Mental Health Services Historical and Policy Perspective

1. Mental Health Services Historical and Policy Perspective University of Oklahoma School of Social Work Master’s Advanced Curriculum Project Supported by:

2. Social Work Objectives • Present traditional Native approaches to Western concept of mental illness • Present history of U.S. Government’s mental health service orientation - Hiawatha Insane Asylum and reasons for contemporary mistrust of mental health care especially for elders • Present historical timeline for Native Mental Health Policy and Services in U.S. • Present current behavior health service structure – Information about access for clients including tribal services specific for elders health and socio-economic needs • List newest bills with impact on behavioral health • Present relevance to elders

3. Traditional Concept of Mental Illness “Native peoples generally do not have a notion of ‘insane’ or ‘mentally ill.’ I have been unable to locate a Native Nation whose indigenous language has a word for that condition. The closest I can come is a word more closely aligned with ‘crazy,’ which means someone is either very funny, or too angry to think straight.”1 Yellowbird, P.

5. Hiawatha Asylum for Insane Indians2, 3 • 1st Federal mental asylum for an ethnic population • Signed into law in 1899 with $75,000 appropriated at request of 2 South Dakota Congressmen • 1st Superintendent, Oscar S. Gifford an attorney who had wrote up the papers for sale of asylum grounds to congress • Opened in Canton, South Dakota 1903 • Dr. Harry Hummer, psychiatrist became superintendent in 1908 • Secretary of Interior sent Dr. Samuel Silk in 1929 to investigate multiple accounts of staff complaints of neglect, cruel patient treatment, sexual harassment

6. Results of Dr. Samuel Silk’s Series of Investigations of Hiawatha Asylum3 • Only 20-30 actually belonged in a mental hospital • Used as a penal institution • Large population of young people • Difficulties at school, argued with reservation agent, white man, or spouse • Majority of time patients were physically restrained for no reason • Abuse, neglect, trauma, torture, death • 121 inmates were buried there • Closed in 1933 for poor care • Purchased by City of Canton for $1.00 • Building was razed, Golf course is over the site and graves

7. Dr. Silk’s Own Words “Would not the United States, if it could be held liable at all, be liable in these cases for enormous damages? The records of the asylum itself show them to be perfectly sane. They are known to be perfectly sane, to the director of the asylum Dr. Hummer. But he assumed the position that these people were below normal - mentally deficient - and they should only be discharged after they were sterilized, and as he did not have any means of doing this, there was nothing left but to keep them there”. Excerpt from Dr. Silk’s Report as quoted in A Haunting Legacy:Canton Insane Asylum for American Indians By Elizabeth Stawicki, December 9, 1997, Minnesota Public Radio http://news.minnesota.publicradio.org/features/199712/09_stawickie_asylum

8. National Library of Medicine “If You Knew the Conditions…”Health Care to Native Americans: An Exhibit at the National Library of Medicine (April 15, 1994-August 31,1994) Exhibit Case 5 “The facts in the case as presented in clinical notes and correspondence would indicate that the reservation agent was determined to have this boy hospitalized, despite the fact that the superintendent of the hospital reported repeatedly that he was not a case for this institution, as he had been unable, after several months of observation to determine any sufficient cause for hospitalization. At the time of the survey visit, correspondence was still in progress between the two superintendents and the Indian Office. It seemed obvious, however, that the agency superintendent was determined to be rid of this boy. This conclusion was strengthened after comparing notes with a member of the survey staff who had studied the facts of the case on the reservation from which the boy came. He was subsequently sent home.” ---Dr. Herbert R. Edwards http://www.nlm.nih.gov/exhibition/if_you_knew/if_you_knew_01.html

9. Websites Related to Hiawatha http://www.hiawathadiary.com/front.html Sponsored by the Friends of Hiawatha Foundation this website offers a history of the asylum, lists of patients, and pictures. http://news.minnesota.publicradio.org/features/199712/09_stawickie_asylum/ Link to A Haunting Legacy: Canton Insane Asylum for American Indians By Elizabeth Stawicki; December 9, 1997 Contains interview with former worker at Canton, excerpts from Dr. Silk’s report, and an interview with a descendent of a patient.

10. History of Contemporary Mental Health Services3 • 1965 – Office of Mental Health was created and located at Window Rock, AZ • 1960s to 1977 – Training program to train local tribal members to become mental health technicians began on Navajo reservation. • 1965 to 1990 – Develop of ambulatory mental health care • 1987 – National Plan for Native American Mental Health Services Created • Authored by Mental Health Programs Branch of Indian Health Service (IHS) with input from tribal communities and service providers • Described current status of mental health services, recommendations for improvement with special references to providing minimal mental health services to children and adolescents • 1987 October- National Plan became Public Law 101-630 • 1st authorization for comprehensive program for Native American Mental Health • 13.7 million authorized, but funds were not appropriated

11. Current Mental Health Services System • Behavioral health and/or substance abuse services • Operated by the tribe (see tribal website) • Cherokee Nation lists behavioral health with health services • Link is to list of service sites that will specify if behavioral health is offered • http://www.cherokee.org/Services/Health/HealthClinics/Default.aspx • Chickasaw Nation lists 3 behavioral health clinics and details of services • http://www.chickasaw.net/services/index_491.htm • Creek Nation behavioral health vision statement and list of staff • http://www.muscogeenation-nsn.gov/health%20administration/BHS.htm • Behavioral health and/or substance abuse services • Operated by the IHS • Link is to the vision and mission statement of IHS Behavioral Health Programs • Retrieved July 30, 2008 from http://www.ihs.gov/NonMedicalPrograms/HPDP/index.cfm?module=focus&option=mental&newquery=1

12. Accessing Services A list of behavioral health program, contact information, and director name in that are within the Oklahoma City IHS Area. The list includes programs that are tribally in addition to those managed by IHS. Retrieved July 30, 2008 from http://www.ihs.gov/MedicalPrograms/Behavioral/index.cfm?module=BH&option=ProgResults National Resource Center on Native American Aging sponsors a service locator Behavioral health issues are often complicated by socio-economic needs. The service locator identifies programs by state and tribe Lists 23 Service Centers in Oklahoma for American Indian Elders You can click on the map for each state and then on the individual tribal icons to gain a list of services and description Retrieved July 30, 2008 from http://ruralhealth.und.edu/projects/nrcnaa/servicelocator.php

13. Indian Health Service Mental Health and Social Services Program Goal: The goal of the MH/SS program is to alleviate the pain and suffering associated with behavioral health problems. • The Indian Health Service Mental Health and Social Services (MH/SS) Program is a community oriented clinical and preventive mental health service that provides inpatient hospitalization, outpatient mental health and related services, crisis management, case management, prevention programming and outreach services. The Indian Health Service MH/SS staffs work within American Indian and Alaska Native communities to provide clinical and preventive services that address the full range of mental health and social problems present in individuals to communities, including depression; suicide; traumatic life circumstances including child abuse, neglect and domestic violence; and co-occurring disorders including the interplay among physical disorders, addiction, and behavioral health. • MH/SS Program staffs work within the social and cultural contexts of their communities to promote healthy lifestyles as well as advocate for increased access to Federal, state, and local mental health, social service, and entitlement programs. Taken directly from IHS Website http://www.ihs.gov/NonMedicalPrograms/HPDP/index.cfm?module=focus&option=mental&newquery=1

14. 2007 LegislationH.R. 5501 • To authorize appropriations for fiscal years 2009 through 2013 to provide assistance to foreign countries to combat HIV/AIDS, tuberculosis, and malaria, and for other purposes. • Title VI: Emergency Plan for Indian Safety and Health - (Sec. 601) Establishes in the Treasury the Emergency Fund for Indian Safety and Health. • Authorizes appropriations to be transferred from the Treasury to the Fund for the five-year period beginning on October 1, 2008. • Directs the Attorney General, the Secretary of the Interior, and the Secretary of Health and Human Services, in consultation with Indian tribes, to establish an emergency plan that addresses law enforcement, water, and health care needs of Indian tribes for each of FY2010-FY2019. • 7/25/08 Presented to President for signature • http://www.thomas.gov/cgi-bin/bdquery/z?d110:H.R.5501:

15. 2008 Legislation S.1200 (H.R. 1328, 2007) Title: A bill to amend the Indian Health Care Improvement Act to revise and extend the Act. • Subsumes substance abuse and mental health programs into behavioral health programs. • Directs the Secretary, acting through IHS, to: (1) encourage Indian Tribes and Tribal Organizations to develop tribal plans and to participate in developing areawide plans for Indian Behavioral Health Services; (2) coordinate with existing national clearinghouses and information centers to include plans and reports on their outcomes; and (3) provide technical assistance for plan preparation and development of standards of care. • Requires updates of memoranda of agreement with respect to behavioral health services. • Revises requirements for a comprehensive behavioral health prevention and treatment program. • Requires the Secretary, acting through IHS, to ensure that the mental health technician program involves the use and promotion of the Traditional Health Care Practices of the Indian Tribes to be served. • 2/28/08 Senate sent to House for approval • http://www.thomas.gov/cgi-bin/query/D?c110:5:./temp/~c110ZPJGKo::

16. Relevance to Elders • Native elders may not feel that formal mental health (counseling) is an option of care • Due to the bias against mental health within the general American society • Due to distrust of the non-traditional service providers • Need to offer all services that are available • Tribal, state, local levels • Inquire about elder specific behavioral health provider & programs • Recognize diversity of service preference • Traditional healers • Behavioral health • Medication • Any combination of the three above • Elders were alive during the time of Hiawatha Insane Asylum which can contribute to mistrust of mental health providers • Reference Mental Health Status of Older Native Americans

17. References • Yellowbird, P. (n.d). Wild Indians: Native perspectives on the Hiawatha Asylum for insane Indians. Washington DC:Center for Mental Health Services Research, Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. • Bhatara, V.S., Gupta, S., Brokenleg, M. (1999, May). Images in psychiatry: The Hiawatha asylum for insane Indians. American Journal of Psychiatry, 156, (5), 767. • Nelson, S.H. (1991). A national program supporting mental health services for Native Americans. Hospital and Community Psychiatry, 42, (10), 1049-1053. • National Indian Health Board. (2008, September, 29). Efforts to reauthorize Indian health care improvement act in this 110th congress are shut down. Retrieved November 11, 2008 from http://www.nihb.org/