Mental health and North American Indian/Native communities: cultural transactions, education, and regulation.

Critical issues in the delivery of mental health services to North American Indians/Natives residing in rural areas are discussed by describing Indian populations/communities; briefly summarizing available literature concerning the nature of mental health problems within Indian communities; examining Indian belief systems relevant to participation in mental health service delivery processes; exploring community expectations for structuring participatory interactions which may inhibit utilization of mental health services; and describing transactions between Indian consumers and non-Indian professionals which have become typical over time. The rural context was examined as it interacts with individual and community characteristics to affect Indian mental health. Relations between geography and culture, important in understanding the mental health problems of Indian people, are discussed in regard to expanding community healing resources through empowerment, and viewing "education as transformation" as a key concept in enhancing community healing processes.