American Indian Rural Youth and Mental Health: Community Knowledge and Methods for Help-Seeking

Background and Purpose: There has been limited research with American Indian/Alaskan Native (AIAN) youth on their knowledge and preferred methods of help-seeking for mental health concerns (depression, suicidal ideation, surviving trauma, etc.). Much of what we know about AIAN mental health comes from adult perspectives, though prevalence of mental health issues among youth in this population is particularly high.  The purpose of this paper is to identify support for mental health help-seeking among AIAN youth that is contextually and culturally relevant by investigating how social work researchers and practitioners can use community strengths and knowledge in designing mental health programs. 

Methods: As part of a larger study, seven semi-structured focus groups were conducted with self-identified AIAN youth (14-17; n = 6) and young adults (18-25; n= 14) in a rural community in the Pacific Northwest.  Participants were recruited via fliers and a community liaison that lived in the community.  Focus groups were conducted in local community centers.  Group participants (n=3-6) were separated by gender and age: male participants, 14-17 and 18-25 (n=9); female participants 14-17 and 18-25 (n=11).  Groups were asked questions related to their current knowledge of mental health, supports and resources in the community, and how they would prefer to tailor a program specific to their needs.  Thematic coding of verbatim transcripts was completed using Dedoose software by two independent coders using inductive content analysis and grounded theory. 

Results: Youth exhibited substantial knowledge of mental health such as barriers to help-seeking (shame, money, transportation, availability of resources) and people or places they could go to for help (counselors, friends, family, spiritual support).  Youth expressed concerns about professional help because they value their privacy and were aware that reporting mental health crises could lead to professionals telling family or outsiders—which they noted may be unique to rural living in small communities where friends/family may work at service locations. Youth were able to identify friends, family, or service providers as resources for help; however, the individual the youth contacted was dependent upon the type of mental health need (e.g. suicidal ideation versus the loss of a loved one). Youth mentioned traditional practices such as “sweating” and “smudging” as methods of healing; however, some participants noted the importance of culture in healing depends on the individual.  Females were more likely than males to describe social services and cultural influences that have been useful in their healing. 

Conclusions and Implications: From this study we learned that youth seek out resources that provide them a sense of safety and confidentiality in addition to having the option to either participate in cultural practices or not, depending on need and preference.  Social work interventions could benefit from understanding that a combination of cultural openness, family supports, and confidentiality can create a positive space for mental health healing.  Additionally, recognizing community strengths prior to implementing programs may support community participation.  Understanding the community context, from the perspective of stakeholders, can support social workers to effectively work with this population and their help-seeking preferences.