Native American communities prioritize culture, recruiting for mental health treatment

The shortage of Native American mental health clinicians is both a professional and a personal issue for Mary Owen.

“I’ve struggled with depression myself since high school,” said Owen, a Native American doctor in Duluth and associate dean of community health at the University of Minnesota Medical School.

Owen, a member of the Tlingit Nation, grew up in Juneau, Alaska, where “natives were at the bottom of the charts,” she recalls, and the racism she often encountered made her feel like a second-class citizen.

She has devoted much of her professional career to increasing the number of Native American health professionals of all kinds. Owen said she has always struggled to find local therapists — for her own patients in Duluth and for herself.

“I could definitely relate more to a counselor of color, just our shared history of trauma and marginalization in this country. But I couldn’t even find that,” she said.

“And also, someone who can relate to my experience as an Indigenous woman, as a woman who is always invisible in this country, [I’ve also] I’ve never been able to find that.”

Although exact numbers are hard to come by, there are probably only 200 to 300 Native American psychologists nationwide, out of a population of several million.

“American Indians are the most underserved and underrepresented when it comes to the ratio of psychologists to potential population,” said Doug McDonald, a professor of clinical psychology at the University of North Dakota and a member of the Oglala Lakota and Northern Cheyenne tribes.

Students enrolled in the Native American psychology doctoral program at the University of North Dakota pose for a photo on Aug. 21, 2021.

Courtesy of the UND Indians in Psychology Program

At the same time, there is a significant need for mental health services in local communities. According to government estimates, nearly 20 percent of Indian adults have experienced mental illness. The suicide rate among Native teens is more than twice that of white youth. Indigenous people experience severe psychological distress at more than twice the rate of the general population.

“It has to do with the history that we’ve lived and that we can’t break away from,” explained John Gonzalez, a professor of psychology at Bemidji State University and a member of the White Earth Nation.

“We have generations and generations of people who have been through trauma and continue to experience various forms of trauma, and then continue to struggle to live in poverty.”

And while he stresses that not every local person will experience negative outcomes because of it, “there’s enough of that in our community where there hasn’t been a lot of healing,” he said. “This is what needs to happen.”

Culturally appropriate care

For healing to occur in Native American communities, experts emphasize the importance of providing culturally appropriate mental health care.

To explain why, MacDonald tells a story he remembers from finishing school, when a non-Indigenous classmate tried to help a young Indigenous customer. He remembers watching when the girl came in for her third session and immediately noticing that her hair had recently been cut short.

“They sit down and my colleague looks at her and says, ‘Oh, what did you do with your hair?’ She had such nice hair.”The young native client bursts into tears, gets up, leaves and never comes back,” he said.

McDonald explains that some traditional indigenous people cut their hair when they are grieving. In this case, he later learned that the client’s mother had died.

“It was unintentional, what my colleague did, she was caring, she was trying to be helpful. But it was a huge mistake,” he said.

For the past 30 years, McDonald’s has worked to try to reduce the number of these cultural “blunders.”

When he received his doctorate in 1992, he estimated that there were only 100 Native American psychologists.

In response, he started a program at the University of North Dakota called Native American Doctoral Training in Psychology, focused on training more Native American psychologists and increasing the cultural competence of non-Native providers.

The program is written into the federal Indian Health Care Improvement Act, which also provides funding for similar programs at the University of Montana and Oklahoma State University.

A man holds two bottles of medicinal oils

Richard Wright holds bottles of infused oils that are given to patients who need an alternative to traditional burn techniques in his Minneapolis office on Wednesday.

Ben Hovland | MPR news

Since then, progress has been steady but slow. Over the past 30 years, UND’s program has graduated about 30 local psychologists. That’s the most of any university, but at that rate, MacDonald admits, the program “will never be able to meet the needs in Indian country on our reservations and in urban Indian centers.”

But some of these graduates are planting seeds to produce even more mental health professionals to serve local communities.

Gonzalez is one of them. Last year, he launched a program at Bemidji State University designed to encourage Native American students studying psychology.

“We meet with them every other week. And it’s just a time for them to come together as local students, share what’s going on in their lives, talk about what’s going on in class, what’s going on at home, and things they’re struggling with,” Gonzalez said. .

There were six students in the initial cohort of Indigenous psychology students. One of them has already graduated from university. The program now offers scholarships to up to ten Native American students majoring in psychology through a recent grant from the Blandin Foundation.

“Most of these students want to go back home,” Gonzalez said. “They want to go back and provide service in the community.”

A bouquet of cedar and sweet grass

A bundle of cedar and a tangle of sweet grass, two of the spiritual remedies Richard Wright uses, sit on his desk in his Minneapolis office Wednesday.

Ben Hovland | MPR news

Traditional treatment

Jessica Gourneau—one of the first graduates of the Indian in Psychology program at the University of North Dakota—is now clinical director at the American Indian Family Center in St. Paul, which provides many services out of an old Indian Health Service clinic on the city’s east side.

When she first started more than 20 years ago, Gourneau realized that the approach to mental health she learned in school wasn’t working for her clients, who were often dealing with complex historical trauma.

Bits and pieces worked, but “nothing helped people get to the point of healing,” she said.

Now, she said, the center helps people tap into the resilience and healing that already exists among indigenous people by focusing on traditions, values ​​and ceremonies. “Because we notice that people are praying for it,” Gourneau said. “And they’re taking advantage of that.”

Two years ago, Gourneau and others successfully lobbied the state legislature to create a program specifically aimed at funding traditional healing for tribal communities.

Two million in annual funding now helps ten tribal nations and five American Indian urban organizations across the state incorporate traditional healing practices into the treatment of mental health and substance use disorders.

This process begins the first time people enter an American Indian family center, Gourneau explains. Vendors will visit customers, offer food and try to build a relationship. They don’t just perform a diagnostic assessment. They also ask about spirituality and cultural identity.

“It’s an important part of mental health. So when we get to that, we start talking about it and giving them that space,” she said.

A man with glasses and gray hair sits at a desk

Local spiritual healer Richard Wright poses for a photo in his Minneapolis office on Wednesday.

Ben Hovland | MPR news

If clients are interested, providers will put them in touch with community elders, including Richard Wright, who works as a spiritual assistant at the Minneapolis Indian Health Council.

“One of my first questions is, ‘Where are you from?’ To me, that’s a diagnostic characteristic,” he said. “It helps me develop a series of questions to determine if they are traditional.”

Wright is 73. He speaks slowly, softly. His office is filled with tobacco, sweet grass, and sage—traditional remedies he shares with clients. Being able to return to his traditions as an Ojibwe man allows him to “share some of the practices that we use to heal people,” he said.

Wright leads healing circles and community ceremonies that can have a profound effect on people.

“I’ve had people come up to me at these healing ceremonies and talk about feeling suicidal, that it helped them live another day,” Gourneau said. “It hits very close to home. That speaks to them.”

She said people often need traditional ceremonies to return to as they work through what they learn in therapy.

“I feel the traditions and values ​​speak to the Indian in them,” Gourneau said. “And that opens them up to being open to that process.”

This story is part of Call to Mind, American Public Media and MPR’s initiative to foster new conversations about mental health. Tune in to MPR News with Angela Davis for a discussion with a local therapist at 9 a.m. on Tuesday, October 18. You can also listen to a one-hour special Call to Mind on looking for color suppliers Wednesday October 19th at 9am

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