Page 9 - Castle MD Spring 2020

With his decades of experience, and as the institute’s (and perhaps the state’s) only street outreach psychiatrist, Dr. Koyanagi and his IHS partner seek out individuals who are the most difficult to treat: those with acute mental illnesses.
spends Friday mornings with IHS homeless outreach field manager Justin Phillips. Together they walk the streets and visit homeless camps in urban Honolulu and Waikiki, offering medical care and other services. With his decades of experience, and as the institute’s (and perhaps the state’s) only street outreach psychiatrist, Dr. Koyanagi and his IHS partner seek out individuals who are the most difficult to treat: those with acute mental illnesses. Some of them he has known for years, many of them he knows by name. They know him as “Dr. Chad.”
Dr. Koyanagi says it can take years and dozens or even hundreds of encounters with these patients to build their trust
and persuade them to take psychiatric medications that can help stabilize their lives and set them on a path to permanent housing. He works closely with ER units, enforcement agencies, HPD’s crisis intervention team, the justice department and other agencies to help these individuals get the care they need.
His compassionate work with IHS and Oahu’s homeless has been featured
in a two-part television report called “Prescribing Hope” by Hawaii News Now. The first part aired in 2017 and earned multiple awards, including a regional Emmy and national Murrow award. The second part, a follow-up report in 2019, is up
for multiple awards. Hawaii News Now also recognized Dr. Koyanagi as one of the station’s “hometown heroes.” Some of his greatest rewards, however, are success stories like Jeanette, a homeless patient he had been seeing since he was
in medical school. After 35-plus years on the street and refusing treatment, she is on anti-psychotic medication, has moved into a “home” at Safe Haven, and has reconnected with her family, including a sister who had spent nearly four decades trying to help her.
Not all of Dr. Koyanagi’s outpatient work comes through his IHS outreach. He maintains a small private practice of 15
to 20 patients, referred by families or community members who have asked for his help. These are patients that no one else will take or have fallen through a gap in the healthcare and legal systems, leaving their loved ones with few options to get care for them.
His work as a hospitalist at Castle complements his community psychiatry and private practice. Being able to refer patients to Castle’s inpatient treatment program (which Dr. Koyanagi describes
as the best in the state) and take care of them himself is reassuring to those who otherwise might resist such treatment. There was a news story five years ago about one of Kailua’s chronically homeless, but beloved residents, who was found in critical need of medical care by a group
of concerned citizens. They called Dr. Koyanagi who quickly organized a team of police, fire department and EMS personnel to get him to Castle. With financial and other support from the community, he was able to move off the street and into a care home.
Dr. Koyanagi shared another story of help and hope on the other side of the Pacific Ocean. Ten years ago, he was a bone marrow donor for a Texas man dying of aplastic anemia. Now cured, the two men have remained friends (top right). They see each other every couple of years, either in Texas or Hawaii.
Besides his busy and fulfilling medical career, Dr. Koyanagi enjoys two other pastimes: Sports fan and foodie, “but not the fancy kind of food”. He follows U.H. sports, of course; has season tickets for a couple of national football and basketball teams; and is a “cautious” Red Sox fan, in light of recent team scandals. His go-to restaurants for good food and good value are JJ Dolan’s pizza in downtown Honolulu the fried chicken plate at KJ’s Local Grindz in Kaneohe; and W & M Bar-B-Q Burger in Kaimuki.
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