Bridging the Gap

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Purdue Global University *

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Apr 3, 2024

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Bridging the Gap: Access to Mental Healthcare Among American Indians and Alaska Natives Shannon Liller Purdue Global University DN733 Ethics, Policy, and Advocacy for Population Health Dr. Shirlean Pelham Bennett 11/18/2023

Bridging the Gap: Access to Mental Healthcare Among American Indians and Alaska Natives Mental healthcare access in the United States is a fundamental human right and essential for overall well-being. However, this access is markedly uneven, especially for American Indians (AI) and Alaska Natives (AN), progenies of Aboriginal people. These groups have historically endured trauma and continue to face racism and discrimination, contributing to heightened mental health issues (Smye et al., 2023). This situation is compounded by several obstacles to mental healthcare, such as geographic remoteness, cultural variances, lack of insurance coverage, and a deficit of psychiatric health professionals adept in working with the native population (Mental Health America, 2023). Addressing these inequities is vital for the health and fulfillment of AI and AN people. This paper aims to thoroughly explore the challenges of accessing mental healthcare among Native communities, examining the extent of the issue, its consequences, and potential solutions through policy initiatives, all within the framework of ethical nursing practices. Scope of the Problem According to the findings released by NAMI in 2023, there are "5.2 million" AIs and ANs residing in the United States who continue to face significant disparities in their mental health outcomes (para. 1). National data confirms that they are more vulnerable to psychiatric mental health disorders such as depression, PTSD, substance use disorders (SUDs), and suicide, as emphasized by SAMHSA (2023). NAMI (2023) reports that nearly one-fifth of the Indigenous population in the U.S. has encountered at least one of these mental health issues, with PTSD doubling that of the general population. Lack of access to mental healthcare directly impacts the United States on many levels, including state, federal, and community levels.

Impact on U.S. Population Regarding Access to Mental Healthcare for Indigenous Peoples This issue becomes a matter of public health, safety, and social injustice at a federal and state level. Despite obligations to Native people in the United States stemming from historical agreements, there is a significant disconnect between policy and actual service provision, leading to under-resourced and inadequate mental health services (O’Keefe et al., 2021). This shortfall not only perpetuates cycles of ill health and poverty among them but also imposes a financial burden on the healthcare system in America due to increased emergency care and an increased need for the involvement of social services (The White House, 2022). Access to psychiatric health care for native populations is severely lacking, leading to a variety of negative consequences. This issue affects the individuals in these communities and imposes economic, social, and cultural costs on society. Targeted efforts should be made at all levels of government, focusing on providing culturally sensitive and accessible mental health services. Stakeholders for AI and AN Mental Healthcare Mental health access for indigenous people involves many stakeholders playing a crucial role. The AI and AN communities are the primary recipients of mental health services and often co-design these services, which is central to the process (Serchen et al., 2022). Their unique needs and cultural contexts drive the demand for more tailored and respectful mental health care. Tribal leaders and governments are also key stakeholders, advocating for the rights and needs of their population. They often navigate complicated relationships with federal and state governments to secure necessary resources and policy support (Montesanti et al., 2022). The government is responsible for policy making, funding, and oversight of mental health services. Other mental health professionals, such as psychiatric providers, nurses, and social

workers, are essential stakeholders when they are trained to give culturally competent care. In addition, non-profit organizations and advocacy groups contribute significantly, raising awareness, lobbying for better policies, and providing services, including The Indian Health Service (IHS) and WeRNative, (Mental Health America, 2023). Academic and research institutions are also invaluable for generating data and evidence-based strategies to address mental health challenges (Kwon & Saadabadi, 2022). Although each stakeholder should contribute to a holistic approach, addressing the clinical aspects of mental health and the socio- cultural and economic factors that influence it, there are several ethical dilemmas associated with mental healthcare access for the AI and AN population. Ethical Dilemmas and for AI and AN Mental Healthcare Access Mental healthcare services for Native Americans pose several ethical dilemmas. These dilemmas entail but are not limited to, cultural sensitivity versus standardized care, historical trauma and trust, and resource allocation. Although our healthcare aims to provide culturally sensitive care, it often cannot be due to standardized healthcare education and practice in the U.S. (Kwon & Saadabadi, 2022). Furthermore, AI and AN people experienced centuries of racism, separation, and historical trauma through exploitation and mistreatment by healthcare systems (Oldani & Prosen, 2021). In addition, there are significant deficits in allocating funding and mental health services within the Native communities (Lofthouse, 2022). Socioeconomic Disparities Native American communities across the United States experience significant socioeconomic disparities, including poverty and lack of insurance, which impede their access to mental health services (NAMI, 2023). Disparities are further exacerbated by underfunded health services in tribal areas, which often lack the resources to provide quality care. These disparities

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