In Hawaiʻi, A Mental Health Support System Focuses on Cultural Competence and Connection

As wildfires tore across the Hawaiian island of Maui in August 2023, devastating the historic community of Lāhainā and killing 102 people, Michele Navarro Ishiki jumped into action.

A licensed clinical social worker and certified clinical supervisor and substance abuse counselor, she’d worked in the mental health field for more than two decades, and she wanted to help. Navarro Ishiki wasn’t from Lāhainā — she was born and raised in Pāʻia, also in Maui — and she didn’t know what would be needed, but she knew the most important question: “How can I support Lāhainā?”

The most immediate answer had little to do with the mental health care she was trained to provide. People who’d evacuated were separated from their families, worried about missing loved ones, and urgently needed food, water, toiletries, and other basic necessities. While Navarro Ishiki and her fellow clinicians offered mental health support to first responders in the area immediately after the fire, most of their time was spent transporting requested supplies to hubs that distributed necessities to families.

As Navarro Ishiki distributed supplies and talked to people whose roots run deep in Lāhainā, or whose families had come to Hawaiʻi from Southeast Asia in search of a better life, she heard a repeated theme: Responders had traveled to Maui from all over during the wildfires to offer support — but it often wasn’t the support people most needed.

“They were well-intentioned, but not always culturally competent,” she said. “Especially as it relates to our historical trauma, well-intentioned people can sometimes hurt people.”

People displaced from the wildfires described a therapist who’d shown up on Maui to help, then grew upset when people didn’t seek out mental health services. Another pushed newly evacuated community members to talk about what they’d seen, and whether any of the dead or missing were loved ones.

“People were not ready to talk about it,” Navarro Ishiki explained. “They lost their community, they lost their identity, their livelihood, and for many, loved ones. They were just trying to wrap their minds around that, and wondering where their next meal would come from.”

She understood. For Navarro Ishiki, integrating her clinical training with her Native Hawaiian culture and knowledge of her people is vital.

“I am who I am because of the people who came before me: my kupuna — my ancestors — my community, my mentors, my ʻohana [family], my parents,” she said. Understanding the thousands of years of culture and way of life, and the historical trauma, that inform Hawaiʻi today is essential. “Our people need our people to do this work.”

Most survivors of the Lāhainā wildfire weren’t ready to talk about their experience until months later, Navarro Ishiki said. As a responder, she found the devastation she encountered — even the smells in the air — deeply unsettling. “I couldn’t work after what I saw,” she said. “If we could do it all again, we would wait for the call” for help to arrive.

When she began to work in-depth with wildfire survivors in January of 2024, she observed that the Western conventions of therapy — office setting, one-on-one appointments, rigid boundaries between therapist and patient — weren’t a good cultural fit for many people.

Instead, Navarro Ishiki said, the support she offered often took the form of kūkākūkā, a cultural practice she defines as “talk story.” Sharing personal stories and cultural history as a community is an important practice in the long Native oral tradition.

“We do it as a group, as a family, as a community,” she explained. “They may not be looking to find a solution. It’s just not to carry the weight of what’s in their minds, their hearts.”

In the aftermath of the wildfires, Navarro Ishiki founded Piha Wellness and Healing, a nonprofit focused on providing mental health support to Hawaiian communities, and in developing peer support specialists and mental health practitioners focused on providing culturally competent care. She’d seen the need for Piha’s mission well before the fires, she said, but had decided to put founding a nonprofit on hold as her private practice grew. The devastation on Maui made it an urgent priority.

Piha Wellness and Healing, which now serves approximately 400 people per year, will be supported by a $200,000 grant from Direct Relief.

Navarro Ishiki described speaking with Dr. Byron Scott and Annie Vu, Direct Relief’s chief operating officer and associate director of U.S. emergency response, about her plans for the nonprofit as kūkākūkā. “It felt like we were talking story and building pilina,” which means connection in Hawaiian, she said. “I didn’t feel like I had to sell myself…Culturally, I could be who I am, and I was seen for that. I felt it, and it was genuine.”

Young therapists of Native descent confide to Navarro Ishiki that they’re worried about building a client list, establishing a practice, and gaining experience. She tells them they’ll have the opposite problem: “We work within a system where we will never have enough of us, even though we work hard to put ourselves out of a job.”

As in many traditional societies, connection to place and ancestry is vital to Kānaka ʻŌiwi (Native Hawaiians), Navarro Ishiki said. For example, it would be nearly impossible to overstate the cultural and historical importance of Lāhainā, once the home of the Hawaiian monarchy, to its people — or the grief caused by the wildfire’s destruction. Navarro Ishiki, whose own family has belonged to a community for seven generations, understands this connection to place innately.

“It’s not my intention to speak for Lāhainā,” she said when asked about the community impact. She’s there to support, not to represent.

She also teaches peer support specialists and therapists in training the importance of asking, not telling. “We know not to put our biases on people,” she said. The most important question is still, “This is what I have, what I do: How can I help you?”

It’s also important that the often “sterile” therapy model — impersonal office, strict rules — isn’t what Piha represents.

“If we just do our session and then we’re done, then that’s not culturally appropriate, in my opinion,” Navarro Ishiki said. Her goal is “to shift the paradigm…we are not here to work in siloes.” If a patient doesn’t want to talk about their wildfire experience, but they need a box of food or a place to find financial support, then that’s what she hopes Piha’s peer support specialists and providers will do.

For Navarro Ishiki, that’s kākou effort — when everyone does the work together.

“The meaning of piha is to be full, filled,” she explained. “Our vision is for every home to be healed and be piha in their wellness and healing…for our kupuna, those who came before us, those who stand beside us, and those who come after us.”

In response to the Maui wildfires, Direct Relief has provided more than $2 million in medical aid and more than $2.3 million in financial support to health providers and community organizations, including Piha Wellness and Healing.