Racism can be conceptualized as unfair and avoidable disparities in power, resources, capacities, or opportunities centered on ethnic, racial, religious or cultural differences (Berman & Paradies, 2010). Racism can manifest through cognitive beliefs (e.g., stereotypes), feelings (e.g., prejudice) or practices and behaviors that are discriminatory. Although they are not mutually exclusive, racism can occur at three levels: internalized, interpersonal, or systemic racism. In this article, we shall discuss mental health impacts on indigenous communities.
Racism is increasingly recognized as a factor that plays a role in mental health as well as disparities in mental health care. This can be particularly true among many of the most marginalized groups, including Indigenous communities.
Indigenous communities can be found in countries throughout the world and make up an estimated 5% of the world’s total population. While these communities are unique and differ from one another in a variety of ways, they do have a shared history of trauma, forced migration, discrimination, and segregation that have had lasting effects on generations of Indigenous peoples.
Racism is a significant factor contributing to the onset of mental health conditions, but it also plays a major role in increasing disparities that contribute to worsening mental health.
Research suggests that racism affects health and well-being by increasing unhealthy psychological responses, contributing to poor health behavior, physiological dysregulation, sleep disruptions, and higher rates of substance use.
In November 2020, the American Medical Association formally recognized racism as a public health threat.
Table of Contents
- 1 Indigenous Communities Face Prevalent Racism
- 2 Mental Health Effects of Racism
- 3 Treatment Issues
- 4 How Indigenous Communities Cope
- 5 Indigenous Mental Health Resources
Indigenous Communities Face Prevalent Racism
Racism directed toward Indigenous people is a common problem throughout the world. In the United States, research suggests that both discrimination and harassment are widely experienced among Native Americans.
These experiences occur in multiple domains and locations including in health care, education, and the criminal justice system. Racism can come in a variety of forms including racial slurs, harassment, exclusion, and microaggressions.
The mental health effects of past traumas are also something that these communities continue to grapple with. Racist policies in the United States subjected Native Americans and Alaskan Natives to significant psychological trauma. Such policies were aimed at stripping people of their cultural identity and heritage.
For example, children were often removed from their families as part of forced assimilation programs, separated from their parents, siblings, and extended families for months or even years at a time.
They were unable to speak their own languages and were barred from participating in their spiritual and cultural traditions. Such practices created massive collective and intergenerational trauma, damaging families, their children, and entire communities.
It is important to recognize that racism is not something confined to the past. The U.S. Department of Justice has reported that Native American and Alaskan Natives are the victims of more violent crime than any other racial group in the U.S.
The cumulative effects of these experiences can take a tremendous toll on physical, emotional, and psychological well-being. In the U.S., Native Americans face issues including poorer health, lack of quality health care, higher mortality rates, and higher rates of suicide, drug and alcohol use, and sexual violence.
Such issues are not confined to the U.S., however. Indigenous people live in counties all over the world and often experience various forms and degrees of racism. One survey of Aboriginal people in Victoria, Australia found that 92% of those surveyed had experienced racism during the previous year. Those who experienced the most racism also reported the highest levels of psychological distress.
Such reports suggest that finding ways to reduce racism can play an important role in improving the mental health of people who are part of Indigenous communities.
Mental Health Effects of Racism
According to the most recent census data, 1.3% of the U.S. population identifies as Native American or Alaskan Native.5 Of these individuals, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 19% have experienced a mental illness during the past year.
Evidence suggests that people who experience racism are at a greater risk of developing a variety of mental health conditions including depression, anxiety, and post-traumatic stress disorder (PTSD).
Some evidence suggests that exposure to racism can have particularly harmful effects when it occurs during important developmental windows in childhood.
One study found that Aboriginal and Torres Straight Islander children who experienced direct racial discrimination during early childhood had an increased risk for negative mental and physical health outcomes during middle childhood compared to kids who had not experienced such racism.
Substance and Alcohol Use Disorders
In the U.S., Native Americans and Alaskan Natives are significantly more likely to report having experienced the symptoms of an alcohol or substance use disorder in the past year than other races.
While a number of variables may contribute to the higher substance and alcohol use rates among American Indian people, research has suggested that factors such as racism, discrimination, and historical trauma play a significant role.
Participants in one small study of tribal members in the state of Montana cited racism as a contributing factor to the onset of substance use as well as a major barrier to recovery. Other risk factors that are known to play a part in high substance use rates include trauma exposure, poverty, and post-traumatic stress disorder.
Some participants in the study cited the intertwined effects of racial trauma and poverty as key factors driving substance and alcohol use. “People can’t understand…there’s intergenerational trauma, and then this need to belong, with such a high rate of poverty, a high rate of unemployment—they say it’s like 80% on the reservation,” one participant explained.
Statistics show that Indigenous communities all over the world are frequently impacted by suicide at much greater rates than the non-Indigenous population. In the United States, the Indian Health Service reports that the suicide rate for Native Americans and Alaskan Natives is 1.6 times higher than it is for all other races found in the U.S.
A 2011 report by Statistics Canada found that the suicide rate among Indigenous people in Canada was three times higher than it was for non-Indigenous Canadians. In particular, young people between the ages of 15 and 24 as well as women were found to be particularly vulnerable.
What are some explanations for the increased suicide risk faced by Indigenous peoples? Current racism as well as the effects of cumulative grief and historical trauma can all play a role in contributing to high suicide rates among Indigenous communities.
Historical trauma refers to the cumulative psychological effects that affect people across generations due to a significant collective trauma.
Research suggests that up to a third of Indigenous adults report having daily thoughts related to this form of trauma, leading to serious negative emotional effects.10 Historical trauma has been linked to symptoms such as survivor’s guilt, depression, poor self-esteem, increased fear, and self-destructive behavior.
Statistics also suggest that Indigenous communities face higher rates of domestic violence. Native American and Alaskan Native women experience among the highest races of intimate partner violence and sexual assault.
The Association on American Indian Affairs reports that women, girls, and Two Spirit people are most impacted by violence, with nearly 85% of American Indian and Alaska Native women reporting that they have experienced violence during their lifetime.
Missing and Murdered Indigenous Women
This is particularly evident in the missing and murdered Indigenous women (MMIW) epidemic that has affected individuals in the U.S. and Canada. The corresponding movement inspired by these acts aims to raise awareness of the disproportionately high rate of violence, homicide, sexual assault, and sex trafficking experienced by First Nations, Métis, Inuit, and Native American women.
In addition to the mental health effects of racism, race-based discrimination can also play a role in treatment. Systemic racism and relationships between Indigenous and non-Indigenous cultures can influence a variety of factors related to mental health treatment.
The American Psychiatric Association reports that the utilization of mental health services by Native Americans and Alaskan Natives is low. This is likely due to the combination of several factors, which include a lack of mental health services, a low number of culturally trained providers, and the stigmatization of mental health conditions in Indigenous communities.
Attitudes Toward Treatment
Because of the high prevalence of racism directed toward many Indigenous communities, people may be less likely to seek out treatment when they are facing mental health issues. For example, researchers have found that 1 in 6 Native Americans report seeking medical assistance because of anticipated discriminatory or unfair treatment.
Indigenous beliefs about mental illness can also play a role in the type of help people decide to seek. In many cases, people may be more likely to seek help from a traditional or spiritual healer who is part of their community rather than from a medical source.
Because Indigenous worldviews differ from those of many non-Indigenous cultures, expressions of emotional distress may also be different from the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the resource used by doctors to diagnose mental health conditions.
Access to Services
Racism can also play a role in affecting the availability and accessibility of mental health services in Indigenous communities. Some research suggests that people may be more likely to prefer ethnically matched providers, particularly among groups who have been historically marginalized by non-Indigenous people.
In the U.S., there is a scarcity of mental health care providers who are of Native American or Alaskan Native background.
Indigenous communities also often lack access to health services. Healthcare accessibility is often impacted by policies that neglect the needs of Indigenous communities. Access to mental health services is also often severely limited by a number of factors including lack of insurance coverage and a lack of accessible clinics serving Indigenous communities. While tribal reserves may provide mental health services, many Indigenous people live outside of these areas.
Lack of Culturally Trained Providers
Culturally competent mental health care is important in order to understand and address the needs of people who are part of Indigenous communities. The Indian Health Service reports that more than 50% of mental health programs and more than 80% of substance and alcohol abuse programs are tribally operated.
This helps to ensure that people are better able to access holistic, integrated, community-based services that incorporate cultural and traditional practices while addressing issues such as racism, historical trauma, and cultural healing.
However, this means that people living in areas outside of tribal communities may have a much more difficult time accessing such services and finding culturally sensitive care.
People are also affected by Western views of mental well-being that neglect Indigenous views of mental health and trauma. In his book Healing the Soul Wound: Counseling With American Indians and Other Native Peoples, psychologist Eduardo Duran describes the concept of a “soul wound,” which describes the way traumatic events disrupt the interconnections between the mind, body, and spirit. Duran suggests that mental health practitioners need to provide interventions that address these holistic connections.
In order to address the effects of trauma and provide quality mental health services, it is essential for providers to consider the perspective and experiences of Indigenous peoples.
Racism in Healthcare
In a report exploring experiences with the Canadian healthcare system, Indigenous people reported widespread racism and discrimination that impacted both access to care and health outcomes.16 Approximately half of non-Indigenous health care workers reported witnessing racist or discriminatory actions toward Indigenous patients and nearly 30% of Indigenous people reported hearing racist comments regularly.
Such discrimination often takes various forms but included such things as:
- Denial of service
- Poor communication
- Minimizing problems
- Assuming drug or alcohol use
- Poor pain management
- Lack of respect for cultural protocols
“The overall tone of what I can only describe as ‘disdain’ that was shown to my family day in and day out for taking up space in the hospital. The glances, the glares, the apathy was heavily noted by many of us, as it seemed they would prefer that we not be there,” explained one First Nations woman of her family’s ICU experience while her father was dying.
Indigenous patients also report that health care workers are often resistant to even hearing about cultural health practices. Thirty percent of respondents reported that requests to follow cultural practices with regards to events such as birth and death were often denied.
How Indigenous Communities Cope
Because of the serious detrimental effects of racism, finding ways to reduce discrimination and its impact are important to the health and well-being of Indigenous communities. There are a number of other factors that can be helpful in mitigating the mental health impacts of racism.
Indigenous worldviews can serve as a protective force. Many Indigenous cultures throughout the world hold worldviews that emphasize the importance of family, social bonds, and connectedness. Such connections and supportive relationships can play an important role in bolstering the mental health and well-being of Indigenous communities.
The American Psychiatric Association reports that protective factors that can reduce the risk of negative mental health effects and promote increased well-being include:
- Appreciation for the wisdom of elders
- Connections to the past
- Strong identification with culture
- Traditional health practices
Indigenous Mental Health Resources
Some programs that offer mental health resources for Indigenous communities include:
- One Sky Center: Offered by the American Indian/Alaska Native National Resource Center for Health, Education, and Research, One Sky Native has resources related to mental health, substance use, and suicide prevention.
- StrongHearts Native Helpline: This service offers a national helpline that people can call (1-844-762-8483) for anonymous and culturally sensitive help with dating and domestic violence.
- WeRNative: Aimed at and created by Native youth, this site offers information on mental health, culture, relationships, and LGBTQ/Two Spirit issues.
In summary, there is an abundance of research demonstrating the profound negative effects that racism can have on Indigenous communities. The widespread prevalence of continued racism demonstrates that such issues need further intervention that seeks to end discrimination.
Because of the prevalence and impact of racism, addressing it over the course of treatment can be important for recovery. However, research suggests that racism and its effects are rarely discussed by mental health professionals during treatment.
The mental health effects of racism on Indigenous communities points to the need for both policy and social changes that can help reduce stereotypes and discrimination while addressing the economic, health, and social inequalities that continue to reinforce the lingering impact of colonization and racial trauma.