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    Indigenous/Native American Mental Health

    Nov 23 2022

    November is Native American Heritage Month. Today, two psychiatrists who have worked with Indigenous peoples join us to talk about the struggles and protective factors associated with Indigenous mental health and how mental health professionals and others can become better advocates for Indigenous/Native American communities.

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    Resources for This Episode

    Mary Hasbah Roessel, M.D., is a Navajo (Diné) psychiatrist from Round Rock, Arizona on the Navajo nation. She is a distinguished life fellow of the American Psychiatric Association and current APA Area 7 Trustee and works in Santa Fe, New Mexico at the Santa Fe Indian Health Center. She received her medical degree at the University of Minnesota in Minneapolis and returned to the southwest to complete her residency in psychiatry at the University of New Mexico. She received an APA/ NIMH Fellowship during her residency and has since worked for 30 years with Indigenous peoples of the southwest, Alaska, and British Columbia. She has special expertise in cultural psychiatry. She grew up on the Navajo reservation with her family and extended Navajo family. Her grandfather Ashihii, was a revered Navajo medicine man. She was the lead facilitator to the Indigenous Cultural competency course working with the American Psychiatric Association’s Division of Diversity and Health Equity. She is a member of the Climate Psychiatry Alliance and APA Caucus on Climate Change and Mental Health. She presented on a panel discussing Missing and Murdered Indigenous Women at the United Nations Commission on the Status of Women in March 2016. She has provided presentations on Indigenous knowledge and climate change and wrote a chapter in the book:Groundswell- Indigenous knowledge and a call to action for climate change, edited by her husband, Joe Neidhardt, M.D., and daughter/artist, Nicole Neidhardt. Her chapter is on Essential Elements of Change, focused on living within two worlds—Indigenous and Western cultures in this climate crisis. She presented at COP26 in Glasgow, in November 2021 with her husband and daughter. The title of their presentation was: Walk In Beauty: Future Dreaming Through Indigenous Knowledges and Western Science. She enjoys spending time with her family hiking and participating in Navajo ceremonies in New Mexico and Arizona.

    Monica Taylor-Desir, M.D., MPH is a Consultant with the Department of Psychiatry and Psychology at the Mayo Clinic in Rochester, MN, where she serves as a community psychiatrist for the Olmsted County Assertive Community Treatment Team and as the co-chair for the Diversity and Inclusion Committee for the Mayo Midwest Department of Psychiatry and Psychology. Prior to joining Mayo Clinic, Dr. Taylor-Desir served as a community psychiatrist for tribal communities for 16 years. Dr. Taylor-Desir graduated from the University Of Cincinnati College Of Medicine. After completing her psychiatry residency and a fellowship in community psychiatry at Emory University, Dr. Taylor-Desir began her career with the Winslow Indian Health Care Center in Winslow, AZ working with a predominantly Navajo population. This work was through her commitment to the National Health Service Corps as a Scholarship recipient. Dr. Taylor-Desir then moved to Phoenix, Arizona to serve the Salt River Pima-Maricopa Indian Community for eight years. She was the first tribally hired psychiatrist and provided outpatient psychiatric care to community members, worked with the crisis team, the Salt River Department of Corrections and the community residential treatment center. She also worked to secure psychiatric care between state and tribal jurisdictions. Dr. Taylor-Desir then moved to New Town, North Dakota to serve the Mandan, Hidatsa, Arikara Nation for three years as their Chief Medical Officer and psychiatrist for the Elbowoods Memorial Health Care Center. She was instrumental in securing SAMHSA grants addressing mental health and substance use in tribal communities. One of her proudest honors is receiving the American Psychiatric Association 2019 Award for Excellence in Service and Advocacy from the Women of the Assembly. Dr. Taylor-Desir also serves as a member of the National Advisory Committee to the National Health Service Corps, where she continues advocacy for and service to tribal and rural communities.

    Transcript for Audio

    Joy Lloyd-Montgomery: Hello and welcome to Mentally Healthy Nation, a podcast from the American Psychiatric Association Foundation. I'm Joy Lloyd-Montgomery.

    Joy Lloyd-Montgomery: November is Native American Heritage Month, and as we approach Thanksgiving, it's fitting that we reflect on the impact that colonization has had on hundreds of tribal communities in the United States. As you sit, drive, or stand on land originally belonging to the indigenous people of this country, I invite you to listen to a conversation between one of our hosts, Christopher Chun-Seeley and two psychiatrists, Dr. Mary Hasbah Roessel and Dr. Monica Taylor-Desir, to learn about the historical impacts of trauma in indigenous communities, the state of mental health for many indigenous people, and how mental health professionals can better care for them.

    Christopher Chun-Seeley: First, I just want to thank both Dr. Roessel and Dr. Taylor-Desir for joining us here for this very crucial and timely conversation about Indigenous Native American mental health. I'd love to start with learning more about the both of you. Dr. Roessel, can you start with us first and share a little bit about your background? What led you to become a psychiatrist and your experience working with Indigenous American communities?

    Dr. Mary Hasbah Roessel: So, ya'ateeh. Mary Hasbah Roessel, [foreign language 00:01:58]. I'm Navajo and was raised primarily on the Navajo reservation. And so, introducing myself in the Navajo way really grounds me in this conversation. And so, for me, growing up on the Navajo nation, it was really important to give back and to share who I am. And then I felt maybe now I feel that I was privileged in my background as a Navajo person because my parents were both educators.

    Dr. Mary Hasbah Roessel: And so, I really wanted to actually be a veterinarian first. But as I got older, I decided with the help of my family to kind of veer me in the direction of medicine. And then part of why I chose psychiatry was that my grandfather is a Navajo medicine, he was a Navajo medicine man. And for the Navajo people, we really look at ourselves in really treating the whole person both in body, mind and spirit and with your environment. And I felt psychiatry really, really does that in a really good way as well.

    Dr. Mary Hasbah Roessel: And also, another mentor that I had was Dr. Karl Menninger, and he came and visited with my grandfather and was good friends with my parents. And so, again, having someone who was a psychiatrist that valued my background as an indigenous person was really important. Because going into medicine, growing up on the Navajo reservation, it was a very extreme cultural shift for me.

    Dr. Mary Hasbah Roessel: And so, having these perspectives being valued at least by one psychiatrist was important for me. And so, that's what my background is and why I wanted to be working with indigenous peoples. And most of my career I have worked with indigenous peoples.

    Christopher Chun-Seeley: Thank you Dr. Roessel for joining us here today. And though I'm sure you would've made an absolutely wonderful veterinarian, very happy to have you in the field of mental health. I will say as someone whose great-grandmother was a social worker without the title and kind of inspired me to become a social worker, I completely understand the story and that connection to that story that you just told. So, thank you for that. Dr. Taylor-Desir, your turn. Tell us a little bit about yourself and what brought you here.

    Dr. Monica Taylor-Desir: Good morning. My name is Dr. Monica Taylor-Desir. I'm a community psychiatrist, meaning I did a fellowship in community psychiatry, which allows me to work with systems from family to schools to communities. I have been working in psychiatry for a while, but I started out working with indigenous communities.

    Dr. Monica Taylor-Desir: So, wanted to be a psychiatrist from about age of 13. I was blessed to have two mentors growing up and role models that were pediatricians, both black females. And as I was growing up, they were saying, "What do you want to be when you grow up?" And I'd say a psychologist. And They're like, "No, no, no, you want to be a doctor. You want to be a psychiatrist." I remember telling them, "No, no. All they do is prescribe medicine. I want to be able to talk to patients."

    Dr. Monica Taylor-Desir: And really enjoyed my training through medical school and the National Health Service Corps paid for medical school. So, that meant when you're finished, you owe some service to an underserved community. And at the time that I came out, there was a list of many placements within the Bureau of Prisons and a lot of tribal communities. So, I thought it would be an adventure. I interviewed at several tribal communities and first started out working at the Winslow Indian Healthcare Center, which served majority of Navajo patients.

    Dr. Monica Taylor-Desir: And so, Navajo communities are very special to me and they really helped form the foundation of my practice being trained in western medicine. Nobody ever said spiritual and mental health is a foundation of health. And then when I started practicing, that's what I was taught and learned, and it was great to be able to experience that.

    Dr. Monica Taylor-Desir: So, I worked with the Navajo community in Winslow for four years, so mostly the southwestern region of the Navajo nation. And then I worked with the Salt River Pima-Maricopa Indian Community for eight years, which is in Scottsdale, Arizona. And then moved to North Dakota to work with Mandan, Hidatsa, Arikara Nation. So, three very different communities and I enjoyed working with each one of them.

    Christopher Chun-Seeley: Thank you Dr. Taylor-Desir, and I'll give an additional introduction to her as well, being a Foundation Board Member and Dr. Roessel also being a Board of Trustee Member for the American Psychiatric Association. So, we do have some really great thought leaders here with not only, I think Dr. Roessel, thank you again for I think your personal experience that you've already shared, but also with Dr. Taylor-Desir with multiple different opportunities to engage with different indigenous communities.

    Christopher Chun-Seeley: And mental health impacts us all. And if any of the listeners for the podcast know, we continue to have these crucial conversations about mental health and how it impacts particular communities. So, Dr. Taylor-Desir, I'm wondering if you can get us started with just talking a little bit about what the mental health landscape is for native and indigenous communities here in the United States.

    Dr. Monica Taylor-Desir: Yes. Definitely, my focus during my practice was very much on suicide prevention. So, when I first started working and I worked in indigenous communities for 16 years, that Native Americans had the highest rate of suicide out of any ethnic population. And really, it was youths and were looking between 11 and age 25.

    Dr. Monica Taylor-Desir: So, really just focused on suicide prevention, partnering with traditional healers, medicine men in the community, and really looking at what are some of the resilience factors for each community and how we can partner to build on those strengths. Because we know the indigenous communities are resilient, they're here. And a lot of times growing up in school, we didn't learn very much about indigenous communities. And even I have some young people in my life that are thinking there are no Indians. It's like there are Native American people that are here. So, really just building on that resilience.

    Dr. Monica Taylor-Desir: What I also saw in terms of mental health issues, a lot of posttraumatic stress disorder, which was really related to historical trauma and also substance use disorders where people were using substances as coping mechanisms. So, those were the three main issues that I saw.

    Christopher Chun-Seeley: Dr. Roessel, is there anything else that you'd like to add around the mental health landscape in particular, are there anything that Dr. Taylor-Desir, you mentioned suicide and substance use, but is there anything else that is prevalent and why have we kind of reached to those prevalence rates today?

    Dr. Mary Hasbah Roessel: I feel what is also prevalent within indigenous communities is this historical trauma response and also just perpetuation of trauma and we inflict it upon ourselves. And also, we are very vulnerable population too. And so, our trauma experience is quite high, particularly with indigenous women. The murder rate for indigenous women is almost seven times higher than the national average. And the missing and murdered indigenous women epidemic that is going on right now too.

    Dr. Mary Hasbah Roessel: And I believe a lot of that is because the history that our country is based on is based on really taking from indigenous peoples. When we were first here and before contact, there were over 25 million indigenous peoples, and now we're only 2% of the population. So you know something occurred during that timeframe and a lot of it was not good.

    Dr. Mary Hasbah Roessel: And I think that that is also why we've been displaced. We've had our children removed from us forcibly without consent to go to boarding schools. And so, that is also another factor because a lot of our family systems and family relationships and transmission of culture were disrupted during that time. And to be removed from your sacred homelands, where much of our knowledges are taken from is really a traumatic experience. And so, I believe that that is really what we are left with here.

    Dr. Mary Hasbah Roessel: And so, when we talk about high rates of suicide, high rates of substance use disorders and high rates of the trauma that is inflicted upon us, we have been a very oppressed people. And so, that is what I think a lot of people that are working with indigenous people and want to work with indigenous people need to understand and educate themselves on. Because if you don't really know the accurate history of our country, and you look at indigenous peoples that are like at the border towns around the Navajo nation and you see a very vulnerable broken down people in some ways, if that's your lens that you're looking at.

    Dr. Mary Hasbah Roessel: But really look further into our culture and how it's still vibrant and how we are still here and resilient and there is resurgence movements going on, then you realize, okay, you got to put all the pieces together and not just look at one part of what is happening in our country, and be really open to that, especially if you want to work within indigenous communities. So, because there are so many beautiful parts of us and yet historically, you do need to understand that as well.

    Dr. Monica Taylor-Desir: And I think you don't really understand the impact of historical trauma until you were, I think, immersed in the community and really working side by side with community members. And I say this, I'm going to say maybe over 20 something years ago when I first started working with Navajo, straight out of training, not having any focus on the mental health issues in Native American peoples while I was in training. And then sort of knowing a little bit about historical trauma relating it to Black and African American community, which at that point, I didn't really understand the impact.

    Dr. Monica Taylor-Desir: But I was very welcomed into my workplace, a Native American community, and they involved me in some of the ceremonies. And so, I had an opportunity to participate in Kinaalda, which was a puberty ceremony for a young girl in the Navajo community. And I thought it was just wonderful that the whole community would come together, the whole family would come together to celebrate womanhood for this young person.

    Dr. Monica Taylor-Desir: And I remember asking her mother what her Kinaalda was like. And she said she didn't have one. I was thinking, "Well, how are we doing this ceremony? I thought it was traditional from generation to generation." And she told me, "Well, I was in a boarding school and I couldn't have one." And she couldn't speak the language. And just thinking about how she couldn't celebrate that milestone because she was afraid when you go back to school, the boarding schools, that they would be punished for that, for celebrating something that is so important in communities.

    Dr. Monica Taylor-Desir: So, really just thinking about the impact of not having your language, not having those ceremonies and those milestones celebrated. And really, the other thing I would think about is looking at family role models. So, sort of the whole family structure was just destroyed, taking the children away and putting them into institutions. And that's been a ripple effect across generations.

    Christopher Chun-Seeley: I think for our listeners, I hope this is a very sobering conversation to start out with, because I think, one, I was aware of the epidemic of missing and murdered indigenous women, but I did not know the statistical significance of indigenous women being murdered at a rate seven times higher. And I just wanted to repeat that because I think that is significant and I just wanted to say that again for our listeners so that they understand that that is a fact and we want to share that.

    Christopher Chun-Seeley: I also just want to mention that I think the removal of individuals that are key to the family and then the erasure of culture is something that this country is very good at and something that we, from a historical context, I think from people who want to be healers in their community, whether that's mental health professionals or practitioners or providers of any service need to understand that historical context and what that means.

    Christopher Chun-Seeley: And I think to the point shared what it means to partner with the community, what it means to be invited into that community and I would offer something for people who are training directors or those overseeing individuals who are going to be the next line of mental health professionals is a little activity that I got to do was just asking your trainees, graduate students, whatever they may be, to sit down and ask them for the first three words that come to mind about a particular community and see whether or not those are negative or positive, and why do we always associate certain negative terms with certain communities and don't think about the positive side of things.

    Christopher Chun-Seeley: And I think that's because of the lack of knowledge and insight and commitment to understanding communities that we work with. So, I just wanted to mention the resiliency and the closeness to family and the support systems that are engaged and involved and all these other positive things that we don't necessarily come to mind in the general population when we think about indigenous communities.

    Christopher Chun-Seeley: Dr. Roessel, I'm wondering if you can share your experience with the perception of mental health issues and treatment in indigenous American communities. I think we've touched a little bit on the historical context of where we're at with the landscape, but in particular for the Navajo nation.

    Dr. Mary Hasbah Roessel: So, for the Navajo, like I said, partly why I wanted to go into psychiatry in the medical field was I did see us as being more of a holistic provider in medical care. We paid attention to the social issues, the spiritual issues, and also the personal body, mind and spirit. And I felt like, "Okay, I can go with that and I can integrate that and utilize my own knowledges as an indigenous Navajo person."

    Dr. Mary Hasbah Roessel: And I think what Navajo, what the shared commonality there in terms of a place to start, and again, as a person coming in working with the Navajo, I think it's being open and having an open mind. But really for us, our foundation is being in harmony with the world and being in harmony with ourselves, which is partly related to having positive thinking, having a positive outlook, and then always being centered and mindful and integrated into the present day.

    Dr. Mary Hasbah Roessel: And so, those concepts and foundations for us are part of what we do when we're a really good psychiatrist and you utilize the resources that we have and what we're taught. And so, I think having that awareness that this culture has some things to offer is really valuable.

    Dr. Mary Hasbah Roessel: And so then for the Navajo to have say the Indian Health Service in the community providing most of the care for the Navajo at first it's off-putting because of the historical issues that have occurred for us. And a government, we were in the Department of War and the government way back when they were trying to figure out what to do with us, but then now we're the Department of Human Services. And so, it's a little bit tricky in terms of how we perceive the government and how we're to receive services from a governmental agency.

    Dr. Mary Hasbah Roessel: So, those are the things even though I did and have primarily worked with the Indian Health Service in my career up in Shiprock for five years and also up in Alaska, which was actually a tribal program. And then now here in Santa Fe, New Mexico and Albuquerque. And those are the places that I've primarily worked and they were mostly Indian Health Service places.

    Dr. Mary Hasbah Roessel: So, I have that awareness that there is going to be some mistrust around accessing care in that way. But also, what's happening in indigenous and especially in the Navajo area is that the Navajo are starting to create their own ways of providing mental health services that is integrated with more traditional counselors and integrating them into their programs.

    Dr. Mary Hasbah Roessel: And then also for us, when we were providing services, particularly up on the Navajo nation, we utilize the Navajo therapists that we had there to develop what they wanted to do, what they felt were important programs to implement in the area because they were from the area.

    Dr. Mary Hasbah Roessel: And so, that's how we were able to again, break down more barriers. They were Navajo speaking counselors and therapists. We were providing community-based programming like clubhouses within our community. And that was more welcome with utilizing Navajo concepts and things like that. And then, youth programming as well and school programs.

    Dr. Mary Hasbah Roessel: And so, I think the perceptions improve when you're utilizing the resources around you and recognizing there's value. But still, there still would be Navajo people, even people here in Santa Fe. It is not something that you want to share in terms of your own cultural background. For a Pueblo person, this is where I work primarily with Pueblo people.

    Dr. Mary Hasbah Roessel: And so, again, you have to know the people that you're working with, understand what their differences are. We talk about all these different tribes and I know we'll go into that later. So, it wouldn't be something here that I'm bringing in a medicine person because that's going to be more of a taboo thing, it's separate.

    Dr. Mary Hasbah Roessel: But you just have to understand that in terms of the perceptions for indigenous peoples, we can break down those barriers as long as we're working within our communities and utilizing the knowledge carriers and the traditional healers to help with providing that care, and shifting our approaches and utilizing the hózhó model, which is being in harmony, the hózhó náhásdlíí, walking in beauty. Those are beautiful concepts that we can as mental health professionals really say that this makes so much sense. This is why I wanted to be in medicine so that I can really get to those concepts and helping people and see it in a more beautiful way.

    Dr. Mary Hasbah Roessel: And so, I think that that's kind of where I think we have common ground. And so, that we reduce the misconceptions around accessing mental healthcare with indigenous peoples.

    Dr. Monica Taylor-Desir: And I think also when you're coming from outside of the community, and again, I just found the Navajo community so welcoming, but it's also approaching it and we talk about cultural humility, really just wanting to learn from the people who are already there and understanding what their practices are and what they find strength in, what they find hope in, what their understanding is of mental illness and why things happen.

    Dr. Monica Taylor-Desir: I think one of the challenges that for both the Navajo community and when I was working in North Dakota is that often we had to send our patients so far away to get care. If they needed to be hospitalized, when I was working in Winslow, we'd first try Flagstaff, which was an hour away. And then we'd try Phoenix, which was another two hours. And then, we tried Tucson, which is two more hours down the road, or sometimes we'd have to fly them over to Albuquerque.

    Dr. Monica Taylor-Desir: And so, when you think about getting care or getting inpatient hospitalization and then your social network, now this was the time before Zoom, nobody can imagine that now, before Zoom and all of this in FaceTime, it was really, I also thought about what was the impact of sending family members away for care and then having them reintegrate back into the community.

    Dr. Monica Taylor-Desir: But it's really important to partner with the leaders in the community, which aren't always the elected leaders. And they're usually who is that voice of wisdom in the community. And I think my other advice would be you can't run ahead of your community.

    Dr. Monica Taylor-Desir: So, as much as in different places where you've worked where we're going to come in and large institutions, they want to give grant funding or they want to give funds and then they want to say, "This is what we are doing." But you really need to find out what the community wants, what they identify as their needs and walk with them but not run ahead of them.

    Christopher Chun-Seeley: One of my favorite TED Talks is, I think it's titled Shut Up and Listen. And it's all about not just listening to the community, but it's doing just that. It's like you might think that your ideas and the way that things have worked for you are going to work for this community, but if you don't understand all of the different nuances and hey, I don't want to give away the TED Talk, but it's basically hippos came and that's where they feed. So, why would you build a garden there? We knew that that's where the hippos came to feed. If you would've asked us, we would've told you to build it up there.

    Christopher Chun-Seeley: But that communication line or that ability to just engage in conversations and not just listen. But I think Dr. Roessel, you also talked about implementing what was said. It's not just sitting and listening to these communities, it's also implementing what they're asking for. I love the walking in beauty.

    Christopher Chun-Seeley: I think being in harmony with the world and with yourself, you're right, it speaks to me as a social worker. It speaks to me as a mental health practitioner. It speaks to what I hope to produce for the communities that we're working with because we know that when the world is tumultuous outside, you can't be in harmony with yourself because you're so worried about everything else. And when you're worried about yourself, you can't be in harmony with the world outside.

    Christopher Chun-Seeley: And we have to take care of all of those pieces and making sure that you are bringing that cultural humility and that culturally competent care, like speaking the Navajo language or the language of that community with those practitioners and integrating that care with traditional counselors I think is really important.

    Christopher Chun-Seeley: I want to touch on Dr. Taylor-Desir, the concept of being strength-based and hope-based and really focusing on that to begin with and not the negatives or the pitfalls, trying to find what those strengths are and what those points of resiliency are. And then thinking more broadly about that access to care.

    Christopher Chun-Seeley: I kind of wrote down when you were sharing that it's the farther away you get from that community, the less likely you are to receive culturally competent care. When you remove that support system, you lose a protective factor for what we know is engagement in these support services. So, I think these are all really good things for mental health professionals to think about when they're thinking about providing care across multiple different communities.

    Christopher Chun-Seeley: As Dr. Roessel kind of talked about, there's so many different communities, about 574 recognized native tribes across the country. There must be a huge amount of diversity among indigenous communities in the US and how is that factored into the care that you delivered on as well as the training that we have to think about for the next generation of mental health practitioners.

    Dr. Monica Taylor-Desir: And I just want to say, it's 574 federally recognized native tribes. There are some state tribes that are recognized and then there are tribes that haven't gotten there recognition. So, there's more than just 574. We just have those are the federally recognized tribes.

    Dr. Monica Taylor-Desir: Again, it's sort of just, I think something I try to emphasize, especially as teaching trainees and colleagues, when we talk about indigenous mental health or Native American mental health, it's not a one size fits all. And you do have to think these are 574 nations. So, they have their own cultures which are beautiful, their own languages, their own court systems and health systems. And those are things you take every community individually. So, I worked four years with Navajo Nation and they with the Winslow Indian Healthcare Center, so the Navajo community, and really they provided a great foundation for me.

    Dr. Monica Taylor-Desir: But when I went to Salt River at Pima-Maricopa Indian community, it was again starting over, finding out what the traditions are, what the culture was. I was so used to hearing Navajo spoken all the time. It was just natural to hear that and to see people, especially older women and traditional dress.

    Dr. Monica Taylor-Desir: And then I started working in Scottsdale, Arizona, which is suburban urban, and I didn't hear the native language as spoken for almost two years until I got to work with an elder member of the community. So, you think about what is different in their traditional practices or spiritual practices when they're speaking their language, what is important to them. And that was different. And so, when I worked in North Dakota, they do sun dancing, which Navajos did not do or Hopi tradition did not do. And so, there's always a different culture and you learn that. But I think also in terms of teaching our mental health professionals and our trainees, if you are able to bring in someone from the community that can really speak to the experience and the culture and the history, I think that's the best thing to do to bring in the person with lived experience, and also to talk about just histories of institutions where we practice.

    Dr. Monica Taylor-Desir: So, I have been able to work with my trainees and bring in Dr. Valerie Guimaraes, who is a doctorate level nurse practitioner, and she serves as a Native American ambassador for our clinic. And she was able to talk with our residents about some of the history of our clinic and the history of the Native American population in the communities.

    Dr. Monica Taylor-Desir: And I think that's important because we're now moving more towards land acknowledgements and it should just be more than just acknowledging who was there before, but also really trying to understand that culture.

    Christopher Chun-Seeley: Well, Dr. Roessel, do you want to add anything before... I was just going to correct myself and say, I mentioned earlier the removal and the erasure and federally recognized, I think is a really nice point. Dr. Taylor-Desir to make is federally recognized is very different than the total number of communities that are out there. So, I think that's a very great distinction. Dr. Roessel.

    Dr. Mary Hasbah Roessel: Yeah. I think speaking to that, indigenous peoples, we were given a certificate of Indian blood number and it's based on one of the tribe to decide what blood quantum, so to speak, because we got kind of brainwashed into this to say and fight among ourselves because that's what the government wants us to do in terms of saying, "Okay, I'm one quarter at Navajo, one half Navajo and one quarter makes me a Navajo or less than that doesn't make me a Navajo." And that's the government telling us who we are basically.

    Dr. Mary Hasbah Roessel: But again, individually, we're so diverse. And so, unfortunately, within the federal government system and where I work, you do have to have a certificate of Indian blood to be able to be seen here. But in tribal communities, anybody can come in and be seen in those tribally run mental health centers and hospitals. So, that I know is just more of an issue these days in terms of when you're working with people, indigenous peoples in the communities, especially probably back east because that's where many of first contact, a lot of the peoples were lost there and they are state recognized trying to get federal recognition because that's what the government requires at this point in time.

    Dr. Mary Hasbah Roessel: But I think there is a movement saying we really need to move away from blood quantum and the attachment to your community, having ancestors that you can relate to and be connected to in your community is really what is a foundation for being an indigenous person in that community.

    Dr. Mary Hasbah Roessel: And the diversity too is such that again, knowing your history, where you're going to work, who you're going to work with there is important because you need to know, okay, here, that we were warring tribes. The Navajo, we're pretty good at being raiders and things like that, but we created clans for the people that we brought into our communities like a Mexican clan, a Pueblo clan, and things like that.

    Dr. Mary Hasbah Roessel: So, it's important to understand when you're working and speaking, not to get too comfortable with one person's perspective, but again, be open to how they perceive themselves in relationship to other tribes because we were at odds against ourselves either and have had maybe still continue to have difficult relationships with some of the tribes.

    Dr. Mary Hasbah Roessel: And that's all part of as you get to know your patients, understanding where they're coming from, what their backgrounds are, not being judgmental, but really just helping them to find their way and how they have an identity for themselves. Because that's the most important thing really too, again, with our work is helping us to feel good about our identities and support that and not have a judgment around the government assigning us a CIB number and things like that.

    Dr. Mary Hasbah Roessel: And then, why some people chose not to get enrolled because of the perceptions and relationships with the government structures or again, families being stolen and taken away from their home communities and not having that opportunity to have that certificate of Indian blood. Some, then feeling like they are not connected. And those are the things of diversity that I think that we really need to recognize and understand and be open to with working with in indigenous peoples.

    Christopher Chun-Seeley: Hey, I just want to highlight again some things that both Dr. Roessel and Dr. Taylor-Desir mentioned here. One size doesn't fit all. And I think we need to challenge ourselves as mental health professionals and as communities to go deeper than just maybe a performative land acknowledgement and more of a understanding of what that community was and still is in that particular area, in that there are differences even within the Navajo community and what does that mean for even these particular differences in communities and some of those historical contexts can really inform the way in which you approach delivering competent cultural care.

    Christopher Chun-Seeley: And we've talked a little bit about this, but I want to touch on, we've talked about the positives. Let's not harp so much on, what are those protective factors that indigenous communities and indigenous and Native American peoples bring to the table that we often overlook as mental health practitioners or community members?

    Dr. Monica Taylor-Desir: One thing I really like to look at is definitely spiritual practices, cultural practices, the family structure, which is not always what we think is maybe a western nuclear structure of mom, dad, brother, sister. There are a lot of what I say, kinship relationships or a lot of grandparents raising grandchildren. And that is a strength.

    Dr. Monica Taylor-Desir: I always like to say, what are the things that have gotten you to this point? Because there are always some resilience factors that we often overlook. I know we have gotten to use resilience so, so much now. But at least when I was practicing, the word wasn't so common when I was in that community. But just definitely looking at some of the resilience factors. Dr. Roessel?

    Dr. Mary Hasbah Roessel: I think that understanding and seeing that our worldview is not just with an individual. We are collectively in nature. We are part of nature. We want to be in harmony with nature. We want to be in harmony with ourselves and with the people around us, with our relationships.

    Dr. Mary Hasbah Roessel: And so, what indigenous peoples I think now are really striving for is to reclaim their culture, their language, identity, lands if possible. The LANDBACK movement is really important right now because our land was stolen from us and we really recognize that that was a significant impact on how we were able to develop and evolve and continue and perpetuate our own cultures and spirituality and language of course, and our laws, which the laws are in the land for us. And so, protectively, we are still here. And so that we have been able to adapt and be resilient.

    Dr. Mary Hasbah Roessel: And so, I think that that is part of what's protective is that our adaptability to be able to live in these different worlds. I was able to adapt to be in the culture of medicine and I still didn't lose my identity. I still seek out people who help support me and are there to help me to be the person that I am.

    Dr. Mary Hasbah Roessel: And so, I think protectively, having that self-identity and then having the spiritual grounding and understanding where that came from is so valuable. And also, the recognition, again, elders are very valuable. The youth are very valuable. You learn from both, from all those generations particularly. And so, there's a lot of respect for your knowledge keepers because they were the ones too, and our ancestors who helped us get to where we are today.

    Dr. Mary Hasbah Roessel: But I really feel that we're reclaiming a lot of these protective factors that may have been not so evident, but we're understanding that that has what sustained us continuing with our spiritual practices and regaining all of that. I feel that that's where the indigenous peoples are moving towards.

    Christopher Chun-Seeley: And so, how do we, outside of maybe assigning trainees and others to listen to this podcast, what other things can we make sure that the next generation of psychiatrists and other mental health professionals learn about spiritual practices and traditions to be aware of when they are treating members of the indigenous community? And I guess, what recommendations do you have out there for mental health professionals as well to improve the care they deliver to these community members?

    Dr. Mary Hasbah Roessel: Well, I think part of that is having our own indigenous peoples being in these spaces because you're not going to have issues around cultural appropriation and things like that. And you need to access this knowledge from appropriate indigenous peoples that can share that knowledge and give you permission to utilize some of these knowledges in your practice and things like that.

    Dr. Mary Hasbah Roessel: I know just an example of how fellowships have been very valuable within the APA and how it helped develop some departments within here at University of New Mexico, for myself, I felt that it was something, again, if we get more indigenous youth and indigenous trainees, there's so many possibilities. But for instance, with me, I received an APA NIMH fellowship when I was a resident at the University of New Mexico there in the Department of Psychiatry. And I was able to get it for a couple of years.

    Dr. Mary Hasbah Roessel: And so, what I did was develop an office of Native American psychiatry. And with that money was able, with the help of my family, of course, we had culture camps up on the Navajo Nation, up on the mountain just across from where I'm from and Round Rock on the Lukachukai Mountains up there where our sheep camp was.

    Dr. Mary Hasbah Roessel: And so, we created these camps in the summertime for just a weekend, fed people traditional indigenous food, our local foods, and also immerse them into our culture and the language and the perception that, again, stop talking, you're coming here. You're going to have to listen to us in Navajo and you're going to listen to this conversation in Navajo for 30 minutes, then that's okay because we'll interpret it for you. It was really a telling experience where some people were so impatient. Why aren't you interpreting this? Why do I have to listen to Navajo all the time? Why can't I ask a question in the middle of an elder telling me a story?

    Dr. Mary Hasbah Roessel: And so, you realize, okay, "Hey, this is the way I am back in my world and here I am trying to be a part of another person's world and I really can't get there." But we told people about and educated them around Navajo ceremonies, Navajo perceptions around healing, the hózhó, the hózhó náhásdlíí, being in harmony. And so, that's what we were able to do.

    Dr. Mary Hasbah Roessel: And I think we had about nine years of that. We just kind of kept it going and it was really valuable, because people from Indian Health Service came. Doctors, they would always come up to me later and say, that was such a valuable experience to be able to go and have that immersive experience with the Navajo in that way and help me to be a better doctor with my patients.

    Dr. Mary Hasbah Roessel: I had this really a better understanding of the world view of the Navajo and how we are in the world and have an expectation of a patient has to behave in a certain way when you're in my clinic. And if you don't behave that way, there's something wrong with us. But culturally, there was something different around us and there was nothing wrong with us. And we also brought in medicine men too, the Department of Psychiatry and gave presentations.

    Dr. Mary Hasbah Roessel: And so, that is what a fellowship was able to accomplish. And so, when we're able to have trainees that say are indigenous or have a specific interest and say indigenous ways of knowing, indigenous culture and things like that and how to be a better provider, those are opportunities. I mean, even just small little things not being so insular, but to allow these opportunities for, if you're having a division of diversity and health equity within your university settings, there is an opportunity for that.

    Dr. Mary Hasbah Roessel: Bring in medicine people, bring in knowledge carriers to speak about these differences and how we approach our mental healthcare. And I did that up in Colorado yesterday, University of Colorado. I gave a talk around indigenous knowledges and how it can be a way forward in climate change. And so, it's really valuable.

    Dr. Mary Hasbah Roessel: And the other thing is there are resources out there if you just want to read it for, well, this is the culture card and that is through SAMHSA. It's a quick read to ground you or make you understand, oh wow, there's a lot to know about indigenous peoples. Sometimes Indian Health Service conferences will have these. Sometimes the Indian Health Board will have trainings and ways to educate mental health professionals around specific issues.

    Dr. Mary Hasbah Roessel: And so, bringing that in, and as a university, I think it's your obligation really in some ways to have relationships with your local tribal communities, not just for research purposes, but to serve the community around you because these are many of these are land grant institutions and that's what they're supposed to be doing.

    Dr. Mary Hasbah Roessel: And so, then understanding that too and being able to leverage maybe as a trainee, as a faculty member that this is what we need to be doing more into in the community, being out there, letting them know what we have, how you can help people be in partnership with us too, because this is what we need to be doing more of. And sometimes we don't see that we have roles like that to play, especially as mental health professionals, especially if we don't think that we're getting the education that we need to be getting, how are we able to do that.

    Dr. Monica Taylor-Desir: I was going to say those are such good examples. I think when we look at just some training opportunities, I like the way you described it, more of a cultural exchange. And okay, COVID put a stop to some of that, where we couldn't go and visit and really immerse ourselves.

    Dr. Monica Taylor-Desir: But I definitely would say if there are opportunities to go into communities and learn from tribal communities, just learn, and not talk, just learn, that would be a good opportunity. But I also think about as we're talking about Native American mental health and just how we tend to do better with providers that look like us. So, I was going to say, now everyone don't run out and say, "Okay, I have to find a Native American psychiatrist." Because we are still working on that. And if you haven't heard the numbers of things, Native American psychiatrists are like 0.2% of psychiatrists in the United States.

    Dr. Monica Taylor-Desir: So, how do we get our young ones to really look into going into mental health? And so, we think about some programs, high school programs where you start talking about health and college mentoring programs and where they have some of that for Native American college students, just thinking about going into medicine, but also being mentors. And Dr. Roessel, I like how you mentioned the APA fellowships. As a Foundation member, I love the APA fellowships. So, how they can provide great mentorship and opportunities.

    Dr. Monica Taylor-Desir: But I really think in terms of learning from each other, bringing in people from the community and not just limiting it to what we in western medicine may be seeing, "Okay, where's the Native American psychiatrist." Also think about the medicine may have, also think about the traditional healer, also think about the elder and the community that has that wisdom. So, those are some items I wanted to share.

    Dr. Monica Taylor-Desir: And I also have a couple of resources. I'm really proud of a toolkit that I worked on with colleagues through the Robert Wood Johnson Foundation. My colleagues in North Dakota and I were able to put together a toolkit for suicide prevention and mental health promotion in tribal communities.

    Dr. Monica Taylor-Desir: And that was Dr. Leolani Ah Quin, Dr. Anita Martin and Kelly McGrady, who is a nurse and community member and wonderful person with lived experience. So, we work to put that toolkit together. And you can find that on the Clinical Scholars website, which is clinicalscholars, NLI, like National Leadership Institute. So, it's I'm also a person that likes to be on social media, so I love looking at We R Native and their handle is @WeRNative or Healthy Native Youth and also the Center for Native American Youth. They have really good resources for mental health.

    Christopher Chun-Seeley: Thank you so much for sharing all of those resources. Dr. Roessel mentioned the SAMHSA culture card, this toolkit, Dr. Taylor-Desir, what we'll make sure is we will link to this at our podcast page, so for our listeners, we'll make sure you have easy access, and make sure you'll go give those social media pages a follow as well.

    Christopher Chun-Seeley: So, we're having this conversation and that's all well and good, but issues facing indigenous communities are often overlooked on the national stage. Dr. Taylor-Desir, you shared a little bit about suicide prevention and the alarming rate of youth suicides. Dr. Roessel, you brought to light that indigenous women are murdered at a rate seven times higher. These aren't things that are probably in the public know. So, what suggestions do you have for bringing more intention and more action to issues facing indigenous communities?

    Dr. Mary Hasbah Roessel: Well, I think that there are going to be ongoing issues around our climate and climate change. And so, that's another really important issue with indigenous communities, because land is so important to us and we've lost so much of our lands. But we know how to care for the land. We know how to be in relationship to the land. But yet I think indigenous peoples will be a way forward. And so, in terms of understanding and looking at climate change, indigenous knowledges are going to be a way forward as we go into this crisis.

    Dr. Mary Hasbah Roessel: And so, what can be valuable is knowing in your area what is important for your indigenous community, what are the issues that the indigenous peoples are facing and really feel are important? And that's what I find even here. There's a lot of indigenous activism going on as well. And you need to support, again, and be an ally for indigenous peoples in what we feel are the issues that are important to us today. And a lot of that is dealing with the climate, helping Mother Earth be healed and that type of thing.

    Dr. Mary Hasbah Roessel: And because that is all part of our mental health, if that's part of being out of balance, if we don't have the harmony with nature and the land around us. And so, then being an ally as a privileged person, that's kind of where you come from. You have privilege there as an ally.

    Dr. Mary Hasbah Roessel: And so then you put forward these issues and recognize, "Wow, this leader over here in my community is speaking really wonderful things around reclaiming the indigenous gardens or helping," because that's all part of, again, the mental health, being a part of the youth and getting communities and families together and get this knowledge dispersed out there.

    Dr. Mary Hasbah Roessel: So, I think part of being a psychiatrist, a mental health worker in a community where you are among indigenous peoples is to be supporting and elevating and helping get this knowledges and really help the people that you're sitting there in front of to feel confident and validated for the work that they want to be doing as an indigenous person.

    Dr. Mary Hasbah Roessel: Because a lot of the time, we don't get that validation because we are perceived as being invisible and we don't matter because we're such a small population. But yet, as I said, I feel what is on the national stage is climate, the climate change and indigenous knowledges are going to be a way forward for that.

    Dr. Mary Hasbah Roessel: And myself, my husband, my daughter, we've really worked in that field and a resource that is out there is the book that my husband, Joe Neidhardt and our daughter, Nicole Neidhardt, put out, which is Groundswell Indigenous Knowledges and a Call to Action for Climate Change and looking at all the voices. And it's a perception from a psychiatrist. So, it's really helpful. And there's a documentary that's attached to that. And if you go to is all the resources there and how to access the book and how to rent the documentary.

    Dr. Mary Hasbah Roessel: And One Sky Center is a resource that I think is very valuable. It was founded by Dr. Dale Walker, a Cherokee psychiatrist. And the center provides resources to understand what the health disparities of indigenous peoples are and also resources for how to access some of that information and how to create an evidence-based program working with indigenous peoples. And as well it provides access to mentorships between native peoples. Its website is And so, I think again that that's part of what is going on in the world right now.

    Dr. Mary Hasbah Roessel: And then also, in terms of the missing and murdered indigenous women and our relatives epidemic, it is always being aware. It is part of that, even the human trafficking that's out there. We don't look for these signs in terms of who's being abused, recognizing in your community that there's people that are missing. We don't know where one of my patients when I don't know what happened to her.

    Dr. Mary Hasbah Roessel: And so then being a part and being proactive and, okay, let's figure out what's going on here. Let's help our family member be validated and be heard that this is an issue and this relative needs to be found. Because a lot of the times we just, again, we turn it off, "Oh, go tell the police and they'll find her." That's not the way it is. We found out in Canada, there were so many cold cases and the RCMP was not following up on these cases and there were so many missing and murdered indigenous relatives and they figured out the cases were really very high.

    Dr. Mary Hasbah Roessel: And so, that's what we need to be doing. And on a national stage, Deb Haaland is our secretary of the Department of Interior, who's Laguna and she's putting issues to light in our country, which I feel really again validated and happy that somebody on a national level is doing that, speaking to the missing and murdered Indigenous women's registry and speaking to climate change and speaking to other issues that are really important to us because often our issues are never on the national stage usually, but yet she's putting these issues forward for us to really speak to.

    Dr. Mary Hasbah Roessel: And so, we just need to be good allies, help your indigenous relatives, patients, community members to have that voice, share their voice, repeat what you know is important that they're trying to share and get out there, because we are so often just kind of in the background, but yet as an ally you can really do so much more to help get these issues on a national level and even in a community level where you live.

    Dr. Monica Taylor-Desir: I would agree. I really like how you said being an ally. And the other thing is really, my other word is advocating. So, I think we often forget as psychiatrists the position of power you have. So, you might be invited to be on committees, on councils, at a roundtable, a governor's roundtable. And sometimes, I'm going to say if you bring up issues related to indigenous health, Native American mental health, they may not hear you the first time or the second time.

    Dr. Monica Taylor-Desir: So, a lot of times, and I'm laughing because I would have to say things over and over and over again in Arizona and North Dakota, but don't get tired of advocating for your community. Be an ally. Learn what the issues are. And I think any opportunity you have to even influence the curriculum at your institution, a curriculum for learners to bring forward a presentation at a conference or to be on a panel, those are places where you can continue to advocate for mental health of Native American communities.

    Christopher Chun-Seeley: Well, I think you have given our listeners a lot to think about today and a lot to hopefully enact in their own practices, even as simple as looking up what tribal communities you actually are living on with the land that they still are deserved.

    Christopher Chun-Seeley: And I think for us as community members and for those of us who are mental health professionals listening, I think it's really important to emphasize that if we want to be able to obtain, to be able to walking in beauty and to be in harmony with the world, we need to understand that the world outside of us and what is happening, who is a part of that world and a part of those communities and the impact and historical context of that, but also how that impacts ourselves and how we show up into rooms, I think to Dr. Taylor-Desir's point and how we are that ally so that we are bringing the right people to the table, so that we are listening to the community and then implementing what the community needs, so that we are emphasizing and focusing in on the strength and the hope of that community.

    Christopher Chun-Seeley: And that we are also not limiting ourselves to just how the federal government federally recognizes tribal communities and expand our thoughts outside of just what the government allows us to see as federally recognized and to make sure that we are using the tools at our disposal, whether that's fellowships and the experiences that we can create, like the cultural camps to make sure that we are doing what we can do to be the best ally and advocate for community members who are indigenous and come from tribal or native communities and are needing us to address the ways in which from a historical context, they have been removed and their culture has been erased and the trauma that needs to be addressed there.

    Christopher Chun-Seeley: And I think there's a lot of work to be done and want to make sure that we are continuing to do the work as the APA Foundation to address these things.

    Christopher Chun-Seeley: So, I do just want to thank both Dr. Monica Taylor-Desir and Dr. Mary Roessel. And I've said a lot, I've tried to encompass everything that we've said in this very long discussion into a very neat box, but I do want to pass the baton or the mic over to each of you to close us out and give us the final words as our guest for this episode. And we'll start with Dr. Taylor-Desir, and then we'll end with Dr. Roessel.

    Dr. Monica Taylor-Desir: Great. Well, thank you. I think I always like to just encourage people working with tribal communities to start with recognizing strengths and building on strengths, and also just to be a good ally and advocate.

    Dr. Mary Hasbah Roessel: I think what is so important and it's so simple, is to just approach the person, the community that you're working with in terms of where they're coming from and then go from there. Because if you're not listening and not centering that encounter with where that person is coming from and what they want to get out of, say the conversation with you or the therapeutic relationship with you, then you're not really going to be helpful to them and really won't be able to engage. And so, I think that that's so important is again, a lot of it involves stop talking and listening and centering yourself with a person that you're with.

    Joy Lloyd-Montgomery: Dr. Mary Hasbah Roessel is the Navajo psychiatrist from Round Rock Arizona on the Navajo Nation. She's a distinguished life fellow of the American Psychiatric Association and current APA Area 7 Trustee and works in Santa Fe, New Mexico at the Santa Fe Indian Health Center.

    Joy Lloyd-Montgomery: Dr. Hasbah Roessel received her medical degree at the University of Minnesota in Minneapolis and returned to the southwest to complete her residency in psychiatry at the University of New Mexico. She has a special expertise in cultural psychiatry and has worked for 30 years with indigenous peoples of the southwest, Alaska and British Columbia.

    Joy Lloyd-Montgomery: She grew up on the Navajo Reservation with her family, an extended Navajo family. And her grandfather was a revered Navajo medicine man. Dr. Hasbah Roessel was a lead facilitator to the indigenous cultural competency course working with the American Psychiatric Association's Division of Diversity and Health Equity, and she presented on a panel discussing missing and murdered indigenous women at the United Nations Commission on the status of women in March, 2016. Dr. Hasbah Roessel is also a member of the Climate Psychiatry Alliance and APA Caucus on Climate Change and Mental Health.

    Joy Lloyd-Montgomery: Dr. Monica Taylor-Desir is a consultant with the Department of Psychiatry and Psychology at the Mayo Clinic in Rochester, Minnesota, where she serves as a community psychiatrist for the Olmsted County Assertive Community Treatment Team and as the co-chair for the Diversity and Inclusion Committee for the Mayo Midwest Department of Psychiatry and Psychology.

    Joy Lloyd-Montgomery: Prior to joining Mayo Clinic, Dr. Taylor-Desir served as a community psychiatrist for tribal communities for 16 years. Dr. Taylor-Desir graduated from the University of Cincinnati College of Medicine. After completing her psychiatry residency in a fellowship in community psychiatry at Emory University, Dr. Taylor-Desir began her career with the Winslow Indian Healthcare Center in Winslow, Arizona, working with a predominantly Navajo population.

    Joy Lloyd-Montgomery: Dr. Taylor-Desir then moved to Phoenix, Arizona to serve the Salt River Pima-Maricopa Indian Community for eight years. She was the first tribally hired psychiatrist and provided outpatient psychiatric care to community members, worked with the crisis team, the Salt River Department of Corrections and the Community Residential Treatment Center. She also worked to secure psychiatric care between state and tribal jurisdictions.

    Joy Lloyd-Montgomery: Dr. Taylor-Desir then moved to Newtown, North Dakota to serve the Mandan, Hidatsa, Arikara Nation for three years as their chief medical officer and psychiatrist for the Elbowoods Memorial Healthcare Center. She was also instrumental in securing SAMHSA grants, addressing mental health and substance use in tribal communities. Thank you to our esteemed guests, Dr. Mary Hasbah Roessel and Dr. Monica Taylor-Desir. And thank you to our audience for listening. To learn more about indigenous mental health, please check out the links in the description of this episode. For more information about the APA Foundation, you can visit

    Joy Lloyd-Montgomery: If you learned something today or this episode resonated with you, please consider sharing it with a friend, family member, or colleague. I'm Joy Lloyd-Montgomery. Take care. We wish you well.

    Christopher Chun-Seeley: The views and opinions expressed in this podcast are those of the individual speakers in their personal capacity only, and do not necessarily represent the views of the American Psychiatric Association Foundation or the views, official policy or position of the institutions and organizations with which the speakers are affiliated.

    Christopher Chun-Seeley: The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.