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Missing: Mental health care providers in the Arctic

  • Author: Jill Burke
    | Opinion
  • Updated: September 14, 2016
  • Published September 14, 2016

Research into the rapidly changing environment of the Arctic includes more than tracking sea-ice levels, polar bear populations, new shipping lanes, energy costs and melting permafrost. It also focuses on the lives of people confronted with adapting to the changes.

Critical among the priorities is promoting wellness for those who live in the Arctic. And specifically, doing more to prevent suicide, which has long had an outsize impact on far-north populations.

"This suicide issue has been around a lot longer than our fuel crisis. We know from statistics that have been coming in from the past two decades that we have a pretty serious health disparity," Cheryl Rosa, the Anchorage-based deputy director of the U.S. Arctic Research Commission, said in an interview Wednesday.

"This is a problem that hasn't gone away with what has been done so far," Rosa said.

Last year the commission set into motion the Arctic Mental and Behavioral Health Working Group. Now, that group is ready to dig in.

"In Alaska, the suicide rate is almost twice the U.S. national suicide rate, with even more disproportionate rates reported from Alaska Native communities," says a flier outlining the group's work and mission.

In 2015, 200 Alaskans died by suicide, according to the state Bureau of Vital Statistics. Most were men. And one-third of those who died were Alaska Native and/or Native American. Of Alaska's estimated 738,432 residents, nearly 15 percent are Alaska Native or American Indian, according to 2015 U.S. census data.

Two more striking data points stand out. The leading cause of death for Alaskans ages 15 to 24 is suicide, and in 2015, nearly one-third of Alaska's high-school students reported feeling sad or hopeless for two weeks or more.

The working group plans to tackle mental health (depression and suicide) and behavioral health (substance abuse and addiction) from three angles: data collection and analysis, workforce development and early intervention for children and teenagers.

Rosa, who spends a lot of time collecting and evaluating existing scientific research, said the depth of available research on mental health is woefully lacking.

"The mental-health discipline is behind. There is so much research needed, and when you compare it to physical health research, it is like night and day. It's not just Alaska. But in Alaska we have a particularly bad problem," Rosa said.

Suicide rates are high across the circumpolar north, something the working group attributes in part to pressures remote, indigenous communities experience in the face of rapid modernization.

Adapting to social, political, economic and environmental changes, coupled with historical traumas from early contact with Western culture, can intensify the pressures young people experience and their expectations for the future.

Identifying the skills young people need to be healthy and thrive in such dynamic environments is one of the group's goals. What kinds of early interventions work? What's in place now? What could be put in place to help further?

Research shows early intervention and prevention programs are crucial to lowering suicide risk, according to the working group. But finding the money to keep the programs going is a challenge.

Medicaid and the Indian Health Service won't pay for most preventative services or early intervention, even when it's court-ordered, Rosa said. As a result, many of the intervention and prevention programs are limited in scope and last only three to five years — the average length of a grant. Unless more money comes in, the programs disappear.

"With U.S. health care we are reactive instead of proactive. We should be putting time into prevention instead of waiting to get to the crisis point," Rosa said.

Finding qualified mental and behavioral health providers is another problem the working group hopes to help solve. From psychologists and psychiatrists to therapists and behavior health aides, there aren't enough to go around.

"If all funded positions were filled right now there would still be an unmet need in Alaska," Rosa said.

Recruiting people to live and work in rural Alaska and to stay in the positions long term is difficult.

The mental health field requires extensive record-keeping. Often, there isn't enough support staff to help a provider manage the load, and compensation is too low to offer an incentive to take it on, Rosa said.

Significant gaps also exist along the continuum of mental and behavioral health care. Often, patients are released quickly from inpatient stays, but need transitional care before going home, only to find none is available, Rosa said.

The U.S. Arctic Commission is also looking at renewable energy, water and sanitation issues in the Arctic. But by far, the most difficult task has been suicide and mental health, Rosa said.

"This is a highly sensitive subject. There is so much stigma about mental health in the first place. There are a lot of reasons why this is a hard one. But that is not a reason not to do it. If anything it's even more reason to do it," she said.

The working group will evaluate its findings at the end of 2017.

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