Remarks by
TED SEARLE
Acting Deputy Director

Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

SAMHSA American Indian and Alaska Native Inservice

Rockville, MD
November 15, 2004

PowerPoint version

Good afternoon. I’m pleased to be here on behalf of the Center for Mental Health Services. Our Director, Kathryn Power, sends her regrets that she could not be here today. Improving the mental health of all Americans, particularly those in underserved populations such as American Indians and Alaska Natives, is a vitally important topic and one that I know Kathryn views as a priority for CMHS. I want to thank all of you for coming here today and being committed to learning about what SAMHSA is doing through its tribal initiatives.
I want to start by telling you how American Indian and Alaska Native mental health issues fall squarely within the context of mental health transformation and the President’s New Freedom Commission Report.

[SLIDE 2]

As you know, Mental Health Systems Transformation is one of the four SAMHSA redwoods and CMHS has the lead on implementing the recommendations of the President’s New Freedom Commission Report, Achieving the Promise. While the Report covers many broad areas of behavioral health, reducing and eliminating disparities for racial and ethnic minorities is one of its six major goals.

In Achieving the Promise, the Commission acknowledged that the mental health system has not kept pace with the diverse needs of racial and ethnic minorities, often underserving or inappropriately serving them. Specifically, many mental health systems have neglected to incorporate respect or understanding of the histories, traditions, beliefs, languages, and value systems of culturally diverse groups. As a result, American Indians, Alaska Natives, African Americans, Asian Americans, Pacific Islanders, and Hispanic Americans bear a disproportionately high burden of disability from mental disorders. This higher burden does not arise from a greater prevalence or severity of illnesses in these populations. Rather it stems from receiving less care and poorer quality of care. At CMHS, we are actively working to close the gap for American Indians and Alaska Natives.

[SLIDE 3]

The Commission’s report suggests that mental health systems can respond to the needs of ethnic and racial minority populations by implementing existing standards, thus building trust, increasing cultural awareness, and responding to cultural and linguistic differences. Our grant programs employ the SAMHSA Guidelines for Assessing Cultural Competence to ensure that all grantees are prepared to work with diverse populations.

[SLIDE 4]

One of the ways that we are reducing the burden of mental illnesses and severe emotional disturbances on racial and ethnic minority communities is through the Child Mental Health Initiative. This program has cultural competence as one of its core values and is open to States, territories, and tribal applicants. Last year, of the 63 grants, 8 were Tribal grantees and 2 were from the Territories. This year, we expect to make 20 new awards, and, as usual, we expect to receive a number of high-quality proposals from Tribal governments and territories.

[Slide 5]

In looking at the 1998 and 1999 cohorts of grants, almost 12 percent of the 40,000 children served, or about 4,700, were self-identified as American Indian or Alaska Native. We know that for the children who received services from these grants, improvements were seen across a range of outcome measures including emotional and behavioral problems, school performance, residential stability, clinical functioning, and involvement with the criminal justice system.

[Slide 6]

A key component of the Child Mental Health Initiative is the Circles of Care Program. This truly transformative program employs the powerful symbol of the circle—in our case, the Circles of Care—to ensure that Native American and Alaska Native children in every community, urban or rural, on or off reservation, will have a bright childhood and future. Circles of Care grants help tribal and urban communities plan, design and assess service models that represent their own ideals for how children should be served. For example, in Juneau, Alaska, the Southeast Alaska Native Youth Mental Health Services Initiative held an Elder's forum during which 20 esteemed elders told stories and recalled memories of their respected leaders to reveal 15 points that represent their Tribal Values. Tribal delegates adopted those values as the underpinning for this community’s systems of care and other work around elder care, sobriety and wellness. By developing strong partnerships within the community and identifying a common set of values, they have recognized the importance of establishing a consumer and family driven system—the cornerstone of a transformed system.

[SLIDE 8]

Circles grants are available to Federally Recognized Tribes, Urban Indian Programs, and now, Tribal Colleges and Universities. These grants provide funds for building infrastructure for behavioral health services. We have already had two cohorts of grants; one in 1998 that had 9 awards and

[SLIDE 9]

one in 2001 that had 7 awards. This year, we expect to issue another 7-9 awards, so that a total of $27 million will have been provided for this program.

[SLIDE 10]

Another way we are supporting this transformation is through technical assistance from the National Indian Child Welfare Association and the National Center for American Indian/Alaska Native Mental Health Research. These groups have helped grantees find creative ways around the many obstacles that stand between Native American children and the mental health and substance abuse services they so desperately need— obstacles such as, remote frontier locations, a limited array of services, language barriers, mistrust… and others.
Collaboration has been critical to the success of Circles of Care grantees. Much like the way tribes have traditionally helped families in need—wrapping the entire village around the child—we have drawn on Federal, State and local resources and encouraged family participation in developing systems that both strengthen and draw strength from their traditional culture.
Our partners include — the Indian Health Service, the National Indian Child Welfare Association, the University of Colorado, the National Institute of Mental Health, and the SAMHSA tribal team. Working collaboratively, we have been able to successfully develop models that consider the mind…the body…and the spirit…— “the whole person”—a concept that honors the Native American view of the world.

Building effective Circles of Care requires many hands. I would like to acknowledge one pair of hands, in particular…those of our colleague, Jill Erickson, the CMHS Project Officer for Circles of Care. This program has made great strides over the years, due in large part to her dedication, guidance, and experience. Jill you have our deepest appreciation for your efforts and unwavering commitment to this cause.

[SLIDE 11]

To build the consumer and family-centered, recovery-focused system called for by the President’s Commission, CMHS has committed to several other programs to recognize and understand both the commonalities and the differences among Americans and offer approaches that are sensitive to our diversity.

Here are a few other CMHS activities addressing the needs of Native communities:

• In the Safe Schools/Healthy Students grant program awards were made to several tribal
  schools to prevent youth violence and promote mental health.
  
• A program that should have been included on this list is a grant that was issued last year
  under the National Child Traumatic Stress Initiative. This grant is focused specifically on
  child trauma among American Indian populations. The University of Oklahoma is developing
  the "Indian Country Child Trauma Center" with the overarching goal of developing trauma-
  related treatment protocols, outreach materials, and service delivery guidelines specifically
  adapted and designed for Native American children.
• The suicide rate for American Indians and Alaska Natives is 1.5 to over 3 times the national
  rate, particularly among young Native males ages 15 to 24, whose suicides accounts for
  65 % of all AI/AN suicides. Utilizing evidence-based suicide prevention programs for this
  target population can save lives. Therefore, CMHS has a contract with the One Sky Center
  for the development of information on prevention programs for youth suicide in this
  historically underserved population.

In Fiscal Year 2005, the President’s Budget includes $44 million for the Mental Health
Transformation SIG program. Our current plan is to make tribal governments eligible to apply for
these catalytic Transformation grants.


[SLIDE 12]

Finally, CMHS is proud to be an early supporter of the First Nations Behavioral Health
Association. Providing a national voice for Native consumers, providers, researchers, and policy
makers, First Nations is a promising organization with the capacity to provide technicalassistance and leadership to the field. We look forward to working with them as partners in theirown right and as members of the National Alliance for Multi-Ethnic Behavioral Health Associations.

[SLIDE 13]

Earlier I spoke about the significance of the circle in Native American culture. There is much wecan learn from this culture…from the Indian worldview. For example, in Native culture, a child with an emotional disturbance is considered sacred. What a profound difference it would make if our mainstream mental health care system was oriented to think this way!

We are committed to help create such a system -- a recovery-focused system that serves every individual… including children and adults in tribal and urban Native communities across this country.

We should never stop advocating for the needs of the “whole” person. We should never lose focus on the family and its culture and values as a most powerful resource when it comes to improving the lives of Native people everywhere! In the words of Wilma Mankiller, “Never, never give up!” Together, we can, and we will, make a difference.

Thank you.