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SAMHSA treatment guidance on Native populations highlights cultural considerations, best practices

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is issuing a Treatment Improvement Protocol (TIP) to improve access by American Indians and Alaska Natives to treatment for substance use disorders that is scientifically sound and culturally informed.

TIP 61 “Behavioral Health Services for American Indians and Alaska Natives” furthers SAMHSA’s mission to advance the behavioral health of the nation and improve the lives of individuals living with mental and substance use disorders, and their families. The guidance provided through TIP 61 offers the behavioral health field practical and culturally relevant approaches for delivering effective behavioral health services to American Indian and Alaska Native clients.

“SAMHSA is committed to directing proven treatments to all communities. TIP 61 complements other work being done by SAMHSA to increase tribal communities’ access to science-driven, effective treatments,” said Elinore F. McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use and the head of SAMHSA. “TIP 61 is part of a comprehensive approach to improve behavioral health outcomes for this population, including $50 million in direct funding to tribal governments to address the opioid crisis and other grant funding support to improve connections to mental health services for school-age youth, enhance and expand treatment and recovery, and reduce suicidal behavior.”

TIP 61 was developed through a highly participatory process that included tribal experts and federal partners. “The Indian Health Service (IHS) is committed to partnering with SAMHSA to ensure that American Indians and Alaska Natives receive the best behavioral health services possible,” said RADM Michael Weahkee, Principal Deputy Director of IHS. “The collaborative process undertaken with tribal researchers, educators, and behavioral health providers to develop this TIP supports our priority to continually improve behavioral health services and ensure that they are holistic, culturally responsive, and trauma-informed.”

TIP 61 also furthers SAMHSA’s government to government relationship with tribal nations. “Now more than ever, tribal nations and the federal government must work together to address behavioral health needs in tribal communities,” said Lt. Governor Keel, President of the National Congress of American Indians. “Tribal leaders drove development of the National Tribal Behavioral Health Agenda, and NCAI supports SAMHSA’s continued efforts to improve behavioral health services, which is a critical next step.”

There are three components to TIP 61:

  • Part 1 focuses on American Indians and Alaska Natives’ history, their historical trauma, and critical cultural perspectives. It discusses demographics, social challenges, and behavioral health, highlighting the importance of providers’ cultural awareness, competence, and culture-specific knowledge. It also describes specific treatment interventions, including traditional American Indian and Alaska Native interventions and cultural adaptations to standard behavioral health approaches.
  • Part 2 is intended for administrators, program managers, and clinical and other supervisors to help them foster a culturally responsive environment for American Indian and Alaska Native clients. Specific topic areas include workforce development, considerations in program and professional development, and culturally responsive program policies and procedures.
  • Part 3 describes the available literature on behavioral health services for adult American Indians and Alaska Natives. It examines epidemiological studies and culturally responsive adaptations to standard behavioral health services.

TIP 61 and its sub-components are available to download from the SAMHSA Store at

People who need treatment for substance use disorders or mental illnesses can find help by visiting SAMHSA at or by calling 800-662-HELP (4357). Reporters with questions should contact SAMHSA’s press team by calling 240-276-2130 or by emailing

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes.

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