Native Americans/Alaskan Natives and mental health

Many American Indian and Alaskan Native populations are highly affected by behavioral health and substance abuse issues. They experience one of the highest rates of suicide of any demographic group in the United States. Native Americans frequently contend with issues that prevent them from receiving quality medical care, such as cultural barriers, geographic isolation, stigma and mistrust of treatment, and lack of financial resources.

Introduction

The US Bureau of Indian Affairs (BIA) identifies an individual as American Indian if there is legal demonstration of at least one-fourth Indian heritage. Generally, the term “Native Americans” includes all peoples considered American Indians or Alaska Natives (such as the Inuit and Aleut). Many of those termed Native Americans prefer to view their ethnicity in terms of their tribe, however. Due to a tendency to place all Native Americans into one large classification, much of the literature is based on generalizations from one or two specific tribes and ignores the vast diversity of the cultures included.

Many sociologists follow John Ogbu’s categorization of two kinds of minorities: oppressed immigrant groups, who assimilated into the dominant society after two or three generations, and caste-like groups, whose social status rarely changes. Caste-like minorities include groups who either were brought to the United States against their will or were subjugated because of European migration to North America. Ogbu’s perspective calls attention to the centuries of legalized racism a minority group has experienced, such as confinement to reservations. Groups most often included in the second category are African Americans and Native Americans. Opponents of this concept question whether data exist to support the categories.

Mental Health Issues

The percentage of Native Americans or Alaskan Natives aged eighteen or older who reported a major depressive episode in 2007 was 9.2. This compared with 2.9 for Asians, 6.1 for African Americans, 6.3 for Hispanics, and 8.1 for whites. Native American and Alaskan Natives also have disproportionately high death rates from unintentional injuries and suicide.

Suicide is another area of concern for Native Americans and Alaskan Native communities. In 2020 the rate of deaths by suicide was 23.9 per 100,000, an increase of 7 percent over ten years.

The 2021 National Survey on Drug Use and Health (NSDUH) concluded that Native Americans and Alaskan Natives suffer disproportionately from substance use disorders compared with other racial groups in the United States. The survey found that in 2021, 36.1 percent of Native Americans or Alaska Natives aged twelve or older used illicit drugs, compared with 24.3 percent for Black people, 22.5 percent for whites, and 19.4 percent for Hispanics. Native Americans and Alaska Natives saw the highest rates of drug overdose deaths in 2020 at 41.9 per 100,000.

The COVID-19 global pandemic that began in 2020 had a more severe impact on minorities, including Native Americans and Alaska Natives. The isolation of many communities meant the economic effects of business shutdowns was significant. These and other pressures often negatively affect mental health for example by increasing anxiety. Tribal leadership reported increasing rates of suicide among young Native Americans during the pandemic.

Cultural Values

Knowledge of traditional cultural values of Native Americans and Alaskan Natives can be helpful to mental health personnel. At the same time, it is important to remember the great variation that exists because of differences between and within groups and that every culture contains all the possible values.

Minority group members may feel resentful or defensive because of past treatment of their ethnic group. This can immobilize or impede them in present-day functioning or contribute to depression. Messages about success within the traditional American value system tend to overlook the fact that successful performance for individuals rests on a foundation of mental health.

Increasingly, mental health centers and professionals are employing a holistic approach to mental health by combining primary and mental health care. This view is more consistent with the traditional view of the interrelationship between the mind and the body held by Native Americans and Alaskan Natives, as well as with the value they place on the overall harmony of life.

The Mental Health Profession

Barriers to cultural competence on the part of mental health professionals include a sense of entitlement and a lack of awareness of the need to adapt. This sense of entitlement suggests that standards provided by their professional training or their own life experiences should motivate clients and emanates from the assumption that the successes the mental health practitioner has enjoyed are available to everyone else in the same way. The lack of awareness of the need to adapt overlooks the client’s “inner curriculum,” which is the primary influence in the healing process. Although the concept was designed to be applied to the classroom, it is as important in the mental health care setting. Mental health settings that are aware of the inner curriculum provide services that are based on the following assumptions:

•Individual characteristics influence change by the client.

•Cultural identity is to be valued and included.

•Culture serves as a framework for sense making.

•Change is influenced by self-interpretation and self-directedness.

•Clients respond to provisions for individualization.

When possible, both Western and the traditional healing techniques of Native Americans and Alaskan Natives should be used. When both are available in mental health clinics, clients are more comfortable seeking mental health services.

According to the Kaiser Family Foundation, in addition to structural barriers to diagnosis of mental illness, people of color also may not be diagnosed because screening tools are not culturally appropriate. Another issue is that symptoms of mental illness and substance use disorder are more likely to be treated as criminal acts.

Bibliography

Kwon, Sherry C., and Abdolreza Saadabadi. "Mental Health Challenges in Caring for American Indians and Alaska Natives." National Library of Medicine, 4 June 2022, www.ncbi.nlm.nih.gov/books/NBK570587/. Accessed 10 Feb. 2023.

Lee, Wanda M. L., et al. Introduction to Multicultural Counseling for Helping Professionals. 3rd ed. New York: Routledge, 2014. Print.

Lyon, William S. Encyclopedia of Native American Healing. Santa Barbara, Calif.: ABC-CLIO, 1996. Print.

McAuliffe, Garrett, et al., eds. Culturally Alert Counseling: A Comprehensive Introduction. 2nd ed. Thousand Oaks: Sage, 2013. Print.

Ogbu, John. Minority Education and Caste: The American System in Cross-Cultural Perspective. New York: Academic, 1978. Print.

Panchal, Nirmita, Heather Saunders, and Nambi Ndugga. "Five Key Findings on Mental Health and Substance Use Disorders by Race/Ethnicity." Kaiser Family Foundation, 22 Sept. 2022, www.kff.org/racial-equity-and-health-policy/issue-brief/five-key-findings-on-mental-health-and-substance-use-disorders-by-race-ethnicity/ Accessed 10 Feb. 2023.

Suzuki, Lisa A., and Joseph G. Ponterotto. Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications. 3rd ed. San Francisco: Jossey, 2008. Print.