Survivors of the Maui wildfires still face profound emotional and psychological challenges nearly three years after the deadliest U.S. wildfire in more than a century killed more than 100 people, destroyed more than 2,200 structures and displaced an estimated 10,000 residents.
The disaster left scars on a landscape that is slowly being rebuilt in Lahaina and surrounding communities, but the healing and recovery for many who lived through it is far from over. Mental health providers, researchers, and state officials say the critical need for emotional and psychological support shouldn’t be overlooked — particularly now during Mental Health Awareness Month.
While debris removal and rebuilding efforts continue from the Aug. 8, 2023, fires, many survivors remain in a prolonged cycle of grief, instability and trauma that has been compounded by subsequent disasters, including recent Kona-low storms that damaged homes and displaced families on Maui and Oahu.
Mental health professionals say the continuing strain has revealed both the scale of long-term disaster trauma and the limitations of Hawaii’s mental health infrastructure, where provider shortages and housing instability continue to hinder recovery efforts.
“There’s still very much trauma in the society,” said Joseph DeLorenzo, an Oahu-based therapist specializing in trauma, PTSD and grief counseling who began working with wildfire survivors immediately after the disaster. “I was just doing crisis work for the first three weeks … Whoever was calling in, I would shift around my schedule to see them so that they had somebody they could talk to.”
DeLorenzo said the survivors often arrived in therapy disoriented, emotionally overwhelmed and struggling to regulate their nervous systems after narrowly escaping death.
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“It’s super important to have someone there for you in the first days, weeks, couple of hours,” he said. “There’s a very small time window of helping someone regulate their nervous system with this type of trauma.”
Some survivors eventually transitioned from emergency counseling into long-term therapy. For others the need for therapy was gradually reduced as they rebuilt support systems and regained stability.
Still, DeLorenzo said many survivors remain psychologically displaced even if they have secured temporary housing or employment, comparing the experience to entering an unfamiliar environment without any social foundation.
Economic instability has become one of the largest ongoing stressors for survivors, particularly as many businesses destroyed in the fires have yet to reopen and affordable housing remains limited. DeLorenzo said many residents are trying to recover emotionally while also navigating unemployment, rising costs and uncertainty about long-term housing in Hawaii, where the cost of living was already among the highest in the nation before the disaster.
The prolonged rebuilding process has also deepened frustration and distrust among some survivors who feel abandoned by institutions meant to help them, he said.
“When things are not going as fast as they should be, or people aren’t getting enough help, then they lose faith in the government,” DeLorenzo said.
Documented impact
Research continues to show the long-lasting psychological toll of the Maui fires.
A March University of Hawaii at Manoa study found wildfire-exposed Maui residents faced significantly elevated risks of depression and anxiety compared to residents on other islands.
Residents inside burn zones had a 53% higher risk of depression and a 67% higher risk of anxiety, according to the study. Maui residents outside burn zones also experienced elevated mental health risks, including more than double the risk of suicidal thoughts.
Researchers found that housing instability and lost income accounted for more than half of the wildfire’s impact on mental health outcomes.
Many survivors continue to exhibit trauma responses associated with distrust and social withdrawal, DeLorenzo said, especially after enduring life-threatening conditions during the fires. As a result, some survivors avoid seeking help altogether.
Mental health challenges among men have emerged as a particular concern during the recovery process, according to providers and state officials.
DeLorenzo said after businesses and workplaces were destroyed, many male survivors have struggled with losing their sense of purpose and identity as providers. He said societal expectations around masculinity often discourage men from expressing grief or emotional vulnerability, leading some to suppress their emotions while trying to appear strong for their families.
“Society has always told men not to show their emotions,” DeLorenzo said. “This amplified it to another level where it’s, ‘I need to be strong for the women, be strong for the children.’”
The emotional suppression can manifest differently depending on the individual, DeLorenzo said. Some men may become angry or aggressive, while others withdraw entirely and isolate themselves socially. DeLorenzo said those who become quiet and emotionally withdrawn can be especially concerning because they may not outwardly show signs of distress.
Non-traditional coping
Rather than relying solely on traditional talk therapy, DeLorenzo said many men respond better to activity-based and peer-centered forms of support that allow them to reconnect socially without the pressure of directly discussing emotions.
“Men are very pack-type animals,” he said. “It’s not so much verbal things they’re looking for.”
He suggested recreation centers, intramural sports leagues and community gathering spaces could help survivors rebuild social connections and find emotional outlets through shared activities and community engagement.
Tia Hartsock, executive director of the Hawaii Office of Wellness and Resilience, said the approach aligns with broader research showing men are often less likely to seek traditional talk therapy and more likely to engage through peer support and group-based settings.
Hartsock said creating opportunities for men to “talk story,” debrief and connect informally with one another can help normalize conversations around mental health and reduce stigma surrounding emotional vulnerability. She said those spaces do not necessarily need to center on discussing feelings directly, but rather on creating environments where men feel comfortable gathering, sharing experiences and supporting one another.
She added that peer-based support has been especially effective among first responders and noted that the approach also reflects traditional Hawaiian cultural practices, including the concept of the hale mua, where men historically gathered in community spaces to discuss challenges and find collective solutions.
Multiple traumas
Hartsock said post-disaster recovery often brings broader increases in anxiety, depression, substance abuse and domestic violence across affected communities.
She said one of the most persistent challenges has been that major disasters reactivate earlier traumatic experiences, recalling a conversation with a survivor still in traumatic shock days after the fire who began discussing the deaths of family members from years earlier.
Repeated emergencies since the fires — including severe storms, housing instability and ongoing uncertainty around recovery — have made it difficult for many to regain a sense of normalcy, Hartsock said.
As Hawaii enters another disaster season, she warned that recovery efforts remain ongoing and that additional climate-related events could continue straining communities already coping with prolonged trauma.
“Healing effort takes time,” Hartsock said. “It takes time to be in spaces that you feel like you can actually heal in.”
She said meeting basic needs such as stable housing, rest, healthcare access and food security is critical to helping survivors regulate stress and begin processing trauma in healthy ways.
Hartsock also emphasized the importance of resilience-building activities, including spending time in nature, connecting with supportive communities and maintaining healthy routines.
“It’s really important to connect with other people and have mentors and have space to do that,” she said. “That builds our ability to be more resilient when we’re faced with another challenge.”
Framework for wellness
In April, the Office of Wellness and Resilience released the Hawaii Mental Health and Well-Being Framework for Disasters and Traumatic Events, a statewide framework developed in response to lessons learned from the Maui fires which integrates trauma-informed care principles into emergency management planning and emphasizes culturally grounded approaches to healing and resilience-building.
The framework recommends creating resilience hubs — community-centered facilities capable of rapidly coordinating mental health and wellness services during disasters — as well as mobile outreach units to deliver services directly to displaced residents and isolated communities.
Hartsock said one major lesson from the fires was the importance of maintaining direct communication with community organizations and providers.
The office continues to hold regular coordination calls with nonprofits, healthcare organizations and mental health providers to identify barriers affecting survivors and adjust resources accordingly.
The framework also prioritizes culturally rooted healing practices and peer-based support systems, involving aina-based healing, cultural practices, lomilomi massage and acupuncture that have been particularly effective in helping survivors process trauma outside traditional clinical settings, Hartsock said.
The office also has emphasized peer support and psychological first aid training for community members. Hartsock said hundreds of residents recently participated in psychological first aid training following the Kona-low storms.
More providers needed
But at the same time, Hawaii continues to face a shortage of behavioral health providers.
“There’s so few therapists anyway,” DeLorenzo said. “For people to find a therapist, and then stay with a therapist is very, very hard.”
State officials hope a new law taking effect July 1 will help expand the workforce.
Act 93 establishes a provisional associate mental health counselor license allowing graduates to practice under supervision while completing post-graduate clinical hours required for full licensure.
The law replaces the previous internship exemption system and is intended to increase workforce capacity during long-term recovery efforts and future disasters.
As Hawaii enters another disaster season, Hartsock said resilience-building efforts must remain a long-term priority, especially as communities continue recovering from compounding emergencies.
“This is a marathon,” she said. “We remain committed to this long-term recovery.”