Mental Health Essentials in Native Communities:

A Guide for Grantees

What is mental health? 

Mental health is more than the absence of mental 

disorders. It is an integral part of health—there is no 

health without mental health. Mental health is a state 

of well-being in which an individual realizes his or her 

own abilities, can cope with the normal stresses of life, 

can work productively, and is able to contribute to his 

or her community.1 

A range of socioeconomic, biological, and environmental 

factors may affect mental health; however, mental 

illnesses affect persons of all ethnicities and 

socioeconomic statuses. It is important to understand 

the American Indian and Alaska Native (AI/AN) cultural 

approach to mental health and wellness. Many of these 

communities view overall health holistically, often 

focusing on the restoration of balance during illnesses 

or life challenges. 

A History of Trauma 

There are 573 federally recognized tribes and 65 

state-recognized tribes in the United States. After 

over 500 years of contact with non-Native cultures, the 

indigenous population in North America has survived 

many traumas, including disease, war, removal from 

their native lands, forced boarding school attendance, 

and relocation. In the early 20th century, the AI/AN 

population was 5 percent of the original population 

estimated at first European contact.2

Despite this historical trauma, many AI/AN communities 

have found resiliency by maintaining their traditions, 

culture, language, and sovereign rights as tribal nations 

well into the 21st century. 

However, this resilience has come at a cost. Native 

Americans suffer from disparities in almost every social 

indicator that measures individual and community 

well-being, including mental health and wellness. As 

shown in Table 1 on the next page, the 2013 National 

Survey on Drug Use and Health found higher incidence 

of mental health-related illness for AI/AN populations 

when compared to the non-Native population.

Draft, May 2018

This fact sheet was prepared for SAMHSA under contract number 

HHSS280201300001C with SAMHSA, U.S. Department of Health and Human 

Services (HHS). The views, opinions, and content of this publication are those 

of the author and do not necessarily reflect the views, opinions, or policies of 

SAMHSA or HHS.

Mental Health in Indian Country

For many tribes, wellness is perceived as a whole-self 

model that includes mental, emotional, physical, and 

spiritual aspects. For a society grounded in family and 

community, nurturing relationships is very important. 

Many practices in AI/AN identity and culture are 

considered integral to mental health in Native 

communities. These practices include respecting 

and honoring community elders and tribal leaders, as 

well as varied subsistence activities which promote 

interdependency with nature. It is important to note, 

while regional practices and language dialects might be 

similar, each tribe is unique and caution should be used 

to avoid generalizations.

Figure 1. Holistic view of a person’s overall well-being

Physical Emotional

Spiritual Mental
* This publication lists non-federal resources to provide additional information 

to consumers. The views and content in those resources have not been formally 

approved by HHS. Listing of the resources is not an endorsement by HHS or its 

components.

Mental Health Myths and Facts

This section reviews the facts behind two myths about 

mental health.

Myth: Children do not experience mental health 

problems.

Fact: Half of people who experience mental health 

disorders show signs before age 14. Even young 

children may begin to show warning signs of mental 

health concerns. Early mental health support can 

help a child before problems interfere with other 

developmental needs.4

Myth: Personality weakness or character flaws cause 

mental health problems. People with mental health 

problems can snap out of it if they try hard enough.

Fact: Circumstances are different for everyone, and 

many people need help to get better. People with 

mental health problems can get better, and many 

recover completely.5

Overcoming Negative Perceptions

In some AI/AN communities, adverse views of 

mental health do exist. This may correlate with the 

level of the individual or involved family members’ 

deculturation from traditional belief systems. However, 

the degree of negative perception varies from tribe to 

tribe and even within tribes, depending on their own 

beliefs about mental and physical health.6

As tribal communities return to using traditional 

healers, ceremony, and ritual, some AI/AN individuals 

who experience mental health issues are more willing 

to seek traditional strategies to help with depression, 

anxiety, and substance use disorders than other types of 

treatment. As shown in Table 2, the Native worldview 

of health and wellness varies in many ways from that of 

the majority culture in the United States.

About the Tribal TTA Center

The Tribal Training and Technical Assistance (TTA) 

Center is funded by the Substance Abuse and Mental 

Health Services Administration (SAMHSA). The Tribal 

TTA Center uses a culturally relevant, holistic approach 

to deliver TTA on mental and substance use disorders, 

suicide prevention, and mental health promotion. TTA 

is offered to a broad audience of all tribal communities, 

a focused audience of SAMHSA tribal grantees, and an 

intensive audience of selected AI/AN tribes per year.

1 World Health Organization. (2016). Mental health: Strengthening Our 

Response. Retrieved from http://www.who.int/mediacentre/factsheets/fs220/en/

2

 Office of the Surgeon General, Center for Mental Health Services, National 

Institute of Mental Health. (2001). 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. Retrieved from 

https://www.ncbi.nlm.nih.gov/books/NBK44242/

3

 SAMHSA. (2014). National Survey on Drug Use and Health 2013. 

Retrieved from https://www.samhsa.gov/data/sites/default/files/

NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf

4

 MentalHealth.gov. (2017). Mental Health Myths and Facts. Retrieved from 

https://www.mentalhealth.gov/basics/mental-health-myths-facts

5 See footnote 4

6

 Taylor & Francis. (2005). Stigma of mental illness among American Indian 

and Alaska Native Nations: Historical and contemporary perspectives. Issues in 

Mental Health Nursing, 26, 1,001–1,024 doi:10.1080/01612840500280661

7 See footnote 6

To receive more information about the Tribal TTA 

Center or to submit a TA request, call (301) 257-2967 

or visit http://www.samhsa.gov/tribal-ttac.

Table 1. 2013 mental health – AI/AN and the general U.S. populations3

Mental Health Category Age AI/AN U.S.

Any mental health Illness (AMI) 

(past year) 18+ 26.0 18.5

Serious mental health illness (SMI) 

(past year) 18+ 5.8 4.2

Major depressive episode (past year) 18+ 8.9 6.7

Mental health service utilization

 (past year) 18+ 15.7 14.6

Suicidal thoughts 18+ 4.8 3.9

Co-occurring AMI-substance use 

disorder 18+ 7.4 3.2

Co-occurring SMI-substance use 

disorder 18+ 1.1 1.0

Table 2. Worldview differences that impact mental health care7

AI/AN Majority Culture

Relational/circular Linear, point A to point B

Mind, body, spirit/one Psyche is the focus

Mystical/acceptance Scientific/verification

Ceremonials/rituals Psychotherapy

Tribal connectedness Individualism

Spirituality and balance Organized religions

Cooperation/sharing Competition/winning

Patience/respectful Assertive/forceful

Present-oriented Future-oriented

Herbs, plants, nature Psychopharmacology