The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv

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The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Honoring Heritage Traditional and Contemporary
Medicine as Partners in Healing Anchorage,
Alaska February 18, 2006
Dale Walker, MD Patricia Silk Walker, PhD
Douglas Bigelow, PhD Bentson McFarland, MD,
PhD, Michelle Singer
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Native Communities
Advisory Council / Steering Committee
One Sky Center
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Program Goals

• Promote and nurture effective and culturally
  appropriate prevention and treatment
• Identify and disseminate evidence-based
  prevention and treatment practices
• Provide training and technical assistance
• Help to expand capacity

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One Sky Center Outreach
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One Sky CenterRecognizes Traditional Healer
Rita Pitka Blumenstein For Her Lifetime of
Local, National and International Service to
Native Health Care
R. Dale Walker, MD, Director
February 18, 2006
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Native Aspirations!
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Six Missions Impossible?

• How do we define ourselves?
• How do we define health care?
• 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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Overview

• An Environmental Scan
• Behavioral Health Care Issues
• Fragmentation and Integration
• Introduction to One Sky Center
• Native Aspirations!
• Introduce the SAMHSA Family
• Best Practice Evidence-Based Indigenous
  Knowledge

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Health Problems

• Alcoholism 6X
• Tuberculosis 6X
• Diabetes 3.5 X
• Accidents 3X
• Physicians 72/100,000 (US 242)
• 60 Over 65 live in poverty
  (US 27)

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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. Delivery

• 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 Health
• 4. Urban Indian Health
• State and Local Agencies
• Federal Agencies SAMHSA, VAMC

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Disconnect Between Addictions / Mental Health

• Professionals are undertrained in one of two
  domains
• Patients are underdiagnosed
• Patients are undertreated
• Neither integrates well with medical and social
  service

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Difficulties of Program Integration

• Separate funding streams and coverage gaps
• Agency turf issues
• Different treatment philosophies
• Different training 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? (Carl Bell, 7/03)
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Best Practice
Culturally Specific
Outcome Driven
Integrating Resources
We need Synergy and an Integrated System (Carl
Bell, 7/03)
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Indigenous Knowledge
Definitions

• Is local knowledge unique to a given culture or
  society it has its own theory, philosophy,
  scientific and logical validity, which is used as
  a basis for decision-making for all of lifes
  needs.

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Knowledge is a community resource It defines
and drives the community. Its
interconnectedness, its multifaceted and
multidimensional, its revered, its language,
communication and history. Its collective
memory. Its captured and maintained for future
generations. Its a reflection of life
experience. Its acquired through listening and
being empathetic. Its wisdom, strength and
leadership. Its a strategic resource. Its the
power of a good mind. Its imperfect. Its a
gift bestowed by the Creator.

Quote from Tom
Maracle
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Traditional Medicine
Definitions

• The sum total of health knowledge, skills and
  practices based upon theories, beliefs and
  experiences indigenous to different culturesused
  in the maintenance of health.
• WHO 2002

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Evidence-based Practices
Definitions

• Interventions that show consistent scientific
  evidence of improving a persons outcome of
  treatment and/or prevention in controlled
  settings.
• SAMHSA 2003

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Best Practices
Definitions

• Examples and cases that illustrate the use of
  community knowledge and science in developing
  cost effective and sustainable survival
  strategies to overcome a chronic illness.
• WHO 2002

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World Conference on Science
A partnership begins!

• Recommended that scientific and indigenous
  knowledge be integrated in interdisciplinary
  projects dealing with culture, environment and
  chronic illness.
• 1999

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ID Best Practice
Best Practice
Clinical/services Research
Mainstream Practice
Traditional Healing
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Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
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Healing Concepts 1

• Healing takes time and time is healing
• Healing occurs within the context of a
  relationship
• Achieving energy of activation is necessary
• Biological systems behave similarly across all
  levels
• Lewis Mehl-Madrona 2002

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Healing Concepts 2

• Distractions of modern life inactivate
  catalysts for change
• Modern culture teaches us to ignore emotions
• Physiological change requires a break in usual
  daily rhythms
• Ceremony helps the spiritual dimension of healing
• Lewis Mehl-Madrona 2002

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Traditional and complementary medicine is widely
and increasingly used in all regions of the world
Sources Eisenberg DM et al. 1998 Fisher P
Ward A, 1994 Health Canada, 2001 World Health
Organization, 1998 and government reports
submitted to WHO.
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What Is Integrative Medicine?
Wellness
Basic Science
CAM literacy
Patient Centered Care
Evidence Based Medicine
Cultural Sensitivity
Power Of the Mind
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Principles of Integrative Medicine

• It is better to prevent disease than to have to
  treat it later.
• Recognition of the interaction between body,
  mind, spirit, and environment.
• A desire to integrate the best of conventional
  and unconventional medicine.
• The belief that bodies respond uniquely, so
  treatment must be customized.
• A belief in the innate healing powers of the
  body.

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The Intervention Spectrum for Behavioral
Disorders
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Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
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Ecological Model
Individual
Peer/Family
Society
Community/Tribe
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Interpersonal societal
Environmental
Stigma
Community
Tribal attitudes
Parents
Peers
National attitudes
Personality
Attitudes beliefs
Individual
Genetics
Cultural beliefs
Schools
Local legal
Interpersonal
State attitudes
Personal situations
Individual
Portrayal in media
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Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
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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
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Métis Health in Canada

• 82 - Health care programs developed to reflect
  Aboriginal culture
• 81 - Need for better language translation
  services
• 67 - Return to Aboriginal medicine and healing
  practices would improve health
• 60 - Do not know where to get traditional
  medicines or have access to traditional healing
  practices
• 67 - would use traditional health more often if
  covered by health care system
• 66 - would use traditional health practices more
  often if available through local health centre
• 62 - attribute poor health to experience in
  Residential School system
• 57 - Attribute poor health to the loss of land
  and culture

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Selected Treatment/Prevention Activities

• The Talking Circle
• Smudging
• Story telling
• Traditional healers
• Medicine Person
• Herbal remedies
• Traditional ceremonies
• Sweat Lodge
• Traditional Experiences Preservation