Throughout American history, the United States government, despite well-documented treaties, has unjustly treated Native Americans. Treaties ratified in 1851 and 1868 were violated during the COVID-19 pandemic national emergency, which may be surprising to people who believe that the failure to uphold such legal documents is an outdated issue.
As noted by the Substance Abuse and Mental Health Services Administration (SAMHSA), there are eight domains of wellness — physical, relational, occupational, mental/emotional, intellectual, spiritual, environmental and financial — and any domain can affect another. This article will highlight how COVID-19 disproportionately impacted several domains of wellness for Native people and how counselors can address increased mental health concerns.
The physical toll
In a December 2021 article published in The Princeton Review, Riis Williams reported about a study conducted by Princeton University researchers, which found that U.S. COVID-19 mortality rates of Native Americans were 2.8 times higher than white people. Comparatively, this study also found that mortality rates were 1.6 higher for Black Americans and 1.8 higher for Latinos than white people. Comorbid factors contributing to these significantly higher rates include lack of access to affordable health care, poverty, historical and current treatment by the U.S. government, and higher rates of high-risk health issues.
Shortly after the pandemic began, Kolby KickingWoman highlighted a distressing problem in a June 2020 article published in Indian Country Today, writing that “tribal leaders are working to keep their citizens safe from the coronavirus while juggling attacks on tribal sovereignty.” For example, in April 2020, the Cheyenne River Sioux and Oglala Sioux tribes implemented highway checkpoints for the purpose of contact tracing to reduce the spread of COVID-19. According to a May 2020 article in Indian Country Today, Cheyenne River Sioux Chairman Harold Frazier said that vigilance was required because the health care system on his reservation had “only eight hospital beds and six ventilators,” which was alarming given the high rate of infection that was occurring in the United States at the time. Nevertheless, South Dakota Gov. Kristi Noem tried to stop these efforts by giving the Native nations a 48-hour timeline to remove the checkpoints. The Cheyenne River Sioux Chairman Frazier and Oglala Sioux Tribe President Julian Bear Runner ignored the order, stating that they would remove the checkpoints when they deemed that it was safe to do so. Gov. Noem then involved the Bureau of Indian Affairs and threatened legal action. In May 2020, an increased number of positive COVID-19 cases led the Rosebud Sioux Tribe to also implement checkpoints on tribal land highways.
In an action of solidarity, a bipartisan group of state lawmakers wrote a letter in support of these tribal actions to Gov. Noem, and they cited the 1851 and 1868 Fort Laramie Treaties, which clarify that the state “has no jurisdiction over the highways running through Indian lands in the state without tribal consent.” Gov. Noem responded by sending a written plea to then President Donald Trump for federal intervention. Citing this plea, U.S. Sens. John Thune and Mike Rounds and U.S. Rep. Dusty Johnson sent a letter to U.S. Interior Secretary David Bernhardt requesting clarification on jurisdiction. The Association for Multicultural Counseling and Development’s Native American Concerns (NAC) group also wrote a position letter in support of tribal sovereignty. In the end, Native sovereignty was maintained, and the decision to have contract tracing checkpoints was applauded.
This conflict, however, did not end with the unjust challenge over highway checkpoints. As predicted by Chairman Frazier, when members of the Cheyenne River Sioux Tribe and Oglala Sioux Tribe fell ill with COVID-19, they did not have sufficient medical resources to meet the needs of their communities. And despite having available hospital beds in South Dakota, tribal members were forced to seek medical assistance in other states, traveling as far as Denver and Cheyenne, Wyoming. This not-so-subtle form of discrimination led to an Eight Circuit ruling that supported the 1868 Great Sioux Nation Treaty, which requires the United States to provide “competent physician led-health care.”
A similar discriminatory health care policy occurred at the Lovelace Women’s Hospital in Albuquerque, New Mexico, where pregnant Native American women were singled out for COVID-19 testing based on their race and zip code. In a June 2020 article in ProPublica, Bryant Furlow unveiled that this hospital’s secretive policy resulted in some Pueblo Nation mothers being separated from their newborn babies for up to three days. No other hospital in the area enacted a similar policy for new mothers, and the practice was finally identified and stopped months later. This egregious practice is evocative of the 1860 U.S. cultural genocide policy to separate Native children from their parents and place them in government boarding schools, which ceased in the 1970s. Policies of this nature are reminiscent of historical traumas, and they also create new traumatic experiences and contribute to negative mental health outcomes.
The financial toll
The pandemic also severely hurt Native Americans economically when public commerce restrictions led to a significant economic downturn. Many of the revenue streams Native nations rely on are in the hospitality and service sectors, gaming industry and public-driven enterprises, such as the Hualapai Tribe’s Skywalk over the Grand Canyon. Generally, these enterprises were either closed or experienced significant revenue losses during the pandemic, which decreased the economic health of the community-based tribes.
Although many Americans experienced financial hardship due to the ramifications of the pandemic, the Native American circumstances were compounded due to the intersection of the high percentage of COVID-19 deaths with tribal economic interdependence for survival. According to the 2020 report by the National Center for American Indian Enterprise Development, more than two-thirds of Native-owned businesses suffered significant revenue losses.
As noted in a 2020 report by the Federal Reserve Bank of Minneapolis, Native American employment had the biggest drop in April 2020 of any racial group. This decrease in employment was also highlighted by Robert Maxim, Randall Akee and Gabriel Sanchez in a 2022 Brookings article that exposes the vast differences in unemployment rates across Native American, Asian American, Black and white populations. In January 2020, the unemployment rate for Native Americans was 7.5%, Black Americans was 6%, Asian Americans was 3%, and white Americans was 3%. In March 2020 the unemployment rate drastically increased, with 28.6% unemployment for Native Americans, 16% for Black Americans, 14% for both Asian Americans and whites Americans. The unemployment rate in January 2022 displayed improvements, with 11.1% unemployment for Native Americans, 8% for Black Americans, and 4% for both Asian Americans and white Americans. The authors of this article acknowledged a prolonged disparity, noting it was the “first time the government published monthly unemployment data on Native Americans.” This former exclusion has had negative effects on economic recovery efforts, supports and research, which was highlighted in a 2022 Journal of Counseling & Development article by NAC members. In addition, as noted in a 2021 report by the Food Research and Action Center, the pandemic also exasperated food insecurities in a unique way for Native communities, resulting in locations running out of basic supplies at unprecedented rates.
On a positive note, Mark Trahant, in a May 2022 article published in Indian Country Today, noted that members of Congress intended to use a recent U.S. Congress report that detailed persistent structural barriers that have limited economic opportunities within Native communities to inform public policy. The American Rescue Plan’s investment of $31 billion into Indian Country is an attempt to bridge these gaps. The U.S. Congress report highlighted the interconnectedness of economic status and resources in relation to health outcomes. Much is still unknown, including the investment’s impact, yet the hope is that these positive movements can make a tangible difference.
The mental health toll
The loss of multiple family members and tribal elders who were the carriers of traditional knowledge and language can be especially difficult to bear, given the depth and breadth of such cultural information on personal and tribal identity. This can be especially devastating when the elder was the last living person with knowledge that predated the U.S. policy of boarding schools, which systematically removed Native American youth from their families and was an intentional form of cultural genocide.
These losses were experienced by Native Americans in various geographical areas, including rural, suburban and urban areas, and on reservations. Native clients living in urban areas away from their Native communities, which have suffered great losses, might have faced barriers and restrictions that prevented them from participating in grieving rituals, thus complicating their grief. These clients may have also experienced isolation and disconnection from ceremonies, cultural practices and community support due to limitations caused by the pandemic, adding further emotional challenges.
Local, state and federal policies that have racial disparities can add exponentially to bio-psycho-socio-spiritual aspects of the presenting problem with severe implications that reach beyond the non-Native pandemic experience. Due to these distressing impacts, practitioners should be aware of the historical trauma that the pandemic has triggered for Native American people who have suffered multigenerationally from U.S. betrayal and a failure to support Native interests. In a November 2021 NPR article, Adrienne Maddux, executive director at Denver Indian Health and Family Services, and Spero Manson, director of the University of Colorado’s Center for American Indian and Alaskan Native Health, shared that the pandemic had heightened
historical trauma and the “sense of pain, suffering of helplessness and hopelessness” for Natives who have endured oppressive circumstances for generations. These observations dovetail with Allyson Kelley and colleagues’ findings in a 2022 article published in the American Indian and Alaska Native Mental Health Research that confirm significantly higher rates of American Indian and Alaska Native (AI/AN) children experiencing orphanhood as a result of the pandemic.
The shelter-in-place orders and other mandates contributed to disturbances in physical and mental health due to the disruption in social, cultural, and economic practices and norms that are at the core of what it means to identify as a Native American. These circumstances contributed to increased rates of depression, suicidality and other pandemic-related stressors. A post-pandemic poll conducted by NPR, the Robert Wood Foundation and Harvard T.H. Chan School of Public Health found that Native Americans now suffer from increased depression, anxiety, sleep problems, stress and posttraumatic stress disorder.
Before the pandemic, 50% to 88% of homes on tribal lands lacked internet, broadband and even phone services, so it is easy to see how these disparities elevated difficulties for Native Americans to transition to shelter-in-place orders, virtual opportunities and telemedicine. In a 2022 article published in American Indian and Alaska Native Mental Health Research, Amanda Hunter and colleagues reported that some Native American researchers used funding and advocacy to improve technological infrastructure, yet this help was limited to a few areas. These honorable efforts, however, were not able to mitigate the long-term effects of the technological disparities.
A 2022 article in Shift Nursing reported that the depression rates for people in North Dakota had risen from 19.2% in 2020 to 33.3% in fall 2021. And of particular concern, the 2019 Fargo Cass Public Health Assessment found “a suicide rate of 45.1 for Native Americans in North Dakota, compared to the national average of 13.4.” This article also highlights access to insurance and costs as barriers to mental health treatment.
On the positive note, mental health practitioners benefit from knowing that protective cultural factors can serve as a resource for Native American clients. Amanda Hunter and colleagues detailed how the protective factors of community, relationality, abundance, strength and resilience found in AI/AN communities have improved outcomes during the pandemic. These protective factors may exist for Native American clients who are struggling with post-pandemic issues and help them to pave a way forward through their struggles with anxiety, stress and depression. Many Native communities executed resilience during the hardships, disparities, challenges to sovereignty and disruptions to protective factors. Continued mental health support is essential to sustain resilience.
Clinical considerations
Mental health practitioners demonstrate ethical care by incorporating how the aforementioned tolls affect Native clients while also seeking knowledge and understanding to maintain cultural competency. Counselors can learn more about current events within Native American communities by reading Native news resources such as Indian Country Today, IndianZ and Native News Online. Along similar lines, it is culturally responsible to understand that each tribe has its own culture and to be aware of tribal resources. Here are a few tribal resources that might be helpful depending on location: Northwest Portland Area Indian Health Board, Native Hope, Indigenous Story Studio, One Sky Center, We R Native, Center for Native American Youth at the Aspen Institute, First Nations Development Institute, and Centers for American Indian and Alaska Native Health. More general resources can also be found at the Indian Health Service (an agency under the U.S. Department of Health and Human Services) and SAMHSA’s Tribal Training and Technical Assistance Center websites.
In September, Kristi Taylor-Bond, a nationally certified addictions counselor and a chemical dependency clinical supervisor in Alaska who works with Alaskan Native populations, shared the following description of how the pandemic has affected the Alaska Native community with the NAC group: “COVID has halted in-person gatherings, which are essential to Native communities. It is common for Alaska Native crafters and artists to gather at the Native hospital and other corporation-run locations to sell crafts [and] traditional foods and to visit with friends. With these activities ceasing, many elders have been more isolated and unable to earn income from selling their art. Elders are especially vulnerable to mental health decline when they are not able to connect with loved ones.” This statement reverberates how important it is for counselors to access clients’ understanding of culture and their sense of belonging to culture as well as how disruption from this culture affects mental wellness.
AI/AN clients benefit when counselors include the following spectrum factors for cultural consideration during sessions:
Connection/disconnection: Explore how AI/AN clients are experiencing connection to their community and cultural practices.
Contributor/burden: Ask AI/AN clients how they perceive their community is experiencing their needs. Does the client see their needs as a burden to others? Is there balance to how the client views their own contribution and needs?
Collective/isolation: Determine AI/AN clients’ degree of connection to elders. This is important because elders hold wisdom for healing and challenging times.
Balance/imbalance: Guide AI/AN clients to reflect on what is working and explore the balance of wellness from the client’s cultural perspective.
Cultural responsible therapeutic services also include the method in which counseling is offered. Telehealth is becoming a more widely used modality, so additional considerations are important to keep in mind. Taylor-Bond also shared the following with the NAC group: “While telephonic and video sessions may be a very successful alternative for urban and younger folks, Alaska Native elders and those living in more rural settings are not finding the same success, in my opinion. There is a really beautiful part of building rapport with AN elders that I have found, and that is just being with them. … Lots of the rural kids and adults I’ve worked with first get to know you by experiencing you.”
SAMHSA and the U.S. Department of Health and Human Services have shared research informing how cultural disruption is a risk factor for suicide and mental illness in AI/AN communities.
What counselors can do
Policy informs funding and laws, and funding delivers resources to initiate change. Counselors can engage in local and federal advocacy to improve facilities, research, treatment and access. There are many ways counselors can advocate and encourage changes. Understanding how local laws affect mental and behavioral health allows clinicians to discuss the impact and needs of Native American clients and practitioners with legislators. It is essential for counselors to know the systemic barriers that create limitations for Native American clients to obtain mental health care in order to inform elected officials on ways to improve access to these services. Identifying methods to deliver culturally appropriate services will improve the quality of service and access to care.
When counselors advocate for efficacious culturally appropriate services, policy makers can pass legislation that protects vulnerable communities, builds access to culturally competent services and designates funding to increase equitable services and research. Supporting scholarship through funding is necessary to increase culturally appropriate interventions for therapeutic services. Currently, the funding for AI/AN research is 0.01% of the mental health research budget of the National Institutes of Health. In their article, Hunter and colleagues revealed how the pandemic has disproportionately affected Native communities, and more research is needed to explore the underlying factors and impacts of COVID-19.
In their 2022 article, Kelley and colleagues shared how communities across Indian Country established policies, adapted services, created education and service delivery strategies, and developed resources to keep individuals and families safe. Many of these communities partnered with federal agencies, including the Centers for Disease Control and Prevention, Federal Emergency Management Agency, and Indian Health Service.
Advocacy and progress take time and can provide healing to Native American communities. It was not until the passing of the American Indian Religious Freedom Act of 1978 that Native Americans could more freely worship in the United States. In 2021, Deb Haaland became the first Native American to serve in the presidential cabinet as the U.S. Secretary of the Interior. In August, Mary Peltola became the first Alaskan Native elected to the U.S. House of Representatives. In July, more than 1,000 acres of land were returned to the Onondaga Nation in New York, acknowledging them as the original stewards of the land. This recognition allows for healing and restoration as it further emphasizes sovereignty. There remain numerous injurious land policies fueling advocacy efforts, including the Dakota Access Pipeline and national monuments such as Bears Ears and Grand Staircase-Escalante.
The American Counseling Association began its 2022 Conference & Expo with a land acknowledgment. This acknowledgment is essential in the collective healing process and promotes an understanding of the compounding historical and current trauma many Native people endure in their lived experiences. This understanding provides counselors with a window into how the complex traumas may present in symptomatology and offers insight to healing pathways. It truly takes all of us to create a representative government and institute change to heal and progress together.
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AMCD Native American Concerns group
The Native American Concerns group is one of seven focus group for the Association for Multicultural Counseling and Development (AMCD), a division of the American Counseling Association that works to promote ethnic and racial empathy and understanding. AMCD encourages changing attitudes and enhancing understanding of cultural diversity. The Native American Concerns group actively supports Native voices in research and provides advocacy for Native counseling issues. It is a resource and community base for Native counselors and those who serve Native populations. Learn more by visiting multiculturalcounselingdevelopment.org.
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Nicola A. Meade is a national certified counselor, a licensed clinical professional counselor in Maryland, a licensed professional counselor in New Jersey, the co-vice president for the AMCD Native American Concerns group, and an assistant professor of counseling and psychology at Georgian Court University. Her extensive work includes serving as a domestic violence advocate for Native women, increasing counselors’ understanding and awareness of Native voices, and researching counselor identity and workplace-based racism. Contact her at nicolaameade@gmail.com.
Roni K. White is a national certified counselor, a licensed clinical professional counselor in Maryland and a co-vice president of the AMCD Native American Concerns group. She founded Apricity Wellness Counseling, a small private practice in Gaithersburg, Maryland, focusing on trauma, spirituality, minoritized women and relationships. Visit her at apricitywellness.com.
Carol ZA McGinnis is a certified spiritually integrated psychotherapist, a board-certified telemental health practitioner, a national certified counselor, a licensed clinical professional counselor in Maryland and a current member of the AMCD Native American Concerns group. She is an associate professor of counseling in the graduate counseling department at Messiah University. Her research interests include functional anger, spirituality in counseling, and Xbox video gaming. To learn more, visit www.anger.works.
Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.
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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.