1. High risk for mental health challenges
    1. Due to racist institutional, structural, and cultural practices in the United States, Native and Indigenous peoples face some of the highest barriers to accessing mental health services and as a result are among the highest-risk groups for mental health challenges.
  2. Patterns of displacement, dehumanization and other problematic practices
    1. Some of those practices include centuries of displacement from traditional homelands, forced assimilation policies, medical racism, and ongoing dehumanization of Indigenous people — including the devaluation of Indigenous life.
  3. Accurate representation is key
    1. Storytelling can have a positive impact by accurately representing the historical treatment of the Native community, showing the impact of intergenerational trauma, and highlighting protective factors like strong family bonds, as well as depicting culturally competent care
This section was written in partnership with IlumiNative.

Storytelling Tips

Diversify representation
  • Elevate stories that showcase the strength, power, and determination of Native communities, in collaboration with Native storytellers, directors, and actors. 
  • Native people must be central in the process of telling Native stories about mental health. When incorporating a specific Native community into a story, make sure to have consent and work in meaningful consultation with the community. 
  • On rare occasions, Native and Indigenous people are included in mainstream entertainment. Their stories are often framed from a negative and deficit-based perspective, which can negatively influence the way Native people, especially youth, see themselves. When telling stories about mental health in Native communities, find opportunities to showcase the strength, power, and determination of Native communities, alongside the challenges they face.
  • Use the Expert Directory to find partners who can inform nuanced, accurate representation of Native and Indigenous mental health. 
Show conversations about mental health and help-seeking
  • Show conversations that will resonate with Native viewers, including discussion of how core parts of Native identity can support mental health. 
  • Cultural priorities like spirituality, community, and tradition can be portrayed as an additive to conversations about mental health, rather than as barriers to having those conversations. 
Depict effective, realistic help-seeking and treatment
  • Highlight effective resources that exist both in and outside of tribal areas.
  • While access to culturally competent Native mental health care is lacking, resources do exist within and outside of tribal areas. Highlighting these services may increase the likelihood that viewers will speak up and get help.
Highlight the power of coping skills and self-care
  • Portray cultural factors that can strengthen Native mental health.
  • For the Native community, effective coping and self-care practices rooted in tradition can be protective factors. Existing protective factors include a worldview that encompasses the notions of connectedness (with the past and with others), strong family bonds, adaptability, and mentoring by elders, as well as meaningful traditions and spiritual practices.
Represent the complex causes of mental health challenges
  • Accurately represent the mental health impacts of trauma experienced by Native people over centuries. Work with advisors from the Native community to better understand how to represent the impact of that trauma and discrimination on mental health. 
  • Many of the challenges Indigenous communities face today are the results of trauma experienced by their parents/elders and the discrimination they may see or experience in their own lives. Seeing portrayals of this intergenerational trauma and modern-day mistreatment can help validate difficult feelings and help Native viewers seek appropriate support.
Avoid sharing potentially harmful details
  • If your story involves suicide, learn the best practices for preventing contagion and clustering. 
  • Native youth, especially those living in tribal areas, may be at increased risk of suicide clusters where communication about a suicide can play a role in additional youth suicides in that community taking place.
  • If the story involves violence against Native women, refrain from including explicit content depicting violent acts that may be (re)traumatizing for Native viewers. 

Use the Expert Directory to find partners who can inform nuanced, accurate representation of Native and Indigenous people’s mental health.


For context, in this section:

  • Native/Native American: This term refers to the descendants of the original peoples who inhabited what is now the United States. (including Alaska Natives and Native Hawaiians.)
  • Indigenous: The word Indigenous refers to the descendants of all original peoples across the globe.
  • American Indian: The term Indian is embedded in federal law and therefore appears in any federal legislation or judicial proceedings but should not be used to refer to Native peoples today.
  • In content, it is considered best practice to refer to Native People based on their tribe (for example: Lakota people).

To properly understand Indigenous and Native communities’ relationship with mental health, one must recognize the deeply ingrained institutional racism and dehumanization of Native and Indigenous peoples that has transpired over the past 500 years. These harmful beliefs and practices have been cemented by countless policies practiced by institutions; federal, state, and local governments; and culturally throughout U.S. society.

As a result of these policies, as well as other factors, Native and Indigenous peoples are among the highest-risk groups for mental health challenges, which include the following: 

Another factor that puts Native people at increased risk for distress, substance misuse, and suicide is historical trauma. This trauma includes forced relocation, the removal of children who were sent to boarding schools, the prohibition of the practice of language and cultural traditions, and the outlawing of traditional religious practices.

Additionally, Native women experience higher levels of violence than other women in the United States and survivors of physical or sexual violence are at increased risk for psychological distress and suicidal behavior. Violence against Indigenous communities began with the introduction of patriarchy and settler colonial violence, and lives on today through the hyper-sexualization and dehumanization of Native women and girls, leading to the epidemic of missing and murdered Indigenous women and girls.

Despite federal obligations that guarantee programs and services, such as health care, to Tribes and their citizens, the Indian Health Service is underfunded. At the same time, most clinics and hospitals of the Indian Health Service are located on reservations, while most Native people live outside of tribal areas.

In the rural areas where many Native people live, accessing culturally competent care can be very difficult.

A history of institutionalized medical racism towards Native people, such as the forced sterilization of 3,406 Native women without their permission between 1973 and 1976, may also prevent people from seeking help from Western mental health services. Native people who are struggling with anxiety, substance misuse, or depression are more likely to seek help from a spiritual and/or traditional healer than from mental health professionals. 


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