Samuel John

Nursing 360
Kapiolani Community College
Clinical Synopsis Writeup Mental Health Hawaii
As far as I can tell, the similarity among my clients throughout the course of these
clinical rotations is they all have a diagnosis of mental illness. A few of them have comorbid physical conditions as well, but the main shared similarity is a mental illness. It
makes sense. It is the reason they are clients at a mental health facility. Now, as it relates
to public health, this fact raises some interesting points.
In the community, that is, the realm of public health, mental health often goes
unseen, either due to unawareness, convenience or misunderstandings. I often hear people
say, Oh hes just crazy, or pointing and laughing at the bizarre behavior of another. I
also hear people calling people on the street bums, lazy, or drug addicts. While
there may be some truth to these statements, it is inappropriate and irresponsible to
generalize and write-off in this way every individual on the street, without a home or
struggling to make it day-to-day. Mental health carries a negative stigma is something
we hear often, especially as nursing students.
What strikes me is the fact that when I really think about it, all of my patients look
just like normal people. Sure, there might be a little something off here and there, but for
the most part, I would not be able to tell there was something the matter with them just by
looking at them. I think this is how it goes in the community at-large as well. There are
large numbers of people suffering or grappling with a mental illness, but since nothing
looks the matter on the outside, it just goes unnoticed and overlooked. Perhaps if we had
more services and resources available and accessible to help those who had a slight or

minor mental illness issue, we could treat them before it got to a point where they
required acute inpatient facilities.
Multiple research articles and reports show that mental health is lacking the
supplies and resources it needs to meet demand. According to Riker (2015), about 20%,
or 1 in 5, U.S. teens have a diagnosable mental illness, and the average delay between
onset of symptoms and intervention is 8 to 10 years. The same article highlights the fact
that Hawaii has only two mental health facilities in the state Queens Medical Center
and Kahi Mohala Behavioral Health specifically designed to treat teens suffering from
mental illness, and both of these facilities are on Oahu. In addition, the states budget for
mental health was cut by 12 percent from 2009 2011. According to Lincoln (2013)
mental health is a crisis in Hawaii and needs to be addressed. An emerging and
disturbing trend affecting numerous systems and facets of our daily lives, healthcare
included, continues to present itself as a most perplexing dilemma provide a
growing/increasing population quality service with dwindling/limited resources. How can
this be accomplished? Is it even possible?
It is also worth noticing that all of my clients will require some form of follow-up
care, treatment therapy, or services on an outpatient basis. For example, they most all will
benefit from some kind of therapeutic support group, and so having these
services/resources available in the community becomes a priority. It is necessary to
provide safety for the sake of public health. Therefore, it is in the public healths benefit
to provide resources for those suffering from mental illness to get the help they require.
This is because by providing treatment and therapy to those in need of it, it is possible to
prevent a certain number of criminal activities that have a direct mental illness

correlation, for example, a psychotic patient suffering from auditory hallucinations telling
him to hurt others. It is in the publics best interest then to request and advocate for
increased healthcare services meant to identify and help treat mental health issues.
Notably, these healthcare services should be focused on preventative and community
services, rather than acute care, as this approach has been identified as more costeffective and beneficial in regards to positive client outcomes (Lincoln, 2013).
Are there any solutions on the table, any actions being taken to implement these
identified issues? Lincoln (2013) states that because of the Affordable Care Act, health
care providers (private, non-profits) and the states public health agency are working
closer than ever with a common purpose to improve the health of people in Hawaii. They
are required by law to every 3 years assess and evaluate best practices specifically
relating to community health (which can, and should according to several health care
providers, include schools, churches, workplaces) and make adjustments accordingly. In
addition, policymaking is also identified as a key factor in making this push for
improving Hawaiis mental health status work. As such, it appears the will and
understanding to increase resources and improve mental health services for the people of
Hawaii are there, but when it will happen and whether or not these changes will actually
be implemented, and more importantly, stick, still remains to be seen.
For those people who really need it, especially my clients that I got to meet and
care for over this clinical rotation, I sure hope they get the resources they need. Because
not only is it for their own individual benefit and for the benefit of those close to them, it
is for the benefit of the public as well.

References
Lincoln, M. (2013). Statewide study identifies Hawaii's top health concerns. Hawaii
News Now. Retrieved from
http://www.hawaiinewsnow.com/story/22758669/statewide-study-identifieshawaiis-top-health-concerns
Riker, M. (2015). Teen's mom: "It's not that he's a criminal. He's mentally ill". Civil Beat.
Retrieved from http://www.civilbeat.com/2015/09/teens-mom-its-not-that-hes-acriminal-hes-mentally-ill/