BIPOC Mental Health Month – Beyond The Numbers: American Indians/Alaskan Natives

There are 3.7 million individuals in the U.S. who solely identify as American Indian/Alaska Natives, with an additional 5.9 million identifying as a combination of American Indian/ Alaska Native and another race. It is estimated that at least 18.7% of American Indian/Alaska Natives have experienced a mental health condition within the past year.

Historical Context | Barriers to Well-Being | Cultural Beliefs | Strengths & Resiliency Factors | Resources

Historical Context

In the United States, Indigenous peoples are commonly referred to as American Indians, Native Americans, Native Hawaiians, and Alaska Natives, though many prefer to identify with their tribal nation or community. Before the European colonization of North America, and subsequent genocide of the vast majority of American Indian populations, Indigenous peoples inhabited these lands for tens of thousands of years and cultivated immense knowledge of medicine, wellness, and agriculture. Historically, American Indian/Alaska Natives have made massive contributions to modern U.S. culture, with the Iroquois League of Nations influencing the current form of democratic government, and the Plains Indian tribes’ use of Hand Talk, the origin of present-day American Sign Language. Furthermore, there have been various contributions from traditional Native American values, such as respect for the Earth, fellow humans, and elders, as well as values of generosity and bravery.

While native tribes and lands that exist within the U.S. are federally recognized sovereign nations, they have been deeply impacted by European settlement and U.S. policies that dehumanize and remove the established needs of these communities. This began with violent land takeover and genocide, robbing Indigenous communities of natural resources, territories, lives, language, traditions, and ancestral knowledge. Communities were forced onto reservations – often overpopulated and less monetarily valuable land with little access to basic resources such as clean drinking water and indoor plumbing.

The U.S. government has historically failed to follow through on many treaty promises and has underfunded programs for American Indian/Alaska Natives, leading to severe poverty on many reservations. There were attempts to wipe out Indigenous cultures through forced assimilation and discriminatory policies, including the removal of children from their homes and placing them in boarding schools or foster care, most of which banned any expression of their native culture and stripped children as young as 4 of their names, language, and cultural norms. These boarding schools have been found to be sites of mass graves that hold the bodies of American Indian/Alaska Native children who died from neglect, abuse, and illness. Today, the vast majority of American Indian/Alaska Natives are closely related to someone who was targeted or impacted by these policies as recent as the late 1970s.

American Indian/Alaska Native communities still face inequities, including a high rate of missing and murdered Indigenous women, significant loss from the COVID-19 pandemic, and inaccessible resources. These groups face unique mental health challenges rooted in this historical trauma and the continued oppression of their communities.

Barriers to Well-Being

Access to mental health care, among other health resources, is one of the largest barriers to well-being for American Indian/Alaska Native individuals. Due to high levels of poverty among Indigenous populations, many Native people in America face financial challenges that prevent them from receiving services. Enormous amounts of Indigenous individuals compared to white Americans don’t have health insurance, and nearly half of Indigenous people in America rely on Medicaid or public coverage. Physical access to care is severely limited by the rural locations of many Indigenous communities, and while most clinics and hospitals of the Indian Health Service are located on reservations, the majority of Native people in America live outside of tribal areas.

One of the most significant issues with access to care in American Indian/Alaska Native communities is access to culturally responsive care. Indigenous experiences in America are informed by historical context that many providers are undereducated about. There is evidence that Indigenous people have fundamentally different understandings of human psychology and mental health than that within the Westernized Medical Model of Illness. American Indian/ Alaska Native cultures have traditional psychological frameworks and healing methods, often based in spiritual beliefs and involving cultural practices, that are discounted by the Western medical system. Even when Westernized care is accessed, it isn’t always valuable to the individual and how they view the world.

Cultural Beliefs

It is important to recognize that Indigenous communities cannot be entirely generalized into one culture, as there are 574 federally recognized American Indian/Alaska Native tribes and nations. The concept of mental health challenges, how and why they develop, and treatment options have many different meanings and interpretations among various native communities, but specific cultural beliefs are under researched and not widely known among those outside of these tribes. Generally, many American Indian/Alaska Native communities value a shared identity formed by not only their relationship to their community, but also to their land, current relatives, and ancestors. Thus, loss of land and stewardship over one’s traditional natural resources and animals can be experienced as a significant loss of self and community. In some communities, this is even directly correlated with suicide. In many Indigenous cultures, physical and psychological symptoms are not distinguished, which can impact the way Native people process and express their emotional distress. In many cases, this is not consistent with standard diagnostic categories used in the American healthcare system and may lead to underreporting of mental health concerns.

Indigenous individuals who meet diagnostic criteria for many mental health conditions are much more likely to seek help from a spiritual and/or traditional healer than from Western medical sources. This avoidance of Westernized health care has a few factors – there is a lack of programs and providers that understand and are responsive to Indigenous culture, as well as minimal awareness and access among the Indigenous community of mental health conditions and available support. Historical and cultural trauma also contributes to the mistrust many Indigenous people have of Westernized medical services typically used in the U.S.

Strengths & Resiliency Factors

Many Indigenous cultures embrace a worldview that naturally encompasses protective factors that support mental health: connectedness with the past and with others, strong family bonds, adaptability, oneness with nature, wisdom of elders, meaningful traditions, and strength of spirit are all values that promote well-being.

Deep connection with culture and the past is present in many Indigenous communities. Traditional sources of healing may include use of rituals, ceremonies, dance, music, storytelling, and natural medicines. Studies have found involvement in traditional activities, identification with American Indian culture, and involvement and importance of traditional spirituality to be the most influential protective factor in fostering resilience among American Indian & Alaskan Native adolescents.

Family and community bonds within Indigenous cultures tend to be strong. Large family units expand and strengthen the support network that many individuals function within. Additionally, positive relationships with non-familial adults can be a key factor in maintaining well-being for youth, and youth (and adults) in Indigenous communities can seek wisdom and guidance from tribe leaders and community elders.