Poverty in Spirit

Some argue that substance abuse can often be an attempt at self-medication by those in mental anguish because dopamine improves mood and increases self-confidence. However, while crystal meth causes fewer side effects on other parts of the body than other amphetamines, long-term users face chemical imbalances such as debilitating psychoses.

"Plus, even though there are different words in different tribes which specifically describe mental health problems, nobody talks about it because it's already hard enough being Indian," says Ross. She recalls the words of author and activist Velma Wallis, who labeled those with mental health issues as being on the periphery of communities, further marginalized within their own marginalized communities.

To respond to such needs, many tribes are attempting to install separate health facilities to focus on mental health issues. According to Dr. Danelle Reed-Inderbitzin, program director of the Kwawachee ("Helping Hands") Counseling Center for the Puyallup Tribe, such sites can provide a safe place for clients of all ages.

"We have an outpatient program and provide medication management, individual group and family therapy, as well as some outreach and prevention," she says. "Because we serve only Natives and with managed care, we work really hard with early intervention and prevention strategies that a lot of hospitals cannot do because insurance doesn't pay for it."