History of the Behavioral Health Aide Model

In 1988 the Anchorage Daily News published a Pulitzer Prize winning series entitled “A People in Peril” that documented the despair of Alaska Native peoples with stories of suicide, alcoholism, and community disintegration. Statistics for that period indicated that suicide occurred at a rate of 257 per 100,000 for males age 20-24. These jarring real life stories of the suffering of Alaska Native peoples caused a ground swell of governmental response in the state of Alaska and in 2003, ANTHC received congressional funding for the “Counselor in Every Village Program”. In that same year, the Advisory Board on Alcoholism and Drug Abuse estimated 42,000 adults in Alaska needed treatment for a substance use disorder. Of the Alaskan adults needing treatment only 3,586 received treatment. It is common for people with mental health conditions or substance use addictions to be reluctant to seek help because of the belief that behavioral health issues are the result of one’s own moral weakness or personal failings.

The behavioral health client experiences greater barriers to treatment because of perceived societal judgement of their condition and their own personal shame, hopelessness, and self-doubt about their ability to overcome their illness or addiction. On a national basis, behavioral health conditions such as depression, anxiety and addiction are very common (one in four Americans experience mental health or substance use disorders), but because of the stigma and shame associated with behavioral health conditions, 80% of patients seek help in hospital emergency departments (ED) rather than with behavioral health providers. Due to a lack of time and behavioral health training, medical personnel often do not address behavioral health issues;  it is estimated that 60-70% of those who seek help in a hospital ED leave without receiving treatment or a referral for their behavioral health condition. 

The Alaska Native Injury Atlas 3rd Edition reported the leading causes of hospitalization of Alaska Native/American Indian people. “Behavioral health” was reported as the second leading cause of hospitalization after “pregnancy & childbirth”. This data appears to show that individuals with behavioral health conditions come to the attention of the health care system only after their situation reaches crisis proportions.  The Behavioral Health Aide (BHA) workforce increases access to care for people who struggle with behavioral health conditions but do not feel safe seeking help for these conditions. BHAs are community members who understand the cultural and historical context of their clients and strive to reduce the stigma associated with seeking help. They are part of an established service and referral structure within their regional Tribal Health Organization (THO) and are trained to provide a wide array of services from prevention and early intervention to treatment and aftercare. As autonomous entities, THOs choose which behavioral health services they will provide based on the needs of their region.