In Access to Care, Alcohol Use Disorder, Awareness Events, Cultural Competence, National Native American Heritage Month, Substance Use Disorder, Trauma, Treatment

Important Facts About Native American Heritage Month

Important Facts About Native American Heritage Month

Why is it important to observe National Native American Heritage Month (NNAHM) even if you are not Alaska Native or American Indian (IA/AN)? Looking at the data for this population can be a real eye-opener:

  • Health disparities are very pronounced among the IA/AN population. Those among the IA/AN populations rank among the lowest in the nation in health outcomes and social determinants of health, including cancer treatment, higher death rates, and higher rates of hospitalization (Payne et al., 2018). There are a variety of reasons for the disparities, including (but not limited to):
    • High poverty rates and poor mental health outcomes due to past and current discriminatory practices (Sarche and Spicer, 2009).
    • Forced assimilation (Whitbeck et al. 2004; Bolt 2009).
    • Historical trauma, described as “cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experience” which contributes to substance misuse and interpersonal violence (BraveHeart 2003).
    • Failure of agencies and organizations to provide self-determination and self-governance for managing and providing services in health and behavioral health due to lack of adequate funding of the agencies or mismanagement (US Government Accountability Office 2016).

IA/AN populations are also vastly under-represented in the research base, yet are often hesitant or refuse to participate in research studies because of past researcher misconduct (Hiratsuka et al., 2017).

  • Suicide rates in particular are the highest for IA/AN populations. According to the Centers for Disease Control (CDC), AI men in the U.S. have the highest suicide rate in the nation, at 34.8 suicides per 100,000, and suicides among the IA/AN population has increased faster than the U.S. population as a whole since 2000. Further, there are approximately 25 suicide attempts for every suicide and high rates of suicidal ideation (Leavitt et al., 2018). In Nevada, suicide is the 3rd leading cause of death for NA males (Facts About Suicide. (n.d.). Retrieved October 29, 2020).

What Helps Level the Playing Field for AI/AN Populations?

Some things that behavioral health providers and others can do to begin to help address disparities in treatment and services include:

  • Build resilience in behavioral health clients: “meaningful and consistent social connection, awareness about how one’s suicide would negatively effect loved ones, and knowledge and utilization of available health services were found to help built resilience to suicide risk among AI/AN people across a wide age range” (Shaw et al., 2019).
  • Assess your organization’s readiness to embrace culturally competent services: One study examined results of the Organizational Readiness to Change Assessment (ORCA) subscales for 27 Veteran’s Administration (VA) facilities in the Western U.S. to assess their “organizational readiness and capacity to adopt and implement native-specific services and to profile the availability of AI/AN veteran programs and interest in and resources for such programs” (NOE et al., 2014). The subscales for Program Needs, Leader’s Practices, and Communication predicted whether VA staff thought their facilities were meeting AI/AN veterans’ needs. The results provide some support for the hypothesis that implementation of organizational change models identified by earlier research might advance readiness and implementation of culturally specific programs and treatment.
  • Enhance Self-determination models when applying for funding for new research. One study investigated mental health care delivery disparities in AI/AN populations of 32 tribal health organizations in Alaska. The study looked at the funding application review processes within the tribal health system, University systems, and other institutions from three perspectives: public health, legal policy, and mental healthcare. Data on mental health funding to tribes were obtained from the Substance Abuse and Mental Health Services Administration. The resulting conclusions of the research included to increase mental health funding opportunities for federally-recognized tribes, model funding practices on principles of tribal self-determination, and support diverse interventions that are culturally-based and culturally-appropriate (Payne et al., 2018)

History of NNAHM

At the turn of the twentieth century there was a movement to recognize the contributions of the first American in establishing the U.S. American Indian Day was the brainchild of Dr. Arthur C. Parker, a Seneca Indian and director of the Museum of Arts and Science in Rochester, N.Y. The full story of how American Indian Day evolved to become what we now know as National Native American Heritage Month is available on the observance’s “About” page.

According to its website homepage, “The National American Indian and Alaska Native MHTTC works with organizations and treatment practitioners involved in the delivery of mental health services to American Indian and Alaska Native individuals, families, and tribal and urban Indian communities to strengthen their capacity to deliver effective evidence-based and experience-based practices. This includes the full continuum of services spanning mental illness, prevention, treatment, and recovery support.” Their mission is “to ensure that American Indians and Alaska Natives have ready access to high-quality, evidence-based and experience-based, culturally appropriate, and self-directed behavioral health services and recovery supports – provided through a collaborative and integrative network of care – that effectively improves health and well-being.”

One of the many resources provided is the Native Center for Behavioral Health YouTube channel, with playlists that include the MHTTC Webinar Series, Native Veteran Resilience and Wellness, and the Behavioral Health Webinar Series.

Resources from the National American Indian and Alaska Native Mental Health Technology Transfer (MHTTC) Center:

Mental Health in Our Native American Communities Vol 1 Issue 3 Spring 2020 – Suicide, Trauma, and Finding a Way to Heal

Mental Health Evidence-Based Practices for American Indian and Alaska Native Schools and Communities – an Environmental Scan Repository

Community-led life promotion plans for Indigenous youth and communities – Guide

Suicide Prevention: Assessing the Environment and Culture for Risk

Resources from the Suicide Prevention Resource Center:

Transforming Tribal Communities: Indigenous Perspectives on Suicide Prevention

Resources from the National American Indian & Alaska Native  Addiction Technology Transfer Center (ATTC):

Virtual Native Talking Circle: Staying Connected in Challenging Times

Look for additional resources on the CASAT OnDemand Resources & Downloads page.

Check out the Catalyst Blog for additional cultural competence blog posts for a variety of special populations!

Can you speak to your experience with AI/AN treatment and services? Please share your thoughts and resources in the comments below.

References

Facts About Suicide. (n.d.). Retrieved October 29, 2020, from https://nvsuicideprevention.org/facts-about-suicide/

Providing Culturally Competent Services for American Indian and Alaska Native Veterans to Reduce Health Care Disparities

Hiratsuka, V. Y., Beans, J. A., Robinson, R. F., Shaw, J. L., Sylvester, I., & Dillard, D. A. (2017). Self-Determination in Health Research: An Alaska Native Example of Tribal Ownership and Research Regulation. International journal of environmental research and public health, 14(11), 1324. https://doi.org/10.3390/ijerph14111324

Leavitt RA, Ertl A, Sheats K, Petrosky E, Ivey-Stephenson A, Fowler KA. Suicides Among American Indian/Alaska Natives — National Violent Death Reporting System, 18 States, 2003–2014. MMWR Morb Mortal Wkly Rep 2018;67:237–242. DOI: http://dx.doi.org/10.15585/mmwr.mm6708a1external icon

Noe, T. D., Kaufman, C. E., Kaufmann, L. J., Brooks, E., & Shore, J. H. (2014). Providing culturally competent services for American Indian and Alaska Native veterans to reduce health care disparities. American journal of public health, 104 Suppl 4(Suppl 4), S548–S554. https://doi.org/10.2105/AJPH.2014.302140

Payne, H. E., Steele, M., Bingham, J. L., & Sloan, C. D. (2018). Identifying and reducing disparities in mental health outcomes among american indians and alaskan natives using public health, mental healthcare and legal perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 5-14. doi:http://dx.doi.org.unr.idm.oclc.org/10.1007/s10488-016-0777-7

Substance Abuse and Mental Health Services Administration. Improving Cultural Competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

Shaw, J. L., Beans, J. A., Comtois, K. A., & Hiratsuka, V. Y. (2019). Lived Experiences of Suicide Risk and Resilience among Alaska Native and American Indian People. International Journal of Environmental Research and Public Health, 16(20), 3953. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph16203953

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