How cuts in state mental health care affect Kaua‘i

LIHU‘E — Pandemic-induced budget cuts two years ago led to an 11% reduction in state adult mental health care positions.

On Kaua‘i, one clinical psychologist, one social-service assistant and six human-service professionals were laid off as part of the 2020 cuts. In all, 99 permanent positions and 63 temporary positions were cut statewide.

Now, despite a state budget surplus, whether or not these positions will be restored remains an open question.

“It impacted the number of consumers that we were able to serve on Kaua‘i,” state Department of Health Acting Communications Director Katie Arita-Chang said. “We can’t add new consumers until the case-management staff is available. It also limits the number of people that can be served by our clubhouse program.”

“We want to make sure that we can serve all residents across Hawai‘i,” she added. “Losing those positions really impacted our ability to do that.”

State Rep. Jimmy Tokioka, who represents Lihu‘e and portions of Wailua and the South Shore, viewed restoring DOH mental health funding as important, especially considering the state has extra funding this year.

“(It’s) going to support quite a few people, especially now in a time when they need it,” he said.

While legislators and officials have been supportive of increasing mental health funding, there has been confusion as to how to go about doing it.

Senate Bill 2132, introduced by state Sen. Karl Rhoads, seemed poised to address this issue by restoring the cut positions. The bill passed the Senate unanimously earlier this month, cleared first reading in the House, and was referred to committee, but was not scheduled to be heard by the committee deadline last week.

Chair of the House Finance Committee State Rep. Sylvia Luke described the bill as “unusual,” because budget items like this generally come through the executive budget or a governor’s message, not separate legislation.

The fact that the positions were not included in the budget, Luke said, led to confusion about what the DOH actually wants.

“We’re trying to get to the bottom of it — whether it was supposed to be included and it was an oversight or if it’s just something that, up the chain, they don’t support,” said Luke.

Mental health during a pandemic

These cuts came at a particularly difficult time, with the COVID-19 pandemic sparking a nationwide mental health crisis.

U.S. Census data shows that about 4 in 10 adults reported symptoms of anxiety or depressive disorder in 2021, up from 1 in 10 adults who reported these symptoms from January to June 2019.

Calls to the Hawai‘i CARES mental health and substance abuse crisis line likewise saw a dramatic increase during the pandemic, up over 50% from 2019 to 2020.

“We did see more negative impacts on mental health during the pandemic, due to isolation, restrictions, and the economic impact,” said Arita-Chang.

On Kaua‘i, shortly after the onset of the pandemic, four men committed suicide within the span of one week.

The lack of social interaction during the pandemic also made mental-health care more difficult, according to Franci Davila, who works as a mental health counselor on island and runs the nonprofit Kaua‘i Mental Health Advocates.

“We need social interaction,” said Davila. “A majority of people don’t want to be online when they are seeking mental health care services. They want mental health professionals to be able to sense their energy.”

A bright spot in this is that, statewide, growing mental health problems didn’t translate to higher suicide rates.

Preliminary data shows there were 124 suicides from April through December 2020 — lower than the 150 suicides in the same nine-month periods from 2015 to 2019 and the 138 suicides in those months from 2010 to 2014, the DOH said.

‘A long-standing problem’

It can be difficult to get adequate mental health care on Kaua‘i, even pre-pandemic.

“This has been a longstanding problem — it’s just gotten worse during the pandemic,” said state Rep. Nadine Nakamura, who represents north and east Kaua‘i. “Sometimes people are waiting one or two months to get an appointment. That’s way too long to address the immediate needs that people are experiencing.”

These long wait times are caused by a shortage of mental health professionals on island, according to both Nakamura and Davila.

“We live on a very isolated, rural island with limited resources,” said Davila. “There’s not enough mental health professionals here to provide the appropriate support we need for our communities.”

Nakamura attempted to address this shortage earlier this year, introducing a bill that would have improved telehealth access and allowed psychologists and certain nurses to have some prescription-writing authority, but that measure also died in committee.

Tokioka also advocated working with nonprofit organizations like the Aloha United Way to improve mental health care access.

“Government takes a long time — there are organizations out there that can get resources and services to the people way faster than we can,” Tokioka said.

Another important part of the equation is education, Davila said. If they are able to secure funding, her organization hopes to begin putting on mental health training workshops.

“It’s preventative work when we start to educate people on the significance of mental health and how to respond appropriately to mental health issues,” said Davila. “It empowers the community to be active participants in a collective mental health and wellness action.”

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Guthrie Scrimgeour, reporter, can be reached at 647-0329 or gscrimgeour@thegardenisland.com.