Schizophrenia is a chronic and incapacitating brain disorder that impacts both the patient with the condition and those who must care for them.

The disease affects about 1.1% of the US population age 18 and older according to NIMH, and is characterized by a variety of symptoms such as hallucinations and delusions, among other things. Symptoms usually develop in men in their late teens or early twenties and women in their twenties and thirties, but can even appear in childhood.

Like other healthcare systems, IHS treats patients with schizophrenia. IHS has not conducted a specific survey on schizophrenia prevalence. However, Peter Stuart, MD, national consultant for Psychiatry for Indian Health, pointed to a 2007 study published in BMC Psychiatry examining two tribal population groups that found that the occurrence of schizophrenia among members of the two groups studied was consistent with prevalence rates in the general population.

American Indians and Alaska Natives (AI/ANs) may possibly fall in the lower range in terms of prevalence and incidence of schizophrenia in the US, according to Stuart. “In rural areas you tend to see lower rates of schizophrenia. I want to caveat that with the fact that we support a very diverse population. It has been predominantly rural over the years, but in the last decade or so the urban part of the AI/AN has grown significantly and we really don’t know a great deal about what is happening in those settings.” He pointed out that one interesting study to pursue would be to compare schizophrenia prevalence rates between urban and rural AI/AN populations.

Caring for Patients

IHS is unique in how it is organized and provides care. About 60% of mental health services are tribally operated rather than federally operated, according to Stuart. AI/ANs are very diverse with over 500 recognized tribes. “This is where we are very different from the VA and DoD, we are not a monolithic organization.”

Stuart says that many IHS sites have active behavioral health programs, though like the general population, rural areas often experience shortages of mental health professionals. Antipsychotic medications to eliminate the symptoms of schizophrenia are also available to IHS beneficiaries.

It is important to have providers who are culturally attuned to the population to avoid the over diagnosis of psychiatric disorders, noted Stuart. “Certainly, in our more traditional communities, the way people talk about certain kinds of experiences, the way they deal with dreams or visions may be quite different than how the predominate ethnic groups in those areas perceive those things. It does speak to the importance of having culturally attuned providers providing the services, and we do work hard in IHS to orient providers to these issues.”

IHS has made an effort to encourage AI/ANs to pursue training in social work, counseling, and psychiatry, which Stuart said, “adds some protection in terms of reducing the likelihood of misdiagnosing a normal cultural experience as a psychotic experience.”

In addition to the use of modern medicine, there is an increasing appreciation for the role of traditional healers in helping patients, including those with serious mental illnesses like schizophrenia. IHS now has a number of sites with active “traditional medicine” departments that provide access to a range of locally accepted traditional healing approaches.

These can include providing interventions through practices such as sweat lodges. “We have patients who are actively engaging in a variety of traditional healthcare practices for treatment of their psychotic condition. In the past, that wasn’t something you talked about in the clinic.”

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