Hawaii is facing a fentanyl and mental health crisis, prompting psychiatric professionals to develop new approaches to care. Dave Fields, a psychiatric nurse practitioner and founder of Fields Psychiatric Consultants, provides trauma-informed care to people on Oahu and Maui struggling with mental health challenges, addiction, psychosis, and homelessness. Fields described a systemic problem he has witnessed across hospitals and shelters: “Over the years, working in hospitals and shelters across the state, I’ve seen too many people fall through the cracks. While we can often stabilize someone in the short term, they’re frequently sent back into the same broken system.”
Fields identified a critical danger related to fentanyl, noting that the drug is appearing widely in various substances. “Fentanyl is showing up everywhere, and many people don’t even realize they’re taking it,” he said. “It’s especially dangerous for those who are struggling with untreated schizophrenia, trauma or PTSD.” Recognizing the systemic barriers to providing effective care, Fields obtained a law degree to help reform policies that make mental health treatment difficult.
Policy and System Reform
Fields emphasized that addressing the crisis requires broader systemic change beyond individual clinical interventions. He stated: “Mental illness and addiction are real, and they’re treatable. But to truly make a difference, we need earlier support, more compassion and policies that reflect the realities people face every day.” He identified outdated crisis-diversion laws as one of the main obstacles to improving outcomes. These policy gaps prevent the kind of sustained, preventive care needed to keep vulnerable individuals out of emergency situations where fentanyl exposure becomes a life-threatening risk.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.hawaiinewsnow.com/2025/07/21/tackling-mental-illness-addiction-with-psychiatric-nurse-practitioner/