Editor’s note: This interview discusses heavy themes of mental health and substance abuse.
A street psychiatrist based in Honolulu was recently recognized with a top honor. Dr. Chad Koyanagi is a community psychiatrist and one of the nation's few practicing street psychiatrists. Koyanagi works for multiple agencies, including the Institute for Human Services, Aloha House on Maui and Hope Services on Hawaiʻi Island.
He meets people where they are — on the streets, in encampments, and throughout the community. This spring, he received an award from the National Alliance on Mental Health.
Koyanagi sat down with The Conversation to speak about his career.
Koyanagi is a McKinley High School alumnus with degrees from Harvard University and the University of Hawaiʻi at Mānoa John A. Burns School of Medicine.
He's worked in traditional settings including hospitals, rural health clinics, and the state Department of Health. But he said that he has always spent part of his career in street outreach, focusing on people who are chronically homeless and living with severe mental illness.
"Going back 26 years, when I first started doing this work, there were people around downtown who, at first glance, were quite severely mentally ill, quite impaired, chronically homeless," Koyanagi said. "Now, driving around town, you see these unfortunate people everywhere. Like every neighborhood, almost every street has unsheltered folks who are struggling with mental illness and unable or unwilling to get the help they need. So by working in more traditional settings, that has allowed my primary passion of working in the streets to kind of coordinate a lot of the resources that are available."
He told HPR that he has developed a "tool belt" of resources to help his patients, but added that trust is a huge factor that he and his team work to build and maintain with the people they meet.
"I spend all my energy to try to get to know them, build trust. Sometimes it takes weeks, sometimes months, sometimes years, and then eventually some miracles happen, like they're willing to go to a shelter with you, or work with you to try to find permanent housing, or better yet, if they're willing to start a long-acting injectable medication, that's going to be a game changer for them," Koyanagi said.
One of Koyanagi's most memorable stories was when he and his team helped a woman who was living in a rural part of Hawaiʻi Island. Her ex-husband reached out to Koyangi and said she was suffering from schizophrenia and severe psychosis.
"I think they had sent a provider out there a time or two, and she just declined care because she was so ill. And then with the Hope Services team, we went out there a bunch of times, building that trust, building that rapport, and with the help of the ex-husband and patient's son, we were able to get her to agree to treatment, and she trusted me enough to accept intramuscular injection of an antipsychotic medication. And ever since that point has been a trajectory towards improvement," Koyanagi said.
The patient's relationships improved, including with her son, who told Koyanagi that he was unable to go to college while her mother was ill.
"This family had exhausted every possible traditional means of getting her help. It just took the right connection, and my team was able to go out there and willing to help her," he said. "Every time we see her, it's amazing. You feel like you want to cry, so inspiring that someone can recover like that."
Koyanagi was one of 13 doctors that was honored with an Exemplary Psychiatrist Award. He was the only recipient from Hawaiʻi. He told HPR that the recognition is especially meaningful coming from NAMI and its board members.
Koyanagi said that he hopes the community can show more compassion for people and families dealing with mental illness.
This story aired on The Conversation on July 7, 2026. The Conversation airs weekdays at 11 a.m. Hannah Kaʻiulani Coburn adapted this story for the web.
