Jesse Valentin, MSW, LICSW, is a Diné two-spirit enrolled member of Navajo Nation, a therapist at Gather Behavioral Health and provides consultancy for Indigenous mental health curriculum and program design. Jesse Valentin is a previous social worker with CVT, and also teaches on issues of cultural competency and trauma informed clinical practice at Winona State University Master of Social Work program.
The colonial history, stigma and inequitable access to healthcare in the U.S. prevents many Native Americans from seeking healing services and support. Clinical practice, policy and research methods often fail to capture the features of pain and suffering experienced across Native communities living on tribal lands and across the U.S.A.
Transforming mental health care for Natives means increasing Native clinicians and creating greater accessibility to services. For non-Native providers, this means adopting a decolonized framework to mental health. Doing so looks like accepting an Indigenous view of the world as a mutually supportive system with the cosmos, where well-being is balanced between body, mind and spirit.
To be well is to have our lives in balance; it is not enough to understand mental health from a biological, personal, intellectual and emotional functioning viewpoint.”
Despite efforts by western medicine to treat and support Natives, health disparities and inequities are desperately challenging, with little progress made over the last few decades. This progress has been slow in part because the mental health system has not embraced an Indigenous paradigm to serve Indigenous people. Western medicine focuses on treating an individual, with promotion of autonomy as the marker for increased mental health and well-being. Relationships are at the core of Native identity and security. If one maintains relationships with the Creator, oneself, community, land and all of creation, one will be safe, have identity and self-actualize. This is in sharp contrast to Maslow’s Hierarchy, and from this perspective, the individual places self-actualization at the top of the pyramid and physiological at the bottom.
Indigenous conceptualization of needs overlap, interconnected with spirituality at the center. This Indigenous clinical perspective states that if one maintains proper relationships with the Creator and supportive community, they will have safety, identity and self-actualization (Issak et al., 2020). Because the Indigenous worldview universally views spirituality as the most important element impacting mental health and well-being, the systematic de-emphasis on the positive impacts of prayer, meditation, somatic rituals and ceremonies have generated a chasm between Native communities and western mental health.
Indigenous people believe we are a spiritual being on a human journey.”
The influence of spiritual forces impacts this journey and is a result of the complex relationships between the physical, mental, environmental and spiritual forces outside of us. Cultural and spiritual teachings provide people with a sense of purpose, sense of future, connection to their ancestors, to the Creator and spiritual helpers that guide and shape our human existence. Indigenous teachings vary by tribe, but the universal golden thread that is constant is the belief that well-being is achieved through balancing the mind, body and spirit. Each of these components of life hold equal value and weight; achieving balance is the essence and the objective of the Indigenous human experience.
Native clinicians and researchers have been creating behavioral health models that are a natural fit for how Natives conceptualize help-seeking for mental health issues (Ansloos et al., 2022). Native clinicians understand the need for mental health care to incorporate spirituality as a lifestyle, language fluency, and ceremonies to engage the community in a relational way. Linking culturally-normed pathways of help-seeking increases Native individuals’ access to appropriate mental health or substance abuse treatments. Indigenous clinical substance abuse treatment models such as Wellbriety, have higher treatment completion rates and lower relapse rates for Natives than western models offer.
Though Western medicine has typically minimized the importance of the spiritual realm and its influence on human behavior, Native communities have always embraced ritual, ceremony and spiritual interventions as valid mental health approaches. Indigenous clinician Rosemary Whiteshield, Ph.D, leads projects focused on increasing equity, culture, and community values in policy-making, mental health and education. She is a leader in the indigenization of graduate psychology curriculum to broaden psychology education past the western perspective. The sovereignty and function of spirituality and culture are intrinsic factors in mental well-being and has only recently been supported by western mental health research.
Centering Indigenous world views does not mean a rejection of western knowledge or research.”
Instead, it signals an acceptance and understanding that Indigenous research and treatment interventions by Indigenous healers within our own communities is the preferred treatment option.
There have been huge losses in Native culture and language due to colonization. Recent revitalization efforts are underway across Native America. Indigenous elders, educators, and clinicians teach about mental wellness and Natives are better able to develop values and a sense of purpose to maintain a sense of direction in life. Genocide, colonialism, land theft, inequitable economic opportunities, and climate change have historically and continues to contribute to Native people’s dislocation from culture, language, family, land, and spirituality.
Spirituality has been the cornerstone of existence for Indigenous communities for millennia, and Indigenous elders and researchers have found that “without cultural teachings, religion, and language (Natives) experience a sense of loss and lack of future orientation, which are precursors for high-risk behaviors,” (Hodge et al., 2009). Without cultural teachings Indigenous folks may feel lost, disconnected and unable to understand who they are within the larger context of human existence.
Natives can increase well-being by reconnecting to culture, spirituality, language, and community.”
The western mental health paradigm reinforces the tenets of colonialism with a hierarchy lacking recognition of the spiritual or cultural needs of Natives. Decolonizing mental health is a relational worldview, which requires being open to understanding that spiritual forces require constant and careful attention. Native mental health providers and healers have diverse healing traditions that have endured despite the oppressions of colonization.