Stigma of mental illness among American Indian and Alaska Native Nations: historical and contemporary perspectives

North Dakota State University, Fargo, North Dakota 58078, USA.
Issues in Mental Health Nursing 01/2006; 26(10):1001-24. DOI: 10.1080/01612840500280661
Source: PubMed


Among American Indian and Alaska Native (AIAN) people, the concept of mental illness has different meanings and is interpreted in various ways. This paper describes the realities of mental health care that confront AIAN people. Stigma is associated with mental illness, which can be a barrier for those individuals who are in need of mental health services. Within the context of the AIAN historical and contemporary experiences, the paper details domains that negatively influence the lives of AIAN people. Included are the failure of the U.S. government to fulfill its treaty agreements with AIAN people; the disparities in income and education, and the pervasiveness of poverty; and access to care issues. These domains help to set the stage for health disparities that frequently catapult AIAN people to early morbidity and mortality. Importantly, many of these conditions are preventable. The paper concludes with recommendations for a more diverse workforce that will include AIAN mental health professionals who are available to provide culturally competent care to AIAN people in a variety of settings.

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Available from: Donna M. Grandbois, Aug 18, 2015
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    • "Other areas of health present a similar picture. The stigma associated with mental illness persists across many cultures and causes harm, and like others, many Indigenous people are reluctant to attend and have inadequate access to health care services [13,14]. In the US, ongoing disparities in income and education and the pervasiveness of poverty all impact negatively on the mental health and wellbeing of American Indian and Alaska Native peoples and lead to early morbidity and mortality [14]. "
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    ABSTRACT: Indigenous peoples have worse health than non-Indigenous, are over-represented amongst the poor and disadvantaged, have lower life expectancies, and success in improving disparities is limited. To address this, research usually focuses on disadvantaged and marginalised groups, offering only partial understanding of influences underpinning slow progress. Critical analysis is also required of those with the power to perpetuate or improve health inequities. In this paper, using Australia as a case example, we explore the effects of 'White', Anglo-Australian cultural dominance in health service delivery to Indigenous Australians. We address the issue using race as an organising principle, underpinned by relations of power. Interviews with non-Indigenous medical practitioners in Western Australia with extensive experience in Indigenous health encouraged reflection and articulation of their insights into factors promoting or impeding quality health care to Indigenous Australians. Interviews were audio-taped and transcribed. An inductive, exploratory analysis identified key themes that were reviewed and interrogated in light of existing literature on health care to Indigenous people, race and disadvantage. The researchers' past experience, knowledge and understanding of health care and Indigenous health assisted with data interpretation. Informal discussions were also held with colleagues working professionally in Indigenous policy, practice and community settings. Racism emerged as a key issue, leading us to more deeply interrogate the role 'Whiteness' plays in Indigenous health care. While Whiteness can refer to skin colour, it also represents a racialized social structure where Indigenous knowledge, beliefs and values are subjugated to the dominant western biomedical model in policy and practice. Racism towards Indigenous patients in health services was institutional and interpersonal. Internalised racism was manifest when Indigenous patients incorporated racist attitudes and beliefs into their lived experience, lowering expectations and their sense of self-worth. Current health policies and practices favour standardised care where the voice of those who are marginalised is often absent. Examining the effectiveness of such models in reducing health disparities requires health providers to critically reflect on whether policies and practices promote or compromise Indigenous health and wellbeing--an important step in changing the discourse that places Indigenous people at the centre of the problem.
    BMC Health Services Research 06/2012; 12(151):151. DOI:10.1186/1472-6963-12-151 · 1.71 Impact Factor
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    • "However to date research about cultural beliefs of ethnic minorities about mental health is limited, especially outside North America. In North America research conducted on the cultural beliefs of ethnic minorities typically identified perceived discrimination and stigma by the authorities and the medical establishment as a barrier to mental health care and a cause for underutilisation of services, and this has continued to be the focus of this kind of research in recent years (Burgess et al 2008; Gary 2005; Grandbois 2005). This type of stigma or perceived stigma can be considered 'external'. "
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    ABSTRACT: BACKGROUND: Existing knowledge about the cultural beliefs of black and minority ethnic (BME) communities in the UK regarding stigma and mental illness is limited. MATERIAL: Data were collected in 10 focus groups, five with service users and five with laypersons, from BME communities in London. DISCUSSION: Thematic analysis identified that cultural beliefs regarding mental illness reflect four different voices present within the BME communities. CONCLUSION: The study revealed that cultural beliefs influencing both relationships with family and, consequently, help-seeking for individuals with mental illness must be considered in the development of anti-stigma interventions and when engaging communities around mental healt.
    International Journal of Social Psychiatry 05/2012; 59(6). DOI:10.1177/0020764012443759 · 1.15 Impact Factor
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    • "Mental health issues for young men, such as depression, anxiety, grief, and loss, are an increasing public health concern (Breland & Park, 2008). In particular, mental health conditions among AI populations have been associated with both historical and contemporary experiences (Grandbois, 2005). AIs in the United States have endured many historically significant events, including colonization, epidemics, warfare, and forced subjugation. "
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    ABSTRACT: The Fort Peck Sexual Health Project: A Contextual Analysis of Native American Men is a community-based participatory research (CBPR) project that explores the extent to which knowledge, attitudes, and beliefs about sex, intimate relationships, and mental health influence sexual and reproductive health. For the purpose of this study, the influence of age, fatherhood, and mental health factors related to historical trauma and loss on young American Indian (AI) men's intention to use birth control was examined. In-depth interviews were conducted with 112 Native American men between the ages of 18 and 24 years. The mean age reported was 21 years. Thirty-eight percent of the young men reported having children. The young men reported experiences of historical trauma during their lifetime as well as emotional responses due to historical losses. Ninety-five percent reported that it was very important that they use some form of birth control to prevent their partner from getting pregnant within the next year. Logistic regression analysis indicated that, as age increased, young men were less likely to use birth control to prevent pregnancy. The young men who reported feelings of loss due to experiences related to historical trauma and loss were more likely to use birth control. Findings from this study suggest that public health efforts to educate AI men about planned pregnancies and the use of birth control may be most effective in adolescence. Public health programs that address mental health concerns such as the emotional responses due to historical losses may assist young AI men in their decision to use birth control.
    American Indian and Alaska native mental health research (Online) 01/2012; 19(1):57-75.
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