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A looming mental health crisis in Indian country

If mental health care for American Indians is free, why is it underutilized
- particularly if there is no financial barrier and transportation is
provided to mental health facilities?

Given the unique historical relationship between the United States
government and Americans Indians, many have a deep-rooted distrust of
institutional resources and are more unlikely to seek their services as a

Stated University of Colorado Health Science Center professor Spiro Manson:
American Indians are the fastest growing ethnic group, and the most
underserved and neglected by the mental health field. Mental health
delivery through the Indian Health Service is widely underutilized for
various reasons.

However, there is now a movement to shift away from conventional counseling
and move in the direction of culturally sensitive mental health approaches
that integrate American Indian cultural values into treatment to better
interface with the Indian patient population.

IHS mental health clinics are geographically isolated and pose complicated
utilization barriers such as unconscious physician bias and prejudice.
Also, the socio-demographic and cultural differences between American
Indian communities create challenges to the development of comprehensive,
coordinated and sustained quality services specific to individual tribes.

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More than half of all American Indians live in urban areas and receive
little or no support from the IHS. The remaining half live on reservations
or rural non-reservation areas and receive support through IHS facilities.
Unfortunately, funding is not divided proportionally between these service

A majority of the IHS budget is directed towards serving American Indians
on reservations or rural areas near reservations. The IHS operates on a
$2.4 billion budget with $370 million directed at IHS facilities. Under the
fiscal year 2004 budget, only 2 percent of that budget is directed for the
Urban Indian Health Programs, which has been the norm since 1979. Only a
fraction of this 2 percent will be allocated to serve more than 50 percent
of the Indian population's mental health needs in urban areas. As a result,
a lack of professional specialty services and fewer comprehensive helper
networks contribute to the mental health crisis for urban Indians.

The underutilization of mental health services can be directly attributed
to the lack of cultural sensitivity that American Indians feel toward
Western psychological services. American Indians hold that these
psychological services are insensitive and unresponsive to their needs, and
that they are to be feared and mistrusted. Teresa LaFromboise of Stanford
University said physicians often impose their Western cultural bias onto
American Indian problems, resulting in efforts to shape client behavior in
ways that conflict with traditional values and lifestyle preferences.

If we were trying to extract policy implications for future mental health
services, they would only be speculative because of the limited research
conducted in Indian country for these specific challenges. If, indeed,
funding increased sufficiently enough to build the necessary mental health
facilities for both urban and rural/reservation Indians, mental health
disparities would only be marginally affected.

I believe that this problem can be solved within and between Indian
communities, if they were to work synergistically. Our mission, and that of
individual clinics along with the IHS, is to work toward ensuring that the
current generations are the last to allow shame and stigma to act as
barriers to effective, culturally appropriate treatment - and the last to
suffer from the effects of multigenerational traumatic effects.

Jeremiah David Simmons, Yankton Sioux, is a senior currently enrolled at
Stanford University, where he is pursuing a degree in Human Biology.