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Volunteer Voices: Safeguarding Mental Health on the Navajo Nation

As a psychiatrist and Project HOPE volunteer, Dr. Cristina Riley-Lazo has helped Navajo health care workers cope with intense stress, burnout, and grief. What are the unique challenges these health workers face? And what does it reveal about our understanding of mental health care?

By Abby Henson

Mental health care is essential for a healthy life. But experts agree: we are in the midst of a mental health crisis that will only worsen as the impacts of the COVID-19 pandemic cut deeper.

Dr. Cristina Riley-Lazo is an integrated psychiatrist who works at a recovery center in New Mexico. Her treatment style focuses on mental health as a public health issue and addresses topics on spirituality, trauma, grief loss, identity, shame, and resilience. She also focuses on strategies that reach beyond medication management like good nutrition, exercise, and emotional well-being.

Dr. Riley-Lazo has been a Project HOPE medical volunteer since 2017, when she deployed to Puerto Rico following Hurricane Maria. Most recently, she volunteered in Navajo Nation to provide surge support during the COVID-19 outbreak.

Read on to hear Dr. Riley-Lazo’s thoughts on what many people don’t realize about mental health, the unique cultural dynamics of working on the Navajo Nation, and how helping health care workers can be a more complex, layered process.

Overall, what do you think people do not realize about mental health and the growing need for mental health support?

People do not realize that mental health is just as important as physical health. They don’t think of mental health as part of community and public health. One example is the increase in school shootings: These shootings affect not only the people directly involved, but also the families, schools, communities, regions, and the country. People don’t put the importance on education and prevention for mental health in the same way they do for physical health.

Can you tell us about the work you were doing to strengthen mental health resiliency during your time in Navajo Nation?

I worked with the staff on the Navajo Nation and addressed burnout and resiliency during COVID-19, since they had been working such long hours in difficult conditions. I did group presentations at the outpatient clinics, ER, ICU, and inpatient units. I covered topics on stress, burnout, grief, and the emotional impact of losing co-workers. I also offered people a chance to talk with me if they needed additional support. I facilitated workshops for the mental health department staff since they were getting referrals but not necessarily accessing support for the work they were doing during COVID-19.

collage of medical staff in facemasks
A few of the frontline health workers at Northern Navajo Medical Center in Shiprock, New Mexico. Photo by Steve Bronson.

What were some of the unique social and cultural aspects you faced while volunteering on the Navajo Nation?

It was important to recognize a broader perspective of health care that included physical, mental, and spiritual well-being. For example, there was one well-known staff person who died of COVID-19. We felt it would be helpful to add a spiritual piece when processing the grief, so a Native healer joined our debriefing session and did a blessing for the staff. The cultural significance of family also was very relevant, especially when many staff had family members who were also patients at the hospital where they were working.

Being culturally sensitive is important wherever Project HOPE works, but would you say it is even more important when it comes to strengthening one’s mental health?

Yes. Respecting cultural traditions is a crucial aspect of developing rapport and strengthening mental health. People from different cultures do not necessarily define mental health in the same way. There may be stigmas associated with talking with a therapist or psychiatrist, so it can be useful to address these issues in the context of overall health.

Is there a difference between helping beneficiaries and helping health care workers when it comes to strengthening mental health?

Yes. There was a big need for psychological first aid among the survivors of Hurricane Maria in Puerto Rico. We looked at how we could provide mental health resources for the current crisis and fill the gap since they couldn’t access their usual health care.

It was different working with health care workers on the Navajo Nation, because the emphasis was on stress reduction and resiliency while working long hours in stressful conditions. The health care workers were dealing with personal grief and loss, in addition to having responsibilities in the workplace.

Would you tackle that differently since it is more layered with health care workers?

Yes, it is more layered. Health care workers may have more energy to respond to a crisis at the beginning. Once the acute crisis becomes chronic, however, staff burnout increases. People can do long hours for a period of time, but this eventually becomes exhausting and unsustainable. They must endure both personal and professional stressors simultaneously. My role was to support health care workers who were going through the crisis themselves and providing services for others.

Is it even more important for health care workers to have their own personal self-care strategies due to this layered piece?

Absolutely. Personal self-care is a big priority. Developing internal and external resources is paramount to the well-being of health care workers.

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