American Indian and Alaska Native Mental Health: Diverse Perspectives on Enduring Disparities

Abstract

As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal communities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear disparities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consideration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research published during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms.

Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: Combining an evidence based treatment with cultural, traditional, and spiritual beliefs

“…Adding to the difficulty, EBTs have often lacked the ability to incorporate traditional AI/AN beliefs that are critical and central in working with this population, yet maintain fidelity to the EBT manual. In a review of mental health treatment efficacy with AI/AN up to 2012, Gone and Trimble (2012) report that "although a large subset of publications on AI/AN mental health is devoted to psychosocial interventions with these populations, these are almost exclusively review, reflection, and advocacy pieces rather than systematic empirical investigations of therapeutic processes and practices with AI/AN participants. "…”

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…Some of these factors, including sex, race, ethnicity, and sexual orientation, have been found to be associated with disparities in medical care and health outcomes (Gone and Trimble 2012;HallLipsy and Chisholm-Burns 2010;Lagomasino et al 2005;Primm 2006;Smedley et al 2003;Thomas et al 2011;Vega et al 2009).…”

Addressing the Spiritual Needs of American Indians: Predictors of Satisfaction

“…In some cases, health care personnel may even pathologize Native spirituality (Cross, 2002). Indeed, lack of sensitivity to AI spirituality has been posited as a factor that may inhibit help-seeking among AI clients (Venner et al, 2012), which is an important concern given the health disparities with which Native Americans wrestle (Gone & Trimble, 2012). This line of reasoning underscores the critical nature of research designed to identify predictors of satisfaction in this area.…”

“…Indeed, a paucity of research has employed AI samples with the goal of improving services to this population (Gone & Trimble, 2012;Weaver, 2005). Some recent research has sought to develop culturally valid spiritual assessment tools (Hodge & Limb, 2011).…”