Historical and Current Contexts for the Tribal Behavioral Health Agenda

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The Historical and Current Contexts

View Section Two: Historical and Current Contexts (PDF | 7.9 MB).

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Federally Recognized Tribal Governments

• The United States has a unique government-to-government relationship with Indian tribes that is grounded in the U.S. Constitution, numerous treaties, statutes, Federal case law, regulations, and executive orders that establish and define a trust relationship with Indian tribes.
• Within the boundaries of the United States, there are currently 574 federally recognized and dependent sovereign American Indian and Alaska Native nations, tribes, rancherias, villages, and pueblos and 55 state-recognized tribes.

Learn more about Historical and Current Contexts:

• Search Federally Recognized Tribes – Department of the Interior
• My Tribal Area – U.S. Census
• A profile of American Indians and Alaska Natives in the U.S. labor force – U.S. Bureau of Labor Statistics

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Historical and Intergenerational Trauma

Historical trauma is recognized as the root cause of much of the behavioral health disparities currently experienced by American Indians and Alaska Natives.

• What is Historical Trauma?
• Understanding the Impact of Intergenerational Trauma
• Understanding Historical Trauma and Resilience When Responding to an Event in Indian Country (PDF | 17 MB)

Behavioral Health: State of Urgency

Behavioral Health: State of Urgency

View Section Three: Behavioral Health: State of Urgency (PDF | 7.9 MB).

American Indian and Alaska Native communities are aware of the physical health challenges of their people, but there are also behavioral health challenges that are often more difficult to discuss and that also impact overall health and well-being. These behavioral health challenges are associated with increased exposure to trauma, depressive symptoms, substance misuse, and suicidal thoughts.

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Trauma

• Trauma Informed Care - IHS offers web-based training on trauma informed care (TIC). IHS TIC training has been modified and adapted to address the unique experiences, including historical trauma, of American Indians and Alaska Natives.
• MMIP Action Plan (the MAP) (PDF | 533 KB) - The Administration for Family and Children (ACF) updated its MMIP Action Plan (the MAP), whose long title is Culture is Prevention: A Strength Based, Culturally Grounded Journey Toward Prevention, Intervention, and Healing. The MAP builds on the work throughout ACF and engagement with the Intradepartmental Council on Native American Affairs (ICNAA) to advance a holistic approach to violence prevention and healing from trauma. Importantly, the MAP identifies administrative processes and opportunities to leverage ACF’s grant funding, community engagement, and rulemaking authority to accelerate this work. Additional resources and information on the MAP and MMIP are available on the ANA website.

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Substance Use

• 2023 National Survey on Drug Use and Health: American Indians and Alaska Natives (AI/ANs) (PDF | 2 MB)
• IHS Supports Tribal Communities in Addressing Alcohol and Substance Abuse
• Health Conditions and Health Care Use Among American Indian and Alaska Native Adults by Tribal Land Residential Status: United States, 2019–2021 (PDF | 402 KB)
• Drug Overdose Prevention in Tribal Communities

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Suicide

• Suicide Clusters within American Indian and Alaska Native Communities: A review of the Literature and Recommendations (PDF | 778 KB)
• Suicides Among American Indian or Alaska Native Persons — National Violent Death Reporting System, United States, 2015–2020
• Suicide Prevention and Care Program Cooperation among Tribal, Federal, and other partners is imperative to create a safety net of interconnected programming - health, education, law enforcement, public health and well-being, economic development, and physical and behavioral health - to maximize effectiveness of services and to protect individuals against suicide risk.
• The 2024 National Strategy for Suicide Prevention (PDF | 13.4 MB) is a bold new 10-year, comprehensive, whole-of-society approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide prevention field.

Health Care and Supportive Service Considerations

Health Care and Supportive Service Considerations

View Section Four: Health Care and Supportive Service Considerations (PDF | 7.9 MB).

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Health Care and Service Systems

• Indian Health Service – The IHS is the principal federal health care provider and health advocate for Indian people, and provides a comprehensive health service delivery system.
• Office of Urban Indian Health Programs
• Native American Veterans – According to the Department of Defense, American Indians and Alaska Natives have one of the highest representations in the armed forces. VA consults with American Indian and Alaska Native tribal governments to develop partnerships that enhance access to services and benefits by Veterans and their families. VA is committed to ensuring that Native American Veterans and their families are able to utilize all benefits and services they are entitled to receive.

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Workforce Development

• Workforce – SAMHSA works with federal and other partners to increase the supply of trained and culturally aware professionals to address the nation’s behavioral health needs.
• Loan Repayment Opportunities
• Scholarship Program
• Surging the Public Health Workforce: Lessons Learned from the COVID-19 Response at State, Tribal, Local, and Territorial Public Health Agencies

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Indian Health Care System Funding

• How Increased Funding Can Advance the Mission of the Indian Health Service to Improve Health Outcomes for American Indians and Alaska Natives

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Access to Services

• The Affordable Care Act and American Indians and Alaska Natives
• American Indians and Alaska Natives – Affordable Care Act and IHS/Contract Health Services
• Health coverage for American Indians & Alaska Natives

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Availability and Quality of Services

• The Center for Medicare and Medicaid Services (CMS) Division of Tribal Affairs works closely with American Indian and Alaska Native (AIAN) communities and leaders to enable access to culturally competent healthcare to eligible to CMS beneficiaries in Indian Country. CMS collaborates with the Indian Health Service and other federal partners to facilitate access to high quality and timely healthcare.

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Attitudes Toward Behavioral Health and Services

• National Quality Accountability Dashboard – The Indian Health Service dashboard monitors and reports information on compliance with IHS policy requirements, accreditation standards, or regulations at hospitals and ambulatory health centers. The tool also supports oversight and management and will allow IHS to make fact-based decisions to ensure quality and safety of care.

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Supportive Services

• The Bureau of Indian Affairs’ Social Services program supports an array of social service activities that strengthen Indian families, promotes family stability, and ensures health and well-being.
• BIA funding for Indian Child Welfare Act (ICWA) programs support social workers that work with tribal courts, state courts, and Indian families in the areas of child protection. Children are reunified with their families when possible. When reunification is not possible, children are placed into Indian foster and adoptive homes.

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Public Health and Research Infrastructure

• Conducting Research in Tribal Communities – National Institute of Justice Conducting research in tribal communities involves forging partnerships with tribal governments.
• Supporting Ethical Research Involving American Indian/Alaska Native Populations (PDF | 1.1 MB)
• Native American Research Centers for Health (NARCH) – The Native American Research Centers for Health (NARCH) program funds federally recognized American Indian/Alaska Native (AI/AN) tribes and organizations for health research, research career enhancement, and research infrastructure enhancement activities. Components of each NARCH award may be supported jointly by NIGMS and additional participating NIH Institutes, Centers and Offices with research missions well-aligned with the proposed activities.
• Tribal Epidemiology Centers are an Indian Health Service who serve American Indian/Alaska Native Tribal and urban communities by managing public health information systems, investigating diseases of concern, managing disease prevention and control programs, responding to public health emergencies, and coordinating these activities with other public health authorities.

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