News & Announcements

New HEAL Initiative Coordinates With the VA to Help Veterans with Mental Illness

Posted: May 16, 2018

A private veterans' group, AMVETS, is joining with the Department of Veterans Affairs (VA) to try to help mentally ill veterans who have fallen through the cracks in the system.

"We all hear about 20 [veterans] a day that take their own life ... or [those who] become incarcerated without first receiving the support and treatment they need, which should include mental health services," Lana McKenzie, RN, chief medical executive of AMVETS, a group that represents the interests of 20 million veterans, said at a press briefing here Tuesday. "Today we're here to change that."

The multi-pronged initiative, called Healthcare Evaluation, Advocacy, and Legislation (HEAL), involves reaching out to veterans through a series of town halls, round tables, and other public forums. AMVETS is hiring case managers to work with the veterans and get them connected to healthcare services inside or outside of the VA, whichever is appropriate.

The organization is also launching a hotline, 833-VET-HEAL, for veterans to reach out for help that way.

AMVETS will work with the VA to coordinate services for the veterans they help through the initiative.

"You may be thinking, 'Why now?'" McKenzie continued. "The answer is simple -- we all know better; we have a responsibility to do better." She noted that more than 300,000 vets who have returned from Iraq and Afghanistan are dealing with post-traumatic stress disorder (PTSD), and many have incurred traumatic brain injury (TBI). "The AMVETS health team will ensure that any veterans who seek out support have access to all the services available, and we will also seek out veterans who may have fallen through gaps in care."

VA Secretary David Shulkin, MD, praised the initiative. "Mental health and particularly suicide prevention is our top clinical priority at the VA," he said. Shulkin listed steps his agency has taken to help veterans with mental illness, such as using predictive analytics to figure out which veterans are at highest suicide risk, and expanding mental health services to include those with a less-than-honorable discharge. "But most important is our work with partners on outreach to veterans who need help ... so this type of initiative is very important."

Carolyn Clancy, MD, executive in charge at the Veterans Health Administration, said the importance of assistance on the front lines "can't be overemphasized ... Veterans who get into our system for mental services have dramatically better outcomes."

The initiative is estimated to cost about $700,000, and AMVETS is hoping that it can partner with interested corporations to raise some of those funds. The money goes toward "all the information technology, travel, and the hiring of professionals," explain Sherman Gillum, chief strategy officer at AMVETS. "The idea is to present this as a [stock offering] where companies will 'invest' in what we're doing."

After the press briefing, Gillum talked with MedPage Today about the kinds of veterans that are likely to fall through the cracks. One example is a veteran diagnosed with both PTSD and with mild TBI. "The symptoms of [mild TBI] are not enough to warrant admission to a hospital, so [he or she is] treated for the PTSD," while the TBI is more or less ignored, especially since it's not obviously disfiguring, he said. Things can get worse when a veteran goes outside the VA for help, especially if no records are brought over from the VA.

Women veterans are another potential target for the initiative, he added. Whether or not they are getting help "depends on whether they're comfortable enough to immerse themselves in the VA -- a lot of times they aren't."

Read more on Medpage Today.



How Isolation, Stigma, and Shame Are Harming Black Women Living With HIV

Posted: May 14, 2018

“Before I was diagnosed with HIV in 1994, I was a huge people person, but afterwards, I didn’t want to be bothered with the world,” Gina Brown, a community organizer for the Southern AIDS Coalition, told The Root.

The New Orleans native added that not only was she hiding from herself, but she was also hiding out of fear of people finding out she was positive: “I thought if people looked at me, they would know I had HIV, so when I was home, I never opened my windows or raised my blinds. No one ever knew I was home.”

She added, “I was a plant wilting in the dark, living in darkness, depression, and pain.”

Now, in 2018, one might believe that Brown’s experiences are merely a thing of the past, but sadly, that’s not the case. Isolation, stigma and a lack of support are still haunting black women living with HIV/AIDS, especially in the South, according to a recent study, “Networks That Care: An Ethnographic Research Study of Women Living With HIV.” (pdf) Most importantly, these factors play a role in whether or not HIV-positive women stay linked into lifesaving care.

Conducted by ViiV Healthcare in conjunction with its Positive Action for Women initiative and ReD Associates, “Networks That Care” provides a snapshot of 14 HIV-positive African-American women—both cisgender and transgender—living in New Orleans, whose own personal experiences drove the report, an approach that is often rare in research.

“We had a firm belief that in order to find better solutions that would work [for this demographic], we have to put [these women] at the center of the design and decision-making,” said Amelia Korangy, who leads ViiV’s Positive Action for Women programming.

Translation: Listen to black women.

And if you lean in close enough to hear their brave voices, you’ll learn that while trying to grapple with their positive diagnosis, they are also caught in the crosshairs of external and internal stigma, a community lacking true knowledge about HIV, and crippling fear that the community they have spent their lives creating and building up will turn its backs on them.

For these ladies, this is literally a matter of life and death.

In Their Own Words

One major trend that jumps off the report’s page is how prevalent isolation and internalized shame are in these women’s lives. Living in the Bible Belt and being force-fed dated and inaccurate notions about the virus, many believed they “were not supposed” to contract HIV.

As one participant pointed out, “I always heard the stigma, ‘Homosexuals will be first.’ In street terms, it’s a gay disease.” Others claimed that HIV was for “prostitutes” and “promiscuous women,” with one even believing that her diagnosis morphed her into “a person I never thought I would be.”

As Korangy explains, an HIV diagnosis drastically alters how these women view themselves and their morality: “For a lot of women, a positive diagnosis challenges their sense of who they were, partly because of the shame and because they believe they are breaking social norms. That’s why it’s important to reinforce that regardless of [their HIV status] they are still a great mother, a great sister, and a great friend.”

She added, “Instead, too many times, they don’t feel worthy of love or support. There is this notion that no one is ever going to love them or see them the same way again.”

According to some of the women interviewed, these feelings led to an array of consequences, including depression, substance abuse, and even suicide attempts. And while low self-worth led to self-isolation, isolation was also a result of rejection, humiliation, and/or verbal and physical abuse from family and romantic partners.

One participant shared that when she lived with her family—before they eventually kicked her out—they made her eat from separate plates, bleached the tub after she used it and forced her to wash her clothes in a different washing machine. Mind you, it’s impossible to transmit HIV from casual contact, but such myths persist.

Witnessing ill-treatment of other HIV-positive people—whether it’s within one’s family, from folks on the block or at one’s neighborhood church—has served as a cautionary tale that has stopped positive people from disclosing. But this rings especially true for black women, who tend to be more dependent on their family and social networks for support. Also, for those who had children, the report found that mothers were afraid that disclosing would mean their kids would be bullied and shunned, so they remained silent.

One woman was clear: “I don’t want to be talked about ... people not liking me, whispering, say nasty things, put something up that’s derogatory. I just keep my business to myself.”

But what was really heartbreaking was how far some of the women would go to conceal their status from their loved ones.

One woman admitted that she would literally hide her AIDS meds in her underwear drawer, delete all web history related to HIV and cover her face with a towel so they wouldn’t hear her crying. She truly believed that her raw emotion would reveal the fact that she was HIV-positive.

For Marsha Jones, the executive director of the Dallas-based Afiya Center, these painful stories are not just NOLA-specific; they are happening all over the country: “For years, we’ve seen so many women like this, not comfortable bringing their full selves to the table, hiding their status or just being in complete denial that they have HIV. Sadly, too often, these are the same women that fall out of care and end up dying as a result of keeping this secret.”

The Emotional and the Physical Are Connected

As Jones mentioned, isolation and shame don’t just impact the mental and emotional health of black women living with HIV/AIDS; they are also directly linked to these women’s physical health and mortality.

According to the Centers for Disease Control and Prevention, in 2015 black women accounted for 60 percent of new HIV diagnoses among all women living in the U.S. We are also nearly 20 times more likely to contract HIV than our white counterparts, and in 2014, positive black women had a higher death rate than women of all other races and ethnicities.

Marc Meachem, ViiV’s head of external affairs, agrees with Jones, noting that from HIV prevention to treatment, black women are not reaping the benefits of these biomedical interventions. “In places like San Francisco, in a near future they will reach their goal of no HIV infections,” Meachem said, “but the promise of medicine and treatment is not being enjoyed equally, especially in places like the South that is the hotbed of new HIV infections.” He added, “Black women can’t get to zero if we don’t have insight into their lives and experiences.”

With this intense and much-needed focus on their personal lives, in no way does “Networks That Care” dismiss or ignore the sociopolitical and structural factors that fuel the AIDS epidemic in black America, such as economic instability, racism, mistrust of the medical system, housing instability, gender inequality, IV drug use, and high rates of incarceration.

All of this works against black women, HIV positive or negative, but Meachem stresses that we cannot ignore that “[there are] women living with HIV who don’t believe they are even worthy of treatment.”

Where Do We Go From Here?

Yes, many of these findings are disheartening, but there is a silver lining: There are strategies and solutions that can and do empower black women living with HIV/AIDS. For starters, having allies, even if it’s one person, can make a huge difference in their lives.

Octavia Lewis, a trans black woman who was diagnosed in 2006 in Georgia, can speak to this firsthand. “As a trans woman, I honestly believed I would contract HIV at some point in my life,” she said, “but when I got my diagnosis, reality sunk in, and I sat at home for weeks letting myself waste away. I thought no one was going to love me.” 

Lewis added, “Thankfully, my roommate reminded me I could live with this disease and that I was going to be OK. I can only imagine how much better other people would be if [they] had that person in their corner.”

In addition, the report found that once women got over their initial mistrust of the medical community and got linked to care, many admitted that going to appointments with their doctors was a game changer.

This rang especially true for those isolated from social settings who found themselves interacting with doctors and clinical staff who were culturally competent, empathetic and treated them like “normal people.” These crucial moments established trust and encouraged women to come back and continue accessing care, not just to strengthen their own health, but to feel less alone.

But this is just a start.

Obviously, advocates and researchers have more work to do, but so do the rest of us, given that HIV-negative folks inflict most of the stigma and pain on positive folks in our community. Our contribution could include educating others and ourselves about the epidemic, checking our own misogyny and transphobia and realizing that if black lives actually matter; we cannot leave behind black folks living with HIV—not ever.

“Ignorance is the enemy, and when we come to you all speaking our truth, it’s important that you all are not saying things that not only didn’t make sense 25 years ago but make even less sense now,” Brown stressed, adding, “Uplift us, listen to us, learn from us and love us.”

Read more on TheRoot.com



Latinos are Hit Especially Hard by The Opioid Crisis in Massachusetts, But Why?

Posted: May 11, 2018

The tall, gangly man twists a cone of paper in his hands as stories from nearly 30 years of addiction pour out: the robbery that landed him in prison at 17; never getting his GED; going through the horrors of detox, maybe 40 times, including this latest, which he finished two weeks ago. He's now in a residential unit for at least 30 days.

"I'm a serious addict," says Julio Cesar Santiago, 44. "I still have dreams where I’m about to use drugs, and I have to wake up and get on my knees and pray, 'let God take this away from me,' because I don’t want to go back. I know that if I go back out there, I’m done."

Santiago, who is Puerto Rican, has reason to worry. Near-real-time data on the opioid epidemic in Massachusetts, produced by the Baker administration, shows the overdose death rate for Latinos has doubled in three years, growing at twice the rate of any other racial group.

These numbers suggest the opioid crisis is hitting Latinos especially hard in Massachusetts. State officials say they don't know why. But interviews with current and former drug users, addiction treatment providers and physicians reveal a range of problems that put Latinos at greater risk of an overdose and death.

Few Bilingual Treatment Programs

A man in sneakers, jeans and a short-sleeved plaid shirt slaps greetings to a small group at Casa Esperanza, a collection of day treatment, residential programs and transitional housing in Boston's Roxbury neighborhood. He plops down next to Irma Bermudez, who, at 43, describes herself as a "grateful recovering addict." She's in the women's residential unit.

Bermudez says the high Latino overdose death rate "has a lot to do with the language barrier." It keeps anyone who can't read English well out of treatment from the start, as they try to decipher websites or brochures that advertise options. If they skip the text and call a number on the screen or walk into an office, "there’s no translation, we’re not going to get nothing out of it," Bermudez says.

Latinos interviewed for this story describe sitting through group counseling sessions, part of virtually every treatment program, and not being able to follow much, if any, of the conversation. They recall waiting for a translator to arrive for their individual appointment with a doctor or counselor and missing the session when the translator is late or doesn't show up at all.

Eleven percent of the state's estimated opioid overdose deaths last year were Latino, and yet Casa Esperanza says it has the only day and residential addiction treatment program in Boston where all the direct care staff speak Spanish.

There is no comprehensive list of addiction services in Massachusetts where translators are available at will. Several in Massachusetts listed as offering Spanish translation on the SAMHSA Find Treatment website could not say how many translators they have or when they are available. The SAMHSA site is only available in English, but Spanish-language translators are available by phone. The state's online help site is developing a Spanish-language version. In Boston, there are some addiction recovery programs that offer services in Spanish.

At Casa Esperanza, 100 men are waiting for a spot in the male residential program, so recovery coach Richard Lopez spends a lot time on the phone trying to get clients into a program he thinks has at least one translator.

He jabs at the air, voice rising with frustration as he role-plays a call: "You gotta press 1, you gotta press 2 and then when you get through all this voice thing, you get a voicemail."

Eventually, says Lopez, he'll get a call back during which an agent typically offers to put Lopez's client on another waiting list.

"Cheese and crackers," Lopez says, hitting the side of his head. "You’re telling me that this person has to wait two to three months? I’m trying to save this person today. What am I going to do, bring these individuals to my house and handcuff them so they don't do nothing?"

'It's Not Cool To Call 911'

Lopez has close ties these days with providers, the police and EMTs. But his attitude toward first responders, back when he was using heroin on the streets, explains another reason Latinos may be dying from an overdose more often than other drug users.

"It’s not cool to be calling 911," says Lopez about if a person sees someone overdose. "I could get shot, and I won’t call 911."

It's a machismo thing, says Lopez. "To the men in the house, the word 'help,' sounds like degrading, you know?" he says.  Calling 911 "is like you’re getting exiled from your community."

Santiago says this isn't true for everyone. A few men have called EMTs to help revive Santiago: "I wouldn't be here today if it wasn't for them." But Santiago and others say there's growing fear among Latinos of asking anyone perceived as a government agent for help, especially if the person who needs the help is not an American citizen.

"They fear if they get involved they’re going to get deported," says Felito Diaz, 41.

Bermudez says Latino women have their own reasons to worry about calling 911 if a boyfriend or husband has stopped breathing. "If they are in a relationship and trying to protect someone they might hesitate as well," says Bermudez, if the man would face arrest and possible jail time.

Obstacles To Starting Over

In the last five years, 79 percent of Casa Esperanza clients have spent time in prison, often for drug possession or a drug-related crime. That makes finding a job and building a stable life when they leave treatment difficult.

"You want to start over. You want to start fresh, but you can’t do it because you have your past in your bag," Bermudez says.

Santiago says he feels stuck, as if he hasn't progressed past the high school education cut short when he went to jail at 17. "I'm stuck," Santiago says. "I'm 44 years old now, and I still see myself doing the same things I was 30 years ago. It just feels like, how am I going to change? The only way I know how to live and cope is doing drugs."

Some Casa Esperanza graduates find work in addiction treatment. Diaz cycled in and out of drug court twice, which he says "did wonders for me," before finding this program. Now, he runs the men's residential unit. "I'm shocked," says Diaz, "a drug addict for 23 years, left alone with keys, in charge of 30 individuals. Who would have thought that about me?"

But many Latinos are not finding the same success.

"The stigma is so hard," says Lopez. "The only thing that’s available is a dishwasher or working in a kitchen; are you serious?"

"Or going back to what you know," says Bermudez.

For some, that means using, and sometimes dealing drugs. Which raises another reason some Latino drug users say they are hit especially hard by this epidemic: an inside track to cheap, readily available drugs.

The Internal Trade

The Drug Enforcement Agency (DEA) says many high-level distributors in Massachusetts are Dominican and often collaborate with Mexican, Colombian and Puerto Rican drug dealers.

"Dominican TCOs [Transnational Criminal Organizations] pose a significant threat to the domestic drug trafficking landscape in mainly the East Coast of the United States, with their strongest influence concentrated in areas of the Northeast located along the I-95 corridor," according to the 2017 DEA National Drug Threat Assessment.

Some drug users in Boston echo this analysis.

"The Latinos are the ones bringing in the drugs here," says Rafael, a man who uses heroin and lives on the street not far from Casa Esperanza. "The Latinos are getting their hands in it, and they're liking it."

Some Spanish-speaking drug users in the Boston say they get discounts on the first, most potent cut. That social connection matters, they say.

"Of course, I would feel more comfortable selling to a Latino if I was a drug dealer than a Caucasian or any other because I know how to relate and get that money off them," says Lopez.

The social and occasional family networks of drug use create another layer of challenges for some Latinos, says Dr. Chinazo Cunningham, who treats many patients from Puerto Rico. She primarily works at a South Bronx clinic affiliated with the Montefiore Medical Center.

"The family is such an important unit, it's difficult if there is substance use within the family for people to stop using opioids," Cunningham says.

Cunningham says the opioid epidemic has been in the Latino community for decades and is one reason for the group's high incarceration rate. In Massachusetts, Latinos are sentenced to prison at five times the rate of whites.

"It's great that we're now talking about it because the opioid epidemic is affecting other populations," Cunningham says. "It's a little bit bittersweet that this hasn't been addressed years before, but it's good that we're talking about treatment rather than incarceration, and that this is a medical illness rather than a moral shortcoming."

The Underlying Risk Factor: Poverty

Latinos are hardly a uniform community, but they share an important risk factor for addiction: poverty. In Massachusetts, four times as many Latinos live below the poverty line as do whites. Ninety-seven percent of Casa Esperanza clients were recently homeless. The agency has 37 units for individuals and families. The wait for one of these apartments ranges from one to 10 years.

"If you’ve done all the work of getting somebody stabilized and then they leave and don’t have a stable place to go, you’re right back where you started," says Casa Esperanza Executive Director Emily Stewart.

Stewart praises the Baker administration for diving into the data that shows higher overdose death rates for Latinos. The state has some information online, in Spanish. Department of Public Health Commissioner Monica Bharel is scheduled to visit Casa Esperanza and meet with other Latino addiction treatment providers later this month.

The next step, Stewart says, has to be a public information campaign via Spanish-language media that explains treatment options, including medication-assisted treatment or MAT, which she says it not well understood.

Some research shows Latinos are less likely to have access to or use the opioid-based medicines, methadone and buprenorphine, than other drug users. One study shows that may be shifting. But Latinos say, access to buprenorphine, brand name Suboxone, is limited in Massachusetts because there are few Spanish-speaking doctors who prescribe it.

Read more and listen to the story on WBUR.org



The NNED-a-thon Winner is…Changemakers!

Posted: May 11, 2018

Congratulations to the NNED-a-thon winner, Team 2—Changemakers!  Twelve teams of NNEDLearn 2018 participants competed in a fast-paced interactive challenge to brainstorm strategies on the use of networks, including the NNED, to assist with eliminating disparities in behavioral health.  Teams comprised of individuals from different organizations and representative of all five NNEDLearn 2018 training tracks examined strategies for establishing and reinforcing partnerships to promote community health and well-being.  The NNED-a-thon was an opportunity for NNEDLearn 2018 participants to interact with other participants not in their assigned training track and expand the potential for peer-to-peer learning. 

NNED-a-thon 2018 Winning Team

Modeled after hack-a-thons that are commonly used by technology innovators to problem-solve, the NNED-a-thon teams had four minutes to present their strategies for enhancing the NNED based on two assigned attributes of a healthy network.  Changemakers presented their two attributes—“value” and “capacity to tap the network assets”—and identified concrete strategies for applying each of the attributes to the NNED.  The team described multiple values of the NNED, including collaboration, shared learning, acceptance, and skill development.  The capacity for NNED members to tap the network assets through utilization of the online discussion forum which allows for continuing conversation with other NNED organizations was emphasized during the team’s presentation.  Understanding that multiple doors of entry are needed to maximize the potential to tap the network’s assets, Changemakers highlighted multiple entry points within the NNED for members to access information and connect with each other. 

Moving forward, the Changemakers expressed the need to increase clarity of communication across the network.  Showcasing the shared values and unique talents of NNED members was proposed to help motivate members to connect with each other.  Changemakers reminded everyone that leveraging social media to connect NNED partners and networks is key. The team suggested creating a NNED mobile app, using a single-sign on, social media format to access all features in the website, and marking content with hashtags to make it easier to connect with NNED partners.  

We look forward to implementing the feedback as best possible. Thank you to all NNEDLearn 2018 participants for their great work in the 2018 NNED-a-thon!

Find out how you can get involved in the NNED-a-thons and NNEDLearn!



Back to the Land: How One Indigenous Community is Beating the Odds

Posted: May 08, 2018

The following article was written by and from the perspective of David Danto, the Program Head of Psychology at the University of Guelph-Humber.

In northern Ontario, surrounding James Bay and Hudson Bay, lie six remote First Nations communities.

They range in size from several hundred members to several thousand. They have no road access linking them to other communities in the region, and with varying degrees of ease, they can be reached by rail, air, boat or winter ice road. Many of these communities struggle with a host of mental health issues including high rates of suicide, substance abuse, and depression.

One community stands out, by virtue of its low rates of suicide and mental health services utilization. This community shares a history of oppression, victimization, and suffering with its sister communities. It also endured the relatively recent trauma of a natural disaster.

How is it that this one community has produced what appear to be more positive mental health outcomes?

To investigate this question, I developed a research project in collaboration with Dr. Russ Walsh of Duquesne University. We interviewed community leaders and resident mental health service providers about the strengths of their community with respect to mental health. As non-Indigenous psychologists, we used a culturally sensitive method that focused on listening and that privileged the perspectives of participants.

We avoid mentioning any communities by name, to protect the confidentiality of participants. There are relatively few communities in the James and Hudson Bay region and populations are relatively small. Our research participants included community leaders and elders. Even limited information about these communities would risk identifying individuals.

The strength of community members’ connection to the land emerged as the most striking finding. Participants spoke of this connection as woven through mental, physical, spiritual and emotional dimensions of the self. They described it as foundational to their faith, uniting those with otherwise differing spiritual beliefs and possibly stabilizing the community in the face of other differences.

“Back to the land,” said one community member. “When you’re there, it’s like your spirit, your mind, and your physical well-being — everything improves when you’re out there; it’s like you rejuvenate while you’re out there.”

“We have a belief,” said another community member. “I’m not going to give it a word of religion or culture. No, it’s a way of life, you know. It always was in the beginning, and it is today.”

The medicine wheel

A challenge for this study, as for the bulk of research within Indigenous communities, was the “outsider” status of the researchers themselves. Despite our interest in, and concern for, the well-being of Indigenous communities, we remain unavoidably non-Indigenous Western psychologists. This “from the outside in” orientation runs the risk of further oppression and colonization in the name of scientific truth.

Qualitative methodology, despite its focus on the experiences of participants in their own words, still undertakes the task of organizing and interpreting participants’ accounts, and hence also entails the risk of colonizing participants’ experiences.

To minimize this risk, we decided to organize and interpret participant narratives using the medicine wheel of traditional healing. Rod McCormick, the B.C. Regional Innovation Chair in Aboriginal Health at Thompson Rivers University and a member of the Mohawk (Kahnienkehake) nation, provides the following overview of the medicine wheel:

“The Aboriginal medicine wheel is perhaps the best representation of an Aboriginal worldview related to healing. The medicine wheel describes the separate dimensions of the self — mental, physical, emotional and spiritual — as equal and as parts of a larger whole. The medicine wheel represents the balance that exists between all things. Traditional Aboriginal healing incorporates the physical, social, psychological and spiritual being.”

Indigenous Canadian healing traditionalists view the person as comprised of these integrated categories. An individual’s health and wellness result when these realms are balanced and integrated. By organizing our qualitative analysis along these lines, we sought to frame the results in culturally appropriate terms, and thereby set the stage for community conversations regarding mental health.

Through my work in northern Ontario, I have developed connections with mental health workers in the region. Over several months, Dr. Walsh and I had a series of conversations with them regarding their interest in community-oriented and strength-based research to inform their mental health interventions. The proposed study was supported by the community’s leadership.

Connection to the land

To our eyes, the most notable finding was the way in which connection to the land was interwoven throughout all aspects of the medicine wheel.

Participants’ comments regarding physical, spiritual, mental and emotional health often referred to attitudes and practices that affirmed a fundamental connection to their land:

“To know the land… you know you’re capable of things other kids aren’t, knowing where I came from, what I’m capable of.”

This connection informed individual and community efforts to maintain well-being and also seemed to provide a bridge between different spiritual beliefs. That is, community members of divergent spiritual orientations shared a belief in the land as foundational to their faith. This cohesion was evident in community activities and programs, as well as in acknowledgment of shared culture and history.

It may well be the case that members’ shared connection to the land and ready access to the land was sufficiently strong to tolerate differences that might otherwise polarize a community. And from this shared sense of connection may follow the sense of hope expressed by most of the participants:

“Everybody, even if they disagree… when it comes to a crisis and someone needs help… that’s where your strength is: The whole community comes together.”

This may hold implications for health and healing initiatives both within and beyond this community. If a sense of connection to the land is a central feature of well-being, then it may need to be a central feature of mental health interventions.

Identity and autonomy

Two other themes emerged. One was the community’s relative distance from “outside influence,” facilitating greater identity and autonomy. The other was the rather recent shared trauma of natural disaster and relocation, which required a pulling together of community resources in a way that more diffuse challenges and traumas may not.

To the degree that these factors are foundational to the strengths of this community, there may be implications for more general intervention and prevention programs. Specifically, these findings suggest that when communities can unite to face a set of problems and have a fair degree of autonomy (or freedom from outsider influence) in responding to those problems, they may be best able to draw upon their shared resilience and communal spirit. For those wishing to facilitate this resilience and spirit, the challenge is to do so in a way that affirms rather than usurps the community’s independence.

We plan to continue our investigation of these issues with a follow-up study. This will address the role of land-based interventions in promoting resilience and mental health.

Read more on TheCoversation.com.



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