About the Author

Beth Fukumoto

Beth Fukumoto served three terms in the Hawaii House of Representatives. She was the youngest woman in the U.S. to lead a major party in a legislature, the first elected Republican to switch parties after Donald Trump’s election, and a Democratic congressional candidate. Currently, she works as a political commentator and teaches leadership and ethics at the Harvard Kennedy School of Government. Opinions are the author’s own and do not necessarily reflect Civil Beat’s views. You can reach her by email at bfukumoto@civilbeat.org.

It’s been six months since I was able to see a therapist, but I am one of the lucky ones.

“This message is for Beth Fukumoto,” the frazzled voice said. “Due to the ongoing open-ended strike among the Kaiser therapists, your appointment has been, for now, canceled.”

My appointment was supposed to be on Sept. 14, and when I called to reschedule, the earliest available was Feb. 9.

The Kaiser strike ended in late February, the longest strike by mental health workers in U.S. history. It focused on an unreasonable patient-to-provider ratio and months-long wait times, and based on my own experience, the strike was absolutely justified.

In the past seven years, I have seen a therapist between one to four times per month. My therapists have helped me change negative thought patterns, overcome social anxiety and manage emotional distress.

These last six months have been the longest I’ve gone without an appointment.

Yet, in Hawaii, I’m one of the lucky ones.

Community First’s July 2022 Access to Care survey found that nearly 3 in 10 Hawaii residents reported that they or a family member were in need of counseling or coping skills. Health care providers said that mental health counseling was Hawaii’s most needed specialty (78%) followed closely by psychiatry (73%).

Similarly, Mental Health America’s 2023 Access to Care Rankings showed that 187,000 adults in Hawaii have a mental health condition with 20% reporting that their treatment needs were unmet. 

Kaiser Permanente mental health strike
Kaiser Permanente mental health workers shown during the lengthy strike. (Provided/Andrea Kumura/2022)

Hawaii’s ratio of mental health provider to patients, 1 to 360, is slightly higher than the national average of 1 to 350. This ratio leads to fewer appointments for existing patients and long waiting lists for new patients. Hawaii Pacific Health’s Find A Provider tool does not show any behavioral health specialists or psychiatrists accepting new patients.

A recent call to the Queen’s Patient Support Center also yielded no results after several calls to providers. HMSA members might find the best results with their provider search, which shows 483 psychologists and 171 psychiatrists accepting new patients.

Of course, the wait times may still be significant.

Specific statistics on wait times are not available. However, according to Kumi Macdonald, executive director of NAMI Hawaii, the organization hears that “there is almost always at least a one month wait time, but it can be up to six months. Some people, especially on the neighbor islands and those with Medicaid or Medicare, have an even longer wait.”

The problem is clear. Hawaii’s shortage of mental health support passed crisis level a long time ago. And it seems Hawaii’s politicians are taking it seriously this session.

In their January addresses to the Legislature, Gov. Josh Green and Chief Justice Mark Recktenwald both stressed the state’s urgent need for mental health resources. On Tuesday, Hawaii’s lawmakers passed a slate of bills that attempt to move the needle. 

While each of the bills could have an impact, these three have the biggest potential to increase appointment availability for Hawaii residents suffering from mental illness.

Senate Bill 164 appropriates an unspecified amount of funds for the Hawaii State Loan Repayment Program which helps support health care professionals, including mental health specialists. This bill is the most familiar of the three as the program has already supported 76 practitioners since 2012.

The governor’s budget requests $10 million in fiscal year 2024 and $20 million in fiscal year 2025 for the program. However, the original bill contained $1 million. I’m hoping that the House Finance Committee will add more funds to the program before it passes the budget bill to the Senate next week. 

Senate Bill 320 establishes a working group to consider adopting the Psychology Interjurisdictional Compact, which is an interstate agreement that facilitates the practice of psychology across state boundaries. Commissioning this study won’t have any immediate impact. However, if we eventually join the compact as the original bill intended, we would be expanding our resident’s pool of mental health providers.

Thirty-six states have already signed on. However, Massachusetts, Alaska, and Oregon, which have the lowest patient-to-provider ratios, are not members. The compact may not yield the desired results without support from the states with more resources.

House Bill 1300 would authorize provisional or associate-level licenses for psychologists and other mental health practitioners, allowing them to be paid and credentialed while they are still in the process of meeting their supervised experience requirements. If approved, this bill could quickly expand the behavioral health workforce and reduce wait times. According to the Hawaii Psychological Association, this bill “will significantly increase the speed with which trained, qualified, credentialed, and culturally cognizant practitioners can enter the workforce and meet Hawaii’s demands.” 

Out of these three bills, HB 1300 would provide the most immediate relief. But, each of these options is necessary to address our ongoing shortage of providers and ensure that the 69% of Hawaii’s untreated adults suffering from a mental illness can seek and find care.

Civil Beat’s community health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation and Papa Ola Lokahi.


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About the Author

Beth Fukumoto

Beth Fukumoto served three terms in the Hawaii House of Representatives. She was the youngest woman in the U.S. to lead a major party in a legislature, the first elected Republican to switch parties after Donald Trump’s election, and a Democratic congressional candidate. Currently, she works as a political commentator and teaches leadership and ethics at the Harvard Kennedy School of Government. Opinions are the author’s own and do not necessarily reflect Civil Beat’s views. You can reach her by email at bfukumoto@civilbeat.org.


Latest Comments (0)

Dear Civil Beat,Many thanks to Beth Fukumoto for her most informative article on the acute shortage of mental health providers in Hawaii, dated March 9, 2023. With one exception, the Hawaii Psychological Association has testified in support of the bills mentioned in the article. At this time we are reviewing the proposed interstate compact to ensure that psychologists from other states (who will be allowed to practice in Hawaii) are both properly trained and culturally competent.Sincerely,Alex Lichton, Ph.D.Chair, Legislative Action CommitteeHawaii Psychological Association

alex.lichton · 11 months ago

For all the poor Kaiser patients, unless you need cheap meds, I'd consider changing providers, but minimally you can go to the Psychology Today Website, search "Honolulu County" and "Therapists" and then go to the Under "$90" search criteria and you will find pre-licensed professionals and Marriage and Family Therapy interns working under already licensed people's supervision. Then I'd try to get Kaiser to reimburse (although no guarantees they will). Some of those folks are surprisingly good at what they do.

Frank_DeGiacomo · 11 months ago

Years go by. People trying to become licensed leave the profession due to financial pressures of waiting all those years.I'm all for the associates license, the loan repayment program, and the license portability between states, but a hurdle is the low reimbursement rates from Medicare and Medicaid too. Hopefully our Congressional delegation can help raise it when there's a chance it'll actually pass. Medicare for all won't work if the reimbursement rates are so low these educated, trained, and licensed people can make more money elsewhere.

Frank_DeGiacomo · 11 months ago

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