Supporting Native Hawaiian Youth Mental Health Through Indigenous Culturally-Driven and Land-Based Healing Approaches

Kānaka Maoli (Native Hawaiians) are the Indigenous People of the Hawaiian Islands. Their connections to the ‘āina (land) and moana (ocean) are deeply spiritual: ‘āina and moana are considered both ancestors—linked directly to Native Hawaiians through their genealogy and creation stories, and serving as a healer—and the foundation of Native Hawaiian identity and well-being. These connections also underpin Indigenous Knowledges and cultural practices, which can serve as an asset for Native Hawaiians’ well-being.

More specifically, engaging Indigenous Knowledges through culturally-driven and land-based approaches (see box below) can promote the mental health and well-being of Kānaka Maoli youth by facilitating connectedness, instilling a sense of pride and positive self-identity, and emphasizing healing and resilience. Community-based initiatives that center culturally-driven and land-based healing approaches can cultivate environments that support not only the well-being of individuals, but also a thriving Lāhui (Nation; Native Hawaiian community inclusive of people, lands, waters, animals). Therefore, these approaches are essential for fostering health, healing, and resilience within Native Hawaiian communities.

This brief first provides historical background on Native Hawaiian cultural Traditions and on geopolitical shifts that have impacted their connections to the land, which serves as the foundation for their well-being; such shifts have also compounded the cumulative impacts of intergenerational trauma. We then review the potential for Indigenous culturally-driven and land-based approaches to improve Native Hawaiian youth’s mental health, and provide several illustrative examples of community-based programs. Finally, we offer additional considerations for policy and funding strategies to incorporate culturally-driven and land-based approaches, and conclude with recommendations to policymakers, practitioners, and researchers.

The following box defines key terms and concepts used in this brief within the Indigenous (Native Hawaiian) context:

Historical Context for Understanding the Current Health Status of Native Hawaiian Youth

Native Hawaiians’ deep connection to the land, and their cultural practices and ancestral Knowledges, are inherent strengths that support their health and well-being, including youth mental health. However, several historical events have undermined, disrupted, and attempted to disconnect Native Hawaiians from these community strengths; in turn, these events have undermined Native Hawaiians’ well-being over time.

The illegal overthrow of the Hawaiian Kingdom in 1893—an act later acknowledged by the United States Congress as a suppression of Native Hawaiian sovereignty—set in motion a series of policies and practices meant to undercut Native Hawaiian culture.[i],[ii],[iii] For example, an 1896 English language-only law banned use of the Hawaiian language, a vital source of cultural Knowledges, in public schools. Native Hawaiians’ ability to use the language in public schools was not restored until 1986, after decades of advocacy led by Native Hawaiians. In 2022, the state of Hawaii passed a resolution to formally apologize for the 90-year ban. Further, the privatization of land for economic and military endeavors in the 20th century also markedly changed Native Hawaiians’ access to land and the ocean, which are places of cultural significance, connection, and sources of well-being.[iv],[v],[vi] These experiences of colonization and cultural trauma had an immense impact on those who directly endured them and have had a lasting impact across generations even to today, as Native Hawaiians disproportionately face socioeconomic disadvantages such as lower educational attainment, higher than average rates of poverty, systemic racism, and health disparities.

Presently, the systemic impacts of cultural trauma among Indigenous populations are evident in the disproportionate health disparities faced by Native Hawaiians and Indigenous Peoples globally. Studies show higher rates of chronic illnesses such as diabetes, heart disease, and obesity linked to the disruption of Traditional practices and disconnection from the land. The deliberate attempts to destroy Native Hawaiian Knowledge systems—through suppression of the Hawaiian language and restricted access to culturally significant resources (lands and oceans)—have further exacerbated these disparities.

Moreover, intergenerational trauma manifests in high rates of mental health challenges among Native Hawaiians, and Native Hawaiian youth are not immune. Data indicate that Native Hawaiian youth are more likely to experience sadness, depression, and suicidal ideation than their non-Native Hawaiian peers. Additionally, Native Hawaiian adolescents face elevated risks for early substance use and exposure to drug offers, along with higher substance use rates, reflecting the long-term impact of cultural trauma on behavioral and mental health.

The Importance of Indigenous Culturally-Driven and Land-Based Approaches to Youth Mental Health

Culturally-driven and land-based approaches to health promotion and prevention efforts may represent a key component of efforts to address the health disparities and cultural trauma faced by Native Hawaiians. Programming and services that use these approaches go beyond providing intervention or treatment, as they seek to revitalize cultural practices and (re)connect individuals with their heritage. Land-based healing plays a crucial role in fostering deep connections between Indigenous People and the land to promote various aspects of Indigenous health through physical, mental, emotional, and spiritual well-being. These wholistic aspects of Indigenous health are deeply intertwined for Native Hawaiians, and are interconnected in how the land strengthens cultural identity and the natural environment. These connections are also essential for restoring balance and resilience within Indigenous communities and could represent a source of strength for Native Hawaiian youth’s mental health and substance use prevention.

To implement a culturally-driven approach, communities can use community-based participatory research (CBPR) as a tool to develop and refine programs and services. Indigenous CBPR allows Native Hawaiian communities to lead in the identification of health concerns and the development of cultural and land-based programs. These processes not only involve Indigenous communities taking the lead to identify concerns but, importantly, to drive solutions and ensure that initiatives are led and facilitated by respected Kupuna (Elders), Knowledge Holders, and cultural practitioners. Such individuals are essential for driving culturally-driven programming: Their leadership and inclusion facilitate respectful and ethical engagement of Indigenous Knowledges and cultural practices—for example, by guiding appropriate collection and use of Traditional medicines. Their engagement in programming and services also presents opportunities to preserve and perpetuate cultural teachings in curricula and materials while creating a space for younger generations to connect with their cultural heritage and lessons in ways that will carry them forward for future generations. A culturally-driven approach cannot be done without Kupuna and cultural practitioners.

In fact, within Indigenous communities, culturally-driven approaches have long been used in local services, nonprofit organizations, and treatment facilities. The following examples of community-driven programs showcase what it looks like to employ culturally-driven and land-based healing approaches in research and programming within Native Hawaiian communities, and demonstrate how CBPR and culturally-driven programs can address the health and well-being of Native Hawaiians. By integrating Traditional practices and ensuring that the community leads the efforts, these projects and programs not only aim to improve health outcomes but also strengthen cultural identity and resilience for individual participants, their families, and communities.

---

Examples of culturally-driven and land-based approaches in Native Hawaiian communities

The Hoʻouna Pono Curriculum has been developed through a community-based research approach. Hoʻouna Pono is a culturally-grounded curriculum delivered in schools that employs local and Traditional Hawaiian contexts and storytelling for substance use prevention. Research on the school-based curriculum is situated on Hawaiʻi Island and assesses perceived risks of substance use, drug offers, and strategies to resist substance use among youth. By engaging with youth, the curriculum was further refined and developed to include stories related to substance use that became part of video vignettes used to educate participants on substance use and related drug offer situations (and how to address them). In providing vignettes, the curriculum also draws on Native Hawaiian cultural connections of ‘ohana (family) and aloha (love) as driving forces of strength to refuse drug offers, within familiar contexts and related curricula activities.

The Puni Ke Ola Program is a community-driven initiative focused on substance use prevention among Native Hawaiian ʻōpio (adolescents) and haumana (students) that draws on Hawaiian ways of being and knowing. Puni Ke Ola uses Hawaiian kaona (layered meaning), moʻolelo (storytelling), and ka ʻao (legends) in combination with ocean and land-based culturally-driven practices situated in a Traditional and sacred fishpond. Within this community-based program, haumana learn from kiaʻi loko (Traditional fishpond guardians, protectors, and caretakers) about the fishponds through Indigenous research that is combined with experiential learning and discussions using photovoice to link Native Hawaiian culture to health and well-being.

The Inspiring Hope Study focuses on youth suicide prevention among Native Hawaiian and Pacific Islanders. This community-initiated study employs a culturally adapted approach that incorporates cultural protocol and connection to the Waianae community. The study’s research team aligned evidence-based prevention strategies with community and cultural roots to intentionally consider the values and aspects of aloha (love), ola (life), and pilina (connections) to the land, family, and broader community. The Inspiring Hope Study was situated within a school-based health center in a predominantly Native Hawaiian and Pacific Islander community. As a result, this study reflects the values of the community and uses the Lōkahi (unity, unify, in one accord, harmony) wheel, which includes balancing kino (body), naʻau (emotions), pili ʻuhane (spiritual), and manaʻo (mind) with kuleana (responsibility) and ʻohana (family). These values were included in the study’s activities to identify strengths while including cultural protocol such as ʻoli (chanting) to create a space of good intention among youth participants.

Hoʻomau Ke Ola is a nonprofit organization that provides substance use treatment and recovery services to Native Hawaiians and other longer-term locals of Hawaiʻi. The organization is deeply rooted in Hawaiian cultural healing via its community-based efforts to integrate Hawaiian values, Traditions, and practices in their treatment programs. While the organization offers a range of clinical treatment services, such as residential and outpatient services, it also supports transitional living for individuals experiencing substance use and mental health concerns and has served over 4,000 individuals since its inception. Using community-based and culturally-grounded methods, Hoʻomau Ke Ola offers familial and community supports in recovery and familial repair, while also creating space for healing. Its programming emphasizes recovery via repaired connections to culture, identity, and spirituality. Under the guidance of Hoʻomau Ke Ola’s respected Kupuna and cultural director, whose Knowledges are in turn transcended (passed on) by the Kupuna who came before them, cultural values and practices are also present through the organization’s use of laʻau lapaʻau (Traditional medicines) and ʻāina (land)-based healing—all facilitated by intentional engagement with the sacred valleys accessible to the organization.[1]

The Menehune Film Academy is a nonprofit organization that uses Traditional teachings and digital storytelling as a way of (re)storying the narratives of the Waiʻanae community. As a Kānaka Maoli (Native Hawaiian)-owned, grassroots effort, the organization has served Waiʻanae for over two decades. Menehune Film Academy provides digital enrichment programs that foster an environment of safety and healing for Native Hawaiian and Pacific Islander youth from the community. The programming facilitates learning about the intersections of their Traditional Ocean ways and cultures with environmental health and mental health. Youth learn about the history and current experiences of their community from cultural practitioners and Traditional Water People and reflect on their personal lives and experiences; then, they share their stories with the broader Waiʻanae community. Menehune Film Academy serves the entire West Coast from Mauka (mountains) to Makai (ocean), including all the valleys, in partnership with those who have local Indigenous Knowledge, allowing youth to learn from and with the stories of their homelands. Through digital storytelling, youth are empowered to preserve their cultural heritage and stories of old and new for future generations.

---

Considerations and Recommendations

To support the health and well-being of Native Hawaiian youth, policymakers and funders should pay increased attention to—and increase investment in—culturally-driven and land-based healing approaches in Indigenous communities. Policy and funding strategies that prioritize resources for, and accommodate the use of, cultural and land-based healing practices would support ongoing community-based initiatives and enhance understanding of how these efforts can mitigate Native Hawaiian health disparities and improve long-term well-being.

Recently, federal efforts have shifted to call for the inclusion of Indigenous Knowledges and culture within practice and services delivery. A 2024 memo from the federal Office of Head Start outlines policy guidance and directives, priorities, standards, and initiatives focused on Tribal American Indian and Alaska Native populations for culturally appropriate services. Although the Office of Head Start’s focus is on upholding the sovereign rights of Tribal Nations to use curricula and assessments that align with cultural values, practices, and cultural language preservation efforts, the guidance may also serve as a model for other agencies—for example, by supporting the use of culturally-grounded approaches in youth programming and services, as well as similar efforts to support Native Hawaiian and Pacific Islander Nations.

In addition, in 2021, the White House issued guidance to federal agencies—Indigenous Traditional Ecological Knowledge and Federal Decision Making—to elevate the role of Indigenous Knowledges in policy and decision making. While the guidance is associated primarily with environmental management efforts, the application and aim—to respect and elevate Indigenous Knowledges—are also applicable to the relationships between Indigenous Peoples and the environment, and to these relationships’ multidirectional benefits to the well-being of Indigenous Peoples. Therefore, the Memorandum seeks to align federal efforts with Indigenous value systems to include community-based and culturally-driven efforts for all Indigenous Nations, which provide a foundation for efforts to support the well-being of Native Hawaiian youth.

There are additional considerations for developing and implementing community-based, culturally driven, land-based healing programs. This work takes additional time, flexibility, and adaptability, and such programming requires strong, trusted, and nurturing relationships with communities. Specifically, for more sensitive topics—such as mental health and substance use efforts—such efforts require a profound trust and sensitivity between researchers and the community, which would be facilitated via co-creation and co-learning processes led by Indigenous scholars and practitioners. Having Indigenous researchers and evaluators who understand the political, sociocultural, and economic challenges of Indigenous communities is necessary for understanding the community’s contexts and its resource needs. It is critical to have Indigenous Elders and cultural practitioners involved in these types of programming, and to think intentionally about meaningful research, evaluation, and community-driven evidence that make sense and are comfortable for Indigenous and Native Hawaiian communities. In particular, community-driven evidence is an important component of working with Indigenous Peoples; given that the current status of research emphasizes evidence-based programming and services—which may be incompatible with more qualitative Indigenous methodologies—these processes often decenter Indigenous cultural, Knowledges, and land-based practices.

To ensure the success of these interventions, they should be developed in partnership with Native Hawaiian communities. This collaborative approach ensures cultural relevance and empowers communities to lead their healing processes. Moving forward, additional research on the effectiveness of culturally-driven and land-based healing programs could inform practitioners on appropriate care delivery models and shape policy conversations. As additional research continues to highlight the effectiveness of Indigenous culture-as-intervention models, there is a clear call to action for policymakers, researchers, and health practitioners to support and invest in these community-based, culturally-driven and land-based healing approaches.

---

Acknowledgement

I extend my heartfelt gratitude for my community and Pasifika Nations, Kupuna, Kumu (teachers), and ‘ohana who have provided me with invaluable guidance and support for creating spaces for healing and thriving throughout the Pacific. Mahalo nui loa (thank you very much) for trusting me to walk alongside this journey of reflection, research, evaluation, and healing as we reclaim our stories and our health. This piece is a reflection of our shared commitment to honoring Tradition and fostering the well-being of a thriving Pacific. I also want to send a heartfelt mahalo to my Indigenous colleagues and co-authors who provided guidance and a shared space for learning and privileging the voices of my community. It is also with great gratitude to colleagues at Child Trends—Matt Haugen, Brent Franklin, Dominique Martinez, Laura Ramirez, and Shreya Mukhopadhyay—who dedicated so much time, effort, and guidance in creating meaningful review, feedback, and support of this blog to uplifting the voices of the Pacific.

---

---

Endnotes

[i] Kameʻeleihiwa, L. (2000). Native land and foreign desires: Pehea lā e pono ai? Bishop Museum Press.

[ii] Sai, D.K (2011). Ua Mau Ke Ea: Sovereignty Endures: An Overview of the Political and Legal History of the Hawaiian Islands. Honolulu: Pūʻā Foundation.

[iii] Silva, N.K. (2004). Aloha Betrayed: Native Hawaiian Resistance to American Colonialism. Durham: Duke University Press.

[iv] Kameʻeleihiwa, L. (2000). Native land and foreign desires: Pehea lā e pono ai? Bishop Museum Press.

[v] Sai, D.K (2011). Ua Mau Ke Ea: Sovereignty Endures: An Overview of the Political and Legal History of the Hawaiian Islands. Honolulu: Pūʻā Foundation.

[vi] Silva, N.K. (2004). Aloha Betrayed: Native Hawaiian Resistance to American Colonialism. Durham: Duke University Press.

---

Reference

[1] Yamane, C.Y.E.W. (2015). Personal Communication with Cultural Director of Hoʻomau Ke Ola.