Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indian and Alaska Native (AI/AN) people. IHS is the principal federal health care provider and health advocate for AI/AN people. The provision of health services to members of federally recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the U.S. Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders.

IHS Mission: To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

IHS Vision: Healthy communities and quality health care systems through strong partnerships and culturally responsive practices.

IHS Strategic goals

  • To ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people.
  • To promote excellence and quality through innovation of the Indian health system into an optimally performing organization.
  • To strengthen IHS program management and operations.

IHS Relationship with BH2I

IHS supports changing the paradigm of mental health and substance use disorder services from being episodic, fragmented, specialty, and/or disease-focused to incorporating it into the patient-centered home model.

Research has shown that more than 70 percent of primary care visits stem from behavioral health issues. With major depression currently the second leading cause of disability, it is clear that primary care settings have become an important access point for addressing both physical and behavioral health care needs. In addition, AI/AN communities experience alarming rates of suicide, alcohol- and drug-related deaths, domestic and sexual violence, and homicide.

Describing the burden of trauma within any population is difficult. However, indicators in terms of socially destructive behaviors are often used to illustrate this public health issue that impacts lifespan accumulation and chronic stress. Studies now indicate that resulting trauma from such events can even be passed from one generation to the next, resulting in intergenerational and historical trauma. While mental health needs can often go untreated and even unnoticed, childhood trauma’s lasting effects into adulthood are often evident in physical manifestations, leading to negative health consequences.

These extreme disparities highlight an urgent need for improving access to mental health services in primary care for children and families through the integration of behavioral health services, including trauma-informed care, within primary care settings.

In addition, recognizing that behavioral and physical health problems are interwoven, delivering behavioral health services in primary care settings reduces stigma and discrimination. The majority of people with behavioral health disorders treated within an integrated primary care setting have improved outcomes.

Behavioral Health Integration Initiative (BH2I) aims to plan, develop, implement, and evaluate behavioral health integration with primary care, community-based settings, and/or nutrition, diabetes care, and chronic disease management

The purpose of the BH2I effort is to improve people’s physical and mental health status by developing an integrative, coordinated system of care between behavioral health and primary care providers. The BH2I effort promotes the IHS mission to raise the physical, mental, social, and spiritual health of AI/AN people to the highest level by supporting sites that have identified gaps and established efforts to advance integrated care.