As Mental Health Crisis Worsens In Hawaii, Psychiatrist Shortage Takes Heavy Toll On Kids
Lanai resident Uri Cabatu is a single mother of a 14-year-old boy with autism and attention deficit hyperactivity disorder.
Her son takes psychiatric medications to control his outbursts, tantrums and other challenging behaviors and to improve focus. There’s no psychiatrist on Lanai, so Cabatu relies on telehealth appointments with a provider in Honolulu to keep her son’s prescriptions up to date.
But the provider won’t refill a medication without seeing the boy on screen, and busy schedules make that hard to pull off, which has resulted in medication delays.
Lanai residents Uri Cabatu, left, and Vanessa Janikowski say having more psychiatrists who live and work on neighbor islands would help families deal with the complexities that come from raising children with mental health challenges. (Courtesy: Vanessa Janikowski)
“Sometimes he skips medications for two, three days, up to a week,” said Cabatu, who works as a home health care aide. “It’s very difficult.”
When her son goes off his medication, his behaviors can rapidly deteriorate and stress within the family can spike, affecting everyone’s mental health and emotional wellbeing.
Valerie Janikowksi, a registered nurse on Lanai and Cabatu’s employer, knows the struggle well. Her 18-year-old son also has ADHD and requires medication. He was diagnosed at age 4 by a psychiatrist in Honolulu. Telehealth was just starting to emerge in Hawaii in 2010 so the family flew to Honolulu for appointments, a cumbersome, time-consuming and expensive process.
“It was exhausting,” Janikowski recalled.
Although telemedicine eased some of that strain for families like Cabatu’s and Janikowksi’s, it’s no panacea, especially for children who find it hard to bond or express their feelings with a health professional on a screen.
But with a severe shortage of pediatric psychiatrists in Hawaii, combined with growing demand for mental health services fueled by the pandemic, social media, bullying and other factors, many Hawaii families are desperate to find whatever help they can get.
In the best of times, navigating medical bureaucracy can be a head-pounding experience. But hunting for a child psychiatrist or therapist on the neighbor islands can often seem downright fruitless.
“I have people who are waiting up to nine months for an appointment,” said Mark Ansel, a Big Island therapist with a doctorate in social work.
The dearth of providers and the consequences from that shortage are borne out by data from the University of Hawaii Manoa, community surveys and interviews with mental health providers, patient liaisons and families.
Despite the grim statistics, some hope may be coming. Efforts are underway to ease some of the strain by getting more people trained as mental health providers. That would include everyone from masters-level community therapists to advanced nurse practitioners and physicians with degrees in psychiatry.