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A Lahaina woman seeking psychological help has cycled through five mental health care providers since the wildfires ripped apart her community last August.

Her experience isn’t unique.

Maui United Way interim director Lisa Grove says many Maui fire survivors struggling with symptoms of anxiety, depression or post-traumatic stress disorder are receiving care from an ever-changing roster of counselors deployed to Maui for a brief time from other states to quell a brewing post-disaster mental health crisis.

It’s not just a continuity of care problem. When the Lahaina woman finished her final therapy session with one of these fly-in counselors, Grove said the provider asked her for a series of vacation tips: “What are the good beaches? Where should I go to eat?”

There have also been complaints about providers asking Maui fire survivors, “Are you sure you want to be living here?” when many people affected by the fires have been rooted on Maui for generations and have no other place to go. Other providers have told their Maui patients, “You’re living in paradise, how could that be a problem?” or repeatedly mispronounced Kihei during therapy sessions, according to Grove.

Therapists on the front lines of a mental health crisis sparked by last summer’s deadly Maui wildfires say they can’t keep up with unrelenting demand for their services. Fly-in social workers, counselors and psychologists have helped fill a void in the local workforce. But now some fire survivors are declining to receive treatment from out-of-towners, citing a cultural divide.

The problem, clinicians say, is there simply aren’t enough local providers to meet the need.

At least one forthcoming study shows that demand for psychological care on Maui is greater today than it was coming out of the Covid-19 pandemic. That’s according to results from a community mental health survey sponsored by the and funded by the and the . 

The report, which is expected to become publicly available in the next few weeks, found a significant bump in the number of people on Maui compared to two years ago who reported that their mental health has deteriorated.

Among people directly affected by the fire, the data shows a slump in mental wellness that’s even more acute, according to Grove, the lead researcher and author of the report.

“Every single data point says it’s worse than you think it is in terms of mental health,” Grove said. “And that’s what we’re trying to help our funders and the community understand, which is that we may only be at the very beginning of this thing.”

On an island far short of the resources to deal with the psychological impact from the Aug. 8 fires, one way forward has been the recruitment of short-term help from other states.

This method of bolstering a flimsy system has created a revolving door that’s been tiring for some fire survivors who’ve had to build and rebuild trust and rapport with several different mental health providers over a short time span. It’s also created friction in some cases where providers unfamiliar with the island’s unique social and cultural norms have inadvertently caused frustration or offense to people in crisis. 

Some displaced fire survivors, for example, say disaster relief volunteers prodded them to move off-island for better housing opportunities and a cheaper cost of living. Former Hawaii Red Cross CEO Diane Peters-Nguyen said she was fired from the nonprofit in early May after she called for reforms and urged the organization to stop coaxing Maui wildfire victims to relocate to other islands or states.

“Cultural competency is really important,” Grove said. “The fire was traumatizing. And then the next stage of the process has been really re-traumatizing — for some people even more traumatizing — especially when they’re trying to get help from someone they feel doesn’t understand them.”

It’s now common for Maui fire survivors — both adults and children — to forgo mental health care if they can’t be paired with a local provider, according to Maui marriage and family therapist Tina Boteilho, who’s coordinated psychological support and treatment for fire survivors in partnership with nonprofits and state and county government.

“We have children that share their trauma story with a clinician and then the person goes, ‘Oh, thank you so much for sharing. My contract is ending on Friday, so I’m going back to the mainland now.’” Boteilho said.

“The problem with that is we were slaughtered in Covid,” she explained. “So many professionals left the island and they have not returned because they can do telehealth now from somewhere cheaper. And now I have a bunch that tell me they want to come back but they can’t afford to come back because housing is so expensive and inflation is too much.”

Despite the dearth in clinicians, there are some new local resources.

The state opened two certified behavioral health clinics in Lahaina and Kahului to try and meet the skyrocketing demand for mental health care in the aftermath of the fires. Staffing the clinics has so far not been problematic, according to AMHD acting administrator Dr. Courtenay Matsu.

The new clinics accept patients of all ages and have no eligibility requirements — a departure for an agency that has historically positioned itself as the state provider of care to uninsured or underinsured adults diagnosed with a serious, chronic mental illness. People struggling with grief, guilt or symptoms of anxiety and depression can now access care from the agency on Maui even if they lack a formal diagnosis. 

“To find a provider, sometimes it’s challenging,” Matsu said. “So this just provides everybody another option.” 

The health department could not say many people have received services at the new clinics, citing issues with its data system.

State health regulators this year also launched the , also called Malu i Ka ‘Ulu, a local call center that offers support and resources to people impacted by the Maui fires. It compliments , which is designed to offer fast help to callers dealing with mental health emergencies or suicidal thoughts.

Still, the workforce shortage is a problem. On Maui, the number of psychiatrists needs to increase 59% for adults and 77% for children and adolescents, according to University of Hawaii professor Kelley Withy, who conducts an . 

There are other challenges. Stigma is preventing some people affected by the fires from seeking out mental health care, especially among certain ethnic groups. Others don’t recognize that they need mental health care or have a clear idea of how it could help them navigate out from under the wildfire’s psychological fallout.

“We’re not doing enough to explain to people, ‘Here’s what can happen when you have this neutral expert to help you figure things out, here’s what you can expect to get out of counseling.’” Grove said. 

A new initiative launched in April with a $1 million donation to aims to address the needs of children impacted by the Aug. 8 wildfires by sending out a team of mental health counselors to meet with youth on their own turf.

Funded by the Sentry Insurance Foundation, Malama Na Keiki is a year-long program that deploys counseling teams to knock on doors in the hotels where many fire victims still live or stop youth on the street or the beach or at The Boys and Girls Clubs of Maui to offer counseling.

The program interfaces with roughly 200 youth per month and aims to provide youth participants with counseling at least six times over the course of a year. 

At Lahaina public schools, teachers and staff have received training in areas such as psychological first aid, traumatic grief in children and self-care, according to the . But the Malama Na Keiki program’s efforts include outreach to students who may not regularly attend school or who may not seek out the school-based resources available to them.

“There’s counselors that are there in the schools but what we’re finding is a lot of kids aren’t necessarily going to them,” said Makana Rosete, community impact coordinator at Maui United Way. “What sets this program apart is that it’s meeting kids where they are, where they like to hang out, and not the other way around.”

The program also targets kids who may be living on the beach or otherwise homeless.

One stereotype the program is trying to erase, according to Grove, is the idea that kids are naturally resilient.

“Kids are resilient if they have a toolbox, if they learn coping skills, if they have family support,” Grove said. “But it isn’t a natural thing for our keiki to know how to navigate out of the most traumatic thing of their entire life.”

Another $650,000 in was announced by Maui United Way this week, with the money going to support projects by seven local nonprofits: Boys and Girls Clubs of Maui, Imua Family Services, Maui Arts and Cultural Center, Nohona Health, Pacific Birth Collective and The Spirit Horse Ranch. 

Civil Beat’s coverage of Maui County is supported in part by a grant from the Nuestro Futuro Foundation.

Civil Beat’s community health coverage is supported by the , and .