In honor of National Native American Heritage Month, Dr. Mary Hasbah Roessel joins us to discuss her experiences and insights into the mental health care needs of Indigenous communities, particularly focusing on the Navajo culture. She emphasizes the importance of holistic healing that addresses the body, mind, and spirit, and highlights the historical trauma that affects mental health in these populations. Dr. Roessel advocates for building trust and understanding cultural practices in mental health treatment, and she shares recommendations for psychiatrists working with Indigenous patients.

Transcript for Audio

Erin Connors [00:00:00]: Hello and welcome to Mental Health Pathfinders. My name is Erin Connors and I'm Associate Director of Media Relations for the American Psychiatric Association. Every month we will share a new podcast featuring APA members who are helping to chart a course to the future of mental health care. Thanks for joining us.

In recognition of National Native American Heritage Month, our guest today is Dr. Mary Hasbah Russell, a Navajo psychiatrist and distinguished fellow of the American Psychiatric Association. Dr. Russell practices at the Santa Fe Indian Health Center in Santa Fe, New Mexico. She grew up in the Navajo Nation with her parents and grandparents and has worked for more than 30 years.

30 years with indigenous peoples of the Southwest, Alaska, and British Columbia. Thank you for joining me today, Dr. Russell.

Mary Roessel [00:00:54]: Thank you for having me.

Erin Connors [00:00:57]: So is there anything about the Navajo culture and experience of growing up on a reservation that drew you to psychiatry?

Mary Roessel [00:01:06]: Yes, there are really a lot of parallels for instance, with the Navajo, the way we approach healing and taking care of patients is very holistic.

We address the body, mind, and spirit. And so, when I was growing up, I had that experience very closely with my Navajo Medicine Provided that type of healing and so I was able to witness it and also have my own ceremonies when I was growing up on the Navajo Nation and so I see psychiatry also having a similar way of approaching patients and taking care of patients in terms of addressing the body minded spirit and of course within the bio psychosocial model, you know, we really have that ingrained within the way we approach patients.

And I also had the experience of Dr. Carl Menninger being my mentor and a dear friend of our families. And he would come and really recognize the significance and value of the way Navajo approach healing. And so he was able to kind of let me think about the fact that I. I think I can do this. I think I can be a psychiatrist and, you know, move away from the Navajo Nation.

Erin Connors [00:02:25]: Can you share a bit more about your experience working with Indigenous communities?

Mary Roessel [00:02:29]: Yes. So as you stated, I have been working within Indigenous communities for over 30 years. I work with an Indigenous population now, and so the experience has taken me all the way to Alaska. And even British Columbia to practice and work with indigenous people.

And I think you know, some of the things that are really significant and important about that is that I have that familiarity with having come from a reservation and rural community so that. When I'm working with these indigenous populations, I'm able to understand and know where they're coming from and understand the needs and things like that.

And so in terms of experiences, you know, I've gone. on airplanes to see patients in Alaska. I'll do home visits and go to ceremonies and be a part of the patient's ceremonial practices. And so it's quite different than if you were working in a city. Population and you really have, you know, more of an office perspective with your patients, but for working with indigenous communities, you really become a part of their lives and families.

And so I've been doing that. I've known like in Santa Fe, I have patients that are I've seen, I've known for over 20 years. And so it's a really Wonderful experience. And I've really enjoyed it.

Erin Connors [00:04:02]: So what is unique about the mental health care needs and treatment for the indigenous people of like the Navajo and other native communities in the U.S.?

Mary Roessel [00:04:13]: Well, what's unique about the mental health needs is that we have a high rate of depression suicide PTSD and trauma and substance abuse issues, some of the highest in the nation, but also What is the backdrop to that is that we've endured a lot of historical trauma with the settling of the United States and the intent of the United States government was to exterminate indigenous peoples and they did exterminate much of our population, but we are still here.

But despite that, we still have these high rates of mental health needs. And so the other part of that in terms of having these mental health issues is that we also have high rates on these reservations, particularly of unemployment. We have a lot of poverty and lack of running water and electricity.

And so those social determinants of health are really affecting our population and make it much more difficult to address treatment and assessing patients. And so I think what, Is also very important is that we don't trust a lot of people who are coming in here attempting to provide mental health care for us because of these historical issues, historical trauma.

And so that is also a particular issue that needs to be identified and understood when you're working with indigenous populations.

Erin Connors [00:05:52]: When you think about everything that you just said right there, what are some of the initiatives or approaches that you believe are effective in promoting mental health equity in these communities?

Mary Roessel [00:06:04]: So a lot of what needs to happen is establish relationships with indigenous people. And so having a program that will provide Integration of cultural practices is really significant and important because of the issues with trust having an open door policy, not having a western centric model because You know, if you tell somebody who's traveled 30 miles, who had to round up some gas money, you have to tell them that, hey, you can't, we can't see you today because, you know, you missed your appointment, it's, you're 30 minutes late.

If you're getting into that way of approaching your patients, you're not going to establish much trust, and you're not going to really be able to address and get at what they need. And you, so you really need to approach the patient from where they're coming from. So part of that is that integrating traditional, even healers, into your program is really valuable because then you are recognizing that there is value in reintegrating and elevating their cultural background and knowledge and ceremonial practices along with their healing and so that you have to have a balance of approaching the patient with the interest of having the culture and ceremony be a part of their healing, as well as providing what you have for your the mental health issues.

You know, in a Western approach, for sure, because many Indigenous people will come to you because they want to get that kind of care and they understand how that can be valuable, but you definitely have to be creating a really appropriate and significant relationship in terms of trust building when you're providing these treatments.

Erin Connors [00:08:06]: You, you named a few here, but maybe, can you share a few more recommendations you have for psychiatrists who serve these indigenous patients regarding the role of cultural considerations and what they play in diagnosis treatment and overall mental health care?

Mary Roessel [00:08:19]: Well, when you're working with patients, say in a tribal community that's on a reservation or even within an indigenous population that's urban, you really want to create an open door policy and create trust, and you want to also not have cultural biases or have your own biases around how you expect this indigenous person to relate to you or what you expect them to be if they, present as a traditional Navajo, but yet they go to church every, you know, every week, you know, don't make assumptions on who this person is.

You really need to get to know them. The other part of it is you have to understand the culture And really understand, you know, the limitations about what you're able to take in terms of some of these cultural practices, because some indigenous people are very closed off about their religious practices, and they won't talk about that, and so if you don't, you know, know or don't try to understand or learn about the culture that you're working within, then you're not going to get very far either and you're going to create a lot more mistrust and not have these patients come in to access the care that they really do need with you there.

I also really strongly recommend, like I said before, is that you have to understand the historical trauma and the history of the settling of the United States and how it treated the Indigenous populations. Because if you don't understand that, then you don't understand why there is such a high level of trauma and why there is a high level of mistrust with your patients.

And you also really need to understand too, when you're providing say medications, that a lot of patients aren't going to maybe follow the treatment plan that you have laid out. So you really do have to approach the patient from where they're coming from, really provide a lot of education around medications and the approaches and treatments that you have.

And along with that, just really elevate and understand that if they are seeing traditional healers. And they are integrating ceremony into their practice that you are also supporting that and that you are recognizing that's kind of a way that they're keeping their identity intact as an Indigenous person and not saying, you know, again, the Western model is often cookie cutter and say, well, you can't do that.

You can't do that. But with an Indigenous person, you really have to be flexible. And the other part, too, that I think is really important is that people might come in with their whole family, but yet you have an identified patient, and so then you have to sometimes do family therapy, you have to understand who's the person in charge here in this family unit and so it's just a really important, if you don't understand about the family relationships and how important family is and the kinship systems that are in many of these tribal communities then you're not going to get very far and you're not going to be able to really address these unmet mental health issues.

Erin Connors [00:11:44]: Dr. Russell, thank you so much for joining us today. We really appreciate you taking the time to talk to us.

Mary Roessel [00:11:49]: Yeah. Thank you for having me.

Erin Connors [00:11:53]: And to our listeners, join us each month for a new edition of Mental Health Pathfinders. You can find us at psychiatry. org slash podcast or your favorite podcast platform.