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Kadoka More Central Location Than Rapid City for IHS Anti-Suicide Treatment Facility

Indian Health Service is building a $1.8-million outpatient therapy center on the Sioux San Hospital campus in Rapid City to tackle high demand for behavioral health services among American Indians in West River. Specifically, the new facility responds to the epidemic of youth suicide on the reservations.

Wait—Rapid City isn’t on a reservation….

High rates of suicide and suicide attempts are not exclusive to Pine Ridge, which is home to the Oglala Sioux Tribe. Reservations across the state, including Rosebud and Cheyenne River, have grappled with mental-health crises over the years. Federal experts say that some reservation children experience a form of post-traumatic stress from exposure to family turmoil.

The plans for the 7,900-square-foot modular building call for space to provide behavioral health services and a duplex with two, three-bedroom compartments to host overnight stays for families and transitional patients. The existing staff at the Sioux San Hospital will provide the aftercare to patients, and IHS officials assert it “is centrally located” among the three reservations [“Tribe Says Behavioral Health Unit Being Built Too Far from Reservation,” AP via Rapid City Journal, 2016.03.22].

If I were centrally locating myself among the tribal headquarters of the Pine Ridge, Rosebud, and Cheyenne River reservations, I wouldn’t put myself in Rapid City. I’d draw the triangle connecting Pine Ridge, Rosebud, and Eagle Butte and look for someplace with water and a gas station inside that triangle…

West River map
Possible “centrally located” site for behavioral service center for American Indian patients from western South Dakota reservations. Map clipped from Google, annotated by CAH.

…like Kadoka. Kadoka may not be the friendliest place for our Lakota sisters and brothers, but find me any off-reservation town in South Dakota where Indians don’t get looked at crosswise, and I’ll buy you a lottery ticket.

The average distance to Kadoka from the three tribal headquarters listed is 94 miles. To Rapid City, the tri-HQ average is 157 miles. If tribal members from Lower Brule and Fort Thompson want to avail themselves of the new services, the trip to Kadoka would be 96 miles less, an hour and a half shorter, than the trip to Rapid.

IHS says building a new facility outside of Rapid could increase costs by half a million, but Rosebud Sioux Tribe Health Board member O.J. Semans says IHS chose Rapid City for its own convenience, not that of the tribal members it serves. Even Senator John Thune apparently thinks better service closer to more tribal members is worth the extra cost:

“There are already a litany of well-known problems facing the Great Plains Area IHS, which is why I don’t believe building a new counseling facility nearly 100 miles away from Pine Ridge will help fulfill our commitment to our tribal citizens in South Dakota or mitigate the damage that’s already been done,” Thune said in a statement Tuesday [AP, 2016.03.22].

Naturally, the optimal solution would be a quality behavioral health facility fighting youth suicides on each reservation, as close to the tiospaye as possible. But if IHS can only afford one new facility (and tell us again why IHS is short on cash, Senator Thune?), then IHS should strongly consider placing it in a genuinely central location to the tribes.


  1. Craig 2016-03-23 10:22

    It might sound like a nice idea to put such a facility closer to the reservation, but there are several logistics barriers of which I’ll focus on two.

    1. It would be very, very difficult to staff such a facility if it were located in a low population area which admittedly is in the “middle of nowhere”. Finding general practitioners in these areas is increasingly hard, but finding physicians with a specialty in mental health would be exceptionally difficult and you may find a facility with no staff to serve patients.

    2. A standalone facility would not have the advantage of utilizing staff from the existing facility of aftercare or the ability to float staff over for coverage during peak times or when several staff members are out due to planned vacations, illnesses etc. This isn’t the type of facility you build on an island. You need a network nearby which can help support the patients and one which will lead to better care.

    Is this inconvenient? Certainly – but due to our state geography the only city in the West River area of large enough size to support such a facility is Rapid City. Rapid City is large enough to attract talent to staff the facility, and the city itself offers services for families who may be visiting the patients such as lodging and dining options. Kadoka, with its population of around 700 residents, would never be able to adequately support such a facility

  2. Tasiyagnunpa 2016-03-23 10:25

    Kadoka is not just an off-rez town, it’s a BORDER TOWN. I have stories, Cory. Spent my junior high and freshman year there.

    NO. You have no idea how awful an idea this is. Rapid City is a natural pathway for most. Pierre even.

    But we want TALENT. It’s what we lack at IHS on the reservations already.

  3. Curt 2016-03-23 10:44

    I think Tasi is correct – RC or Pierre are probably the best locations for a center like this one. There would, however, be outreach facilities required in outlying locations.
    In truth, RC is actually a quasi-reservation community. The IHS Soo San hospital is located on a large parcel of land that was granted to the Great Sioux Nation approx. 100 yrs ago. What has been allowed to happen to IHS facilities across the nation in recent years is absolutely criminal.

  4. leslie 2016-03-23 11:28

    tasi, why is IHS talent poor? underfunding? prestige? treaty? competence? oversight? administration? hiring? low pay? management? we know vets are underserved. big systems are difficult. RCRH certainly has most of these problems to some extent. the national health system we are grappling with now is interested in profit, 1st. medicare, Medicaid, obamacare, IHS, VA. big systems. they could be very successful with skilled administration. only the wealthy and privileged get the best care. Notorious RBG has survived 10 years with pancreatic cancer, a killer. scalia however didn’t take very good care of himself despite the best federal doctors. he ate and drank. overweight.

    appropriate politics and constant work are the only solutions, and that is not the GOP. I not medically trained. only imo.

  5. Richard Schriever 2016-03-23 11:46

    Craig – as was stated earlier – convenience for IHS staff trumps convenience for clients in this case. Your lengthy rationalization doesn’t alter that FACT.

  6. Richard Schriever 2016-03-23 11:47

    BTW – Wanblee is the on-rez site closest to the center here.

  7. Mark Winegar 2016-03-23 12:07

    I grow weary of seeing monies earmarked to help Native Americans in South Dakota squandered or rerouted to benefit Non-Natives. We saw it with GEAR-UP and countless other projects in the past. Please let’s not do it again.

  8. Bill Dithmer 2016-03-23 12:41

    If they build it for $23 a sf its gonna be junk anyway.

    Kadoka couldnt keep a GP living there so staff would never buy or build there.

    Wanblee is the armpit of the Pine Ridge. Every time something nice is built there someone trashes it, community center, Crazy Horse School, the clinic. Its a tough place to work and even worse to live for a professional.

    The only thing that will bring the suicide ratedown is a jobs program. This is just a feel good idea.

    The Blindman

  9. MD 2016-03-23 14:01

    Its hard enough to keep therapist appointments when they are just down the street let alone 100+ miles away with lackluster transportation options. Who thought that Rapid City was a good idea?

    If attracting help is a problem, set up a bus to transport staff to the area that needs the help, rather than just relying on the clients to transport themselves to rapid.

  10. Roger Cornelius 2016-03-23 14:02

    If John Thune did a little research and if IHS would tell the truth, they’d find out that behavioral health programs on each reservation have been tried and have worked.
    Each facility had a competent staff and Sioux San was able to offer residential family support. Sioux San also provided support for patients needing long term care.
    About 5 to 7 years ago the Aberdeen IHS Area Office started to gut all behavioral health programs in the Aberdeen area.
    Today the Sioux San program doesn’t have a psychologist, psychiatrist, PA or nurse practiconer, the only staff member left in the office is an administrative assistant that refers patients to GP’s in the clinic wing of the hospital.
    I have personally known doctors and nurses that worked for IHS and loved their work and would have continued working there if it weren’t for IHS ever shifting policies and an uncertain future for potential long term providers.
    If given the choice between Rapid City and Kadoka, I would choose Rapid City, Rapid City is a fast growing regional center for health care and provides so many amenities to patients and families.
    I can only imagine what it would be like to be stuck in Kadoka with bleak surroundings and people that hate me.
    I’m tired of hearing that IHS is broke or that they don’t have enough money, that is bullshit. They do have it and choose to spend it in all the wrong areas while making patients suffer and die.

  11. Roger Cornelius 2016-03-23 14:09

    The idea that only jobs programs will reduce the suicide rate for those with with mental health problems is not only stupid, it suggest that those with those beliefs should seek mental health treatment.

  12. Craig 2016-03-23 14:21

    Richard: “convenience for IHS staff trumps convenience for clients in this case.”

    How convenient is it for patients/clients when they have a shiny new therapy center but can’t find a single doctor willing to live or work in Kadoka?

    I’ve worked with doctors and I know some of the challenges faced with filling specific specialties in South Dakota even when you include Sioux Falls or Rapid City. Trying to fill such a position in a town of 700? You will either find a substandard care provider who isn’t employable elsewhere, or you’ll see a revolving store of Doctors coming off of Residency to serve for six months or a year before they find something better.

    When it comes to behavior health, having a consistent doctor is important. The patients deserve that much – and since IHS won’t pay enough of a salary premium to convince someone to locate to the middle of the prairie I fear those patients would be stuck with the leftovers.

    There is more at play than simple convenience. I wish it were that simple.

  13. Spike 2016-03-23 15:36

    I agree with Roger that there was a system in place that was dismantled by mid level IHS administrators. Most IHS facilities have good housing available that good care givers are willing to live in…but the screwed up inconsistent policies of IHS often run them away. After all its not that far from PR (or Kadoka?)to RC for someone with the means. I know caregivers that commuted. They quit because of management disfunction not location.

    Unfortunately the new term for IHS.. Indian Homicide Service

    An obsolete system with absentee management.

  14. Douglas Wiken 2016-03-23 16:38

    Patients get paid mileage to see doctors. My guess is the major problem with Kadoka is not that the doctors don’t like it necessarily, but many doctor’s wives are loath to live in places like Kadoka or Winner or any other rural area. They really don’t care if their husband’s like to hunt pheasants.

  15. Roger Cornelius 2016-03-23 16:49

    When did IHS start paying for patients transportation, I’ve never heard of that or know anybody that got paid mileage.

  16. Spike 2016-03-23 17:21


    You probably know many tribes attempt to support needy tribal members and families in their trips to Doctors. Paid for by tribal funds. Those tribal funds are NOT federal dollars but revenue from other sources. Considerable annual amounts of cash spent off-rez for gas, food, lodging. I’m sure that’s what Mr Wiken is referring to.

  17. Spike 2016-03-23 17:25

    Medical travel assistance is the term I’ve heard. Could be some grant programs involved from other sources but definitely NOT IHS.

  18. Roger Cornelius 2016-03-23 17:27

    Thanks Spike, that clearly explains it, it is hard to believe that IHS would pay a penny more for what is required of them.
    That is also a very worthwhile program for those with the greatest need.

  19. Douglas Wiken 2016-03-23 18:01

    They and white poor too can get a statement from hospital and take it to SD Welfare office to get mileage paid. My wife fills in forms for them nearly every day at Winner Hospital.

  20. Bill Dithmer 2016-03-24 06:39

    ” The idea that only jobs programs will reduce the suicide rate for those with with mental health problems is not only stupid, it suggest that those with those beliefs should seek mental health treatment.”

    Yes Roger I’m saying the only way to lower the suicide rate is through prosparity, and the only way to accomplish that is jobs.

    We were talking about mental health here, of course those people that have suicidal thoughts should seek treatment. Whats your idea keep going like they are?

    The Blindman

  21. leslie 2016-03-24 07:18

    Veto hb1060. Indian kids suicides and self esteem trump schoenbecks. Then Call Usbgn And Support Name Change. A Decision May Come In April. Get On The Right Side Of History Governor.

  22. Bill Dithmer 2016-03-24 07:34

    ” You might assume that suicide rates would be elevated in lower-income neighborhoods and counties, and the study’s authors do point to findings that higher income generally lowers suicide risk. For example, an individual with family income less than $10,000 (in 1990 dollars) is 50% more likely to commit suicide than an individual with income above $60,000.”

    From your link Jerry.

    The Blindman

  23. jerry 2016-03-24 07:55

    So income really is not a real factor in mental illness, from my link. The idea that a location like Kadoka or Rapid City or Pierre could be considered for a treatment center does not make sense. What does make sense is the availability of treatment at a prompt consideration. Each tribal center should have a treatment center and a detox that has service 24 hours a day with qualified staff. This is not a jobs program per se, but could be viewed as such with the centers employing not only qualified staff, but also those that provide the other needed services.

  24. jerry 2016-03-24 08:05

    Incomes lower than 10K are killed by society itself, starved to death with lack of nutrition as well a needed medical attention both mental and physical, adequate housing as well as the energy required to keep it habitable. These factors are the noose around the neck of all society. Actual police protection would certainly keep suicide risk much lower.

  25. leslie 2016-03-24 09:34

    “those people that have suicidal thoughts should seek treatment”


    repeating, alcoholics average 25 years before sobriety, if they don’t die. guns are quicker. suicide is immature impulse, at least in youngers

  26. Bill Dithmer 2016-03-24 09:36

    Leslie, now your just making excuses.

    The Blindman

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