PIERRE, S.D. — When a reported "rash of suicides" among tribal youth hit the Pine Ridge Indian Reservation in early 2015, JR LaPlante said leaders were "confounded." The onslaught claimed five young lives in a matter of two months, prompting leaders to declare a state of emergency.

More than four years later on Tuesday, Aug. 27, LaPlante — who works as Avera Health's tribal relations director, and is a member of the Cheyenne River Sioux Tribe — told legislators that among other suspected causes, officials concluded that part of the problem was inaccessibility to mental health care on the remote reservation located in southwest South Dakota.

LaPlante's testimony came as part of the South Dakota Legislature's summer study on telehealth and telemedicine, or health care provided to patients remotely via video chat, phone correspondence or other technology.

The summer study — chaired by Republican state senator and registered nurse Deb Soholt — comes after the Legislature in March passed bills defining telehealth in state statute, and requiring that insurance companies not bill telemedicine differently based solely on the fact that care was delivered remotely.

After 2015's emergency, LaPlante said officials concluded that young people on the reservation needed mental health care to be brought right to them, ideally at school, so as not to pull them too far from the classroom. What resulted was a memorandum of understanding between the Oglala Lakota tribe, the Indian Health Service and Avera Health to create a grant-funded public-private partnership.

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Funded by the U.S. Health Resources and Services Administration, the Pine Ridge Children’s Telehealth Services Network provides an avenue for providers to deliver mental health services to children in remote parts of the reservation via telemedicine. LaPlante said the program is still in development, with hopes to creating a transferable model to be used on other reservations, as well.

In their abstract on the program, the HRSA said that young people on Pine Ridge "face extreme health, social and quality of life issues that derail hope for an otherwise bright future," creating a greater need for mental health care.

They added, "reaching children living in isolated, rural communities throughout the reservation and connecting them with the help and care they need, when they need it, can be extremely difficult due to geographic isolation and a lack of financial resources to travel extensive distances."

The issue of inaccessibility to health care is not exclusive to Native reservations, particularly in a rural state like South Dakota, and more than just mental health care is needed.

Per documents submitted to the study, the state Department of Health as of January 2019 qualified 60 of South Dakota's 66 counties as "shortage areas" for mental health care. Soholt said Tuesday that telehealth could potentially close some of those gaps by bringing health care to South Dakotans, so they can stay in their communities, rather than travelling great distances to see a doctor.

The summer study will continue to meet in order to develop new legislation on telehealth for the 2020 legislative session, which begins in January. There remain logistics to be fleshed out with legislation: How will telemedicine be billed to insurance companies? What licensing requirements do providers have to meet in order to practice remotely? Can doctors prescribe medication to patients remotely?

According to the National Conference of State Legislatures, these questions are answered differently by state legislatures across the country. South Dakota will continue to answer them for itself throughout the summer.