New Tribal Agenda Aims to Improve Behavioral Health in Native Communities



The U.S. Department of Health and Human Services (HHS) today has announced the release of the Tribal Behavioral Health Agenda (TBHA), a first-of-its-kind collaborative tribal-federal blueprint that highlights the extent to which behavioral health challenges affect Native communities, in addition to strategies and priorities to reduce these problems and improve the behavioral health of American Indians and Alaska Natives.


There are 567 federally recognized and dependent sovereign American Indian and Alaska Native nations, tribes, rancherias, villages, and pueblos.  American Indians and Alaska Natives represent 2 percent of the total U.S. population (6.6 million persons), but experience disproportionately high rates of behavioral health problems such as mental and substance use disorders.  In addition, these communities’ behavioral health needs have traditionally been underserved.


Mental and substance use disorders — which may result from adverse childhood experiences, historical and intergenerational trauma, and other factors — are also reflected in high rates of interpersonal violence, major depression, excessive alcohol use, suicide, and suicide risk.  Overall, these problems pose a corrosive threat to the health and well-being of many American Indians and Alaska Natives.


“This new initiative represents an important step in our government-to-government relationship and gives American Indian and Alaska Native tribes a greater role in determining how to address their behavioral health needs with urgency and respect,” said SAMHSA Principal Deputy Administrator Kana Enomoto.


The Tribal Behavioral Health Agenda blueprint includes the following four tenants:


  • Provides a clear national statement about the extent and impact of behavioral health and related problems on the well-being of tribal communities.
  • Recognizes and supports tribal efforts to incorporate their respective cultural wisdom and traditional practices in programs and services that contribute to improved well-being.
  • Establishes five foundational elements that should be considered and integrated into existing and future program and policy efforts.
  • Elevates priorities and strategies to reduce persistent behavioral health problems for Native youth, families, and communities.


Findings from SAMHSA’s National Survey on Drug Use and Health indicate that adult (ages 18 and older) American Indians and Alaska Natives had experienced higher rates of past year mental illness compared with the general population (21.2 percent versus 17.9 percent).  Similarly, American Indians and Alaska Natives ages 12 and older had higher levels of past year illicit substance use than the general population (22.9 percent versus 17.8 percent).


The TBHA framework is organized around five foundational elements that provide both content and direction for collaborative efforts.  They are:


  • Focusing on healing from historical and intergenerational trauma;
  • Using a socio-cultural-ecological approach to improving behavioral health;
  • Ensuring support for both prevention and recovery;
  • Strengthening behavioral health systems and related services and supports; and
  • Improving national awareness and visibility of behavioral health issues faced by tribal communities.


“The IHS is committed to improving behavioral health care for the American Indian and Alaska Native people by using the Tribal Behavioral Health Agenda to integrate care within community health systems,” said IHS Principal Deputy Director, Mary L. Smith. “This agenda recognizes that successful and sustained behavioral change requires cultural reconnection, community participation, increased resources and the ability of those serving American Indian and Alaska Native populations to be responsive to emerging issues and changing needs.”


The TBHA includes the American Indian and Alaska Native Cultural Wisdom Declaration which acknowledges that cultural wisdom and traditional practices are fundamental to achieving improvements in behavioral health. In addition, the TBHA uses historical and current contexts for developing the recommendations that form the blueprint. It also incorporates shared priorities and strategies that can be addressed by tribes, federal agencies, and other entities working together.


Tribal leaders called for improved collaboration with key federal agencies to address these behavioral health challenges. The National Tribal Behavioral Health Agenda is the result of extensive consultation among tribal leaders, the Substance Abuse and Mental Health Services Administration (SAMHSA), Indian Health Service (IHS), and National Indian Health Board (NIHB).


“Tribal leaders and stakeholders provided meaningful and comprehensive input to create the Tribal Behavioral Health Agenda, which will be a valuable tool and resource to address the critical behavioral health needs we see across Indian Country,” said Stacy Bohlen, Executive Director, National Indian Health Board (NIHB). “NIHB is grateful to have served a coordinating role with Tribes in the creation of the TBHA, and we look forward to continuing the work with our communities as they plan and implement TBHA strategies that will work best for them.”


The TBHA honors the trust relationship that the U.S. Government has with federally recognized tribes and reflects effective government-to-government interactions. Tribes have their own creation stories, cultures, traditions, and languages.  The TBHA’s development was based on identifying the unique perspectives of tribes while building strategies based on their shared values and beliefs.  The shared beliefs of balance — spiritual, physical, mental, and emotional — ensured that the resilient practice of culture and other protective factors helped form the TBHA’s priorities.


“The Tribal Behavioral Health Agenda is an exciting next step to advance the emotional, spiritual, and mental well-being of American Indians and Alaska Natives,” said Jacqueline Pata, Executive Director, National Congress of American Indians (NCAI). “NCAI looks forward to collaborating with SAMHSA, IHS, Tribal leaders, and Native youth across Indian Country to advance the goals of the TBHA.”


The collaborative process used to develop the TBHA shows that significant opportunity exists for tribes and tribal organizations, federal agencies, urban Indian health programs, and other interested parties to work together to improve the behavioral health of tribal communities.


“We are very excited and pleased that SAMHSA continues to extend opportunities to partner with urban Native communities through this collaborative effort to help form systems and services to better our communities,” said NCUIH’s Interim Executive Director Alejandro Bermudez-del-Villar.  “This collaboration offers an avenue for NCUIH members and the communities they serve, to share their stories and provide solutions for addressing the challenges facing American Indian and Alaska Natives living in urban areas.”


To access the TBHA visit:

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