The first shall be last; but can the last be first?

The State of Hawaii has long prided itself on being a leader in the nation in its provision of mental health and other social and health services. In 1986, and again in 1988, the Public Citizen Health Research Group, a Ralph Nader affiliated entity, ranked Hawaii 51st among the states and the District of Columbia in its care of the seriously mentally ill. Initial reaction within the mental health community in Hawaii was primarily one of perplexity and disbelief. Although it quickly realized that this report was based on the cursory opinion of one principal individual, drawing upon very little data and solid comparable information, the impact of these rankings has been to focus much more attention upon what really is happening to the seriously disabled mentally ill (SDMI) in this state. Hopefully, the eventual results will conform to the original intent of the report's authors, Drs. Fuller Torrey and Sidney Wolfe, namely a new, enhanced and broadbased commitment to improving services to this special and often forgotten population in need.