The ongoing mental health challenges American Indian/ Alaskan Native populations face are rooted in a long history of trauma and mistreatment, social determinants of health (SDOH), and a lack of funding for programs. As previously mentioned, high rates of suicide, drug/alcohol abuse, and mental health issues are a testament to intergenerational trauma passed on year after year without a resolution. To provide a little context, the government forcefully relocated thousands of Native American tribes, which resulted in thousands of deaths, cultural disruption, mass poverty, and community/resource loss. The Native Americans, who were very spiritual beings, lived in harmony with Mother Earth and utilized their land rich with resources, but were introduced to new affluences such as alcohol, drugs, guns, and traumatic experiences. Many became predisposed, altering their way of thinking and disturbing their already unsettled harmony, leading to substance addiction among other issues. The exposure of alcoholism, murders, and the cruel oppression of their peoples over the years weighed heavily on their hearts and mental stability. To endure such traumatic experiences, as we all know, causes depression and other mental health issues, such as substance abuse and suicide. Hence, when I refer to historical trauma, I mean generations and generations of mental health issues that have devastated and continue to destroy these communities, as they lack access and funding for effective mental health programs.
According to the U. S. Department of Health and Human Services Office of Minority Health (2026), it was reported in 2022 that AI/AN people are 91% more likely lose their lives to suicide. In addition, substance abuse is a major problem among this population, which has high rates (U. S. Department of Health and Human Services, 2023). As mentioned, historical trauma/ mistreatment and SDOH have a longstanding impact that shapes the current structure of present times. To address these challenges, tribal councils and health boards, along with federal agencies such as the Indian Health Service (IHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC), provide direction and funding to improve health outcomes. The tribal councils are aware of the co-occurring mental health issues, and in collaboration with SAMHSA have developed an action plan to address these issues. A policy developed to improve the well-being of AI/AN communities is the Indian Health Care Improvement Act (IHCIA). The policy authorizes health services for AI/AN and helps improve the health of this population (Warne & Frizzell, 2014). Some important aspects of the act include Medicare and Medicaid billing and reimbursement, the Children’s Health Insurance Program (CHIP), and recently expanded services for behavioral health and hospice (Indian Health Service, 2010). The key public health sector is the Indian Health Service (IHS), created and regulated by the federal government to provide health care to American Indians as recompense for the oppression caused by the relocation acts. There are several IHS facilities across the country serving American Indian and Alaskan Native communities that offer a comprehensive range of services, including primary care, dental, optometry, physical therapy, pediatrics, emergency medicine, obstetrics, women's health, and several specialties. According to the HIS (n. d.), the IHS is the primary health care system and advocates for native people to help improve health outcomes.
References
Warne, D. & Frizzell, L. B. (2014). American Indian Health Policy: historical trends and contemporary issues. American Journal of Public Health, 104(3), S263-267. https://doi.org/10.2105/AJPH.2013.301682
While I appreciate that the United States government is making an effort (and rightfully so), I wonder if they are missing the mark. Given the long history of trauma and mistreatment, I imagine there is a great deal of mistrust and resentment. Health policy cannot so easily be disentangled from that. The Tribal Nations are sovereign governments that have the right to determine their own health care and how it is delivered. Do current federal acts and policies support that sovereignity or are they causing overreliance on Western models? While I do not have the best understanding of the delivery of care, I would be surprised if traditional healing methods are included or supported. Studies have shown that for mental…