If you ever find yourself on Kinoole Street in Hilo, you’ll likely see Doug. He’s a fixture in the community.

Published: Oct. 9, 2023 at 9:04 PM PDT | Updated: Oct. 12, 2023 at 7:34 PM PDT

HONOLULU (HawaiiNewsNow) – If you ever find yourself on Kinoole Street in Hilo, you’ll likely see Doug. He’s a fixture in the community.

On a recent day, Doug could be found perched on an orange bin that he rolls up and down the sidewalk. When asked how long he’s been living on the street, he says “22 years.”

Outreach workers say Doug generally keeps to himself.

In conversation, he can be quick-witted one minute and seemingly lost the next — unaware he’s in desperate need of help.

“A lot of his behaviors are suggestive of schizophrenia and lack of insight,” said Dr. Chad Koyanagi, the only psychiatrist in the state that takes his practice to the streets.

He’s worked with the homeless for more than two decades. He also heads up a successful psychiatric street medicine team on Oahu.

Over the years, Koyanagi has treated scores of patients, providing them with psychiatric medication that allows them to regain control of their lives so they can get off the street and into housing.

It’s that work that caught the attention of Hope Services, Hawaii Island’s largest homeless service provider. With their help, the doctor is now traveling to Hawaii Island every other Wednesday to head up the agency’s new psychiatric street medicine program.

It’s a first for the rural community — and a program that’s desperately needed.

On Hawaii Island, officials estimate about half of the homeless population need psychiatric services. And data shows the island’s homeless population is growing — jumping 45% in just five years.

In 2019, volunteers counted 690 people living in homeless camps and shelters across Big Island. Now, that number stands at more than 1,000.

Experts say street medicine can significantly reduce the cost of caring for and stabilizing homeless people, reducing the number of ER admissions and hospitalizations.

Without extra help, the average person experiencing homelessness visits the emergency room five times — a year at a cost of $18,500, according to the National Library of Medicine.

Koyanagi says one of the biggest challenges the team has encountered since the program launched in May has been staying in consistent contact with patients.

“Finding people, locating people,” he said. “Everything is so spread out.”

Koyanagi says without consistency, it’s nearly impossible to build the trust needed to get a psychiatric patient to accept help.

“Showing them that some parts of their life might get better with medications or case management or connecting them with the health care system,” said Koyanagi.

The Hope Services Psychiatric Street Medicine Program was made possible thanks to about $26,000 in funding from Hawaii County and another $20,000 from the Kaiser Foundation and the Hawaii Community Foundation. But that money is set to run out by next May.

To keep the program going, the service provider needs donations. Meanwhile, advocates are pushing to have street medicine added to the county’s budget again next year.

During a recent visit to Hilo, Koyanagi asked Doug if he’d ever seen a psychiatrist.

Doug responded, “For what?”

“Without me coming here. Sad to say guys like Doug have almost no chance of success,” said Koyanagi. “They go through 30 to 40 years of untreated psychosis.”

But with the doctor’s help and a team of advocates in his corner, there’s hope for Doug and others like him wandering the streets of Hawaii Island.

“Do you have any questions for us,” Koyanagi asks Doug.

Doug responded, “Not right at the present. But I’m working on it.”

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