Native communities face behavioral health challenges and disparities. For Native Americans, multiple factors influence health outcomes, including historical trauma and a range of social, policy, and economic conditions such as poverty, under-employment, lack of access to health care, lower educational attainment, housing problems, and violence.
These disparities have consequences. Suicide is the second leading cause of death among American Indian and Alaska Native youth ages 8 to 24. Also, while there is general awareness that Native Americans experience higher rates of alcohol and substance use, the scope of these behavioral health problems is not fully understood.
Native communities face service delivery issues that are complicated by personnel shortages, limited health care resources, and distances to obtain services. There also are other issues that inhibit access to appropriate behavioral health services such as referrals from school, detention, court, housing, primary care, child welfare, and other systems.
National Tribal Behavioral Health Agenda
Tribal leaders have consistently called for more coordination and collaboration among federal agencies whose efforts contribute to the health and well-being of American Indian and Alaska Native communities. In response, tribal leaders and various federal agencies developed the National Tribal Behavioral Health Agenda for enhanced coordination. This national agenda is framed by four cross-cutting tribal issues: youth, culture, identity, and individual self-sufficiency. It also includes the following five foundational elements:
- Historical and intergenerational trauma. Historical trauma is the impact of chronic stress and trauma that negatively affects health, which is magnified when entire communities experience and re-experience past and present trauma. The focus of this element is to support healing.
- National awareness and visibility. The intent of this element is to support the development of priorities and actions that help to improve understanding of American Indian and Alaska Native behavioral health disparities, as well as their consequent impacts on physical health and well-being.
- Social-ecological approach. The goal of this element is to support the development of priorities, interventions, and other actions that capture the larger context within which American Indian and Alaska Native behavioral health issues are rooted. These priorities can be taken by tribal, federal, state, and local governments and private groups to collectively contribute to positive outcomes.
- Prevention and recovery support. The aim of this element is to support the development of priorities and actions that identify and address the barriers to early intervention for American Indians and Alaska Natives. Early intervention is required to sustain positive emotional health.
- Behavioral health services and systems improvement. The intent of this element is to support the development of priorities and actions to improve coordination, linkages, and access to behavioral health-related services.
SAMHSA’s efforts reflect a commitment to upholding the federal government’s historical and unique legal relationship with American Indian tribes through consultation, outreach, education, and engagement. SAMHSA’s mission is to provide efficient and effective delivery of resources and services to ensure that American Indians and Alaska Natives have access to prevention, treatment, and recovery support services that reflect the best of modern science and traditional cultural practices.
The Office of Tribal Affairs and Policy (OTAP) serves as the agency’s primary point of contact for tribal governments, tribal organizations, and federal agencies on behavioral health issues that impact tribal communities. OTAP supports SAMHSA’s efforts to implement the Tribal Law and Order Act (TLOA). The Office of Indian Alcohol and Substance Abuse (OIASA) is an organizational component of OTAP. Under TLOA guidelines, OIASA coordinates federal partners and provides tribes with technical assistance and resources to develop and enhance prevention and treatment programs for substance use disorders, including the misuse of alcohol.
SAMHSA supports an innovative training and technical assistance project that helps tribal communities develop and implement community-based prevention plans to reduce violence, bullying, and suicide among American Indian and Alaska Native youth. Another SAMHSA initiative designed to respond to the high rates of attempted suicide among American Indian and Alaska Native youth is the Garrett Lee Smith State/Tribal Suicide Prevention Program. Grantees work closely with government agencies and the private sector in developing and implementing statewide or tribal youth prevention and early intervention strategies. SAMHSA has also awarded Tribal Behavioral Health Grants, called Native Connections, to reduce suicide and substance abuse in tribal communities.
Dear Tribal Leader Letters
SAMHSA's communications to tribal leaders and American Indian and Alaska Native population on significant programs, resources, and policy development through Dear Tribal Leader (DTL) Letters.
- SAMHSA to hold a virtual Tribal Consultation session – 2018 (PDF | 1.3 MB)
- SAMHSA announces a Joint Tribal Consultation and Listening Session on the Opioid Epidemic – 2018 (PDF | 431 KB)
- SAMHSA asks for input on the draft Treatment Improvement Protocol (TIP), Behavioral Health Services for American Indians and Alaska Natives (PDF | 574 KB)
- SAMHSA introduces the Suicide Safe mobile app – 2015 (PDF | 683 KB)
- SAMHSA is seeking feedback on the revised Tribal Technical Assistance Committee charter – deadline for comments is August 29, 2014 (PDF | 97 KB)
- SAMHSA, in collaboration with HRSA and IHS, announces the Promoting Suicide Prevention Efforts in American Indian and Alaska Native Communities: A Cross Agency Approach – 2014 (PDF | 120 KB)
- SAMHSA is requesting feedback on the Revised SAMHSA Tribal Consultation Policy — deadline for comments is August 29, 2014 (PDF | 81 KB)
- SAMHSA Tribal Leaders Listening Session held during the NCAI mid-year conference – 2014 (PDF | 78 KB) and draft agenda (PDF | 47 KB)
- SAMHSA announces the Tribal Behavioral Health aka Native Connections funding opportunity – 2014 (PDF | 80 KB)