Mental Health Resources for Native Americans

Mental health struggles are on the rise, impacting Americans across every race and ethnicity. However, some segments of our population have disproportionate rates of mental health disorders, along with significant barriers to care. One of the most affected groups in our country is the Native American community.

Indigenous/Native is a descriptive, umbrella term that refers to those who lived in the United States before European colonization. Census and survey data often identify these residents as American Indian and Alaska Native (AI/AN). Native people groups living in North America, being those with tribal or community affiliation, account for 1.1% of our population today.1 When you consider those identifying as AI/AN alone or in combination with another race, this group comprises 9.7 million people in the U.S. population.1

As of 2022, the U.S. contains 574 federally recognized tribal nations and 324 American Indian reservations.2 Along with such a large number of tribes and reservations comes great diversity and cultural differences among Native people groups. However, some core themes tend to prevail. An attachment to land and nature, strong familial bonds, and nurturing long-time traditions are common threads among AI/AN communities.3

Unfortunately, other prevalent trends among Native people include multi-generational trauma, mental illness, suicide, and substance abuse disorders. The Indigenous population has long suffered from mental health inequities in the U.S. Read below to learn more about mental health struggles among Native Americans, identified barriers to care, and resources for help.

CDC data from recent years reports that Native populations are more likely to experience serious psychological distress and mental health disorders than other demographic groups in the U.S.4 5 In fact, 2022 data indicates that 19.6% of AI/AN adults experienced mental illness within the year prior, with 7.3% of these cases being serious mental illnesses.6 Despite these statistics, there is a large portion of individuals who do not receive medical care for their mental health. For example, in 2019, only 13.9% of AI/AN adults received mental health services, and just 11.1% received prescription medication for their psychological health.5

This raises the question of why Native Americans are so disproportionately affected. Along with factors like poverty and a lack of proximity to care, research has demonstrated a direct link between historical trauma and mental health struggles.7 The impacts of colonization and forced relocation on emotional and mental health have contributed to intergenerational trauma experienced by Native communities.8 This type of trauma can show up in many different ways, including substance abuse, depression, and anxiety to name a few. Below, we explore the most prevalent issues plaguing the AI/AN population: substance abuse, post-traumatic stress disorder (PTSD), and suicide.

Substance Abuse

The Substance Abuse and Mental Health Services Administration (SAMHSA) 2022 Survey data indicates that AI/AN people are more likely to binge on alcohol or engage in heavy alcohol use than any other race or ethnicity in the U.S.9

Data also points to heightened marijuana, methamphetamine, and cocaine use among Native communities. Of particular concern are statistics regarding the disordered usage of prescription pain relievers and opioids among AI/AN people; a shocking 6.2 and 6.6% of AI/AN people struggle with abusing these drugs, in contrast to 1.9 and 2.0% of non-Hispanic White individuals, respectively.

These startling numbers paint the picture of a rising epidemic. The overdose death rate for AI/AN people increased by 39% between 2019-2020, taking the lives of 42.5 of every 100,000 people.10 Even before this increase, Native populations experienced the highest drug overdose death rates for any people group in 2019.11

Given the prevalence of substance use, it’s essential we all educate ourselves on indicators of a problem. Signs you or someone you know may be struggling with substance abuse include:12 13

• Mood changes
• Hostile, angry, or secretive behavior
• Changes in appearance or hygiene
• Missing work/school
• Changes in relationships with friends and family
• Changes in appetite or sleep habits
• Sudden weight loss or weight gain
• Neglecting responsibilities
• Unexplained financial problems
• Changes in personality or attitude
• Loss of control over drug use

Many elders and leaders in the AI/AN community believe that decreased cultural involvement among Native people has contributed to the ever-increasing rates of substance abuse.14 The importance of community support and the connection and engagement in traditions and spiritual practices expands across all facets of health. Concrete research backs up this concept; for example, a 2022 study of Native Americans seeking substance abuse treatment in an urban setting found that those who reported greater participation in traditional practices experienced less anxiety and depression.14

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that you can develop after experiencing or witnessing a terrifying event.15 While most people who experience a traumatic event recover with time, some individuals deal with lingering symptoms that can interfere with their ability to function in their everyday lives. Physical symptoms of PTSD include:16

• Trouble sleeping
• Trouble concentrating
• Angry or aggressive behavior
• Excessive drinking or other risky behavior
• Easily startled
• Feeling on guard at all times

People dealing with PTSD also experience distressing mental symptoms, such as the following:

• Intrusive flashbacks
• Nightmares or recurrent and unwanted memories
• Urge to avoid people or places that remind them of the trauma
• Feelings of hopelessness
• Feeling detached or numb
• Difficulty remembering things

While the prevalence of PTSD in the U.S. has been estimated to be between 4.8% and 6.4% of the general population, data estimates that between 16% and 24% of the AI/AN community suffers from this disorder in their lifetime.17 Unsurprisingly, PTSD often goes hand-in-hand with other mental health struggles, such as depression, anxiety, and alcohol abuse. For Native communities specifically, alcohol is their most frequently used substance, and AI/AN people have higher rates of alcohol-related deaths than other U.S. ethnic groups.17

Sadly, the historical traumas that have impacted the Native American population have undoubtedly contributed to this legacy of PTSD. Among other things, AI/AN members of our country have grappled with the devastating effects of:3

• Loss of ancestral land
• Displacement
• Forced removal
• Government-operated boarding schools
• Forced family separation
• Prohibition of cultural practices

Additional current-day struggles, such as the disproportionately high rates of violence against AI/AN women, continue to result in trauma and lingering PTSD.18

Suicide

According to the CDC, suicide was found to be the second leading cause of death for 10-24-year-olds among the AI/AN population in the U.S. in 2022.19 To put it in further perspective, the suicide death rate for Native adults is about 20 percent higher than that of the non-Hispanic White population.

The SAMHSA 2022 National Survey on Drug Use and Health revealed that 7% of AI/AN adults had serious thoughts of suicide within the past year, and 2.5% made plans for suicide.9 This lines up with further data from the CDC that AI/AN communities are disproportionately affected by suicide, surpassing rates among all other racial and ethnic groups in the U.S.20

These alarming statistics have spurred education efforts in Native communities. Suicide is a complex problem with layers of root issues that have to be addressed to make a difference, but there is still hope because suicide is preventable. We can’t always know what someone is thinking inside, but there are signs to look for.21

• Changes in personality
• Changes in sleep habits (much more or much less)
• Isolating themselves
• Behaving recklessly
• Giving away possessions
• Talking or joking about death
• Expressing feelings of hopelessness or anxiety
• Using substances more frequently

If someone you know needs help, call or text 988 to reach the Suicide and Crisis Lifeline or scroll down for more resources. In addition to encouraging them to seek treatment, you can help by being a supportive and compassionate listener, making sure that they know you care and want to hear their feelings and thoughts.

The healthcare disparities impacting the Native American community have been both longstanding and daunting. We’ve highlighted just some of the most significant barriers to care affecting the AI/AN population.

There is much work to be done to break down these barriers affecting the Native American population. Culturally appropriate health care, specific to each tribe’s traditions and practices, is ideal for healing the mind and body of the Native people. This highlights the overwhelming need for Indigenous mental health providers across the country. Integrating traditional healing and Western healthcare is only possible with intentional communication and respect between the two systems.7

There are many resources and helplines available when you need somewhere to turn for mental health help, whether during a crisis or not. In this case, we have compiled a list of resources specifically catered to the Native community.

When in crisis

• Crisis Text Line: Partnered with We R Native, text NATIVE to 741741 for free crisis counseling 24/7.
• 988 Suicide and Crisis Lifeline: Call or text 988 anytime, 24/7, or chat on the website for confidential support.
• Native and Strong: The offshoot of the 988 Lifeline specifically for Native individuals. Call 988 and press 4.
• Stronghearts Native Helpline: 24/7, anonymous call/chat line offering domestic, dating, and sexual violence support for AI/AN people.
• BlackLine: Call 800-604-5841 or download the app to text. Peer support and counseling for all in the BIPOC community.
• Trevor Project: Call 866-488-7386 or text START to 678678 for 24/7 confidential support for the LGBTQ+ and Two-Spirit community.
• Trans Lifeline: Call 877-565-8860 to reach a trained crisis counselor for the Trans community.
• RAINN (Rape, Abuse, and Incest National Network): Call the National Sexual Assault Hotline at 800-656-HOPE or chat on the RAINN website for 24/7 support.

Mental health support

• Caring Text Message: Native youth can text “CARING” to 65664 to receive hopeful and encouraging songs, videos, and messages. This program was developed by Thrive, a suicide prevention organization.
• Center for Medicare and Medicaid Services (AI/AN): A guide to finding mental health and substance abuse disorder services for Native people.
• Inclusive Therapists: Get matched with a BIPOC culturally competent therapist.
• Indian Health Services: Find federally-operated mental health programs in your area.
• Indian Health Services: Find a youth treatment center.
• Indigenous Wellness Research Institute: Tips by Native Aunties for mental health.
• Native American Healing and Counseling Collective: Teletherapy mental health services from a Native perspective.
• National Queer and Trans Therapists of Color Network (NQTTCN): Provides a directory of culturally competent mental health providers for queer and trans members of the BIPOC community.
• One Sky Center: Provider locator for mental health and substance abuse within Native American communities.
• Paths Remembered Project: Resources for Two-Spirit and LGBTQ+ individuals in the Native community; also an opportunity for no-cost connection to an affirming mental health provider.
• Substance Abuse and Mental Health Services Administration: Treatment locator map for mental health and substance abuse disorder.
• Sovereign Bodies Institute: Offers support services for Native survivors of violence.
• We R Native: Mental health resources and guides directed towards Native youth.