Native American Mental Health: What You Need To Know

Historical Trauma and Mental Health

Historical trauma plays a role in the mental health concerns of Native American people. The most robust research shows that this population has higher rates of post-traumatic stress disorder (PTSD), addiction, and suicide than the general U.S. population.

These conditions are sometimes rooted in trauma and may also be linked to the fact that many Native American people live in impoverished, high-risk settings.

Historical trauma for Native Americans stems largely from:

• War
• Disease
• Genocide
• Forced removal from land
• Forced separation from families
• Forced integration to mainstream societal norms

The scars of massacres, incarcerations, and suppression are still with many Native people today. Historical trauma, driven by colonization, can result in intergenerational poverty. Native Americans have a poverty rate of 24.5%, the highest rate of any ethnic group in the U.S.

According to Joseph P. Gone, PhD, professor of anthropology and of global health and social medicine at Harvard University, it is important to look at a Native American person’s mental health through the lens of past colonization and dispossession. When we do so, we can consider how historical injustices result in adverse mental health outcomes.

Such a view helps us factor in much more of the context of an individual’s illness, Gone maintains.

“What we’re saying is that they, along with a whole bunch of other people in their community, have been exposed to a long history of subjugation that put the whole community at risk,” Gone states.

Gone, who is a member of the Aaniiih-Gros Ventre Tribal Nation of Montana, explains, “We can think about [the source of these disorders] in terms of our [Indigenous] place in society and about the disadvantages and adversity we’ve faced. In some cases, people have barely survived genocide.”

The Effects of Violence

Violence is all-too-common within Native communities, often tied to the intergenerational poverty and historical trauma many Native American people experience.

According to SAMHSA, Native American women report higher rates of victimization than women of any other ethnic group in the U.S., with them being nearly twice as likely to be assaulted or raped as white or Black women. Nearly 80% of sexual assaults against Native American women are committed by non-Native men.

Native American people also experience higher rates of interpersonal violence—a 2014 study cites that one in 30 Native children experience child abuse compared to one in 58 in the general population. The same study cites that 46% of Native American women reported physical assault by an intimate partner in their lifetime, compared to 41% of Black women, 35% of Hispanic women, and 32% of white women.

Interpersonal violence within Native and Indigenous American communities can often be linked to the historical violence inflicted on them. The 2014 study above describes how the U.S. government created risk factors known to increase trauma, substance misuse, and cycles of violence.

For example, among other atrocities, the U.S. government forcibly sent Native children to boarding schools, separating these children from their parents and exposing them to abuse. That effort attempted to strip the Native American community of their sense of identity, spirituality, and community.

In addition, Native American people have a higher rate of substance use disorders, which is linked to higher rates of interpersonal violence. The use of alcohol and other substances is a common response to trauma.

Cultural Strengths for Native American Populations

In exploring Native American mental health, it is important to recognize and appreciate the cultural strengths that positively impact well-being.

Cultural factors that can strengthen Native American mental health include:

• Connection to land and nature
• Connection to the past
• Common threads among different tribes
• Strong family bonds
• Ties with elders
• Participation in cultural traditions, prayer, and ceremony

Understanding both protective and risk factors for mental health informs the approach to care in Native communities. When considering care, it’s important to first acknowledge challenges that lie in the way.

Challenges With Accessing Care

Native American people face a system that struggles to recognize and build on their strengths. It can be difficult to find treatment that best reflects their culture.

According to the American Psychiatric Association, many Native American people experience stigma around seeking mental health care. Individuals may fear being perceived as weak or may worry about bringing shame upon their families.

Nevertheless, studies have shown that Native American people are more likely than other Americans to seek help for their mental health challenges.

The Indian Health Service

The Indian Health Service (IHS) is the government agency responsible for caring for the needs of Native peoples. Studies have shown that the IHS is both underfunded and overwhelmed by the number of people who need treatment.

A 2011 article about the lasting disparities of Native American mental health describes a significant expansion of the IHS over the years. Such growth impacted the system’s service structure, treatment, and rehabilitative programs.

Although the IHS prioritizes the hiring of Native American providers, most clinicians who work for the system do not belong to this population. Because of educational inequalities, Native American mental health providers are underrepresented. This is especially the case for those who hold advanced degrees, such as psychiatrists and psychologists.

Evidence-Based Treatment

Evidence-based therapies (EBT) are treatments that have been researched extensively. When creating an EBT, researchers look at how beneficial the treatment is to people with specific mental health conditions. However, few EBT studies have included Native American people.

Because Native Americans have been excluded from research, we do not know how treatment would carry over to members of the population—nor do we know how cultural differences may factor into the effectiveness of these treatments.

Psychological Mindedness

Many therapeutic interventions are based on the expectation that patients have or will develop a deeper level of introspection and self-awareness, often referred to as psychological mindedness.

The traits of being psychologically minded include:

• Having a deep interior life
• Being introspective
• Spending a lot of time getting to know oneself
• Crafting and refining a personal story
• Being self-directed

Gone states that this way of focusing on oneself as a self-contained individual goes against the way many Native Americans view themselves and the world. “Indian people, especially those living in reservation communities, are not egocentric in the default way that [non-Native] individuals in the suburbs would be,” he says.

Gone describes Native American culture as more collectivist: a person’s identity and role are important in relation to their family and tribe, with responsibilities to nature and the surrounding environment being integral. Consequently, therapeutic interventions based on psychological mindedness may not always be the preferred approach for Native Americans.

Family Reputation and Status

According to Gone, Indian life is often organized by reputation in terms of status and access to resources. This is especially the case on the reservation. When someone goes to a clinic for mental health services, they may be concerned that their treatment could jeopardize their family status in some way.

Gone states that under such conditions, there is ambivalence about the risk of seeking help.

How Do We Create Culturally Competent Care?

Many mental health organizations try to adjust traditional evidence-based therapy to fit the needs of Indigenous Americans. EBTs are used in many areas of treatment, from addiction to suicide prevention. However, because these treatments are traditionally Western, they do not always resonate with Native people.

Gone points out that Native communities often have little interest in adopting EBTs. Instead, many individuals from these communities are more invested in traditional healing.

Once Tribal Nations gained responsibility for Native American health centers, one of the first innovations they made was including traditional spiritual practices in treatment.

For example, the sweat lodge is a traditional Native American ceremony practiced across several tribes that involves ritual and prayer.

The sweat lodge ceremony symbolizes rebirth. It began to have a comeback in the 1970s when several alcohol treatment centers in Oregon began using it as a treatment along with standard therapies. Today, it can be found in almost all Native American treatment centers.

Most Native-led mental health programs heavily prioritize tradition, prayer, ceremony, trust for elders, and traditional healing ways. While many Native American people seek and respond to standard psychotherapy, many others find solace in reconnecting to cultural practices.

For example, as a result of trauma, a person may be isolated from others. Perhaps they have the core belief that they are incapable of giving or receiving love. They may feel disconnected both from other people and from a higher power.

By participating in a sweat lodge ceremony, which involves rituals of purification as well as communal prayer and singing, they may find ways to move through their trauma, find community, and experience spiritual connection.