THE EFFECT OF RESERVATION LIFE ON THE MENTAL HEALTH OF NATIVE AMERICANS

USTAT GORAYA

Major: Neuroscience

Class of 2023

Abstract

Since the Europeans colonized the Americas, the Native Americans have been forced to give up their land to make way for settlers. Most accommodated them over time and some resisted. Either way, Native American communities faced irreparable damage, and even today, living on reservations, they face hardships that most people are not accustomed to. Reservations lack the most fundamental resources, and this is the primary cause of distress in this community. The way reservations are today greatly contributes to the deterioration of the mental health of the indigenous people. Substance use disorders and suicide rates are on the rise. To take a step towards betterment and reform for this community, representation of more Native Americans in Congress is needed. Acts like the American Indian and Alaska Native Veterans Mental Health Act of 2020 need to pass in Congress to provide resolution to years’ worth of trauma that this group has unfortunately had to suffer through.

Introduction

The United States of America, arguably the most powerful country in the world, is a melting pot of many different ethnicities and nationalities. The coexistence of such diverse communities allows the US to be a role model for the rest of the world. However, one community that has attempted to coexist with the American way of living, giving up its land for settlers since the very beginning of times, has unfortunately been ill-treated and stripped of its quality of life. That community would be the Native Americans. Native Americans, who can trace their ancestry in North America as far back as the beginning of history, are underserved and are one of the most underrepresented groups in the entirety of the United States. The United States Constitution has guaranteed life, liberty, and the pursuit of happiness for all citizens, but, sadly, the last element of this declaration has not been carried through to the indigenous people.

Since the European colonization of the Americas, Natives have been subjugated, and the sovereign nations that persisted were eradicated from existence through forced diaspora. The most infamous instance is the Trail of Tears, which caused a tremendous loss of life (Myhra, 2020). Today, with a major portion of the Native American population decimated, Natives are still not given the care they deserve (Myhra, 2020). Though reservations have been made for them, life on the reservations lacks the most fundamental resources one needs in today’s day and age. Because of this, many suffer mental distress.

Even though reservations have been built so Native Americans can practice and maintain their culture and customs, they lack major financial and health-related resources. Most indigenous people on reservations lead a poor quality of life, living through poverty and seclusion (FireMoon, 2020). Many, because of the nature of reservations, develop mental health issues that haunt them for the rest of their lives. Even worse, many times, they are not capable of affording treatment, forcing them to resort to their community, which in today’s day and age has drifted towards social isolation (FireMoon, 2020). Due to a lack of funds and basic facilities, it can be inferred that, to a great extent, reservation life is contributing to mental health issues within Native American communities. Two of the most major ones are substance use disorders due to insufficient healthcare resources and suicide due to social isolation.

Substance Use Disorders

Substance use disorders (SUDs) exist in all communities, but a lack of resources and medical attention on reservations has exacerbated the preexisting issue, lengthening the mental struggle in Native communities. Substance use disorders involve drugs and alcohol and are developed when a person reaches a mental and physical point of dependency on them that leads to unhealthy levels of consumption. Though SUDs exist in all communities, the fact that Native American adults “exhibit high rates of binge drinking, heavy drinking, and illicit drug use” in comparison to adults in other “racioethnic groups” reveals the predisposition the Indigenous people have to developing these disorders (Serier, 2020). If a community has higher rates of substance abuse, it will consequently have higher rates of developing addiction, and the mere fact that Native Americans are “more than twice as likely to have SUDs than the general population” reveals just that (Hallum, 2019). In addition, if “alcohol mortality rates for AI/ANs are approximately five times the rates of the general population” and the mortality rate for “other drugs is nearly double the rate for the general population,” one can reasonably conclude that these statistics include deaths due to SUDs, as substance addiction has an extremely high probability of leading to death (Hallum, 2019). Not only do these statistics reveal the magnitude of the SUDs among the Native community, they allow one to gauge the impact of SUDs on this specific community in comparison to the rest of the Unites States. Considering the skyrocketing rates of addiction and mortality that may be caused by SUDs in the Native community, one cannot help but wonder why these rates are specifically high in Native communities.

The rates of SUDs may be high among indigenous people due to the traumatic past that they experienced, and considering the state of healthcare on reservations, one can reasonably assume that that must be a contributing factor in exacerbating and extending SUDs among Natives. In fact, Native Americans have “the greatest unmet need for treatment among all ethnic groups in the United States” (Hallum, 2019). The Indian Health Service has tried to create clinics on reservations to compensate for the lack of resources and treatments, but “IHS is severely and chronically underfunded,” and because of this, individuals “may be denied provider recommended services” (Sommerfeld, 2018). This causes Natives to be forced to pay out of pocket or carry on without the treatment they need (Sommerfield, 2018). It may be argued that they can use health insurance to pay for the services, but Natives are “more likely to be uninsured” compared to the rest of the United Sates (Sommerfield, 2018). Healthcare in general is losing its affordability as time goes on, and people living on reservations already lack resources, which causes them to not invest in healthcare to cover health costs. Even if they do have the money to pay for the resources, the health clinics, as mentioned above, do not have the ability to support a large number of people, and because of this, Natives “must travel to seek care, which adds an additional barrier and may prevent them from receiving needed services,” (Gonzalez, 2020). Even if a treatment is developed in clinics on the reservations, “efficacious treatment is useless without avenues for implementation,” and the clinics do not have resources to create treatment options, nor any means of distribution nor manufacture (Venner, 2012). Considering the dire conditions of healthcare on reservations, one speculates whether the rate of SUDs, disorders that cause mental and physical distress, in the Native American population may have been lower had there been adequate healthcare on reservations. The mere fact that Natives have the possibility of being denied treatment they need to treat SUDs is sufficient evidence that the conditions on reservations are making SUDs and other mental health problems among Native Americans worse.

Suicide

In addition to the conditions on reservations making SUDs worse among Natives, social isolation on reservations has increased depression among Natives as well, leading to suicides. Every community has individuals struggling from depression that end up taking their own lives, but the fact that American Indian and Alaskan Native youth “carry the greatest burden of suicide attempts and deaths in NM [New Mexico]” is shocking (Qeadan, 2020). In fact, New Mexico has suicide rates that have increased… [and are] double the national average,” making suicide the “eighth leading cause of death” in the state in 2015 (Qeadan, 2020). The fact that indigenous people constitute the largest percentage of suicides in the state discloses the poor condition of the Native youth and calls for an urgent need for intervention. A study conducted at TCU (Tribal Colleges and Universities), a place “reflecting the cultural and social norms of the local AI/AN reservation,” suggests that behavior indicating positive mental health and the reporting of suicidal behavior can be enhanced among Natives through “community campaigns to support changes in interpersonal communication styles, and inclusion in community events” (Duran, 2020). By having solid social support and a feeling of belonging, instances of suicides or even depression can be avoided in general. Unfortunately, as time goes on, reservations are starting to lack just that, contributing to increases in suicide and depression.

American Indian communities were known to be tight-knit and extremely vibrant culturally, but as time has progressed and reservations have become the norm, Native Americans find themselves distant from one another. Earlier in history, when reservations were not developed, and some Natives were living in tipis housing eight people “within encampments of 200–800 persons,” everyday life “focused on hunting and ceremonial engagement” (FireMoon, 2020). The social life Natives had was exuberant, but as time went on, Native Americans had little choice other than to live in “independent households” on reservations, and this stripped them of the dynamic “family structure” they had had in “pre-reservation days” (FireMoon, 2020). The “opportunities for everyday contacts with community members and kin,” something foundational to the entire Native American culture, were greatly reduced, further creating distance among the community members (FireMoon, 2020). This “lack of intimate and close connections” ultimately has caused the community, especially the young people, to feel “distressed and lonely” on reservations, spurring a “problematic trend” of suicide in the youth (FireMoon, 2020). According to the interpersonal-psychology theory, the act of suicide is further exacerbated by “a sense of low belongingness or social isolation over a long period of time,” and, unfortunately, as time goes on, social isolation is becoming more prevalent in this community, which will only increase rates of suicide (Quedan, 2020). Not only do reservations lack the fundamental resources to sustain a healthy life, they are starting to head towards social isolation, and this, without a doubt, is having an extreme detrimental mental effect on the youth, contributing to suicide rates among this group of people.

ACKNOWLEDGEMENT/RESPONSE

The United States created the Bureau of Indian Affairs and Indian Health Service to better the overall well-being of Natives living on and off reservations. Even though this may be true, the fact that “four of the nation’s five counties with the lowest life expectancy at birth are located on AI/AN land in North and South Dakota” reveals that the actions taken by the government are not enough and that the living conditions on reservations are not ideal by any means (Armstrong, 2020). One may dismiss one or two counties, but the fact that four out of five counties with the lowest life expectancies are inhabited by Indigenous people is saddening, as these people, people who the land actually belongs to, are leading poor and shortened lives. Even in 2019, during the partial government shutdown, the Indian Health Service was affected greatly, while “Medicare, Medicaid, and the Veterans Health Administration” were spared from the repercussions (Armstrong, 2020). The Indian Health Service delivers care to “2.56 million” Natives, and the fact that services involving citizens’ health were impacted for a certain group of people for a shutdown of merely 35 days reveals the dire condition and calls for an immediate reform to improve the quality of life of these people (Armstrong, 2020). Considering these statistics, it can be concluded that living on reservations is hugely impacting quality of life of Natives’ mental and overall health due to the unstable nature of vital services.

Others may believe that living on reservations is a personal choice and that if something is done through consent, it cannot be a source of distress. Though it is a personal choice, given the trauma Natives have been through together and the number of Native tribes that have historically been eradicated from existence, it is understandable that they still have the desire to live together, even if that means sacrificing necessities and living on reservations. Through the course of history, forceful migrations of Natives have taken place, which have caused a huge loss of Native American lives. Because of the Trail of Tears alone, “10,000” people perished (Myhra, 2020). Cherokees were put into “concentration camps” without “food or any belongings,” while many women were raped and children were beaten (Myhra, 2020). The fact that this is just one of many examples of a forceful migration reveals a lot of disturbing elements of the history of the ill treatment that Natives have endured. Having gone through so much mental, physical, emotional, economic, and social abuse together and having their culture practically destroyed, their desire to remain in a tight community on reservations with people they connect with explains their need to stay on reservations even if the living conditions are not ideal. Because a small number of tribes remain, it is harder to instill the culture in their posterity, which may be another reason why they choose to live the way they do. The argument that Natives choosing to live on reservations means reservations cannot be a contributing factor in the deterioration of their mental health is therefore flawed because Natives may be prioritizing their community over their personal needs.

Conclusion

Considering how reservation life has the potential to do more harm than good, it can reasonably be concluded that the state of reservations today has a huge impact on the mental health of Indigenous people. For example, SUDs exist in all communities, but what differentiates the Native communities from other communities is the complete lack of healthcare on reservations. Other communities have the benefits of health insurance, but for Native Americans, attaining that itself is a struggle, and this contributes to higher rates of addictions within the community as well as other unattended issues. Another example of the effect of living on reservations is a loss of a communal experience, which leads to an increase in the rates of suicide in Native communities. Social support is vital for any human being to thrive, but the fact that Native Americans are not getting enough of that and are instead heading towards social isolation is contributing towards suicide rates in the community, especially in adolescents.

To compensate for the trauma this community has gone through, legislation needs to pass that allocates funds towards sufficient healthcare on reservations. To do that, there needs to be more representation of Natives in Congress and in other governmental bodies, because, presently, the Native community is highly underrepresented. Currently, among the few Native American leaders is Congressman Tom Cole of Oklahoma, who has introduced the American Indian and Alaska Native Veterans Mental Health Act of 2020 (“Congressman,” 2020). Under this act, the VA (Department of Veteran’ Affairs) would be required to have a coordinator who would make sure that every VA medical facility is prepared to provide care to Native American veterans (“Congressman,” 2020). Plans like these are being put forth, but since they only cater to a specific portion of the Native population, they cannot be the only solution. Since a reliable form of healthcare takes time to develop for the entire Native American community and every individual must have access to healthcare no matter the circumstances, reservations can hold free outpatient clinics that have a team of professionals meeting with Natives frequently. Each reservation can have its own unique team. From both a consumer and provider perspective, this option is not as taxing as it seems, as many such teams exist in the US and around the world and many healthcare professionals voluntarily hold clinics free of cost every year. Having an interdisciplinary approach to healthcare benefits the

Native American community, as more people are seen by professionals in less time and with multiple approaches offered to tackle an issue. In addition, because healthcare will take time to develop and many reservations are in isolated places, there needs to be legislation that provides sufficient infrastructure for Natives to travel to other locations to get their health conditions treated, as travel is a major barrier for many. There also needs to be more mental health awareness campaigns in the reservations because they are extremely secluded from the rest of the American society and the topic of mental health can be extremely taboo. Adolescents should have access to counseling should they need it and should be made aware of the resources they have access to as American citizens. There are many ways the quality of life of Natives can be enhanced, and with an urgent need of intervention due to the deterioration of mental health among the Native American population, the time to take initiative is now.