Case Synopsis

Intergenerational trauma compounded throughout centuries by the effects of colonialism have left indigenous peoples within the Americas in grave despair. Indigenous communities are subject to a variety of human rights violations and social neglect, which contribute to reduced physical and mental health. The United Nations Permanent Forum on Indigenous Issues has identified these insufficiencies in acknowledging higher rates of poor mental health, substance abuse, and elevated rates of suicide, when compared to non-indigenous peoples. The World Health Organization has developed the Mental Health Gap Action Program Intervention Guide (mhGAP IG) to assess, monitor, and manage, neurological, and mental health conditions, including suicide, in non-specialized health contexts. This case provides an example of how one fictitious indigenous community located off the coast of Central America is seeking to use the mhGAP IG due to the recent suicide clusters within a six month period. The case seeks to highlight how international agencies collaborate in developing interventions for the populations they serve, specifically, between the Pan American Health Organization and the Americas. The protagonist, Juan Santos, is left to question how he will implement the mhGAP in his community with limited resources to encompass cultural considerations and appropriate community engagement to lower suicide rates, mental health, and substance abuse.

Case Objectives

  1. To understand the implications of shortcomings in various social and cultural determinants of health and the onset of and influence on mental health, substance abuse conditions, and suicide.
  2. Evaluate the risks and/or benefits of interventions in indigenous communities, with particular attention to cultural continuity, patient-centered care, and outcome assessment tools.
  3. Develop an understanding of community collaboration and participatory relationships between public health agencies and indigenous communities.

Case Study Questions

  1. How can public health agencies improve suicide-reporting-data collection for underreported and suspected cases?
  2. Which key elements of implementation science must be adapted for the uptake of interventions in culturally diverse communities?
  3. What methods must be employed to assess the Program’s effectiveness and relevance?


indigenous peoples, youth, suicide, mental health, PAHO, mhGAP, substance abuse, alcohol, self-harm, cultural continuity, cultural sensitivity

Additional Author Information

Ashley Sebastian, BSc, MPH

Sandra Del Pino, JD, M.Tr, Cultural Diversity Advisor

Devora Kestel, MSc, Unit Chief, Mental Health and Substance Use

Gerald McKinley, PhD, Assistant Professor



Recommended Citation

Sebastian, A., Del Pino, S., Kestel, D., McKinley, G. (2017). From Theory to Action: Implementing an Internationally Developed Mental Health and Substance Abuse Program in Indigenous Communities in the Americas. in: John-Baptiste, A. & McKinley, G. [eds] Western Public Health Casebook 2017. London, ON: Public Health Casebook Publishing.