APA urged a congressional appropriations subcommittee last month to support President Clinton’s Fiscal 2001 budget increase of $229 million for the Indian Health Services (IHS), including $6 million designated to expand mental health services.

To meet the enormous health and mental health needs of the American Indian/Alaska Native (AI/AN) population, however, more funds are needed, said James Thompson, M.D., APA deputy medical director and head of the Division of Education, Minority, and National Affairs, before the House Appropriations Subcommittee on Interior and Related Agencies.

"Since 1992 the Indian Health Service has experienced almost a 20 percent loss of its spending power for health care. This reduction has resulted in decreases in important health care services, especially in the mental health arena," said Thompson.

There is only one mental health provider per 23,350 Native-American children and adolescents, according to the National Indian Child Welfare Association, Thompson noted.

Severe staffing shortages mean that only 43 percent of the total AI/AN population receive minimal health services, and only 21 percent receive adequate social services, Thompson testified.

"Most service units and tribal programs are operated with one or two providers, who primarily provide crisis-related services with little backup due to the isolated, rural nature of their practice," stated Thompson.

Because the demands on providers are great, there is rapid turnover that "adversely affects the availability of a single backup psychiatrist, let alone the essentials of an adequate, cost-effective mental health and social services program," added Thompson.

Meanwhile, suicide continues to be the second leading cause of death for 15- to 24-year-old American Indians and Alaska Natives, he pointed out. More than half of all persons who commit suicide in Indian communities have never been seen by mental health care providers, said Thompson.

"Sadly, suicide is often the result of missed opportunities to treat problems such as depression, alcoholism, child abuse, and domestic violence, all of which are pervasive in the AI/AN population," Thompson testified.

American Indians and Alaska Natives also continue to have significant health problems because of substance abuse. Studies have estimated that the alcoholism mortality rates of AI/ANs are nearly 1,000 percent greater than the national average, according to Thompson. An estimated 95 percent of AI/ANs are affected directly or indirectly (via family or friends) by alcohol abuse, added Thompson.

"Congress needs to support the IHS’s efforts to develop a permanent and effective alcoholism and substance abuse prevention program," Thompson told the subcommittee.

He also urged the subcommittee to prohibit nonphysicians from prescribing medications for the Native-American population.

Thompson praised the growing coordination of mental health services between the IHS and other government agencies. Also, if enacted, the Indian Health Care Improvement Act (HR 3397) would require comprehensive behavioral health services to be developed and implemented by Indian tribes and tribal organizations.

"The American-Indian and Alaska-Native people need your leadership to appropriate the necessary funds and take other essential actions to ensure the adequate delivery of health care, particularly for those who suffer from mental illness and substance abuse," Thompson emphasized in his testimony.