MAUI — Survivors of the Aug. 8, 2023 Maui wildfires continue to face psychological trauma, economic instability and housing insecurity nearly three years after the disaster. The fires killed more than 100 people, destroyed more than 2,200 structures and displaced an estimated 10,000 residents, ranking as the deadliest U.S. wildfire in more than a century.

Debris removal and rebuilding efforts are ongoing, and recent Kona low storms damaged homes and displaced families on Maui and Oahu. Many survivors remain in a prolonged cycle of grief, instability and trauma compounded by subsequent disasters, with Hawaii's mental health infrastructure facing provider shortages and housing instability that hinder recovery.

"There's still very much trauma in the society," said Joseph DeLorenzo, an Oahu-based therapist specializing in trauma, PTSD and grief counseling. He said survivors often arrived in therapy disoriented, emotionally overwhelmed and struggling to regulate their nervous systems after narrowly escaping death. "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," he said.

Economic instability has become one of the largest ongoing stressors. Many businesses destroyed in the wildfires have yet to reopen, affordable housing remains limited, and the cost of living in Hawaii was already among the highest in the nation before the disaster. DeLorenzo said many residents are trying to recover emotionally while navigating unemployment, rising costs and uncertainty about long-term housing, and that the prolonged rebuilding process has deepened frustration and distrust among some survivors.

A University of Hawaii at Manoa study in March found that wildfire-exposed Maui residents faced 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, while Maui residents outside burn zones experienced 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, and some avoid seeking help altogether, DeLorenzo said. Mental health challenges among men have emerged as a particular concern, with many male survivors struggling with losing their sense of purpose and identity as providers after businesses and workplaces were destroyed, he said. DeLorenzo said societal expectations around masculinity often discourage men from expressing grief or emotional vulnerability, with some suppressing emotions while trying to appear strong for their families.

"Society has always told men not to show their emotions. This amplified it to another level where it's, 'I need to be strong for the women, be strong for the children,'" DeLorenzo said. He said emotional suppression can manifest differently depending on the individual, with some men becoming angry or aggressive while others withdraw entirely and socially isolate, and that those who become quiet and emotionally withdrawn may not outwardly show signs of distress.

Tia Hartsock, executive director of the Hawaii Office of Wellness and Resilience, said research shows men are often less likely to seek traditional talk therapy and more likely to engage through peer support and group-based settings. DeLorenzo said recreation centers, intramural sports leagues and community gathering spaces could help survivors rebuild social connections.