Psychiatrists Build Bridges to Troubled Community

Twice a month for the last three years, a member of the Minnesota Psychiatric Society (MPS) buckles the seatbelt in a small private plane for the flight from Minneapolis to Bemidji in northern Minnesota. From there, the psychiatrist drives another 40 miles to the Red Lake Indian Reservation to donate a day's services to a small, isolated community stricken by tragedy.

On March 22, 2005, a 16-year-old student walked into Red Lake High School, and he killed a security guard, a teacher, and five students and wounded seven others before committing suicide. He had already murdered his grandfather and his grandfather's girlfriend before going to the school.

The effect on the community, home to members of the Red Lake band of Chippewa Indians, was devastating, said MPS member L. Read Sulik, M.D., in a recent interview. The tragedy struck an area already burdened by poverty, unemployment, and significant mental health problems, he said. Those problems included a suicide rate 10 times higher than that of other Native-American groups in the state and 30 times higher than that for non-Hispanic Minnesotans.

“Immediately following the shooting, the federal government provided money for counseling and other mental health services,” said Sulik, a child psychiatrist and pediatrician who was recently appointed Minnesota's assistant commissioner for mental health and substance abuse.

Red Lake Hospital's geographic isolation only worsened the tragedy's effects, hospital CEO Constance James told Psychiatric News.“ We were on our own afterwards with no urban community nearby.”

The federal funds went to the tribal health department and the schools, but not to the hospital, said James, who arrived two weeks after the shootings.

That left a gap that the MPS thought it could fill, at least on a temporary basis. Because mental health resources in the area were limited, the MPS created the BRIDGES program, persuading a dozen psychiatrists to donate their time to the community. They took turns every other Saturday flying 240 miles north from the Twin Cities.

Volunteer pilots from Angel Flight Central flew the psychiatrists to Bemidji and brought them home again in the evening. The MPS gave Angel Flight pilots Art Mouyard of Woodbury, Minn., and Tim Baird of Richfield, Minn., its Community Partnership Award in May.

“Given the timing, we needed a case manager at Red Lake, and we got a good one in George Aurand, R.N., a psychiatric nurse,” said Sulik. Aurand schedules patients for the psychiatrists' visits and connects each patient with a local nurse practitioner, primary care physician, or other provider.

“At first, there was some skepticism about outside providers coming to the reservation, but very soon the BRIDGES doctors were accepted by the community,” said Aurand in an interview.

BRIDGES was set up under a one-year contract, but is continuing on an open-ended basis until the reservation authorities decide the additional help is no longer needed. The program has helped build the capacity to treat mental health problems at Red Lake and change the mental health climate, said Sulik.“ Suicide rates have dropped, but all the added effort hasn't eradicated the need.”

The program has lived up to its name. Over the last three years, Red Lake Hospital has hired two American-Indian psychiatrists, a Ph.D. psychologist, and a psychiatric advanced-practice nurse.

Before the BRIDGES program began, the hospital contracted with two outside psychiatrists who came once a month, mainly to do medication management, said Albert Allick, M.D., who joined the staff 18 months ago. The MPS psychiatrists do full assessments of the patients they see and then consult with Aurand.

“Native Americans have big abandonment issues, and Red Lake feared that the federal government might divert support after Hurricane Katrina later in 2005,” said Allick, who is Chippewa. His ancestry also eventually helped break down resistance to treatment on the reservation. Patients are more willing to disclose information than when he first arrived, and he has fewer no-shows.

Thus continuity of care is especially important in this population and has been helped by the ongoing commitment of the MPS psychiatrists. A second psychiatrist, Eric Swenson, M.D., has been hired as clinical director but also serves part time in the clinic.

Their work is augmented by the knowledge of the volunteer psychiatrists, who include geriatric, child, substance abuse, and pain specialists.

“I think it also helps that Read Sulik understands how remote the place is and what the needs are out here,” said Allick. “It also relieves some of our own feelings of isolation to talk shop with colleagues when they're here.”

Integration of mental health services between the tribe, Indian Health Service, and local school system has improved in the last three years, and capacity is expanding, said Sulik.

Red Lake Hospital hopes to improve its intensive day services, develop a telepsychiatry service, and create an inpatient stabilization unit, said James. But the effects of this volunteer initiative are only just beginning to be felt.

“A program like BRIDGES can change the face of behavioral health care in rural America,” said James. ▪