Video and highlights for “5 Slides: Raising awareness of mental health solutions”

May was mental health awareness month and the COVID-19 pandemic and resulting economic downturn has caused widespread despair and feelings of vulnerability. As part of our “5 Slides we’re discussing” series, State of Reform hosted three experts in mental health solutions.

In this conversation, Dr. Josh Green, lieutenant governor for the State of Hawaii, Kumi MacDonald, executive director for National Alliance for Mental Illness (NAMI) Hawaii, and Katy Akimoto, SVP of Health Management at Hawaii Medical Service Association (HMSA) discussed the impact of COVID-19 on mental health and Hawaii’s response to people suffering from mental health challenges.



In her comments, Akimoto discussed the utilization of services by gender. She said in 2019 women utilized services more than their male counterparts, and that trend continued into the pandemic.

“Women traditionally have used services at a higher rate than men, but this was increased during 2020. Women were doing a better job [at using the services available] and this does not bode well for men.” 

She said an example is the percentage increase in utilization for females with an eating disorder diagnosis. From 2018 to 2019, there was a 3.9% increase in utilization, and from 2019 to 2020 a 48% increase. But for men the diagnoses for alcohol and substance use disorder decreased by 59% in 2020. Akimoto said this decrease is troubling.

“People hypothesize [the decrease] is because of the lack of social interaction, and because this is a kind of hidden disease that hasn’t led to treatment that is appropriate.” 

A dashboard created by the Hawaii Department of Health (DOH) and the University of Hawaii which tracks behavioral health statistics in the state shows there are currently 82,100 individuals who have a substance use disorder in Hawaii.

The dashboard also shows that Oahu had the highest number of individuals who were unhoused and experienced substance use disorder in 2020 with 683.

Green focused his comments on how each facet of a person’s life affects their health. He said that social health is the integration of our traditional view of health care, social determinants of health and the other larger questions in society that affect personal health. 

One aspect of the social determinants of health is the availability of local agriculture to communities. In Hawaii the high cost of production for local products means they are often more expensive than imported products — making local food purchases not an option for many families. 

A 2018 report by the DOH found that Hawaii imports as much as 85-90% of their food and residents spend over $3 billion each year purchasing food sourced off the islands. Green said:

“We do not have a sustainable local ag culture here, but we do know that when people eat well diabetes numbers go way down, blood pressure is controlled much better, longer lived lives, but that takes money. It turns out we could actually produce a lot of our own food in the state of Hawaii if we chose to eat more vegetables and certain other starches that we have, but you can’t sustain full ranching on the small amount of land that we have here.” 

One way that Hawaii is integrating healthier choices is through the ‘Aina Pono programs and increasing local food in student meals. MacDonald spoke about what NAMI is doing to increase mental health in schools as well. 

“We know that if the kids get treated early the outcomes are so much better, even with serious mental illnesses. And mental health is really the core of our wellbeing, if we don’t have mental health we don’t have health.”

A recent national analysis of data by Mental Health America ranked Hawaii as having the highest percentage of survey participants who reported thinking about or planning suicide during the pandemic. MacDonald said NAMI Hawaii’s goal is to not only provide support to people with mental illness, but also education, advocacy and awareness. She said their multi-faceted approach has resulted in the rise of demand for services.

“As the pandemic rolled out we just had more and more demand for services, we were the busiest ever. The pandemic was a horrible time but there was a silver lining in that mental health finally is getting the attention that is so needed.”