Understanding Native Behavioral Health: Problems and Solutions One Sky Center R Dale Walker, MD...

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

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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

E-mail

Dale Walker, MD

onesky@ohsu.ed

u

Or visit our

website:

www.oneskycent

er.org