Then he is brought back to share the vision with the medicine man and to integrate the experience into his life. Of course, capacity is the elephant in the room. There is far less capacity (i.e., sufficient numbers of sufficiently expert personnel) than needed in most AI/AN locales. In some locales, especially small, rural, AI/AN communities, expert treatment and care are almost non-existent. It is obvious that greatly increased capacity (i.e., funded positions) is required to meet the need for behavioral health services dealing with depression, substance abuse, and behavioral problems. For example, May described ramping up the capacity in the Navajo Nation over a 10 year period. This cultural intervention consisted of comprehensive health services developed and delivered over a 10 year time period, as an Adolescent Suicide Prevention Project. Upon community input, it broadened to address the complete array of underlying issues. It obtained active involvement of the community in assessment and planning, ultimately being institutionalized as a tribal behavioral health department. Interventions included education and awareness raising; identifying and monitoring risks; identifying high-risk persons and families; outreach/screening/intervention in service institutions and social venues; school-based life skills and other interventions; natural helpers for advocacy, referral and non-professional counseling; and professional mental health delivered in community settings. The capacity was increased over the period from 1.2 full time equivalents (FTE) to 57 FTE. Outcomes were reduced suicide gestures and attempts. Increased numbers of funded personnel positions is not an easy solution. Another solution is to increase the productivity of existing personnel. The capacity gap is so huge and so crucial, that increased suicide, violence, and substance abuse prevention training for existing personnel can be considered a system-wide strategic imperative, per se.
Then he is brought back to share the vision with the medicine man and to integrate the experience into his life. Of course, capacity is the elephant in the room. There is far less capacity (i.e., sufficient numbers of sufficiently expert personnel) than needed in most AI/AN locales. In some locales, especially small, rural, AI/AN communities, expert treatment and care are almost non-existent. It is obvious that greatly increased capacity (i.e., funded positions) is required to meet the need for behavioral health services dealing with depression, substance abuse, and behavioral problems. For example, May described ramping up the capacity in the Navajo Nation over a 10 year period. This cultural intervention consisted of comprehensive health services developed and delivered over a 10 year time period, as an Adolescent Suicide Prevention Project. Upon community input, it broadened to address the complete array of underlying issues. It obtained active involvement of the community in assessment and planning, ultimately being institutionalized as a tribal behavioral health department. Interventions included education and awareness raising; identifying and monitoring risks; identifying high-risk persons and families; outreach/screening/intervention in service institutions and social venues; school-based life skills and other interventions; natural helpers for advocacy, referral and non-professional counseling; and professional mental health delivered in community settings. The capacity was increased over the period from 1.2 full time equivalents (FTE) to 57 FTE. Outcomes were reduced suicide gestures and attempts. Increased numbers of funded personnel positions is not an easy solution. Another solution is to increase the productivity of existing personnel. The capacity gap is so huge and so crucial, that increased suicide, violence, and substance abuse prevention training for existing personnel can be considered a system-wide strategic imperative, per se.
CBIdescription5rev2b11Jan2010.docx