Global Focus, Local Acts: Providing Mental Health Services to Indigenous People
Section snippets
Challenge: Proximity
Historically, mental health services have been concentrated in urban areas at clinical, agency, or hospital settings. The introduction of community mental health clinics made services more accessible to people in some rural locations. Yet, even in developed countries, geography often challenges the accessibility of mental health services for indigenous peoples. In communities that are “off the road system,” access to mental health care requires that the patient travel to access services or that
Strategy: Itinerant providers
Delivery of services by an itinerant psychiatric nurse can offer access to mental health services for people in remote communities, without incurring the expense of developing a community clinic or requiring repetitive travel by patients. Based in a regional office, itinerant providers travel among remote communities providing mental health services. In addition to enhancing patient access to services, this approach conforms to the holistic perspective on healing that is shared by many
Challenge: Community knowledge of mental health concepts
Community response to mental health issues cross the boundaries of country, culture, and tribal or communal affiliation. Mental problems are often perceived as the outcome of spirit possession, magic, punishment by God, or personal failings (Karim et al., 2004), and unusual behavior by an individual may elicit shame and fear among members of his or her family and community.
Approximately 30% of people in any population can be expected to develop one or more mental health disorders in their
Strategy: Forging learning alliances
People find inspiration and comfort in the familiar; this is likely more accurate when they experience mental distress. Thus, itinerant psychiatric nurses who serve indigenous peoples must attend to what is known and familiar in regard to mental health and healing within a community even as he or she introduces modern perspectives and practices. In approaching traditional and scientific ideas as potentially complimentary, the psychiatric nurse can provide indigenous people with access to new
Challenge: Human resources in the context of traditional healing
Chief among the resources in a community are traditional healers who are often the first helpers sought out by those with mental health problems, as people continue to perceive traditional healers as a major source of health care (Beals et al., 2005, Crawford & Lipsedge, 2004, Manson, 2000, Offiong, 1999). Healing among indigenous peoples is more than curing disease or illness. It is conceptualized in holistic terms, and well-being is a quality of individuals, couples, families, and communities
Strategy: Working within the context
Research shows that when conventional mental health services and traditional healing are available in indigenous communities, people seeking assistance often make use of both (Levers, 2006, Offiong, 1999, Patel et al., 2007). Because traditional healers are gatekeepers and bridges to the community, collaboration and a working alliance with them can powerfully influence the effectiveness of the mental health provider (MHP).
Another potential resource lies in recruiting and training behavioral
Challenge: Cultural congruence
In all of their work, itinerant psychiatric nurses must critically and thoroughly examine their understanding of the culture of their patients. As with any group, knowledge of one indigenous culture is not applicable to all indigenous people. Still, there are sufficient commonalities to merit some tentative principles that may serve as a foundation for ideas, critical thinking, and testing one's experience and knowledge of clinical work within indigenous communities. Ultimately, each
Strategy: Promoting cultural congruence
In closing we offer some basic suggestions for the psychiatric nurses who become involved in intercultural endeavors. Offered as a starting point, these ideas suggest perspectives that appear to be common across many or most indigenous cultures. These common tenets may allow an MHP to enter into an indigenous community with working strategies that encourage a more robust learning process toward building cultural competence.
Conclusion
Providing mental health services to indigenous peoples requires that psychiatric nurses come to understand indigenous beliefs about balance, relatedness, and holism that underlie the concept of health and healing. In building relationships with elders, leaders, and traditional healers, one may learn about the ways of the people and gain acceptance within a community. Such relationships may evolve into a consultant network that guides, validates, and supports one's work within the community.
References (44)
- et al.
Mental health, substance use and suicidal behaviour among young indigenous people in the Arctic: A systematic review
Social Science and Medicine
(2009) What traditional indigenous elders say about cross-cultural mental health training
Explore: The Journal of Science and Healing
(2009)- et al.
Treatment and prevention of mental disorders in low-income and middle-income countries
Lancet
(2007) - et al.
No health without mental health
Lancet
(2007) - et al.
Resources for mental health: Scarcity, inequity, and inefficiency
Lancet
(2007) Behavioral health aide project
Conversation, language and possibilities: A postmodern approach to therapy
(1997)- et al.
Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: Mental health disparities in a national context
American Journal of Psychiatry
(2005) Cognitive therapy: Basics and beyond
(1995)- et al.
Systems theory and family therapy: A primer
(1999)
Social services and indigenous populations in remote areas: Alaska Natives and Negev Bedouin
International Social Work
Creating futures: Influencing the social determinants of mental health and wellbeing in rural, indigenous and island peoples
Australasian Psychiatry
Counseling indigenous Shone people in Zimbabwe: Traditional practices versus western Eurocentric perspectives
Alternative
Health in the Andes: The modern role of traditional medicine. The Globalist
Seeking help for psychological distress: The interface of Zulu traditional healing and Western biomedicine
Mental Health, Religion and Culture
Cultural competence continuum
Focal point: The bulletin of the research and training center on family support and children's mental health
The Inspiration of Hope in Bereavement Counseling
Issues in Mental Health Nursing
Towards an understanding of suicide in first nation Canadians
Crisis
Honoring the power of relation: Counseling native adults
Journal of Humanistic Counseling Education and Development
An invitation to social construction
Mental health services for Native Americans in the 21st century United States
Professional Psychology: Research and Practice
Holistic Community Development: Wellness for the Collective Body
American Indian Culture & Research Journal
Cited by (10)
The mental health of Indigenous peoples in Canada: A critical review of research
2017, Social Science and MedicineMeasuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review
2024, Journal of Racial and Ethnic Health DisparitiesIndigenous Cultural Safety Training for Applied Health, Social Work, and Education Professionals: A PRISMA Scoping Review
2023, International Journal of Environmental Research and Public HealthPrevalence of Depression and Generalized Anxiety Disorder Among Mexican Indigenous Adolescents and Young Adults: Challenges for Healthcare
2021, Child Psychiatry and Human DevelopmentMental Health and Addictions Care: A Path towards Mental Health Care with Northern Indigenous Peoples
2021, Health and Health Care in Northern Canada