Native American Indians

Approximately 1.5% of the U.S. population -- 4.1 million Americans -- identify themselves as having American Indian or Alaska Native (AI/AN) heritage. The Federal government currently recognizes 561 different AI/AN tribes and there are many other tribes that are not officially recognized. AI/ANs speak over 200 indigenous languages. Approximately 280,000 speak a language other than English at home; more than half of Alaska Natives who are Eskimos speak either Inuit or Yup'ik. Most American Indians live in Western states, with 42% in rural areas compared to 23% of whites. In 1980, most American Indians lived on reservations or trust lands, compared to only 20% today. Over 50% now live in urban, suburban, or rural non-reservation areas. In 1980, only 56% of AI/ANs 25-years-old and over had graduated from high school. By 1990, this percentage had increased to 66%, but it was still below the 75% rate for the Nation as a whole. In 1998, AI/AN men and women were roughly twice as likely as whites to be unemployed. In 1999, about 26% of AI/ANs lived in poverty, compared to 13% for the United States as a whole and 8% of white Americans.

Need for Mental Health Care

No large-scale epidemiological studies of AIANs have yet been published. The results of one such study which will provide considerable information about the prevalence of mental disorders among the AIAN population are expected in the near future. One small study with a 20-year follow-up found the lifetime prevalence of mental disorders to be 70%.

The Great Smoky Mountain Study found that AI children had similar rates of disorder (17%) compared to white children (19%). AI children had lower rates of tics (2 vs. 4%) and higher rates of substance abuse (1 vs. 0.1%). Almost all of the latter was accounted for by alcohol use among 13-year-old AI children.

Large-scale studies of mental disorders among older American Indians are lacking, but smaller studies have found rates of depression ranging from 10 to 30%.

The prevalence rate of suicide for AI/ANs is 1.5 times the national rate. AIAN males ages 15 to 24 account for two-thirds of all AI/AN suicides. Violent deaths – unintentional injuries, homicide, and suicide – account for 75% of all mortality in the second decade of life for AIANs.

High-Need Populations

AI/ANs are over-represented among high need populations including the following:

• People who are homeless. While representing less than 2% of the U.S. population, it is estimated that AI/ANs constitute 8% of Americans who are homeless.
• People who are incarcerated. In 1997, an estimated 1 out of every 25 AI/AN adults were in the criminal justice system. A 1998 study found that 1 out of every 2 adolescents in a Northern Plains reservation juvenile detention facility had a substance abuse or mental health disorder. Many of these youth had multiple disorders.
• People with alcohol and drug problems. Prevalence rates for current alcohol abuse and/or dependence among Northern Plains and Southwestern Vietnam veterans have been estimated to be as high as 70% compared to 11 - 32% of their white, black, and Japanese American counterparts. The estimated rate of alcohol-related deaths for AI/ANs as a whole is much higher than it is for the general population.

People exposed to trauma. The rate of violent victimization of AI/ANs is more than twice the national average. The higher rate of traumatic exposure results in a 22% rate of PTSD for AI/ANs, compared to 8% in the general U.S. population. The American Indian Vietnam Veterans Project found lifetime prevalence of PTSD to be 45 to 57% among AI veterans, rates significantly higher than among other Vietnam veterans.

Children in foster care. Until 1978 when Congress passed the Indian Child Welfare Act to end "a pattern of discrimination against American Indians," an estimated 25 to 30% of AI/AN children had been removed from their families. By 1999, AI/AN children accounted for only 1% of children in foster care.

Availability of Mental Health Services

Approximately 101 AI/AN mental health professionals are available per 100,000 AIANs, compared to 173 per 100,000 for whites. In 1996, only about 29 psychiatrists in the U.S. were of AIAN heritage.

Access to Mental Health Services

The Indian Health Service (IHS) is the Federal agency responsible for providing health care to Native populations. However, only 20% of AIs report access to IHS clinics, which are located mainly on reservations.

Medicaid is the primary insurer for 25% of AI/ANs. Only about 50% of AI/ANs have employer-based insurance coverage, compared to 72% of whites. 24% of AI/ANs do not have health insurance, compared to 16% of the U.S. population.

Use of Mental Health Services

Representative community studies of AI/ANs have not been published, so little is known about the use of mental health services among those with established need. Smaller studies found that, off AI adults with a mental disorder, 32% received mental health or substance abuse services, about the same as the U.S. population as a whole. Among Cherokee children with a mental disorder, only 1 in 7 received professional mental health treatment, a rate similar to the non-AI sample. Cherokee children were more likely than white children to receive treatment through the juvenile justice system and inpatient facilities. AI/ANs appear to use alternative therapies at rates equal to or greater than whites.

Appropriateness and Outcomes of Mental Health Services

Few AI/AN have been included in the controlled clinical trials used to develop treatment guidelines for the major mental disorders.