Behavioral Health in Alaska Native Communities

Good morning. Thank you for that warm introduction.

This is my fifth visit to Alaska native lands and Indian country, as well as my fourth visit to the state of Alaska. Over the course of my travels, I have seen first hand some of the many issues in your communities that you, as tribal leaders, health directors, and other state partners, face. In particular, we would like to extend our sympathy to the people of Hooper Bay, who lost houses and a school to a recent fire.

I am committed to working with you to find solutions to the health problems of Alaska Natives and American Indians.

One of the health challenges that many people in Alaska Native and American Indian communities face is the complex role of behavioral health in health promotion and disease prevention. Many chronic health conditions that millions of Americans suffer from, including Alaska Natives and American Indians, are largely preventable because they are tied into poor choices and poor habits that people persist in.

Alaska Native communities suffer from far greater rates of behavioral health problems than the rest of the U.S.:

• Alaska Natives die of accidents almost four times as often as other Americans;
• Alaska Native children between the ages of 1 and 14 die from accidents 5 times as often as other American children.
• Alaska Native women report drinking alcohol during pregnancy more than eight times as often as American women, and report smoking during pregnancy more than two and a half times as often;
• Alaska Native girls between the ages of 15 and 17 give birth twice as often as other American girls;

And though Alaska Natives compose just 19% of the state’s population, they suffer disproportionately from behavioral health issues:

• 47% of Alaska Native men currently smoke, as compared to 28% of other Alaskan men;
• 7% of Alaska Native men report that they drink and drive, compared with the 5% of other Alaskan men; and
• More than half of the children in state custody are Alaska Natives.

Any of our efforts to improve the health of Alaska Natives must begin by acknowledging and addressing these unmet behavioral health needs.

Clearly, Alaska Native communities face great challenges in behavioral health. However, with native communities, we have an opportunity to increase their health and well-being by integrating tribal traditions and customs with other behavioral health strategies. For many Alaska Natives, subsistence living offers great economic, cultural, and spiritual benefits. In addition, traditional cultural practices, foods, and gathering practices can offer many behavioral health benefits. We want to empower communities and individuals to benefit from their cultural heritage as much as possible.

The IHS Division of Behavioral Health operates as an umbrella for our mental health, social services, alcohol and substance abuse, and other Alaska Native and American Indian behavioral health programs. Through it, we are focusing on four strategic areas:

• Mobilizing tribes and tribal programs to promote behavioral health in systematic, evidence-based approaches that embrace traditions and culture as critical foundations for that health;
• Supporting programmatic collaborations within communities, as well as with state and federal programs and agencies;
• Promoting leadership development from the tribal community level to the national level, with training and mentorship; and
• Advocating for behavioral health programs located in tribal communities from federal, state, tribal, local, and free market organizations.

Now, I’d like to tell you about some of our specific programs to meet the behavioral health needs of Alaska Natives.

Behavioral Health Aides: On the village level, one of our main approaches to meeting behavioral health needs has been the behavioral health aide program, which is unique to Alaska. Behavioral health aides are similar to community health aides-who offer basic primary care on the community level-and dental health aides-whom we are currently certifying and having trained to provide basic dental care on the community level. Behavioral health aides are a new type of provider that we have developed to provide a broad-range of behavioral health services. The idea with behavioral health aides is to have them live and work within a community context. When it comes to providing behavioral health services in rural and remote locations, we want to shift away from the approach that requires a diagnosis before treatment, to one that intervenes early and disrupts the cycle of unacceptable behaviors and poor choices that lead to health problems. We currently have 123 village-based behavioral health aides spread about native communities, and are working toward a minimum long-range goal of 470.

Tele-Behavioral Health: To support the work of behavioral health aides, we are working to expand the Alaska Tribal Health System’s tele-behavioral health capacity to provide best practice and best quality behavioral health care to rural Alaska Natives and American Indians. In particular, we want to:

• Increase the availability of clinical support and supervision for village-based behavioral health providers,
• Increase access to direct clinical behavioral health services for rural residents, and
• Increase clinical collaboration among village-based behavioral services staff.

Suicide Prevention: We are all greatly concerned about suicide in Native communities. The problem is severe: the suicide death rate is 4.6 times greater among Alaska Natives than among the rest of the U.S. population, and youth between the ages of 15 and 24 have a suicide death rate that is 9 times greater. Fortunately, over the past year, we have made some positive advances against these tragedies:

• Our Substance Abuse and Mental Health Services Administration has awarded Maniilaq, the Regional Native Health Organization based in Kotzebue, nearly half a million dollars per year for suicide prevention.
• Through the Alaska Native Tribal Health Consortium Behavioral Health Consultant, we are providing training and consultation to the Norton Sound Health Corporation on village-based behavioral health services with emphasis on prevention and early intervention.
• And we are contracting with the Alaska Suicide Prevention Council to search for suicide-prevention partners.

Methamphetamine Abuse: The abuse of methamphetamine has also placed a burden on tribal communities. The Indian Health Service reports that over 30% of Alaska native and American Indian youth have experimented with methamphetamine, and that 1.9% of Alaska Natives and American Indians over the age of 12 are currently using it. To put that in perspective, according to the Centers for Disease Control and Prevention, that is almost three times higher than the national rate of whites-which is 0.7%-and four times higher than the rate of Hispanics and Latinos-which is 0.5%.

• I have heard how members of the Alaska Native community such as Mr. Lincoln Bean, Senior, are very concerned with the impact of methamphetamine abuse on children due to the toxic and explosive nature of its manufacture.
• To help Alaska Natives and American Indians overcome their abuse of methamphetamine, this year, HHS began working with tribes to implement an initiative entitled Empowering Our Youth through Tribal Leadership: Meth in Indian Country. Through this partnership, we have been hosting a series of roundtables with tribal representatives in the hope of finding solutions to this problem and to keep your communities health, stable, and safe.

Problems like methamphetamine abuse and other behavioral health issues are complex, and we don’t have answers to all of them. But I am confident that through open discussion and by working together, we can help individuals and families in Alaska Native and American Indian communities live long and healthy lives.

In addition, to assist the social and economic development of Alaska Native communities, I would like to announce three important grants:

• An award of $55,000 for one year to the Telida Village Council, to help them develop an effective and efficient tribal government through codes, ordinances, and a procedural policy manual.
• An award of $174,280 for one year to the Hoonah Indian Association to help them assess the cultural accuracy of exhibits on display at the Cultural Heritage Center.
• And an award of $452,270 for 3 years to the Council of Athabascan Tribal Governments to help them build a the foundation for the development of effective tribal natural resource programming. This grant will enable participating tribes to increase their capacity to govern their lands and resources effectively.

Thank you.