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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/AN communities are significantly more likely to report past-year alcohol and substance use disorders than any other race. Suicide rates for AI/AN people are 1.6 times higher than the U.S. all-races rate [PDF - 14 MB]. Domestic violence rates are also alarming, as AI/AN women are reported as having among the highest rates of sexual assault and intimate partner violence victimization.


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. IHS's Division of Behavioral Health (DBH) 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 AI/AN 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, more than 50 percent of the mental health programs and more than 90 percent of the alcohol and substance abuse programs are Tribally operated. This evolution in behavioral health care delivery and management is changing the face of behavioral health services in Indian Country. Where IHS was previously the principal behavioral health care delivery system for AI/AN people, 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 must not 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.


For more information, please visit the Division of Behavioral Health website. To speak with a spokesperson, please contact the IHS Public Affairs Office at 301-443-3593.

October 2016

Download this Fact Sheet [PDF - 54 KB]