Global Focus, Local Acts: Providing Mental Health Services to Indigenous People

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Four fundamental challenges to the provision of mental health services to indigenous populations are discussed, including proximity to services, community knowledge of mental health principles, human resource use, and cultural congruence. We describe concepts common to most indigenous approaches to mental well-being, including restoring health through balance and relatedness. Some strategies of practice are suggested to facilitate the cultural competence of psychiatric nurses and other mental health professionals who work with indigenous peoples. We contend that changes in availability of mental health services to indigenous peoples across the globe can be initiated with local actions by professionals who serve this population.

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.

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