The Hidden Crisis among Native Americans: Alcoholism, Mental Health and a Lack of Resources

Introduction
One of the most disturbing aspects of life as a Native American is the fact that this population suffers from historical trauma—the trauma of having lost their land, their way of life, and essentially their freedom to self-determination when the American colonies began to assert themselves and push the Natives off their land. The Cherokee were expelled from the East, for instance, by the Indian Removal Act in the 19th century, and countless more were slaughtered in brutal territorial wars of conquest as the US expanded westward. Historical trauma is a real struggle for this invisible minority (Brown-Rice). It has led to a deterioration of mental health among Native Americans, who in turn now suffer from alcoholism, substance abuse and a lack of access to adequate mental health care (Hartmann and Gone). Compared to other ethnicities and racial groups, Native Americans experience higher lifetime substance abuse rates. There are many factors that contribute to this statistic: historical trauma, violence, unemployment and low levels of attained education—but at the end of the day it is evident that Native Americans have been marginalized, historically speaking, for centuries—and such marginalization denies them equal opportunity and boxes them into a way of life that is psychologically dehumanizing (“Substance Abuse Statistics for Native Americans”). Famous Native American novelist Sherman Alexie writes about what it is like to be an alcoholic Native American in his novel Flight. He also describes what it is like to be, basically, an orphan—which is what many indigenous people feel themselves to be in white American where Uncle Sam is the symbol of patriotism. There is literally no representation of Native American greatness in the mainstream consciousness. It should not be surprising, therefore, to find that this invisible population suffers from alcoholism and poor mental health more than any other population.
Understanding the Native American Experience
Before analyzing the alcoholism and mental health of the Native American population, it is helpful to understand this population just from a humanistic point of view. Few authors have penetrated the Native American psyche like Sherman Alexie. And of course he is a Native American, so his perspective is vital for understanding what it is like to be of this population. In Flight, Alexie describes the life of a Native American boy who has lost a mother to cancer and whose father is lost in a haze of alcoholism. The boy bounces from one foster home to another, but all the Native American fathers he meets are abusive and violent drunks. There is some self-destructive impulse in Native American men, as though they are continually heaving themselves upon their own spears and daggers in despair at having lost their way of life two centuries ago.
There is also the fact of racism, and Alexie describes this in very bitter detail in The Absolutely True Diary of a Part-Time Indian: “Our white dentist believed that Indians only felt half as much pain as white people did, so he only gave us half the Novocain” (2). It is an off-hand comment meant as a joke, but it does get to the heart of the matter for Native Americans. They have been mistreated as a population and that pain they have experienced is real. It is part of their historical trauma and part of the reason so many of them seek to self-medicate. It is also why so many of them need mental health services. Yet the issue remains: they are a population that is marginalized; access to adequate mental health care is not available to them. Because no one is there to treat them, they treat themselves—with alcohol—which only makes matters worse.
Native Americans carry a great deal of baggage in terms of historical trauma. That baggage has never been dealt with in a meaningful manner. The foremost authority on this matter is Alexie: his novels explore the underlying reality of the most invisible population. Yet Alexie is an author who is often marginalized and even canceled in some parts of the US. He is seen as provocative and worthy of being banned in schools because he brings up matters that some take as offensive—not understanding that Alexie is merely reflecting the truth of the situation. If the truth of what the Native American population has endured for centuries is not confronted, their situation will never improve. Mainstream America has driven them out of view and now even still refuses to give them any consideration.
Alcoholism
Alcoholism is a significant contributor to mental health problems, such as depression and suicide. Native Americans are highly susceptible to these problems, as the Centers for Disease Control and Prevention note: “Death records show that American Indian and Alaska Native (AI/AN) death rates for both men and women combined were nearly 50 percent greater than rates among non-Hispanic whites during 1999-2009.” The fact that suicide rates are 50% higher among Native Americans than among whites shows how deeply troubled this invisible population is: they have no sense of inclusion, no sense of hope, no sense of belonging, and no sense of having a future. They are riddled with mental health problems that drag them down, and their constant crutch is alcohol as Alexie shows again and again. His people are afflicted by alcoholism and they have been since it was introduced to them by white settlers.
The culture of Native Americans is such that they feel a strong interconnectedness with things: all of life is meant to be interconnected and interdependent. And when their own lived experience suggests otherwise—shows them that they are not connected to the rest of the world but are, rather, cut off and cast aside—it causes them to feel as their whole world were collapsing. That is the psychosocial reason for their dependency on alcohol (Tachine, Cabrera and Yellow Bird). When their family systems break down, they seek escape in alcohol. When their social support systems fall apart, they seek escape in alcohol. When the years of alcohol abuse drive them in to a state of mental deterioration, they have no hope because there is no helping hand to bring them out of their mental and emotional pit.
Their alcoholism keeps them mired in an economic pit as well. Native Americans have the highest poverty rate in the US. Fewer than 1 in 5 Native Americans will ever obtain a college degree. This severely limits their job prospects and prevents upward mobilization. The cycle of hopelessness continues from one generation to the next (Krogstad).
Lack of Access to Care
Native Americans suffer from depression and substance abuse in droves. Alcoholism is almost like a character trait at this point, as Alexie frequently points out in his works. These are health issues that could be addressed—but they cannot be addressed if there are no access points for health care (Garrett et al.). As Mental Health America points out, over 827,000 Natives have reported mental health problems in the past year. Native Americans have reported experiencing mental health issues more than 2.5 times as often as other ethnicities. Access to mental health services is limited to Native Americans due to the isolated communities that many live in. Lack of health insurance plays a large part in this.
Mental health services could be of great benefit to this population. Mental health counselors and therapists could use approaches like trauma-informed therapy to help individuals suffering from alcoholism, abuse, depression and suicidal ideation to deal more effectively with their issues. Grief is very much a part of the Native American experience. This is a population that has suffered substantially. Family systems have deteriorated from one generation to the next so that children are thrust into a Native American foster care system that is itself broken and beyond repair (Alexie). In short, the population is in need of serious help.
Yet that help is sorely lacking in terms of access to care. In more economically advanced parts of the nation, access to care is not a problem. This is because health care is an industry; it is a business. Just as any business is going to prefer to set up shop in an area where there are consumers who can pay for products and services, it is the same with health care. As health care providers have been increasingly brought under umbrella corporations, there are fewer and fewer providers who can set out on their own. Even if they could, they would have to look at the financial advantages of determining where to establish themselves. Most providers do not want to provide mental health care services to the poorest parts of the country because it is simply not a lucrative business model. Health care providers are in the business to make money. It is a nice idea to help people, but in reality it is a business.
Thus, because so many Native Americans live in poverty, they attract few health care operators to their communities. Their situation deteriorates because they are written off by the corporate health care offices as indigents who cannot further enhance the corporation’s bottom line. That is the unfortunate truth and the reason why there is such a lack of access to care. The Affordable Care Act was supposed to expand access to care for all populations but business remains business in the US—and what is proposed as policy often fails to translate when policy is implemented and monitored in the real world where people live and breathe and work.
Solutions
Expanding access to care is not as easy it may sound. First, there have to be providers willing to set up offices in poorer communities where many Native Americans live. With developments in telehealth, it is possible that some clinics may be able to have sessions with individuals without actually having to be in the same geographical location; using the Internet to set up a virtual platform where therapy can be given online is one option that health care providers could and should explore in the future.
However, it would require the receiver of the therapy to have access to Internet systems—and in poor communities where any extra money is often spent on alcohol or substances that are abused, it is unlikely that the Internet is a readily available option. That means even if the technology is available for telehealth-based therapy, the likelihood of it being used as an access point remains low.
That leaves individual care providers establishing themselves in Native American communities to increase health literacy and provide mental health care where it is needed. Social workers can play a part in bringing about change in a system that has neglected this community. Social workers are on the front lines and they can be activists in their own right by advocating for invisible populations like the Native American community. Their advocacy can be important in bringing to light issues that the federal government can address. But even here the government works so slowly and so inconsistently that it is difficult to see this as a hopeful option.
What is really needed for this population is more cultural acceptance and less marginalization. There is no way for the US to make up for past crimes committed against this population—but it can start to change things for the better by providing a way for this population to be more integrated into American communities. Cultural stereotypes have to be abandoned and bias and prejudice also have to be set aside. Far from being banned in schools, the works of Alexie should be read and celebrated: his is a voice that is crucial, honest and sensitive. He writes with humor and understanding and sensitivity, and people can learn a great deal about this population and their experiences by exploring his works. Understanding is the key to change.
Conclusion
The Native American population is an invisible population that has been marginalized by mainstream American society for centuries. It should, therefore, not be surprising to find that this population, to whom interconnectedness means so much, suffers so greatly from mental health issues, such as depression, suicide and alcoholism. Their family structures have deteriorated, they live in poverty—more so than almost any other population in the US—and there is little to no access to mental health care for this population. This is a group that is in need of help—but help is slow to come because there is so little understand in mainstream America about what it is like to be a Native American in today’s world.
Works Cited
Alexie, Sherman. The Absolutely True Diary of a Part-Time Indian. NY: Little, Brown and Company, 2007.
Alexie, Sherman. Flight: A Novel. New York: Black Cat, 2007.
Brown-Rice, Kathleen. "Examining the Theory of Historical Trauma Among Native Americans." Professional Counselor 3, no. 3 (2013).
Centers for Disease Control and Prevention. “American Indian and Alaska Native death rates nearly 50 percent greater than those of non-Hispanic whites.” CDC, 2014. https://www.cdc.gov/media/releases/2014/p0422-natamerican-deathrate.html
Garrett, Mario D., et al. "Mental health disorders among an invisible minority: Depression and dementia among American Indian and Alaska Native elders." The Gerontologist 55.2 (2015): 227-236.
Hartmann, William E., and Joseph P. Gone. "Psychological?mindedness and American Indian historical trauma: Interviews with service providers from a Great Plains reservation." American Journal of Community Psychology 57.1-2 (2016): 229-242.
Krogstad, J. “One-in-four Native Americans and Alaska Natives are living in poverty.” Pew Research, 2014. http://www.pewresearch.org/fact-tank/2014/06/13/1-in-4-native-americans-and-alaska-natives-are-living-in-poverty/
Mental Health America. “Native and Indigenous Communities and Mental Health.”
Mental Health America, www.mhanational.org/issues/native-and-indigenous-communities-and-mental-health. Accessed 3 Dec. 2020.
“Substance Abuse Statistics for Native Americans.” Edited by Michael Kaliszewski,
American Addiction Centers, Feb. 2020, americanaddictioncenters.org/rehabguide/addiction-statistics/native-americans.
Tachine, Amanda R., Nolan L. Cabrera, and Eliza Yellow Bird. "Home away from home: Native American students’ sense of belonging during their first year in college." The Journal of Higher Education 88.5 (2017): 785-807.