The Challenge of Finding Culturally Competent Mental Health/Addiction Counselors/Facilities for the Native American Population in Indiana American Indian Center of Indiana, Inc. By Doug Poe Executive Director 317-917-8000 dpoe@americanindiancenter.org

Outline A glimpse into history and it’s impact on Native American’s Cultural Differences Educational and Economic conditions and their effect on Native Americans Health Disparities of Native Americans Why is Competent Mental Health Not Available? The American Indian Center of Indiana

History To understand the cultural differences of Native Americans and to shed some light on the health disparities that are prevalent throughout this race, it is important to understand the changes that have occurred in their habitat, diet and social issues.

History Pre-European contact statistics state that there were at least 10 million and up to 100 million Native people living in what is now North America Disease had wiped out two thirds of the population before Columbus’s second journey. There were only 300,000 Natives left in 1900.

History 1830 marked the passing of the Indian Removal Act where Congress authorized the removal of all Natives living east of the Mississippi. These removals or “Marches” started in 1831 and lasted until 1875. Two of the more recognized marches were the Cherokee “Trail of Tears” in 1834 and the Navajo “Long Walk” in 1864.

History 1878 – 1948 Boarding School Era Native children ages 6 –16 were forcibly taken from the reservations and sent to Boarding Schools in an effort to assimilate Indians into “white civilized” society. Up until 1934 it was common practice to not allow them to go home or allow visitation during the school year. The Government slogan of this era was “Kill the Indian, Save the Man”.

Major Events That Have Influenced The Beliefs, Attitudes and Culture Navajo Children Arrival Navaho Children Assimilated

History 1883 – 1978 Practicing Native American Religion or Ceremonies was a Federal Crime 1887 – General Allotment Act (Dawes Act) was used to break up Tribal lands into small partials. 1921 – The Snyder Act – Provided the first funds for Indian Health.

Major Events That Have Influenced The Beliefs, Attitudes and Culture From 1883 to 1978 is was a federal offense to practice Native American religion, spirituality, ceremonies and gatherings. This law was passed to stop the “Ghost Dance Ceremony” in specific which led to the massacre of over 300 men, women and children of the Sioux Nation at Wounded Knee in 1891. The government thought this “Dance” was to put a “hex” on their troops. In actuality, it was to prepare the Natives for battle and to face their own death. This law was in force until the passing of the Native American Freedom of Religion Act of 1978. Because of this persecution, many traditions and practices went “underground” and most still remain there today. This will make it difficult for you to understand some of the needs of your clients.

Major Events That Have Influenced The Beliefs, Attitudes and Culture Wounded Knee 1891 New York 1893

Major Events That Have Influenced The Beliefs, Attitudes and Culture The Dawes Act of 1887 still has a major influence on the living condition of Indians on the reservations. Native Americans were always “tribal” or “communal” in their living. They always had encampments where everything was shared and everyone had a specific roll. The Dawes act divided up the reservation lands into equal partials and dispersed the population which lead to a disarray of the people, hunger, and still is the biggest contributor of the infant mortality rate and sexual abuse rate of Native American Women.

History 1953 to 1968 Policy of Termination and Relocation Relocation offices were set up in CA, Chicago, Detroit, Dallas and Denver. Whole families were moved with the promise of jobs. Less than 1/3 received work and the result was the family fell into poverty and the children were removed from the home.

History 1920 – 1974 It is estimated that 30% of all Native children born during this period were removed from their families and placed into white foster homes. This was a common practice until the passing of the American Indian Child Welfare Act in 1978.

History 1965 – 1978 Sterilization Period It is estimated that up to 42% of all Native American women of child bearing age living on reservations were sterilized without their consent or knowledge. These procedures were done thru the Indian Health Services under the direction of the Department of the Interior.

Cultural Differences Indian Euro-American Cooperation Group Harmony Modesty and Humility, Physical Modesty, Not putting one’s self forward Non-interference Silence is valued, ability to listen and wait Emotional control, contemplation Competition Individual Achievement Overt identification of accomplishments, physical exhibition Advice giving, counseling Points made by aggressive verbal behavioral Action over inaction, direct confrontation

Cultural Differences Indian Euro-American Patience, group decisions by discussions and consensus Generosity and sharing, material possession given away, respect earned by giving rather that saving Indifference toward the future, saving for one’s own benefit not accepted Work was done only as needed to feed the family Rapid response, decision making, problem solving Individual ownership, amassed material property Saving for the future, insurance, retirement. Puritan Work Ethic. Work for the sake of work, rigid schedule

Cultural Differences Indian Euro-American Spirituality and religion, non-evangelical, land based, pluralist, inclusive, integration with all daily activities, each person responsible for their own path, no original sin/damnation For Christian Belief system, evangelical, activity based, portable, restrictive creeds, hierarchical, worship at specific times, salvation, 2nd coming

Cultural Differences Indian Euro-American Extended Family Orientation – Aunts and uncles considered as mothers and fathers, grandparents traditionally parented, family members often “kept” by other relatives with no disruption of a family unit, multi-generation and multi-geographical “homes” with family members. Nuclear Family Orientation, natural parents are the only valid responsible parties, measure of successful rearing is for children to “leave home”

Education In a study conducted in February 2010 by the Civil Rights Project at UCLA Graduate School of Education; the graduation rates were reviewed in Alaska, Arizona, California, Idaho, Montana, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Washington and Wyoming. (All with high % of NA populations) Less than 50% of American Indians graduate from high school. In one state less than one third of Native American finished high school. Graduation rates in study states – Asians 77.9%, Whites -69.8%, Blacks 54.7%, Hispanics 50.8% and Native Americans 46.6% Contributing factors include: attending rural and isolated schools, high teacher and principal turnover, lack of relevant curricula and assessment practices, inadequate funding, and other health, social, and economic disparities.

Economic Conditions According to the 2010 U.S. Census, 7 of the top 10 poorest counties were in counties that incorporated Indian reservations. The per-capita income average for these areas is $8,800. There are 5 counties in SD, 1 in ND and 1 in AZ.

Health/Domestic Violence Domestic violence is a new era Native American issue. Prior to the removal period, it was handled by the tribe and male family members. NA women experience the highest rate of violence of any group in the United States. NA women suffer violent crime at a rate of three and a half times the national average. It is estimated that three-fourths of Native American women have experienced some type of sexual assault in their lives. Date rape and date physical abuse is rampant in certain tribes. Sources Mending the Sacred Hoop and Minnesota Indian Women’s Resource Center

2010 Tribal Law and Order Act Gives tribal jurisdiction over non-Native offenders for crimes of sexual violence. Deputizes tribal police to arrest and prosecute non-Natives who commit crimes on tribal land. 3 year maximum sentence for rape. 86 % of rapes and sexual assault on NA women on a reservation are by non-Indian. 70% are white offenders. One in three, at least once. Rapes of NA women.

Mental Health Lifetime Depression Rates in the US Native Americans 19.17% Whites 14.58% Hispanics 9.64% African American 8.93% Asian or Pacific Islanders 8.77% Source National Institute on Alcohol and Alcoholism October 3, 2005

Child Mental Health Ages 2 - 17 Race % U.S. Pop. % of Race w/Dep. White 54.4 22.9 Latinos 20.3 19.7 Black 16.8 18.5 Asian 3.3 16.2 Native 1.2 36.0 Other 4.0 22.0 Source Slippery Rock University of Pennsylvania – Kimberly Forrest PhD

Suicide Rates US Suicide Rates Per 100,000 (2009) White 15.9 American Indian 17.5 Asian or Pacific Islander 7.0 Hispanic 6.4 African American 6.3 Source CDC 2014

Health American Indians have the highest rate of obesity, diabetes, and the highest rate of cancer related diseases. Death from alcoholism is six and one-half times greater than in the general population.

Health Native population at a glance: Suicide is the number six killer of Native Americans across the country and as high as number 3 on some reservations. Infant mortality is 300% higher on the reservations than any other place in the United States. This is due to infrequent or non-existent pre-natal care and living conditions immediately after birth.

Health There is very little data on Native American health in Indiana. This is due to several anomalies. Many NA individuals self medicate with naturalistic or traditional herbs and treatments. Which in itself can cause problems if they do enter an emergency situation. Traditional NA healing is very spiritual and involves healing the person more than treating the dieses. Some return to the reservation once a year for an annual check-up. Some will travel to Nashville, TN or Minneapolis, MN for treatment at Bureau of Indian Affairs hospital. A lot of NA who recently have entered “main stream” America, do not know how to maneuver the social system and traditionally are not going to seek assistance.

Substance Abuse Racial /Ethnic Subgroups Ranking of Substance Abuse Including Alcohol Hispanic 14.89% Native American 10.60% African Americans 7.70% Asian or Pacific Islander 3.20% Risk factors include low family income, residence in the Western U.S., residence in areas larger than 1 million, lack of health insurance, no high school education, single and single parent homes. Source HealthyPlace.com

Health and Alcohol Native Americans have three times the alcohol dependence rates than the national average 45% of Native veterans are alcohol-dependent – twice the rate for non-Natives Native American death rates for people 15-24 is 11.4 times higher that for non-Natives. This attributed to higher rates for homicide, suicide, accidents and death attributed to alcoholism. (Center for Substance Abuse Treatment 1994) Indian Health Services state that 17 to 19 percent of all Indian deaths are alcohol-related compared to 4.7 percent for the general population. Studies from Dr. Ting-Kai Li from IU School of Medicine show that Native Americans are lacking two that prevent and protect from heavy drinking. Particularly, the gene for the enzyme aldehyde dehydrogenase which plays a major role in metabolizing alcohol.

HIV/AIDS HIV/AIDS is a rapidly growing concern. NA make up 0.02% of the total population, but account for 3.0% of the total aids population. There is a large percentage of under 25 year olds in the NA population compared to other races.

Statistics If you live on a reservation: Your life expectancy for a male is 48 years and 52 for a female. Suicide will rank as high as the #3 reason for death. The infant mortality rate will be 300% higher than any other place in the U.S. 60% of the homes will not have electricity or water. You will live in some of the poorest counties in the country. You will have the highest rate of obesity, diabetes and cancer of any race. You will have a 60% chance of being sexually assaulted if you are a woman. 42% of all NA women of child bearing age were sterilized during the 1970’s. You will have a 46.6% chance of graduating High School.

Statistics Reservation and rural Native Americans: Addictions NA have three times the alcohol dependence rates than the national average. Have a 6 ½ times greater death rate from alcohol and alcohol related illness than any other race. 45% of Native veterans are alcohol-dependent – twice the rate for non-natives. Indian Health Services state that 17 to 19 percent of all Indian deaths are alcohol-related compared to 4.7 percent for the general population. Studies from Dr. Ting-Kai Li from IU School of Medicine show that Native Americans are lacking two genes that prevent and protect them from heavy drinking. Particularly, the gene for the enzyme aldehyde dehydrogenase which plays a major role in metabolizing alcohol.

Statistics Health 80% of Native American children will be Type 1 diabetic by 2025. Have a 328% greater chance of death from diabetic complications. Have a 650% greater chance of death from tuberculosis. Suicide is the #6 cause of death. Cancer deaths are increasing in NA populations while reducing in other populations. Many believe this is related to the exposure of atomic bomb testing, uranium mine exposure and contaminated water sources.

Statistics 75% of all NA women have experienced some level of sexual assault in their lives. President Obama established the 2010 Tribal Law and Order Act that allowed tribes to prosecute individuals that came onto Tribal land and committed sexual assault. There were an estimated 10 to 100 million Natives in North American pre-euro pen contact and only 234,000 left in 1900. There are over 55,000 NA in Indian based upon the 2010 census. There are 565 federally recognized tribes in the United States. It became a federal offense to practice NA cultural and spiritual ceremonies in 1883 and the law did not change until 1978 when the American Indian Religious Freedom Act was enacted.

Native Spirituality Native Americans believe that the person must be “whole or right” before treatment of an illness or disease can occur. They do this with ceremony, prayer and the use of the four sacred herbs. These are tobacco for offerings, sweet grass for purification, sage for cleansing and medicine and cedar for protection. If you have Native patients, they may want to use these things in their rooms. These things are to NA as a cross is to a Christian.

Why No Competent Mental Health What mental health or treatment facility knows the cultural requirements of NA? Name a mental health or addiction specialist that know the cultural requirements of NA.

Why Native Americans Do Not Go to Mental Health Facilities They do not trust you They would rather try traditional methods and will until something happens and they are arrested or put in some sort of a facility They believe you not only do not understand their way of life and spirituality, but feel you look down upon it and them for being NA

Why Native Americans Do Not Go to Mental Health Facilities They have been wronged for so long that there is a diagnosis now for historical trauma in NA They have been told for so long that NA are the lowest level of race, that they hide their identity and if they can, they will have white on their drivers license and register into the hospital as white because they believe that if you find out they are NA you will not treat them the same as whites and believe they will receive a lower level of treatment

American Indian Center of Indiana The American Indian Center of Indiana, Inc. (AICI) was founded in 1992 and originally was called the Indiana American Indian Manpower Council Inc. (IAIMC). 1994 – programs expanded to include health/wellness, substance abuse, child care, cultural and arts. 1998 - Name changed to AICI; received funding from Indiana Minority Health Coalition

AICI 2000 -2005 – AICI expanded health programs, developed GED classes and computer labs, provided holiday food baskets, and created a newsletter. 2007 – relocated to John H. Boner Community Center and negotiated a statewide MOU with WorkOne Our major funding source is from the Department of Labor through the Workforce Investment Act (WIA).

AICI We also receive funding from the Indiana Minority Health Coalition which allows us to attend all of the powwows in Indiana where we distribute health information and conduct free health screenings such as Glucose, blood pressure, A1c, cholesterol and colorectal cancer screenings. We also work with various schools of nursing in conducting various research projects on the NA population. We have done diabetes, heart disease, access to care, vaccination and STD studies and also provide Intervention classes in diabetes and mental health. The intervention programs are multi week long classes to give the participants tools to cope and handles their particular disease.

AICI Mission Statement Vision Statement The mission of the American Indian Center of Indiana shall be to promote unity and well being among Indiana’s American Indian’s, Alaska Natives, and other people indigenous to the United States through personal, economic, social, health outreach and cultural education development; and to promote the strengthening of mutual understanding and respect among Indian and non-Indian people in Indiana.   Vision Statement As the only state wide Native American organization, our vision is to empower all Native American people in Indiana to strengthen collaborative relationships to achieve common goals and secure the foundation for future generations.

AICI There are approximately 55,000 American Indian and Alaska Natives (AI/AN) in Indiana per the 2010 U.S. Census. Highest AI/AN populations by county in 2000 Marion – 6,769 Lake – 2,636 St. Joseph – 2,290

AICI AICI is serving participants from 63 different federally recognized tribes. We can serve individuals 18 years of age and older who are members of federally recognized tribes. We provide job training skills, education funding and industry training funding. We are expanding our services to work with Prisoner Re-entry and returning veteran assistance. We are partnering with faith based organizations to enhance our programs offered to our participants.