About the State of Hawaiʻi Behavioral Health Dashboard

Funded by the Centers for Disease Control and Prevention Overdose Data to Action (OD2A) grant, this website was created in part by the University of Hawaiʻi at Mānoa and the Hawaiʻi State Department of Health, and made possible by ongoing collaboration with the following partners:

  • Department of the Medical Examiner, City & County of Honolulu
  • Department of Public Safety
  • Hawaiʻi Police Department
  • Interagency Council on Intermediate Sanctions, including:
    • Judiciary, State of Hawaiʻi
    • Department of Public Safety, State of Hawaiʻi
    • Department of the Attorney General, State of Hawaiʻi
    • Office of the Public Defender, State of Hawaiʻi
    • Hawaii Paroling Authority, State of Hawaiʻi
    • Department of the Prosecuting Attorney, City & County of Honolulu
    • Honolulu Police Department, City & County of Honolulu
  • Kauaʻi Police Department
  • Laulima Data Alliance
  • Maui Police Department

We gratefully acknowledge all staff who continue to build, maintain, and support this website.

About the Overdose Data to Action project

Overdose Data to Action (OD2A) is a CDC cooperative agreement aimed at (1) expanding public health surveillance to allow for higher quality and more timely and comprehensive data collection for drug-related misuse and overdose morbidity and mortality, and (2) using these data to drive prevention strategies. The project has multiple surveillance and prevention focal points, including strengthening state and local capacity for public health programs; connecting health systems, state and local partners and agencies, and community members to improve prescribing practices and share data; increasing access and usability of the Prescription Drug Monitoring Program; improving treatment access and engagement, and building awareness among our community. For more information about Hawaiʻi’s OD2A program see OD2A-C3

About the State of Hawaiʻi Behavioral Health Dashboard Data

Common terms used in this dashboard:

  1. Substance use disorder (SUD): “occur[s] when the use of alcohol and/or drugs causes
    clinically significant impairment, including health problems, disability, and failure to
    meet major responsibilities at work, school, or home” 1
  2. Co-occurring disorders: disorders that a person experiences at the same time. In this
    dashboard, we present data on people with a substance use disorder who may also
    experience co-occurring mental illness, or vice versa (people with mental illness who
    may also experience co-occurring substance use disorder).
  3. Polysubstance use: use or consumption of more than one drug at the same time or
    within a short period of time of each other.
  4. Behavioral Health: emotional, psychological, and social aspects of health or well-being,
    including mental health and substance use.
  5. Crisis: “an acute emotional upset; it is manifested in an inability to cope emotionally,
    cognitively, or behaviorally and to solve problems as usual.” 2 Signs of a crisis may
    include feeling like something is wrong without being able to explain the reason for it,
    feeling hopeless, panicked, trapped, empty, or in a lot of pain, and nothing seems to help.

Citations:

  1. Substance Abuse and Mental Health Services Administration (2022) Mental health and
    substance use disorders SAMHSA. Available at: https://www.samhsa.gov/find-
    help/disorders#:~:text=Substance%20use%20disorders%20occur%20when,work%2C%20sc
    hool%2C%20or%20home     (Accessed: January 30, 2023).
  2. Centers for Disease Control and Prevention (2020) Crisis: A definition Available at:
    https://wwwn.cdc.gov/WPVHC/Nurses/Course/Slide/Unit2_7#:~:text=Crisis%20is%20an%20ac
    ute%20emotional,usual%20(Hoff%2C%202009     (Accessed: January 30, 2023).

Laulima Data Alliance 

Emergency department discharge data was obtained from Laulima Data Alliance, which is a nonprofit wholly-owned 501(c)(3) subsidiary of the Healthcare Association of Hawaiʻi (HAH) that collects, analyzes, and disseminates statewide health information. Discharges are classified by the ICD-10 code groups below. Labels may have been abbreviated due to spacing constraints. Mental disorders are classified by the F01-F99 groups (11 total). Substance use disorders are classified by the F10-F19 subgroups (10 total). 

  • F01-F09 Mental disorders due to known physiological conditions (includes post-concussional syndrome) 
  • F10-F19 Mental and behavioral disorders due to psychoactive substance use
    • F10 – Alcohol related disorders 
    • F11 – Opioid related disorders 
    • F12 – Cannabis related disorders 
    • F13 – Sedative, hypnotic, or anxiolytic related disorders 
    • F14 – Cocaine related disorders 
    • F15 – Other stimulant related disorders (includes methamphetamine) 
    • F16 – Hallucinogen related disorders 
    • F17 – Nicotine dependence 
    • F18 – Inhalant related disorders 
    • F19 – Other psychoactive substance related disorders 
  • F20-F29 Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders 
  • F30-F39 Mood [affective] disorders (includes major depressive and bipolar disorders)  
  • F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (includes adjustment and post-traumatic stress disorders) 
  • F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors (includes insomnia-related disorders) 
  • F60-F69 Disorders of adult personality and behavior (includes borderline personality and anti-social personality disorders) 
  • F70-F79 Intellectual disabilities  
  • F80-F89 Pervasive and specific developmental disorders 
  • F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (includes conduct, oppositional defiant and attention deficit hyperactivity disorder (ADHD)) 
  • F99-F99 Unspecified mental disorder 

Numbers are not mutually exclusive; discharges may have involved multiple substance use or mental health disorders. Includes all transfers.  

Drug Overdose Surveillance & Epidemiology (DOSE)

Discharge Data Case Definitions:

Each category below includes unintentional, intentional self-harm (analyzed separately), and
undetermined intent poisonings for the initial encounter only–does not include assault, adverse
effect, or underdosing.

  1. All Drug: poisoning by drugs, medicaments and biological substances—does not include
    assault, adverse effect, underdosing; initial encounter only—does not include subsequent
    encounter(s) or sequela;
  2. All Opioids: poisoning by opium, heroin, other opioids, methadone, synthetic narcotics,
    fentanyl or fentanyl analogs, tramadol, synthetic narcotics, unspecified narcotics, and
    other narcotics
  3. Heroin: poisoning by heroin
  4. Stimulants: poisoning by cocaine, unspecified psychostimulants, caffeine,
    amphetamines, methylphenidate, ecstasy, and other psychostimulants

Important Data Considerations:

  • Missing Data: discharge data submitted by state/jurisdiction health departments can be
    delayed or temporarily stalled. Once data sharing resumes, emergency department visit or
    hospitalizations not shared during the initial data exchange, may not be backfilled or shared.
  • Data overlap: drug overdose visit counts are not mutually exclusive and represent the
    nesting of drug categories (i.e., suspected all drug category includes the number of suspected
    opioid-, heroin-, and stimulant-involved overdose visits; suspected heroin counts are included
    in the suspected opioid category; and cases that involve multiple substances can include both
    opioids and stimulants).
  • Reporting delays: as states/jurisdictions continue to onboard new data-sharing facilities to
    support syndromic surveillance activities, some facilities experience occasional interruptions
    in data availability. Data may also evolve over time (e.g., introducing new diagnosis codes).
    As a result, reported cases and rates can change over time.
  • Suspected overdoses/poisonings: these data are not necessarily verified by toxicological
    testing and are considered “suspected” overdoses, not confirmed cases.
  • Undercounts: data likely represent an undercount when accounting for inaccuracies in
    coding

References:

  1. “Technical Guidance for the Drug Overdose Surveillance and Epidemiology (DOSE)
    System: Version 2.4.” CDC: Centers for Disease Control & Prevention, pg. 41, October
    2022.
  2. “Drug Overdose Surveillance & Epidemiology (DOSE) Dashboard: Nonfatal Overdose
    Data.” CDC: Centers for Disease Control and Prevention, Important Data
    Considerations, https://www.cdc.gov/drugoverdose/nonfatal/dashboard/index.html.

Wide-ranging ONline Data for Epidemiological Research (WONDER)

The data available on WONDER (Wide-ranging ONline Data for Epidemiologic Research) are county-level and national mortality and population data spanning the years 1999-2022. Data are based on death certificates for U.S. residents. Each death certificate contains a single underlying cause of death, up to twenty additional multiple causes, and demographic data. Mortality data from the death certificates are coded by the states and provided to National Center for Health Statistics (NCHS) through the Vital Statistics Cooperative Program or coded by NCHS from copies of the original death certificates provided to NCHS by the State registration offices. For more information, see  Technical Appendix from Vital Statistics of United States: 1999 Mortality.

The State Unintentional Drug Overdose Reporting System (SUDORS) – City and County of Honolulu only

CDC’s State Unintentional Drug Overdose Reporting System (SUDORS) collects information on drug overdose deaths of unintentional or undetermined intent from a variety of data sources, including death certificates, medical examiner/coroner reports, and postmortem toxicology. Hawaiʻi submits data to SUDORS twice a year.  Counts shown are likely underestimates as some cases for the time periods shown are currently being processed and have not yet been included in this dashboard; additional case data, including data from the neighbor islands, are forthcoming.

SUDORS is part of the larger, Overdose Data to Action (OD2A) grant from the U.S. Centers for Disease Control and Prevention (CDC). More information on OD2A is available at https://www.cdc.gov/drugoverdose/od2a/index.html.

Hawaiʻi Coordinated Access Resource Entry System (CARES) – crisis-related calls only 

Hawaiʻi CARES crisis call data represent incoming calls to the Hawaiʻi Coordinated Access Resource Entry System (CARES) line which is a free, 24/7 coordination center for support with substance use, mental health and crisis intervention, open to all Hawaiʻi residents. Call volumes currently reflect the number of incoming calls for mental health and crisis intervention only.  

Individuals may call 808-832-3100 from any island or toll-free 800-753-6879. Callers are routed to Hawaiʻi CARES if they: 

  • Dial 911 and request crisis support.
  • Dial 988 (dialing code for the National Suicide Prevention Lifeline [NSPL]) from a Hawaiʻi phone number (area code 808). If an individual is calling from a non-Hawaiʻi phone number, the call will be routed to the local chapter based on their phone’s area code.

Definitions of Levels and Presenting Problems for inbound calling data can be found in this document.

Hawaiʻi State Department of Health – Behavioral Health Services Administration 

Alcohol & Drug Abuse Division (ADAD): ADAD aims to reduce the severity and disability effects related to alcohol and other drug use by assuring access to an integrated, high quality, public/private community-based system of prevention strategies and treatment services designed to empower individuals and communities to make health-enhancing choices regarding the use of alcohol and other drugs. 
 
ADAD uses the Web Infrastructure for Treatment Services (WITS) to collect, analyze, and report all information from providers of their services. AMHD clients were classified as having co-occurring substance use and mental health disorders if their electronic health record was associated with an F-code diagnosis code other than F10-F19. 

Adult Mental Health Division (AMHD): AMHD seeks to improve the mental health of Hawai’i’s people by reducing the prevalence of emotional disorders, and mental illness. Services include mental health education, treatment and rehabilitation through community-based mental health centers, and an in-patient state hospital facility for the mentally-ill, including those referred through courts and the criminal justice system. 
 
AMHD uses Netsmart myAvatar to collect, analyze, and report information from providers of their services. AMHD consumers were classified as having co-occurring substance use and mental health disorders if their electronic health record was associated with any F10-F19 diagnosis code. 

Child and Adolescent Mental Health Division (CAMHD): CAMHD aims to improve the emotional well-being of children and adolescents, and to preserve and strengthen their families by assuring early access to a child and adolescent-centered, family-focused community-based coordinated system of care that addresses the child’s and adolescent’s physical, social, emotional, and other developmental needs within the least restrictive environment. 

CAMHD uses the INSPIRE MAX system to collect, analyze, and report all information from providers of their services. CAMHD clients were classified as having co-occurring substance use and mental health disorders if their electronic health record was associated with any F10-F19 diagnosis code. 

Developmental Disabilities Division (DDD): DDD’s mission is to foster partnerships and provide quality person-centered and family focused services and supports that promote self-determination. 
 
DDD uses the INSPIRE system to collect, analyze, and report all information from providers of their services. DDD clients were classified as having co-occurring substance use and mental health disorders if their electronic health record was associated with any F10-F19 diagnosis code.