While many children in Maui County returned to school this week, a new report focusing on the mental health of children ages 10-17 who were exposed to the 2023 Maui Wildfires is raising some serious red flags.

The report found that while many are seeking mental health support, more than half of the children surveyed showed signs of depression. The report added that one out of four children reported low self-esteem, and many have experienced challenges at school and home.

The report, “From Crisis To Recovery: Health and Resilience Two Years After The Maui Wildfires,” found that most children appear physically healthy. But the study also found that 32% of affected West Maui residents are still struggling to get medical care or prescriptions, reflecting clinic shortages, transportation barriers and other service gaps.

According Heather Long, there are higher rates of depression in youths on Maui.

“We’ve seen more drinking and vape use and younger vape use, some starting in middle and elementary school,” said Long, the program director of adolescent treatment services for the nonprofit Maui Youth and Family Services.

The state Department of Health has established two Certified Community Behavioral Health Clinics on Maui, one in Kahului and another in Lahaina, that provide outpatient mental health and substance use services for youths and adults.

Long said Maui lacks a residential drug abuse treatment program for youths, as well as behavioral health counselors in the schools.

“The residential treatment is a higher level of care than outpatient,” she said. “People or teens who have an acute substance abuse disorder need the higher level of care, which is residential treatment.”

She said those youths who need these residential treatment services are sent off island to Oahu or the continental United States.

“The counselors are overrun. We can’t keep up with the number of kids that need to be served,” she said. “We can’t ignore it anymore.”

The UHERO study included more than 1,800 participants. It found recovery is still in progress with reports of worsened health dropping from 48% a year ago to 36% in the second year.

“Suicidal thoughts declined by nearly half, and rates of severe depression and anxiety also fell significantly,” the study said. “These improvements suggest that emotional healing is underway for many.”

The study said at the same time, some challenges persist. Post-traumatic stress disorder remains widespread, “affecting nearly one in three participants.”

Physical health indicators, such as lung functions, have worsened for many, pointing to gaps in long-term care.

The study said social stress remains heavy with nearly half of the study participants still in temporary housing and worried about food shortages.

The study also found that community resilience remained strong with support from family and neighbors.

But it noted that renewed investment and attention needs to be paid to chronic physical health conditions and trauma recovery as well as permanent housing.

The study said the groundwork for coordinating resources is being laid through the launch of the Maui Health Registry tracking shifts in participants and continuing to foster healing, reliance and a healthier future.

The study said the platform for the Maui Registry, mauiregistry.com, provides an opportunity for West Maui residents to share their experiences and help others to find hope.

Each participant’s visit took approximately one hour. Participants first completed a

comprehensive questionnaire, either in-person or online, covering wildfire exposure, housing,

employment, food security, and mental health.

Following the questionnaire they then completed a basic health check: height, weight, automated blood pressure reading, pulse and oxygen saturation. A blood sample was tested on-site using the i-STAT system to measure electrolytes, lactate, kidney function, and blood sugar.

All adults were offered in-person consultations to review their physical and mental health results.

Each received a printed summary, access to the MauiWes Health Portal, appropriate referrals, and a $100 incentive for participating.

Those who enrolled in the study included 1,800 adults and 200 children. Women made up 61%

of adult participants. The racial and ethnic mix was unusually diverse for a research cohort: 30% White, 20% Native Hawaiian or other Pacific Islander, 19% Filipino, 18% Hispanic/Latino, and 9% non‒Filipino Asian, closely reflecting the racial composition of the affected regions pre-wildfire.

Six in ten adults were between 35 and 64 years old–the very life stage where job loss, mortgage stress, and caring for both kids and elders collide. Financially, the cohort skewed lower‒income: one‒third lived below the federal poverty line, and another third hovered within 50 percent above it.

The report said alongside survey responses and point‒of‒care tests, the team collected small samples of venous blood, saliva, urine, and cheek‒swabs.

According to the report, these specimens are frozen at −80 °C in Honolulu, creating a biobank that future toxicology, transcriptomics, metabolomics, and epigenetic studies can draw upon–important, because the long‒term biological effects of massive wildfire smoke exposure remain poorly understood.

For the full report, go to tinyurl.com/mmvpe6r9.