A shortage in health care workers and stigma have posed problems, but some residents have their eyes on solutions.

Haylin Dennison, a licensed therapist and social worker, is well connected in Oahu’s behavioral health community, but she still struggled to find mental health services for her transgender son during the pandemic. 

“Access is a real issue,” Dennison said, adding that during the coronavirus pandemic “the sickest of the sickest kids couldn’t get treatment for suicide and suicidality.”

The state faces many challenges in addressing and treating residents’ mental health needs, especially in rural areas and on neighbor islands. The behavioral health care worker shortage, for one, has been a persistent issue as a high cost of living and remote locations hamper recruiting efforts. The problem has taken a particularly heavy toll on children in Hawaii. 

“People will call us asking, ‘how can I get services? I’m on this island, and there are no psychiatrists through my son’s insurance. What do I do?’” said Kumi Macdonald, executive director of the National Alliance on Mental Illness Hawaii. She said waitlists for a therapist or psychiatrist range from one to six months. “Six months is not unusual,” she said.

Hawaii Pacific University mental health textbook students
Students from Hawaii Pacific University pose with copies of a new textbook on mental health practice in the islands. (Courtesy: Hawaii Pacific University/2023)

Despite scarce resources, Dennison and others are focused on finding solutions. 

In March 2022, Dennison opened Spill the Tea Cafe, a mental health clinic for adolescents that hosts group sessions as a way to keep up with the demand for therapy services. It also provides a space for teens to get to know one another while studying, playing games and drinking boba.

“Building community doesn’t have to look like, ‘Oh, we’re just going to sit around and talk about depression.’ It’s about exploring yourself and doing really fun activities that are naturally therapeutic,” said Dennison. Both Spill the Tea Cafe and NAMI Hawaii also offer support groups for parents or family members who care for someone with mental illness.

Similarly, Marta Garrett, an adjunct professor at Hawaii Pacific University, struggled to find a textbook for the 11 clinical psychology doctorate students in her evidence-based practice class that took Hawaii-specific considerations into account.

So she assigned her students to work together to write one, which is how “Integrating Evidence-Based Mental Health Practice in Hawaii,” which will be released on Tuesday, came about.

“In any doctoral course, I would’ve had (the students) write a significant paper, but I thought, ‘why write a paper that no one but me is going to read?’” said Garrett.

Because Hawaii is the most culturally diverse state in the country, the students looked at how cultural factors like immigration status, parenting style and spirituality, among others, might impact treatment for conditions like depression and anxiety.

“What does the research say if you have a 30-year-old who is suffering from (a certain) kind of anxiety? And what if that person was of Filipino descent? Or Chinese-Hawaiian?” said Garrett. “We scoured all of the research to find what was out there and what was missing, and then looked at how the evidence-based practices would fit within the cultural parameters that we had created in our case studies.”

“Building community doesn’t have to look like, ‘Oh, we’re just going to sit around and talk about depression.’ It’s about exploring yourself and doing really fun activities.”

Haylin Dennison of Spill the Tea Cafe

Each student in Garrett’s class contributed to the book, including Tori Gutierrez, who worked on the chapters about anxiety disorders, grief and loss, and traumatic brain injury. She found that treatment methods that prove successful in other places, might not work in Hawaii.

“If someone says, ‘I’m having problems with my family,’ on the mainland, therapists would say, ‘Well, you should distance yourself from your family,’ whereas here, I don’t think that would fly at all,” Gutierrez said.

Her approach to each of the case studies in the textbook was guided by culture. A clinician helping someone with anxiety, Gutierrez writes, may benefit from using words or descriptions from the patient’s culture to describe the diagnosis. And for a patient dealing with prolonged grief, Gutierrez discussed how being mindful of beliefs in modern new-age Hawaiian religion may tie into the therapeutic journey.

For Gutierrez, tackling the state’s mental health needs is about more than just addressing the worker shortage. 

“Hawaii needs mental health practitioners. And not just any mental health practitioners, but practitioners who are culturally sensitive and understand where people are coming from and how best to help them,” said Gutierrez.

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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