Mental Health Services For Indigenous Families: Access and Challenges

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.

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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. 

Barriers to mental health treatment

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. 

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." 

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

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

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

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. 

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."