adolescent treatment center concept, I had supported it as a sound strategy on several levels. But as I have delved into how this sorry mess developed, I discovered that there was such ample doubt about the viability of the center concept that many questions that should have been answered about why it should have been built in the first place were ignored.

In 2013, an organization called Families First Hawai‘i Services, based here on Kaua‘i, conducted a county-supported feasibility study to answer all outstanding questions about the adolescent treatment center. A couple days ago, I spoke to Norma Doctor Sparks, the attorney who headed the study, about what she found.

I read the feasibility study and found it raised many concerns about the viability of the of the center. One of the most important conclusions was: “Maintaining the cost-effectiveness of a highly expensive service such as an adolescent substance abuse treatment facility on Kaua‘i is difficult because only very few Kaua‘i adolescents would be appropriate for the service.”

It continued: “If bed slots are not available (from an existing public agency, such as the Hawai‘i Department of Health), building, purchasing or leasing an adolescent substance abuse treatment facility will be cost-prohibitive and not feasible.”

It was already clear, Sparks said, that the DOH Child and Adolescent Mental Health Division was not in a position the underwrite the operating costs of a freestanding center on Kaua‘i. That has never changed, and the state’s financial problems driven by COVID-19 and the evolving recession make it unlikely there will be any developments on that front soon.

Former Mayor and County Councilmember JoAnn Yukimura, who voted against proceeding with the adolescent treatment center project, had the same view.

When I asked Sparks if she completed her project with any confidence that the county could build and afford to operate the center, she responded with two words: “Absolutely not.” She added: “I’m not surprised, but I’m disappointed, because I think there is a need.”

Yukimura went even further. She noted that the feasibility study questioned the plan to house both male and female patients at the center. Besides, Yukimura said, the concept of using inpatient care for adolescent substance abusers “is not the best practice anymore.”

All in all, Yukumura said, “I am disappointed. We spent $7 million to build that facility, but now we have to find a use for it.”

I also spoke with Dr. Gerald McKenna, the most experienced addiction specialist on our island. McKenna told me he served on an advisory committee helping to plan the center, but was frustrated because the county had an unexpectedly difficult time finding a contract operator.

When an operator was finally identified, McKenna said, it was an O‘ahu-based provider called Hope, Inc., of which McKenna said he had never heard. He recalls walking into a meeting only to realize that Hope, Inc., included no specialists with whom he was familiar. “I am sitting across from a group,” he said, “and I’m thinking, ‘who the hell are these people?’”

Then, very recently, McKenna said he found out from news media accounts that “all of a sudden, they were fired and that was it. That’s where I am now. I have no idea what’s going on there.”

More important, perhaps, both Sparks and McKenna said the concept of best practices in treating adolescent drug-abuse issues is to use a family-therapy approach that relies on keeping kids in their homes and providing them a complex of services there. Short-term inpatient treatment for detoxification can be needed, but in-home services are key, he said.

“Addiction is a family problem, and adolescent addiction makes that an even-more-compelling question,” McKenna said. “There’s such a huge amount of addiction on our island, and we only see the most-desperate ones. The need for a program to help them is as important now as it was 10 years ago.”

McKenna said part of the problem is that Kaua‘i’s isolated situation has ensured that contemporary drug-abuse-treatment concepts are slow to take hold here. “The island is 50 years behind the times,” he said. “There is so much prejudice against people who have addictions.”

Kollar, who also served on the study group that first evaluated the adolescent center concept, said that, in retrospect, the attitude within county government “was always along the lines of ‘if you build it, they will come.’ But there were always questions about whether that model would be financially feasible.”

Kollar’s plan considers the building the county has just spent millions to construct as a place that can best be used as a facility in waiting, until the time that economic conditions post-COVID-19 improve and treatment concepts evolve far enough for such an inpatient center to make any sense.

“In the meantime, for that building to be sitting empty is just absolutely unacceptable,” he said. “People were aspiring to do a very good thing. It turns out that that model is not gonna be what works right now.”

Without anyone intending it, the county has made a mess of the Adolescent Treatment and Healing Center. What once seemed so promising turns out to be an unproven concept about which there were reasonable warnings starting at least seven years ago. Now, we also have a pandemic and a recession to deal with.

We’re stuck with this building. Let’s hope Kollar can find some way to make it useful and meaningful for the next few years. But let’s vow that we won’t approach a problem this complicated in such misguided and fanciful ways again.

•••

Allan Parachini is a Kilauea resident, furniture-maker, journalist and retired public relations executive who writes periodically for The Garden Island.