A state mental health agency has filled a key position on Lanai, restoring in-person social services to patients with severe psychiatric conditions amid a housing crisis that had forced two prior applicants to pull out of the job because they could not find an affordable place to live. 

Left vacant for nearly two years, the social worker position is the Hawaii Health Department’s only full-time job based on Lanai within the Adult Mental Health Division to help patients cope with diagnoses that range from depression to schizoaffective disorder.

With no AMHD staff physically on the island to help patients manage their symptoms between twice monthly psychiatric appointments, some patients had said they felt abandoned.

The new hire begins work on April 1.

“I have tears of joy,” said Jozy Malacas-Kinoshita, 61, who receives care from AMHD to treat twin diagnoses of bipolar and substance abuse disorders. “It’s like, wow, there is light at the end of the tunnel and it’s shining bright for me right now. It feels like my life is coming back together again.”

AMHD is the state provider of psychiatric and social services for uninsured or underinsured adults with a serious mental illness, including about 25 Lanai patients.

The agency’s difficulty in filling the position exposes problems that often feed off each other: a statewide doctor shortage and a dearth of affordable housing.

For months, Pulama Lanai, the management company that oversees billionaire Larry Ellison’s 98% stake in the small island northwest of Maui, reserved a housing lease to help the state agency make a hire that sticks. Two candidates previously accepted job offers for the social worker position but pulled out when they couldn’t find an affordable place to live on Lanai, a common problem in Hawaii.

But on Lanai, an island of roughly 3,000 residents, the issue is compounded by the finite housing stock, a third of which is owned by Ellison.

Workforce housing was inadequate on Lanai long before Ellison bought most of the island for $300 million in 2012. But the problem has been intensified by an influx of hotel and construction workers employed by Pulama Lanai.

Critical staffing vacancies plague numerous state departments, prompting some unique solutions.

Pulama Lanai, for example, leases units to the state Department of Education to facilitate the hiring of teachers, some of whom have been recruited from the Philippines to fill longstanding job vacancies at the island’s only grade school.

The two Ellison-owned Four Seasons hotels on the island also struggle with worker housing, with some hospitality staff living at the resorts.

Pulama Lanai declined to comment for this story.

“It’s quite a commitment Pulama made, which I’m very pleased about,” said Reynold “Butch” Gima, who retired from the social worker position after 31 years in 2021 after he was suspended twice over his opposition to pandemic-era changes in the delivery of AMHD services to Lanai patients.

Since then, the agency has not had any full-time staff based on Lanai for the first time since 1990.

Some patients cited the changes in their services during the pandemic as a cause of poor outcomes in their mental health.

“There are all kinds of different reasons why people need these services and some are really hurting,” Malakas-Kinoshita said. “On Lanai, we are part of Maui County and we need services just like everybody else.”

She also expressed appreciation to Pulama Lanai for facilitating a housing lease for the incoming social worker.

“They’re the foundation of this community and without them putting their feet into the water nothing gets done,” she said.

Ellison is privately funding the construction of the 150-unit Hokuao Housing Project, which aims to shore up a workforce housing problem that has made it difficult to attract professionals to move to the island and fill positions in fields ranging from hospitality and construction to human resources and health care. 

The project, which is under construction, has been criticized by some residents for some of its rules and regulations and for the absence of any homes for sale.

The Hokuao development will offer leases on 76 affordable units and 74 market rate units.

A decade ago the county came up with a plan to develop more than 400 affordable units on the outskirts of Lanai City. There has since been no tangible progress.

Civil Beat’s coverage of Maui County is supported in part by grants from the Nuestro Futuro Foundation and the Fred Baldwin Memorial Foundation.