Therapy On The Beach: Program Targets Youth Mental Health Crisis On Maui With Mobile Counseling

Maui marriage and family therapist Tina Boteilho tells the story of a young girl who fell to pieces during an adolescent group counseling session for fire survivors when she was instructed to paint the Lahainaluna “L,” as a form of art therapy.

It turns out that when the girl and her family fled Lahaina as the town erupted in flames on Aug. 8, her mother told her to keep her eyes locked on the iconic landmark overlooking the town as a means to distract her from the traumatic scenes unfolding outside the car window, according to Boteilho.

For the girl, a symbol meant to evoke hometown pride and a sense of belonging was instead a reminder of her family’s escape from the fire, a reminder that instantly surfaced a wave of disturbing memories.

Another child that Boteilho has provided care to now avoids anything related to emergency responders, separating the fire trucks and police cruisers from his miniature toy car collection and refusing to play with them.

Across West Maui, it’s become harder to secure psychological care since last summer’s wildfires, which incinerated the offices of one of the region’s main mental health care providers, created new transportation problems for people who lost their homes and cars and diminished the island’s already strained mental health system.

Meanwhile, mental health providers islandwide say they expect the island’s adolescent mental health crisis will continue to escalate. Some providers say they’re only beginning to see the repercussions of last August’s devastating wildfires on the psyches of young people.

Online therapy and a revolving door of short-term help from fly-in providers from other states is helping to boost the availability of youth mental health treatment, although some experts and advocates have criticized these methods as subpar to in-person care from a local provider.

More help is expected to materialize down the line, as some Maui mental health advocates work to earn the credentials they need to provide clinical care themselves.

Other providers on Maui have found success with a new mobile program that delivers mental health counseling to children and teens in their everyday environment, be it their favorite beach, at summer camp or in their government-issued hotel room.

After experiencing trauma, it’s not unusual for children to develop emotional or behavioral changes. They might become clingy, show signs of anxiety, lash out, throw tantrums, become withdrawn or struggle with eating or sleeping. 

Sometimes a reminder of the trauma they endured can trigger overwhelming emotions of anger or fear or sadness.

Yet as the one-year anniversary of the Aug. 8 fires approaches, Boteilho said some kids who are struggling feel that by now they should have been able to heal and move on.

“It’s like being single on Valentine’s Day,” Boteilho said. “It’s that feeling of, ‘How come everybody’s through this and I’m still struggling? How come everybody’s going to concerts and I’m not past it? How come all my friends are having fun and I’m not?’”

Maui United Way interim Director Lisa Grove, who has supported numerous post-fire mental health initiatives, said she’s encountered a number of youth, as well as adults, who’ve put expectations on themselves to achieve certain milestones in their psychological recovery that may not be realistic.

“They’re feeling this extreme pressure to get back on track,” Grove said. “But there’s no clear pathway to get back on track.”

There are two major roadblocks to delivering mental health care to Lahaina youth, said Boteilho, who has coordinated psychological support and treatment for first responders and fire survivors in partnership with nonprofits and state and county government since the day after the fires.

One is a dire shortage of mental health workers, especially those qualified to treat children.

On Maui, the number of psychiatrists needs to increase 59% for adults and 77% for children and adolescents, according to the University of Hawaii’s annual statewide medical workforce survey. 

The other issue is that mental health support often isn’t available where youth can readily access it. 

At Lahaina public schools, teachers and staff have received training in areas such as psychological first aid, traumatic grief in children and self-care, according to the Department of Education website. The U.S. Public Health Service Commissioned Corps assigned mental health providers to every West Maui school. 

But Boteilho said many children aren’t receiving help because they aren’t asking for it. This is often due to stigma or a lack of understanding that their internal struggles could be lessened by talking with a trained professional, she said.

Some children aren’t reaching out to teachers and school counselors because the adults in their household have minimized their mental health struggles.

“You have families who are literally telling some of these kids, ‘knock it off,’” Boteilho said. 

Other adolescents struggle with survivor’s guilt and may be reluctant to reach out for help because of it. 

“It’s the feeling of, ‘Well, I didn’t lose my house,’ or, ‘I lost my house but I didn’t lose a family member,’ or ‘my school didn’t burn down but theirs did,’” Boteilho said. “It’s that constant comparison to someone else’s experience and the downplaying of your own.”

Then there’s the problem of students who didn’t return to school after the fire. 

During the school year, Boteilho said it wasn’t uncommon for her and her colleagues who offered mental health support to displaced Lahaina families in their government-sponsored resorts to find children in their hotel rooms during the day. Sometimes, she said, kids were alone in these emergency accommodations while their parents went to work. 

According to Boteilho, some parents who questioned whether local schools could keep their children safe on campus in the event of another blaze never sent their kids back to classes after the fire.

“These are kids who’ve been isolated, who are dealing with their own mental health but also the mental health of their parents and also other family members,” Boteilho said. 

For all these reasons, the delivery of mental health services to kids in their natural environment has been a key to success for professionals like Boteilho who are working to confront child and adolescent trauma in Lahaina.

She helped develop Malama Na Keiki, a new initiative launched in April with a $1 million donation from Sentry Insurance Foundation to Maui United Way. The yearlong program aims to address the needs of children impacted by the Aug. 8 wildfires by sending out small teams of mental health counselors to meet with youth on their own turf. 

Often this means counselors will spend hours knocking on doors in the hotels where some fire victims still live. Counseling teams also seek out youth who are struggling with their mental health on the beach, at YMCA summer camp or at programs sponsored by The Boys and Girls Clubs of Maui.

“They’re really just kind of like pounding the pavement, finding these kids, making those connections with their families and parents and getting them help,” Boteilho said.

The Malama Na Keiki program’s efforts include outreach to homeless youth and those who may not regularly attend school.

The program is currently providing counseling to roughly 60 youth with a goal of growing that number and providing all youth participants with counseling at least six times over the course of a year. 

One of the participating Lahaina families recently moved to Kihei after the Federal Emergency Management Agency placed them in a home there through the agency’s long-term lease program for displaced fire survivors. So the counseling team followed them there.

“We worked with them in Lahaina and now that they’ve moved to Kihei we continue to work with them in Kihei,” Boteilho said. “The three kids still go to school in Lahaina, the mom still works in Lahaina and they are wanting to return to Lahaina, but they are working on the process of rebuilding (a home) and permitting and that’s going to take years, unfortunately, I think.”

Delivering services to youth in the places most comfortable and convenient to them helps solve another problem: transportation. 

Roughly 4,000 cars were burned in the August wildfires and another 1,000 vehicles were damaged or abandoned during the rush to escape as Lahaina went up in flames, according to Maui County officials. 

For some parents who are down a vehicle, getting their kids to and from therapy appointments is simply too much of a hardship.

Amber Drake, who lost her generational family home in the fire and leads support groups for Lahaina fire survivors for the Maui chapter of the National Alliance on Mental Illness Hawaii, agrees that transportation can be an issue for people of all ages trying to make it to therapy appointments. 

Nonetheless, demand for clinical care in West Maui is high, Drake said, and wait lists are long. In an effort to bolster the availability of locally available psychological support, she recently enrolled in graduate school for clinical mental health counseling at the University of Hawaii Hilo.

“My own personal therapist, her practice burned to the ground,” Drake said. “She’s just doing telehealth now.”

Drake said she’s thankful to be able to keep up her regular therapy appointments online, but she said it’s harder to communicate, especially when it comes to subtle emotional cues and body language, through a little box on the computer screen.

Civil Beat’s coverage of Maui County is supported in part by a grant from the Nuestro Futuro Foundation.

Civil Beat’s community health coverage is supported by the Cooke Foundation, Atherton Family Foundation and Papa Ola Lokahi.