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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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Behavioral Health

Health People and Life in Balance Diagram: Spiritual, Emotional, Mental and Physical


The high rates of alcohol and substance abuse, mental health disorders, suicide, violence, and behavior-related chronic diseases in American Indian and Alaska Native (AI/AN) communities are well documented. Each of these serious behavioral health issues has a profound impact on the health of individuals, families, and communities. For example, AI/ANs are significantly more likely to report past-year alcohol and substance use disorders than any other race, and suicide rates for AI/AN people are 1.7 times higher than the U.S. all-races rate. Domestic violence rates are also alarming, with 39 percent of AI/AN women experiencing intimate partner violence-the highest rate in the U.S.


The last 30 years have seen the development of innovative community-based approaches to addressing alcohol, substance abuse, social services, and mental health issues. The Indian Health Service (IHS) brings much-needed attention to behavioral health and its relationship to the prevention of chronic disease, preventable mortality, and health promotion. The IHS Division of Behavioral Health focuses on the strength and resiliency of AI/AN communities in the implementation of strategies that integrate and adapt various types of behavioral health techniques.


In the ongoing effort to meet behavioral health challenges in Indian Country, there is also a trend toward tribal management and delivery of behavioral health services in their communities. Particularly in the last decade, Tribes have increasingly contracted or compacted via the Indian Self Determination and Education Assistance Act, Public Law 93-638, to provide these services themselves. Currently, over 50 percent of the mental health programs and over 80 percent of the alcohol and substance abuse programs are tribally operated. This evolution in behavioral healthcare delivery and management is changing the face of behavioral health services in Indian Country. Where IHS was previously the principal behavioral healthcare delivery system for AI/ANs, there is now a less centralized and more diverse network of care provided by federal, tribal, and urban Indian health programs.

The documented connections between behavioral health issues and chronic diseases underscore the need for holistic and integrated solutions. Finding solutions will require sustained collaboration between Indian health programs and policymaking bodies, as well as a willingness to thoughtfully engage deep issues such as historical trauma and cultural renewal, and a readiness to include entire communities in healing work. The importance of integrated perspectives that include cultural and traditional practices and community-wide healing and wellness cannot be underestimated.


The IHS continues to develop and share effective programs throughout the Indian health system, with a focus on developing programs that are collaborative, community driven, and nationally supported. This effort seeks to establish effective long-term strategic approaches to address the range of behavioral health issues in Indian Country. Additional information can be found at the following website link:


For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.

January 2015

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