A lack of Indigenous mental health professionals and mistrust of the effectiveness of mental health treatment are two of multiple barriers that may keep Indigenous people from seeking and using mental health services, a review in Psychiatric Services suggests.
Christiana J. Goetz, M.A., Christopher J. Mushquash, Ph.D., and K. Amanda Maranzan, Ph.D., of Lakehead University in Ontario searched five databases—PsycINFO, PubMed, Web of Science, Social Services Abstracts, and Bibliography of Native North Americans—for original studies with data specific to Indigenous people about barriers to or facilitators of seeking professional help for mental disorders. Of the 1,010 records that the researchers identified, the final synthesis included 41 articles with information specific to Indigenous people in Canada, the United States, Australia, or the Pacific Islands.
The researchers identified six main themes associated with mental health service use among Indigenous populations:
Informal supports: Participants reported being more comfortable talking to family and friends than to a mental health professional.
Structural obstacles and supports: Participants reported a lack of mental health services and resources for Indigenous patients, including a lack of access to Indigenous service providers and long waitlists for care. Transportation assistance and referrals were identified as facilitators of help seeking and service use.
Stigma and shame: Participants’ feelings of shame and embarrassment about mental health concerns and perceived or experienced discrimination were associated with a decreased likelihood of seeking mental health treatment; anonymity encouraged seeking mental health treatment.
Self-reliance and uncertainty about services: Many participants expressed skepticism about the effectiveness of mental health treatment, and many expressed the desire to handle their problems on their own.
Cultural factors and mistrust of mainstream services: Participants emphasized culture in their preferences for mental health professionals and treatment; some participants did not trust non-Indigenous professionals. Allowing families access to traditional modes of health care, based on Indigenous values, facilitated care.
Need for outreach and information regarding mental illness and services: Participants’ lack of recognition of mental health problems was a significant barrier to seeking help; greater knowledge of mental illness was associated with more positive attitudes toward mental health treatment.
“Increased funding, increased availability of culturally sensitive services, and incentives for Indigenous people to be educated and trained in mental health services delivery would enhance help seeking among Indigenous people,” the authors wrote. “On a larger scale, policymakers have a responsibility to address the systemic barriers that inordinately affect access to proper mental health support for Indigenous populations.”
More information about this review can be found on APA blog post “Indigenous Populations Face Unique Barriers to Accessing Mental Health Help.”
For related information, see the Psychiatric News articles “Mindfulness Has Parallels to Indigenous Cultural Practices” and “Culture as Treatment: Some Indigenous People Wary of Evidence-Based Treatment.”
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