In Hawaii, the path to mental health care is fraught with obstacles, not least of which is the daunting wait times that stretch upwards to six months for individuals seeking therapy. There is just one mental health professional for every 360 residents in the state. These are professionals born and educated here, but who are finding better opportunities on the mainland.
This provider shortage, and the bottleneck in access it’s created for the people of Hawaii is not just a matter of inconvenience; it’s a crisis that exacerbates the mental health struggles of our community, especially in the wake of the pandemic and Maui wildfires.
Yet, despite the clear and present need for more mental health professionals, a significant number of qualified clinicians find themselves on the sidelines, unable to contribute to the solution due to Hawaii’s unduly restrictive laws.
Under the current system, many mental health professionals, including psychologists, marriage and family therapists (MFTs), and mental health counselors, complete their degrees full of ambition to serve. However, they face a critical roadblock: the requirement for at least one year of supervised experience without the possibility of remuneration for their services through insurance reimbursement. This is because these post-grad therapists are working to complete their supervised hours required for licensure — a credential that their counterparts in psychiatry acquire more straightforwardly after completing their medical degrees.
The result? Only the largest and most well-funded agencies can afford to take on and adequately compensate these trainees.
Enter House Bill 1830 — a legislative proposal now in its third year of being considered — which is designed to bridge this gap by granting trainees in these professions a provisional temporary license. These licenses would enable emerging professionals to receive insurance reimburse- ment for their services, thereby opening the door for more agencies to offer training opportunities and for private practice therapists to take on and compensate trainees.
This approach not only expands the workforce ready to tackle our mental health care crisis but also ensures that trainees receive the most relevant preparation for their future careers in private practice. Importantly, research supports that the quality of care provided under such provisional licenses matches that of fully licensed professionals, debunking any concerns about compromised patient outcomes.
However, the stakes extend beyond just filling vacancies and reducing wait times. The current situation contributes to a “brain drain,” where trainees, discouraged by the lack of compensation and opportunity, either abandon their chosen path or relocate to states with more favorable licensing practices and lower costs of living.
Furthermore, the economic barriers to entering the mental health profession disproportionately affect minority communities, perpetuating a cycle of underrepresentation and, consequently, poorer outcomes for minority clients who benefit from therapy with professionals who share similar backgrounds.
Despite broad support from various organizations — including multiple state agencies — and the clear benefits it promises, HB 1830 has faced legislative hurdles, failing to advance in the past two sessions.
The urgency of the mental health crisis in Hawaii cannot be overstated, and the delay in legislative action only prolongs the suffering of those in need.
The message is clear: The time for action is now. We must rally behind HB 1830, urging our senators to support its passage in the Senate Ways and Means Committee before the end of this week. By doing so, we take a crucial step toward addressing the dire shortage of mental health providers in our state, enhancing the quality of care for all the people of Hawaii, and building a more inclusive and equitable bench of mental health professionals.
Let us not be spectators in this pivotal moment. Contact your senator, voice your support for HB 1830, and be part of the movement toward a healthier, more resilient Hawaii.
Becky Gardner is an attorney, mental health advocate and owner of a government relations firm representing the Hawaii Psychological Association, among others.