Indigenous and Native Communities and Mental Health

Indigenous, or Native, people who lived in what we now call the United States prior to European colonization currently make up about 1.5 percent of the U.S. population.

Native peoples’ mental well-being is closely tied to their deep connection to nature and to their community. Therefore, the violence of colonization and displacement was and continues to be especially traumatic for native communities.

Other Factors

Treatment concerns

Beliefs around mental health conditions and the causes vary widely among native people. In general, native culture recognizes an overlap between the physical and psychological, and native people sometimes show mental health symptoms in ways that are not well-documented in U.S. medicine or consistent with standardized diagnostic criteria.

Native people who meet the criteria for depression, anxiety, or substance use disorders will often seek help from a spiritual or traditional healer instead of a doctor.

Because of historical violence and mistreatment, Native people also express a higher level of medical mistrust than white people.

When native people do access care, they often receive care that does not address their unique cultural needs.


Racial trauma, also called race-based traumatic stress, describes the mental and emotional damage caused by encounters with racism, racial or ethnic discrimination, and hate crimes. Any individual that has experienced a racist incident is at risk of suffering from race-based traumatic stress.

Indigenous peoples have experienced violence, dehumanization, oppression, and genocide at the hands of colonizers and the U.S. government. This historical trauma (defined as “cumulative emotional and psychological wounding, over the lifespan and across generations, emanating from massive group trauma experiences”) still affects Indigenous peoples today.

This historical trauma has resulted in Indigenous people’s forced relocation and land dispossession, epidemics, and forced assimilation and sterilization. These traumas continue to happen today.

Access to care

About 15 percent of indigenous people are uninsured, compared to 6 percent of whites.

Many indigenous people reside in rural areas where access to mental health services is severely limited. Additionally, most clinics and hospitals of the Indian Health Service are located on reservations, yet the majority of Native Americans no longer reside on reservations.

Substance use

Because of the generational trauma inflicted upon indigenous communities, substance use is sometimes a coping mechanism. Data indicates that Native Americans have the highest rates of alcohol, marijuana, cocaine, inhalant, and hallucinogen use disorders compared to other ethnic groups.

Additionally, substance use and addiction are major concerns among indigenous youth. Results of a 2018 survey show nearly 1 in 5 Native American young adults (aged 18-25 years) has a substance use disorder. The survey also indicates approximately 4 in 10 Native American youth (aged 12-17 years) have a lifetime prevalence of drug use.


According to SAMHSA, suicide is the second leading cause of death among American Indian and Alaska Native youth ages 8 to 24. Suicide rates for Native youth are more than double the rate of white youth. The overall death rate from suicide for American Indian/Alaska Native adults is about 20 percent higher as compared to the non-Hispanic white population.

Indigenous and Native Communities and Mental Health

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