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Shedding Light on Two Spirit Mental Health

For Native people who identify as Two Spirit, rates of depression, anxiety, and post-traumatic stress disorder are significantly high.

A Note on the Two Spirit Identity: Many Native cultures held space for a third gender that blended the male and female spirits, providing them with better insight to the spiritual world. These honored individuals served their communities as healers, leaders, artisans, and in other important roles. To encompass the variety of traditional terms used to express such an identity, the unifying term ‘Two Spirit’ was created. Because it reflects a specifically Indigenous view of gender and identity, ‘Two Spirit’ is appropriate only for Indigenous / tribal individuals. This term should not be used (and is not used herein) to refer to non-binary or gender-expansive identities, however similar, from other cultures.

By the Numbers

  • 9x Non-cisgender Native people report serious psychological distress at a rate nine times higher than the general U.S. population.
  • 57% More than half of Native trans people reported having experienced homelessness due to their trans identity.
  • 50% One in two Native trans people reported negative healthcare experiences related to their trans identity.
  • 12x 57% of non-cisgender Native people attempt suicide at some point—a rate twelve times higher than the general U.S. population.

Mental Health Risk Factors

A gender-diverse identity does not inherently put a person at risk for mental health issues. Two Spirit people may face alienation within their tribal community as well as within the LGBTQ community, and this discrimination acts as a major barrier to getting the care they need. Other significant risk factors include:

  • Limited access to healthcare and/or gender-affirming care
  • High levels of poverty
  • Rejection by family and friends
  • Systemic racism and homophobia
  • Personal trauma including assault and abuse
  • Intergenerational trauma including loss of land, culture, and traditional practices

Substance Misuse

Although there is a scarcity of data focusing solely on Two Spirit people, problematic substance use is a topic that arises frequently. Because of the high rates of trauma Two Spirit people face, and with a lack of adequate, affordable, and gender-affirming care available, many turn to self-medicating with drugs and alcohol.

  • Two Spirit people report having their first alcoholic drink at a younger age, which can contribute to a higher likelihood of addiction.
  • Two Spirit adults have higher rates of alcohol misuse than both heteronormative Native and non-Native populations.
  • Two Spirit people are more likely than other Natives to have used illicit drugs.

Taking Care of Your Mental Wellness

Staying connected—with your culture, your social circle, and your support network—has proven to be among the best ways to keep a positive frame of mind.

  • Connect with your culture.

    Many Two Spirit people stay resilient by connecting with elders and participating in Indigenous ceremonies, healing practices, and traditional activities.

  • Maintain strong community ties.

    Find a sense of belonging by getting involved with Two Spirit organizations and attending gatherings in-person when you are able.

  • Be good to your body.

    Eating a nutritious diet, getting enough sleep (7–9 hours each night), and getting regular exercise are crucial for staying well.

  • Find competent care.

    When you need support, reach out to culturally specific resources and look for providers who understand and affirm your identity.

Your health is worth it, so don’t be afraid to advocate for yourself when needed.

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