Mental Health Services For Indigenous Families: Access and Challenges
- For those experiencing suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline at 988
- For those experiencing abuse, please contact the Domestic Violence Hotline at 1-800-799-SAFE (7233)
- For those experiencing substance use, please contact SAMHSA National Helpline at 1-800-662-4357
Mental health services for Indigenous families usually aim to provide culturally appropriate care for mental health challenges. Findings from the National Alliance on Mental Health (NAMI) indicate that Indigenous communities often continue to experience barriers to access, availability, and overall quality of care in mental health services. Moreover, some behavioral health programs don’t provide treatments that incorporate cultural, spiritual, and traditional dimensions relevant to Indigenous communities.
Access to mental health care can vary widely depending on an individual's location and circumstances, as well as other factors. For example, while most clinics and hospitals associated with the Indian Health Service (IHS) tend to be located on reservations, many people live outside these areas. Accessible resources like online therapy platforms may be one way to bridge this gap.
Social issues and mental health
Historically, Native people have experienced multi-generational trauma, often resulting from discrimination, poverty, forced assimilation, lack of opportunity and access, and other factors affecting mental health and emotional well-being.
The need for mental health services for Indigenous families
Barriers to mental health care and treatment for Indigenous peoples
According to a comprehensive study on barriers and facilitators to care, Indigenous communities may be less likely to receive professional mental health treatment. Some main themes that have been identified in relation to these findings include the following:
- Indigenous people tend to be more likely to rely on informal networks of support, such as friends and family.
- Access to mental health services and resources in rural, isolated communities may be scarce. Many people also face long waitlists when services are available.
- Living in an urban setting may be linked to increased access to mental health services.
- Perceived stigma around mental illness may prevent people from seeking help. For example, those whose peers did not know about their concerns may be more likely to seek help.
- Skepticism about the effectiveness of mental health services can be common.
- Reluctance to use formal mental health services may be tied to "a history of damaging institutional experiences."
- Younger people may be comfortable using mental health apps, which may be considered less intimidating and more accessible.
- Distrust of non-Indigenous counselors and concerns that they lack cultural competence can influence whether a person seeks treatment.
- Many people lack awareness of the signs of mental illness.
The above factors were identified as being contextually linked to broader societal, systemic, and structural concerns affecting Indigenous populations. Such concerns typically involve historical and intergenerational trauma, discrimination, and geographic isolation.
Potential problems with traditional approaches to treatment
Another relevant factor involving treatment for mental health challenges may involve the conceptualization of mental illness. For example, Native and Indigenous people may associate various meanings and interpretations with the concepts of mental illness and well-being that differ from mainstream diagnostic criteria.
Expression of emotional distress is inconsistent with mental health standard diagnostic categories
As noted in findings published by Mental Health America, "physical complaints and psychological concerns are not distinguished, and Native/Indigenous people may express emotional distress in ways that are not consistent with standard diagnostic categories."
Indigenous peoples do not seek mental health care services from a licensed therapist
Those who meet the formal diagnostic criteria for depression, anxiety, and substance use disorder may be more likely to seek help from a spiritual or traditional healer than to work with a licensed mental health professional like a therapist.
Other barriers to access to mental health services for Indigenous families
Other barriers to access may include those listed below:
- Economic hardship
- Lack of awareness of mental health challenges, services, and resources
- Lack of availability of culturally competent mental health providers who are sensitive to concerns affecting Indigenous and Native communities
Most Indigenous families and children do not reside in areas with mental health services
In addition, those who live in rural and isolated areas may not have access to appropriate mental health services, as most clinics and hospitals within the Indian Health Service system are located on reservations. However, most Indigenous and Native people do not reside in these tribal areas.
Mental health services for Indigenous children and families
Available government services include the Indian Health Service (IHS), the Indian Country Child Trauma Center (ICCTC), and the Centers for Medicare & Medicaid Services (CMS) Division of Tribal Affairs.
- The Indian Health Service (IHS) generally provides services for American Indians and Alaska Natives belonging to the 574 federally recognized tribes.
- The Indian Country Child Trauma Center (ICCTC) is a SAMHSA-funded program that provides training, technical assistance, and resources on trauma-informed care. Its Oklahoma City-based center offers treatment to children who have experienced trauma and sexual abuse.
- The Centers for Medicare & Medicaid Services (CMS) Division of Tribal Affairs typically works with American Indian and Alaska Native communities to offer access to eligible CMS beneficiaries in Indian Country.
Mental health resources
Below are several additional mental health resources.
- The One Sky Center: This resource center’s mission statement is geared toward the prevention and treatment of mental health and substance misuse. It generally provides consultation, training, and technical assistance to American Indian and Alaska Native programs and also has a "find a therapist" locator.
- WeRNative: As a health resource made for and by Native Youth, WeRNative usually aims to promote a holistic approach to health, including topics like history, identity, the environment, physical health, community service, and resilience. Its mental health challenges sections include topics like depression, stress, anxiety, substance misuse, grief, and anger.
- StrongHearts Native Helpline: This is a 24/7 dating violence helpline offering personal, anonymous support and advocacy related to domestic and sexual violence. Its helpline is available by phone and online. This resource also features articles on finding a shelter, the connection between colonization and domestic violence, elder violence, red flags for romance, and other topics related to emotional and physical abuse. StrongHearts is located in the Greater Minneapolis area, on the ancestral lands of the Sioux Santee and Wahpekute peoples.
- Circles of Care: Provided by SAMHSA's Center for Mental Health Services (CMHS), Circles of Care offers a discretionary grant to American Indian and Alaska Native tribes, tribal organizations, urban Indian programs, and Tribal colleges. It's primarily aimed at infrastructure development and the prevention of substance misuse, as well as efforts to improve mental health and wellness services employing culturally relevant approaches.
Another approach to therapy
Therapy with a culturally competent therapist who respects you and your worldview may foster improved mental health and well-being. If you live in an area where access to mental health services is limited, you may want to consider online therapy, an option that enables you to attend sessions from the location of your choice via phone, video, or online chat.
Web-based therapeutic interventions
A 2020 scoping review involving 31 studies on the use of web-based therapeutic interventions (WBTI) among Indigenous populations suggested that "culturally appropriate, evidence-based WBTI have the potential to improve health, overcome treatment barriers and reduce inequalities for Indigenous communities."
Takeaway
Why is it important to have mental health services?
Many people are experiencing mental health conditions worldwide. Hence, the importance of accessible mental health services that provide quality treatment for people with mental health challenges. Mental health services help people manage their symptoms, conquer mental health challenges, and enjoy more productive lives.
What are the Indigenous ways of dealing with mental health?
There are many Indigenous communities worldwide, each with their own unique practices for supporting mental health concerns. Even within the US, different Indigenous communities may not have the same ways of addressing mental health and social issues. When looking at how a community might promote mental health among its members, research the specific tribe or group you’re curious to know more about. You can also ask a tribal member respectfully about their practices.
Many Indigenous groups treat mental wellness as the result of community care for one another, especially in close knit tribal groups. When one member is struggling, all members may support them. However, Indigenous people in the US also use Western medicine and healthcare services to treat mental health issues.
What is the highest common mental disorder for Indigenous groups?
Post-traumatic stress disorder (PTSD) and substance use disorders are the most common mental illnesses in Native American people. These individuals are at a higher risk of historical trauma, which has been associated with a higher frequency of psychiatric disorders. In the US, Indigenous youth are often at a higher risk of suicide. To promote mental wellness, communities may look at ways to reduce the stigma of seeking help and to incorporate higher-quality mental healthcare and mental health promotion into daily life.
Why do Native Americans struggle with mental health?
Native Americans may be more likely to struggle with mental health because they are more likely to experience traumatic events, poverty, a lack of resources, geographical isolation, and other factors that are known risks for mental illness. Traumatic experiences from the past may also have impacted future generations, as parents and grandparents may have developed trauma disorders and other mental health concerns and, without sufficient treatment options, passed on many behavioral habits and challenges to their children. In close-knit communities that are often geographically isolated, these patterns can infiltrate an entire community.
What type of therapy is most in demand?
Cognitive-behavioral therapy (CBT) is one of the highest-demand types of therapy due to its popularity and effectiveness. However, many types of therapy are in demand, including trauma therapy and more specialized formats that might not be offered in large quantities in many cities, especially areas where there are less treatment providers.
What are four barriers that may prevent people from receiving help?
Four barriers to receiving mental health treatment include cost, availability in one’s area, mental health stigma, and time. Online therapy may be a solution to some of these barriers, allowing people to get care even if they live in an area where there are not many low-cost options available to them.
How do Indigenous people cope with mental health?
Indigenous people cope with mental health in many ways, just as non-Indigenous people do. Coping methods can vary by region, tribe, or community, and not everyone within a certain group copes in the same way. However, many groups appreciate connection with family, nature, and community as ways to get through challenging moments.
What are the traumas of Indigenous people?
The traumas experienced by Indigenous communities also depend on the region, tribe, and community. However, within the US, many Indigenous families were subject to having their children taken from them and put in Christian boarding schools, which led to the erasure of Indigenous languages, culture, and family for many years. These traumas led to generational traumas that continue to impact families in the US to this day. Many other traumatic occurrences have been witnessed and recorded since the colonization of the US. Being aware of these traumas and the abuse that Indigenous communities have faced can be a way of reducing stigmas surrounding the current mental health struggles Native Americans may be living with.
How does community service help mental health?
Community service helps mental health by showing you the value of improving the life of another person, even if it’s just one. Like volunteering, this form of support shows gratitude to your community and a desire to help, even if it doesn’t give you money or services in return. In addition, it can strengthen your connection to the greater community of humanity, reminding you that all people are human and all humans deserve compassion and basic needs.
How can Indigenous people heal from trauma?
Trauma therapy may be a helpful option for people who have gone through trauma, especially on a widespread scale. Trauma therapy with an Indigenous person or person of color might feel safer, and you might also consider working with someone who has unique experience treating people who have generational trauma. Basic talk therapy may not be as helpful, as trauma often impacts the body in unique ways.
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