Two of the biggest challenges in the immediate and long-term aftermath of the Aug. 8 fire that destroyed most of Lahaina and killed at least 115 people will be the mental health of survivors and the need to ensure government transparency in the recovery, according to a new report from the University of Hawaii.

“The health effects of the disaster are profound. They go beyond the tragic loss of lives and the immediate injuries that many suffered,” according to the report released Thursday by the university’s Economic Research Organization.

The report, titled “After the Maui wildfires: The road ahead,” was prepared by 16 experts from a variety of disciplines including economics, environmental science, public health, finance and governance.

The experts said research conducted in the aftermath of the 2018 Camp Fire that killed 85 people and leveled the California community of Paradise, and other major wildfires, found a significant rise in post-traumatic stress, depression and anxiety disorders among survivors both right after the disaster and often years later.

Mental health impacts from fires can also trigger physiological damage to hormone regulation, the heart, and the brain, the report found.

While signifiant federal and state resources are being deployed to Lahaina, it’s imperative to find enough qualified mental health practitioners to care for fire survivors, and that will likely be a big challenge in the medium and long term, the report says.

It’s also important to have mental health practitioners with ties to the local community and culture.

That could be especially difficult given Hawaii’s severe shortage of psychiatrists, psychologists, licensed clinical social workers and mental health therapists, particularly on the neighbor islands.

Besides that, there’s the logistical problems. Much of Lahaina’s healthcare infrastructure burned down and many people who might have driven to Central Maui for mental health care are now carless.

Given all that, it’s critical that services be made available close to survivors, whether they’re in Lahaina, Kula, where more than a dozen homes were destroyed in the Upcountry fires, or elsewhere on Maui, the report found.

The Hawaii Department of Health appears to be aware of the needs and is taking steps to meet them.

“We understand the behavioral health impacts from the Maui wildfires are severe and are likely to be long lasting,” said Marian Tsuji, the state’s deputy director of behavioral health, in a news release. “We also know that the impacts may not be revealed for weeks or even months after the disaster.”

Tsuji’s department is working with community partners to make sure that Maui residents have access to comprehensive and culturally sensitive behavioral health support. This includes a wellness navigator program for survivors staying in hotels. The navigators go door to door with carts containing toiletries, snacks, toys for children and other donated items, and they offer information about mental health services.

“There is a danger that post-disaster governance will be hobbled by bureaucratic turf battles and fragmented jurisdictions of authority.”

UHERO Report

The department is setting up telepsychiatry services and hiring local behavioral health clinicians to provide support to survivors for several months.

The U.S. Department of Health and Human Services has provided four federal behavioral health providers on Maui to assist, according to DOH.

Locations for in-person behavioral health visits include the Lahaina Comprehensive Health Center at Akoakoa Place below the Lahaina Civic Center and the Maui Community Mental Health Clinic at 121 Mahalani Street in Wailuku.

The Hawaii CARES Crisis Line is also available 24/7 by calling or texting 988 or visiting hicares.hawaii.gov.

The department plans to create peer support groups, increase telehealth services as communications are restored, and add additional crisis hotlines, according to the release.

Meanwhile, as the recovery moves forward, the University of Hawaii report emphasized the need for efficient government coordination and transparency.

Effective governance of the recovery will involve state and county governments, local nonprofits, community groups, FEMA and other federal agencies.

“There is a danger that post-disaster governance will be hobbled by bureaucratic turf battles and fragmented jurisdictions of authority,” according to the report.

The other issue is regaining the community’s trust, said UH political science expert Colin Moore.

Post-disaster redevelopment environments often favor “big top-down strategies that leave the community feeling left out or not being consulted,” he said.

In West Maui, trust in government was already a problem even before the fire. It experiences one of the lowest voter turnouts of any place of the island, an indicator that people don’t feel invested in elected leaders, Moore said during a press conference.

It’s going to be a “real challenge” to rebuild that trust, Moore said. One way to approach that is to create as inclusive a governance system as possible, to involve community stakeholders “from day one,” he said.

That’s probably going to take many community meetings facilitated by outside professionals and it’s going to require lots of transparency on the part of government. All that’s necessary to make sure the public is heard, knows how decisions are being made, has a seat at the table, and is confident that the millions of dollars in relief aid is reaching the people who need it the most, Moore said.

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