May is National Mental Health Awareness Month — a time to recognize the invisible struggles that so many in our communities face. But awareness alone isn’t enough. We need action, and we need to start by confronting a hard truth: in Hawaiʻi, your Zip code too often dictates the quality of care you can access.
Across our Islands, mental health challenges are rising. Anxiety, depression, trauma and stress affect thousands — from keiki to kūpuna. In 2020, over 11,000 youth in Hawaiʻi experienced a major depressive episode. More than half of them didn’t get the help they needed. For adults, more than 30% report symptoms of anxiety or depression — yet one in five who seek care never receive it.
But the gap in care is not the same everywhere. Where you live can mean the difference between getting timely support — or waiting weeks, even months, for help. On Oʻahu, mental health services might be a short drive away. But on Neighbor Islands like Maui, Kauaʻi, and Hawaiʻi Island, waitlists for youth therapy can stretch four-to-six weeks. In rural areas, the shortage of providers is even more severe. This is unacceptable.
Your Zip code should never be a barrier to care. Yet time and again, we see how geographic location — and economic disparity — determine who gets help and who continues to suffer in silence. Neighbor Island communities bear the brunt of this inequity. On these Islands, only 8% of those lost to suicide were receiving mental health treatment at the time of their death, compared to 40% on Oʻahu. That is not just a statistic — it’s a devastating gap that costs lives.
This isn’t just about geography — it’s about equity. Native Hawaiian, immigrant, LGBTQ+, and low-income communities all face higher barriers to care. Nearly 23% of Native Hawaiian and Pacific Islander adults report experiencing mental illness each year, yet only 16% receive treatment — far below the national average. Youth living in poverty endure the added weight of stigma, bullying and social exclusion, all of which fuel mental health struggles.
These inequities are compounded for military families — of which Hawaiʻi has many. With over 73,000 Department of Defense personnel and nearly 90,000 veterans living here, our Islands are home to thousands who carry the burdens of deployments, reintegration challenges and post-traumatic stress. Yet even they face barriers to accessing culturally competent, local care.
At Child & Family Service, we operate the ʻOhana Resiliency Center (ORC), where licensed therapists who live and work in Hawaiʻi provide specialized care to military families. But one clinic cannot meet the scale of this need statewide.
The deeper issue is funding. Hawaiʻi’s mental health care system has been chronically underfunded for years. Medicaid reimbursement rates are so low that providers struggle to stay open, especially in underserved communities. The result? Fewer professionals, longer waitlists and worsening outcomes for those who need help most. We need sustained federal investment through agencies like [the Substance Abuse and Mental Health Services Administration], expanded Medicaid funding, and a commitment from our state to prioritize mental health as essential care.
At CFS, we’re working to meet people where they are, offering services across Oʻahu, Kauaʻi, Maui County, and Hawaiʻi Island. We use evidence-based therapies like cognitive behavioral therapy and models like Transition to Success, which address not just symptoms, but root causes — poverty, trauma, and social inequities that erode mental well-being.
But our efforts alone aren’t enough. This Mental Health Awareness Month, we must confront the reality that where you live can define whether you receive life-saving care or none at all. That must change.
Mental health is a shared responsibility. It’s about more than just offering services — it’s about ensuring everyone can access them, no matter where they live. Let’s normalize asking for help. Let’s demand funding that supports providers in every corner of our state. And let’s make sure that no one in Hawaiʻi is left behind simply because of their Zip code.
The time to act is now. Together, we can build a stronger, healthier Hawaiʻi for all.
Amanda Pump is president and CEO of Child & Family Service. Michael Young is president and CEO of Albert C. Kobayashi Inc., and serves as a board member for Child & Family Service. For more information about Child & Family Service, visit childandfamilyservice.org.
