A new U.S. government report highlights serious gaps in mental health care for many American Indians and Alaska Natives, groups that suffer from problems including a teenage suicide rate more than twice the national average.
One in five hospitals and clinics in Indian Country provide no mental health services, according to the Inspector General's Office of the Department of Health and Human Services.
Only half provide drug therapy treatments, and at dozens of facilities some drug treatments are handled by non-licensed social workers, counselors and nurses.
The inspector general's report covers a government health system that serves almost 2 million people, belonging to more than 500 tribes scattered across 35 states. It was released Friday by Montana U.S. Sen. Max Baucus.
The Democrat in 2008 had requested an investigation into problems with mental health care on reservations, which often are set in remote areas with struggling economies and where health care services of any sort are often in short supply.
"The demand for mental health services outstrips capacity at some IHS (Indian Health Service) and tribal facilities," the report's authors wrote, adding that American Indians and Native Alaskans "rank first among ethnic groups as likely to suffer mental health disorders such as anxiety and depression."
The consequences of those problems came into dramatic focus over the last two years on Montana's Fort Peck reservation. Five suicides and 20 attempts in one year at the rural reservation's Poplar Middle School prompted tribal leaders last year to declare a crisis and the government to dispatch an emergency team from the U.S. Public Health Service.
At least two more teenagers have killed themselves since and dozens of other children across the reservation have tried.
The inspector general's report says drug and alcohol abuse, depression, and unemployment also drive the need for better access to mental health services.
Some changes have been made since Baucus first called for the investigation, including new programs promoting the use of telemedicine, in which doctors can speak with patients remotely.
"In Montana, we've seen all too well the tragedies that result when folks don't get the mental health care they need," Baucus said in a statement. "It's clear from this study that more needs to be done, and my staff and I will continue working with Indian Health Service and folks on the ground in Montana."
The inspector general's office called for the Indian Health Service to further expand the use of telemedicine and also link up with non-native mental health care providers.
An Indian Health Services spokeswoman said no one from the agency was available late Friday to comment on the report. But in an August letter to the Inspector General Daniel Levinson, IHS director Yvette Roubideaux said she agreed with the recommendations and would work to put them into practice.
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