Painting the big picture on a Navajo reservation

Once upon a time, Anne Newland wanted to go to film school.

But because life unfolds with its own logic, she instead became a doctor with the federal Indian Health Service (IHS). And shaped by her experience working with Native Americans and the unique system that serves them, she realized the importance of focusing on population health. Today, Newland is working toward a master’s degree at Harvard School of Public Health (HSPH).

A Mongan Commonwealth Fund Fellow in Minority Health Policy, Newland has served as a physician at the Kayenta Health Center in Arizona for eight years, and as acting clinical director for the past three. A remote outpost with a downtown consisting of a small strip of stores, Kayenta is located about 25 miles south of Monument Valley, in the heart of gorgeously sculpted red-rock country. But the movie-set scenery belies deep public health problems.

Teen suicide, domestic violence, depression, isolation, substance abuse—all are pressing issues on the reservation. “We have therapists, psychiatrists, and substance abuse counselors at the health center, but services need to be greatly expanded,” Newland says.

In particular, the seriously mentally ill—the patients Newland describes as “train wrecks about to happen”—need better support. With no involuntary commitment laws, tensions have erupted over whether such decisions lie with the tribal authority or the state. There’s also a chronic shortage of inpatient beds. All told, these problems have left mentally ill patients in limbo.