The%20American%20Indian/Alaska%20Native%20National%20Resource%20Center%20for%20Substance%20Abuse%20and%20Mental%20Health%20Services

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The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Native Community Disaster Management Planning,
Assessment, Care, and Follow-up San Diego,
California June 8, 2006
Dale Walker, MD Patricia Silk Walker, PhD
Douglas Bigelow, PhD Michelle Singer
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Native Communities
Advisory Council / Steering Committee
One Sky Center
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One Sky Center Partners
Tribal Colleges and Universities
Cook Inlet Tribal Council
Alaska Native Tribal Health Consortium
Prairielands ATTC
Red Road
Northwest Portland Area Indian Health Board
One Sky Center
Harvard Native Health Program
United American Indian Involvement
Jack Brown Adolescent Treatment Center
National Indian Youth Leadership Project
Tri-Ethnic Center for Prevention Research
Na'nizhoozhi Center
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One Sky Center Outreach
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Presentation Overview

• An Environmental Scan
• Behavioral Health and Education System Issues
• Fragmentation and Integration
• Discuss Suicide as Disaster planning, care,
  assessment, follow up
• Integrated care approaches and interagency
  coordination are best overall solutions

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Six Missions Impossible?

• How do we define health, education, and social
  problems?
• How do we define disaster?
• How do we ask for help?
• How do we get Federal and State agencies to work
  together and with us?
• How do we build our communities?
• How do we restore what is lost?

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A Quiet Crisis Federal Funding and Unmet Needs
in Indian Country, July 2003

• Funding not sufficient to meet needs for
• Health care
• Education
• Public safety
• Housing
• Infrastructure development needed

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Native Health/ Educational Problems

1. Alcoholism 6X
2. Tuberculosis 6X
3. Diabetes 3.5X
4. Accidents 3X
5. Suicide 1.7 to 4x
6. Health care access -3x
7. Poverty 3x
8. Poor educational achievement
9. Substandard housing

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American Indians

• Have same disorders as general population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated

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Agencies Involved in B.H. Edn

• 1. Indian Health Service (IHS)
• A. Mental Health
• B. Primary Health
• C. Alcoholism / Substance Abuse
• 2. Bureau of Indian Affairs (BIA)
• A. Education
• B. Vocational
• C. Social Services
• D. Police
• 3. Tribal Education/Health
• 4. Urban Indian Education/Health
• State and Local Agencies
• Federal Agencies SAMHSA, Edn

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Disconnect Between Education/Behavioral Health

• Professionals are undertrained in one of the two
  domains
• Students as patients are under diagnosed and
  under treated
• Students have less opportunity for education
• Neither system integrates well with medical,
  emergency, legal, and social services

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Difficulties of System Integration

• Separate funding streams and coverage gaps
• Agency turf issues
• Different philosophies
• Lack of resources
• Poor cross training
• Consumer and family barriers

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Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning?
(Dale Walker,
Carl Bell, 7/03)
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Best Practice
Culturally Specific
Outcome Driven
Integrating Resources
We need Synergy and an Integrated System
(Dale Walker, Carl Bell, 7/03)
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Emergency situation

• Event where, in order to protect the people,
  goods and the environment, requires a quick
  response for which the normal procedures and
  resources of an organisation are adequate.

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Disaster

• Event, endangering the safety of people, goods
  and the environment, that exceeds the
  organisations normal response capabilities
  (resources or procedures)

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When Does an Emergency Become a Disaster?

• A disaster depends largely on the community
  itself. What is its size, its resources, its
  experience in dealing with a certain hazard.

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Suicide A National Crisis

• In the United States, more than 30,000 people die
  by suicide a year.1
• Ninety percent of people who die by suicide have
  a diagnosable mental illness and/or substance
  abuse disorder.2
• The annual cost of untreated mental illness is
  100 billion.3
• 1 The Presidents New Freedom Commission on
  Mental Health, 2003.
• 2 National Center for Health Statistics, 2004.
• 3 Bazelon Center for Mental Health Law, 1999.

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Our Native Community Issue

• For every suicide, at least six people are
  affected.4
• There are higher rates of suicide among survivors
  (e.g., family members and friends of a loved one
  who died by suicide).5
• Communities are closely linked to each other,
  increasing the risk of cluster suicide.
• 4 National Center for Health Statistics, 1999.
• 5 National Institute of Mental Health, 2003.

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Suicide Rates by Age, Race, and Gender 1999-2001
Source National Center for Health Statistics
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Native Suicide A Multi-factorial Event
Psychiatric Illness Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance Use/Abuse
Hopelessness
Family Disruption Domestic Violence
Suicide
Family History
Negative Boarding School
Psychodynamics/ Psychological Vulnerability
Historical Trauma
Suicidal Behavior
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Suicide

• The complexity of causes necessarily requires
  a multifaceted approach to prevention that takes
  into account cultural context. Cultural factors
  play a major role in suicidal behavior. and its
  treatment

Violence A global public health problem, World
Health Organization, 2002, p. 206. DeLeo, D.
Cultural Issues in suicide and old age. Crisis,
1999, 2053-55.
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Current Cluster Suicide Crisis in a Tribal
Community

• 300 attempts in last 12 months
• 70 attempts since November
• 13 completions in 12 months
• 8 completions in 3 months
• 4 to 5 attempts per week
• Some attempts are adult
• Age range of completions 14-24 years of age
• Most completed suicides are female
• 80 Alcohol related
• All hanging

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Suicide

• Problems are complex and go beyond the
  capacity, resources, or jurisdiction for any
  single person, program, organization, or sector
  to change or control. Disaster

Lasker R., Weiss E., Broadening Participation in
Community Problem Solving A Muiltidisciplinary
Model to SupportCollaborative Practice and
Research. Journal of Urban Health Bulletin of
the New York Academy of Medicine. Vol 80,No 1.
March 2003. p.5.
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BIA Schools

• 184 elementary and secondary schools and
  dormitories (55) as well as 27 colleges
• In 23 states
• 60,000 total students
• 238 different tribes
• Majority of the schools are located in Arizona
  and New Mexico
• Second greatest number of schools in the states
  of North Dakota and South Dakota
• Third greatest lie in the northwest

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Why should schools be involved?

• When students behavioral health problems are
  barriers to learning and development. From
  Carnegie Task Force on Education.
• Schools need to take steps to minimize factors
  that lead to student alienation and despair.
• Schools are in a unique position to promote
  healthy development and protective buffers, offer
  risk prevention programs, and help to identify
  and guide students in need of special assistance.

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Adolescent Problems In Schools
Alcohol Drug Use
Fighting and Gangs
Bullying
Weapon Carrying
School Environment
Sale of Alcohol and Drugs
Sexual Abuse
Unruly Students
Truancy
Attacks on Teachers Staff
Domestic Violence
Drop Outs
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Four Phases of Emergency Management

• Mitigation (prevention)
• Preparedness
• Response
• Recovery

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Community Assessment
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Community Assessment

• Five parts to a community assessment
• Description of community
• Assessment of needs
• Assessment of resources
• Community history
• Problem statement(s)

3.1
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Stages of Disaster

• The community response in grief.
• HEROIC From impact to about one week out.
• HONEYMOON Lasts several weeks and there is a
  sense of the community pulling together.
• DISILLUSIONMENT One month to even a couple of
  years. Hype is gone and questions are
  unanswered.
• RECONSTRUCTION Final stage with realization of
  what has been experienced and what they can do to
  restore the community.

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Prevention Programs Enhance Protective Factors

• strong family bonds
• parental monitoring
• parental involvement
• success in school performance
• pro social institutions (e.g. such as family,
• school, and religious organizations)
• conventional norms about
• drug use

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Ecological Model
Individual
Peer/Family
Society
Community/Tribe
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Implications for Treatment

• Teach adolescents how to cope with difficulties
  and adversity
• Increase their repertoire of coping strategies
• Cognitive therapy is most effective approach

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Stress Management

• Mental health professionals with child/family
  training
• Information, information, information
• Provide energy outlets for kids
• Provide parents with time away from kids
• Provide best possible sleep environment
• Therapeutic play (drawing, role play)

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Comprehensive Behavioral Health/School Planning

• Prevention and behavioral health
  programs/services on site
• Handling behavioral health crises
• Responding appropriately and effectively after an
  event occurs

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Community Driven/School Based PreventionIntervent
ions

• Public awareness and media campaigns
• Youth Development Services
• Social Interaction Skills Training Approaches
• Mentoring Programs
• Tutoring Programs
• Rites of Passage Programs

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Effective Family Intervention Strategies
Critical Role of Families

• Parent training
• Family skills training
• Family in-home support
• Family therapy
• Different types of family interventions are used
  to modify different risk and protective factors.

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Promising Strategies

• Home visitation
• Parent training
• Mentoring
• Social cognitive
• Cultural

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Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
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Potential Organizational Partners

• Education
• Family Survivors
• Health/Public Health
• Mental Health
• Substance Abuse
• Elders,

• Law Enforcement
• Juvenile Justice
• Medical Examiner
• Cultural specialist
• County, State, and Federal Agencies

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Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org