Access to Mental Health Services at Indian Health Service and Tribal Facilities

Compared to other populations in the United States, American Indians and Alaska Natives (AI/AN) experience a disproportionately high rate of mental and behavioral health challenges and a high incidence of end stage renal disease. Eighty-two percent of tribal and IHS facilities provide some type of mental health service; however, the range of services is limited at some facilities. Only 20 of 506 IHS and tribal facilities reported that they provide kidney dialysis services at their facilities; most AI/ANs receive dialysis services at non-IHS/nontribal dialysis facilities.

IHS is responsible for providing Federal health services to AI/ANs. IHS operates from 12 Area Offices across the country to oversee the delivery of health services to members of federally recognized tribes eligible for IHS health care. The reports are based primarily on a survey of IHS and tribal facilities that provided health services from January 2008 to June 2009. We also conducted site visits and interviews at a sample of 98 facilities and at all IHS Area Offices.

Access to mental health services

Of the 630 IHS and tribal facilities, 514 provide some type of mental health service. Facilities that do not provide mental health services refer clients to other providers either outside the AI/AN community or on the reservation. Staffing issues and shortages of highly skilled providers limit AI/ANs' access to mental health services. Physical, personal/social, and economic challenges of AI/ANs may affect access to mental health services. We recommend that IHS (1) provide guidance and technical assistance to help tribes explore potential partnerships with non-AI/AN providers of community mental and behavioral health services, (2) continue to expand its telemedicine capabilities and provide guidance and technical assistance to tribal health care providers to expand and implement telemedicine, and (3) develop a plan to create a database of all IHS and tribal health care facilities. IHS concurred with all three recommendations.

Access to kidney dialysis services

Only 20 of 506 IHS and tribal facilities reported that kidney dialysis services are provided at their facilities; most AI/ANs receive dialysis services at non-IHS/nontribal dialysis facilities. Of the facilities that did not provide dialysis services, 56 percent reported that they assist in referring their patients to other facilities, both IHS/tribal and non-IHS/nontribal. The remoteness of dialysis facilities can affect the availability of services and create hardships for AI/ANs. Most IHS and tribal facilities do not provide kidney dialysis services because of a lack of resources and small patient populations. Finally, many IHS and tribal facilities assist tribal members in accessing dialysis services by providing transportation and expanding access to specialists. We recommend that IHS (1) develop a plan and provide expertise to assist tribes in expanding dialysis services, (2) develop guidance and technical assistance resources to help IHS and tribal facilities offer alternative treatments for dialysis services, and (3) develop a plan to create a database of all IHS and tribal health care facilities. IHS concurred with all three recommendations.