IHS roundtable conference on involuntary commitment of dangerously mentally ill Indian patients, June 16-18, 1992, Albuquerque, NM.


This publication is the Executive Summary of the Roundtable Conference. Participants included experts in the fields of mental health, Indian law, and public health. Participants examined practical and legal problems related to the involuntary commitment of mentally ill Indians in certain states due to alleged jurisdictional and fiscal restraints. The Roundtable participants developed a consensus statement and interim recommendations to assist the Indian Health Service (IHS) in its quest to overcome these problems. At the Conference, the IHS initially sought a solution that could be implemented IHS-wide. The Roundtable participants explored the possibilities of using legislation, litigation, or administrative mandate to solve these this issue but ultimately determined that each tribe must be treated individually. Given the strong emphasis on tribal self-determination in Congress and the Administration, the Roundtable participants favored an approach to encourage each tribe, together with the IHS, negotiate an agreement with the state. It was the consensus position of the Roundtable participants that tribes and states should negotiate agreements to set up procedures for involuntary commitment of reservation Indians. It was also recommended that the IHS take a proactive role in encourage tribes to negotiate procedures with states to ensure that reservation Indians can be treated when involuntary commitment is necessary. When enacting a code, tribes with reservation boundaries extending into two or more states will have to consider the standards of each state where involuntary placement in those state facilities could occur. The Roundtable participants concluded that the status quo is unacceptable and is a hardship to dangerously mentally ill reservation Indians and those attempting to care for them. The Roundtable participants acknowledged that their recommendations do not represent the IHS position or policy. However, the Roundtable concluded that action towards resolving problems in states when access to care is limited or non-existent must take place, and that the IHS has a role and responsibility to move these discussions forward.