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Culturally Appropriate Mental Health Care to Address American Indian/Alaska Native (AI/AN) Mental Health Disparities

posted Aug 3, 2018, 1:03 PM by daniel yoo   [ updated Aug 3, 2018, 4:27 PM ]
Posted by Sean A. Bear, BA, CADC, Co-Director, National American Indian and Alaska Native Addiction Technology Transfer Center, University of Iowa, and AI/AN Caucus Member 

Non-Hispanic American Indian and Native American (AI/AN) adults and children are at greater risk than all other racial groups of experiencing poor mental health outcomes and unmet medical and mental healthcare needs. For instance, suicide rates for AI/AN adults and youth are higher than the national average

For native people, cultural differences play a crucial role in this gap as well as in the misdiagnosis. An accurate assessment is not possible without intimate knowledge of another culture; such knowledge cannot always be learned in the present educational systems, many of which do not share the same historical accounts or knowledge tribal systems have been teaching for thousands of years. 

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) states that understanding a culture means comprehending and applying that culture’s beliefs, ceremonial rituals, and customs. With the Native American culture, this would not be possible without the actual time and tutelage of an American Indian or First Nations Healer and Spiritual Person, who would be most qualified to provide the appropriate expertise. In order for native-serving providers to meet the standards set forth in the DSM-5, they must learn from outside of the Western medical education system. 

Few mental health diagnostic tools, assessments, or treatments have been studied in AI/AN communities. For instance, few mental health treatment models apply spiritual phenomena—such as spirits, ghosts, or healing—but this is an area common within Native American tribes. 

Native Americans also experience historical trauma that produces negative impacts on mental health and wellbeing and that can be passed down through generations both socially and genetically. Native Americans can experience historical loss symptoms (e.g., depression, anxiety, substance use disorders) as a result of the cross-generational transmission of trauma from historical losses (e.g., loss of land and population). Historical trauma must be taken into account in mental health assessments of native clients and patients. When considering historical trauma, we should be reminded that the Native American Religious Freedom Act was passed only in 1978, meaning that native people in the United States have only legally been able to practice our ceremonial ways for the past 40 years. 

Discrimination also contributes to poor mental health outcomes and persists among AI/AN communities. One example is what goes on in many community stores: Native people regularly experience looks of distrust and are followed from aisle to aisle. People from other cultures treat them with disgust and contempt. This is done not only by non-natives but also by those within the tribal community who have become assimilated to the Euro-American philosophy that blood quantum and being enrolled in a tribe is a traditional practice. 

Looking at mental health disparities, we must remember to consider cultural differences between patients and providers, diagnostic tools, discrimination, and historical and continued trauma. Although some of these topics are not heard by many, they are important in the holistic care that is needed for tribal communities and members throughout the country. If we all seek true peace in and among all peoples, we must look into the possible future of mankind and the planet but also into the depths of ourselves, which is where our healing begins.
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