A Systematic Review of Indigenous Pathways to Resilience Sheena Brown PhD MPH Mel and Enid Zuckerman College of Public Health University of Arizona Tucson AZ Background The experts talk ID: 569301
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Native American Adolescents: A Systematic Review of Indigenous Pathways to Resilience
Sheena Brown PhD MPH
Mel and Enid Zuckerman College of Public Health
University of Arizona, Tucson AZSlide2
Background“The experts talk about our community in terms of statistics and numbers. They don’t realize that these statistics
are
our friends, cousins, and brothers. They [the experts] don’t know that they might have had
a
brilliant future or who they were before bad things happened to them. They just have them
as
a statistic.
”
Jaron
Kie
(17),
Laguna youth group Albuquerque, New
Mexico
www.apha.org
“This
is my concern, that mental health … is bad, you have horrible statistics
but
no information about why it is so horrible. So, if you treat the symptom of
alcoholism
and not have it in the context of historical trauma, you are to miss
what
really the whole family is suffering from. What the whole generation is
suffering
from. So, this is my big concern that historical trauma doesn’t really
get
assessed as a diagnosis, it doesn’t get
treated.”
Native
American Community
Leader
UCDavis
CRHD, 2009 Slide3
American Indians and Alaska Natives (AIAN) are frequently among the most highly vulnerable populations including those who are homeless, incarcerated, and victims of traumaAIAN youth
75%
of deaths AIAN youth (12-20yrs): intentional injury, homicide, suicide*
79%
of youth in the Federal prison system are AIAN** 50% national high school graduation rateLiterature Review: Mental health issues of AIAN adolescents; programs, program needs, inequalities, risk and protective factors Explore the concept of resilience as a protective factor *SAMHSA**Bureau of Justice Statistics, 2004
BackgroundSlide4
MethodsDatabases searched: Pubmed, EBSCO, Web of ScienceTo
be included the article had to:
B
e written in English
Be peer-reviewed and published before May 1 2014 Identify AIAN adolescentsSpecify mental health focusIdentify social and environmental factors Search terms: Native American, American Indian, Alaska Native, Adolescent mental health, Adolescent and family mental health Slide5
Results – Literature
R
eview
Peer reviewed articles
(n=28)Number of journal articles identified
in database search (n=772)
Titles and abstracts with epidemiological, clinical and non-definitive
age focus
excluded
(n=710)
Number of articles reviewed by primary categories (n=62)
Mental Health Services (n=10)
n
=6
Mental Health Inequities (n=10)
n=3
Mental Health Needs (n=
8
)
n
=6
Risk Factors
(n=10)
n
=7
Articles excluded as Other
( n=18 )
Articles excluded, policy and/or off-topic focus
( n=16 )
Protective Factors (n=6) n=6
N=44Slide6
Mental Health ServicesServices predominantly community based and federally fundedProgram protocols originated from non-native communities
Medicalization of mental health issues
Pharmaceutical
influence on mental health diagnoses
Insufficient staff numbersPolitical, economic, institutional forces interpreted as MH issues ObstaclesSelf-relianceQuality of careCommunication / trustSlide7
Mental Health InequitiesAIAN adolescents suffer from disproportionately high rates of certain mental disorders and suicide
Substance abuse
Disruptive behavior disorder
Suicide
IncarcerationEffective mental health services remain in short supplyLack of Native cliniciansDistrust of non-Native cliniciansFunding Slide8
Mental Health Needs“The year 1992 was declared the "Year of the American Indian.” As we begin the new year, I am certain that all Americans want to continue to observe the respect that Native Americans deserve, by doing our best to raise Indian health status to the highest level possible by the year
2000”
Inouye 1993
Negligible mental
health services available to AIAN youth1 provider: 23,000 youth (Inouye 1993)Providers not always equipped to respondLack of facilities for youthSlide9
Risk FactorsIntergenerational traumaAlienation from family / lack of family cohesionLack of meaning and purpose, hopelessnessExposure to violence
Grief and loss
Poverty
Unemployment
Abuse Stigma Protective FactorsCommunity & family supportFamily connectionSupportive peer networksMeaning & purpose, hope
Culture & Ceremony
Traditional healing
Spirituality
Ethnic identity optimism, self-esteemSlide10
Recommendations Mental Health ServicesThe role of cultural, religious, and often social values and beliefs
are
poorly
understood
and accepted, by the general populationEvaluation of the role of traditional healers working with adolescentsRe-evaluate requirements for certification of lay-MH counselorsThe traditional holistic approach is different to non-Native MHS Slide11
Recommendations Mental Health InequitiesTailor or
augment
existing mental
health treatments
and services or…Reimagine MH approaches with local communitiesFamily involvement – key protective factorFunding: evidence vs innovationSlide12
Recommendations Mental health needsFamily is a key protective factorYouth involvement, Family involvement, Community involvementMental health services incorporated into education system
Program focus on values of individual communitiesSlide13
ResilienceThe ability to rise above adversityAll communities have strengths – deficit based programs negatively define, label and blame individuals
Community resilience; moving beyond labels
Risk and protective factors are context & environment dependentSlide14
Who Decides What Is And What Is Not Mental Illness?“Mental illnesses without aberrant symptomatology may not be viewed as illness at all” (Keltner
1993)
Prior
to European contact, there was no concept of mental illness
per se.Among various AIAN people, mental illness is viewed as: (a) a form of supernatural possession (b) an imbalance and disharmony with the inner and outer natural forces in the world (c) the expression of a special gift
Source:
Grandbois 2005Slide15
Worldview Differences that Impact Mental Health CareAmerican Indian/Alaska Native Majority culture• Relational, circular • Linear, point A to B
• Mind, body, spirit/One
• Psyche
is the focus
• Mystical/acceptance • Scientific/verification• Ceremonials/rituals • Psychotherapy• Tribal connectedness • Individualism• Spirituality & balance • Organized religions• Cooperation/sharing • Competition/winning• Patience/respectful • Assertive/forceful• Present oriented • Future oriented• Herbs, plants, nature • PsychopharmacologySource: Grandbois, 2005 (Table 2).
Who decides what
is,
and is not mental
illness?Slide16
ConclusionsNative initiated programsCulturally appropriate evaluationsIncrease tribal access to core Federal funding sources
Economic needs of youth
must
be addressed
Youth need to have important roles in the communityNeed meaning & a sense of autonomy in their livesEducation system – does it currently serve the needs of youth?Program focus on family cohesion and community strengthsReduce emphasis on defining the problemMuch information is not in the peer-reviewed literatureSlide17
Contact Information:
Dr. Sheena Brown
sheenab@email.arizona.edu
This
work was supported by the Center for American Indian Resilience (CAIR) a NIH-NIMHD P20 Exploratory Center of Excellence (1P20MD006872) awarded to Northern Arizona University with subcontracts to University of Arizona and
Diné
College
Photograph by
Sebastião
SalgadoSlide18
References Grandbois, D. M. 2005. Stigma of mental illness among American Indian and Alaska Native Nations: Historical and Contemporary perspectives. Issues in Mental Health Nursing, 26:1001–1024.
Inouye DK. 1993. Our future is in jeopardy: The mental health of Native American adolescents. J.
Health
Care
Poor &Underserved. 4: 6-8Keltner BR. 1993. Native American Children and Adolescents: Cultural Distinctiveness and Mental Health Needs. JCPN 6(4): 18-23U.S. Congress, Office of Technology Assessment. Indian adolescent mental health. OTA-H-446. Washington, DC: U.S. Government Printing Office, 1990.