Aaron Ginsburg M Ed, LCMHC, LCAS | Clinical Instructor
Crisis and Assessment Services
UNC Health Care at WakeBrook
Native American mental health is an all too often overlooked area of need. In looking at statistics provided by Mental Health America (https://www.mhanational.org/issues/native-and-indigenous-communities-and-mental-health), Native/Indigenous people in America report experiencing serious psychological distress 2.5 times more than the general population over a month’s time, the suicide death rate for Native/Indigenous people in America between the ages of 15-19 is more than double that of non-Hispanic whites, about two-thirds now live in urban, suburban, or rural non-reservation areas; about one-third live on reservations and lack of awareness about mental health issues and services that are available and a lack of programs and providers that are sensitive to native and indigenous culture can prevent Native/Indigenous people from receiving treatment. As an enrolled member of a federally recognized tribe, who does not live on tribal land a big area of concern for me has been how non tribal systems treat Native Americans and the lack of appropriate resources. Earlier this year I began working with the wonderful Dr Hunt-Harrison on trying to improve this, a big piece of which being developing collaboration between organizations like UNC and local tribal communities, in hopes that they may be able to provide education to our residents, interns and providers and that we may learn more about the services they offer.
Early in the morning on June 14th I had the honor of meeting Dr Freida Saylor, the Clinical Director of Behavioral Health Services at the Cherokee Indian Hospital. Dr Saylor generously spent her morning allowing me to tour the facility, meet the staff, and better understand the work they are doing there.
What I saw in Cherokee can only be described as a beautiful system of care. This is a system driven by love for the patients, the needs of the community, and a truly integrative approach. While touring their acute inpatient psychiatric unit I was shown the seclusion room. I learned that they have never had to use it, or forced medication. This is because of how they engage with their patients. The feel of the unit, the warmth of the staff, was unlike any inpatient unit I have ever seen. Care was evident in every facet, across every discipline, with obvious inter disciplinary cooperation and camaraderie.
When you look at all the services provided by the Cherokee you see a continuum that includes inpatient treatment, peer support, outpatient for adults and children, crisis services, detox, MAT, therapeutic foster care and the communication between programs and implementation of services is seamless. Services are also dictated by the needs of the community, not the system. Homelessness, food insecurity, and pretty much any proximal and powerful ecological drivers that exacerbate psychiatric symptoms or precipitate relapse, those are targeted by treatment and providers. When a patient is discharged from inpatient they have a designated support person, be it a family member, community member, or if need be, staff member. Patients are truly welcomed into the hospital, and I saw Dr Saylor and many other staff members take time for a personal connection with patients.
A big part of tribal culture is service to others. In my tribe we call this “living the Chahta spirit”, and, while there are differences from tribe to tribe this spirit of service is one I have found to be a commonality. In Cherokee, everything they do has this spirit behind it. Dr Saylor made a point to remind me that my family can receive services there, telling me that “any tribal member is important”, regardless of tribe. She also shared their philosophy of “there is no wrong door to treatment” and “we don’t throw people away”. These values, this philosophy, this is what makes the world kinder, warmer, and invites people to trust in providers, to seek treatment.
There is so much our system can learn from ones like the Cherokee Health System, not just in terms of treating the Native American population, but all patients. Hopefully Dr Saylor will be doing Grand Rounds for us soon, and this will be a truly important opportunity . I would also encourage providers to make the trip there, see for themselves what’s being done, and learn as much as they can.: