Improving Indigenous Mental Health: Q&A with Monica Desjardins

November is Native American Heritage Month—a time to learn about and celebrate the cultures, histories, traditions, and resilience of American Indian/Alaska Native (AI/AN) communities. At RTI, we're also reflecting on the past and present-day challenges that these communities face and how our public health research helps address systemic disparities.

The theme of 2023's Native American Heritage Month is Tribal Sovereignty and Identity. We sat down with Monica Desjardins, a public health analyst at RTI and member of the Navajo Nation, to discuss how her work is helping to improve mental health in Indigenous communities.

Tell us about your research and what inspired you to pursue studying and improving American Indian/Alaska Native (AI/AN) mental health.

Yá’át’ééh Shidine’é. Shí éí Monica Desjardins yinishyé. 'Adóone’é nishlínígíí’ éí Honágháahnii nishlí. Haitian Dine’é éí bá shíshchíín. Tl’ógí dine’é éí dashicheii nááná. Nakih Haitian Dine’é éí dashinálí. Hello, my name is Monica Desjardins. I am part of the Navajo Nation. I belong to the One-Walks-Around Clan. I was born to the Haitian People and to the Weavers-Zia Clan.

I am an early career American Indian (AI) public health professional focused on addressing mental health disparities within AI communities by improving the effectiveness and accessibility of mental health services. Here at RTI, I aim to build the Institute’s capacity for Tribal partnerships. Some positions I hold on projects that involve AI/AN peoples are serving as the Data Manager for the Zero Suicide Initiative Coordinating Center and as the Associate Tribal Program Specialist for the National Missing and Unidentified Persons System. 

My interest in the mental health field stems from disparities found among AI communities, particularly the Navajo Nation. I have witnessed firsthand the implications of mental health disparities within my reservation, such as the high suicide and substance abuse rates among Navajo youth. The Navajo Nation has an underdeveloped mental healthcare field where patients receive insufficient services due to a lack of resources and healthcare quality. It is evident that the Navajo Nation needs proper initiatives implemented to ensure adequate overall healthcare.

What are some of the most pressing mental health issues and inequities that AI/AN communities experience?

While AI/AN make up approximately 3% of the overall US population, they are disproportionately affected by suicide and substance use disorders, such as opioid use. 

According to the CDC, rates of suicide among AI/AN individuals have been increasing since 2003, and in 2015, were 3.5 times higher  compared to other racial/ethnic groups with the lowest rates. Nearly half of all AI/AN suicides in 2020 were among those aged 25-44 years. A particularly big concern is suicide among youth. For AI/AN youth and young adults ages 18-24, suicide is the second leading cause of death.

In terms of substance use disorders, in 2017, AI/ANs had the second highest overdose rates from all opioids compared to all other racial/ethnic groups, and as well as the most alcohol-induced deaths. 

How does addressing AI/AN mental health disparities relate to and support tribal sovereignty and identity?

A key approach to improve the mental health services and systems of care within AI/AN communities is using Indigenous community mental health workers. Tribal communities that have used this approach have seen promising outcomes, such as increasing the availability of culturally effective care, and ultimately increasing tribal health, economic self-determination, and sovereignty. 

What are some key priorities or goals to keep in mind when developing mental health treatments and interventions for AI/AN communities?

It is critical to implement programs that address the Indigenous Determinants of Health and are culturally tailored and sensitive to the communities they focus on. There is heterogeneity among the 574 federally recognized tribes, and therefore that requires evidence- and culturally-based approaches that are specific to each tribal community. 

Additionally, to engage in tribal health equity research, it is critical that Non-Native researchers recognize that there are cultural differences specific to health-related values and beliefs. For Indigenous people, there is an overarching concept of health that is comprised of physical and mental wellbeing. Instead of using standards derived from western mental health care, it is crucial to understand what the cultural and traditional practices for health and wellness are for the specific tribal community and aim to incorporate them into treatment and interventions. 

What recent interventions have been found to be successful? 

Interventions that are successful in addressing suicide and substance use disorders in AI/AN communities are tribally led or culturally tailored to fit the needs of the community. 

Due to the rising opioid overdose crisis in Indian Country, there have been numerous innovative efforts from both the Indian Health Service (IHS) and tribes to reduce opioid morbidity and mortality amongst AI/ANs. Some examples from the IHS include a mandated pain management training for all prescribing physicians and the dissemination of best practices in opioid overdose prevention, such as programs that incorporate ceremony and cultural practices. An example of a community-driven approach developed by a tribe includes the Lummi Nation’s healing spirit clinic model, which incorporated medically-assisted treatment while offering cultural therapists to teach tribal, traditional, and spiritual practices to aid in healing. 

Combatting the suicide epidemic in AI/AN communities is another major area of focus. One major IHS effort is the Zero Suicide Initiative, which is a system-wide change that enhances service access and quality through continuous improvement. It uses a comprehensive approach to suicide care and aims to reduce the risk of suicide for all individuals seen in the health care system. 

A particularly successful tribe- and community-driven approach to reduce suicide rates is the White Mountain Apache Tribe’s Celebrating Life Suicide Surveillance System. This novel system was mandated by the tribe for all schools, medical and social service staff, first responders, and community members to aid in the reporting and identification of individuals at risk for suicide or displaying suicidal behaviors across their reservation. The Celebrating Life system contributed to a 38% decrease in suicide deaths between 2001 and 2012.

How can non-Native researchers equitably work with and include AI/AN communities in their research?

It is important for the research to be more tribally and community led, instead of simply “participatory research.” To begin involving AI/AN people in research, it is most important to develop relationships and establish trust between the researchers and the community. And when collecting data of AI/AN peoples, it is vital to honor tribal sovereignty and be good stewards of the data. In most partnerships with tribal communities, memoranda of understanding or data use agreements are typically put in place to govern the exchange and ownership of the data.

Ultimately, Non-Native researchers need to develop cultural competence to ensure they are understanding and respecting the cultures of tribal nations.