By Dennis Les. | Ret. USAF E-8 | Graduate Student, Clinical Mental Health | Hawaii News Hoku | October 2025

The Question Nobody Wants to Answer

Everywhere in Hawaiʻi you hear talk about “mental health awareness.” Yet awareness alone rarely results in actual access. If policy makers accept that Hawaiʻi faces a mental-health access crisis, then the question becomes: why has the state not adopted the Counseling Compact (LPC-Compact) which allows licensed counselors from other states to serve clients here under regulated conditions? Other states have done so—39 states plus the District of Columbia have passed enabling legislation—and some (Arizona and Minnesota) have begun issuing privileges to practice. The fact that Hawaiʻi, geographically isolated and provider‐scarce, has not yet adopted the Compact raises real questions about priority and policy inertia.

The Need Is as Clear as the Pacific

Data from Hawaiʻi’s schools show stark realities. Only about one in five middle‐school students on Oʻahu report that they “always” receive the help they need when feeling upset or anxious. Reflecting broader workforce stress, the Hawaiʻi Department of Education reports only 61 school psychologists for the entire state—roughly one for every 2,800 students—when national guidance recommends closer to one per 500. This suggests a major access gap for students needing mental-health services (Hawaiʻi Department of Education, 2024). According to Mazie Hirono (2022), Hawaiʻi is “in crisis” when it comes to health-care worker shortages, including behavioral health.

The Compact Could Be a Game-Changer

The LPC-Compact creates a professional “passport” enabling licensed counselors in one member state to provide counseling services (including via telehealth) to clients who are physically present in another member state, while allowing the client’s state to retain oversight of the practice location. For Hawaiʻi, this is a tailored solution: mainland counselors could provide telehealth to Hawaiʻi residents, and Hawaiʻi‐licensed counselors could serve clients who travel into the state. This matters particularly in a tourism-heavy economy. When visitors maintain therapy sessions while vacationing, insurance reimbursements and licensing fees accrue under Hawaiʻi’s jurisdiction. The policy therefore offers both improved access and potential economic benefit.

Instead, We’re Still Arguing About Paperwork

Bills introduced in the Hawaiʻi Legislature—HB 1390 and SB 322—specifically aimed to enable Hawaiʻi’s participation in the Compact by authorizing the Director of Commerce & Consumer Affairs to license counselors from other Compact states. Both bills stalled in committee. Among the reasons cited: alignment concerns between Hawaiʻi’s licensing framework and the Compact’s minimum standards; possible loss of state licensing revenue; and questions about whether out-of-state counselors would grasp local culture (Hawaiī Legislative Research, 2024). Meanwhile, Hawaiʻi’s elected officials are publicly speaking about the broader mental health workforce shortage. Governor Josh Green (2024) stated, “Through this bill, we affirm our commitment to a more humane and effective approach to addressing mental-health crises in our communities” when signing workforce-related health care bills into law.

Filling Cracks with Techs, Not Therapists

Hawaiʻi’s schools are increasingly relying on Registered Behavior Technicians (RBTs) and other behavioral-support technicians to serve students with autism spectrum and behavioral needs. These roles are indispensable—but they come under supervision and do not replace fully licensed counselors or therapists. The result: the system has many “hands on deck,” but not enough licensed captains at the helm. In effect, the shortage of independent-practice licensed professionals remains unaddressed.

The Missed Economic Opportunity

Joining the Compact is not just a matter of access—it has economic implications. Hawaiʻi accommodates approximately nine million visitors annually; many of these individuals maintain therapy via telehealth back home. In the absence of Compact participation, their sessions may need to pause while in Hawaiʻi, because the client’s physical location triggers licensing requirements. If Hawaiʻi adopted the Compact, counselors licensed elsewhere could serve those clients legally while they are here, resulting in increased provider reimbursement, licensing revenue, and general excise tax income flowing into the Hawaiʻi economy. In short: access + economics = opportunity.

When Government Moves Slow, People Pay Fast

Hawaiʻi routinely passes resolutions about “mental-health awareness month” and issues prospective statements. But when a concrete tool—authorizing counselors across borders with oversight—appears, the legislative engine stalls. Meanwhile families, students, veterans and providers wait. Delays in governance translate into delays in care. The cost of inaction is real and growing.

A Straightforward Fix

If Hawaiʻi truly means to prioritize mental health, the path is clear:

1. Pass the LPC-Compact enabling legislation and enact regulations accordingly.

2. Update telehealth statutes so island, neighbor-island and visitor‐situations are covered.

3. Expand the supervision infrastructure so the increased number of providers (including RBTs/techs) are supported by licensed clinicians.

4. Set measurable goals: shorter wait times, increased provider counts, greater continuity of care.

Final Word

This is not a partisan issue. It’s not left or right. It’s about right or wrong. Hawaiʻi does not lack heart. It lacks urgency. The data are clear, the tool is ready, and the need is urgent. The only remaining question: will Hawaiʻi act?

HawaiiNewsHoku – Where island truth meets accountability.— Dennis Les

References:

Hawaiʻi Legislative Research. (2024). HB 1390 – Comments : Licensed Professional Counseling Compact. LegiScan. https://legiscan.com/HI/comments/HB1390/2024

Hirono, M. (2022, September 14). Senator explains need for immigrants to address Hawaiʻi’s health-care crisis. KHON2 News. https://www.hirono.senate.gov/news/in-the-news/senator-explains-need-for-immigrants-to-address-hawaiis-health-care-crisis

Hirono, M. (2025, April 6). Hirono warns of mental health crisis impacts from proposed federal agency cuts. Maui Now. https://mauinow.com/2025/04/06/hirono-warns-of-mental-health-crisis-impacts-from-proposed-federal-agency-cuts/

Hawaiʻi Department of Health. (2025, October 1). Hawaiʻi recognized as a national leader in mental health in new report. eHawaii.gov. https://health.hawaii.gov/news/newsroom/hawai%CA%BBi-recognized-as-a-national-leader-in-mental-health-in-new-report/

Hawaiʻi News Now. (2023, November 5). Rep. Ed Case hosts ‘Talk Story’ event prioritizing veteran’s mental health. https://www.hawaiinewsnow.com/2023/11/06/loved-ones-community-leaders-gather-celebration-life-former-republican-state-lawmaker-sam-slom/

Office of the Governor of Hawaiʻi. (2024, June 27). Governor Green signs 22 bills for Hawaiʻi’s health care, community systems, and health care workforce development. https://governor.hawaii.gov/newsroom/office-of-the-governor-news-release-gov-green-signs-22-bills-for-hawai%CA%BBis-heath-care-community-systems-and-health-care-workforce-development-into-law/

Turn0search0. (2024). HB 1390 Bill Text. Hawaiʻi State Legislature. https://data.capitol.hawaii.gov/sessions//session2024/bills/HB1390_.HTM