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Article Excerpt
Current mental health practices appear to be largely ineffective in terms of meeting the needs of many Native Americans (Graham, 2002; Weaver, 2004). According to nationally representative survey data (N = 134,875), Native Americans are significantly more likely to indicate that they have unmet needs in the area of mental health care than are white Americans (Harris, Edlund, & Larson, 2005). Conversely, the perceptions of unmet mental health care needs among African Americans, Asians, and Hispanics are usually lower than those of white Americans--often significantly lower (Harris et al., 2005). The high level of unmet needs among Native Americans calls for some type of explanation.
In what might be considered the conventional hypothesis, the higher perceived need among Native Americans is related to the existence of higher rates of mental health challenges in this population. Indeed, a substantial body of research indicates that the prevalence rate of mental health challenges among Native Americans is significantly higher than it is among white Americans and many other populations (Beals et al., 2005; Harris et al., 2005; Kulis, Napoli, & Marsiglia, 2002; Stiffman et al., 2006; Weaver, 2004). Thus, perceptions of unmet need are posited to exist because of the magnitude of the challenges and the scarcity of resources. The solution, according to this view, is to increase access to professional service providers so that mental health challenges can be met.
This hypothesis, however, is based on the premise that Native Americans lack sufficient access to professional service providers. Yet according to recent, nationally representative data, Native Americans are just as likely as whites Americans to use mental health services (Harris et al., 2005). This is true for those experiencing one or more health symptoms as well as for those with serious mental illness. For instance, among Native Americans with serious mental illness (n = 161), roughly 61 percent had used mental health services (Harris et al., 2005). In absolute terms, this was the highest percentage of service usage among the groups surveyed. These data suggest that the high level of perceived unmet mental health needs cannot be attributed solely to lack of access to mental health services.
An alternative, critical viewpoint posits that the problem lies not with the degree of access but with the services themselves. Professional mental health services are often perceived by Native Americans to be ineffective (Graham, 2002; Weaver, 2004). One recent survey of tribal members living on four reservations (N = 965) assessed the effectiveness of various types of services commonly used to address mental health and substance abuse problems (Walls, Johnson, Whitbeck, & Hoyt, 2006). Of the 21 types of services assessed, those provided by professional service providers were perceived to be the least effective. Services provided by off-reservation social workers, the most numerous providers of mental health services in the United States, were perceived to be the least effective of all.
In short, perhaps the reason so many Native Americans report unmet mental health needs--despite receiving relatively high levels of mental health services--is simply because the provided services do not meet their needs. The service models are simply ineffective. Yet, as implied earlier, much of the existing scholarship on Native Americans supports, either implicitly or explicitly, existing Western models of service delivery.
This article provides an alternative viewpoint, positing that the Western therapeutic project is inconsistent with many Native American cultures and often serves as a form of Western colonization. We suggest abandoning this value-informed project and rebuilding the helping process on tribal knowledge foundations. In keeping with this goal, we offer a relationally based Native perspective in which wellness results from the complex interplay of spirituality, physical status, cognitive and emotional processes, and environment. Before proceeding, however, the diversity of perspectives that exists among Native Americans should be noted.
NATIVE AMERICAN--A CONSTRUCTED CONCEPT
It is important to recognize that terms such as "Native American" and "American Indian" are linguistic devices designed to denote contemporary descendents of a wide variety of tribal nations. Over 550 American Indian tribes are currently recognized by the federal government (Fuller-Thomson & Minkler, 2005). In addition, many other tribes are recognized only by state governments, and still others are working to obtain official governmental recognition. Each tribe, whether recognized or not, is informed by a culturally unique worldview (Trujillo, 2000; Whitbeck, 2006).
Although Native Americans commonly affirm a number of values (Cross, 1997; Jackson & Turner, 2004), no single Native perspective exists among the 4.3 million people who self-identify as American Indian or Alaskan Native in the United States (U.S. Census Bureau, 2000). In this article, we present one Native perspective that has broad resonance among many Native Americans. Before delineating this perspective, we discuss how mainstream mental health services can oppress Native clients, in spite of good intentions on the part of practitioners.
THERAPY AS COLONIZATION
In practice settings, it is widely accepted that the theoretical perspective brought to the table influences how problems are conceptualized and addressed (Tjeltveit, 1999). Practitioners using a cognitive perspective may be more likely to view problems as stemming from unhealthy schemas and recommend interventions that emphasize salutary thoughts. Alternatively, those operating from a behavioral theoretical framework may be...
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