Native American Mental Health: What You Need To Know

Native Americans have faced many unique challenges over the years. It’s time we acknowledge their mental health struggles

March 1, 2024

Native American communities live in a unique cultural context—the heritage shared by members of these communities influences their mental health outcomes, as well as their access to treatment.

Native Americans face barriers to treatment due to availability, accessibility, and acceptability. We must consider treatment strategies that are helpful for this population—a group that represents a wealth of cultures, languages, and experiences.

Before we can address the needs of this population, it’s important to recognize differences that can exist between mainstream American perceptions of mental health and those held within Native American communities.

Keep Reading To Learn

  • What historical trauma is and how it impacts Native American people
  • Which conditions are most commonly experienced by Native American people
  • How traditional practices may help treat Native American mental health concerns

Before We Get Started…

Throughout this article, we refer to the Indigenous people of the U.S. as Native Americans. For more information about terminology, please refer to the content provided at the bottom of this article.

There is a lack of solid data on the population’s health concerns. Native Americans have had decreased involvement in health studies for several reasons:

  • It is difficult to pinpoint health factors among such a diverse population. The Native American population consists of 574 Federally recognized tribes, each with its own language, history, and customs.
  • The Native American population is small and dispersed. It comprises just 1 to 2% of the entire U.S. population—depending on how the population is counted—and is dispersed across over 300 reservations and 200 Alaska Native corporations. These are mainly located in rural parts of the country.
  • Determining the number of Native Americans in the U.S. can be difficult. This population is susceptible to ethnic fraud, the practice of people with very distant or imagined Indian ancestry identifying as Native Americans. Moreover, many immigrants from Latin America increasingly identify as Indigenous or Native, but without ties to recognized tribal communities in the U.S.
  • Because of the history of colonization and oppression of Native Americans in the U.S., many people of this population are hesitant to trust research and the government.

Indigenous Community Mental Health

Indigenous person in blanket sitting on side of a hill.

Dr. Joseph P. Gone explains the challenges of bringing evidence-based clinical practices to Indigenous communities.

Indigenous person in blanket sitting on side of a hill.

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.

The Impact of Domestic Abuse

Dandelion with seeds flying away

While the effects of intimate partner violence can be devastating, they are preventable. We can all play a part to ensure that relationships are healthy, respectful, and nonviolent for everyone.

Dandelion with seeds flying away

Substance Misuse

Substance addiction is a serious issue that can be found around the world, affecting people regardless of nationality, ethnicity, gender, religious affiliation, and sexual orientation.

While research shows that Native American populations experience higher rates of substance use disorders than the general U.S. population, the rates vary widely between the diverse tribal communities of North America.

The only way to fully understand the impact of these disorders on Native American communities is to look closely at each tribal population.

The most comprehensive research found that research participants were 1.5 to 2.5 times more likely to report experiencing lifetime alcohol dependence compared to the general adult U.S. population.

A 2020 study in the International Journal of Mental Health and Addiction reported that between 1999 and 2015, Indigenous people had an increased rate of opioid-related deaths compared to white people. The study pointed out that between 2011 and 2015, Indigenous people in Minnesota were over six times more likely to die of opioid overdose than white Minnesotans.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), methamphetamines have been devastating to some tribes. SAMHSA points out that drug cartels target rural reservations for sales of the drug and use as distribution hubs due to the complicated and underfunded law enforcement in those areas. Native Americans now have the highest rate of meth usage of any ethnic group in the U.S.

native american young woman with blanket

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) arises when a person has been exposed to or has experienced a frightening, shocking, or dangerous event.

The most comprehensive research on the mental health status of tribal communities found that research participants were two to three times more likely to experience PTSD than the general U.S. adult population.

A 2015 review of research on PTSD in the Native American population found that participants often mentioned combat experience and interpersonal violence as leading causes of PTSD.


According to the Centers for Disease Control (CDC), suicide rates are higher among Native Americans than for any other racial group in the U.S. and are the ninth leading cause of death for this population.

Native American youth are particularly vulnerable, with SAMHSA reporting that suicide is the second leading cause of death for Native youth ages 15 to 24. These youth are dying more than four times as often as young people in the U.S. general population.

Some of the main predictors of suicide include:

  • Past suicide attempts
  • Domestic violence
  • Trauma
  • Access to firearms
  • Hopelessness and impulsivity
  • Lack of support
  • Existing mental health issues

Because so many of these factors are present in Native communities, suicide prevention must be a pillar of mental health care for this population. Education and awareness are equally important—when people know the signs, they are better able to aid in prevention efforts.

Learn more: Understand the signs of suicide and what to do if you or your loved one is struggling

Watch Now!

Dr. Heidi Browne provides an overview of PTSD and other trauma-related disorders, offers practical tips for recognizing their key signs, and shares evidence-based treatment options for those impacted by them.

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.

Native American woman stands outside in sunglasses, face mask on ear

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.

Cultural Curiosity in the Clinic

Clipart illustration grid of face profiles with different features

Dr. Cecil R. Webster Jr. provides a framework for how clinicians can use the concept of intersectionality to understand how patients’ overlapping identities affect their mental health.

Clipart illustration grid of face profiles with different features

On a Path Towards Cultural Humility

Addressing and treating Native American mental health means acknowledging and understanding past and ongoing transgressions that yield historical trauma, which is a complex undertaking.

When working with Native American patients, mental health professionals should embrace cultural humility and understand the effects of ongoing mistreatment on Native American people. Clinicians should learn about the cultural and spiritual practices of their patients’ tribes.

Mental health professionals who work in a Native American community have a strong obligation to understand the culture of the people they are working with. This involves stepping outside the clinic.

Providers can build trust by engaging in community events and social justice advocacy. Understanding what is taking place in the community often provides important context for treatment.

Clinicians should remain aware of cultural and power differences that exist. They should keep in mind the role that historical trauma plays in the mental health challenges of Native American people. It is important to understand how distress may be experienced or expressed differently from the dominant culture.

Throughout treatment, clinicians should look out for assumptions they might make. They can question whether interventions they plan on making will be helpful. Mental health professionals should continue to reassess how therapy is going, what is working and what isn’t working, and which community supports are available.

Finding the Right Treatment for You

If you are a member of the Native American community and plan to meet with a mental health care provider, ask questions. Find out if the provider has worked with Native people before. Ask if they have training in the traditional or spiritual practices that apply to you.

If they’re not of the same tribe, or aren’t Native American themselves, ask about their cultural understanding of your people. How will that play into your communication? Do they understand trauma-informed care?

Most of all, if you are struggling, know that other Native American people have experienced mental health concerns and have found support.

When seeking mental health care, it can be helpful to ask a trusted member of your community what has worked—and is working—for them. Many Native American people have been there, have sought help, and have recovered. You can too.

If you or a loved one is struggling, McLean is here to help. Call us today at 617.855.3141 to learn more about treatment options.

Suicide and Minority Youth

Dr. Tami Benton shares data showing higher rates of suicide attempts and self-harm among minority youth compared to white youth populations.

Unpacking Native Terminology

It is important to understand the various terms used to describe members of the Native American population.

As the National Museum of the American Indian points out, the terms American Indian, Indian, Native American, and Native are acceptable. These terms are often used interchangeably in the U.S.

The best way to refer to a person or group is to ask them which terms they prefer.

The most specific way to refer to tribal members is by their tribal or nation names (for example, Cherokee). Most members of the community prefer to use these names.

Beyond tribal names there are three primary intertribal Indigenous groups in the U.S.: American Indian, Alaska Native, and Native Hawaiian.

More broadly, the term American Indian is referenced in the Declaration of Independence and the U.S. Constitution. All Federal Indian laws and policies hinge on this designation. Members of the community often still refer to themselves as Indian, as well.

The term Native American technically includes American Indians, Alaska Natives, and Native Hawaiians. It is not tied as closely to law and policy.

The term Indigenous is the broadest term to refer to the original inhabitants of any country, not just the U.S. The term Indigenous Americans has the same general meaning as Native Americans.

Want More Information?

Looking for even more information about Native American mental health? You may find these resources helpful.

Interesting Articles, Videos, and More

Learn more about mental health and what you can do if you or someone you care about is struggling.

Helpful Links

The following organizations have useful information, community resources, and hotlines.

Indian Health Service
IHS provides a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes.

StrongHearts Native HelpLine
StrongHearts Native Helpline, 844.762.8483, is a domestic violence and dating violence helpline for American Indians and Alaska Natives, offering culturally appropriate support via phone and online chat.

WeRNative provides a comprehensive health resource for Native youth by Native youth, promoting holistic health and positive growth in local communities and the nation at large.


The following publications were referenced while creating this article. You may find them useful as well.

  1. Gone JP, Trimble JE. American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology. 2012;8:131-60.
  2. Gone J. Community mental health services for American Indians and Alaska Natives: Reconciling evidence based practices and alter-Native psy-ence. Annual Review of Clinical Psychology. 2023;19:23-49.
  3. Hall R. Distribution of the sweat lodge in alcohol treatment programs. Current Anthropology. 1985.
  4. Substance Abuse and Mental Health Services Administration. Suicide clusters within American Indian and Alaska Native communities: A review of the literature and recommendations. HHS Publication No. SMA17-5050. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. 2017.
  5. Substance Abuse and Mental Health Services Administration. Behavioral health services for American Indians and Alaska Natives. Treatment Improvement Protocol (TIP) Series 61. HHS Publication No. (SMA) 18- 5070EXSUMM. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2018.