National Minority Mental Health Awareness Month Blog Series

By Victoria M. O’Keefe, Ph.D. (Cherokee/Seminole Nations of Oklahoma)
Mathuram Santosham Endowed Chair in Native American Health, Assistant Professor, Licensed Clinical Psychologist
Associate Director, Center for American Indian Health
Department of International Health, Social & Behavioral Interventions
Johns Hopkins Bloomberg School of Public Health

Dr. Victoria M. O’Keefe My late grandma, Virginia Feather Revas, was a Cherokee Nation citizen, a fluent speaker of ᏣᎳᎩ ᎦᏬᏂᎯᏍᏗ (Cherokee language), and a Community Health Representative (CHR) for our tribe. CHRs are embedded within their tribe and serve important roles in health promotion for their communities.¹ My grandmother served our tribe proudly and instilled in me the importance of working on behalf of our people. My favorite memories with her, from visits to Oklahoma, were going to our family’s creek to catch ᏥᏍᏛᎾ (crawfish) for dinner, attending stomp dances and pow wows, and admiring her talent for beadwork and quilt making. These memories are important teachings that I value now more than ever.

My grandma’s words to work on behalf of our people always stuck with me. As a first-generation college student and undergraduate psychology major, I quickly realized I wanted to focus my career path on mental health research with and for Native people. The urgency I felt in this decision was due to a few reasons. First, there was hardly any representation of Indigenous people or content in my education from kindergarten through my undergraduate training. Invisibility of American Indians/Alaska Natives (AI/ANs) from public discourse is a modern form of discrimination and impacts numerous areas of Native life, including mental health.² It wasn’t until I was in a clinical psychology doctoral program that I saw and had Native role models as professors, and learned about mental health research and clinical work with Native communities. Second, I searched the empirical literature and found that the majority of published articles about AI/AN communities and mental health reflected deficit-based and Westernized narratives/methods. Tribal values and teachings, like the ones my grandma passed on to me, weren’t represented in research. Finally, I remember reading an article by Dr. Joseph Gone (Aaniiih) illuminating “the sad reality [is] that the mental health needs of this nation’s Native American citizens remain largely overlooked and ignored” (p. 10) due to the federal government’s lack of fulfilling its trust responsibility to tribes.³ These factors motivated me to use my education as a pathway to increase and improve Native representation in academia, encourage strengths-based and alternative approaches to mental health that are responsive to AI/AN community needs, and engage Indigenous knowledge and cultural strengths that promote mental health and wellness.

Though my grandma didn’t get to see me accept my first job at Johns Hopkins Bloomberg School of Public Health at the Johns Hopkins Center for American Indian Health (JHUCAIH) in 2017, I’m constantly reminded of her teachings and her own work as a CHR. The innovative suicide prevention work developed by the White Mountain Apache Tribe and JHUCAIH, is carried out by community mental health workers (CMHWs).⁴ CMHWs serve their own communities, reduce barriers to, and stigma associated with, mental health care services, and provide culturally effective brief interventions and psychoeducation.⁵ This capacity building within tribes promotes self-determination over community mental health and overall wellness. The expansion of local mental health care by CMHWs can also promote tribal languages, values, and traditions that directly and indirectly help reduce mental health inequities.⁵

To promote AI/AN mental health, we need to rely on our community strengths and traditional teachings – teachings that connect mental health with physical and spiritual health. We also need to create culturally safe spaces for AI/AN youth and scholars to lead the next generation of wellness practice with tribal communities. I hope every day that I’m making my grandma proud and that I’m passing on a bit of her legacy as a beadworker, novice Cherokee language speaker, and promoter of tribal communities’ health and wellness.

The Center for American Indian Health is providing information on COVID-19 for Native Communities. Visit https://caih.jhu.edu/programs/category/covid-19-response.

References

1. Indian Health Service. (2020). Community Health Representative. https://www.ihs.gov/chr/
2. (2018). Reclaiming Native Truth. https://illuminatives.org/reclaiming-native-truth/
3. Gone, J. P. (2004). Mental health services for Native Americans in the 21st century United States. Professional Psychology: Research and Practice, 35(1), 10-18. doi: 10.1037/07357028.35.1.10
4. Cwik, M. F., Barlow, A., Goklish, N., Larzelere-Hinton, F., Tingey, L., Craig, M., Lupe, R., & Walkup, J. (2014). Community-based surveillance and case management for suicide prevention: An American Indian tribally initiated system. American Journal of Public Health, 104(Suppl 3), e18–e23. https://pubmed.ncbi.nlm.nih.gov/24754618/
5. O’Keefe, V. M., Cwik, M. F., Haroz, E. E., & Barlow, A. (Epub 2019). Increasing culturally responsive care and mental health equity with Indigenous community mental health workers. Psychological Services. https://pubmed.ncbi.nlm.nih.gov/31045405/