A Scoping Literature Review of the Behavioral Health Workforce and Workforce Development in Hawaii

Background and Purpose: According to the National Survey on Drug Use and Health, an estimated 6.87% of those aged 18 or older in Hawai‘i had co-occurring substance use disorder and any mental illness in 2022 and 2023. However, there is a critical shortage of behavioral health professionals in the state of Hawai‘i. All counties in Hawai‘i have been designated as Health Professional Shortage Areas (HPSA) in mental health. Despite these challenges, the extent of behavioral health workforce shortages and the landscape of workforce development programs in Hawai‘i remain unclear. Understanding these gaps is essential for developing and targeting training and educational initiatives, supporting data-driven decision-making for educators, policymakers, and behavioral health stakeholders. This scoping review aims to examine the current behavioral health workforce shortages, identify existing workforce development programs, and offer recommendations for strengthening the behavioral health workforce in Hawai‘i.

Methods: A scoping review was conducted using the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) Checklist. An article search was performed in five databases: PubMed, CINAHL, Web of Science, PsychINFO, and MEDLINE, for the years 2000-2025. A search for keywords in the title and abstract of each article was conducted using the following keywords: behavioral health, mental health, substance, drug, addiction, workforce, hawaii, and hawai'i. In addition to the five databases, government and other college/university reports were identified through a manual search.

Results: The search yielded 32 articles and 5 reports; after applying exclusion criteria, 6 articles and 5 reports remained for final synthesis. The literature identified persistent shortages across multiple behavioral health occupations, including social workers, psychiatrists, psychologists, marriage and family therapists, mental health counselors, and substance use counselors. Three key workforce development initiatives were highlighted: (1) improving access to care using telepsychiatry; (2) providing innovative fellowship programs training for undergraduate and graduate students of social work and related fields for gaining knowledge, skills, and experience in behavioral health, and (3) offering distance learning to increase the number of behavioral health social work training statewide. Despite these efforts, there are notable workforce gaps, limited diversity reflective of Hawai‘i’s communities, insufficient collaboration among providers, and inconsistent data collection and reporting practices.

Conclusions and Implications: Findings underscore the urgent needs to expand and diversify the behavioral health workforce in Hawaiʻi. Key recommendations include improving data collection and disaggregating workforce data by occupation, fostering cross-sector collaborations, increasing support for culturally and linguistically diverse trainees, and enhancing funding mechanisms for behavioral health education and training. Continued investment in innovative workforce development efforts is essential to address persistent behavioral health workforce shortages. Highlighting these gaps and solutions can inform workforce policy, program development, and future research, guiding social work practitioners and scholars in efforts to build capacity and strengthen behavioral health workforce.