Treatment Denied, Prisons Supplied
Photo of a typical solitary confinement cell courtesy of Édouard Hue.
Hawai’i’s mental health system has failed its residents for decades. Recent plans to inspect prisons for mental health services acknowledge a problem the state has long ignored: the carceral system has become the default solution for mental health crises. The state’s reliance on jails to manage mental illness, illustrated through multiple federal lawsuits, audits, and decades of underfunding, proves that this crisis is neither accidental nor inevitable; it is the direct result of policies that mirror America’s decades-long embrace of mass incarceration as a substitute for social care. When the state chooses to spend $30 million on jail renovation and construction rather than funding psychiatric clinics, it is making a deliberate choice that adheres to a destructive practice.
Following the deinstitutionalization movement in the 1970s, the U.S. dismantled its mental health infrastructure while expanding prisons and framing poverty, addiction, and mental illnesses as criminal issues, rather than public health priorities. While mass incarceration followed the “war on drugs” and “war on crime,” conceptualized by the Nixon administration and materialized by the Reagan administration under mostly racial motivations, the resulting legislative changes had severe implications for Hawai’i residents struggling with mental illness and substance use.
The Origins of Mass Incarceration
The deinstitutionalization movement—defined by a severe distrust of large state hospitals—swept through psychiatric hospitals nationwide under the guise of liberation. While promising community care, the movement was never fully realized. Instead, catastrophic legislation cracking down on substance use redirected federal funds to prisons and increased punitive resources, rather than clinics and psychiatric facilities. Hawai’i mirrored this shift, increasing its incarcerated population by 709% 8 tm 1978 to 2015, on par with the overall national increase from 294,396 to 1,476,850 inmates—just over 400%— in the same period. In contrast, the state population only increased by ~63% over this time period and the national population increased by ~69%, showing that the incarceration rates far outpaced that of population growth. This demonstrates how Hawai’i’s failure to reinvest in community care is uniquely catastrophic.
In 1991, conditions at the Hawai’i State Hospital (HSH) were so substandard that the U.S. Department of Justice sued the state for “deliberate indifference” to patients’ rights, citing overcrowding, rampant violence, and a “shocking lack of treatment.” By 1994, federal investigators found that the state was still failing to meet constitutional standards, noting that HSH remained dangerously understaffed and incapable of providing adequate care. Decades later, little has changed: a 2020 audit found HSH still violating safety standards, with waitlists exceeding six months and patients discharged without long-term rehabilitation plans. As a result, many were forced to go without necessary and time-sensitive treatment, and previous patients were rendered vulnerable to incarceration.
The Carceral System in Hawai’i
In 2023 alone, Hawai’i ranked last in the nation for the percentage of adults who are unable to receive mental treatment, with the rate of untreated mental illness being the highest in the U.S., and significantly higher than the national average. Thus, the state’s 2019 announcement of a $160 million hospital renovation was less of a solution and more of a confession to previous failures. Staffing shortages and limited bed capacity were two of many issues not addressed by this costly proposal—set to be complete in 2021—revealing the continued pattern of systemic indifference masked by a costly, visually appealing restoration of the facility.
Further exacerbating these issues, the facility faced construction delays, like most projects in the state, and opened a year late in 2022. Even worse, the barely two-year-old hospital is now in need of $40 million in repairs, as of early 2025. Although largely the fault of the construction company itself, these repairs are draining valuable money that could be improving the accessibility of mental health treatments and staff. Instead, they’re being used to solve problems that were entirely preventable during initial construction.
Mass incarceration in America has always been racialized, disproportionately targeting black, Hispanic, and indigenous communities. In Hawai’i, this dynamic manifests in the overrepresentation of Native Hawaiians and Pacific Islanders in prisons and jails. Though this demographic makes up approximately 25% of the state’s population, they comprise about 39% of the state’s incarcerated population—many of whom cycle through Hawai’i’s correctional facilities for low-level offenses linked to substance abuse or untreated mental illness. This reflects a national playbook: criminalize mental illness in marginalized groups and impoverished communities instead of funding care.
Given that there’s no consistently reliable, long-term mental health infrastructure in Hawai’i with adequate staffing, initial contact with mental health patients on the ground defaults to local law enforcement. A December 2020 Audit of the Honolulu Police Department (HPD) found that 69% of officers felt their department didn’t provide them sufficient training, with 44% reporting they received no training in de-escalation tactics to avoid the use of unnecessary force. Unsurprisingly, HPD resolved 453 of 454 mental health calls in 2021 with the use of force.
Once incarcerated, individuals face a system ill-equipped to address their needs:
“About 700 individuals diagnosed as severely and persistently mentally ill are admitted to [OCCC] each year, and 450 to 600 of them [are] on suicide watch. [Between] 9.5 and 12% of the OCCC population [is mentally ill and cycle through the jail every four months, with some cycling through once every six weeks.]”
Hawai’i is allowing too many individuals with mental illnesses to cycle through their criminal justice system. Instead of proposing a $30 million construction plan for a new jail or the renovation of existing structures, the state needs to lay a stronger foundation for its mental health infrastructure. He attempted to address these issues, such as the new OCCC, the largest correctional facility in the state, claiming they’re creating a new facility focused on rehabilitation.
But even this plan has problems. State legislators admitted that finding public funding will be difficult due to the undesirability of prisons as government initiatives. Instead, due to America’s prison-industrial complex, funding may come from the private sector. Privatizing prisons is cause for concern because it turns the justice system into an avenue of economic opportunity. People or corporations with stakes in the “success” of the incarceration facility may weigh decisions against the impact it would have on their profit, leading to detrimental cost-cutting, forced incarceration, and a lack of transparency and accountability about internal affairs. Lastly, stakeholders in privatized prisons may try to influence policies that would benefit the operations of their institution, bringing the goal of the carceral system further from justice. While Hawai’i doesn’t have any privately owned correctional facilities yet, 54 percent of prisoners are incarcerated in private prisons on the mainland—the highest percentage of any state in the country—further demonstrating their aversion to restorative justice and their reliance on the money-motivated American carceral system.
Looking Forward
Rehabilitation in a correctional facility is a reactive solution; it takes place after a crime or crisis has already occurred. So much money could be better allocated and more lives protected with proactive measures, but instead, proposed solutions cater to our country’s persistent, catastrophic history of mass incarceration. For example, effective jail diversion—redirecting offenders to alternate care facilities—for those with mental illness could decrease taxpayer costs by about $2,800 per person. Further, the average cost per case in a crisis program was found to be $1,520–including program costs and psychiatric hospitalization— as opposed to an average cost per case of $1,963 for regular police intervention.
Hawai’i’s priorities are severely misplaced. It has recently implemented bills for healthcare reform—creating crisis intervention and diversion service programs within its Department of Health—intended to funnel individuals struggling with mental illness or substance use into the healthcare system rather than the criminal justice system. At the same time, there are still proposals for renovation or construction of new prison facilities circling, with the potential to offset the gains these intervention programs would provide.
Those who undergo mental health initiatives in jails will experience relapses or recurring symptoms and incarceration if not supported by a more robust and resilient statewide network. In 2024, there were five suspected suicides by Hawai’i inmates—the greatest number since 2015—with more confirmed deaths across the outer islands. The Honolulu Civil Beat has reported on multiple suicides by inmates in OCCC and Halawa Correctional Facility, bringing to light the severe inadequacies of Hawai’i’s system when it comes to taking care of its struggling inmates.
Given that the causes of death are rarely specified by the state Department of Corrections and Rehabilitation, the number of known suicides is clear evidence that Hawai’i’s mental health system has remained in crisis since the state was sued for “deliberate indifference” over two decades ago. To address this, Hawai’i’s government should make the record of inmate suicides available to the public. All sensitive and identifying details would be kept private, but allowing the general public to access the number and date of these deaths would be a way to hold officials and the state accountable.
Hawai’i’s mental health crisis is not a failure of resources; rather, it is a failure of prioritization. For decades, the state has chosen incarceration over care, punishment over prevention, and costly construction over meaningful investment in treatment. The cycle is clear: neglect psychiatric infrastructure, usher the mentally ill into understaffed jails, and spend millions trying (and failing) to fix the consequences, all to the benefit of the stakeholders within the prison-industrial complex.
Still, some progress has been made. In 2024, nine states have received reentry waivers from the Centers for Medicare & Medicaid Services (CMS), allowing states easier transitions for individuals returning to the community from incarceration. To support existing proactive initiatives that would prevent unnecessary incarceration, these waivers would aid those who were previously failed by the criminal justice and healthcare systems in Hawai’i.
Despite some steps being taken to remedy the insufficient mental health infrastructures in prisons and jails, these reforms are long-awaited. This request to investigate Hawai’i’s prison system will likely reveal this obvious conclusion: no amount of jail upgrades can take the place of a functioning mental health system. No reactive rehabilitation program can undo the damage of untreated illness. Hawai’i needs to break this pattern by redirecting funds from carceral band-aids to real, thorough community care that reaches its intended recipients. Until then, the state’s most vulnerable will remain trapped—not just behind bars, but in a system designed to discard them. The question is no longer whether Hawai’i can afford to act— it’s whether it can afford not to.
Jasmine Lianalyn Rocha (CC ‘27) is a staff writer for CPR studying political science and American political history.