March 14, 2001

 

Dear Legislator or State Official,

 

I am writing today to offer a view of mental health and substance abuse treatment needs, as well as current (available) services in rural Alaska. My reasoning with this offer is 2-fold. First, needs for treatment are significant in this tremendously under-funded area of the state. Secondly, it recently came to my attention that a host of legislators have never even traveled to more remote, village, areas of our state. Given that, I simply cannot believe such legislators could understand the truly different environment rural folks exist in nor could those legislators reasonably appropriate funding. Hopefully this letter will assist those who regulate the budget to better meet their duty and responsibility to all Alaskans.

 

Please read on…

 

I recently completed a 14-month contract as director of Yukon Koyukuk Mental Health Program in Galena—an integrated community mental health and substance abuse outpatient treatment program serving the six villages of Galena, Ruby, Koyukuk, Nulato, Huslia and Kaltag. The area served by the program is larger than the state of Ohio. It sits about halfway between Fairbanks and Nome along the Yukon and Koyukuk rivers. There are no roads between the villages save for the rivers themselves in the summer and snow machine trails in the winter. Treatment (and other) travel is frequently by small aircraft—when the planes are flying. Temperatures can reach -40 to -60 regularly in the winter. The total population of the area is believed to be 2500, most significantly of traditional, subsistence-based Athabaskan heritage.

 

During my tenure with YKMH I was responsible for all administrative tasks for the program—grant writing and follow-up, fiscal reporting, contact with tribal, local and state officials, policy and personnel concerns, outreach, development, etc. This while also performing as clinical director, providing emergency services to all villages and also direct clinical services to folks in Galena. No bookkeeper, no finance department, and because I was the 3rd director in 12 months—no governing board of support. The program office was an old un-insulated doublewide trailer whose windows did nor quite shut and thus provided for an interior temperature at times of around 58 with the monitor heater on full.

 

For more than half of my tenure I was without an administrative assistant to at very least answer phones. I was five months into my work before I had a full-time master’s level itinerant clinician to attend to outlying villages. Luckily, I did have, for a time, three less than an associate’s degreed village-based counselors, each providing support in the village of their upbringing. (It is important to note that though the community based-counselors are a vital asset in rural Alaska, the fact that they work in isolated/ home villages means that they often have to treat their own family members—or worse, family members choose to go without treatment.)

 

YKMH, to my knowledge is the least funded (DMHDD) community mental health program in the state. When the additional funding from ADA and Tanana Chiefs (for rural services) are considered, at $343,000 one would be hard pressed to find a less funded integrated program serving that size area and population in the state. (YKMH could seek substance abuse treatment specific dollars, though it was clear to me, at the time, not humanly possible to take on the additional documentation and regulatory requirements that specific funding would entail.)

 

Between October 1999 and December 2000 there was an estimate of 14 deaths for the entire region served by YKMH. Half of those deaths were suicides, with another to follow in January of 2001. Huslia alone suffered 3 suicides between the last days of November 2000 and the middle of January 2001—One village, 3 suicides--in a period of less than 3 months. Substance abuse is known to be a (major) piece in all the suicides, as well as a few more of the total deaths during that period. January’s double homicide in Koyukuk had a significant alcohol abuse component as well.

 

Let me tell you more…

 

Direct services in the village do not involve a client calling the office to make an appointment for assessment, as one would see in the city. That approach does not meet the environment nor culture of the locale. A counselor must respond personally to communities first and only eventually may get to an individual.

 

For instance, following a suicide by gunshot wound to the head in Kaltag, my job as mental health professional included seeing to those who intervened in the suicide. I remember quite clearly, attending to local professionals suffering significant post-traumatic symptoms (agitation, sleeplessness, irritability, fear of additional suicides) as they had to again, “clean the burnt brains off the walls,” following that suicide--a twenty-something woman, their friend since childhood.

 

I attended to those who had to dress the body—her face half gone. I also attended to the victim’s family and the family of others who not only knew her but, like so many in rural areas, had lost family members and other friends to suicide. Last but not least, I was called to work with both community officials in Kaltag and professionals in the other villages to develop quick, preventative supports across the sub-region, following that suicide.

 

This type of work just does not reflect what you may know about mental health and substance abuse treatment work in the city

 

I recall the news from another suicide, in Koyukuk, reaching my office as my itinerant clinician reported back. Four under-age, drunken teenage boys got out of a boat at Last Chance (a store, “for all your favorite beverages…”) where they bought additional liquor and drank it on the way home. 2 or 3 or all of them got into a tussle when one took a gun and aimed to kill himself—which he did, in front of them. My itinerant counselor told me that the children of Koyukuk all came to see the body, crumpled there on the road before it could be cleaned-up and removed. At the time, Koyukuk had just over 90 inhabitants and was without both health aide and VPSO.

 

Six months later, following January’s double homicide, I made an emergency flight to the same village. An infant and his father bled to death from gunshot wounds, the new 19 year-old health-aide unable to make a difference in the tragedy. I arrived to blood on the snow, blood on the door and inside--blood not yet dried on the clinic floor. 

 

My work in Koyukuk was done by rounds about the village. First tending to the aide, then meeting with adults to identify children and adults at risk following the shooting deaths, tending to the young woman both mother of the infant and partner of the child’s father, checking on the family of the 19 year-old who perpetrated the shootings (who incidentally had been tagged at-risk himself many years earlier but without local resources for appropriate treatment), and attending to an elder who was auntie to the deceased on one side of her family and auntie to the perpetrator on the other.

 

I made an additional trip to Koyukuk a few days later to make rounds again. I borrowed a counselor from Fairbanks as my own itinerant counselor was on traumatic sick leave having suffered a near tragedy herself. (Just before Christmas, while returning from one of the numerous suicide interventions she made that year, an engine caught fire in her plane. She and several others nearly died.)

 

In all, Koyukuk lost eight more residents by death and moving in the wake of the homicides. Its population now hovers about 78.

 

 

To earn trust in the village, the professional must show-up at community events--whether a raffle, spaghetti feed or funeral. When I look back on my 14 months in the village, my predominate memory, save for constant under funding--lack of staff and resources--was the number of funerals I attended. It was more than the entire rest of my life combined.

 

I remember witnessing one elder crying over the body of her third adult child dead by suicide. I remember the double homicide father holding his infant son, both lying in the box in the hall, both with their new sewn blankets and fur hats and beaded gloves and moccasins. When I look back, I see another gentleman still in the rescue litter, before his casket was built, lying on bags of ice, wrapped in a sheet with another bag of ice on his chest. He had died a mangled death when he drove off the trail while coming home from another village’s New Year’s party. Alcohol was believed to be involved.

 

My concern now is as then--not only for the precipitators of the deaths—but the effects of the deaths on those isolated communities—especially their children. Darkness grips when you can’t effect a change. There is a darkness in rural Alaska, and it doesn’t have to do with the seasons of the sun. Though occurring with some frequency in all communities of this state, suicide and substance abuse are deadly, deadly, deadly realities in our villages.

 

 

It may seem by the tone of my letter that rural life is completely grim and there are no health supports in the villages. That is wrong. There are longstanding village-based counselors, local government supports, health aides, tribal workers and Headstart programs hard at work in the area. Frankly, I am amazed that they are able to hold on through constant tragedies, but they have and over the last 20 years they have made great progress in their communities and as a region. Presently, wellness teams using the “Kaltag Model” are forming across the greater rural region. It is clear that the YKMH sub-region is ready to take off again in a healthy way—should they receive the financial and technical support they need from the state.

 

In conclusion

 

There are more stories I could offer here. The points I wished to make seem already clear. If not, then imagine the impact on your own community should half the deaths be suicides. Imagine 2 or 3 near relatives—brothers, sisters, parents--killing themselves and quite possibly in front of you. Imagine having to clean up another death by gunshot wound or hanging or by snow machine--another body broken and frozen in the snow.

 

Imagine having laws with no police support--and no treatment options save for a counselor once a month—if the planes are flying.

 

In your role as legislator or state official, you likely have some learned understanding of mental health and substance abuse treatment needs and services in our state. But without ever spending time in a rural region—in the village--you will never understand the full story. These folks do not have the financial support to get to Juneau to talk with you directly; culturally they probably wouldn’t consider such directness. But their needs would be obvious if you spent time with them--in the village.

 

In the meantime, take my word for it. Alaska continues to have a suicide and violent death epidemic in its rural areas. Please do what you can to shift funding priorities to remedy this.

 

Thank you,

 

Maureen Suttman, M.A.

P.O. Box 244893

Anchorage, AK 99524

maureensuttman@hotmail.com

(message phone—907-278-4784)