Identifying and Reducing Disparities in Mental Health Outcomes Among American Indians and Alaskan Natives Using Public Health, Mental Healthcare and Legal Perspectives
The purpose of this paper was to investigate disparities in mental healthcare delivery in American Indian/Alaska Native populations from three perspectives: public health, legal policy and mental healthcare and provide evidence-based recommendations toward reducing those disparities. Data on mental health funding to tribes were obtained from the Substance Abuse and Mental Health Services Administration. As a result of analysis of these data, vital statistics and current literature, we propose three recommendations to reduce mental health disparities. First, where possible, increase mental health funding opportunities for federally-recognized tribes. Second, model funding practices on principles of tribal self-determination. Finally, support diverse interventions that are culturally-based and culturally-appropriate.
KeywordsDisparities Depression Suicide SAMHSA Federal grants
The authors kindly acknowledge Sheila Cooper and SAMHSA for providing access to data on funding to federally-recognized American Indian/Alaska Native tribes.
This study was funded by Ira and Mary Lou Fulton Gift Fund at Brigham Young University.
Compliance with Ethical Standards
Conflict of interest
All author declares that they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
- American Indian Religious Freedom Act of 1978. 42 US Code §1996. Protection and preservation of traditional religions of Native Americans.Google Scholar
- Bakken, G. M. (2000). Law in the Western United States. Norman: University of Oklahoma Press. Retrieved from https://books.google.com/books?hl=en&lr=&id=zjHQWyttp6QC&pgis=1.
- Beals, J., Novins, D. K., Whitesell, N. R., Spicer, P., Mitchell, C. M., & Manson, S. M. (2005). Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: Mental health disparities in a national context. The American Journal of Psychiatry, 162(9), 1723–1732. doi: 10.1176/appi.ajp.162.9.1723.CrossRefPubMedGoogle Scholar
- Bolt, C. (2009). Francis Paul Prucha, The Great Father. The United States Government and the American Indians (Lincoln and London, University of Nebraska Press, 1984, 2 vols., £57.00). Pp. xxxii, 1302. ISBN 8032 3668 9. Journal of American Studies, 21(01), 122. doi: 10.1017/S0021875800005648.CrossRefGoogle Scholar
- Bosman, J. (2015). Pine Ridge Indian Reservation struggles with suicides among its young. The New York Times. Retrieved from http://www.nytimes.com/2015/05/02/us/pine-ridge-indian-reservation-struggles-with-suicides-among-young-people.html.
- Centers for Disease Control and Prevention. (2003). Injury mortality among American Indian and Alaska Native Children and Youth—United States, 1989–1998. Morbidity and Mortality Weekly Report, 52(30), 697–701.Google Scholar
- Centers for Disease Control and Prevention. (2015). American Indian & Alaska Native populations. Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html.
- Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Underlying Cause of Death. 1999–2014 on CDC WONDER Online Database, released 2015. Retrieved from http://wonder.cdc.gov/ucd-icd10.html.
- Cross, T. L., Friesen, B. J., Jivanjee, P., Gowen, L. K., Bandurraga, A., Matthew, C., & Maher, N. (2011). Defining youth success using culturally appropriate community-based participatory research methods. Best Practices in Mental Health, 7(1), 94–114.Google Scholar
- Dunbar-Ortiz, R. (2015). An indigenous peoples’ history of the United States: Volume 3 of revisioning American history. Boston: Beacon Press.Google Scholar
- Giordano, C., Elliot, K., Sribney, W., Deeb-Sossa, N., Sala, M., & Aguilar-Gaxiola, S. (2009). Building partnerships: Conversations with Native Americans about mental health needs and community strengths. Retrieved from http://www.ucdmc.ucdavis.edu/crhd/images/pdf/Native%20American%20Report%20Final%209.09.pdf.
- Gowen, L. K., Bandurraga, A., Jivanjee, P., Cross, T., & Friesen, B. J. (2012). Development, testing, and use of a valid and reliable assessment tool for urban American Indian/Alaska Native youth programming using culturally appropriate methodologies. Journal of Ethnic and Cultural Diversity in Social Work, 21(2), 77–94. doi: 10.1080/15313204.2012.673426.CrossRefGoogle Scholar
- Indian Affairs Bureau. (2016). Indian entities recognized and eligible to receive services from the United States Bureau of Indian Affairs. United States Federal Register. 81 FR 26826.Google Scholar
- Indian Employment, Training and Related Services Demonstration Act of 1992. Public Law 102-477.Google Scholar
- Indian Self-Determination and Education Assistance Act of 1975. 25 U.S.C. § 450. Congressional statement of findings.Google Scholar
- Indian Health Service. (2015). Basis for health services. Retrieved from https://www.ihs.gov/newsroom/factsheets/basisforhealthservices/.
- Indian Health Service. (2016). About IHS. Retreived from https://www.ihs.gov/aboutihs/.
- Levinson, D. R. (2011). Access to Mental Health Services at Indian Health Service and Tribal Facilities. Department of Health and Human Services: Office of Inspector General. Retrieved from http://oig.hhs.gov/oei/reports/oei-09-08-00580.pdf.
- Mays, V., Gallardo, M., Shorter-Gooden, K., Robinson-Zañartu, C., Smith, M., Mcclure, F., et al. (2009). Expanding the circle: Decreasing American Indian mental health disparities through culturally competent teaching about American Indian mental health. American Indian Culture and Research Journal. Retrieved from http://uclajournals.org/doi/abs/10.17953/aicr.33.3.b27481242q461u25?journalCode=aicr.
- National Alliance on Mental Illness. (n.d.). American Indian and Alaskan Native communities mental health fact sheet. Retrieved from http://www2.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=79888.
- Pember, M. A. (2015). Lakota fight suicide spirit with crowdfunding. Retrieved November 30, 2015 from http://indiancountrytodaymedianetwork.com/2015/05/19/lakota-fight-suicide-spirit-crowdfunding-160405.
- Strommer, G. D., & Osborne, S. D. (2014). History, status, and future of tribal self-governance under the Indian Self-Determination and Education Assistance Act. American Indian Law Review, 39. Retrieved from http://heinonline.org/HOL/Page?handle=hein.journals/aind39&id=9&div=&collection=.
- Substance Abuse and Mental Health Services. (n.d.). Circles of care. Retrieved from http://www.samhsa.gov/tribal-ttac/training-technical-assistance/circles-of-care.
- Substance Abuse and Mental Health Services Administration. (2016). About Us. Retrieved from http://www.samhsa.gov/about-us.
- Substance Abuse and Mental Health Services Association. (n.d.). Native connections. Retrieved from http://www.samhsa.gov/tribal-ttac/training-technical-assistance/native-connections.
- Suicide Prevention Resource Center. (n.d.). Suicide among racial/ethnic populations in the U.S.: American Indians/Alaskan Natives. Retrieved from http://www.sprc.org/sites/sprc.org/files/library/AI_AN Sheet Aug 28 2013 Final.pdf.
- Trujillo, A. (2000). Psychotherapy with Native Americans: A view into the role of religion and spirituality. In P. Richards & E. Allen (Eds.), Handbook of psychotherapy and religious diversity (pp. 445–466). Washington, DC: American Psychological Association. doi: 10.1037/10347-018.CrossRefGoogle Scholar
- United States Commission on Organization of the Executive Branch of the Government. (1949), The Hoover Commission Report on Organization of the Executive Branch of the Government. Westport: Greenwood Press.Google Scholar
- United States Department of Health and Human Services. (2016). HHS FY2016 Budget in Brief. Retrieved from: http://www.hhs.gov/about/budget/budget-in-brief/samhsa/index.html.
- United States Department of Health and Human Services. (n.d.). Shortage designation: health professional shortage areas & medically underserved areas/populations. Retrieved from http://www.hrsa.gov/shortage/.
- United States Department of the Interior Indian Affairs. (2016). Frequently asked questions. Retrieved from http://www.bia.gov/FAQs/.
- United States Government Accountability Office. (2016). Indian Health Service: Actions needed to improve oversight of patient wait times. GAO-16-333. Retreived from http://www.gao.gov/products/GAO-16-333.