Beyond Compliance: Addressing Indigenous Mental Health and What Is Missing in Clinical Practice

SPECIAL REPORT: DIVERSITY

Indigenous communities across the United States and globally experience disproportionate rates of trauma, mental illness, poverty, and institutional mistrust. Despite these realities, dominant models of mental health treatment pathologize Indigenous behaviors and beliefs, ignoring systemic oppression and intergenerational trauma. This article explores what is missing in mental health practice for Indigenous populations and introduces decolonizing, culturally grounded models of care.

What Is Missing: Colonized Mental Health Models

Western psychiatry and clinical practice often isolate symptoms from social and historical context. This framework invalidates Indigenous knowledge systems, communal values, and healing traditions, replacing them with Eurocentric norms. Mental health professionals frequently misinterpret traditional parenting or survival strategies as dysfunction. For example, expecting adolescents to contribute financially to the household may reflect cultural interdependence, not neglect. Additionally, families from diverse cultural backgrounds rely heavily on one another and often engage in shared caregiving responsibilities. This interconnectedness can sometimes be misinterpreted as enmeshment, rather than being understood through a communal or collectivist cultural lens.

These misinterpretations lead to punitive interventions. One such example is child protective services (CPS), which may view Indigenous parenting through a deficit lens, often pressuring families to assimilate into White middle-class norms to maintain custody of their children.¹

Case Vignette 1

“Calista,” an Indigenous Guatemalan mother with no formal education and a history of trauma, was referred to CPS for parenting concerns, including poor supervision and inconsistent school attendance. CPS viewed her expectations of a mid-teenager contributing to rent and work as inappropriate.

Through an in-home support program led by a clinician grounded in a decolonizing framework, Calista and her family were approached with cultural sensitivity and an understanding of their historical context. Instead of pathologizing Calista’s parenting, the clinician highlighted her strengths, especially her resilience and dedication to family unity—while also recognizing the systemic and historical forces that shaped her experiences.

When it came to the family’s financial hardship, the clinician created a safe space for the eldest daughter to share her perspective. The youth spoke about her deep love for her family, the extreme poverty that led them to leave their home country, and her role in contributing to rent as the oldest sibling. She also spoke about her mistrust of CPS and feeling that things were worse off with their involvement. She shared that she chose to leave her home and rent a bedroom on her own, given the challenges she and her family were facing. Through her living independently and reflection in sessions, she recognized the unique burden she carried compared with her younger siblings, who were raised primarily in the United States. She noted how working at a young age was necessary in her context but would be considered inappropriate or unnecessary in her siblings’ more economically stable upbringing.

This insight helped reframe her experience not as exploitation but as an expression of care, sacrifice, and cultural responsibility. The youth was then able to move forward and work toward obtaining her high school diploma through an adult education program while also keeping a job to support herself. She also continued to see her family and siblings. The clinician’s approach to bridging was neither shaming nor punitive. The intent was not to endorse underage employment but rather to meet the youth where she was at, with empathy and cultural humility—acknowledging the independence, responsibility, care, motivation, and resilience she has developed through her experience. The clinician also had to do their part in educating themselves on the history of the Indigenous population they were serving and to understand the historical and generational traumas that underpinned the family’s story, and to uplift the resilience and humanity they had.

A decolonizing approach requires this delicate balance: supporting the family’s unique needs while also ensuring safety to prevent further CPS involvement. In this case, it meant the youth refusing to see CPS but allowing herself to take advantage of the support of the in-home program that CPS put in place and funded. The strengths she possessed were then reframed as protective factors that could support her financial literacy and contribute to her long-term goals and self-determined future.

When servicing families, it is through modeling and actions that one can be an exemplar to others in the field who may not be accustomed to or know about this lens and approach. This approach helped prevent family separation and demonstrated the critical value of culturally grounded care.

What Works: A Decolonizing Clinical Framework

1. Neurodecolonization and mindfulness: Neurodecolonization recognizes how colonization shapes brain responses and trauma expression. Mindfulness rooted in Indigenous traditions can regulate the nervous system and promote healing.² This includes grounding, storytelling, and rituals tied to cultural identity, which offer more relevance than Western therapeutic techniques alone.³

2. Trauma-informed, culturally responsive parenting support: Programs must adapt to the literacy, language, and experiences of Indigenous families.^1,4 Instead of imposing behavioral norms, clinicians should validate survival strategies and cocreate culturally aligned parenting plans.⁵ For example, if the parent does not read or write, supporting the way they find easiest to navigate their world is more beneficial than inserting judgment about their lack of literacy skills or pushing them to take English classes. If the parent answers her phone reliably and does not use text message, then the clinician must shift their expectations and norms to that of the client. If there has been a concern around the parent’s engagement in services and the parent has 2 jobs and is not able to attend, it would be most ethical to offer an early Saturday session to meet the family’s reality. If the parental subgroup had previous difficulty setting boundaries around who was entering the home, a plan could be that the parent will work with the clinician in setting boundaries with family or unfamiliar individuals and considering other options to gather with friends so that the children in the home feel safe at all times.

3. Cultural genograms and talking circles: These tools allow families to map intergenerational trauma and resilience. Talking circles, in particular, create communal healing spaces where family members are seen, heard, and affirmed.⁴ Given that mental health professionals have perpetuated the ways of thinking of the West, constructing a binational genogram was reportedly helpful with migrants experiencing the transitions and tribulations of crossing borders.³ Bilingual social workers trained in biculturality and the use of natural helping and community-based healing were effective in working with Latine communities.³

Healing circles have been shown to facilitate resilience and support within undocumented communities.^6,7 According to the Talking Circle for Young Adults (TC4YA) intervention, they have demonstrated significant improvements in stress reduction, cultural identity, and behavioral health outcomes among Indigenous youth.⁶

Decolonizing Supervision: Supporting Ethical Practice

In the United States, Indigenous people have poorer health outcomes compared with other populations. The United States Census Bureau reported in 2018 that Indigenous communities had a poverty rate of 23.7% compared with 9.3% for non-Hispanic White Americans. Some Indigenous communities have 50% poverty rates.⁸ This demonstrates the negative impacts of systemic oppression. In the United States, European settlers engaged in war for land and brought disease, resulting in the death of 99% of Indigenous people.

The National Association of Social Workers’ Code of Ethics, ethics in research, and the Council on Social Work Education expect social workers to support the self-determination of oppressed groups,^9,10 underscoring the alliance needed from mental health professionals with Indigenous communities as well as emphasizing the responsibility of supporting justice, beneficence, and respect.

One of the current challenges in advancing decolonizing supervision is the influence of neoliberalism on social work, which reinforces managerial priorities and limits relational depth in the field. Unspoken norms—such as discouraging personal disclosure or enforcing rigid boundaries—can prevent clinicians from engaging in truly authentic supervision. By decentering (rather than rejecting) Western frameworks and integrating Indigenous and culturally grounded practices, supervision can become more aligned with social work’s core ethical values.^11,12 For instance, a supervisor might misinterpret a clinician’s effort to incorporate alternative ways of knowing as overidentifying with the client, rather than recognizing it as a culturally responsive approach to understanding the client through a different lens.

Horizontal Approaches

The history of social work and other mental health professions can be strengthened by honoring a wider range of ancestors and knowledge traditions. Doing so offers diverse perspectives on how the profession is understood and practiced around the world. Representation matters—when people see role models who reflect their identities and experiences, it helps them envision a meaningful path forward. Because Western frameworks tend to emphasize individualism, social workers and supervisors must also learn from Indigenous perspectives that value community, shared responsibility, and horizontal relationships.

Supervisors, in particular, should reflect on how their own personal and professional histories shape their approach to leadership. It is essential to recognize the colonial roots embedded in dominant ways of thinking to avoid unintentionally reinforcing oppressive systems. Many evidence-based practices are built on positivist epistemologies, which often exclude or silence other valid ways of knowing. To be truly inclusive, evidence-based approaches must make space for multiple ways of understanding and healing.²

Mayor and Pollack emphasize the Indigenous worldview as interconnected with the community, land, and holistic identity.^12,13 The helper is seen in their entirety. Reflexive practices must go beyond performance; they require understanding one’s complicity in oppression and acting accordingly.^12,13

Social work as a profession is global, yet its recognized founders are predominantly Western. Decolonizing supervision helps provide a decentered perspective. Recognizing only Western founders erases other knowledge systems and ways of being.¹ While one African model provides a local approach, there is a need for literature specific to Indigenous populations who have migrated and are navigating the tension between resistance and assimilation.

Referencing Laenui’s model of decolonization and Engelbrecht’s 3 stages (decolonization, authentication, and application) used in South Africa, US-based mental health professionals can adapt a localized model to mitigate the harm caused by hegemonic supervisory practices. Laenui’s stages of decolonization must be considered when advocating for oneself and supervisees. Engelbrecht’s framework can guide localized supervision models.¹¹ Using positionality, supervisors should reflect on their own lenses and how they influence supervision.¹²

Case Vignette 2

“Sara,” a Guatemalan immigrant, feels connected to her Indigenous roots and is in various stages of decoloniality. She resides on the Native lands of the Quinnipiac, Paugussett, and Wappinger peoples.¹⁴ Having experienced colonial trauma in her native country, she wrestles with her mixed identity of carrying indigeneity and European roots. Supervisors supporting communities like Sara’s must embed the 3 stages of decolonization and the 5 steps in authentic supervision into practice.¹⁵ Doing so offers a pathway out of assimilationist norms and toward authenticity. Engelbrecht outlines criteria for authentic social work supervision, which can be found in the Table.⁶

TABLE. Engelbrecht’s Criteria for Authentic Social Work Supervision

Reflections From the Front Line

I carry my patients’ stories, struggles, strength, and love with me in every breath. A hiatus is not about forgetting what I have seen or felt in the community; it is about restoring the energy I need to show up more wholly. I step back to replenish, to reflect, and to come back stronger, more organized, and more prepared to continue standing beside my patients and peers. I am not above them. I do not serve them as an outsider. I serve with them, as one of them—nothing less and nothing more. They are my people. They have always shown up for me, and it is their spirit that gives me the strength to heal others. The love, the resistance, and the resilience I have witnessed is what fuels my own healing.

But let me be clear: My anger is real. The things I have witnessed—families harmed by systems that pretend to help, cultures misunderstood or erased, children pathologized for surviving—have lit a fire in me. That fire is not bitter; it is purpose. It is what motivates me to keep returning, to keep fighting, to keep holding space for the community to heal, to reclaim, and to retain our beautiful culture and sacred ways of being.

Reimagining Mental Health for Indigenous Communities

To meet the ethical obligation of social work and ensure relevance to local populations, mental health clinicians need to have a decolonizing approach when working with individuals that carry Indigenous roots. Supervision must also be decolonized.² This involves expanding its scope, embracing cultural knowledge, and resisting the positivist, assimilationist, and colonial frameworks that have long dominated the field.² Decolonizing supervision requires attention to positionality, critical reflection, and local cultural understanding.¹¹ Supervisors should model humility, encourage reflexivity, and challenge institutional norms that devalue Indigenous knowledge.¹⁰

To adequately serve Indigenous communities, mental health systems must do more than integrate cultural elements into existing Western paradigms. They must reimagine their foundations. This includes decentering Eurocentric assumptions, embracing Indigenous epistemologies, and committing to relational, community-oriented care.¹¹

Healing is not just clinical. It is historical, cultural, and political. Mental health professionals must partner with Indigenous communities to jointly create pathways of liberation and healing that restore what colonization has attempted to erase.

Dr Gereda is a social worker in New Haven, Connecticut. Her opinions are her own.

References

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3. Gray M, Coates J, Bird MY, Hetherington T. Decolonizing Social Work. Routledge; 2016.

4. Morales FR, González Vera JM, Silva MA, et al. An exploratory study of healing circles as a strategy to facilitate resilience in an undocumented community. J Lat Psychol. 2023;11(2):119-133.

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8. American Community Survey. US Census Bureau. 2018. Accessed July 7, 2025. https://www.census.gov

9. Weaver HN. Native Americans overview. In: Encyclopedia of Social Work. Oxford University Press; 2013.

10. National Association of Social Workers. Code of Ethics. NASW Press; 2021.

11. Engelbrecht LK. Towards authentic supervision of social workers in South Africa. Clin Supervisor. 2019;38(2):301-325.

12. Mayor C, Pollack S. Creative writing and decolonizing intersectional feminist critical reflexivity: challenging neoliberal, gendered, white, colonial practice norms in the COVID-19 pandemic. Affilia. 2022;37(3):382-395.

13. Smith LT. Decolonizing Methodologies: Research and Indigenous Peoples. 3rd ed. Zed Books; 2021.

14. Native Land. October 8, 2021. Accessed July 7, 2025. https://native-land.ca/

15. Laenui P. Processes of decolonization. In: Battiste M, ed. Reclaiming Indigenous Voice and Vision. UBC Press; 2006:150-160.