The Register Report, Fall 2006: Competencies Culturally Relevant Competencies When Treating American Indians/Alaska Natives by: Lateffa Carter King, MSW Return to Table of Contents

In order to use culture as a positive force in change and empower individuals to be resilient to the stressors in their environment, mental health services must be accessible, appropriate, and culturally-relevant. To deliver such services to any particular group, clinicians must understand the complex relationships between that group’s contextual history, culture, and current mental health issues. Specifically, the history of any underserved cultural group can provide clinicians with a framework within which to fairly and accurately assess, diagnose, and treat members of that group. Effective services can only be provided given that the clinician 1) possesses necessary cultural competencies, 2) utilizes culturally-sensitive psychotherapy strategies relevant for that group, and 3) employs indigenous systems to compliment traditional service provision.

This paper explores how mental health service providers can develop these proficiencies to meet the mental health needs of American Indians/Alaska Natives.

Contextual History and Cultural Background

The United States (US) Census Bureau estimates that 4.1 million American Indians and Alaska Natives lived in the US in 2000, representing less than 1.5 percent of the total US population. This population is a heterogeneous grouping of more than 500 federally recognized tribes and includes people identifying themselves as Hispanic and/or multiracial members of this group. Those identifying solely as American Indian or Alaska Native comprise less than 1 percent of the US population. Most American Indians live in western states, including California, Arizona, New Mexico, South Dakota, Alaska, and Montana, with 42 percent of this population residing in rural areas, compared to 23 percent of whites. For the purposes of this paper, the following terms will refer to this population: American Indian, Native people, and indigenous people.

The number of American Indians living on reservations and trust lands (areas with boundaries established by treaty, statute, and executive or court order) has decreased tremendously in the past few decades. For example, most American Indians lived on reservations or trust lands in 1980; while today, only 1 in 5 American Indians live in these areas. Furthermore, more than half live in urban, suburban, or rural nonreservation areas. It is the social and political history of Native people and their relationship to the US government that define their distinctive place in American life (U.S. Department of Health and Human Services, 2001).

American Indians and Alaska Natives flourished in North America for thousands of years before Europeans colonized the continent. Early European contact in the 17th century exposed Native people to infectious diseases which caused the population to plummet. As Europeans moved westward through the 19th century, the battles for Indian lands reduced the population to 5% of its original size by the early 1900s. In the 20th century, American Indians experienced both progress and hindrances: in 1924, Congress granted U.S. citizenship to American Indians; however, over the following 20 years, Federal services were withdrawn and Federal trust protection was removed from tribal lands.

One policy which proved damaging to Native communities was the mandatory boarding schools for American Indian children to obtain formal education. American Indian parents were forced to send their children to these schools, in which they experienced disconnection and devaluation of their culture, as well as physical and sexual abuse. Another dehumanizing policy from this period was the attempt to extinguish Native spiritual practices. Participation in traditional spiritual ceremonies was prohibited until the American Indian Religious Freedom Act was passed in 1978. Despite these prohibitions and the Christianization movements, indigenous spiritual practices have survived and are widely embraced even in areas where Christianity is practiced by Native people (Todd-Bazemore, 1999, as cited in DHHS, 2001).

The tremendous loss of lives, resources and forced movement to reservations and other Federal policies have had long-term economic and social effects. Brave Heart and DeBruyn (1998) suggest that social problems within the community are primarily the product of a legacy of chronic trauma and unresolved grief across generations. This phenomenon, which the authors labeled, historical unresolved grief, contributes to social pathology, originating from the loss of lives, land, and vital aspects of Native culture as a result of the European conquest of the Americas. Furthermore, these researchers argue that without a commitment to healing the past, American Indian/Alaska Native communities will not be able to address the resulting trauma, prevent the continuation of such carnage in the present, nor provide positive and healthy community activism to stop the prevalence of pathologies such as suicide, alcoholism, and domestic violence (Brave Heart & DeBruyn, 1998).

American Indians/Alaska Natives are the most impoverished of current minority groups, with over one quarter living in poverty, compared to 8 percent of whites. Furthermore, while comprising less than 2% of the US population, it is estimated that American Indians/Alaskan Natives comprise 8% of the homeless. In 1997, an estimated 1 out of every 25 American Indian/Alaskan Native adults were housed in the criminal justice system. Many American Indians and Alaska Natives are unemployed or hold low-paying jobs. In 1988, both men and women were twice as likely as whites to be unemployed (DHHS, 2001).

In 1990, 66 percent of American Indians and Alaska Natives 25 years old and older had graduated from high school or achieved a higher level of education. Despite these advances, the figure is well below that for the US population (75 percent). They were not as likely as others in the US to have completed a bachelor’s degree or higher. They appear to achieve equally with non-Indian students in elementary school, but decline in performance between fourth and seventh grades (Barlow & Walkup, 1998, as cited in DHHS, 2001).

Mental Health of American Indians/Alaskan Natives

The Indian Health Service (IHS) was established in 1955 as a Federal agency with primary responsibility for delivering health and mental health services to American Indians/Alaska Natives. The IHS clinics and hospitals are located on reservations, yet the majority of American Indians no longer live on them. Today, the HIS remains primarily responsible for the mental health care of American Indians and Alaska Natives. Until 1965, mental health service delivery was sporadic. Congress has enacted and amended legislation to authorize comprehensive mental health services for tribes several times, but consistently failed to appropriate the necessary funds for this legislation (Nelson & Manson, 2000, as cited in DHHS, 2001).

The academic achievement gap is paralleled by a similar trend in mental health status among children and adolescents. One indicator of psychological well being is the suicide rate, which is 50 percent higher than the national rate (DHHS, 2001). A survey from the National School-Based Youth Risk Survey in 1997 indicated that American Indian and Alaska Native youths engaged in more risky behaviors overall than white and black youth (Young et al., 2001). The suicide rate is particularly high among young Native American males ages 15 to 24. This age group accounts for 64% of all suicides committed in the American Indian and Alaska Native population. The rate in this group is 2 to 3 times higher than the national rate (May, 1990; Kettle & Bixler, 1991; and Mock et al., 1996, as cited in Gary, Baker, & Grandbois, 2005). In a survey of American Indian adolescents, researchers found that 22% of females and 12% of males reported having attempted suicide at some time in their lives; while 67% of those who had made an attempt had done so within the previous year (Blum et al., 1992, as cited in Gary, Baker, & Grandbois, 2005). continued

 

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