If they comply with the ….

If they comply with the plans, the charge is dropped. They usually don’t end up with a public criminal record, but the court system can still track them.

Nontribal members are never put in jail, because the tribe lacks jurisdictional authority over them. Instead, a police officer ends up sitting with them in the hospital — sometimes for days — until they can be evaluated.

Not every suicide threat or attempt ends in an aggravated disorderly conduct charge. Ideally, a person in crisis is immediately evaluated by a mental health professional at the Indian Health Service or a telemedicine provider who can refer them to emergency care, if needed.

“Even though there’s difficulties in trying to get care for them, we still persevere,” said Sylvia Longknife, an IHS mental health specialist in Poplar. Longknife is IHS’ only mental health worker on the Fort Peck reservation since two other providers quit this year, meaning she can’t always immediately see somebody in crisis.

Longknife said she sees between two and five emergency cases a week. If the situation is deemed an emergency, the patient is referred to a facility four hours away in Billings. IHS doesn’t have its own transportation, so it either asks family members to drive the patient or requests transportation funds from the tribe.

If a suicide attempt occurs on a weekend, after hours or when a mental health worker is unavailable, police officers who respond may end up taking the person to a hospital for medical treatment, if necessary, and then to jail.

Lisa Dailey, executive director of the Treatment Advocacy Center, a national nonprofit that pushes for access to mental health treatment, said jailing people for attempting suicide criminalizes mental illness. “Prison or jail are the worst settings you can possibly be because you’re in a psychiatric crisis,” she said. Even if the care is good, she said, “being incarcerated is a traumatizing experience.”

Studies have shown that the risk of self-harm in prison increases if someone has been held in solitary confinement or has previously attempted suicide.

The Fort Peck reservation isn’t the only jurisdiction where people can be jailed after a suicide attempt. In New Hampshire, suicidal people often end up in the state’s only secure facility: the men’s prison.

After the Fort Peck tribes approached Carpenter’s Native American politics class last year for ideas, he and his undergraduate students began consulting with tribal members and others in Montana and working to research potential alternatives to jail.

The Flathead tribe in western Montana, for instance, specifies that people should be held in the “least restrictive environment” possible to protect their well-being, short of a jail cell. Carpenter said this could take the form of a “safe house” that separates a person from weapons.

Other potential fixes include requiring that a mental health worker accompany police during interactions with a suicidal person to ensure that jail is the last resort, and creating a new “mental health code” that would treat suicidal people differently from those who pose a threat to others.

The state of Colorado put $9.5 million toward community- based health treatment in 2017, then made it illegal to jail people awaiting mental health evaluations who hadn’t been charged with a crime.

But places like reservations may have no choice. “With no resources, there’s very little you can do about any of those issues,” Dailey said.

The IHS office has sufficient funds to hire four more mental health workers for Fort Peck. “We’re definitely aggressively trying to fill empty vacancies,” said Steve Williamson, chief medical officer of the IHS’ Billings area office.

But the positions have been difficult to fill. IHS and other health providers in northeastern Montana struggle to attract candidates to live in a region 70 miles from the nearest Walmart, with few jobs or entertainment options for families.

FourStar said the tribes hope to use COVID relief aid to improve behavioral health services so that suicide attempts can be treated as civil cases instead of criminal ones. “I think this will go somewhere, as long as we can get the manpower,” she said.