Telepsychiatry for Native American Communities

Native American communities face unique struggles when it comes to accessing health care services, particularly mental health services. Telepsychiatry, the delivery of psychiatric assessment and care through telecommunications technology such as videoconferencing, is a unique opportunity for Native American communities and organizations that offer health services to this important and at-risk population.

Native American men are twice as likely to have alcohol use problems than the national average and 20% of Native Americans are living with post-traumatic stress disorder (Sarchie, Spicer). Additionally, intergenerational trauma is widespread across Native American communities. According to the University of Calgary, intergenerational trauma is the transmission of historical oppression and its negative consequences across generations (2012).

To make matters worse, there is a serious lack of funding for the Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services. IHS is responsible for providing medical and public health services to members of federally recognized Native American Tribes and Alaska Natives. The IHS “spends just $1,914 per patient per year compared with twice that amount ($3,803) that is spent on a federal prisoner in a year” (Sarchie, Spicer).

This is where telepsychiatry can be a tremendous help. It is cost effective for communities as it eliminates travel for individuals, which is expensive and stressful, as well as for providers who would lose valuable treatment time while on the road.

The only major challenge that telepsychiatry must address to serve Native American populations is the lack of internet access. According to Mediashift, more than 90% of tribal populations lack high-speed Internet access, and according to the Federal Communications Commission, usage rates are as low as 5 percent in some areas. However, this stat is for general populations, not the health or community centers that could potentially host telepsychiatry services for their communities.

Some behavioral health directors are skeptical if telepsychiatrists are adequately equipped to deal with intergenerational trauma, one of the biggest challenges facing Native Americans and their communities today. According to the University of Calgary, “There is evidence of the impact of intergenerational trauma on the health and well-being and on the health and social disparities facing native peoples.”

The beginnings of intergenerational trauma are linked to the historical traumas faced by the Native American population. It started with colonialization and continued with the “Indian school movement.” The Indian school movement stripped a generation of its native languages and traditions, and many children were physically, mentally and sexually abused. This trauma manifests itself in a variety of different ways.

According to experts at Social Work Today, “it can put children at a higher risk for post-traumatic stress disorder.” This could help explain the high incidence of PTSD mentioned above. Intergenerational trauma can cause a strange trickle-down effect from parents to children. Parents want to protect their children from being hurt like they were, so they expose their children to the types of abuse they were exposed to as children. Ultimately, parents who were physically abused are more likely to physically abuse their children without even knowing that they are committing abuse. They are also less likely to stop abuse if they see it being carried out on their children by an older generation; they become virtually paralyzed by seeing it rather than being ignited to take action (Social Work Today).

So the question has become twofold: How do mental health professionals reach these communities, and how do they treat them once they get there? The first thing that professionals need to understand is that historical and intergenerational trauma are not the sole motivators behind actions of their patients. The next thing that professionals must understand is that because of the trauma, building patient trust will take longer and progress may be slower to come. Increased funding for longer programs may be part of the answer.

As for actual treatment methods, the main way to identify intergenerational trauma is to use family mapping. From there, cognitive behavioral therapy treatment can be used and this method is the gold standard for child trauma cases. Another method that has been used is eye movement desensitization and reprocessing. EMDR therapy is an eight-phase treatment.  Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. According to a Harvard researcher, this appears to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep. The movement of the eyes back and forth causes internal associations to arise and the client begins to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. This model of therapy reframes our understanding of how trauma affects the mind. It states that mental healing is much like healing from physical pain. In several controlled studies, eye movement desensitization and reprocessing has an 80%-90% treatment success rate among single trauma suffers.

Professionals can increase access to quality care through telepsychiatry and use the treatment methods mentioned above to make a dent in intergenerational trauma and other mental health issues, and help to heal Native American communities.

Works Cited

Sarche, M., Spicer, P. (2008). Poverty and Health Disparities for American Indian and Alaska Native Children. Annals of the New York Academy Sciences, 1136(1), 126-136.

Intervention to Address Intergenerational Trauma. (2012). University of Calgary.

About the Author

headshotConnor Goetten is a student at the University of Illinois majoring in advertising and minoring in sociology. Connor is interested in the way his two areas of study intersect to increase access to health and human services for people in need.

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