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