This week, we spoke with Dr. Anitra Warrior. Dr. Warrior is the owner of Morningstar Counseling and Consultation in Lincoln, Nebraska, and is from the Ponca Tribe of Oklahoma. She earned her Ph.D. in counseling psychology in 2015 and has operated her clinic since 2012. She is also the director of the All Nations Crisis Hotline, a text-based service for Native people.
Listen to their conversation about how technology impacts Native communities below or on Apple Podcasts, Spotify or wherever you get your podcasts.
Listen to “Technology, Access and Crisis Support in Native Lands” on Spreaker.
Transcript
Larry: I’m really excited to be talking to Anitra Warrior, who’s a consultant, psychologist, Ph. D. in counseling psychology and has been working in the tribal communities in Nebraska for years. And there’s a lot I want to ask you, Anitra, because I think that there’s so many interesting questions that I have as somebody who is not part of the Native community and very much interested in how technology is affecting your community, especially young people, how you’re benefiting from it, how you’re dealing with the challenges and so much more. But why don’t we start by talking about the all nations crisis hotline, the work that you’re doing and how it impacts the Native American communities.
Anitra: Absolutely. Thank you so much, Larry. I’m really excited to be here and, and to share because exposure is going to be key for us, you know, across the country, even today, there are several communities that aren’t aware that Native people still exist. And so that’s part of the information that we want to be able to share as well.
But specifically with All Nations Crisis Hotline. That actually started through a partnership with one of the tribes in Nebraska, the Omaha Nation. And this was a result of the crises that we were seeing in the tribal community from the pandemic and access to quality health care. access to just overall support.
You know, if you remember during that time, the panic basically that was there. And when we start looking at our tribal communities and the limited number of providers that are there that are, you know, willing to travel to our tribal communities, we were in a tough, in a really tough position. Thankfully, you know, they were thinking outside the box.
They were able to get additional funding with their clinical services through SAMHSA and received a grant to do more outreach to the community. Because we provide behavioral health services there through Morningstar, we were able to do the crisis hotline and it just came at a perfect time because of the limited access that people were having with in person services.
So that was how the crisis line started after about a year the funding had ended. And so we funded it personally for a while. Poland kind of extended it to the state and then it became too much for us to handle on our own.
And so we partnered with the Santee Sioux Nation who got a Garrett Lee Smith grant through SAMHSA for suicide prevention. It is specific to tribes in Nebraska, but since the onset, we’ve had calls from Native people coast to coast and that’s been really eye opening for us to see that.
Even with the rollout of 9 8 8, we’re still having people that are wanting culturally specific, crisis services available to them.
Larry: And just for those who aren’t familiar with SAMHSA, it stands for Substance Abuse and Mental Health Services Administration. And that’s a federal agency, as I understand, which impacts all Americans, not just Native Americans, correct?
Anitra: Yes, yes,
Larry: absolutely. And speaking of all Americans, I mean, a lot of what you talk about is something that every community has to worry about, especially young people around the country. There’s been a lot of talk recently about mental health issues throughout, throughout the country, really throughout the world.
But let’s talk a little bit about the special challenges that Native American communities and especially Native American youth encounter that may be somewhat different than the challenges that other folks have.
Anitra: Yeah, that’s a great question. And you can go in a lot of different directions. with this, because when we think about the field overall, we have all of the research that has been done, but it hasn’t been done necessarily with the native population.
And the theoretical models that are out there, the diagnoses that are out there, do not necessarily take into account all the nuances of, of various cultures, the social norms, the beliefs. That’s actually why I came into the field, was because of my beliefs as a. And, and how they did not align with what my therapist viewed as healing or as healthy behavior.
And so through my own experience, it was, okay, I’m going to be a psychologist and I’ll have a better understanding of what Native people are experiencing when it comes to our cultural beliefs. And therefore not. pathologize what our culture is. So, those are going to be some of the things that we definitely have to keep in mind when we’re providing these services and we’re thinking about how unique the population is.
It really can come down to those worldviews and the differences in those as well as the customs, our tribal practices, and letting that be the guiding force behind What is healthy? What is healing? What does it look like? Not what the textbook says, not what the DSM says, but what the culture says, according to their lives.
Larry: That’s really fascinating. And I’m curious. As a Native woman and also a trained psychologist, does that ever present a conflict for you between sort of what your training tells you and what your experience or community tells you?
Anitra: Initially it did. And it impacted me, one, as a clinician. In terms of my expectations of what my workload should be, but then also in terms of how I diagnose.
So we definitely do a lot of consultation. There’s a lot of supervision, but for example, one thing that I’ll share with within my tribal community when you’re asked to do something. You say, you say, yes, it’s, it’s an honor to do something and you give to, to show that you’re thankful that you were considered to be able to do something for somebody else.
So there’s a lot of giving. This is basically a no no in the field of counseling or delivering that clinical service. Now, the way that this impacts me as a clinician is I can be asked to do presentations, to do reports, to do so many different things. And culturally, I have to take it on because that would be an honor for me to do that without regard for Burnout work overload.
And so there has to be that level for protection as a professional. Now, as. As a clinician, in what I’m doing, the specific type of model of therapy that I provide, when we’re done with that therapy, we’ve reached a point of healing where they can move, move forward without our services, we do provide a gift for them, we do provide a meal for them.
That is not typical of what you would see within the western methodologies. So that’s how those differences can impact you as a professional, but then also with how you deliver services.
Larry: I know that many Native American communities can be very closely knit and therapy is typically a very personal, very private, very confidential experience.
And does that present any issues in terms of, you mentioned the family, and you get your patient, your client, whatever you want to call them, and then you’ve got their family, their extended family, the tribe, the community? Do you ever have to worry about people getting in other people’s business, so to speak?
Anitra: We do based on what they share but not from what we share. And now this, this would not be just specific to tribal communities. This is going to be basically in any rural community or any specific population, even if they’re within a larger urban area. If it’s a subset of that city, they’re still going to be, we know these people, we have these connections.
So for us, You know, going back to, to using the term relative, this is, this is an intimate relationship between a provider and the person they’re working with. And we honor that by calling them our relatives because they will share with us things that they may not share with, with their blood family, things they may not share with others that are very close to them, but we have the honor of walking through that journey of healing with them.
And that’s why we refer to them as relatives. But there is an ethics code in terms of dual relationships. So even if we’re in that rural community or on a reservation, I would not see my best friend’s child as a clinician. And when it. When, when it comes to the text line, the support that we provide to one another and monitoring the calls and checking in, we make sure that this person does not have the relationship with whomever is, is making the text to our, our hotline.
Larry: Yeah, it seems like you put a lot of thought into trying to maintain sort of the cultural norms of the community and at the same time the ethics and practices of the profession of psychology, which is great. You know, you talked a little bit about rural versus urban, and I’ve been thinking about that, Chris, our producer, who I know you’ve worked with in the past, and I were talking earlier about there are many folks who live on native lands, and there are many folks who don’t, who live in cities and suburbs across the country.
Yeah, absolutely. And I’m curious how that works to the advantage and disadvantage. If you’re, for example, a teen living on native lands versus a teen living maybe in a rural community, hundreds of miles from, from a native land, living among a different culture.
Talk about the pros and cons from a mental health standpoint and from a resource allocation and also how the internet can play a role for good or bad in that situation.
Anitra: Yeah, you know, and that’s really going to be very broad in terms of what the pros and cons may be because that’s going to be dependent on, you know, The tribe and what they’re able to offer.
So here within Nebraska, there is at least one tribe that I’m familiar with that if you’re not living within the reservation boundaries, you’re not able to vote in terms of what happens with their, their tribal government, any new policies that may come into play that will affect the tribe overall.
But if you do not live within those boundaries, you’re unable to vote on those. That can also impact what services might be available in terms of Indian Health Service. So, as we think about clinics, because if you do not live within the service delivery area, then you’re not going to or the reservation, you’re not able to receive medical benefits that might be available.
With the, the pros is that sense of community. We often talk about the social determinants of health with education, with housing, with financing. And, you know, we can see that there are definitely a lot of disparities. There are also a lot of strengths.
And that’s the piece that we want to focus on are going to be those strengths that we’re seeing, but all of that can contribute to overall mental wellness, physical health, longevity. Those are really important factors for us to take into consideration.
Larry: One of the advantages historically. of the online world for people who are in any kind of either marginalized communities or communities that are simply spread out very thinly. So you could be an LGBTQ person living in a part of the country where there are very few LGBTQ people or resources.
Go online and get access to people and resources that you couldn’t possibly get within driving distance from your home. I would imagine the same might be true with somebody who’s native american who lives very far from a reservation being essentially isolated. Do you find that the internet has helped break down that isolation?
Anitra: It was you know during the pandemic. One of the major pages that came up on Facebook was this social distance powwow and powwows are huge for us. Just a wonderful way to gather, to trade, to be a vendor. Sell things to dance, to eat. I mean, just wonderful events that we have all across the country that was gone in 2020 for the majority of 2021 and what.
What our people were able to do was create this Facebook page and people were sending in dance videos and they were, they were dancing to healing music that they were sharing and recognizing people. And then it became, you know, like a national phenomenon that we were seeing and it was. Something that it seemed like people were checking daily, like who is dancing, what is being shared, or even just to hear the music.
That was what technology was able to do to bring culture together. And I think that’s so, so beautiful for us to be able to share that.
Larry: And just as I have been a guest at powwows in the past, even though I’m not Native American, I would assume it might be possible to, assuming I would have been welcome, Absolutely.
Yeah. It’s interesting. Mm hmm.
Anitra: Mm
Larry: hmm.
Anitra: Yeah. Because it’s a completely open page. So anyone could, could do it. And even now that we’re able to have it in person, people are still very active on that page.
So I think accessibility has really been huge in this. One of the studies that I always reference when I’m talking about healthcare for Native people is a study that was done by HRSA.
There are three contributing factors. That’s accessibility. Accessibility and anonymity and what we run into in rural areas is you go to the clinic. People are going to know that you’re there. They’re going to know why you’re there because it’s such a small community. Now, what we’ve been able to have with technology is that anonymity through telehealth.
No one knows when you’re in session. No one knows who you’re working with. And that’s been really phenomenal in terms of increasing outreach to, to communities and individuals, which can also have an impact on acceptability, which was another piece that we talked about. So with technology, that’s been huge in terms of promoting the service.
The other piece that I really love is how, We’re adapting what just marketing materials look like as well. So being able to create artwork that is going to be more reflective of who we are and incorporating that into the work and sharing that, so it’s helping integrate, it’s helping with exposure and then reducing that stigma that’s associated with receiving services.
Larry: Yeah, and the only thing I worry about in terms of mental health, tele mental health, is if you’re in your home and a family member might be in earshot of your, what should be your confidential conversations. I don’t know how you handle that, but that’s what kind of what’s held me, not held me back, but I’ve thought about that in terms of doing therapy at home.
197241 And we do discuss that. So I’ve actually been providing telehealth services since 2014. So well before the pandemic, but it was because I was serving rural communities. And we always have that discussion, making sure that they’re in a private location. I’ve had relatives that have wanted to do a session in the car with the kids and where they’re like, no, absolutely not.
A couple of weeks ago, I had someone who wanted to do a session at a laundromat. Absolutely not.
Larry: Well, they’re cleaning out there, you know, airing their dirty laundry, so to speak.
Anitra: Right. So, but, as a clinician, I had to make that decision and let them know, I respect your privacy and your space and your story.
I’m not going to allow that to be shared openly to everyone. And so I wasn’t comfortable having a session, even though the relative was like, no, I’m fine with us doing it here. I have too much respect for you and your life to do that. We just can’t make it happen that way.
Larry: So the technology is part of the solution, but there’s other issues. There’s sort of human issues as well. For older folks, sometimes it’s fear or simply inability or their perceived inability to master the technology. With the younger folks, sometimes it’s, some people call it tech addiction, overuse, obsessive use sometimes it’s inappropriate content.
There is a question of child exploitation vulnerabilities. Give me your thoughts on how that’s impacting the Native community. Those broad issues about the elders being reluctant and the kids maybe using it in inappropriate ways.
Anitra: You know, just before we met, I had shared with you all that I was wrapping up a session and the session that I, that I was having was with a woman who was almost 80 and she’s been doing very well with, with using the zoom capabilities and so it’s really going to be different per individual, you know, and we have some that will absolutely not do telehealth in terms of the video camera, but they will do phone.
And so we’ve had to be really flexible in that based on what, what they’re comfortable with.
Something that I would highlight that has really been a positive for us is. That the social movement, the understanding of missing and murdered indigenous women and how we’ve been able to share more and more information about this, because this, this has just been horrific in terms of the length of time that this has been happening with crimes against native women without there being full investigations, without it actually being reported.
And now we’re seeing that we’re, there are responses at the state level, at the federal level to where now this is an, this is an issue. Just yesterday, we were dealing with this. This has been part of the benefits of the crisis text line. We had someone who was being sex trafficked because of our team members and the uniqueness of the understanding of the tribal communities.
We were able to help a woman find housing on another reservation and escape that. Now we don’t know where she is today, but we were able to help her in that crisis situation. That was the benefit of the technology.
Larry: And I imagine that would have been much more difficult if she didn’t happen to have a local resource, you know, prior to the technology, being able to bring people in from elsewhere to help her out.
Anitra: Absolutely. Absolutely.
Larry: Well, that brings up the question I was going to ask you about specific examples where technology has significantly helped in crisis intervention. Do you have any other examples or anecdotes to share about ways in which you’ve been able to intervene?
Anitra: Yeah, you know, the anonymity that is there, and I talked about that being an issue with what HRSA reported.
And with this, Not everyone through our tribal communities has the same beliefs. Every tribe, you know, they have different languages, different customs, and practices. And some vary in their beliefs about our creator. For many, prayer and our belief in the spiritual unknown is really important to us.
And within our team members, we have individuals that are very involved with the culture that have that strong knowledge and connection and commitment to that level of healing. One way that we were able to serve a woman who was all, who was also experiencing a very violent situation was prayer. And our agent was able to pray with her.
Through text and that was amazing and we were able to monitor the text, monitor the prayer as it’s happening through the application that we have for our text line. And it was actually just really beautiful to be a part of that and know that. You can text somewhere and get a culturally responsive prayer that understands what it is to be Native and the belief that we can have in the Creator and how that can help us as we’re going through our healing process.
So I think that was another way that, We wouldn’t necessarily think about technology in the Native community.
Larry: And that’s not something that would occur to me, but it sounds very powerful. And I’m also glad you brought up the fact that, I mean, we have a tendency, I think, in every culture to look at other cultures in a very monolithic way, a culture that we’re not familiar with.
And I’m, I’m quite sure that there’s an enormous diversity of political opinions, religious values, financial levels. As there is in any community. Absolutely. Yeah. It’s important for you to understand that. What about your own, you, not just you personally, but all the folks that are doing this kind of work, your own mental health?
I mean, I know I used to be on the board of the National Center for Missing and Exploited Children and we invested considerable resources in protecting our staff because they were dealing with issues and images that frankly would be haunting and disturbing for many people. So who’s protecting the protector, so to speak?
Anitra: You know, within the Native community That’s the key word community. And we’re all related. And that’s how we operate our text line, All Nations is actually under our nonprofit, which is Healing Roots.
And so we started that in 2020 but it’s very closely tied to our counseling business Morningstar. And so they work hand in hand. So we monitor, of course, the techs, we do check-ins with our team members, we cover each other’s shifts, especially when there are cultural events, family events one of our, one of our providers or our agents leads many cultural events is often called upon to be there for families.
When that happens, we give him that time. We give him that, you know, an extra day off to make sure that he’s being taken care of. We also have clinicians that are on board that are there for consultation. We monitor, as I mentioned earlier, we monitor the chats and can do check-ins to make sure that the person is okay, to make sure this isn’t someone they know.
So it’s kind of like all throughout the process. We’re checking on you to make sure that you’re okay. And we have regular consultations with each other, seeing, do we need to do anything additional for, for one another?
Larry: You know, it strikes me that given both your training and your experience in dealing with what’s often considered an at risk population that you may have some insights that could benefit other populations.
Any, any kind of advice for folks that are dealing with other at risk populations?
Anitra: Yeah. And thank you for asking that question. I think the first, the, the first thing that I would recommend is to pause before giving a response and really hearing, so you can understand from their perspective. And. We all have biases.
That’s, that’s just there. We all have biases and being able to check in with ourselves and make sure, like, am I interpreting this as something that applies to me? Or am I interpreting it as something that applies to them? And that’s going to be really important. So pause, check yourself and see, you know, where is it?
Where is the support that I’m providing? Where is it coming from? I think that’s really going to be huge. And then the second take, a piece of this that would really come from our teachings as native people is just being a good relative and taking care of one another. We all, we have, we have all of these policies and procedures and, and we want to make sure that we don’t lose sight of the fact that we’re human.
And that human connection is hardwired in us. And it’s important for us just to make connection and respect each other’s lives. So be a good relative.
Larry: And unfortunately, I’m sure there are some people who are not being good relatives and I’m thinking about cyberbullying both within the Native community and between non Native communities, you know, where it was, you know, coming from outside the community as well.
So I’m going to talk a little bit about cyberbullying within the community and also just to basically the racism that sadly exists in our society where people who are othered or marginalized or different are sometimes mistreated by other people, other cultures.
Anitra: Mm hmm. And we definitely see that even with responses to what we provide.
And it being the woke service, you know, and it has nothing to do with that. There’s no political agenda to being a good relative. Right. There’s no political agenda to being a good human being; we do get those types of harassment. We see covert, overt racism all throughout, even, even as a behavioral clinic and the way that we can be treated by other professionals that at times it’s been really interesting.
There is research that has linked high blood pressure to accounts of racism and what people have experienced. So, you know, it does take that physical toll on people. So I think that that’s also really important for people to understand.
Larry: We do have to wrap up soon, but you know, the name of this podcast is, are we doing tech right? And I guess that’s my question. If you could advise, you know, the metas, the Googles, the Amazon, the tech talks of the world, what advice would you give them in terms of what they can do to help support you in your community, to better support you in your community?
Anitra: I love that question and one is definitely reaching out to our communities and, and seeing what, what is going to be representative of who we are, what might be different ways that we can increase accessibility. What might be different ways that we could even change the landscape to where it’s maybe even bringing more people into tech.
The other piece that I’m thinking about that with, which is always important to me, is workforce development. And okay, how are we bringing in people from these rural communities, from these reservations? And also allowing them to have a voice in what that development looks like, because I can’t speak for every tribe and what, what they might want to recommend, but if we can get more representation from these communities, that’s really going to enhance our critical thinking and really give us the opportunity to improve what that tech can do within our communities.
Larry: Great answer. Dr. Anitra Warrior, thank you so much. Looking forward to being in touch with you in the future as well.
Anitra: Thank you so much. I really look forward to talking with you again.