In the wake of the deadly Lahaina fires, it is no surprise that Governor Green’s proposed supplemental budget for next fiscal year (July 2024–June 2025) focuses on recovery for Maui. More than $450 million is proposed for this purpose, 85 percent of which would go towards managing expected insurance claim payouts for the 2023 wildfires, and for as-yet unspecified recovery needs to be expended by various departments.

However, the governor also proposes to increase much-needed funding for another, less obvious crisis: dealing with Hawaiʻi’s unmet needs for mental health care. This is not a new problem, but it is one that is growing. 

While mental health treatment needs for displaced families on Maui are acute, trends in social isolation—elevated by the pandemic—have increased rates of anxiety, depression and antisocial behavior for many more people. Mental illnesses are significant problems by themselves, but are also more likely to be associated with other chronic diseases. When they occur together, both mental and physical conditions tend to be worse, and more costly for both individuals and society.

Because of widespread stigma related to mental illness, the extent of the problem is not as apparent as it should be. National data indicate that 20–26 percent of the population have diagnosable mental health conditions, and that as few as one in three people with such needs seek care. Many who do try to get help are unable to get timely and consistent treatment. Mental Health America’s 2023 access to care data show several alarming statistics:

• 69 percent of Hawaiʻi adults—130,000 people—in need of mental health care were unable to get treatment, putting Hawaiʻi in last place for the nation. 

• 75 percent of Hawaiʻi’s youth with major depression—12,000 young people—did not receive mental health treatment, ranking Hawaiʻi at 49th in the country.

Real progress toward better mental health care requires destigmatizing the condition so that people are comfortable with seeking care when they need it. When people do seek help, mental health services need to be available and affordable. To make that happen, Hawaiʻi needs: 

• More mental health care providers, including psychiatrists, psychologists, and other licensed therapists; 

• A healthcare system that treats mental health as any other condition that primary medical providers can diagnose, treat, and/or make referrals for; and 

• Adequate reimbursements from public and private insurers to cover mental health care. 

Until such changes are in place, it is crucial to support Hawaiʻi’s underfunded mental health system. According to state spending reports, from 2012–2023, average annual spending per fiscal biennium (in 2022 dollars) decreased by 24 percent for the Adult Mental Health Division (AMHD) and 20 percent for the Child and Adolescent Mental Health Division (CAMHD). Spending at the Alcohol and Drug Addiction Division (ADAD) was variable, ranging from $35 to $44 million over the period. Spending on the Hawaiʻi State Hospital (HSH), which serves people with severe mental illnesses in the criminal justice system, increased by 40 percent.

The number of clients served by Hawaiʻi’s mental health system also decreased between 2012 and 2023, but while clients getting treatment in outpatient settings dropped by 25 percent, those admitted to and discharged from the Hawaiʻi State Hospital increased by 44 percent. Spending reports don’t describe changes in the programs that may have resulted in these trends, but both outpatient decreases and inpatient increases seem to be negative.

Recognizing the need to strengthen state mental health services, the governor’s budget proposes to add $51.5 million to the following programs:

• $33 million to supplement psychiatric services and workforce at the Hawaiʻi State Hospital. This amounts to 64 percent of all mental health funds added in the governor’s budget, and underscores the great cost for care in this setting. The growth in clients and spending at HSH is also a lesson in what happens when we fail to invest in basic human needs, generally, and preventive mental health and substance use services, specifically.

• $11.8 million to expand and offer adequate payment for CAMHD’s contracted services, and for in-community youth programs offered by the Department of Human Services.

• $6,657,400 for AMHD in support of a behavioral health crisis center and supportive housing services. 

Other Investments in People and Communities 

The governor’s budget would also increase funds to support housing, education, and access to nutritious food:

• $6.9 million for housing, including rent supplements, Hawaiian Home Lands, and interventions for people experiencing homelessness.

• $53.4 million for public education and public charter schools, including increasing the reach of school-based meal programs.

• $26 million to the University of Hawaiʻi System, most of it to restore funding lost in last year’s budget.

• $1.7 million for DA BUX and Farm to Food Bank programs, which support nutrition and local agriculture.