Cultural Competence Standards in Managed Care Mental Health Services For Native American Populations

Abstract

Disclaimer: The set of guidelines that are included in this document are general suggestions made by the panel for consideration by clinicians, who must continue to rely on their own professional judgement and training and the individualized assessment and needs of their patients. There is no representation here that these guidelines are appropriate for any particular patient. The panel that developed these guidelines disclaim all liability and cannot be held responsible for problems that may arise from their use.

The Native American Panel as co-participant with other ethnic minority panels for the development of Cultural Competence Guidelines provided information relevant and unique to Native Americans across the United States. The work of this panel was sponsored by The Western Interstate Commission for Higher Education (WICHE) Mental Health Program and funded by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

The Native American Panel offered the "Cultural Competence Standards In Managed Care Mental Health Services for Native American Populations" toward the goal of developing culturally competent managed care organizations who would serve Native Americans in ever increasingly effective and respectful ways. First and foremost, each tribe/nation must be viewed as a sovereign nation based on treaty rights with the United States government. There are also unique issues for Native people who live on reservations and those who live in urban areas. Along with this, there are some reservations that span several states (e.g., Navajo nation includes Arizona, New Mexico, and Utah). These issues make mental health provisions complex when the managed care system must also include the standards of federal, state, tribal, and Indian Health Service into its decisions and plans.

More specific to managed care systems themselves, the Panel developed guidelines for cultural competence at the administrative, governing, and provider levels. Administrators must consider tribal/community policy, values, and culture when developing care policies. The governing body of managed care must consider including personnel with cultural expertise as part of their decision-making procedures. Providers must be knowledgeable about the tribe, traditional healing practices, medicine people, language, child rearing, cultural views of health and healing, family and community structures, and ethnic differences in physiological responses to psychiatric medicines.