Telemedicine Improves Mental Healthcare Access for Native Americans

Native American Communities Face Mental Healthcare Gaps

July is recognized as National Minority Mental Health Awareness Month, shining a spotlight on the mental health challenges faced by underrepresented communities. Among these communities, Native Americans have faced a long history of trauma and often find themselves at the intersection of multiple disparities, including limited access to quality healthcare and higher rates of mental health conditions. These issues are exacerbated by the fact that many Native Americans reside in rural areas, creating significant barriers to accessing the mental healthcare they deserve. The challenges faced by these communities demand urgent attention, and telemedicine holds great potential for increasing their access to quality mental healthcare. Some of the most pressing challenges that could be addressed by telemedicine include overcoming geographical barriers, providing culturally sensitive care, and increasing privacy and confidentiality.

Understanding the Challenges

Historical Trauma

Historical trauma is the “cumulative emotional and psychological wounding over one’s lifetime and from generation to generation following loss of lives, land and vital aspects of culture.” Native American communities have experienced immense historical trauma, including cultural genocide and displacement from their ancestral lands. The loss of cultural practices, language, and belonging has created a profound sense of disconnection and identity struggle within these communities, and this collective trauma has had far-reaching effects on Native Americans’ mental well-being.

In the present, though many Native Americans are generations removed from many of these historical traumas, “daily thoughts about loss, stress, grief, discrimination, and cultural displacement are part of the lives of many.” Furthermore, the trauma isn’t over, with many Native Americans experiencing offensive comments, violence, and harassment in their day-to-day lives. In fact, nearly one in four states that they have experienced discrimination even when going to a doctor.

Mental Health Conditions

These historical and ongoing traumas experienced by Native Americans have had a significant and lasting impact on their mental well-being. Historical traumas have resulted in intergenerational trauma, which is passed down through generations. The pain, grief, and sense of loss associated with these traumas can manifest in various mental health conditions, including anxiety, depression, and post-traumatic stress disorder. In fact, Native people experience serious psychological distress 2.5 times more than the general population. 

Present-day traumas continue to impact Native Americans’ mental health. Systemic discrimination, marginalization, and racism contribute to ongoing stress, low self-esteem, and a constant sense of feeling undervalued. The experience of discrimination in healthcare, education, employment, and other aspects of daily life further compounds the issues that Native Americans already face. 

Members of these communities are also more susceptible to substance abuse, which stems from both historical and present traumas. Data indicates that compared to other ethnic groups, Native Americans have the highest rates of alcohol, marijuana, cocaine, inhalant, and hallucinogenic use disorders. Many Native Americans turn to substance abuse as a coping mechanism to numb emotional pain and/or escape from the harsh realities they face. Substance abuse not only exacerbates mental health issues but also contributes to a higher risk of suicide within these communities. Native Americans between the ages of 15-19 have a suicide rate of more than double that of non-Hispanic whites.

Within Native American communities, there is also often a strong stigma surrounding mental health conditions. This can prevent people from seeking help when they need it and perpetuate the vicious cycle of untreated mental health conditions, which can lead to “unemployment, substance abuse, homelessness…suicide, and poor quality of life.”

Socioeconomic Disparities

Native Americans also face significant socioeconomic disparities that have a negative impact on their mental health. Native Americans have the highest poverty rates among all ethnic groups and more than double that of Whites. They also experience higher rates of unemployment and lower rates of educational attainment. In fact, only 65% of Native students graduate from high school and less than 10% earn a college degree. The burdens of financial stress, unemployment, and educational disadvantages contribute to feelings of marginalization, constrain socioeconomic mobility, and increase overall stress levels, all of which increase Native Americans’ vulnerability to mental health conditions.

Limited Access to Healthcare

Native American healthcare systems are complex, often involving a combination of tribal and Indian Health Service (IHS) resources. Since the passage of the Indian Self-Determination and Education Assistance Act (ISDEAA) in 1975, many tribes have moved toward tribal self-governance with respect to healthcare. Tribes have the authority to operate their own healthcare facilities or enter into partnerships with federal agencies (such as the IHS), state governments, and private organizations. This allows tribes to have great decision-making power and tailor healthcare services to their communities’ specific needs. 

However, many tribal healthcare systems experience major challenges, including limited funding, a shortage of specialty providers, and geographical barriers. Although total funding for the IHS increased over time, the Level of Need Funded (LNF) is only 48.6%. Insufficient funding results in outdated infrastructure and inadequate staffing. Furthermore, tribes often face challenges in recruiting and retaining specialty providers such as psychologists, psychiatrists, and licensed therapists due to rural locations and lower pay. These dynamics limit the availability of treatment for trauma, substance abuse, and other mental health conditions.

New research shows that “over 113,000 American Indians and Alaska Natives (AI/AN) live in a county that lacks an adequate amount of mental health providers. In these mostly rural counties, fewer than 1 mental health provider is available for every 30,000 people.”

How Telemedicine Increases Access to Mental Healthcare

Increased Access and Reduced Financial Load

Telemedicine breaks down geographical barriers, providing individuals in remote communities with virtual access to mental health providers. This helps resolve the issue of provider shortages and significantly reduces wait times for patients. Leveraging this technology also eliminates the need for travel, offering patients more flexibility compared to traditional in-person healthcare settings while also reducing high travel costs. With this decreased financial burden, Indigenous patients are more likely to seek the mental healthcare they need.

Enhanced Patient Privacy and Community Support

Among Native American communities, there is often a stigma surrounding mental illness, which can be a barrier for those who need care. Many Native Americans also avoid seeking care due to fear of discrimination or poor treatment because they are Native. In these scenarios, telemedicine is a wonderful resource because it allows individuals to remain in the comfort of their own homes. Furthermore, telemedicine allows the patient to meet with a provider outside of their own community, offering a more confidential setting. For the Lummi Nation, a tribal community in Washington state, “the privacy that telehealth offers patients was a big factor in the increased adoption during the pandemic,” said Justin Iwasaki, PhD, MPH. Their behavioral health program is now 100% telehealth.

Bridging Healthcare Equity Gaps with Telemedicine

Telemedicine has emerged as a powerful solution to address the challenges that Native American communities face in accessing quality mental healthcare. By leveraging technology, telemedicine can overcome geographical barriers, enhance patient privacy, and provide culturally sensitive care. This approach helps reduce disparities in mental healthcare, improve access to specialized services, and create safe spaces for Native American individuals to seek the support they need. 

Beam Healthcare provides turnkey telemedicine solutions to healthcare systems, ranging in size from critical access hospitals to large healthcare systems like the Mayo Clinic. Founded and run by physicians, our goal is to improve healthcare quality, access, and equity across populations. To learn how Beam can support your organization, explore our services or get in touch with a member of our team.