We must address homelessness in Hawaii, and I have a plan to do it.

It will take compassion, commitment, and significant resources to take on this challenge — as well as leadership, political will, and bold action from our elected officials, and the cooperation of organizations across our state working together and implementing multiple approaches.

I believe we can reduce homelessness in Hawaii by more than 50% over the next four years, and effectively eliminate chronic homelessness as we currently experience it in our state by 2030.

As a State Senator and as Lt. Governor, I have made fighting homelessness a top priority.

I helped create the H4 clinic, a public-private partnership that serves as a new healthcare model for the homeless, and I partnered with HomeAid Hawaii to build the first “kauhale” communities.

Working with homeless communities and advocates across the state, and caring for patients as an ER doctor, I have learned that shelter is a fundamental human need like food and water, and is necessary to sustain health.

Housing is healthcare, and should be considered a basic right in a civilized society.

Chronic homelessness involves many factors — social, economic, medical, and legal — each of which must be addressed to break the cycle and get people into permanent housing.

Unaddressed poverty, addiction, and mental illness are at the root of homelessness in Hawaii, and the costs to our state and our society are enormous.

First and foremost is the human cost to the unhoused in terms of physical and mental suffering, hopelessness, and the loss of human potential and productivity.

Homelessness exposes people to greater risk of injury and infection, often makes existing mental illness and addiction worse, and can inflict long-term traumatic stress.

Our state also bears huge social and financial costs associated with chronic homelessness.

Hawaii has one of the highest rates of homelessness per capita in the nation, with over 10,000 people chronically homeless at any given time.

In Hawaii, 3.6% of patients use 61% of our nearly $3 billion annual Medicaid budget — that’s just 13,000 people who consume well over $1 billion in Medicaid each year, or an average of $82,000 per person per year.

Providing permanent housing to a homeless person can reduce the cost to the state by 43-73%, saving as much as $60,000 in Medicaid per person per year.

These facts begin to show the scale of both the human and social costs of chronic homelessness in Hawaii, and the urgent need for effective policy solutions.

Consulting with experts and working with organizations across the state for the last six years, I have developed a 10-point plan of action to implement a statewide approach to healthcare, social services, and housing for the chronically homeless that I believe can address this challenge in Hawaii over the next decade:

1. Dramatically increase outreach to the chronically homeless, improving trust and communication with the unhoused community and creating a compassionate, clear, and effective protocol to identify each individual’s needs for healthcare, social services, and temporary shelter, and a pathway to help them move toward permanent housing.

2. Deploy Lift Zones around the state — inflatable, non-permanent tent structures in areas of need where the homeless can live for up to 90 days while they receive healthcare, social services, and support in transitioning to permanent shelter, and where law enforcement can monitor day to day activity and provide security.

3. Increase access to existing homeless shelters and provide the resources needed to expand access to medical and social services, with the goal of transitioning people into permanent housing.

4. Open Joint Outreach Centers (JOCs) across the state, free clinics that provide basic healthcare to the homeless, treating minor illnesses and injuries and preventing them from becoming major medical issues, alleviating strain on hospitals and helping the homeless avoid expensive emergency room visits.

JOCs primarily provide wound care and mental healthcare, including long-acting anti-psychotic medications, and JOCs works in collaboration with law enforcement, social service agencies, and housing coordinators to help the homeless receive healthcare, housing, and other programs and resources.

One of our initial JOC locations in Chinatown treated over 1,200 unique patients in the first 10 months of operation, saving our healthcare system an average of $105,000 per week.

5. Expand and improve the H4 — a public-private partnership intended to provide comprehensive services to the chronically homeless, including a hygiene center, a free clinic that is always open, access to social workers and mental health professionals, and permanent housing space, with each H4 facility saving between $40 – 60 million per year in ER visits, hospital stays, and serious long-term health consequences.

6. Build kauhale communities across the state — permanent, sustainable housing sites on public lands in villages of tiny houses of up to 300 people, costing between $2.5 – $5 million each and integrated with medical and social services for residents.

“Kauhale” is a Hawaiian term meaning “village,” a traditional cultural model of housing consisting of tiny homes and communal areas for cooking and gathering, all meant to foster a sense of community and ownership, with average monthly rent of $250 per tiny house.

The first two kauhale communities are already thriving in Waianae and Waimanalo, with the ten more intended for Oahu and the neighbor islands.

7. Expand access to addiction and mental health treatment for the homeless, including more addiction specialists, social workers and greater availability of same day detox, wetbeds at shelters, formal rehab services and referrals, and placement in halfway houses and sober homes for those struggling with addiction.

I will also direct under-utilized healthcare facilities like Leahi Hospital and the Hawaii State Hospital to operate at full capacity to care for those with serious health needs.

8. Implement the Assisted Community Treatment (ACT) law empowering family members and concerned citizens to help homeless individuals who are suffering from severe mental illness and addiction, allowing them to receive the help they need.

9. Designate Ohana Zones to provide of places refuge for the homeless, end sweeps, and reduce the constant pressure of the homeless congregating in public parks and beaches.

The state legislature appropriated funds again in 2022 to fund this initiative, and at least three locations offer water, bathrooms and support services will be necessary on Oahu, and one each on Maui, Big Island, and Kauai.

10. Commit to Permanent Supportive Housing — the “Housing First” model — providing low barrier housing to those ready to accept that level of support, intended to achieve harm reduction and housing continuity.

Chronic homelessness in Hawaii is a challenge that affects all of us — as community members, taxpayers, and as human beings.

With this policy roadmap I believe we can reduce homelessness in Hawaii by more than half over the next four years, and if we stay committed, practically eliminate it by the end of this decade.

Addressing and ultimately solving the challenge of homelessness is the right thing for us to do as a state — as well as the necessary, responsible, and moral thing to do.