As with many other physicians, recommending physical activity to patients was just a doctor…
In 2019, 1.3% of the US population identified as American Indian or Alaskan Native(AI/AN) alone.1 The United States Bureau of Indian Affairs recognizes 574 Tribal entities which are eligible for funding and services by virtue of their status as Indian Tribes.
The Western concept of mental health illnesses may not correspond with the beliefs and interpretations of AI/AN cultures. The words “depressed” and “anxious” are absent from some native languages where alternative expressions such as “ghost sickness” or “heartbreak syndrome” are present.2 Many tribal cultures embrace the notions of interconnectedness balancing the mind, body, and spirit highlighting one’s well-being is entwined with cultural identity, family, and a connection to the past.3
The shared history of trauma caused by colonialism for the indigenous and native populations is believed to be a factor in the reports of 2.5 times more experiences of serious psychological distress in AI/AN populations compared to non-indigenous populations.4 Although numbers vary by tribe, the suicide death rate for AI/AN populations between the ages of 15-19 is more than double than all other racial ethnic groups.5 Elevated risk factors of suicide may be influenced by the fact the 26% of AI/AN live in poverty,2 as well as the higher rates of alcohol and drug abuse compared to all other ethnic groups, and the impacts of "historical trauma, alienation, acculturation, discrimination, community violence, lack of access to care, and exposure to suicide."5
Access to mental health care services is limited by nature of the rural, isolated location of federally recognized indigenous communities. In 2011, mental health services are reportedly available within 82% of tribal facilities.6 Those facilities report barriers to access preventing treatment including half of the facilities reporting physical barriers, one-third reporting persona and social barriers, and nearly one-third reporting economic barriers.6 To further exacerbate the disproportionate barriers to access, while these services do exist they are primarily provided on reservations and consequently 78% of AI/AN live outside of tribal areas7 and 21% lack health insurance coverage.3
Research suggests that indigenous persons with anxiety and depression may seek help from other sources including traditional and spiritual healers.3 There is a scarcity of available ethnically similar providers “approximately 101 American Indian and Alaska Native mental health providers (psychiatrists, psychologists, social workers, psychiatric nurses, and counselors) are available per 100,000 members of this ethnic group… [and only] an estimated 29 psychiatrists in the United States were of Indian or Native heritage.”8 Mental health programs for indigenous persons should address community and traditional knowledge, potentially incorporating structural aspects of CBT,9 to approach healing.
It is important to find a provider who demonstrates cultural competence - which describes the ability of healthcare systems to provide care to patients with diverse values, beliefs and behaviors and taking into account their social, cultural and linguistic needs. Unfortunately, research has shown lack of cultural competence in mental health care, which results in misdiagnosis and inadequate treatment. When meeting with your provider, ask questions to get a sense of their level of cultural sensitivity, such as whether they have treated Native Americans, received training in cultural competence, and how they plan to take your beliefs and practices into account when suggesting treatment. Learn more about finding the right therapist.
- Understanding the Cracks: What COVID-19 Means for the Mental Health of the Marginalized in the United States and Opportunities for Response, blog post by Anna Bartuska BS/BA, Derri Shtasel, MD, MPH, Luana Marques, PhD
- Persistent Trauma of Systemic Racial Inequities and the Perils of COVID-19, blog post by Mbemba Jabbi, PhD and Kathariya Mokrue, PhD
- Protests, Racism and Our Children: Helping Kids Cope, ADAA blog post for parents, Michelle Witkin, PhD
- Addressing Systemic Racism in Action: Understanding the Mental Health Professionals’ Tools for Change, ADAA Blog Post for Therapists, Kimberyle Dean, PhD and Luana Marques, PhD
- Indigenous Story Studio (Canada-based)
- Healing Indigenous Lives Initiative – youth peer leadership program
- Johns Hopkins Center for American Indian Health
- Mental Health Resiliency Resources and Helplines
- The Native Hope – Health and Wellness Blog
- One Sky Center - National Resource Center for American Indian and Alaska Native Health, Education, and Research
- WeRNative - health resource for Native youth, by Native youth
- People of Color Face Significant Barriers to Mental Health Services, CNN.com
- The effects of COVID-19 on the mental health of Indigenous communities
- Historical Trauma: The Confluence of Mental Health and History in Native American Communities
- Blog Post: Mental Health Issues from Historical Trauma Plague Native Americans