They possess familiarity with community dynamics, kinship patterns, spiritual values, attitudes, language and communication styles, and patient expectations (Miller & Pylypa, 1995; Roman et al., 2007; Gampa et al., 2017). Task-shifting is “a process whereby specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualifications” (World Health Organization, 2008, p. 7). Thus, it may take decades to reach a sufficient number of trained AI/AN clinicians to attend to treatment needs in their own or other tribal communities. Many newly trained AI/AN psychologists have the ability to choose academic research positions to address inequities through research and policy over providing direct clinical service. Federal grants have supported recruiting and retaining AI/AN doctoral psychology students, including the Indians into Psychology Doctoral Education program at the Universities of North Dakota and Montana, American Indians into Psychology at Oklahoma State University, and Alaska Natives into Psychology at the University of Alaska (Trimble & Clearing-Sky, 2009).
- Given the different needs of health services by people with different demographic and socioeconomic characteristics, it has attracted scholarly interest to measuring geographical accessibility to health services for various population groups (e.g., by ages and income ).
- While the literature separately discusses these concepts in relation to health and wellbeing, our review found that it does not necessarily present them as inter-connected and equally essential to good cultural health.
- Two were based on cognitive behavioral therapy (CBT); Bennett et al. (2014) adapted CBT to Māori values and another used a culturally adapted ultra-brief CBT intervention with problem solving (Mathieson et al., 2012).
Mental Health and Substance Use Treatment in Tribal Communities
If they’re not engaged with the AMS, they’re usually not engaged with another GP, because of the cost and lack of bulk billing, so it’s difficult to then get that care plan and referral.’ (ML02, Female, Medicare Local staff) Referrers found that service demand had been ‘moderately’ (1), ‘mostly’ (2), or ‘completely’ (2) met. All interviewees indicated at least a moderate level of capacity to meet existing service demand.
Learning from Those Who Do: Land-Based Healing in a Mushkegowuk Community
When we talk about mental health, too often we start with DSM diagnoses, CBT strategies, or mindfulness apps. Instead, we must restore intergenerational, kinship-based healing through relationships, ceremony, land-based practices and daily caregiving. Governments, universities https://www.cswe.org/centers-initiatives/minority-fellowship-program/news/march-2020/ and regulatory bodies must remove barriers preventing Indigenous helpers from full participation in mental health professions.
Suicide prevention in Indigenous communities
Indigenous-specific content (e.g. ceremonies, oral and musical traditions, and weaving and crafting) was described in all but two studies (Bowen et al., 2020; Sun and Buys, 2013b). Decision-making by Indigenous individuals or groups was not reported in one study (Bowen et al., 2020). Indigenous individuals or groups with decision-making responsibilities were described at the study design level (Supplemental Table S5). Six were rated moderate, meaning a 60–79% follow-up rate or non-applicability due to study design, and the remaining 12 were weak as they provided no reasons for their withdrawals and dropouts or because follow-up rates were less than 60%. Three studies were rated strong for withdrawals and dropouts, with follow-up rates 80% or higher and describing reasons for withdrawals and dropouts.
Wexler et al. (2012) completed a study in the Northwest region of Alaska during 2001–2009 and identified risk factors that included being single and not cohabitating, being unemployed, not having an education, SUD, abuse and depressive signs. Indeed, alcohol abuse was a near universal risk factor across studies, with rates of such abuse for suicidal respondents ranging from 36 to 87 per cent (Kettl and Bixler, 1993; May et al., 2002; LeMaster et al., 2004; Wexler et al., 2012; Caetano et al., 2013; Berman, 2014). Six studies identified the prevalence of depression within the AI/AN and Native Hawaiian population, with rates varying by region and tribe (Kaholokula et al., 1999; Beals et al., 2005a; Roh et al., 2015; Burnette et al., 2016; Çayır et al., 2017; Schure and Goins, 2017). Regional differences included communities with poor education systems, and limited opportunities for higher education and employment tended to have an increased prevalence of PTSD in the Northern Plains, whereas only a lack of employment opportunities increased the prevalence of PTSD in the Southwest (Beals et al., 2013a).