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Substance Abuse and Mental Health Services Administration
Living in Two Worlds
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Native American communities experience disproportionate levels of homelessness, substance use, and mental health issues. Jimi Kelley, from the First Nation’s Behavioral Health Association, speaks about his experiences, shares his views on the struggles of Native American communities, and expresses his hopes for addressing and eliminating these issues in the future.
Living in Two Worlds

Jimi Kelley grew up in two worlds: the mainstream culture of the United States and the Native American culture of his mother. Jimi’s mother is Quapaw and Cherokee from the Big Creek community. As a child, Jimi didn’t spend much time growing up in his Native American community and culture, as he was raised in the military. His father was in the military, his mother was a psychiatric nurse practitioner for the Veterans Administration (VA).

In his late teens, Jimi was diagnosed with bipolar disorder and PTSD. While seeking treatment, he found the traditional medical model did not meet his needs, while the understanding and alternate view of mental illness in Native American culture did. Eventually, Jimi found a way to combine western clinical therapy and traditional healing to find balance and stability. Through these traditional methods, Jimi learned to take the best parts of himself, while managing the negative effects of his mental state. Jimi believes that if people were aware of the alternatives provided in both Native American and mainstream U.S. communities, they would find more options and solutions to better meet their individual needs. Such awareness would give credence to the contributions Native American culture could give to American culture and medicine.

Currently, Jimi is working on the SAMHSA initiative Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS). He also works with First Nations Behavioral Health Association's Society of Truth, the TennCare Select Behavioral Health Advisory Committee, and serves on the Board of Directors for the National Coalition of Mental Health Recovery (NCMHR). Finally, he is on the Steering Committee for SAMHSA's creation of Standards and Ethics for Peer Support Specialists. His current projects, combined with the expertise he has gained through working with Native communities for over 15 years, have shown him the extent of problems facing the community. He also has a vision for overcoming these obstacles and what a brighter future might look like.

Many Native people who are currently homeless in urban areas suffer from multiple interwoven issues: inter-generational trauma, alcohol and substance abuse, mental health issues, poverty, violence, and abuse. A study by the VA found that, when compared to the general population, Native Americans are overrepresented by 19% among homeless veterans and report higher rates of substance abuse, but have a somewhat lower rate of psychiatric problems. Another study found that 8% of Native Americans are homeless, compared to 1% of the general population. Jimi believes that in order to address these disparities, more attention must be paid to the specific problems in the Native community, particularly because issues like substance abuse and domestic violence are both stigmatized and seen as stereotypical.

The first step to addressing these issues is to increase cultural competence so treatment is relevant and sensitive to Native American communities, says Jimi. The next step is to create a cultural bridge with Native communities. This bridge will help to integrate traditional ideas and practices into what is often considered the mainstream or dominant model for mental health and psychology. Looking at mental illness in a more holistic way might offer new insight. Jimi realizes this will be a difficult task since these methods are not researched or regarded as legitimate treatment in western medicine.

Jimi also puts forth the concept of “treatment teams,” where specialists from different fields of medicine come together around patient-centered care, representing different perspectives from different cultural models. This practice reflects the phenomenon of eastern medical practices, such as acupuncture, which have been documented to help alleviate pain and are now becoming more mainstream. Within the Native community, specialists recognize the value of practices such as talking circles, spiritual guidance, and taking a holistic approach to mental health. Jimi believes this recognition of value has not yet occurred with Native American medicine and philosophy due to negative stereotypes and perceptions of Native culture.

Today, current and generational issues affect Native American communities, families, and individuals. There is no simple solution. Historically, Native Americans have been marginalized by government policies, such as sending Native children to boarding schools where they are taught to assimilate, resulting in the displacement or extermination of communities. According to Jimi, there is a feeling among Native youth that “everybody hates you,” and these attitudes and conflicts are passed down through generations. As a result, kids grow up with a negative self-image. Additionally, there are problems with economic and political disparity, but there is hope. A grassroots movement, Society of Truth, has sought to integrate traditional Native culture to make it part of the solution—it is a network of Native mental health providers, spanning a wide net of suicide prevention and anti-violence programs that already exist within Native communities. This movement is showing improvement at the community level—there are more culturally based programs in health care, education, and social support being implemented. Many such programs already exist to address substance use, mental health, and youth education in Native communities. These programs are showing both improvement and a reduction in disparities among the communities where they have been implemented, but they need more funding if they are to succeed. Although these programs have made great strides, it is only the beginning and there is plenty more to be done.

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