American Indians and Alaska Natives are at least twice as likely to experience serious psychological distress as compared with White, African American, Asian and Latinx individuals. They also face a higher risk of experiencing poverty, violence and trauma, but have limited access to social services and healthcare that could help address the health and mental health consequences of these stressors. Moreover, these disparities are often exacerbated when AI/AN people live in rural communities.
Though research has demonstrated integrated care can effectively improve access and quality of mental health services in rural areas, successfully integrating mental health services into these areas (especially in clinics that serve AI/AN populations) requires a readily available mental health workforce that has been trained in cultural humility and the historical context of working with marginalized groups. Psychiatry residents, who can potentially serve a critical role in this workforce after they graduate, are more likely to practice post-graduation in settings and with populations they have been exposed to during their training.
With philanthropic support, the AIMS Center and the University of Washington have partnered with the Lummi Tribal Health Center (LTHC) to develop an integrated care rotation for senior psychiatry residents that focuses on delivering care via telepsychiatry to a rural, Coast Salish indigenous population in northwestern Washington state. As part of this six-month rotation, psychiatry residents provide direct care to LTHC patients via telepsychiatry and participate in delivery of integrated care services at LTHC, all under the weekly clinical supervision of a child and adult psychiatrist. Residents also gain an understanding of the historical and cultural context of the Lummi Nation to foster cultural humility in delivering mental health care to AI/AN people and complete a scholarly project of their choosing.
Under the supervision of Jessica Whitfield, MD, MPH, two residents completed the new rotation in 2020-21 and two fourth-year UW psychiatry residents are enrolled this year. Dr. Whitfield and courtesy faculty member Bud Vana, MD, also serve on the panel of experts/coordinators of a recently launched Virtual Care Implementation ECHO Program with the aim to help improve access to care for tribal populations via telehealth.