Nearly 1 in 5 U.S. adults live with a mental illness. Behavioral health issues are ultimately as common as many other health conditions – but the stigma around mental illness, and the paucity of related resources, suggest otherwise. Many insurance payers limit mental health service reimbursement. There’s also a shortage of behavioral health providers, especially severe in rural areas; where cities have 33 psychologists for 100,000 people, rural areas only have 9. These barriers further intensify the idea that mental illness is rare, shameful, or too difficult to treat.
The CDC has confirmed a rise in fatal overdoses since the start of the COVID-19 pandemic, along with increasing levels of anxiety, depression, and trauma. But this rise in mental health and substance abuse issues impacts some communities more than others – and one of the most affected are Native American communities.
Indigenous Crisis: The High Cost of Disconnection
Underserved tribal areas are experiencing an unprecedented behavioral health crisis for several reasons. Poverty, chronic healthcare underfunding, and historical trauma all play a role in increasing the risk for substance abuse, addiction, mental illness, trauma-related disorders, and dual diagnosis/co-occurring disorders.
- Serious Mental Illness (SMI) is highest amongst biracial adults (9.3%), followed by Native American adults at 6.7%.
- 13% of Native Americans aged 18-25 have an alcohol use disorder.
- Native Americans have one of the highest rates of deaths from alcohol poisoning and fetal alcohol spectrum disorders in the U.S.
- Alcoholic liver disease is a major leading cause of death for Native Americans.
- Native American illicit drug use is higher than any other group – from heroin to opioids.
- The suicide rate for American Indians has risen 139% since 1999.
- American Indians experience PTSD more than twice as often as the general population.
It’s clear that Indigenous communities are saddled with intense behavioral health challenges – and unfortunately, they suffer unique barriers when it comes to seeking help.
4 Treatment Barriers in Mental Health
- Lack of culturally informed care. Trust is critical in developing an effective patient-provider rapport, particularly in counseling. But many Native Americans find their behavioral health providers don’t understand their cultural values or environmental challenges. Many also experience discrimination or racism, which can dissuade them from continuing treatment.
- Stigma and lack of privacy. Anonymity is tough to pull off in small or tribal communities, making it difficult for patients to hide mental illness treatment from their friends, families, and colleagues. There may be only one psychologist or one substance abuse specialist in town – or none at all, given the severe shortage of behavioral health providers in rural areas. Patients may languish on a waitlist to find the right provider or an open bed in a detox center.
- Lack of follow-up care and support. Release from a locked ward, rehabilitation clinic or day program is merely a stepping stone in a patient’s journey, not the end of it. Ideally, the next step should be a positive transition into recovery meetings, outpatient therapy, medication management, or resources to help them reintegrate into society. When patients return to their original environment and lifestyle without that ongoing assistance, their progress can suffer.
- Lack of clinical pathways. Mentally ill people often encounter police before they see a clinician; 60% of patients with a behavioral, mood or substance abuse disorder turn to a primary care provider for help instead of reaching out to a specialist. Still others avoid any medical care until a crisis brings them to an emergency department. To ensure these patients receive the right treatment at the right time, all of these pathways must connect to behavioral healthcare providers.
Connecting Behavioral Health and Indigenous Culture
There’s no single answer to the behavioral health crisis in Indigenous communities. Providers sensitive to tribal identity and historical trauma are a necessity; so are the integration of primary, emergency, and behavioral care, and the provision of wraparound services and support. Telemedicine can help solve rural health challenges, while back-to-work and reintegration programs are critical for connecting patients to healthier futures.
But what’s especially effective is this: helping Native American patients receive treatment in their own culture, with care inclusive of their beliefs, values, and therapies. For this reason, Tribal EM is launching behavioral health clinics and programs connected to tribal facilities. As always, our physicians and nurses will fuse culturally informed care with their expertise in substance abuse, mental illness, and behavioral health disorders, while our clinical leaders design efficient healthcare ecosystems. We’ll also continue to hire from within the community, creating employment and economic development opportunities for every tribal area we work with.
Native American communities are undergoing a renaissance in many areas, from economic to education to healthcare. There’s every reason to believe the behavioral health world can radically transform substance abuse rates and mental health outcomes in tribal areas. By pairing clinical expertise with culturally-connected care, we can create a new kind of healthcare environment for Indigenous people – and drive long-lasting change.