Indian consumer evaluation of mental health services.

The Indian Health Service initiated the mental health program to assist American Indian tribes in dealing with problems of mental health on Indian reservations. Mental health programs on Indian Reservations are intended to be community-based. In addition, the community model is intended as a means of ensuring that mental health program practitioners treat individuals from an holistic standpoint; that is, to involve families and other community resources in treating individuals with various disorders. This evaluation provides information from four Areas: 1) Phoenix; 2) Portland; and 3) Navajo. The evaluation attempted to gauge the attitudes and perceptions of individuals in terms of suitability of treatment, personnel and Tribal involvement, community involvement, and planning features of the mental health programs. The evaluation used two separate questionnaires to survey two groups: 1) patients and 2) health advisory board members. The sample size for the patients was 69, far short of the desired 200. The evaluation team reported numerous problems associated with the patient survey. Chief among these problems was the reluctance on the part of the mental health units to participate fully in the study. Participation by advisory board members was minimal, with only 11 individuals responding. The study team decided to interview only those individuals who had direct contact or involvement with mental health programs. The study found that the mental health program was achieving some of the goals that were initially developed. However, the study felt that the mental health program, as a whole, lacks the community orientation that is to be the basis for operations and service delivery. Although referrals come from a number of different sources, problem-solving was on a one-to-one basis, rather than utilizing a combination of resources such as community resources, families, or other Tribal entities. Three patient groups-children, adolescents, and men--were not well-represented in the survey and this requires attention. The most striking feature of the board survey was their desire to have more training that will enable them to become more informed about their duties and about the nature of the mental health programs. The survey indicated that board members could not adequately express either the particular nature of mental health programs, or the philosophy of community upon which the mental health program is generally based. The evaluation team advised that Tribal leaders are highly concerned about the loss of tribal autonomy and control. The effectiveness of any program, be it mental health or otherwise, is ultimately measured by its abilities to draw upon the history and culture of the Indian community which it serves and to devise appropriate strategies for meeting identified needs