Reducing mental health disparities experienced by American Indian males

As one of 16 groups selected to participate in Movember’s Making Connections initiative, the Southern Plains Tribal Health Board (SPTHB)  in Oklahoma has built a coalition committed to reducing mental health disparities experienced by American Indian males. Partners include INTEGRIS Health, Men’s Health Network , and other tribal and non-tribal partners.   

Making Connections for Mental Wellbeing Among Men and Boys, funded by Movember and guided by Prevention Institute, is engaging communities across the U.S. to develop prevention-based initiatives to address conditions in the community that can influence mental wellness.

Dr. Tamara James, SPTHB Making Connections Program Coordinator, and Dr. Ric Bothwell of Men’s Health Network talk about the coalition’s progress and plans, including an innovative program to reduce suicides among youth.

What are some of the disparities that you are addressing with your Making Connections work?

Ric Bothwell: Mortality data from the National Center for Health Statistics (NCHS) shows that rates for suicide, accidental deaths, homicide, and overdoses are much higher for American Indians, and that rates for males are significantly higher than for females in the American Indian population. For two questions on psychological distress in particular, American Indian males were really high compared to anyone else, and that was how frequently they felt hopeless and worthless. In my 40 years working in American Indian communities, there’s nothing that kicked me in the teeth harder than when I saw those data about feeling hopeless and worthless and then the suicide rates, which are three times higher for American Indian males than for males of all races. It was like I was right back at Pine Ridge where I started my career in the 70s seeing the sad eyes of so many boys and men.

How is the coalition approaching its work?

Tamara James: SPTHB serves 43 federally recognized tribes from Oklahoma, Kansas, and parts of Texas. Throughout this planning year, we’ve wanted to first of all hear from the communities to not only see if the priorities that we identified align with theirs, but to also try to identify those communities that are most interested and ready to genuinely engage as partners. So we surveyed tribal community members about their community’s mental health priorities, needs for males, community awareness, and support from tribal leadership, and also gathered feedback through focus groups at the 8^th Annual Tribal Public Health Conference. At the same time, we’ve used this planning year to find the interventions and programs that we think would fit. We’ve really had an opportunity to do that, and that’s where HOPE Squad came in.

What is HOPE Squad? 

Ric Bothwell: It’s a youth suicide prevention program that uses the QPR training approach that is recognized as “evidence-based” by SAMSHA (the U.S. Substance Abuse and Mental Health Services Administration). Under the program, HOPE squads are established in schools, usually middle schools and high schools. The student body selects the peers who they consider the most trustworthy, the ones they would be willing to share their concerns with.  These kids are trained to be “gatekeepers” using the QPR training they received to recognize the warning signs of suicide and if detected to: question the person’s intent, persuade them to accept help if needed and, refer them to an appropriate  professional. These Hope Squad members are supported by and work in coordination with the school system, its counselors, and the mental health facilities available in the community. This approach also has broader implications than suicide prevention: when you deal with the underlying problems and the risk factors for suicide, you also identify a lot of other things that might not end up in suicide but might end up in homicide, domestic violence, substance abuse, bullying, and legal problems.

What are some of the considerations in adapting this program to serve American Indian youth?

Tamara James:  It’s not uncommon, especially for smaller tribes, for the kids to be bused into the public school system. So we have to think about how we implement the program with a focus on those children when they’re a minority within the school system. We also have to consider how to get males to participate; we know that recruiting males is an issue across the board.

Are there other areas of focus that have emerged in your early work?

Tamara James:  We are also planning to work with the Native American Fatherhood and Family Association out of Arizona, which focuses on creating stronger families and parenting, which is another issue our communities identified. These problems have a generational impact and so it is important to integrate whole families and communities in the solutions.

How does being part of the larger Making Connections program figure into your work?

Tamara James: When we’re doing our work, we don’t have to reinvent the wheel; for instance, we worked with several of the sites on the survey that we developed. It’s great seeing the work going on around the country and knowing that other communities are doing work that’s going to contribute to this larger picture of how we’re going to address these issues. Also, I think that’s really critical to feel like you’re not alone in the work that is so emotionally exhausting, intense, and important.

Ric Bothwell: Another benefit of this network is that collectively, we can push this country towards the tipping point where they finally wake up and realize that ignoring men’s health is a horrible social and economic mistake. We need an office of men’s health at the national level to allow for better research and more attention to this: men really do need a specific focus; how they get information and how they accept and ask for help is different. I think Movember and Prevention Institute will have one of the strongest portfolios of collective learnings from all these projects to make the case that it’s time that the federal government recognize this and make the commitment sooner rather than later.