Washington tribes are implementing drug prevention strategies based on an Icelandic health model to help curb increased opioid use among Native youths.
Tribal leaders discussed the model at the 2024 Washington State of Reform Health Policy Conference. Dr. Hossam Mahmoud, regional chief medical officer at Carelon Behavioral Health, said it is a critical time for behavioral health in this country.
“There is increasing need and demand for behavioral health services,” Mahmoud said. “At the same time, we do not have sufficient behavioral health clinicians and sufficient services to meet the need. The care that is delivered is often in silos. Or it’s delivered in a manner that’s not whole health, where it can be pretty fragmented.”
A specific confluence of factors shape the wellness and mental health of tribe members, Mahmoud said.
“When it comes to tribal communities, we have historical and ongoing intergenerational trauma, and a range of social drivers of health, which can be risk factors for certain behavioral health conditions,” he said. “We also have very few behavioral health clinicians that identify as Native, or who have the training to be able to deliver culturally affirming and culturally competent care to tribal communities.”
Summer Hammons is a legislative policy analyst for the Tulalip Tribes, which have about 5,500 members with about 2,700 residing on the 22,000-acre Tulalip Indian Reservation north of Everett. She discussed efforts to improve behavioral health outcomes there. The reservation has a court system, a police force, and a health clinic.
“We have the ability to provide great resources for our people, such as our behavioral health facility (and) healing lodge. But we have to do better. We’re in an opioid epidemic that is taking a lot of our lives in Tulalip. It gets really devastating. If (we) want to change a state system, we have to be innovative. In a social system that wasn’t working before, you have to reinvent all those new processes and not lose energy to keep going.”
— Hammons
Several Washington tribes have declared a state of emergency over fentanyl. Hammons said the Tulalip Tribes have been working with the Washington State Health Care Authority (HCA) for over three years to formulate a plan to address youth health/drug prevention, which led to tribal leaders joining HCA representatives on a trip to Iceland to examine the Icelandic Prevention Model.
Drug use among youths was a growing problem in Iceland, and preventive measures that had been used to educate them about the dangers of drug use were not working. So a group of social scientists, policymakers, and professionals who work with children formed in 1997 to formulate policies—based on research—to work on reversing the trend. The Icelandic Prevention Model helped reduce alcohol use among 15- and 16-year-olds there from 77 percent to 35 percent in 20 years.
The HCA and five tribes—the Tulalip Tribes, Lummi Nation, Jamestown S’Klallam Tribe, Swinomish Indian Tribal Community, and the Colville Tribes—have since formed the Washington Tribal Prevention System, which is based on the Icelandic Prevention Model, to see if the approach will work in Washington.
“It was a different perspective being in Iceland. And it was really healing. I was impressed that the governor’s office and HCA were innovative in acknowledging these [current] systems don’t work any more. The Icelandic model, when we’re converting it, takes a lot of our culture and (goes) into the school system to see the mental health mood of a youth. Being able to be one of the five tribes to model this is really healing for us. I’m excited for it. There’s lots of good innovation coming.”
— Hammons
The program kicked off with a ceremonial contract signing by the tribes on Wednesday. HCA Office of Tribal Affairs Administrator Aren Sparck said the program is based on lessons learned from the Icelandic model.
“What we saw out there was the most advanced prevention system in the world,” Sparck said. “There’s no way to talk to other folks about it, unless you’ve actually been there. We’re talking about different domains—government, health and social services, youth services, youth activities, and justice—all working together to make sure we’re taking care of our children. They’re so far into this the kids don’t even know they’re part of the most amazing system in the world. We’re trying to reproduce that here with five pilot tribes.”
The first two years of the project will feature a lot of administrative work, which will cost between $2-3 million per year. Gov. Jay Inslee designated $1 million for the project in his supplemental budget proposal this year, and grants should help with costs as well.
“This is a 10-year project with a pilot. We’re not going to do this on the short end. The tribes are the ones who design this. We can get our justice department to work with our schools. We have the ability to talk with them as a tribal council. It’s a very natural landing spot for the tribes to do that. You’ll notice that the five tribes we mentioned are some of the larger and more resourced tribes in the state. Some folks aren’t able to do that. Some people don’t have the administrative capability to say, ‘Yes, we’re going to hop right into something like this.’ But the tribes we work with do have that ability.”
— Sparck
Hammons noted that the Icelandic model features collaboration between each participating city and its police department, social department, and surrounding schools.
“And they create a pathway for that young one to have a support system right after school, a safe place to go take a nap, (or do) sports (or) dance because a lot of children don’t know how to self-regulate,” she said. “Over there, they (now) know how to self-regulate because their system is more advanced. They can feel safe in the schools. They know how to respect their own bodies and each other’s. A lot of it is about the youth’s informed decisions. I think the system can be transferred over [here] with the love and attention the program has. It’s not going to be the same system; it’s going to be the same intention.”
Kelly Waibel, a crisis counselor at Tulalip Mental Health, noted that the tribe is also in the early stages of developing a crisis response team.
“Full 24-hour crisis services is the goal,” Waibel said. “Having that within the community instead of having to rely on the county (helps), because they cover a huge area. And law enforcement can’t wait four or five hours for a (designated crisis responder) to get there. So the tribal member ends up going to the hospital, where there’s sometimes not-good outcomes. There are a lot of moving parts.”