Cultural Diversity Resource Manual - American Indian and Alaska Native Resource Manual

161 Pages·2012·5.26 MB·English

A Word from NAMI
If mental health is the foundation of a vibrant, productive society, then access to
treatment must be its cornerstone. Yet, even here in the U.S., where resources for
treatment far outstrip those of our counterparts across the globe, less than a third of those
with mental illness seek treatment. And those Americans whose race, ethnicity, primary
language, and/or economic status have pushed them to the margins of U.S. society face
daunting barriers to the most basic health care. Nowhere are these inequities more
evident than among American Indians and Alaska Natives (AI/AN) with mental illness,
whose morbidity rates for various mental illnesses are astronomically higher (alcoholism,
770% higher; suicide, 190% higher) than those of their white peers.
NAMI's commitment to reach out to AI/AN communities and other underserved
populations was made an official priority on November 9, 2001. On this day NAMI's
Board of Directors approved its new Strategic Plan.
Goal # 3 of this Strategic Plan states:
NAMI must actively reach out to diverse and priority populations.
To improve access to services, NAMI must continue to build its grassroots advocacy
movement by involving increasingly diverse groups. To accomplish this, NAMI must
enlist leaders from diverse cultural communities in order to establish a dialogue with the
communities they represent and to assure that NAMI adopts practices, messages, and
methods that are "culturally competent". NAMI must develop targeted marketing and
outreach strategies to successfully involve these groups. In addition, NAMI must
continue to develop a culture of respect for increased diversity in its governance and
membership.
To achieve this goal NAMI created a Multicultural and International Outreach Center
(NAMI MIO). NAMI MIO's goals are to:
! More centrally involve members of diverse communities in education/advocacy
efforts.
! Develop and disseminate culturally competent direct service/support models in the
field.
! Decrease stigma through public education models that address specific racial and
cultural barriers.
! Improve mental health policy development at the local, state and national level by
increasing grassroots participation.
It is a serious decision to start an AI/AN outreach initiative. It requires a thoughtful
planning process and real commitment. The purpose of this manual is to aid in this
process by providing key information regarding the AI/AN communities, mental
illnesses, outreach strategies, and available resources. This manual is designed as a tool
to help NAMI state offices and affiliates to better understand what is involved in an
AI/AN outreach campaign and aid in the creation of an outreach plan.
This manual covers the following area: the need for AI/AN outreach, the importance of
cultural competence and how to develop it, how to create AI/AN outreach plan (NAMI
examples), how to evaluate your efforts, and how to share your experience with other
NAMIs.
Jim McNulty
President
NAMI Board of Directors
Table Contents
Chapter One
Issues At A Glance: Assessments from the Indian Health Services
Health Disparities Trends 6
Facts on Indian Health Disparities 7
Mental Health 8
Excerpts from the Surgeon General's Report,
Mental Health: Culture, Race and Ethnicity
Chapter 4- Mental Health Care for American Indians and Alaska Natives 9
Chapter 7- A Vision for the Future 35
Chapter Two
Cultural Competency
Working with American Indian and Alaska Native Communities 54
Cultural Competency: Notes for NAMI Chapters 56
Self Assessment Checklist 59
Examples: Healing Our Spirit Worldwide
A Culturally congruent Mental Health Framework 64
Chapter Three
Culturally Competent Outreach
Part 1:
100 Questions for 500 Nations 66
Research: Exploring Issues Facing American Indians and Alaska Native
Communities 80
American Indian and Alaska Native Mental Health Research
The Journal of the National Center 81
Part 2:
Formulating an Outreach Plan 108
Formulating Your Basic Plan 109
Funding For Your Outreach Efforts 111
Case Examples to Use in Outreach 113
Chapter Four
Evaluating Your Outreach Efforts 127
Materials adapted from Outreach to African Americans and Hispanic Families: A
Manual for NAMI Affiliates. Prepared by Judith A. Cook and Jesse Knox, 1993
Program Evaluations
Satisfaction Survey
Outcome Assessment 131
Conclusion 132
Resources
Annotated Bibliography 134
Handbooks
Popular Books
Clinical Research
NAMI Resources
Multicultural and International Outreach Center (MIO) 135
MIO Partner Coalition 136
MIO Technical Assistance 138
Policy: Keys to Effective Lobbying 139
Family To Family Education Program Design: Multicultural Aspects 140
Frequently Asked Questions 141
Development
Fundraising Tips for NAMI Affiliates 148
Planned Giving 152
Special Event Fundraising 153
Office of Consumer Affairs 154
Communications
American Indian and Alaska Native Media Outlets 157
Chapter One
Issues At A Glance: Assessments from the Indian Health
Services
Health Disparities Trends
Facts on Indian Health Disparities
Mental Health
Excerpts from the Surgeon General's Report,
Mental Health: Culture, Race and Ethnicity
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MENTAL HEALTH

ISSUE
Greater than one-third of the demands
made on health facilities in Indian
country involve mental health and social
service related concerns.

BACKGROUND

The Mental Health and Social Services
program is a community oriented
clinical and preventive service program
whose activities are part of a broader,
multidisciplinary behavioral health
approach. Behavioral health teams are
composed of psychologists, mental
health counselors, psychiatrists, social
workers, substance abuse counselors, and traditional healers. The composition of each team is tailored to
the specific issue to be addressed. Substance abuse, trauma, and poverty often complicate the healing
process for American Indians and Alaska Natives. Currently, Mental Health and Social Services programs
promote the mental health of individuals, families, and communities by providing appropriate and
culturally responsive intervention, treatment, and prevention services.

SITUATION
Considerable disparities exist in the psychological well being of American Indians and Alaska Natives.
American Indians, compared to the general population, tend to underutilize services, experience higher
therapy drop-out rates, are less likely to respond to treatment, and have negative opinions about non-Indian
providers. The suicide rate for American Indians is 72% higher than the general population. The highest
suicide rate is found in American Indians ages 15-34 compared to ages 74 and older for the general
population. There is a significantly higher rate of poverty in
American Indian and Alaska Native communities. Poverty often
leads to a lack of housing and overcrowding in homes, as well as
other socioeconomic, education, and health problems. Economic
concerns are often related to domestic violence and childhood
sexual abuse. The potential for mental health problems is
evident.

OPTIONS/PLANS
Additional intervention and prevention strategies that meet
specific needs of individuals, families, and communities are
needed. Investing in inpatient, outpatient, home, and community
services will have a dramatic effect on decreasing the need for
direct health services to respond to the consequences of
behavioral and mental health related issues.

ADDITIONAL INFORMATION
For referral to the appropriate spokesperson, contact the IHS
Public Affairs Staff at 301-443-3593.

This issue summary should be used in conjunction with the IHS “Heritage and Health” and “IHS Profile” documents, available at
http://info.ihs.gov.
February 2001
Need for American Indians and Alaska Native Outreach
The Surgeon General's 1999 Report on Mental Health offered a singular
recommendation: People should seek help if they have a mental health problem or if they
think they have symptoms of a mental disorder.
This simple statement belies the complex reality underlying it: access to mental health
services is fraught with barriers, especially for consumers and families whose race,
culture and class push them to the margins of U.S. health care systems.
Understanding how issues of race and class create barriers to care is essential to
addressing those barriers. Accordingly, this section of the American Indian and Alaska
Native Resource Manual presents demographic information on the concentration and
distribution of the American Indian and Alaska Native populations in the United States,
as well as current research by the Surgeon General's Office on the state of mental health
care for American Indians and Alaska Natives and a vision for the future.
Surgeon General's Report
Chapter 4- Mental Health Care for American Indians and Alaska Natives
Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report
of the Surgeon General. U.S. Department of Health and Human Services:
Introduction
American Indian and Alaska Natives were self-governing people who thrived in North
America long before Western Europeans came to the continent and Russians to the land
that is now Alaska. American Indians and Alaska Natives occupy a special place in the
history of our Nation: their very existence stands as a testament to the resilience of their
collective and individual spirit.
The U.S. Census Bureau estimates that 4.1 million American Indians and Alaska Natives
lived in the United States in 2000. This represented less than 1.5 percent of the total U.S.
population. (U.S. Census Bureau, 2001) The recorded population of this minority group
increased by over 250 percent, largely due to better data collection by the Census Bureau,
an increasing number of individuals who identify themselves as American Indians and
Alaska Natives.
Historical Context
As members of federally recognized sovereign nations that exist within another country,
American Indians are unique among minority groups in the United States. Ever since the
European "discovery" and colonization of North America, the history of American
Indians has been tied intimately to the influence of European settlers and to the policies
of the U.S. Government.