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
(message
phone—907-278-4784)