Barriers to healthcare for American Indians experiencing homelessness

ABSTRACT

Members of American Indian (AI) communities face many barriers to receiving both mental and physical healthcare. These barriers can have a negative effect on overall health. Barriers are compounded for AIs who are also experiencing homelessness, and AI make up a disproportionate percentage of the homeless population nationwide. In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants in a mid-size Midwestern city to identify barriers to care for homeless participants. Key barriers identified in this study for homeless participants were: transportation, phone accessibility, discrimination, and cold and bureaucratic cultures of healthcare systems. Major barriers identified by service providers were: access to care, discrimination and mistrust, and restrictive policies. Given generally higher disease prevalence within the homeless population and health disparities within the AI community, steps should be taken to reduce barriers to healthcare.

KEYWORDS:

• Homeless
• American Indian
• service providers
• barriers
• healthcare

Acknowledgments

The authors gratefully acknowledge the participants for their contributions to this study. We dedicate this manuscript to our colleague and project coder, Amanda Carlson, who has since passed on. We miss her enthusiasm and bright spirit. Finally, the authors wish to acknowledge the reviewers for the quality critiques they provided.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Stephanie M. Wille received her Bachelor’s degree, BAS, from the University of Minnesota Duluth (Psychology) in 2015. She currently works as a research professional in the Department of Biobehavioral Health & Population Sciences at the University of Minnesota Medical School, Duluth campus.

Katherine A. Kemp is currently working toward her Bachelor’s degree, BAS, at the University of Minnesota Duluth (Psychology). She is working as an undergraduate research assistant in the Department of Biobehavioral Health & Population Sciences at the University of Minnesota Medical School, Duluth campus.

Dr. Brenna L. Greenfield is an Assistant Professor in the Department of Biobehavioral Health & Population Sciences at the University of Minnesota Medical School, Duluth campus. Her research focuses on substance use disorder prevention and treatment, with an emphasis on American Indians and Alaska Natives. She conducts community-based participatory research to reduce health inequities, bolster cultural strengths, and identify and intervene on multi-level factors that contribute to such inequities (e.g., racial discrimination).

Melissa L. Walls, PhD, conducts community-based participatory research (CBPR) with American Indian and First Nations communities. A key theme in our collaborative work is to understand the historical and contemporary social determinants of health/mental health for Indigenous individuals and families. She completed her doctoral degree at University of Nebraska-Lincoln (Sociology). Melissa currently works as an Associate Professor in the Department of Biobehavioral Health & Population Sciences at the University of Minnesota Medical School, Duluth campus. Tribal affiliation: Bois Forte and Couchiching First Nation Anishinabe.

Additional information

Funding

This work was supported by the National Institute of Mental Health [grant number MH084565]; National Institute on Drug Abuse (R36 DA034112).