Mental Health in Native North America: The Continuing Effect of Historical Trauma

 

Written by: Heather Lloyd

https://www.mhanational.org/issues/native-and-indigenous-communities-and-mental-health

Historical Trauma is a type of psychological trauma that is passed down through generations of people as the result of “massive cataclysmic events,” according to Dr. Donald Warne of the University of South Dakota. American Indians and Alaska Natives have faced numerous traumas since the colonization of North America, such as large-scale population loss due to European diseases, forced relocation, and forced separation of families, to name a few. (Sandoiu)

Dr. Roger Dale Walker of the Oregon Health and Science University School of Medicine describes Historical Trauma as “Generational Post Traumatic Stress.” According to Dr. Walker, the trauma that Native Americans faced in the past has a direct correlation to the health and wellbeing of living Natives. (Sandoiu)

The statistics on the harmful effects of this trauma are troubling. Dr. Walker notes that the Native American community has a six-times higher incidence of alcohol abuse, three-times higher incidence of depression and twice the suicide risk of Non-Natives. (Sandoiu) According to the U.S. Department of Health and Human Services Office of Minority Health, “In 2017, suicide was the second leading cause of death for American Indian/Alaska Natives between the ages of 10 and 34.” Additionally, 75% of deaths among young Native Americans are the result of suicide, violent crime and accidents. (U.S. Department of Health and Human Services, Office of Minority Health)

 Health programs are in place that are specifically aimed at assisting Native American communities, such as the Office of Minority Health, as well as the federal Indian Health Service (IHS) program. Despite these resources, there is a disparity between the healthcare of the Native American community and Non-Natives. In order to receive healthcare through the IHS, a Tribe must be federally recognized. (U.S. Department of Health and Human Services, Office of Minority Health)

The process for federal recognition was revised in 2015, however the new Official Guidelines document set forth by the Office of Federal Acknowledgement (OFA) has not been produced. (U.S. Department of the Interior, Indian Affairs) The Official Guidelines currently available date from 1997 and have many criteria that exclude certain groups from recognition. These criteria exclude “…Indian tribes that ceased to exist for long intervals,” as well as “'The descendants of one Indian ancestor (a "lineage") who became separated from his or her tribe and now has many descendants…” (United States Department of the Interior, Office of Federal Acknowledgement, p. 38) The latter may be particularly troublesome for descendants of children who were removed from their homes and sent to boarding schools.

Tribes that are federally recognized face their own challenges. Those who live in rural communities, far from health care centers, and those facing income inequality and lack of health insurance coverage have a particularly difficult time accessing healthcare. Access is further impeded by the fact that many IHS medical centers are on reservations, though a significant portion of the Native American community lives outside of reservations. (U.S. Department of Health and Human Services, Office of Minority Health) Statistics from Mental Health America show that Native American communities face an unemployment rate of nearly twenty-seven percent, compared to under fifteen percent for Non-Natives. Additionally, the number of people in the Native American community who do not have health insurance is approximately three times higher than “non-Hispanic whites.” (Mental Health America)

The IHS has methods in place specifically designed to assist the Native American community with healing from Historical Trauma. Within the IHS, this method is referred to as Trauma Informed Care (TIC). TIC aims not only to support Native Americans individually, but also in the community and the workplace. There is also a focus within the IHS on Native American youth. The Substance Abuse and Suicide Prevention Program (SASP) promotes “self-sufficiency behaviors among youth… while ensuring honor and respect for Tribal traditions and practices.” (Indian Health Service)

Unfortunately, accessing resources such as these is difficult even for Native Americans who do have health insurance, as IHS funding is limited. According to the IHS, approximately 60% of healthcare costs for qualified Native American communities is funded by the government. Some medical care must be provided at “IHS/Tribal/Urban facilities/Purchased/Referred Care (PRC)” sites. These sites are not IHS medical centers, and it is the PRC that determines whether there is enough funding for certain types of health care. In addition, medications that are provided by pharmacies that are outside of the IHS network must be paid for entirely by the patient, except in “special circumstances.” (Indian Health Service)

In light of the difficulties Native Americans face in accessing quality healthcare, many Native communities are working together in order to implement government policies that will help fill the gaps in healthcare, as well as workplace assistance and social service needs. (National Congress of American Indians) The National Congress of American Indians (NCAI), which was founded in 1944, has been called, “…one of the most important intertribal political organizations of the modern era.” One of the key goals of the NCAI is to “Improve the quality of life for Native communities and peoples.” (National Congress of American Indians)

Increased awareness of difficulties and disparities faced by Native American communities through education, activism and legislation are critical for change. When governments, as well as individuals, take the time to listen and respond to the needs of others, change can be achieved.

Sources:

Sandoiu, Ana. “The impact of historical trauma on American Indian health equity”.    MedicalNewsToday, 27 November 2020, https://www.medicalnewstoday.com/articles/the-impact-of-historical-trauma-on-american-indian-health-equity

“Mental and Behavioral Health - American Indians/Alaska Natives”. U.S. Department of Health and Human Services Office of Minority Health, 25 September 2019, https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=39

“Profile- American Indian/ Alaska Native”. U.S. Department of Health and Human Services Office of Minority Health, 21 January 2021, https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlID=62

“Guidelines, Precedent Manual, and Sample Narrative”. U.S. Department of the Interior Indian Affairs, Accessed 9 March 2021, https://www.bia.gov/as-ia/ofa/guidelines-precedent-manual-and-sample-narrative

“The Official Guidelines to the Federal Acknowledgement Regulations, 25 CFR 83” PDF, 38, United States Department of the Interior, Office of Federal Acknowledgement, September 1997, https://www.bia.gov/sites/bia.gov/files/assets/as-ia/ofa/admindocs/OfficialGuidelines.pdf

“Native And Indigenous Communities And Mental Health”. Mental Health America, Accessed 9 March 2021, https://www.mhanational.org/issues/native-and-indigenous-communities-and-mental-health

“Trauma Informed Care”. Indian Health Service, Accessed 9 March 2021, https://www.ihs.gov/dbh/traumainformedcare/

“Key Areas”. Indian Health Service, Accessed 9 March 2021, https://www.ihs.gov/nativeyouth/keyareas/

“Frequently Asked Questions”. Indian Health Service, Accessed 9 March 2021, https://www.ihs.gov/forpatients/faq/#q4

“Mission and History”. National Congress of American Indians, Accessed 11 March 2021, https://www.ncai.org/about-ncai/mission-history

“Education Health and Human Services”. National Congress of American Indians, Accessed 11 March 2021, https://www.ncai.org/policy-issues/education-health-human-services