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Mental Health of Native Americans

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Cindy La

on 7 November 2012

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Transcript of Mental Health of Native Americans

of Native Americans Mental Health Background and Causes Treatment and Prevention Historical and Cultural Trauma Mental Health Risk Factors Tackling Mental Illness Life on the Reservation Rampant Poverty High Unemployment Issues and Concerns Trauma and Abuse No Intervention Colonialism and Racism End to Traditional Life Boarding Schools Substance Abuse Primary Concerns Services Available Receiving Treatment Changing the Future Suicide Almost twice the national average
2nd highest cause of death for ages 15-24
Minnesota Red Lake reservation tragedy: High school student killed 8 others, then himself  Violence Substance Abuse Stress-Related Highest delinquency & arrest rates
Violence includes domestic abuse, child abuse, suicide, murder
Murder is over twice the national average Alcoholism death rates are more than 7 times the national average
Linked with 60% of people who also had a depressive disorder Includes depressive and anxiety disorders
Post Traumatic Stress Disorder (PTSD)
61% of children reported having a traumatic experience
Intergenerational trauma Standard of Living Historical Trauma Culture Clash High rates of poverty
Twice as high as that of the general public
Contributes to problems of malnutrition, poor health care, short life expectancy, and limited education
Higher rates of general distress
Unemployment is 2.5 times the national average "Intergenerational trauma": Exposure of an earlier generation to a traumatic event that continues to affect subsequent generations
Forced onto reservations and forced to assimilate
Broken treatises
Pass on stories to younger generations, leading to young Native Americans becoming exposed to and re-traumatized by past troubles
Referred to as "aliens in their own "land" Acculturation vs. Enculturation
Acculturation occurs when unlike cultures come into contact with and influence each other
Has resulted in the loss of many traditional Native American beliefs and practices
Enculturation: Process of learning one's own culture
How Natives seek to regain their identity
Lack of available resources and facilities for health care Cultural Sensitivity Little cultural sensitivity in mental health care treatment programs
Leads to distrust among Native American patients
Leads to Native Americans taking less advantage of available services
When they do take advantage, they don't respond as well and are more likely to quit treatment early Different idioms of distress are present, some of which do not appear in the DSM
Ex. ghost sickness, heartbreak syndrome
Do not use depression/anxiety to describe disorder
Indigent stress coping model
Focuses on trauma as cause of mental illness
Seeks treatment through preserving and strengthening culture and identity Different Views Spirituality Connectedness of mind, body, and soul
Physical and emotional pain viewed similarly
Maslow's hierarchy of needs does not include the need for spirituality
Four categories of spiritual influence of mental health
Learned positive
Learned negative
Innate positive
Innate negative Approaches Collectivity vs. Individuality
Family and community before own well-being
Spatial Relationships vs. Chronological Events
Often don't follow appointment schedules or routines
Do not give chronological explanation relating to appearance of symptoms Lack of knowledge concerning the severity of issues at hand
Few large-scale research studies have focused on the mental health of Native Americans
Native Americans often do not seek care because they are unaware help is available or do not understand the treatment process
Not many effective treatment programs are available Unawareness Indian Health Service (IHS) Bureau of Indian Affairs Largest single provider of mental health services
Provides both inpatient and outpatient care to over 75 million urban and rural Native Americans
Services offered by paraprofessionals and social workers Community service division coordinates educational and social branches where psychological services are also available
Duties include creating programs for Native American youth and adults and providing child welfare and family services Urban Indian
Health Care Programs in which Native Americans have direct control of the management and provision of health services Many urban and reservation Native Americans served by city, county, or state mental health facilities
Points of entry: State hospitals, VA hospitals, day treatment centers, etc.
Referrals come from Native American centers and social service programs State/Local Mental Health Services University Counseling Centers A large number of Native Americans seek psychological services while attending college
Especially true if a Native American psychologist is available
Native American women at private universities more likely to use formal psychological services compared to counterparts at state universities Tribal-Based
Mental Health Care Use traditional healers over all other forms of clinical treatment, yet collaborations between traditional healers and psychologists have been seen to be successful Strengths of Treatment Mental health professionals who view native American mental health from the unique perspective of Native American culture
Take into account their collectivistic culture which has an emphasis on inner connectedness High turnover rate for professionals catering to Native Americans
Issue with support concerning mental health workers who have to deal with undesirable working conditions
Difficulties in delivering psychological services to Native Americans
Treat Native Americans with their own individualistic values
IHS fails to distinguish between initial visits and repeat visits in record keeping, obfuscating any estimates of American Indian mental health service utilization rates
Record keeping in service delivery agencies also uncoordinated, complicating assessment of
satisfaction with services or utilization Weaknesses
of Treatment Challenges in
Receiving Services Racism and discrimination were experienced in mental health services
Stigma and lack of awareness of what is culturally appropriate on the part of the mental health care providers
Historical trauma on the communities
Misdiagnoses of bipolar disorder, PTSD, and ADHD for children and youth in particular
Lack of appropriate mental health care Cultural Differences Historical distrust of the outside population
When compared to the general population, Native American individuals tend to under-utilize mental health services, have higher dropout rates, and are less likely to respond to treatment
Words like “depressed” and “anxious” absent from some of the Native languages
Some tribes use different expressions of illness such as ghost sickness or heartbreak syndrome
Few Native American psychologists Prevention Recommendations Mental Health Services Act (MHSA):
The main goal is “to create a culturally competent mental health care system that addresses prevention of mental illness, provides early intervention services for those in need, uses state-of-the-art treatment to promote recovery and wellness for persons with mental illness, and eliminates disparities in mental health care across socioeconomic and racial/ethnic groups” MHSA
Should be holistic and offered to the community as a whole
Must include Native American healing practices as well as Native American clinicians who would know the culture and the language
Education for health care providers on the meaning of ceremonies which have techniques of prevention embedded within them
Strengthen the cultural identity of the Native American community
Education
Improve upon the services that are already available
NAMI’s Multicultural Action Center works to focus attention on system reforms to ensure access to culturally efficient services and treatments Enhance suicide preventions programs
More efficient debriefing and post-trauma counseling in response to suicide should be addressed further
Make substance abuse treatment options accessible: inpatient rehab programs, outpatient treatment programs, and smoking cessation programs to name a few Jobs are primarily off the reservation
Easy to give up job seeking and turn to substances
Fewer full-time, year-round employees than any other high-poverty community
National unemployment rate of 15.2%
In Navajo Nation, unemployment rate almost 50%; on Blackfoot Reservation, unemployment 69%, compared to 25% for Great Depression High incarceration rates
28% (more than 1 in 4) live at the poverty level
Incomes less than half of general population
Poverty rates for all groups: White 9%, Asian 13%, Pacific Islander 18%, Hispanic/Latino 23%, Black 25%, Non-reservation Indians 26%, Reservation Indians 39% Relationship between poverty/substance abuse/violence
Native American women raped, abused, stalked, and murdered more than any other group in the country
Children likely to be physically/mentally/sexually abused
Overall, Native Americans experience per capita rates of violence more than twice those of general population
Youth experience and witness trauma at a young age From summer 2012 health care rally in California Services primarily available off of reservations
Differences in culture make it difficult to breach cultural divide to see warning signs
Stigma and lack of awareness creates barriers to seeking treatment and using services
Lack of funding
Absence of Native American providers who can adequately address cultural aspects of mental health issues White settlers took over Indian lands
American expansionism sustained by Manifest Destiny
Treatises broken when U.S. Army tried solving America’s “Indian problem”
U.S. Indian policy dictated that youth would be taught Christian ways and be sent to religious boarding schools
U.S. government enforced harmful policies against Native Americans and relocated them to reservations Aliens in their own land
Destroyed intricate native cultures
Disconnection with cultural values and tradition fragmented communities
Native American community seen as a family that is suffering, and role of culture is instrumental in healing and maintaining the well-being of individuals and the community as a whole Richard Pratt: “Kill the Indian in him, and save the man”
Loss of culture when children forced to go to white-run schools
Schools separated and undermined families, stunted emotional development, and damaged parenting skills
Poor conditions and harsh treatment at boarding schools
1928 Meriam Report
Forced removal of Native American children often cited as a lasting impact on mental health of communities Alcoholism and drug abuse are effects
Often the focus of blame for suicide rates
Symptoms, not the causes
Disconnection with culture and heritage cause substance abuse
Substance abuse too often treated outside of the context of historical trauma http://abcnews.go.com/2020/video/hidden-america-children-plains-robert-crumbling-trailer-dreams-2020-14742304 Cindy La, Kimberly Goldstein, Melina Oden
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