Community Member Spotlight: Crystal Hernandez, PsyD., MBA, Fellowship Class of 2024 and Chief Forensic Officer, Muscogee Creek Nation

By Douglas Riddle, PhD, DMin, FAPA, Carol Emmott Foundation Curriculum Director

It makes no sense to talk of healthcare in this country if the important role and circumstances of Native people are not included. While we are seeing increasing numbers of Tribal citizens heading into healthcare leadership, the disproportionate rates of mental health and substance use in Tribal communities call for greater attention to how we can end culturally blind and disempowering systems of care. So often, untreated or under-treated serious mental illness end up being shuffled into the criminal justice system. With the increased focus on tribal control of justice and health systems on Tribal Nations, there is hope for change. Our CEF8 Carol Emmott Fellow from Oklahoma, Dr. Chrystal Hernandez, is leading in finding solutions.

When Crystal Hernandez finished her doctoral program, she didn’t know she was headed toward an opportunity to help shape history. Everyone loves a worthy challenge, and Crystal’s was to share in creating unique justice mental health systems in Indian Country. The United States Supreme Court’s ruling in McGirt v. Oklahoma reaffirmed sovereignty for several Tribal Nations throughout Oklahoma. As a result, new opportunities and responsibilities arrived – in particular, how to address the mentally ill in the justice system. In a majority decision written by Justice Gorsuch, the court found that the establishment of a reservation and the promises related to it could not be undermined just because it had been ignored for centuries. It required explicit action by the U.S. Congress. In the absence of that explicit action, the Oklahoma tribes found their jurisdiction over legal and related matters suddenly affirmed after more than a century of seeing it chipped away. This started with the courts and law enforcement, but quickly affected other aspects of governance.

The history of mental health care for Tribal people is a complex and often misunderstood one. Many of the past systems of care for Tribal citizens involved inhumane treatment, broken promises, erosion of culture, and difficult to reach services. Protective cultural factors were stripped away, replaced by services built without the involvement of the very people that needed services. When this is added to the history of deliberate destruction of native culture through forced separation of children from their homes and attempts at a kind of re-education in boarding schools, it is no surprise that we see exacerbated health issues and a mistrust of healthcare systems.

Into this rapidly evolving landscape, the Tribes of Oklahoma embarked on creating mental health systems within their justice systems that could respect the culture and unique needs of Indigenous people. Crystal Hernandez has been involved in the development and growth of justice mental health systems for several Tribal Nations. She has been guided by a concern for culture and the restoration of meaningful self-governance. As she says, “Our culture is a protective factor. When you take that away, you take away the ability to heal and repair the person, family, and community to lean in on our very foundation and strength.” One challenge is the expectation and need to transform systems overnight, but it also means that systems can be built that actually work for the people providing the care and the people receiving it.

They have risen to the challenge by thinking systemically, focusing on individualized as well as collective healing. That means targeting families, heritage, and incorporating respect for the ceremonies and ancestral teachings of the community. She points out that “the very things that make us strong are often ignored when we are invited to the table, systems continue to be built around us, without us. This is a missed opportunity for inclusion and collaboration.” The current situation provides the chance to reaffirm what is needed and gives them the power to decide what it should be. “We walk on this journey with the power of those that came before us, while holding the responsibility for those that follow us.” The creation of history-making systems of self-governance and service to the most vulnerable Tribal citizens and communities is an integral part of healing and continuance of Tribal Nations.

Crystal is hopeful about the future. She sees other young leaders pushing for more resources and Tribes investing in cultural vitality, including language preservation. Investment in internet connectivity also is encouraging because it makes a broader range of information available for self-governance as well as the delivery of key tele-health programming and social connection. So are the emerging movements of advocacy for the rights of Tribal Nations. As a forensic psychologist, she has seen the consequences of criminal policies that take no consideration for what might be culturally appropriate and responsive to the needs of the community. “We are setting up healing to wellness courts and other specialty courts. We want our people well, where we can create diversion pathways and other services. The goal is to keep individuals healthy and repair the harm caused by harmed people.”

“I am Tribal. These are my people. This is their life and future. I would hope we could build systems where people can get what they need when it comes to substance use and mental health treatment and support. That means making space and honoring these protective factors, building in treatment that takes into consideration how the protective factors of our culture can revolutionize care. This is a model of treating to wellness, infusing treatment with elders, ceremonies, and the deep relationships that can ground the person. We must be in the spaces and places where healthcare is built, funded, designed, and discussed in meaningful and collaborative ways.”