Factors that Put Indigenous Peoples at Risk for Mental Health Problems
Historical trauma: The psychological effects of forced relocation, assimilation, and other traumas inflicted on Indigenous peoples linger today. Indigenous peoples are confronting the trauma, learning the accurate history, and reconnecting with Indigenous spiritual practices and culture to assist the healing journey—but continuing discrimination and ongoing trauma hinder that progress.
Intergenerational Trauma: The intergenerational and unconscious grief from the historical trauma experienced by Indigenous peoples is passed from generation to generation due to forced relocation, land dispossession, and loss of spiritual practices, language and culture. If not addressed and identified accurately, depression, anxiety, PTSD, and substance use can be outward manifestations of the intergenerational trauma and unresolved historical grief.
Racism, racial bias, and discrimination: Racial and ethnic minority populations, including Indigenous peoples, often experience negative social factors such as bias and discrimination that contribute to poor physical and mental health.
- Institutional racism and social determinants of mental health: Institutional racism worsens social determinants of health and mental health, including access to quality education, safe housing, gainful employment, appropriate health care, and a clean environment.
- Low socioeconomic status (SES): Indigenous peoples tend to have disproportionately low socioeconomic status, as determined by education, income, and occupation. Low SES has been significantly associated with a higher risk for mental illness.
Geographic challenges: Many Indigenous people live in urban centers. They may have relocated to these areas for economic opportunities, but in the process may lose the cultural strength that comes from connection to the land. This may contribute to limited resources in terms of health care, mental health, education, and employment.
Difficulties integrating traditional and modern lifestyle: Indigenous persons may struggle to achieve a comfortable balance between tribal traditions and the demands of contemporary life.
Lack of culturally appropriate diagnoses and treatments: Diagnoses such as PTSD have been found to be relevant, but inadequate for capturing the scope of responses to historical trauma experienced by Indigenous peoples. The literature has identified a need to develop appropriate culturally based trauma theory and interventions for Indigenous peoples.
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Suggested Assessment and Treatment Recommendations
- Please see Suggested Assessment and Treatment Recommendations for Marginalized Populations
- Avoid stereotypes and create a welcoming environment that acknowledges and respects the impact of complex histories and traumas of Indigenous peoples. Providers should recognize their own biases towards Indigenous peoples and acknowledge where they are in their own learning and awareness of Indigenous culture and experience. Providers who maintain openness and curiosity about patients with whom they work can achieve cultural agility and sensitivity.
- Encourage patients to reconnect with their culture and community to reinforce identity, resilience, and self-esteem. This can prevent and protect against symptoms of mental illness, especially substance use issues, depression, and PTSD.
- Use cultural practices as primary and adjunctive treatment modalities. Talking circles and drumming circles may be useful as primary treatment modalities or secondary to other treatments. Indigenous peoples have strong connections to this way of healing and connecting to their culture and transmitting Indigenous knowledge. Providers may employ culturally appropriate activities like these with guidance from Indigenous providers. Other ideas to consider are to integrate Indigenous art and aesthetics that are part of the local Indigenous nations in office settings. Providers who regularly treat Indigenous people should consider becoming familiar with local customs and acknowledge traditional territory to show cultural humility and sensitivity.
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APA Mental Health Facts for American Indian/Alaska Natives. 2017 /File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-American-Indian-Alaska-Natives.pdf
APA CME Module: Cultural Competence Curriculum, “Providing Culturally Competent Care to Indigenous Peoples: American Indian/Alaska Native/Native Hawaiian.” 2016.
APA Best Practice Highlights: “Native American Patients” 2016. Indigenous cultural competency self-assessment checklist. Indigenous Corporate Training, Inc, 2016. http://www.ictinc.ca/blog/indigenous-cultural-competency-self-assessment-checklist
Umbreit M. Talking Circles. Center for Restorative Justice & Peacemaking, August 2003. https://www.nacc.org/docs/conference/2014/M4%20-%20Talking%20Circles.pdf