Community Mental Health Services for American Indians and Alaska Natives: Reconciling Evidence-Based Practice and Alter-Native Psy-ence

Abstract

This review updates and extends Gone & Trimble's (2012) prior review of American Indian (AI) and Alaska Native (AN) mental health. First, it defines AI/AN populations in the USA, with an explanation of the importance of political citizenship in semisovereign Tribal Nations as primary for categorizing this population. Second, it presents an updated summary of what is known about AI/AN mental health, with careful notation of recurrent findings concerning community inequities in addiction, trauma, and suicide. Third, this article reviews key literature about AI/AN community mental health services appearing since 2010, including six randomized controlled trials of recognizable mental health treatments. Finally, it reimagines the AI/AN mental health enterprise in response to an "alter-Native psy-ence," which recasts prevalent mental health conditions as postcolonial pathologies and harnesses postcolonial meaning-making through Indigenized therapeutic interventions. Ultimately, AI/AN Tribal Nations must determine for themselves how to adopt, adapt, integrate, or refuse specific mental health treatments and services for wider community benefit.

Keywords: Alaska Natives; American Indians; Indigenized therapies; alter-Native psy-ence; community mental health services; evidence-based practice; postcolonial anomie.