The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Native Community Disaster
Management: Planning, Assessment,
Care, and Follow-up
San Diego, California
June 8, 2006
Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD
Michelle Singer
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One Sky
Center
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One Sky Center Partners
Cook Inlet Tribal Council
Alaska Native Tribal
Health Consortium
Northwest Portland Area
Indian Health Board
Tribal Colleges
and Universities
Prairielands ATTC
One Sky
Center
Red Road
United American
Indian Involvement
Harvard Native
Health Program
Jack Brown
Adolescent
Treatment Center
National Indian Youth
Leadership Project
Tri-Ethnic Center for
Na'nizhoozhi Center Prevention Research
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One Sky Center Outreach
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Presentation Overview
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•
•
•
An Environmental Scan
Behavioral Health and Education System Issues
Fragmentation and Integration
Discuss Suicide as Disaster: planning, care,
assessment, follow up
• Integrated care approaches and interagency
coordination are best overall solutions
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Six Missions Impossible?
• How do we define health, education, and
social problems?
• How do we define disaster?
• How do we ask for help?
• How do we get Federal and State agencies to
work together and with us?
• How do we build our communities?
• How do we restore what is lost?
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A Quiet Crisis: Federal Funding
and Unmet Needs in Indian
Country, July 2003
Funding not sufficient to meet needs for:
• Health care
• Education
• Public safety
• Housing
• Infrastructure development needed
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Native Health/ Educational
Problems
1.
2.
3.
4.
5.
6.
7.
8.
9.
Alcoholism 6X
Tuberculosis 6X
Diabetes 3.5X
Accidents 3X
Suicide 1.7 to 4x
Health care access -3x
Poverty 3x
Poor educational achievement
Substandard housing
American Indians
• Have same disorders as general
population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated
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Agencies Involved in B.H. & Edn
1. Indian Health Service (IHS)
A. Mental Health
B. Primary Health
C. Alcoholism / Substance Abuse
2. Bureau of Indian Affairs (BIA)
A. Education
B. Vocational
C. Social Services
D. Police
3. Tribal Education/Health
4. Urban Indian Education/Health
5. State and Local Agencies
6. Federal Agencies: SAMHSA, Edn
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Disconnect Between
Education/Behavioral Health
• Professionals are undertrained in one of the
two domains
• Students as patients are under diagnosed
and under treated
• Students have less opportunity for education
• Neither system integrates well with medical,
emergency, legal, and social services
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Difficulties of System
Integration
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•
•
•
•
•
Separate funding streams and coverage gaps
Agency turf issues
Different philosophies
Lack of resources
Poor cross training
Consumer and family barriers
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Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning?
(Dale Walker, Carl Bell, 7/03)
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Culturally
Specific
Best
Practice
Outcome
Driven
Integrating
Resources
We need Synergy and an Integrated
System
(Dale Walker, Carl Bell, 7/03)
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Emergency situation
Event where, in order to protect the
people, goods and the environment,
requires a quick response for which the
normal procedures and resources of an
organisation are adequate.
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Disaster
Event, endangering the safety of people,
goods and the environment, that exceeds
the organisation’s normal response
capabilities (resources or procedures)
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When Does an Emergency
Become a Disaster?
•
A disaster depends largely on the
community itself. What is it’s size, it’s
resources, it’s experience in dealing with a
certain hazard.
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Suicide: A National Crisis
• In the United States, more than 30,000 people die by
suicide a year.1
• Ninety percent of people who die by suicide have a
diagnosable mental illness and/or substance abuse
disorder.2
• The annual cost of untreated mental illness is $100
billion.3
1 The
President’s New Freedom Commission on Mental Health, 2003.
Center for Health Statistics, 2004.
3 Bazelon Center for Mental Health Law, 1999.
2 National
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Our Native Community Issue
• For every suicide, at least six people
are affected.4
• There are higher rates of suicide among
survivors (e.g., family members and
friends of a loved one who died by
suicide).5
• Communities are closely linked to each
other, increasing the risk of cluster
suicide.
4 National
5 National
Center for Health Statistics, 1999.
Institute of Mental Health, 2003.
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Suicide Rates by Age, Race, and
Gender 1999-2001
AI Male
Black Male
AI Female
50
40
30
20
Age Groups
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Source: National Center for Health Statistics
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
0
10-14
10
5-9
Rate/100,000 .
60
White Male
Native Suicide: A Multi-factorial Event
Psychiatric Illness
& Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance
Use/Abuse
Hopelessness
Family Disruption
Domestic Violence
Suicide
Family History
Negative Boarding School
Historical Trauma
Douglas Jackobs 2003
R. Dale Walker, M.D., 2003
Psychodynamics/
Psychological Vulnerability
Suicidal
Behavior
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Suicide
“The complexity of causes
necessarily requires a multifaceted
approach to prevention that takes
into account cultural context.
Cultural factors play a major role in
suicidal behavior.” and its treatment
Violence – A global public health problem, World Health Organization, 2002, p. 206. DeLeo, D. Cultural Issues in
suicide and old age. Crisis, 1999, 20:53-55.
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Current Cluster Suicide Crisis in a Tribal
Community
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•
•
•
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300+ attempts in last 12 months
70 attempts since November
13 completions in 12 months
8 completions in 3 months
4 to 5 attempts per week
– Some attempts are adult
• Age range of completions: 14-24 years of
age
– Most completed suicides are female
– 80% Alcohol related
– All hanging
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Suicide
“Problems are complex and go
beyond the capacity, resources, or
jurisdiction for any single person,
program, organization, or sector to
change or control.” Disaster
Lasker R., Weiss E., Broadening Participation in Community Problem Solving: A Muiltidisciplinary Model to Support
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Collaborative Practice and Research. Journal of Urban Health: Bulletin of the New York Academy of Medicine. Vol 80,
No 1. March 2003. p.5.
BIA Schools
• 184 elementary and secondary schools and
dormitories (55) as well as 27 colleges
• In 23 states
• 60,000 total students
• 238 different tribes
• Majority of the schools are located in Arizona
and New Mexico
• Second greatest number of schools in the
states of North Dakota and South Dakota
• Third greatest lie in the northwest
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Why should schools be involved?
• When students’ behavioral health problems are
barriers to learning and development. From Carnegie
Task Force on Education.
• Schools need to take steps to minimize factors
that lead to student alienation and despair.
• Schools are in a unique position to promote
healthy development and protective buffers, offer
risk prevention programs, and help to identify and
guide students in need of special assistance.
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Adolescent Problems In Schools
Fighting
and
Gangs
Alcohol
Drug
Use
Weapon
Carrying
Bullying
School
Sale of
Alcohol
and Drugs
Sexual
Abuse
Environment
Unruly
Students
Truancy
Attacks
on Teachers
Staff
Drop
Outs
Domestic
Violence
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Four Phases of Emergency
Management
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Mitigation (prevention)
Preparedness
Response
Recovery
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Community Assessment
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Community Assessment
Five parts to a community assessment:
• Description of community
• Assessment of needs
• Assessment of resources
• Community history
• Problem statement(s)
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3.1
Stages of Disaster
The community response in grief.
• HEROIC: From impact to about one week
out.
• HONEYMOON: Lasts several weeks and
there is a sense of the community “pulling
together.”
• DISILLUSIONMENT: One month to even a
couple of years. Hype is gone and
questions are unanswered.
• RECONSTRUCTION: Final stage with
realization of what has been experienced
and what they can do to restore the
community.
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Prevention Programs Enhance
Protective Factors
• strong family bonds
• parental monitoring
• parental involvement
• success in school performance
• pro social institutions (e.g. such as family,
• school, and religious organizations)
• conventional norms about
• drug use
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Ecological Model
Society
Community/
Tribe
Peer/Family Individual
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Implications for Treatment
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Teach adolescents how to cope with
difficulties and adversity
Increase their repertoire of coping
strategies
Cognitive therapy is most effective
approach
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Stress Management
• Mental health professionals with child/family
training
• Information, information, information
• Provide energy outlets for kids
• Provide parents with time away from kids
• Provide best possible sleep environment
• Therapeutic play (drawing, role play)
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Comprehensive Behavioral
Health/School Planning
• Prevention and behavioral health
programs/services on site
• Handling behavioral health crises
• Responding appropriately and
effectively after an event occurs
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Community Driven/School
Based Prevention
Interventions
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Public awareness and media campaigns
Youth Development Services
Social Interaction Skills Training Approaches
Mentoring Programs
Tutoring Programs
Rites of Passage Programs
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Effective Family Intervention
Strategies: Critical Role of Families
• Parent training
• Family skills training
• Family in-home support
• Family therapy
Different types of family interventions are used
to modify different risk and protective factors.
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Promising Strategies
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•
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Home visitation
Parent training
Mentoring
Social cognitive
Cultural
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Partnered Collaboration
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
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Potential Organizational
Partners
• Education
• Law Enforcement
• Family Survivors
• Juvenile Justice
• Health/Public Health
• Medical Examiner
• Mental Health
• Cultural specialist
• Substance Abuse
• County, State, and
Federal Agencies
• Elders,
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Contact us at
503-494-3703
E-mail
Dale Walker, MD
onesky@ohsu.edu
Or visit our website:
www.oneskycenter.org
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