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In 2019, suicide was the leading cause of death for Native Hawaiians and Pacific Islanders between the ages of 15 and 24. NHPI students were more likely to have made a plan for suicide, yet they were three times less likely to receive mental health services or treatment medications than non-NHPI students.

Why is this happening? And how does this population continue to slip through the cracks?

This year I’ve introduced , legislation that may begin to provide some answers.

Until the 2000 census, Native Hawaiians and Pacific Islanders were included in the broader category of Asian Americans and Pacific Islanders. This has historically led to a lack of accurate mental health data on the NHPI population.

As a Native Hawaiian woman, it is unacceptable to me to see yet another systemic oversight lead to more lives lost. However, that is also the reason why I feel passionate about understanding how historical and cultural context affects the mental health of Native Hawaiians and Pacific Islanders today.

When the Hawaiian Kingdom was illegally overthrown in 1893, Native Hawaiians were already experiencing a cultural genocide. Contact with Westerners had proven deadly as they brought syphilis, gonorrhea, tuberculosis, smallpox, and other diseases, to which Native Hawaiians had no immunity. This exposure decimated the Native Hawaiian population, crippling our cultural and political influence.

In 1896, under the provisional government known as the Republic of Hawaii, the Hawaiian language was banned from schools and not formally taught again for four generations.

Though Hawaii is unique in its history as a recognized kingdom, the colonial experience of Native Hawaiians is one repeated across Indigenous populations. Native Americans, Alaska Natives, Australian Aboriginals, Maori peoples, and many other native peoples have all experienced varying degrees of erasure. Mental health ramifications of this trauma are also universally felt as NHPI’s continue to experience high levels of incarceration and lower socioeconomic status.

A pattern of high-suicide rates can be seen in Indigenous populations around the world. Studies from high-income countries, including Australia, New Zealand, the United States, and Arctic nations, consistently find elevated suicide rates among Indigenous populations with substantial rate disparities compared to non-Indigenous populations.

To me, this demonstrates that current suicide prevention programs either exclude Indigenous populations or fail to understand how colonial history affects their mental health today.

Suicide prevention is most often approached with treatment medications and mental health services such as therapy. However, within the Native Hawaiian and Pacific Islander communities, mental health can be highly stigmatized.

For many, seeking help does not feel like an option, and this can lead to unhealthy coping mechanisms. Though work is being done to dismantle this stigma, finding the means of prevention that are culturally connected could prove more accessible and appropriate for this community. 

For Native Hawaiians in particular, a healthy sense of self often comes from a balanced connection to aina, ohana, and akua. I use the term aina rather than land because to us aina is much more than just land — it is an ancestor, a life-giving force. There is a spiritual connection to our natural world that Western and conventional models of thought fail to understand.

Today, many Native Hawaiians and Pacific Islanders still struggle to reconnect with a culture they were systemically separated from and the aftermath of this has left a scar on our psyche. However, perhaps this is also the place we begin to find healing, by reimagining the way we approach mental healthcare and suicide prevention.

HB 622 will make permanent the Prevent Suicide Hawaii task force within the Department of Health and require that task force focus on suicide prevention for Native Hawaiians and Pacific Islanders. It is my hope that this bill will result in identifying the unique risk factors of this population and creating culturally conscious treatment pathways and prevention methods that give our Native Hawaiian and Pacific Islanders a healthier sense of community and self.

Doing nothing is not an option. Successfully identifying those at risk and offering effective treatment needs to be immediately initiated. The statistics can be changed but only with committed action and dedicated resources.