Spero Manson
Spero
M. Manson, Pembina Chippewa, PhD, an anthropologist,
is professor of psychiatry at the University of
Colorado Denver School of Medicine where he founded
and directs the American Indian and Alaska Native
Programs.
The
AIANP partners with more than 100 Native communities to
provide research, program development, education and
health care within rural, reservation, urban, and
village settings. Manson
has published more than 150 articles on the assessment,
epidemiology, treatment and prevention of physical,
alcohol, drug and mental disorders across the
developmental life span of Indian and Native people. He
is the founding editor of the journal,
American Indian and Alaska Native Mental Health
Research.
In addition to serving on a wide range of boards and
panels, Manson has received many awards including the
prestigious Herbert W. Nickens Award
from
the Association of American Medical Colleges, the Rema
Lapouse Mental Health Epidemiology Award from the
American Public Health Association, the Walker-Ames
Professorship at the University of Washington, the
Hammer Award from former Vice President Al Gore, and
election to the Institute of Medicine.
The
following interview was originally published in the Summer
2000 issue of
Winds of Change. An
update follows.
Leader in Indian and Native Mental Health Research
What are the mental health issues facing Native
Americans today?
The
environment in which most Indian people live is more
stressful than any other environment in the United States.
Death is a regular companion. There are vehicle accidents
and many other accidents. The health care structures are
spread thin. The safety net during times of crisis is
inadequate.
There’s a growing awareness that grief and trauma can be
transmitted through the generations. There is a wealth of
literature now that indicates that even though the
offspring of survivors of the Jewish holocaust did not have
the direct experience of persecution in concentration
camps, they are more vulnerable to trauma than offspring of
non-Holocaust survivors. This work helps us understand how
the offspring of Indian people who suffered the many
atrocities of the United States government are still
affected by these traumas, even though they are three or
four generations removed from the actual experiences.
This is a backdrop that heightens Indian and Native
people’s susceptibility and potential vulnerability to the
consequences of other kinds of stressors that often pervade
the world in which we live.
It’s not surprising then that, particularly in many rural
reservation communities, there’s a high prevalence of
alcohol, drug, and, mental health problems, including high
rates of major depression at various points in the life
cycle of Native people. There is a high rate of domestic
violence and child abuse and neglect. Increasingly, there
is also Elder abuse and neglect.
It is very important to stress that this is not a statement
about moral weakness or characterlogical weakness of Indian
and Native people. It’s a comment about the stressful
nature of the social environment in which we live. In fact,
it’s incredible that Indian and Native people are as
resilient and vibrant and optimistic as they are. This
really speaks to the strength of our people.
What
kinds of mental health services are needed?
The
environments in which Native people live are particularly
impoverished compared to other environments in the United
States. The amount of money that is spent on mental health
care in the Native community is many times less than the
amounts spent in the states of the union that provide the
least amount of funding for mental health.
A study we reported in 1990 indicated that there were less
than two dozen mental health child specialists in Indian
country. With special congressional appropriations, that
number has probably doubled, but even if the number of
specialists increased ten fold, it would still be
dramatically less than what is needed.
Many initial mental programs were office-based. This is not
a good fit with the Indian community. Gradually models have
been developed that emphasize outreach.
What is the importance of reaching out? Unlike the great
strides that we’ve made in destigmatizing alcohol abuse and
dependence, we have not made that same progress in
destigmatizing mental illness. People are reticent, even
afraid to go to the mental health programs, which are often
housed in trailers attached to the local clinic. Doing so,
they fear, will single them out as being “crazy”. This
speaks to the deep-seated stigma around mental illness,
which only now is beginning to change through the
remarkable grassroots efforts of people like Marla Bull
Bear, Rosebud Sioux, and others like her.
It’s quite common now in many meetings for Indian people to
get up and to talk about their alcoholism, their recovery
and road to sobriety. But you still rarely hear Indian
people acknowledge their own current or past mental illness
and share their struggles and triumphs. Until we reach that
point, regardless of how many mental health services we
fund and how many studies we have, few of these programs
will have any real effect.
Are
there any special roles that Native American professionals
can play in all of this?
There are many,
many roles. The first thing to recognize is that education,
education, education is the most important thing we can do.
We have to educate our leaders – both formal and informal –
about the true picture of mental health and illness in our
community. We also have to educate providers and various
other stakeholders in our community.
For example, co-morbidity–the concurrent experience of an
alcohol and a mental health problem—is more the rule than
the exception. But the way that treatment is organized,
funded, and carried out doesn’t acknowledge this. Some
providers deal with alcoholism as if it was the only
problem. Others deal with a mental health problem, such as
conduct disorder, on its own. Each provider remains blinded
to the presence and the importance of problems other than
the one that she or he is focused on.
In regional adolescent substance abuse treatment centers,
we find that fully one-third to one-half of the youth in
treatment suffer co-morbid mental disorders, typically
depression, post traumatic stress disorder, or conduct
disorder. Unless these mental health problems are addressed
at the same time that the substance abuse is addressed,
they are highly likely to return months later.
In this country, primary care physicians and nurses are
usually the first people who encounter a mental health
problem. They probably also see most mental health
problems, but many of them are not well equipped to
recognize and treat these problems. Even when they do
recognize them, they often do not manage them well. For
example, they are likely just to prescribe drugs, and we
know that pharmacological interventions aren’t always the
best intervention. Psychiatric or other kinds of mental
health interventions are usually also needed.
Many people who are in detention facilities, such as jails
and lockups, suffer from mental health problems that go
unrecognized and keep them at risk for delinquent or
antisocial behaviors. We’ve done a couple of major studies
in which fully half of youth in reservation-based detention
facilities suffer from alcohol, drug or mental health
problems. It’s very clear that the children who are booked
repeatedly have a greater presence of and severity of
emotional and psychological problems.
In schools we often focus on educational difficulties, but
we don’t also think about psychological difficulties that
may impair a youth’s ability to be part of that environment
and to engage in the learning process. Evidence is building
rapidly that many Native youth in our schools suffer from a
wide range of emotional and psychological problems that
impair their ability to learn and to participate fully in
their education.
It’s very important that we move beyond our current ways of
thinking about mental health and mental health care. We
need to recognize that mental health problems arise in a
variety of settings. They aren’t simply the problem of
mental health providers. This underscores the importance of
linkages among mental health providers, teachers, primary
care providers, and detention officers.
The world in which Indian people live also includes the
spiritual. A number of model programs in tribal communities
seek to care for the mental and spiritual aspect as well as
the body. We have many examples in which mental health
providers have formal or informal links with people from
the local spiritual traditions, for example traditional
healers, medicine people, roadmen, or fundamentalist
Christian healers.
Is
there are need for more Native Americans in the mental
health professions?
There
is definitely a need for more Indian and Native people in
the clinical arena. And we need them in the research area
as well. Their involvement will lead to a better
understanding of the nature and extent of such problems,
their root causes and how we can treat as well as prevent
them. We then need to take this knowledge and apply it in a
systematic way.
This article was originally published in the Summer 2000
issue of
Winds of Change.
Update
2007
The American
Indian and Alaska Native Programs (AIANP) includes the
following centers and initiatives
1) Center for Native American TeleHealth and TeleEducation
2) Center on Native Elder Health Disparities
3) Circles of Care
4) Project EXPORT
5) American Indian and Alaska Native Head Start Research
Center
6) National Center for American Indian and Alaska Native
Mental Health Research
7) Native Elder Research Center, a Resource Center for
Minority Aging Research
8) Special Diabetes Program for Indians – Demonstration
Projects
AIANP has a staff of more than 100 people, almost 70% of
whom are Indian or Native. Manson presently administers $62
million in grants and contracts, involving partnerships
with 68 tribes, 12 urban community-based organizations, and
20 Alaska Native villages or regional corporations,
distributed across 17 states. Funding derives from private,
state, and federal sponsors.
For more information about, see the AIANP website.