Introduction
Rehabilitation research has not addressed the extent to which American Indians with severe and persistent mental illness have successfully accessed the public vocational rehabilitation (VR) system. The primary purpose of this research was to examine the level of VR and mental health services being provided in New York State to American Indians with behavioral health diagnoses, including those with dual diagnoses involving substance abuse.

Results
The Rehabilitation Services Administration (RSA) reported that in 1991, the Office of Vocational and Educational Services for Individuals with Disabilities (VESID) had 81 American Indian persons apply for services. Of the 81 American Indians who applied for services in 1991, 43 (51%) were accepted for services. Of these 43 individuals, 16 (37%) had a behavioral health diagnosis. Of these 16 individuals with behavioral health diagnosis, 8 (50%) were closed as rehabilitated.

In the same year, the New York Office of Mental Health data indicated that 179 American Indians of working age were served who had a severe and persistent mental illness––this is more than twice the number who applied for VESID services. Given the baseline information regarding American Indians with disabilities, specifically those with behavioral health diagnoses, it would appear that the level of public VR service delivery to American Indians falls well below the need.

The question is raised as to whether it is possible that American Indians with disabilities in New York State are not aware of VR services or are not aware that they may apply for VR services. One key informant explained to the principal investigator that he had no idea that self-referral to VESID was possible. Other reasons American Indians may not receive VR services include the possibility that they may not have feasible transportation to VR offices, may not have telephones to maintain necessary communication with VR personnel, may be receiving services from some other agencies, may not wish to be rehabilitated, may feel uncomfortable in the VR setting, or other unknown reasons.

Catherine Marshall, Ph.D., CRC, Susanne Bruyere, Ph.D., CRC, David Shern, Ph.D., and Lois Jircitano, J.D.

“If an Indian person needs services, they need a family advocate or need to know the system. It is not a level playing field if Indian people do not assert themselves and present the same posture as majority culture when applying for services. The argument that ‘we don’t do outreach’ doesn’t make sense if cultural values preclude a person from applying/presenting as an agency would expect.”
–Key informant