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Mary Annette Pember
Indian Country Today

As the U.S. struggles with wave after wave of health and economic fallout from the coronavirus pandemic, a silent epidemic of mental illness is looming. Native Americans, already in crisis mode due to limited access to health care and disparities in both physical and mental health, are especially vulnerable.

Health care professionals and grassroots leaders in Indian Country, however, are reporting surprising bright spots in ways that Native people are responding to mental health challenges generated by COVID-19 .

No strangers to making do with chronically underfunded infrastructures and limited resources, Native people are creating innovative ways to battle the loneliness and isolation of life during a pandemic. In 2017, for instance, the Indian Health Service spent $4,078 per person versus the national health care expenditure of $9,726 per person.

“In many ways, we’re used to taking care of ourselves; we can’t afford to wait around for someone else to help us,” says Theresa Henry, cultural keeper for South Dakota Urban Indian Health in Sioux Falls. Henry is a citizen of the Turtle Mountain Band of Chippewa Indians Tribe.

Henry and others interviewed by Indian Country Today describe a spectrum of formal and informal virtual gatherings, phone trees and other socially distanced activities in their communities as a way to survive and remain connected during the pandemic.

People are organizing social distance powwows, jingle dress dances, bead working, ribbon skirt and regalia making and Indigenous food preparation classes and gatherings on social media. Some of the events are huge national gatherings, some are modest local events.

For instance, Valerie Ross Zhawendaagozikwe, a doula with Fond du Lac Band of Lake Superior Chippewa Human Services in Minnesota, meets virtually with an Indigenous prenatal and lactation support group. Zhawendaagozikwe is a citizen of the Muckleshoot tribe and Long Plains First Nation.

Valerie Ross Zhawendaagozikwe is a doula with Fond du Lac Band of Lake Superior Chippewa. (Photo courtesy of Valerie Ross Zhawendaagozikwe)

Hope in a pandemic

In a pleasant turn of events, the rate of no-shows for mental health appointments at several Indian Health Service and tribal health clinics has decreased, according to Dr. Lori Raney of Health Management.

Raney is principal coordinator for the Indian Health Service’s behavioral health integration initiative, a multi-year project with 12 reservation and urban-based clinics seeking to include mental health evaluation and services along with primary care health services.

This integrative care model helps primary care health professionals identify mental health as part of routine care, according to Raney.

For instance, symptoms such as sleep problems, changes in eating habits and headaches may be related to mental health issues.

“Patients may be more likely to pursue mental health services if encouraged by their primary care professional who they know well,” Raney said.

Patients are also making greater use of virtual care, according to Raney. “Virtual appointments seem to remove some of the stigma for patients seeking mental health care,” Raney said.

IHS has used telehealth in varying capacities for at least 20 years in order to serve isolated Native communities.

Glorinda Segay, director of the IHS division of behavioral health, said IHS has expanded its telebehavioral health program to serve patients in their home.

“We are beginning to see an influx of new patients seeking care for grief, anxiety and depression due to the effects of the pandemic and we anticipate this will continue,” Segay said in an email.

(Illustration by Taylor Bennett-Begaye | Poster courtesy of Protect the Sacred and CORE)

Looking at the data

The threats presented by the novel coronavirus for Native Americans, however, are disproportionate and ominous.

Although gaps in statistics make exact rates hard to come by, Native people are clearly at greater risk of infection and death from COVID-19 than other populations. The rate of infection for Native people in eight counties across the country with large Native populations is nearly double the national average, according to the New York Times.

Prior to the pandemic, Native people reported experiencing psychological distress 2.5 times more than the general population, according to Mental Health America.

Once the pandemic arrived, the distress grew. A recent Canadian survey found that 60 percent of Indigenous respondents said their mental health was somewhat or much worse since social distancing measures have been introduced.

Health experts worry that people will turn to drugs and alcohol to deal with the added stress. The Substance Abuse and Mental Services Administration Center for Behavioral Health Statistics and Quality reports that Native Americans and Alaska Natives age 12 and older had the highest rate of substance abuse and dependence in 2017 at 12.8 percent versus White people at 7.7 percent.

Native people, however, are not alone in experiencing higher rates of mental health problems during the pandemic. Emerging data is showing that the entire U.S. population is struggling with the mental health fallout from COVID-19.

According to the Household Pulse Survey, a partnership between the National Center for Health Statistics and the Census Bureau, there are twice as many Americans showing symptoms of depression since April 2020 than during a similar 2014 survey. The Household Pulse Survey was designed to provide relevant information about the impact of the COVID-19 pandemic. Data collection began on April 23, 2020 and will continue for 90 days.

The Washington Post reports that overall, mental health care in the U.S. is traditionally underfunded and plagued by problems of access and insurance roadblocks.

Given this context, the mental health implications for Native people are grave.

Silent battles on top of the pandemic

Domestic violence also continues during the pandemic. “Calls from Native victims have fallen by about 40 percent since COVID-19 hit,” said Lori Jump, director of the StrongHearts Native Helpline. StrongHearts is a domestic, dating and sexual violence helpline for American Indians and Alaska Natives created by the National Indigenous Women’s Resource Center.

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“Since people are sheltering at home, often with their abusers, they don’t have space or time to safely reach out for help,” she says.

Jump, a citizen of the Sault Ste. Marie Tribe of Chippewa Indians, reports that organizers of StrongHearts are pivoting their service offerings.

“We are working to text enable our call line and expand our online chat services so people can ask for help without saying a word,” Jump says.

Lori Jump, director of the StrongHearts Native Helpline. (Photo courtesy of National Indigenous Women's Resource Center)

Jump and other advocates fear that when COVID-19 dissipates, they may find that domestic violence has increased during the pandemic.

“Unlike our mainstream counterparts, we have limited access to data. We don’t know yet what our new normal will be,” Jump says.

Health care professionals also worry that the rates of substance abuse, relapse and overdose are increasing.

“We may find that when the smoke begins to clear that the rates of overdose deaths have increased,” Raney says. “In isolation, there is no one to administer naloxone.” Naloxone is a drug that can counteract the life-threatening effects of an opioid overdose.

“It will be at least six months before we know the mental health fallout from the virus,” she says.

Telehealth assisting mental and spiritual health

Meanwhile, however, IHS is seeing greater benefits from its early reliance on telehealth especially for mental health services.

“Limited access to transportation, money for gas, child care have all inhibited Native people’s ability to keep their traditional in person appointments,” Raney says.

Raney hopes that pandemic-driven expanded Medicare and Medicaid coverage for telehealth services will be continued after the threat from the virus has passed.

“The silver lining is that the pandemic is helping overcome negative social determinants for seeking mental health care among Native Americans,” Raney says.

Raney and others working in mental health care and community services also note that there have been benefits of families staying home and spending more time together.

Traditional, cultural activities usually done with family also provide protective health factors according to Raney, Henry and others.

Henry distributes cultural craft kits, coloring books and Indigenous language books among her clients and connects them to online tutorials demonstrating the work.

“I read books aloud in Lakota and Dakota on Facebook; people really love it,” Henry says.

According to Henry, Native people have a more holistic frame of mind regarding mental and physical health and understand the protective value of cultural activities such as artwork and learning about and practicing traditional ways.

Theresa Henry, cultural keeper for South Dakota Urban Indian Health in Rapid City. (Photo courtesy of Theresa Henry)

Isaac Murdoch, co-founder of the Onaman Collective, a group of Indigenous artists and Nimkii Aazhibikong, an Ojibwe language camp, agrees. Murdoch, citizen of Serpent River First Nation in Ontario, Canada, combines art, land and ceremony as a way to transfer knowledge of traditional teachings and language and as a means to heal from illness driven by colonial forces.

“Mental and spiritual health have a strong connection,” says Murdoch.

Spending time in the forest, picking traditional medicines, and participating in ceremonies helps nurture Native people back to good mental health according to Murdoch.

Traditional Indigenous ceremonies often involve large gatherings of people but Murdoch has been downsizing the activities. “It has been a struggle but I’ve been doing ceremony alone and am finding a more intimate spiritual connection to the land,” he says.

In some ways, Native people may be doing better mentally than others during the pandemic according to Zhawendaagozikwe.

“We understand the connection between spiritual and mental health and have our traditional ways already in place to support ourselves,” she says.

Although many of her clients need help with finances and keeping food on the table, the greatest need is for emotional support according to Henry.

“People need to talk about their fears and be reassured it’s okay to feel that way,” Henry says.

“Supporting and checking up on each other; that seems to be the most important part of surviving the pandemic,” she says.

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Mary Annette Pember, a citizen of the Red Cliff Ojibwe tribe, is a national correspondent for Indian Country Today.