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Mental Health in American Indian and Alaska Native Communities

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David R. Wilson: Hello. And thank you for joining us today for this special discussion highlighting the National Institutes of Health mental health research and resources for American Indian and Alaskan Native communities. My name is Dr. Dave Wilson. I am a member of the Navajo Nation and the director of the Tribal Health Research Office. Today, I'm joined by my colleague, Dr. Josh Gordon. He is the director of the National Institute of Mental Health, which is part of the NIH. The mission of the NIMH is to transform the understanding and treatment of mental illness through basic and clinical research, paving the way for prevention, recovery, and cure. Welcome, Dr. Gordon.

Joshua Gordon: Oh, thanks for having me here. It's a pleasure to be talking with you.

David R. Wilson: As you know, Indian country, although incredibly resilient, has suffered terribly and disproportionately during the first year of this deadly pandemic with waves of isolation, loss, grief. There's a sense in many tribal communities that there's a need to get ahead of an advancing storm of mental health issues. So could you please share a little bit about what you're seeing in terms of the national scale of mental health issues resulting from the COVID-19 pandemic?

Joshua Gordon: Sure. And thanks for this opportunity. The COVID-19 pandemic is a unique event, as you know. But we do have experience with mental health consequences of previous disasters and epidemics. And what we're seeing now is tremendous but foreseeable. We are seeing dramatically increased stress in people's lives as they deal with illness, with loss, unemployment, and with the disruptions to daily routines caused by both the pandemic and the mitigation measures that followed it. The mental health impacts won't be the same for everyone, but large numbers of Americans of all stripes are experiencing depressive symptoms, anxiety symptoms, symptoms referable to stress, and increases in substance use, and for a surprisingly high number of Americans, suicidal thoughts. So far, CDC reports have shown that one or more of these mental health symptoms is being experienced by as much as 40 percent of Americans. They've also shown that these symptoms are experienced most significantly by young adults, by Latinx persons, by Black persons, by Native Americans as well.

Joshua Gordon: And it's also hit hardest those who are economically most challenged in our society. It's hit hardest not just because the pandemic itself has resulted in more individuals from these communities being affected by the virus, but also being affected by the economic impacts. So we're very concerned about this really widespread rise in mental health symptoms. That said, there are some things that we just don't know yet. The good news from prior pandemics and disasters is that most people who experience these kinds of symptoms, this kind of distress, will get better over time, particularly as the disaster abates. But a significant minority of individuals will go on to have lasting or severe mental health symptoms that require professional help. How many Americans will need the help of a caregiver, we don't know yet. But we do know that a lot of them will. And we need to be prepared for this increase in demand for mental health services.

David R. Wilson: Thank you so much. And following up on that, I know that NIMH has been moving very quickly to get ahead of a lot of these issues. So can you briefly tell us, what are some of the NIMH research and resources that may be helpful for community health workers and families to know about if they encounter a member or encounter some of these mental health challenges themselves?

Joshua Gordon: Well, thanks to the research that we've done in the past and the research that is ongoing, we do know a fair amount about what can be helpful. For those who are experiencing mild to moderate symptoms, the most important thing to do is to reach out for help. And that goes both ways. So if you're experiencing those symptoms, reach out to your loved ones, your friends, your family, and communicate with them about how you're feeling. Those social bonds can go a long way to reducing the impact of these symptoms. Other things you can do are eat healthy, get the right amount of sleep, and try to maintain those daily routines that you can. And then, finally, look for and get help when you need it for economic problems, for food insecurity, housing insecurity, etc. We know that meeting people's basic needs can go a long way towards reducing the risk of more severe mental health outcomes. We also know that we don't know everything. And so it's important when you are faced with something like this to conduct more research. And we are conducting research in all sorts of communities all around this country to try to understand not just how significant are the mental health impacts, but what can we do to reduce or mitigate those impacts?

Joshua Gordon: Just one quick example that's germane to many of your audience; we've given supplements to existing, what is called, a collaborative hub to reduce the burden of suicide amongst American Indian and Alaskan Native youth. That's an ongoing research program supported by NIMH. And we've supplemented that program to ask critical questions about the impact of COVID-19 and to test various interventions that might reduce those impacts. That project is a partnership amongst the White Mountain Apache and the Navajo Nation with three satellite partners as well. Now, one might ask, "What if I'm afflicted with severe symptoms? And how will I know? And what should I do?" In general, the guideline we use is if you're having trouble meeting your daily responsibilities, caring for your children, going to work, going to school, caring for your elders. If those daily responsibilities are being interfered with by your symptoms, that's when you should reach out for professional help. Finally, how do you reach out? Lots of different ways. There are lots of crises hotlines available both locally and nationally. And just one that I want to point out is the National Suicide Prevention Lifeline. There's also a Crisis Text Line. And we'll put those numbers on the screen for everyone so that they can write them down if they need them.

David R. Wilson: Wonderful. And so I want to revisit something that you mentioned earlier. You talked about suicide prevention. And I know you're very well aware of this, that prior to COVID-19, American Indian and Alaskan Native communities experienced suicide rates at higher than that of the general population. And deaths are highest among youth and young adults. So, thinking about the daily routines, are these some of the things that family members should really be on the lookout for in order to prevent their loved ones from falling victim to suicide ideation or completion?

Joshua Gordon: Yeah. It is important that family and friends pay attention to their loved ones if they are experiencing pain or distress in the context of COVID or in any other context. Family and friends are often the first to recognize the warning signs of suicide. One telltale sign, again, is when symptoms interfere with these daily activities. But how can you know? What steps can you take if you suspect someone might be experiencing such significant challenges that they're thinking about suicide? Well, the first and most important thing to do is to ask. You can simply ask, "Are you thinking about suicide?" or, "Are you thinking about killing yourself?" This question, when asked with sensitivity and the understanding of the culture and context, can start a conversation that will serve as the first step to getting someone the help they need. A lot of people are shy or afraid that asking such a question might implant in the individual that you're concerned about some ideas that they didn't have before. Research after research study has shown that asking the question doesn't harm the person. It actually helps the person. Next, it's important to keep the person that you're concerned about safe. That might mean spending time with them to make sure that they're safe. That might mean reducing a suicidal person's access to highly lethal items like guns or pills to make sure that it's more challenging for them to act on any of these thoughts that they might be having.

Joshua Gordon: I mentioned being with someone. And being there is something that can be really quite helpful. And the first and foremost component of being there for a loved one is to listen carefully to the feelings that they're expressing. Providing a safe and supportive space for your loved one to express what they're thinking and feeling can also be a tremendous help. Then, after listening, help them connect. You put the National Suicide Prevention Lifeline or the Crisis Text Line in your phone, so it's available when you need it. And you can also help them make connections with a trusted individual, such as a family friend, a tribal elder, a spiritual adviser, or mental health professional, or a doctor or nurse that's caring for them. Staying connected afterwards can really help. Staying in touch with a loved one after they've gotten through the crisis can help minimize the chance of that crisis returning. And I'll just point out that, in addition to the Suicide Prevention Lifeline, the Indian Health Service has information about suicide prevention that's specific to American Indian/Alaskan Native communities. And the Suicide Prevention Resource Center is another location you can go for evidence-based resources for supporting mental health during the pandemic.

David R. Wilson: So this is definitely not an easy topic to discuss, but it's such a critically important one for tribal community members to really recognize and understand that they should not be concerned with any kind of stigmatization, especially those experiencing the event, that they should feel very open and willing to seek that help. I think that that's one of the messages that you delivered that I really want to convey to our listeners. And so, Dr. Gordon, I want to thank you so much for talking with us today about these really important issues around mental health. It's extremely critical for the communities to be aware of NIH's mental health, not only the research, but the resources, especially during this challenging time. And as always, the NIH will always continue to honor our government-to-government relationship with tribes. And we'll also continue to look to build collaborations to meet the needs of tribal nations. So, for everyone out there, thank you so much for listening.

Joshua Gordon: Thanks for having me, again.