Stakeholders discuss options for addressing Hawaii’s behavioral health, workforce challenges


Hannah Saunders


As challenges like substance use disorder and suicidal ideation persist, Hawaii continues attempts to reform its behavioral health system. Leaders in the field met at the 2024 Hawaii State of Reform Health Policy Conference to discuss some solutions, like tackling long wait times to see providers and addressing provider burnout.

Jennifer Siatafu, director of behavioral health at The Queen’s Health System in Honolulu, said the hospital offers hospitalizations for youth ages four to 17, and outpatient services include intensive outpatient programs, and appointments for therapy and medication management. 

“We do have a large population of patients that wait on the inpatient side of our unit for residential care, or even transferring back to other islands,” Siatafu said. 

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Getting patients into residential care has been challenging due to workforce shortages, and neighboring islands may have more resources and support to help the transition, she said. Provider shortages for outpatient treatment is also a challenge, but Siatafu said Queens has a short-term plan when patients get discharged, which includes eight to 10 follow-up visits and medication management, among others, to ensure patients remain stabilized. 

“Sometimes patients don’t have regular providers … But usually patients will have community services, a case manager, and usually … A psychiatrist they can follow up with,” Siatafu said. 

Emily Moser, program director at YouthLine—a free and confidential teen crisis helpline based in Oregon—discussed the organization’s work, which extends to all areas of the country, including Hawaii. YouthLine is a pathway to engage youth on their mental wellness journey. The nonprofit offers teen-to-teen peer youth services, which are a primary aspect of YouthLine’s crisis intervention work. Teen peers provide support through lived experiences that help normalize what their clients are feeling, and encourage seeking help.

YouthLine operates three call centers in Oregon, and supports about 25,000 youths nationwide each year. The organization has 125-175 youth volunteers or interns each year. Moser noted the importance of teen peers providing a workforce development pathway. In the past five or six years, almost all its volunteers have expressed that working at YouthLine was a life-changing experience, Moser said. 

“More than half of them choose a career in social sciences, in counseling, in teaching, and in social work, so we create this pathway in doing the work as a volunteer, and supporting youth nationwide in their most challenging moments,” Moser said. “We have learned that we are in a position … To support this process in bringing young people into the workforce in a very natural and organic way.”

Tia L.R. Hartsock, director of the Office of Wellness and Resilience at the Office of the Governor, said she has been focused on workforce and community wellness surveys relating to health-related social needs (HRSNs) over the past six months. 

“We’ve been working with the University of Hawaii to develop a community wellness survey, as well as a workforce wellness survey,” Hartsock said. 

The workforce survey will query the entire healthcare workforce in Hawaii, and takes about 15 to 20 minutes to complete, according to Hartsock. The Office of Wellness and Resilience is focused on gathering information to develop a baseline report. Hartsock said the goal of the surveys is to understand health disparities and inform legislators how to fund projects, and recruit and retain a healthy workforce—particularly in social services and emergency response. 

“This will be a part of information that hopefully informs for generations on how we move forward to really address secondary traumatic stress, vicarious trauma, burnout, and other pieces about being able to create a healthy workplace in order to have balanced staff,” Hartsock said. “And in order to provide the most appropriate, effective, and efficient services—specifically for those who are receiving our state’s services.”

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