Montana tribes want to stop jailing people for suicide attempts but have no safer alternative | Health news from the healthiest communities



POPLAR, Mont. – When Maria Vega was in her final year in 2015, she found the body of one of her closest friends, who had committed suicide. Days later, devastated by the loss, Vega attempted suicide.

After the attempt failed, she was arrested and taken into juvenile custody in Poplar, a remote town on the Missouri River, a short drive from the North Dakota oil fields. She was placed in a cell and kept under observation for several days until a mental health specialist was available to see her. His only interaction was with the woman who brought food into his cell.

“I remember asking her if I could have a hug and she said, ‘I’m sorry, I can’t do this,'” Vega recalls. “It was honestly one of the most difficult things I have ever experienced in my life. I felt like I was being punished for being sad.

Imprisoning people with a mental health problem is illegal in Montana and all other states except New Hampshire. But Vega is a member of the Fort Peck Assiniboine and Sioux tribes, a sovereign nation with its own laws. An 11-year-old tribal policy allows law enforcement to put members who threaten or attempt to commit suicide in jail or juvenile detention in order to prevent another attempt.

Maria Vega, a member of the Fort Peck Assiniboine and Sioux tribes of Montana, was jailed in 2015 after a suicide attempt. Vega is now part of a group of tribal members, academics and political experts proposing alternatives to the policy of imprisoning people who attempt to commit suicide. The policy was created in 2010 due to a lack of mental health resources on the reserve. (Sara Reardon / KHN)

Fort Peck tribal chiefs say they approved the policy out of necessity because there were no mental health facilities equipped for short-term housing for people with mental crises.

The COVID pandemic has only exacerbated the crisis. In 2020, the tribes filed a record 62 charges of aggravated disorderly conduct, the criminal charge they created in 2010 to allow law enforcement to reserve people they considered a risk to them- themselves or for others.

Fort Peck Tribal Court chief justice Stacie FourStar said this year has been even worse: the tribe is laying two to four charges per week. The policy has swept away people – especially teenagers – with no criminal records and no experience with the criminal justice system, she said.

The judge is concerned that this creates a perverse incentive not to call 911 or seek help when depression sets in. “They don’t want to go to jail,” FourStar said. “They just want someone to talk to.”

Tribal leaders and various mental health advocates have been trying to find an alternative for almost a decade. But the reserve is still sorely lacking both in secure psychiatric facilities and in trained mental health workers. Despite the funding available for the new positions, recruitment efforts have failed and there is still no viable alternative to keeping people safe.

“Their hands are tied,” FourStar said, noting that if “the staff and the facilities are not available, we will put people in a dangerous situation.”

Having experienced imprisonment herself as a teenager, Vega is now part of a team of tribal members, state educators and policy experts seeking alternative solutions.

In May, the group presented a plan to the Fort Peck Tribal Council, which has yet to act on its recommendations. A spokesperson for the Fort Peck tribes said the tribes were studying politics but declined to comment further.

Still, tribal leaders say unless they can attract mental health workers to northeast Montana, the jails are likely to continue. “We can come up with whatever we want,” said Jestin Dupree, tribal lawmaker and chair of the law and justice committee. “We are not getting the doctors, the qualified people.”

The 2010 policy that put Vega in jail followed a cluster of more than 150 suicide attempts and the deaths of at least six teenagers. Overwhelmed by the crisis, the Fort Peck tribal government created the charge of “aggravated disorderly conduct”.

“It came out of desperation,” said FourStar, who was chief tribal prosecutor at the time. “Families weren’t able to meet the needs of their loved ones and they didn’t want them to get hurt.

Those accused of aggravated disorderly conduct are held until they can undergo a mental health assessment and attend a court hearing, where they can receive a court-ordered treatment plan. If they comply with the plans, the charge is dropped. They usually don’t end up with a public criminal record, but the justice system can still track them.

Non-tribal members are never jailed because the tribe has no jurisdictional authority over them. Instead, a policeman ends up sitting with them in the hospital – sometimes for days – until they can be assessed.

Not all threats or suicide attempts end with an aggravated disorderly conduct charge. Ideally, a person in crisis is immediately assessed by an Indian Health Service mental health professional or telemedicine provider who can refer them to emergency care, if needed.

“Even though it is difficult to try to cure them, we always persevere,” Sylvia Longknife, mental health specialist at IHS at Poplar, told Poplar. Longknife is the only IHS mental health worker on the Fort Peck reservation since two other providers stepped down this year, meaning she can’t always immediately see someone in crisis.

Longknife said she sees between two and five emergencies per week. If the situation is considered an emergency, the patient is referred to a facility four hours from Billings. IHS does not have its own transportation, so it either asks family members to drive the patient, or it requests transportation funds from the tribe.

If a suicide attempt occurs on a weekend, after hours, or when a mental health worker is not available, the police responding may end up taking the person to the hospital for medical treatment, if necessary, then in prison.

Lisa Dailey, executive director of the Treatment Advocacy Center, a national nonprofit that lobbies for access to mental health treatment, said jailing people for attempted suicide criminalizes mental illness. “Prison or jail are the worst situations you can be because you are in a psychiatric crisis,” she said. Even if the care is good, she says, “being in jail is a traumatic experience.”

Studies have shown that the risk of self-harm in prison increases if a person has been held in solitary confinement or has ever attempted suicide.

After the Fort Peck tribes approached Carpenter’s Native American Politics class last year for ideas, he and his undergraduate students began consulting with tribal members and others in Montana and look for potential alternatives to prison.

The Flathead tribe of western Montana, for example, says people should be held in “the least restrictive environment possible” to protect their well-being, with the exception of a jail cell. Carpenter said it could take the form of a “safe house” that separates a person from the guns.

Other potential solutions include requiring a mental health worker to accompany police when interacting with a suicidal person to ensure that prison is the last resort, and the creation of a new ‘mental health code. Which would treat suicidal people differently from those who pose a threat to others. .

The state of Colorado has put $ 9.5 million towards community health treatment in 2017, and made it illegal imprison people awaiting mental health assessments who had not been charged with a crime.

But places like reservations may not have a choice. “Without the resources, there’s not much you can do to fix these problems,” Dailey said.

The IHS office has sufficient funds to hire four more mental health workers for Fort Peck. “We’re really aggressively trying to fill the vacancies,” said Steve Williamson, chief medical officer for the IHS Billings regional office.

But the positions were difficult to fill. IHS and other care providers in northeast Montana are struggling to attract applicants to live in an area 70 miles from the nearest Walmart, with few jobs or entertainment options for families.

FourStar said the tribes hope to use COVID relief aid to improve behavioral health services so suicide attempts can be treated as civil rather than criminal matters. “I think it will go somewhere, as long as we can get the manpower,” she said.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism on health issues and was published with permission.



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