IA2 Published in Gerontologist’s WHCoA Edition – Mental Health Disorders Among an Invisible Minority

IA2 staff in conjunction with lead author Dr. Mario Garrett, co-authored an article as part of a special issue of The Gerontologist devoted to the White House Conference on Aging.

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Mental Health Disorders Among an Invisible Minority: Depression and Dementia Among American Indian and Alaska Native Elders

Mario D.  Garrett, PhD,*,1 Dave  Baldridge, BA,2 William  Benson, BA,2 Jolie Crowder, RN, MSN,2 and Nancy Aldrich, BA2

1 Department of Social Work, San Diego State University, California. 2 International Association for Indigenous Aging (IA2), Silver Spring, Maryland.

ABSTRACT: According to the 2010 Census, 5.2 million people identified themselves as American Indian or Alaska Native (AIAN) in the United States. This was an increase of 39% from the prior Census, making AIANs one of the nation’s fastest growing populations. The health and social programs reaching them, however, have experienced documented devastating shortfalls. Decades of inadequate resources have resulted in significant health and socioeconomic disparities. AIANs are often considered an “invisible minority.” In 2012, there were 266,000 AIAN elders 65 or older who claimed one race alone. That number is projected to almost triple by 2030—when the nation’s baby boomers move into the ranks of the older population. This article provides an overview of two primary mental health issues—depression and dementia—that will confront this emerging AIAN elder population. Although other health and social issues exist, this article addresses depression and dementia because they are hidden from the community and from health care agencies. This paper focuses both on the unique characteristics of the AIAN population and why it is important to address depression and dementia. The conclusion explores pragmatic policy recommendations for improving the health and long-term mental health care status of AIAN elders.


1. The federal government should conduct or sponsor studies of the prevalence and incidence rate of depression and dementia among the AIAN population including those who reside within tribal lands and those who do not (the preponderance of AIAN). Ideally, support would come from the National Institutes of Health in collaboration with the IHS.

2. The federal government should support or otherwise undertake a comprehensive review of the state of elder health specifically including mental among the nation’s AIAN population.

3. IHS should eliminate Years of Productive Life Lost (YPLL) as a metric or create metrics to measure progress in health outcomes among the nation’s elderly AIAN population.

4. The IHS, the Administration for Community Living/ Administration on Aging, and other agencies dedicated to serving the older AIAN population’s must ensure an adequate commitment to the health needs—including those related to depression, dementia, and other forms of mental health – of AIAN elders.

5. Policy makers should amend Title VI of the Older Americans Act to ensure Title VI providers have capacity to provide accurate and relevant education to elders about depression, dementia, and other mental health needs and that they are knowledgeable about tribal and nontribal resources available to respond to such needs including diagnosing and providing appropriate treatment or care for such conditions.

6. Policy makers should amend the AIAN part of the OAA’s National Family Caregiver Support Program to ensure that AIAN caregivers have training, educational, and other forms of support for dealing more effectively with depression, dementia, and other mental health needs of family members and others for whom they provide caregiving services.

7. Federal policy should catch up with the extraordinary demographic shift of AIANs from reservations and tribal lands to urban areas. Federal agencies not dedicated to serving tribal communities must recognize that their constituents include growing numbers of urban-dwelling AIANs, many of whom are severely disadvantaged or otherwise invisible to the health and service systems in U.S. cities. Agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Administration for Community Living must ensure their programs respond to the mental health needs of nonreservation-dwelling AIANs.

8. The existing Indian health care delivery system (I/T/U), should develop and improve the capacity of clinical and social service staff to recognize, identify, and treat depression, dementia, and other mental health issues among elderly AIANs.

9. Providers working outside the I/T/U system should develop and improve the capacity of clinical and social services staff who serve AIAN elders to recognize, identify, and treat depression, dementia, and other mental health issues.

10. Policy makers should develop a national research agenda that is focused on identifying and evaluating effective culturally appropriate interventions that can be employed by clinicians and community social services for diagnosing and managing dementia, depression, and other mental health disorders in the AIAN population.