HOUCK – In a remote hogan near the southern edge of the Navajo Nation, Wayne Wilson lights a fire, lays out eagle feathers and remembers his grandfather’s teachings.

“He would talk to me and tell me, ‘Grandson, we’re going to do things here together. We’re going to pray together. We’re going to sing together. And I need you to pay attention as much as you can, because I don’t know how things are going to change.’”

Wilson, like his grandfather before him, is a traditional Navajo healer. He uses herbs, song and ceremony to restore the mental and physical well-being of himself and others, incorporating other practices, such as acupuncture, when needed. “It all depends on the individual,” he says.

Before embarking on this path, Wilson endured a life filled with trauma. He came from a home rife with alcohol and domestic violence, faced isolation and abuse while attending boarding schools as a boy, and had a complex relationship with alcohol himself.

“One day I’d just had enough,” he recalls. “I just got fed up.”

He made his way to the Native American Baha’i Institute, which integrates Native American spirituality with that of the Baha’i faith. The institute’s hogan, a traditional ceremonial dwelling, is where he embarked on a long journey toward finding a renewed relationship with the healing practices of old.

“Here is where my sobriety started,” Wilson says. “The medicine way started here for me.”

Today, Wilson incorporates traditional Navajo practices with those pulled from his Baha’i faith and cultures from around the country and world to heal people.

“It’s a kind of reciprocity,” he says. “What you put out, you get back.”

An ongoing legacy

Researchers have long pointed to the importance of incorporating cultural practices into behavioral health care for Native Americans, but there is an ongoing struggle to ensure those services are accessible and affordable.

In past years, federal and state legislation aimed at increasing insurance coverage of mental health treatment has expanded the availability of Western services for many. But access to culturally responsive care and traditional healing remains limited.

In the larger landscape of mental and behavioral health care, Indigenous communities face significant disparities. Native Americans report experiencing serious psychological distress 2.5 times more than the general population, federal data show. And although overall suicide rates are similar to those of white people, there are key differences among certain age groups – with suicides among Native Americans ages 15 to 19 more than double that of white youth.

Indigenous people also are more likely to suffer from substance use disorders.

A major factor in all of this is multigenerational trauma stemming from a long legacy of colonization, genocide and oppression, as well as forced relocation from traditional lands, sterilization and assimilation.

“We need to recognize that we’re not just talking about history. We are talking about an ongoing legacy and ongoing problems,” said Hilary Weaver, a professor emeritus at the University at Buffalo who studies Indigenous identity and well-being.

Weaver, who’s a social worker and a member of the Lakota tribe, said traditional healers play a significant role in mending these lasting wounds.

“Those traditional ways have been there long before somebody came in with a psychology degree or a social work degree or a nursing degree,” she said. “And there’s a lot of value in those tribal traditions.”

Traditional healing rituals have always been a part of Indigenous culture. Whereas Western medicine focuses on curing, often through the use of medication, Indigenous healing aims to reestablish harmony and balance – more akin, experts say, to “recovering one’s wholeness.”

Practices vary among tribes, but they typically include herbal remedies and ceremonies, such as smudging or sweat lodge gatherings, to heal and maintain mental, physical and spiritual health. And spiritual health is key, along with participation not only from the individual being treated but from loved ones or other tribal members.

“With us, it’s a family affair. Pretty much all things are,” said Roland Begay, coordinator of the Office of Native Medicine at the ​​Chinle Comprehensive Health Care Facility, one of 12 Indian Health Service health care facilities on the Navajo reservation.

A traditional healer for more than 30 years, Begay has a deep understanding of its importance.

“I grew up around Native medicine. I grew up around medicine men,” Begay said. “My great-grandpa, my grandfather, my dad were all practitioners. So I was raised among that.”

Many traditional healers, including Wilson, work independently, but it’s become more common for hospitals and medical facilities to employ traditional healers.

The health center in Chinle has four traditional healers on staff to provide services and two hogans and sweat lodges for ceremonies. At a patient’s request, traditional healing can be integrated alongside Western medicine, all at no cost.

These services, Begay and other experts note, are particularly important for mental health and wellness. In Indigenous communities, depression and other mental health conditions are more likely to be related to family, cultural and community dynamics than individual experience, meaning Western-based treatment without cultural context is often less effective.

“Somewhere, a person gets out of balance,” Begay said, “and the intent is to get him back in balance.”

One of the rare studies published on Native healers, a 1998 study in the Archives of Internal Medicine, found that more than 60% of Navajo patients surveyed had seen a traditional healer and about 40% used them regularly.

More recent studies show that Native Americans who suffer from depression or a substance use disorder are significantly more likely to seek help from traditional healers over other providers.

Avery Denny is a professor of Navajo studies at Diné College in Tsaile and president of the Diné Hataałii Association, an organization of traditional Navajo healers. He has worked in clinical settings alongside psychiatrists before, and he’s seen times where traditional healing has worked where Western medicine hasn’t.

“They’re given pills and psychiatric care, but then that same patient comes back over here and says, ‘I want a second opinion. I want to go traditional. I want to be diagnosed.’”

Like Begay, Denny says family and community are central to the process of healing.

“All the religious intolerance and human rights violations and historical trauma – and all the things that happened to our people that got us all sick – the people that have done that to us couldn’t make medicine for us,” he said.

“They didn’t know how to heal it, to heal us.”

Barriers to care

Traditional services are free to Native Americans at facilities operated by the Indian Health Service, but supply can’t always keep up with demand at the chronically underfunded federal agency.

A 2011 federal report found just 33% of 514 IHS and tribal facilities providing mental health services offered traditional healing. And many of those clinics are located on or near reservations, even though 70% of Native Americans live in urban areas.

“Almost all of those services are for reservation-based populations, and for decades, the majority of Native people have not lived on tribal territories,” said Weaver of the University at Buffalo. “So there’s a mismatch between where services are and where people are. Some Native people have private insurance and can pay for mental health care. Many others do not.”

In some states, health officials are trying to address all this.

For years, Arizona, California and other states have been asking the federal government for the OK to reimburse the cost of traditional healing services under Medicaid.

While IHS provides free health care to Native Americans, services are available only to members of federally recognized tribes and within specific geographic service areas.

With over 50% of Native Americans lacking private health insurance, Medicaid becomes another important source of care. As of 2019, federal data show, some 42% of American Indians and Alaska Natives relied on Medicaid or public health insurance coverage.

In 2015, Arizona established a workgroup to help develop parameters and potential payment methodology related to traditional healing for federal and state Medicaid officials to consider.

In a memo a year later, Arizona leaders noted that traditional healing, “while beneficial to tribal members,” has not been considered a covered Medicaid service, “despite it being promoted in the Indian Health Care Improvement Act and by IHS.”

And yet, to date, the federal government has declined to approve reimbursement.

In a letter last month from the federal Centers for Medicare & Medicaid Services to the Arizona Health Care Cost Containment System, the federal agency said it “recognizes the state’s goals of addressing disparities in the American Indian and Alaska Native community and will continue to work with the state on this request.”

CMS declined additional comment about why the change has taken so long. It so far has not approved reimbursement for traditional healing for any state. A spokesperson said the requests “are still under review.”