U.S. Rep. Kristi Noem (R-S.D.) and U.S. Sen. John Thune (R-S.D.) today raised questions about Indian Health Service’s (IHS) approach to the suicide crisis plaguing South Dakota’s tribal communities.  In a letter to Department of Health and Human Services Secretary Sylvia Burwell, Noem and Thune outlined specific concerns about a proposal to place a new IHS behavioral health program in Rapid City – hundreds of miles away from the individuals it is intended to help. 

“We understand that IHS intends to repurpose nearly $2 million in unspent appropriations to develop an intensive behavioral health program to assist individuals contemplating suicide on Indian reservations in western South Dakota,” wrote Noem and Thune.  “While we are encouraged by this news, we are concerned about the agency’s plans, particularly its decision to place the new facility at the Rapid City Service Unit…. We worry that, by placing the facility so far from the reservations, IHS may not fully grasp the urgent nature of this crisis.”

The rate of suicides among young people in the Oglala Sioux Tribe has reached epidemic levels.  Since December 2014, 15 people between the ages of 12 and 24 have taken their own lives.  There was also a high number of attempted suicides during that time. In October 2015, Noem and Thune traveled to Pine Ridge, South Dakota, to meet with students, law enforcement officers, tribal leaders and others to discuss the suicide epidemic and potential solutions.  Many of the questions included in this letter precipitated from that meeting.

A copy of the letter is included below.

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The Honorable Sylvia M. Burwell
Secretary
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Burwell,

For years, tribal communities in South Dakota have been plagued by suicides. This year alone, over a dozen young people have taken their own lives. Recently, we visited some of our constituents who reside in these communities. We spent the day discussing a wide variety of issues with both adults and young adults. Through our conversations, we found that, while positive steps have been made in anti-suicide efforts, much work remains to be done.  It is evident that access to behavioral health services in these communities is imperative.

Having heard firsthand from many of those affected by this tragic epidemic, we write to gain a better understanding of Indian Health Service’s (IHS) approach in addressing this issue. We understand that IHS intends to repurpose nearly $2 million in unspent appropriations to develop an intensive behavioral health program to assist individuals contemplating suicide on Indian reservations in western South Dakota. While we are encouraged by this news, we are concerned about the agency’s plans, particularly its decision to place the new facility at the Rapid City Service Unit – hundreds of miles away from the individuals the facility is intended to help. We worry that, by placing the facility so far from the reservations, IHS may not fully grasp the urgent nature of this crisis.

Given our concerns, and to help us better understand how IHS is addressing tribal members’ behavioral health needs and how it intends to administer this new program in Rapid City, please provide a written response to the following questions no later than  December 1, 2015:

1) Please provide a detailed account of IHS’ interactions with other federal agencies including, but not limited to, interactions with the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Administration, the Bureau of Indian Education, and the Bureau of Indian Affairs to address the behavioral health needs of tribal members.

2) How has IHS responded to the outbreak of youth suicides on Indian Reservations?  Please provide specific examples of how IHS has interfaced with tribal leaders, members, and health care providers to ensure that those who need assistance receive it. 

3) Prior to reprogramming IHS funds to the new program at the Rapid City Service Unit, did IHS consult with the Great Plains Area Tribes? If so, describe those communications.

4) How does IHS plan on responding to the growing need for additional inpatient behavioral health services on South Dakota reservations?

5) How will IHS staff the new facility in Rapid City?  Please include information pertaining to the number of staff onsite and their medical credentials.

6) Please provide a current accounting of the number of vacant behavioral health provider positions at IHS service units throughout the Great Plains Region and explain how IHS’ staffing plan in Rapid City will affect its ability to recruit providers to fill these vacant positions.

7) How will IHS identify patients on the reservations who are at risk of suicide?

8) Once a patient has been identified as at risk for suicide, what steps will IHS take to ensure that they receive timely care?

9) Given the limited resources our tribal members often have for transportation, will IHS be responsible to transport patients to the facility in Rapid City, and back to their homes?

10) Does your plan include outreach to Native American children at their schools on the reservations? If so, explain the nature and extent of this outreach.

Thank you for your assistance in this matter. We look forward to your responses. If you have questions, please contact Representative Noem’s staff at 202-225-2801 and Senator Thune’s staff at 202-224-2321.

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