How Clinicians Can Support Clients from Native Communities

It’s hard to overstate the need for culturally affirming mental health care for clients from native communities. Most clinicians are all too aware that native communities experience disproportionately higher rates of mental health issues, as well as significant additional barriers to seeking and receiving care. While it would be ideal for every client to have access to a mental health provider with a deep understanding of their specific cultural background, we also know that isn’t realistic given the limited number of clinicians with specialized training or personal connection to the native experience.

To help you gain insight into how to better serve clients from native communities, Alma asked Native American clinician and public health educator Stacy Braiuca, MSW, MPH, LCSW, to share her experience and insights. “While my insights are rooted in my identity as a Potawatomi descendant, they reflect broader themes that resonate with many Native communities, though each carries its own unique history and culture,” says Braiuca.

Can you shed light on the additional barriers that native people face when seeking mental health care?

As a descendant of the Potawatomi people who endured the Trail of Death, I understand that historical trauma deeply influences American Indian communities. This experience effectively cut my family off from our cultural identity and many long standing cultural practices, which I personally have had to re-claim in my own journey.

Similar to the Potawatomi, many Native American Nations, such as the Cherokee, Navajo, and Lakota, have also experienced forced relocations and cultural suppression. These events have left lasting scars, fostering mistrust of governmental systems, including healthcare.

For many, healthcare systems fail to acknowledge traditional healing practices and do not acknowledge Indigenous worldviews on wellbeing, both of which are integral to mental, spiritual, and physical well-being.

What might be some common mental health struggles faced by people from Native communities?

Among Native Americans, including the Potawatomi, mental health struggles like anxiety, depression, and PTSD are often tied to intergenerational trauma. For instance, the Potawatomi's forced relocation in the 1830s echoes the Cherokee’s Trail of Tears and the Long Walk of the Navajo, where entire communities were uprooted.

Each tribe has its own narrative, but the impacts of these removals manifest similarly in mental health challenges. Like the Potawatomi, many tribes, including the Lakota and Blackfeet, have also experienced the erosion of cultural practices and language, leading to identity struggles and higher rates of substance abuse (of substances introduced to them by Colonization).

This collective loss weighs heavily on mental well-being across Native communities.

How can clinicians across backgrounds provide more culturally affirming care to Native clients?

Clinicians working with Native clients need to understand that each tribe has its own cultural and historical context, but many share values like a holistic view of health and a deep connection to land and spirituality. And that each Native person experiences and identifies with their culture differently.

Some are “enrolled” (per genocidal policies implemented by Colonization which no other POC have to deal with), and some are not, but both identities are valid and integral to the individual.

Other cultural concerns include symbolism and practices which differ but have been portrayed by media and the “Hollywood Tribe” (pun for describing the mischaracterization of Native people historically by the movie and tv industries) as generalized.

When Columbus arrived there were over 560 diverse and unique Nations on this continent, many of whom still exist in one form or another, as dynamic surviving cultural groups. The Potawatomi, for instance, revere the eagle for its spiritual symbolism, a practice mirrored by many other Plains and Southwestern tribes.

Acknowledging historical trauma, like the Trail of Death, Trail of Tears and the Long Walk and incorporating culturally informed, trauma-sensitive approaches are essential. For Native clients, care must reflect respect for their sovereignty and cultural identity both as individuals and as collective groupings.

Are there specific steps that clinicians can take to make Native clients feel more supported during sessions?

To support Native clients, if appropriate I may incorporate practices that resonate with Potawatomi culture, such as honoring our connection to nature and respecting traditional roles of storytelling as a healing tool, but first I always find out what my specific client identifies as and with as a Native person.

I acknowledge that many other tribes, such as the Hopi and Navajo, similarly use oral traditions and ceremonies for healing. While each Nation's cultural protocols differ, understanding and integrating these elements into therapy can make a significant difference in comfort levels. For Potawatomi people, for example, recognizing the significance of our removal history and how it shapes our modern identity is critical.

Do you have any additional advice to pass on to clinicians serving native clients?

When working with Native clients, it’s important to recognize that while we share some historical experiences—such as forced relocations or systemic discrimination—each tribe and individual's experience is unique.

For me, as a contemporary Potawatomi woman, my identity is shaped by both the resilience of my ancestors and the challenges of modern Native life. Similarly, other tribes have their distinct histories, whether it’s the removal of the Nez Perce or the struggles of the Seminole in Florida.

Clinicians should approach each client with humility, inquiring about THEIR personal identity as a Native individual and what that means for them, then seeking to learn and respect their individual tribe’s experiences, understanding that we are not a monolith.