Understanding and supporting the mental health needs of American Indian and Alaska Native (AI/AN) people

AI/AN communities and mental health

 

American Indian and Alaska Native (AI/AN) refers to all the people who lived in the U.S. prior to European colonization. According to the 2021 U.S. Census Bureau, 2.9% of the U.S. population – 9.7 million people – identify as AI/AN, with a rich history, culture and customs that predate colonization.¹ 

But while AI/AN people have their own distinct cultural history, they have the same need for mental health care as anyone else. 

AI/AN individuals frequently experience barriers when seeking access to mental health care, preventing them from getting the services they need. Roadblocks that prevent many people from receiving the help include chronic underfunding for services, living in rural or frontier communities, implicit bias within government systems, lack of available and accessible information regarding mental health resources, language barriers, and poverty.²

 

Reducing disparities in care access

 

When working to establish relationships with AI/AN individuals, health care providers can start by learning about and respecting native traditions and history. 

Many AI/AN traditional belief systems focus on connectedness with the past and present, strong family bonds, and oneness with nature. Furthermore, AI/AN people are more likely to seek help for mental health conditions and substance use disorders from a provider who demonstrates cultural humility, or from spiritual and traditional healers.³

“We are committed to listening to and learning from AI/AN people so that we benefit from their lived experience,” explains Merrill Friedman, RVP, Inclusive Policy and Advocacy, Elevance Health. “This approach allows their expertise and cultural values to guide their journey to health and wellbeing.” 

AI/AN individuals living on reservations, particularly elders, typically find traditional healing more accessible. Traditional healing, also known as indigenous ways of knowing, includes oral narratives, symbolic methods of communicating, planting and harvesting techniques, hunting and gathering skills, specialized ways of understanding the greater ecosystem, and the manufacturing of specialized tools and technologies.⁴ 

 

Building trust through listening and learning

 

When providers take the time to recognize AI/AN culture, they take an important first step in building trust. “We need to better understand AI/AN peoples’ experiences and how these experiences shape the way AI/AN individuals seek mental health care,” observes Friedman. 

While some AI/AN peoples do live in rural and frontier areas, the majority actually live in urban areas. Providers respecting AI/AN traditions and preferences, regardless of geography, is critical to improving individuals’ health outcomes. 

AI/AN youth serve many roles in their families and communities, not unlike many other young people. But AI/AN youth also experience mental health concerns at a higher rate than their peers. They are the fastest growing segment of the AI/AN community and often live within multiple cultures. They balance their traditional family structure with the broader integrated youth world, including school, pop culture, and social media.

 

How providers can be successful serving AI/AN individuals’ mental health needs

 

The more providers can do to include AI/AN people and their lived experience in a whole health approach, the better equipped providers will be to advance health equity for AI/AN people experiencing mental health and substance use disorders. Provider training is a key component. “One of our next steps is to offer training that helps clinicians learn more about AI/AN culture and individuals’ experiences,” says Friedman.

“We need to offer services that embrace AI/AN culture,” she adds. “Consistently being present and spending more time engaging with AI/AN communities, in their communities, should be a hallmark of our approach.” 

Providers working collaboratively with the AI/AN community on treatment solutions will ultimately provide the best results. “We are grateful to our tribal liaisons who contribute their teachings to our associate education, program development, and service delivery, which advances our whole health approach to serving AI/AN people,” says Friedman.