Abstract
Native Americans tend to acquire mental illnesses more often than other cultural groups that live in the USA. Suicide and depression rates among these indigenous peoples are growing. Native Americans are reluctant to seek help in medical facilities due to distrust and lack of awareness of the Native context among clinicians. Nurses and other medical professionals need to be attentive to Native Americans’ health care needs and provide culturally appropriate interventions.
Background
The mental health of Native Americans raises concerns among American medical professionals due to the increased risk of substance abuse, violence, suicide, and post-traumatic stress. The agencies that provide health care services for communities of Native Americans are unable to cope with their rising demands because they are understaffed and underfunded, thus leaving Native Americans’ mental health problems unaddressed and aggravating (Gone & Trimble, 2012). So far, the state is unable to address the health care needs of this cultural group and provide them with efficient healthcare that will also consider their cultural background.
Aim and Purpose
The aim of this paper is to understand what healthcare needs with regard to mental health Native Americans (adults, adolescents, and children) might have and how they can be addressed to reduce the rate of incidents related to mental health issues in Native Americans (e.g. suicides). The risk factors that can lead to mental health illnesses in Native Americans will also be addressed. Furthermore, the author also aims to understand what techniques are used by Native healers and how they reflect the relevant health care needs of Native Americans. The impact of discrimination on the mental health of the target population will also be addressed in this paper.
Research Method
The research method is a literature review. The author examined the current literature on the mental health problems of Native Americans and obtained three articles that address the following research questions:
RQ 1. What barriers do Native Americans face when they try to access mental health services?
RQ2. What are the reasons behind the increased rates of mental health illnesses diagnosed in Native Americans?
RQ 3. What strategies do Native healers use that can help clinicians address the health care needs of Native Americans?
Using a literature review as a research method for this paper, the author aims to answer three research questions, understand whether the current health care services are efficient for Native Americans, and discuss how the findings can change nursing practice if taken into consideration.
Review of Literature
West, Williams, Suzukovich, Strangeman, and Novins (2012) discuss the interconnection between community characteristics, health care needs, and mental health in urban Native American youth and families. The potential loss of cultural knowledge decreased interdependence, violence, financial instability, and parenting challenges (teenage or single-parent families) are indicated as factors that severely affect the life in the community. Furthermore, the participants of the study also noted the presence of indicators of negative mental health, such as violence, substance abuse, poverty, and high-stress levels.
The service system needs are the needs for funding and improvements in infrastructure (West et al., 2012). Due to understaffing, constantly changing mental health services are unable to meet Native Americans’ needs in mental health care. Furthermore, they also indicated the need for specific services that would target Native American youth and be culturally relevant (based on spiritual practices). Native Americans also need more programs that will promote general wellness in their communities. A culturally appropriate balance between spiritual and medical practices can encourage Native Americans to seek help in medical facilities rather than among peers and their families.
Barriers that restrict access to health care for Native Americans are the following: poor communication, stigma, practical barriers (e.g. transportation), and lack of knowledge about the mental health services (West et al., 2012). Some of the participants who took part in the study acknowledged they preferred using community supports, family members, or peers to cope with distress rather than seek professional medical help.
Nadal, Griffin, Wong, Hamit, and Rasmus (2014) examine the influence of racial microaggressions on people of color. If individuals frequently face racial microaggressions (such as microinsults or microinvalidations), they are at risk of developing negative mental health symptoms (anxiety, negative view of the world, depression, etc.). Specific microaggressions and microinvalidations, such as being treated like a second-class citizen, viewed as similar to other representatives of the same group, and exoticized correlate with depression and lack of positive affect. Racial invalidation can also lead to the development of a negative view of the world.
Therefore, Native Americans’ health care needs include psychological consultation and counseling that will validate their experiences and evaluate the presence of negative symptoms that lead to depression. It is important for counselors to “assist their clients in thoroughly processing their thoughts and feelings regarding microaggressions” (Nadal et al., 2014, p. 63). Furthermore, medical professionals themselves should pay attention to their communication with the cultural group to avoid expressing any bias toward them; such behavior only increases the cultural mistrust. Thus, it is crucial for a medical professional to be culturally competent and aware of how intersectional identities (gender, race, age) influence the experience with microaggressions of people of color.
Native healers are recognized in Native Americans’ communities as persons who can care for members of the community with the help of Traditional Indian Medicine (TIM). Bassett, Tsosie, and Nannauck (2012) examine the perception of trauma in Native healers and the strategies they use to help members of the community cope with it, as well as PTSD or other mental illnesses (substance abuse, violence, etc.).
The barriers to appropriate mental care as identified by the interviewed healers were the following: distrust, financial need, lack of resources or knowledge about the available care, and clinicians’ lack of knowledge about the Native context. To work on trauma, it is important for clinicians to recognize the context in which Native Americans live and view their injuries. If clinicians are willing to acknowledge the historical trauma or particular approach toward one’s health (as an entity that consists of physical, mental, and spiritual areas), it is possible Native Americans’ will have more trust in non-native health care. This way, their cultural, spiritual, and health care needs will be addressed efficiently.
Implications for Nursing Practice
The findings of the literature review indicate how nursing professionals should approach mental health problems in Native Americans. Specific attention should be paid to the lack of access to professional health care among Native Americans or lack of awareness about the resources available to them. Nursing professionals can spread additional materials about the available resources in communities where Native Americans reside.
The influence of discrimination on Native Americans is evident; nursing professionals need to ensure that neither they nor physicians or other medical personnel express any prejudiced attitude toward Native Americans. Nurses should be aware that besides physical care Native Americans might need counseling or therapy as well to meet their healthcare needs.
Native American context should not be neglected. Nurses need to be respectful and attentive to Native Americans’ perception of spiritual, mental, and physical domains of their body and use this context in their clinical practice. Medical professionals need to educate themselves about the culture of indigenous peoples to show respect and support toward Native American patients and validate their culture. If possible, hospital staff can be educated and trained by a Native healer so that they can understand the concepts used in Native medicine. Furthermore, it is also advisable to indicate awareness of the client’s culture by putting Native art on the hospital’s walls or using other symbols of inclusion (Bassett et al., 2012). Native Americans need to trust their doctors and nurses, and the development of this trust is impossible if medical professionals remain unaware of and insensitive toward the cultural group’s heritage.
Conclusion
Native Americans’ health care needs include available, context-sensitive, and racially unbiased healthcare that will address such issues as substance abuse, historical trauma, PTSD, suicide, depression, etc. Native Americans are in need of professional psychological help that will help them work on their encounters with racial microaggressions. To meet the needs of Native Americans, nurses and other medical professionals need to actively collaborate with Native healers who can teach them about the concepts and ideas common for Native medicine.
It is important to understand that substance abuse, high suicide rates, depression, and PTSD are related to historical and other types of trauma that Native Americans have experienced. Nurses need to validate both negative and positive experiences of Native Americans in their clinical practice and ensure patients are aware of the impact of microaggressions on their health and self-esteem. Workshops about the culture of indigenous peoples and Native medicine can make hospital personnel more aware of appropriate medical interventions during the treatment of Native patients, thus increasing the trust of the latter.
References
Bassett, D., Tsosie, U., & Nannauck, S. (2012). “Our culture is medicine”: Perspectives of native healers on posttrauma recovery among American Indian and Alaska Native patients. The Permanente Journal, 16(1), 19-27.
Nadal, K. L., Griffin, K. E., Wong, Y., Hamit, S., & Rasmus, M. (2014). The impact of racial microaggressions on mental health: Counseling implications for clients of color. Journal of Counseling & Development, 92(1), 57-66.
West, A. E., Williams, E., Suzukovich, E., Strangeman, K., & Novins, D. (2012). A mental health needs assessment of urban American Indian youth and families. American Journal of Community Psychology, 49(4), 441-453.