Eleanor Yurkovich (standing) is the lead investigator for the three-year project. Assisting her is Izetta Lattergrass, a UND graduate and member of the Three Affiliated Tribes. (Photo: Chuck Kimmerle/University Relations)

Exploring the dimensions of treating mental illness of American Indian reservations

Mental illness has as significant an impact within the American Indian community as on the population at large. The reservation environment, however, poses special challenges — and opportunities — for treatment.

Researchers at the UND College of Nursing have completed the second phase of a project focusing on mental health issues of rural reservation-dwelling American Indians with chronic mental illness. The principal investigator is Eleanor Yurkovich, associate professor of nursing.

A three-year, $80,000 Otto Bremer Foundation grant is funding the study titled, “A Needs Assessment Focused on Defining Health and Health-Seeking Behaviors of Native American Indians Experiencing Severe and Persistent Mental Illness.”

In Phase I of this project, the researchers interviewed mental health care providers. This information underscored a major shortcoming in that only acute health care services exist on the reservations, without long-term treatment programs for chronic mental health problems.

In Phase II, the researchers interviewed American Indians experiencing chronic mental illness about their definitions of health, their health-seeking behaviors, and the treatments that work for them. The setting of the study was four reservations in Northern Plains states that include five Indian Health Service Human Service Centers.

Phase III will involve taking these findings back to health care providers, tribal councils, and other involved parties. The researchers will work with them on defining the next steps needed to improve mental health care and expand services, including soliciting grant funding.

Whether among American Indians or the population at large, there are obstacles in treating persons experiencing mental illness.

Individuals often use denial until a health crisis forces them to access acute care resources. Mental health patients sometimes hide their illness by self-medicating their symptoms through chemical use/abuse. Culturally related stigma and lack of understanding can interfere with the ability of patients to receive support from significant others. Trauma, depression, intergenerational/historical grief, anxiety/panic disorders, and schizophrenia are manifest.

Yurkovich noted that improvements are needed to the existing reservation health care system in terms of funding, staff, and infrastructure. More treatment opportunities can draw upon the profound resilience of American Indians themselves.

Both Phases I and II revealed that wellness in the community can be built through community centers, or “psychosocial clubs,” for peer support and sheltered work opportunities for “meaningful doing” that establish purpose and enhance self-esteem.

A dream exists among health professionals, Yurkovich observed, to develop programs that integrate American Indian ceremonies and traditions more visibly into treatment plans. The goal is to enhance patients’ mental health by reinforcing a sense of belonging and connection to their culture.

The researchers emphasize the importance of treating the person with mental problems on the reservation where there is cultural responsiveness, a framework of tribal beliefs and customs, the opportunity to access Native healers, and a holistic approach.

“We’re trying to get the information summarized and sent back to tribal people so they can take it to Senate hearings and try to get more funding for the services needed,” Yurkovich said.

Her fellow researchers at UND are all enrolled American Indians. Co-principal investigator Donna Grandbois, clinical instructor and a psychiatric nurse, holds two UND degrees and is working on her doctorate. She is an enrolled member of the Turtle Mountain Band of Chippewa. Izetta Lattergrass holds a B.A. in psychology from UND and is a member of the Three Affiliated Tribes. Sara Roy, a member of the White Earth Band of Chippewa, holds a B.S. in nursing from UND.

Yurkovich came to UND six years ago from Montana State University. She holds a master’s degree in nursing from Loyola University in Chicago and a doctorate from Montana State.