Background: The Center for American Indian Community Health (CAICH) was asked by local American Indian community members to address mental health issues within the local American Indian community. In response, CAICH developed mental health needs assessment to better understand community needs and priorities. Methods: Using a community-based participatory research (CBPR) approach, CAICH conducted interviews (N=30) and a free list exercise (N=100) among community members regarding their perceptions of mental health issues. Interviews were recorded and transcribed verbatim. These data were analyzed using qualitative text analysis. Free list data were analyzed using Smith's Saliency Index, a weighted mean that takes into consideration the number of people naming an item, where it is placed on their lists, and the number of items in each person's list. Results: Perceptions of mental health and mental illness, the lack of dialogue concerning mental health and/or illness, access issues, awareness of support services, and suggestions to improve mental health outcomes were the main ideas arising from the interviews. The free list results showed that most people think of the Indian Health Service as a provider of mental health services and a place to go for treatment. Of the conditions listed, depression was the main condition that needed to be addressed. Conclusions: There are many mental health needs in American Indian communities in our region. Community members are well aware of the problems and anxious to begin creating solutions.