Indigenous populations face different barriers and are less likely than majority populations to receive professional help for mental health, according to a new study.¹ Researchers at Lakehead University in Ontario, led by Christiana J. Goetz, M.A., looked at the barriers to and facilitators of help-seeking and service use for Indigenous populations in Canada, the United States, Australia, and the Pacific Islands.

Based on an extensive review and analysis of more than 40 research studies, the authors identified six main themes relating to mental health service use among Indigenous populations.

Accessing Mental Health Care

• Informal supports were often used as a first choice for help-seeking compared with formal services. Participants were more comfortable talking to friends and family than to a psychologist or counselor.
• Structural obstacles and supports, including the dearth of mental health services and resources, Indigenous service providers, and collaboration between mental health services and other services (such as general medical, housing, etc.). Indigenous people also faced long wait lists for help. Facilitators of service use included availability of services and provision of transportation. Indigenous people living in urban areas were three times more likely to receive mental health services compared with those living in regional or remote places.
• Stigma and shame. Stigma associated with mental illness and with seeking help were common. Self-stigma about help-seeking was associated with shame and worry about being seen as weak or “crazy.” Participants also worried about disgracing their families. Youths were more likely to engage in treatment if their peers did not know about their mental health concerns.
• Self-reliance and uncertainty about services. Many participants expressed skepticism about the effectiveness of mental health services, and many expressed the desire to handle their problems on their own. Some research found that, especially among younger Indigenous people, mental health apps were seen as a more accessible, less intimidating way to get started.
• Cultural factors and mistrust of mainstream services. “A history of damaging institutional experiences of Indigenous people was associated with a reluctance to use formal services,” the study notes. There was also distrust of non-Indigenous counselors and an expectation they would not have cultural competence.
• The need for outreach and information regarding mental illness and services. Not being aware of mental illness and not recognizing mental health concerns were significant barriers to seeking help. But, “tight-knit and supportive communities embraced opportunities to educate each other about mental health and the available mental health services.”

These factors rest in a broader context of societal, structural and systemic issues facing Native American populations,² such as:

• Historical and intergenerational trauma – the psychological effects of forced relocation, assimilation, and other traumas inflicted on Indigenous peoples have long-lasting effects and can be passed from generation to generation.
• Racism, bias and discrimination, which can harm both physical and mental health.
• Geographic challenges, including isolation from services for those in very rural areas and isolation from family, culture and community for those living in urban areas.

Goetz and colleagues conclude that their research suggests that structural changes are needed to “decrease mistrust of mainstream systems and services and increase funding and resource availability.” As a start toward these changes, initial steps could include educational programs for Indigenous people, families, and communities that foster positive relationships and the use of technology to facilitate access to treatment.