American Indian and Alaska Native Mental Health: Diverse Perspectives on Enduring Disparities Joseph P. Gone 1 and Joseph E. Trimble 2 1 Department of Psychology, University of Michigan, Ann Arbor, Michigan 48109; email: jgone@umich.edu 2 Department of Psychology Center for Cross-Cultural Research, Western Washington University, Bellingham, Washington 98225; email: joseph.trimble@wwu.edu Annu. Rev. Clin. Psychol. 2012. 8:131–60 First published online as a Review in Advance on December 5, 2011 The Annual Review of Clinical Psychology is online at clinpsy.annualreviews.org This article’s doi: 10.1146/annurev-clinpsy-032511-143127 Copyright c  2012 by Annual Reviews. All rights reserved 1548-5943/12/0427-0131$20.00 Keywords American Indians, Alaska Natives, mental health, epidemiology, psychosocial treatments, health disparities Abstract As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal com- munities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear dis- parities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consid- eration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research pub- lished during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms. 131 Annu. Rev. Clin. Psychol. 2012.8:131-160. Downloaded from www.annualreviews.org by 98.225.5.139 on 04/03/12. For personal use only.