Debating Identity: Urban Indians in the Healthcare System
In recent years, the public health sector has recommended that healthcare practitioners become culturally competent in order to reduce health disparities in minority groups. It was reported later in the Surgeon General's Report (1999) on mental health, that culture shapes the healthcare experience for minority groups and in turn may influence the treatment course. Cultural competence models have been proposed in conjunction with the development of ethnic-specific mental health clinics, where practitioners and patients are ethnically similar, and programs are designed with the groups unique cultural needs in mind. This poses a particularly unique dilemma for urban Indians as their identity has come under social and legal scrutiny, which resulted in a debate over eligibility for federally administered health services. In a justification to cut funding for urban Indian health centers, the current administration has put their existence into question, saying that they offer duplicate mental health services that can be found elsewhere in the community.
In light of the current debates over continued funding, I examined cultural competence practices and health treatment at the Missoula Indian Center, an urban Indian center with a staff of eleven and a client base of just under 1,500 people. I interviewed all of the employees and counselors at the Indian center, as well as conducted ethnographic observation of client/provider interactions. Eight of the eleven staff members are American Indian and most consider themselves urban Indian, therefore I was able to gain an understanding of cultural competence practices through the lens of both ethnic urban Indian and non-Indian providers. The data suggests that urban Indian centers provide necessary services for transitioning American Indians, yet there is not a conclusive argument that the cultural component is the primary force making these centers necessary and successful. Some data suggested that the availability of services and cultural resources make these centers a primary choice for urban Indians seeking mental health care.
Advisor:Dr. Sarah Horton; Dr. Richard Sattler; Dr. David Beck
School:The University of Montana
School Location:USA - Montana
Source Type:Master's Thesis
Date of Publication:08/07/2008