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More than twenty-five percent of the US American Indian* population 
lives at or below the poverty line; unemployment is nearly ten percent higher 
than that of the general population (U.S. Census, 2006). On or near reserva-
tions, the numbers are much higher. American Indian youth commit suicide at a 
rate three times that of the general population, (Indian Health Services [IHS], 
2001) while American Indians as a group have a higher mortality rate due to al-
coholism than any other group in the US (Gray & Nye, 2001). The following will 
examine both the mental health and socioeconomic condition of this community 
in order to understand the ways in which the experience of poverty and the high 
rates of poor mental health might relate. There are a number of challenges fac-
ing the American Indian community; this paper will explore poverty as only one 
of the potential factors adding to the mental distress exhibited in the population. 
Poverty is defined from both an absolute and social exclusion perspective. The 
suggested influences on mental health include economic stress, sociohistorical 
trauma, and isolation from institutional resource.

  overty can be explained as an absolute and in terms of social exclusion. 
Absolute poverty refers to a fixed measurement of paucity. In the United States 
this measurement is defined by the poverty line. All individuals who earn an 
income less than or equal to the federally mandated poverty line are considered 
to be living in absolute poverty. Poverty defined in terms of social exclusion 
refers to a lack of institutional resources. This formulation has less to do with 
one’s financial standing, and more to do with the non-monetary variables that af-
fect a person’s life. Silver and Miller (2003) champion the use of the concept of 
social exclusion as a way to encourage a multidimensional understanding of the 
experience of poverty. According to the European Union (2004), social exclu-
sion refers to the process by which individuals are systematically marginalized, 
resulting in consistent disadvantage in terms of educational resources, hous-

Larkin Sealy

P

PoverTy and menTal HealTH in THe ameriCan indian 
CommuniTy

*Because the term American Indian is used by the National Congress of American Indi-
ans, the nation’s largest inter-tribal organization, it will be used throughout this paper to 
refer to Native Americans or First Nations people living in the United States.



19

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ing conditions, employment opportunities, formal justice, political participation 
and freedom of cultural expression. Silver and Miller expand this definition to 
include the degree to which discrimination or racism affect economic and social 
opportunities. Exclusionary poverty should not be confused with a lack of in-
terpersonal or cultural assets, but instead understood as inopportunity for equal 
resource acquisition at the institutional level. While closely related, absolute and 
exclusionary poverty offer different insights into the ways in which individuals 
experience being poor. 

Poverty in the American Indian Community

The experience of the US-based American Indian population† offers a rich 
context within which to examine the association between mental health and pov-
erty. American Indians live in some of the most economically depressed condi-
tions in the country and experience significant rates of mental illness. (Beals, 
Piasecki, Nelson, Jones, Keane, Dauphinias, Red Shirt, Sack & Spero, 1997; 
Andersen & Brownson, 2000, Harris, Edlund, & Larson, 2005). It is therefore 
important to examine the factors and influences that have gone into shaping 
these conditions within the community. 

One factor greatly affecting the American Indian population is poverty. In 
absolute terms and according to the 2000 U.S. Census, nearly twenty-six percent 
of American Indians nationwide live below the poverty line; among the fifteen 
major tribes, this statistic ranges from almost forty to no lower than fifteen per-
cent. For American Indians living on or near reservations, the unemployment 
rate is at forty-nine percent, with thirty-four percent of those working still living 
below the poverty line (BIA, 2003). These numbers show improvement from 
only a decade earlier and yet they still signal serious economic trouble within 
the community. In their exploration of the impacts of the socio-historical experi-
ence of American Indians, Kawamoto (2001) and Beals et al. (1997) highlight 
the exclusionary element of poverty within the community. The multiple histori-
cal traumas endured by the community, coupled with cultural and geographical 
marginalization from the mainstream, have left many resource gaps. Impacts of 
cultural assault enacted through a number of assimilation-focused U.S. policy 
choices can be clearly seen. The 1881 policy prohibiting the practice of Ameri-
can Indian ceremonies, the Dawes Act of 1887 which took from the American 
Indian population nearly 93 million acres of tribal land, the infamous Indian 
Boarding Schools, and the Termination and Relocations Acts of the 1950s are 
only a few such policies. These violent interruptions to tribal life have left much 

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of the American Indian community with limited resources. Efforts to maintain 
tribal communities have consistently been challenged, as has access to full par-
ticipation in the majority culture. The effects of poverty, in the form of economic 
deprivation and social exclusion, as influenced by racist US policy and margin-
alization, are felt on a day-to-day basis.

While reservations in many ways ensure cultural growth and sustainability 
– and for those tribes that escaped removal, a connection to tribal homelands – 
the economic and social conditions on reservation are such that residents often 
go without basic amenities. Currently, slightly more than half of the American 
Indian population lives off the reservation, but the reservation environment is 
still important to explore for a number of reasons. Not only have reservations 
played an important part in the recent history of the community, but the major-
ity of the people living on reservations are younger than those living outside of 
tribal lands (U.S. Census, 2002). This means that for the most part, the newest 
generation of American Indians is being brought up in an environment with ex-
tremely low employment rates, poor housing quality and a host of other indica-
tors of poverty. In addition, Lobo (1998) asserts that most American Indians 
living in urban settings still have a strong sense of “back home” in regards to 
tribal lands. She notes that return visits to reservations and rural territories for 
family and cultural events are common. There has been a consistent history of 
migration between urban sites and reservations within the population (Snipp, 
1997). Finally, conditions on the reservation also offer an interesting perspective 
with regard to the relationship between mental illness and poverty. The fact that a 
great portion of the American Indian population operates in a different economic 
sector from the rest of the country, and as such is removed from direct socioeco-
nomic competition with national peers, challenges the commonly held belief 
that individuals with mentally illness slowly drift towards poverty as a result of 
their inability to successfully compete for societal resources. Reservations offer 
the opportunity to observe the relationship between mental health and poverty 
outside of the influence of direct competition. 

Mental Health Issues in the American Indian Community

Compromised mental health is an area of great concern within the Ameri-
can Indian community. Specifically suicide, alcoholism, and post-traumatic 
stress disorder (PTSD) all exist at levels higher than that of the general popula-
tion. The importance of examining poor mental health and its causes within the 
American Indian community is made abundantly clear when looking at mortal-

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ity statistics. Suicide is the second leading cause of death for American Indians 
between the ages of fifteen and twenty-four and occurs at a rate twice that of the 
national average (IHS, 2001). For American Indian youth between the ages of 
fifteen and nineteen, this statistic rises to three times that of the national average 
(LeMaster, Beals, Novins & Spero, 2004). Deaths related to alcoholism are high-
er for American Indians than for any other racial group in the US, at four times 
the national average. Moreover the loss of productive years of life due to alcohol 
abuse is nearly five times the national average (Cameron, 1999). LeMaster et al. 
note that while the occurrence of PTSD in a random selection of American In-
dian participants from one community was nearly twenty-two percent, findings 
for other American-based populations typically range from one to nine percent. 
Gray and Nye (2001) note that this percentage is equivalent to that seen in sur-
vivors of traumatic events such as mass shootings, major burns, and combat. 
PTSD is often found in tandem with depression, substance abuse, anxiety, and 
violence, which makes its exaggerated presence in portions of the American In-
dian community a source for real alarm. In a study comparing the mental health 
status of women of differing ethnic backgrounds in the United States, Andersen 
and Brownson (2000) showed that American Indian women exhibited the high-
est rates of depression of any other group. Because of the extreme nature of the 
mental distress present within this community, it is critical to try and understand 
the factors driving it. Examining the relationship between the deterioration of 
mental health and the consistent experience of poverty may offer some insight 
and thus lead to better strategies for addressing the problem.

Poverty’s Impact on Mental Health

Within the United States, the relationship between mental health and pov-
erty is often explained through a causal lens: poor mental health acts on the 
individual to increase his or her potential for poverty-level existence. The practi-
cal and imposed hurdles to social and economic functioning encountered on a 
day-to-day basis by people with mentally illness may compromise their ability to 
stay afloat in American society. Individuals suffering from mental illness either 
find themselves drifting to the bottom of the socioeconomic pool or barely able 
to keep their heads above water. 

While there is definite value in recognizing this directional link between 
mental health and socioeconomic standing, it is also important to examine the 
relationship through an inverse lens. In order to truly grasp the nature of mental 
illness as well as the effects of poverty, it is imperative to explore the ways in 

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which poverty may also intensify the potential for poor mental health. Link and 
Phelan (1995) suggest that the more commonly held belief about the interplay 
between mental health and poverty is reflective of a Western vision of the world, 
wherein a kind of sanctity is assigned to the responsibility and agency of the 
individual. What can sometimes be problematic about this perspective is that it 
does not allow for human vulnerability to external influence. By giving weight 
to the alternative analysis, a departure from the dominant perspective is possible 
and a more nuanced understanding of the potential for successful interventions 
in mental health and poverty work can be attained.

There are a number of identifiable points of intersection between the effects 
poverty and mental health within the American Indian community that seem to 
confirm Link and Phelan’s (1995) proposed explanation of the relationship be-
tween these variables. These authors state that an individual’s health must be un-
derstood from within their socioeconomic context because it is only from within 
that context that all of the risks factors an individual encounters can be clearly 
seen. Link and Phelan urge the health community to use this contextualization 
to begin to identify the circumstances of poverty that may act as “fundamental 
causes” of poor health. Kawamoto (2001) locates these “fundamental causes” 
in American Indian history. Alcoholism, other forms of substance abuse, sui-
cide and PTSD can all be linked to a historically-born exclusionary poverty. He 
references the communal memory of the Indian Boarding Schools which did 
not allow children to speak their native language, practice their own religion, or 
connect with their families on a regular basis; the 1954 Termination Act which 
saw 109 tribes formally dissolved and 109 communities scattered; and the 1956 
Relocation Act which encouraged the dissolution of a portion of the remaining 
nations into large American urban centers. Kawamoto argues that each of these 
key periods or moments in American Indian history, instrumental in inflicting 
the exclusionary elements of poverty, have served to create a sense of hopeless-
ness and loss of control in the psyche of the community. Duran, Duran, Brave 
Heart, & Yellow Horse (1998) also contend that beyond the immediate economic 
stresses encountered within the population, the traumatic history of genocide, 
displacement, and cultural assault has resulted in what they term a “soul-wound” 
within the American Indian community. Szlemko, Wood, and Jumper Thurman 
(2006) suggest that the pervasiveness of alcoholism may be in part an attempt 
to medicate the sense of loss and alienation produced by this communal shock. 
The pain that has resulted from these historical experiences, which were very 
much a part of growing exclusionary poverty, has tipped the scales of health in 

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the American Indian community.
Johnson and Tomren (1999) also look at the roots of alcoholism and suicid-

al behavior through lens of the poverty with special attention paid not only to the 
historical events that have played a part in shaping the health of the community, 
but also to current experiences. Johnson and Tomren contend that most schools 
do not cater to American Indian children’s sense of cultural functioning nor do 
they address any language needs. American pop culture also moors American 
Indian identity in the past, often stripping the community of any contemporary 
agency, and racism and cultural marginalization keep many American Indians 
alienated from an ever-present mainstream. Johnson and Tomren suggest a po-
tential connection between these larger experiences of disaffection and the feel-
ings of anomie, helplessness and hopelessness that often accompany suicide. 
Whitbeck, McMorris, Hoyt, Stubben, and LaFromboise (2002) contend that as 
a result of the pervasive economic deprivation and social stress encountered by 
many American Indian communities, some individuals experience high levels of 
consistent depression, which in turn increases their potential for suicidal ideation 
and substance abuse. They specify that continued financial strain as well as feel-
ings of unrelenting social assault, in the form of experienced or perceived dis-
crimination or racism creates significant social stress. This in turn compromises 
the individual’s capacity for free, unfettered development, increasing their risk 
for developing mal-adaptive behaviors. 

Gray and Nye (2001) write specifically about the prevalence of PTSD in 
the community and also connect it to the larger context that surrounds many 
American Indian lives. They assert that the trauma that comes with constantly 
living under economic and social stressors can eventually take its mental toll. 
Robin, Chester, Rasmussen, Jaranson, and Goldman (1997) suggest that the 
American Indian community’s disproportionately high exposure to traumatic 
events accounts for the unusually high rates of non-combat related PTSD. Ac-
cording to their study, which was conducted in a Southwest American Indian 
community, the traumatic events most often cited by individuals suffering from 
PTSD included motor vehicle accidents and the death or severe injury of a loved 
one. These are events often linked to alcohol abuse and suicide, the high rates of 
which have been shown to be the result of or at least greatly exacerbated by the 
poverty experienced in the community. Brave Heart (1998) expands this analysis 
even further, suggesting that American Indians as a community are suffering 
from Historical Trauma Response (HTR) as a result of hundreds of years of 
traumatic events. All of these authors maintain that the damaging effects of the 

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acute poverty experienced by the American Indian population, both in absolute 
and exclusionary terms, has had an undeniable effect on the mental health of the 
community.

Changing Poverty; Changing Mental Health

Costello, Compton, Keeler, and Angold (2003) present a relevant study in 
which they track the mental health of a group of children from varied socioeco-
nomic backgrounds. About one quarter of the study participants are American 
Indian children from one reservation, while the rest are White children from the 
surrounding area. In the middle of the eight-year study, a casino opened on the 
reservation and each American Indian family began to receive a benefit from the 
casino profits in addition to their annual income. Each year the benefits went up, 
and by the end of the study each family was receiving an additional six thousand 
dollars per year—almost half of what a family of four living at the poverty line 
would have made at the time of the study. While the American Indian children 
who qualified as persistently poor had scored much worse on their mental health 
evaluation in the first years of the study, four years after the opening of the ca-
sino almost all of the behavioral problems that the American Indian children had 
been exhibiting improved to the point that they were on par with the non-poor 
White children in the group. It seems that relieving poverty in absolute terms 
was having a measurable impact on the health of the community. Unlike the be-
havioral problems, many of the emotional problems that had occurred with more 
frequency among the poor American Indian children still remained. Costello et 
al. suggest that this may be because emotional dysfunction takes more time to 
rectify itself with intervention than do behavioral problems. Another analysis is 
that while the relief of absolute poverty can bring about some definite improve-
ment in the mental health of the community, it is not a panacea. Kawamoto 
(2001), Szlemko et al. (2006), Johnson et al. (1999), Whitbeck et al. (2002), 
Gray and Nye (2001), Robin et al. (1997) and Brave Heart (1998) all suggest that 
the long-term effects of exclusionary poverty are very real and cannot be eased 
so quickly. The Grand Traverse Band of Ottawa and Chippewa Indians have at-
tempted to address this long-term damage by using gaming profits to create a 
comprehensive health department, complete with counseling and psychological 
services (Cornell, Kalt, Krepps & Taylor, 1998). They are only one in a great 
number of tribes that have taken similar action (Taylor & Kalt, 2005; Grant, Spil-
de & Taylor, 2004; Cornell et al., 1998). Grant et al. (2004) suggest that using 

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increased revenue in tribal communities in this way not only increases personal 
funds, but elevates the quality of life.  With the means to attend to problems, both 
through direct services and by building on strengths with the creation of culture 
and language preservation programs, heritage centers, and community building 
initiatives, the American Indian community can continue to heal and strengthen 
on a holistic level. Real change in the health of an individual can be found by 
assuaging economic hardship, but improving poverty must also involve attention 
to in one’s lived experience. 

Conclusion

The American Indian population is just one example of a community that 
is currently experiencing great stress due to poverty. The challenges that poverty 
creates are felt on a day-to-day basis, and are only amplified when the person in 
poverty is not a member of the majority race or culture. By understanding mental 
health not only as a determinant of poverty, but also as an outcome, we can begin 
to develop productive treatment models. Gray and Nye (2001) argue that if it 
seems preposterous for a mental health practitioner to treat a young woman suf-
fering from PTSD without addressing a past experience of incest, then it should 
seem preposterous to treat the mental health of the American Indian community 
without addressing the experience of poverty. Bringing to bear the ill effects of 
the larger context of poverty on the mental health of an individual has great im-
plications for the future well being of the American Indian community, as well 
as for the wider populations of poor. If we can engage in treatments that take into 
account the observable strain that results from the experience of poverty, both 
in absolute and exclusionary terms, honest and productive health care can begin 
to happen.

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LARKIN SEALY is a first year master’s student at CUSSW. She is plan-

ning to continue her studies at the School of Social Work within the Advanced 

Generalist Practice and Programming method. Her concentration will be in 

Family, Youth and Children’s Services. Larkin’s current field placement is at 

the Antonia Pantoja Preparatory Academy in the Bronx. She holds a bachelor’s 

degree in Sociology from Vassar College. Her email address is las2208@

columbia.edu.

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