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Understanding Native Behavioral Health: Problems and Solutions
One Sky Center
R Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer Doug Bigelow, PhD
Association of American Indian Physicians Annual MeetingPortland, Oregon August 12, 2011
One Sky Center Staff
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Susan Michelle Patricia Doug Dale
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One Sky
Center
1.Opportunity 2. Research
3.Excellence8.Tribal Leadership
4.Training 5. Consultation 6. Technical Assistance
7. Education 9. Mentorship
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One Sky Center Outreach
WHO ARE INDIGENOUS PEOPLES?
“Indigenous peoples remain on the margins of society: they are poorer, less educated, die at a younger age, are much more likely to commit suicide, and are generally in worse health than the rest of the population."
(Source: The Indigenous World 2006, International Working Group on Indigenous Affairs (IWGIA) WHO
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Native Healthcare Resource Disparities
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Agencies Involved in B.H. Delivery
1. Indian Health Service (IHS)A. Mental HealthB. Primary HealthC. Alcoholism / Substance Abuse
2. Bureau of Indian Affairs (BIA)A. EducationB. VocationalC. Social ServicesD. Police
3. Tribal Health4. Urban Indian Health5. State and Local Agencies6. Federal Agencies: SAMHSA, VAMC,
Justice
Social Determinates of Health: Whitehall Studies
• Within a hierarchical society, there is a social gradient for morbidity and mortality. (Poverty, sanitation, nutrition, and shelter are controlled.)
• Higher status folks live longer and healthier.
Health Care Improvement Needs More Than Money:
• Opportunity, Empowerment, Security, Control, and Dignity….
10www.thelancet.com Dec 9, 2006. MarmotAmartya Sen 1998 Nicholas Stern 2004
Critical Elements for Native Peoples
• Self determination• Ecology and environment• Economic prosperity, fairness and equity• Leadership and capacity strengthening• Racism / dominance / imperialism• Healing, services, systems, structures• Cultural sustainability, protection, stewardship• Land• Human rights
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DETERMINANTS OF HEALTH:
RACE AND ETHNICITY• Economic• Political • Social • Educational• Employment• Income• Access to health
care
• Environment• Law Enforcement /
Justice• Home • Colonialism as a
Broader Social Determinant of Health
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It’s the Economy, Stupid
• Recession hit minorities much harder than whites, report says Overall, whites suffered a fraction of the loss that hit Hispanics, Blacks. Orlando Sentinel.
• Race, Gender and Structural Inequalities in the Great Recession and the Recovery (Joel Wendland, Political Affairs)
• America's massive racial wealth gap (The Week)• Separate but unequal: Charts show growing rich-poor
gap (CNN NEWS)• It’s the inequality, Stupid (Zachary Roth | The Lookout)• White Americans Are A Record 20 Times Wealthier
Than Black Americans (Business Insider)
Building a Better America—One
Wealth Quintile at a Time
Michael I. Norton1 and Dan Ariely2
Recession Worsens Racial Wealth Gap
Who Rules America? Wealth, Income, and Power.
Net Worth Financial Wealth
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Behavioral Health Care Issues
Native Health Issues
1. Alcoholism 6X
2. Tuberculosis 6X
3. Diabetes 3.5 X
4. Accidents 3X
5. Poverty 3x
6. Depression 3x
7. Suicide 2x
8. Violence?
1. Same disorders as general population
2. Greater prevalence3. Greater severity4. Much less access
to Tx5. Cultural relevance
more challenging6. Social context
disintegrated
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20SAMHSA Office of Applied Studies, 2001
Adult Serious Mental Illness By Race/Ethnicity: 2001
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0
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Suicide Among ages 15-17, 2001Death rate per 100,000
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Source: National Vital Statistics System - Mortality, NCHS, CDC.
2010 Target
TotalAmeric
an
IndianAsian
HispanicBlack
White Females Males
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Mental Illness: A Multi-factorial Event
Edu., Econ., Rec.Edu., Econ., Rec.
Family Disruption/Domestic ViolenceFamily Disruption/Domestic Violence
ImpulsivenessImpulsiveness
Negative Boarding SchoolNegative Boarding School
HopelessnessHopelessness
Historical TraumaHistorical Trauma
Family HistoryFamily History
SuicidalBehaviorSuicidal
Behavior
Cultural DistressCultural Distress
Psychiatric Illness& StigmaPsychiatric Illness& Stigma
Psychodynamics/Psychological VulnerabilityPsychodynamics/Psychological Vulnerability
Substance Use/AbuseSubstance
Use/Abuse
Individual
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Models of Care
Practice Practice (Service)(Service) Culture ValuesCulture Values
PhilosophiesBelief about causes of problems and solutionsLocal innovation, trial and errorMedicinal use of wild plants and mineralsHealing proceduresOral transmission of knowledgeCommunity evaluation and acceptance
Best Best PracticePractice
Science & Science & ScholarshipScholarship
04/18/2324
Using the OPRE Review
Community Based Logic Community Based Logic ModelModel
04/18/23 Using the OPRE Review25
4. Theory of Change
5. Operations Manual
3. Strategy
8. Long term (Impact)
7. Medium term
6. Short term
04/18/2326
Evaluation in Indian Country
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No No ProblemsProblems
Universal/Selective Universal/Selective PreventionPrevention
Brief InterventionBrief Intervention
TreatmentTreatment
Mild Mild ProblemsProblems
Moderate Moderate ProblemsProblems
Severe Severe ProblemsProblems
Thresholds for ActionThresholds for Action
Spectrum of Intervention Responses
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Domains Influencing Behavioral Health: A Native
Ecological Model
Individual Peers/Family Society/CulturalCommunity/Tribe
Risk
Protection
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Individual Intervention
• Identify risk and protective factors counseling skill building improve coping support groups • Increase community awareness• Access to hotlines other help resources
Culture-Based Interventions
• Story telling• Sweat Lodge• Talking circle• Vision quest• Wiping of tears• Drumming• Smudging• Traditional Healers• Herbal remedies• Traditional activities
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What are some promising strategies?
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Native Partnered Collaboration
Research-Education-TreatmentOHSU
Grassroots Groups
Community-BasedOrganizations
State/Federal
"SHARED VISIONS: BLENDING TRADITION, CULTURE AND HEALTH CARE FOR OUR NATIVE COMMUNITIES”
Early child development and education
Healthy Places Fair Employment Social Protection
Universal Health Care
Health Equity in all Policies
Fair Financing Good Governance
Responsibility
Gender Equity
Political empowerment – inclusion and voice
Areas for ActionAreas for Action
NIDA Native Mentorship
Mentors: 17
Mentees: 21
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Contact us at
503-494-3703
Dale Walker, MD
u
Or visit our
website:
www.oneskycent
er.org
