It’s a mild day in Denver in July 2015, with an overcast sky hanging over a neighborhood of mobile homes. It isn’t unseasonably warm or cold, or memorable in any other way, for that matter. Lynn Eagle Feather, a Lakota Sioux woman, is babysitting her grandchildren.

Eagle Feather’s son Paul Castaway, 35, is a schizophrenic, an alcoholic, and a regular with local police. It’s hard to tell whether it’s the alcohol or the mania, but today Castaway isn’t like himself.

After visiting his mother earlier, being kicked out and returning, he bursts inside his mother’s home, recklessly breaking household items as he does. He grabs a kitchen knife, 7 inches with dulled serrations, and pokes his mother in the neck, drawing blood. Holding it up to his throat, he threatens to take his own life before bolting outside.

Threats like this are shockingly common in Native American communities, where the suicide rate is nearly double the national average and is increasing faster than that for any other race. It is a rate on par with the homicide rate in Chicago and roughly double the opioid overdose death rate nationwide. Eagle Feather doesn’t take it lightly.

She calls the police. “I called for help,” she says. “He would rather go out killing himself.”

When the officers arrive, Castaway is walking along a chain-linked fence.

“Denver Police. Stop!”

Castaway keeps walking, which gives way to running. Knife to his neck, he leads the chase down the unmarked street. He turns a corner and finds himself corralled by a small backyard fence. There is nowhere to hide. He turns to face the officers. He takes seven lumbering steps toward them, both hands gripped firmly on the knife pressed to his throat. “If you shoot me, I’m going to kill myself,” he threatens. “What’s wrong with you guys?”

Three shots ring out. Two bullets strike Castaway, who falls to the asphalt. One tears through his liver. The officers roll Castaway’s unresisting body over and handcuff him as he begins to bleed.

Castaway is taken by ambulance to Denver Health Medical Center, where he dies from his wounds.

In many ways, Castaway’s story is a microcosm of a greater epidemic: a Native American man with chronic mental illness and suicidal ideation, denied help by the very institutions obliged and asked to provide it. His story did not have to end this way.

Castaway shared the devastating traits that have cut through Native American communities for decades, where substance dependence and mental illness are more common than for any other race.

Unfortunately, Native Americans face far too many barriers to mental health care. Among these are extreme poverty and high uninsured rates, forcing many to rely on the federally sponsored Indian Health Service (IHS), which provides free health care to Native Americans. However, chronic underfunding and understaffing have crippled this system. To date, only one-quarter of IHS facilities are able to offer behavioral health services.

As rates of mental illness, depression and suicide trend upward across the country, we need to begin having conversations about how to address these problems as a nation. There is, however, no group that needs answers more direly than our Native American communities. Increasing access to basic mental health services could go an incredibly long way toward healing the wounds that have touched so many Native American lives. Despite this, Congress is likely to pass a budget that increases IHS funds by a modest $97 million while allocating $1.6 billion to building a border wall. The IHS estimates that the cost to address backlogged facilities maintenance requests alone is $515 million.

Paul Castaway didn’t need more walls to find himself trapped by a broken system. He needed help.

Matt Hoyer is a second-year medical student at the Johns Hopkins University School of Medicine.

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