BEHAVIORAL HEALTH

ISSUE

The high rates of alcohol and substance abuse, mental health disorders, suicide, violence, and behaviorrelated chronic diseases in American Indian and Alaska Native (AI/AN) communities are well documented. 

Each of these serious behavioral health issues has a profound impact on the health of individuals, families, 

and communities. For example, AI/ANs are significantly more likely to report past-year alcohol and 

substance use disorders than any other race, and suicide rates for AI/AN people are 1.7 times higher than the 

U.S. all-races rate. Domestic violence rates are also alarming, with 39 percent of AI/AN women 

experiencing intimate partner violence—the highest rate in the U.S. 

BACKGROUND

The last 30 years have seen the development of innovative 

community-based approaches to addressing alcohol, substance 

abuse, social services, and mental health issues. The Indian Health 

Service (IHS) brings much-needed attention to behavioral health 

and its relationship to the prevention of chronic disease, preventable 

mortality, and health promotion. The IHS Division of Behavioral 

Health focuses on the strength and resiliency of AI/AN 

communities in the implementation of strategies that integrate and 

adapt various types of behavioral health techniques. 

STATUS

In the ongoing effort to meet behavioral health challenges in Indian 

Country, there is also a trend toward tribal management and delivery of behavioral health services in their 

communities. Particularly in the last decade, Tribes have increasingly contracted or compacted via the 

Indian Self Determination and Education Assistance Act, Public Law 93-638, to provide these services 

themselves. Currently, over 50 percent of the mental health programs and over 80 percent of the alcohol and 

substance abuse programs are tribally operated. This evolution in behavioral healthcare delivery and 

management is changing the face of behavioral health services in Indian Country. Where IHS was 

previously the principal behavioral healthcare delivery system for AI/ANs, there is now a less centralized 

and more diverse network of care provided by federal, tribal, and urban Indian health programs. 

The documented connections between behavioral health issues and chronic diseases underscore the need for 

holistic and integrated solutions. Finding solutions will require sustained collaboration between Indian 

health programs and policymaking bodies, as well as a willingness to thoughtfully engage deep issues such 

as historical trauma and cultural renewal, and a readiness to include entire communities in healing work. 

The importance of integrated perspectives that include cultural and traditional practices and communitywide healing and wellness cannot be underestimated. 

OPTIONS/PLANS

The IHS continues to develop and share effective programs throughout the Indian health system, with a 

focus on developing programs that are collaborative, community driven, and nationally supported. This 

effort seeks to establish effective long-term strategic approaches to address the range of behavioral health 

issues in Indian Country. Additional information can be found at the following website 

link: http://www.ihs.gov/dbh/. 

ADDITIONAL INFORMATION

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.

January 2015