By Emalee Gillis, NAMI Spokane Blog Editor.

When asked to discuss what culturally specific mental health care means for Native Americans, Shane Garcia, a social worker at the Native Project in Spokane, kept coming back to the term “holistic.”

The Native Project is a medical facility that uses integrated care. The Native Project incorporates behavioral health services with medical services. The Native Project is open to the entire Spokane community. It receives funds in support of underinsured Native Americans who qualify as tribal members of federally recognized tribes.

Mr. Garcia explained that in recent times Native Americans “have gone away from holistic approaches though we speak of it in ceremonies and cultural activities. We are learning to understand it again and to apply it in a way that makes sense to the entirety of ourselves.”

When working with clients assigned to him for mental health services, Mr. Garcia explains the term “holistic” by using the concept of the medicine wheel. He explains that the four components he relates to the medicine wheel are physical health, emotional health, cognitive health, and spiritual health. He said, “I emphasize the importance of these components and their relationship with one another. I talk about how they can impact and support one another. Sometimes focusing on one part will strengthen or indirectly improve the other parts of ourselves.”

One western tool Mr. Garcia uses in his practice that affects more than one part of a person is Cognitive Behavior Therapy. CBT helps clients change thoughts which results in changes to feelings. Through coping with emotions, clients learn to regulate their body.

The acculturalization and assimilation of Native Americans was another concept that Mr. Garcia kept coming back to in the discussion of culturally specific approaches to mental health care for Natives. He explained that “acculturalization and assimilation affected individual Natives differently and it affects a person’s belief on how to deal with mental health. This is the first point of reference. There are so many different circumstances that would separate a Native American from their beliefs. For example, if a Native child was adopted out and never returned to their family, they are lost in another world and may not have been able to regain their trust in themselves or be tied to a native community. There are many different stories and many different experiences out there. Native Americans have had generational trauma from colonization. We need to understand each client for who they are.”

Mr. Garcia explained that because of that history building rapport with Native Americans is key. He added that “It is easier for me to explore their background because we share some history. History tells a lot about who they are and their beliefs.” It is helpful to have a Native American counselor when Natives are working with mental health issues, but there is a shortage. For the Native American counselors who work in the Spokane area, local Natives may be unable to access them if they don’t have the appropriate insurance.

Another challenge in accessing mental health care in Spokane for Natives according to Mr. Garcia is attendance policies. Attendance is related to the whole Native system of beliefs. While there may be a long-term commitment to their mental health, attending counseling sessions consistently has been an issue that can result in a discharge from services. The discharge process can be a trigger and leave the Native client feeling ostracized or intensify feelings of not being accepted. Mr. Garcia’s services do not have a regular attendance policy. He sees some patients irregularly when they need his help which might be once a month or as long as a year between appointments.

Mr. Garcia explained that one part of care for Natives that needs expanded on more is work for the spiritual self. “We are all spiritual people,” he said. “The spiritual self is not necessarily related to religion or faith. The spiritual self is involved in the roles of our lives like brother, sister, caretaker to pets, caretaker to earth—whatever relationships you have. If you are a father, what does a father do for his child? The answers include ‘I need to exercise. I need to take care of myself. That is a role I need to fill.’”

The recovery process for Native Americans could be a little different in terms of activities, according to Mr. Garcia. Recovery can mean enhancing ties to the community. Sometimes Mr. Garcia recommends to his Native American clients that see him for mental health issues that they talk with family, attend pow-wows, do a sweat at a sweat lodge, go root digging, harvest berries, hunt, or anything related to the traditions of their cultures. However, he added that some Native individuals don’t want anything to do with a Native lifestyle.

Mr. Garcia said he often refers his clients to NAMI. He typically put them in contact with NAMI’s Resource Navigator, Robert Lang, who connects them to the monthly support group or session of eight-week classes for people with mental health conditions or to the monthly support group or session of eight-week classes designed for family members of people with mental health conditions. He said that NAMI helps his clients by building support with others in the community dealing with the same things.

Shane Garcia, LICSW, SUDP, is a licensed individual clinical social worker who works at the Native Project. He works with all populations that are established with the Native Project. He is a member of the Hopi Tribe and Kewa Pueblo.          

Emalee Gillis is a writer and blog editor. She is the author of the memoir Adventures on the Path to Living Well with a Mental Illness and has a related TEDx Talk.