Perspectives on Mental Health Crisis Care Among American Indian/Alaska Natives with Lived Experience

Background: Mental health crises have risen in recent decades, with suicide rates increasing by over 37% since 2000. While national and state policies have endeavored to expand crisis services to reduce the harmful impacts of mental illness, the quality of such services is limited, particularly among American Indians and Alaska Natives (AIANs). Additionally, acute crisis management has historically been modeled after medicalized/Westernized frameworks developed by medical professionals. These frameworks have given limited attention to the perspectives of those with lived experience using crisis care. Less consideration has been paid to the experiences of AIAN populations.

This study aims to fill the knowledge gap by identifying key themes from AIANs with lived experience about how crisis is defined, how the individual knew they were in crisis, their experiences using mental health crisis services, and suggested improvements for the current mental health crisis systems and policies.

Methods: From June to August 2024, informed by an advisory board of people with lived experience, practitioners, and academics, seven 1.5-hour focus groups were conducted with people with lived experience (n=27) using mental health crisis services. Of the total participants, four identified as AIAN (n=4). The AIAN people from four different focus groups were pulled for analysis. The participants were asked to define “crisis,” express how they knew they were in a crisis, share their experiences using mental health crisis services, and describe an ideal crisis care system. The transcripts were inductively coded, using grounded theory thematic analysis by two research team members.

Results: The participants were aged 26-45 (n=2) and 46-65 (n=2), identified as non-Hispanic AIAN only (n=2) and AIAN with another race (n=2), cisgender female (n=3) and non-binary transgender (n=1). Emergent themes from the coded transcripts oriented around four categories: 1) definition of “crisis” (e.g., common language); 2) knew they were in crisis (e.g., suicidal, extreme behavior changes, and past or recent traumatic experiences); 3) experiences in mental health crisis care (e.g., re-traumatizing, lack of communication/transparency, agency of care, and staff competency (education and experience with people in crisis); and 4) ideal crisis care system elements (e.g., person-centered, peer-support, involvement in treatment, and culture and family inclusion in treatment plan). While the results are similar to the larger sample, there are two distinct differences among the AIAN populations. AIANs emphasize the importance of cultural practices and family involvement integrated into their mental health treatment plan. Additionally, having a counselor, medical team member, or peer-support worker that are AIAN or have knowledge of AIAN cultural values had substantial positive impacts on the individual’s mental health.

Conclusion and Implications: Mental health crisis care perspectives involve a breadth of categories, including the definition of “crisis,” insights into being in crisis, often harmful experiences in crisis care, and what an ideal mental health crisis care system would look like. It is critical that culture, family, and knowledge of AIAN culture be included into AIAN treatment plans. Perspectives from AIAN participants with lived experience with mental health crisis services can inform revitalization efforts for equitable and effective policy reforms.