When the California Public Health Department announced last year that more than $3.5 million was available for Native American groups working on mental health issues, officials expected to receive a host of applications.

The money was intended to let organizations expand and serve more patients with mental health needs. The funding comes from the Mental Health Services Act, a state law implemented in 2004 that collects a 1 percent tax on personal income above $1 million.

But no applications from organizations serving Native Americans materialized.

Why? That’s the question that advocates and health department officials have been trying to answer in the months since.

The funding is part of the California Reducing Disparities Project, a $60 million effort that aims to improve mental health outcomes for five populations: Latino, Asian Pacific Islander, African American, Native American and lesbian, gay, transgender, bisexual, queer and questioning (LGTBQ).

The fact that no Native American groups applied for grants to expand their capacity calls into question whether the project will be as successful as officials had hoped.

As state officials and advocates try to unpack the outcome of the call for grant applications, they are realizing that there’s not a one-size-fits-all approach to reducing disparities, and that solutions need to adapt to the populations they are trying to address.

“I am surprised, and many other native groups are surprised,” said Janet King, program manager of policy and advocacy at the Native American Health Center in the Bay Area, who helped do research for the disparities project.

“I know one of the things that we found out when we were doing the research is Native agencies are tired of getting one-time money to do something that does great things in community, but then it’s gone, and so are the positive outcomes,” said King.

King said other issues, including different approaches to measuring success, may also account for the lack of applications.

“Overwhelming Disparities”

The disparities project has two parts — a research report and grants. The five-year report, completed last year, looked at each of the five populations, analyzed mental health disparities and tried to come up with solutions.

“Communities of color in California are the majority in the state — they’re 60 percent of the state — but the populations that are the target focus of this strategic plan still face overwhelming disparities in mental health, both in terms of access but also in terms of outcomes,” Ruben Cantu, program director at the nonprofit California Pan-Ethnic Health Network, who compiled the final report, said when a draft version was released in 2015.

Native Americans in California are more likely to experience poverty, violence, substance abuse and depression compared to non-Hispanic whites, according to the Disparities Project report.

At the same time, Native people in California report having less access to mental health care than their white counterparts.

Partially, this is because Native people must be able to prove that they are enrolled in a federally recognized tribe in order to receive treatment at many Indian Health Service clinics. Inconsistencies in tribal enrollment policies and state and federal bureaucracy make meeting this requirement difficult.

Reworking Funding

Because no Native American organizations applied for the grants for expansion, public health officials are deciding how to use that money.

The health department recently reached out to 144 tribal governments and health clinics to share information on the grants, said spokesman Matt Conens. “We plan to issue another solicitation to award two additional grantees working with Native American communities,” he said in September.

In early October, the agency announced that it will give $1.9 million to the California Rural Indian Health Board, a Sacramento advocacy organization. The Health Board will use the funding to provide technical assistance to community programs that are doing prevention and early intervention work to reduce mental health disparities.

Karen Smith, state public health director and officer said that the agency wants to fund small organizations “that are doing meaningful work in their communities to reduce mental health disparities but are not often considered for large grants.”

Some organizations didn’t apply initially because they didn’t have employees who could write a proposal, Conens said.

Eleven small organizations serving the four other populations emphasized by the Disparities Project will receive nearly $13 million combined over five years, the agency announced in July. These grants were reserved for organizations with annual budgets of less than $500,000 and come with six months of technical support.

Aiming for Creative Solutions

King’s organization, the Native American Health Center, is one of the five Native American groups that is already receiving funding for a pilot project.

The health center will use the money to do research that examines the effectiveness of a retreat it holds each year in Marin for Native American youths. Called a GONA, for a Gathering of Native Americans, the retreat teaches young people about their heritage and tries to give them a sense of belonging.

“It immerses them in Native culture and reviews the history of what happened to Native people, which many of them have never heard,” said King, who is a member of the Lumbee tribe in North Carolina.

GONAs have been occurring for more than 20 years, and King said she knows they help improve participants’ mental health and sense of wellbeing. But there has never been any research to back that up.

Part of that is due to a lack of funding, but it’s also because many communities of color, including Native American groups, have qualms about some Western methods of research, King said.

“If there’s money, we want to put the money toward healing, not toward research to show that the healing works, because we intuitively know it works,” she said. Also, “oftentimes research means there’s a control group, which violates a lot of cultural values, because it withholds the healing process from people because they’re in the control group.”

Her organization plans to compare its GONA retreat with other similar ones in the Bay Area, Fresno and San Diego, and use that to draw conclusions about what practices are most effective.

The disparities project aims to bridge the gap between cultural beliefs and research. “We have some freedom to show evidence in way that is meaningful to us,” King said.