Reaching Recovery in Rural and Tribal Areas

The following transcript has been edited for clarity and brevity.

Narrator: Welcome to Justice Today, the official podcast of the Department of Justice's Office of Justice Programs, otherwise known as OJP. We shine a light on cutting-edge research and practices and offer an in-depth look at what we're doing to meet our times' most significant public safety challenges. Join us as we explore how funding, science, and technology help us achieve strong communities.

KAREN FRIEDMAN: I'm your host, Karen Friedman. I'm the Director of Criminal Justice Innovation, Development, and Engagement at OJP's Bureau of Justice Assistance, otherwise known as BJA.

September is National Recovery Month. During the month, BJA and agencies nationwide promote and support new evidence-based treatment and recovery practices.

The National Institute of Health reports that 85% of the prison population has an active substance use disorder or was incarcerated for a drug or drug use crime.

We are joined today by Brad Carlyon, prosecutor for Navajo County in Arizona, to discuss the intersection of the criminal justice system and recovery and how agencies can support recovery in their community.

Brad, as an elected official over the past 15 years, has worked at the intersection of the criminal justice system and recovery in rural North Arizona, and we are so, so pleased to have him here today. Thank you for joining me today, Brad. How are you?

BRADLEY CARLYON: Karen, very good. Thank you for having me on.

KAREN FRIEDMAN: Oh, my pleasure. Can you tell our listeners about Navajo County?

BRADLEY CARLYON: Navajo County is a large rural county in northeastern Arizona. We're approximately 10,000 square miles. If Navajo County were to become the 51st state in the union, we would be the 45th largest state, just slightly behind the state of Massachusetts. While we're big in area, we're not that much for the number of people that we have. We only have 110,000 people in the county, or just about a little over 10,000 per square mile.

We're also a very poor county. Twenty-eight percent of the families in Navajo County have an income under $25,000. Seventeen percent have food insecurities. It is not only the population of Navajo County is poor, but so is the government. Only 18 percent of the land in Navajo County is privately owned and can be taxed. The rest is either Indian land, federal land, or straight land. So it really strains our coffers to be able to raise enough money to adequately service all the residents of our county.

KAREN FRIEDMAN: You've worked as the county prosecutor for 15 years. What role does your office play in helping individuals on the road to recovery?

BRADLEY CARLYON: Well, I've been practicing criminal law in Navajo County for over 30 years. I've been the elected county attorney for 15. And part of that time I spent working as a criminal defense lawyer. In these 30 plus years, I'm now seeing third generations of families enter the criminal justice system. When I started off as a young prosecutor, I was on the—on the edge of being law and ordered; you know, do the crime, do the time. But working on the defense side, I really started to get a different perspective on those who enter the criminal justice system.

I realized that about 5 percent of those that come into the system are truly bad people. Another 10 percent are doing very serious crimes that we need to hold accountable. But 85 percent, about, are those that seem to cycle in and out and in and out of the criminal justice system. And they have a large commonality for many of them, and that is either a substance use problem, a mental health problem, or quality of both. And working within the criminal justice system, I see that the county attorney's office as a prosecuting agency is really at the fulcrum of being able to make a change in those lives.

Part of the struggle being from a poor county is that we don't have enough resources to hire all the prosecutors that we need. So how do I focus on protecting the community? And but yet the community itself sees that 85 percent who are committing what I call quality of life, that affect the quality of life in our communities, that’s the ones they see, and that’s the ones they really want off the street, but yet without giving them help, without giving them services, without giving them treatment, they just—they just keep going through that revolving door, and we see them again and again. And unless they commit felonies, the county doesn’t have resources to get them the help they need with substance abuse or their mental health issues. So we’ve become very proactive in Navajo County, as an office, to try to get services to these people as quick as we can, as soon as they enter into the system. So with the knowledge that more than likely is not going to help the first time but somewhere down the line, we can have that positive impact, get them out of the criminal justice system, put them back into our communities as productive citizens, and lower the number of people who are cycling in and out of our criminal justice system.

KAREN FRIEDMAN: You are singing my song, Brad.

BRADLEY CARLYON: That’s where we need to go.

KAREN FRIEDMAN: I was a judge in Baltimore for over 20 years. I’ve seen all the things that you’re talking about, and I really, truly agree, and, you know, I try to go all around the country explaining to people exactly that, so I appreciate your view. On average, individuals with misdemeanors in Navajo County spend only a few days in the county jail. So why is it so essential to begin the recovery process while in the county jail?

BRADLEY CARLYON: Karen, before I fully answer your question, let me give you some background information on those that are coming into the Navajo County Jail. We ask everybody who's booked in, regardless of the type of charge—be it a misdemeanor, be it a felony—if they would voluntarily answer some questions for us. So between the first of April and the end of July, 964 people being booked into the jail agreed to take the screening. Of those 964, 161 admitted they had an opioid use problem. Eighty-eight of them admitted to having a methamphetamine problem. Eighty-one admitted that they had overdosed at least once on drugs. And 25 admitted that they had overdosed two or more times.

So we're able to start identifying in our jail those with substance use but who are self-admitting to it. And we have developed a fairly robust—both a misdemeanor and felony diversion program to reach out and try to help these people. And we find that it's very important to try to not only identify them in jail but get the services started while they're still in jail because when they come into jail, they don't have the access to their drug of choice. They're starting to withdraw from it. They're more feeling like they need to kick this addiction that has taken over their lives, so they're more open to getting treatment. And we're offering them, while they're in that jail, those who have identified and qualify, either participation in the misdemeanor diversion program or the felony diversion program. And if they agree to participate in it, then we do a more in-depth behavioral health screening to determine what level of treatment that they need when they're released from jail. And we're finding that we're having some greater success with that than those who were putting in these programs who are out of jail who still have that access to their drug of choice, who aren't at that point in time quite as motivated to kick their addiction.

KAREN FRIEDMAN: Great. So they are in the jail. They're beginning this process, and then is there kind of like a soft handoff to the community providers, or what does that look like?

BRADLEY CARLYON: Right now, if they agree to enter into the program, we have partnered with one of our behavioral health providers in the county. And they will actually meet them at the jail, pick them up at the jail, and start that process of getting them into the treatment program that they're screening, show that they need it.

Now, we do have some challenges in Navajo County. As I talked about, only 18 percent is privately owned property. Sixty-six percent of Navajo County is Indian land. We have three tribal tribes within Navajo County: the Navajos, the Hopis, and the White Mountain Apaches, which are considered sovereign nations. And as a result, we have some challenges with providing behavioral health services outside of their tribal communities on reservation lands. But many of our Native Americans who has substance uses, they live in the border communities off the reservation, and we can provide those services. One of the things that we're doing through a BJA program, Reaching Rural, the project that the Navajo County Team is working on creating, is a peer support network that would actually start in the jail with peers, where they can make those connections with substance users in the jails. And then, as they're released to the behavioral health program, continue that peer support to help them along their path to recovery. And that's the next step in the evolution of what we're trying to do to address substance use in Navajo County.

KAREN FRIEDMAN: Navajo County is rural, and rural communities experience specific challenges, such as transportation and access to behavior specialists. What has your agency done to ensure those desiring recovery support have access to services when they leave the jail?

BRADLEY CARLYON: It truly is a challenge. When you think of a county nearly the size of Massachusetts, and you have communities that tend to be an hour away, and you have no mass transit or bus routes or anything, it is a challenge.

Our first challenge was finding the behavioral health provider that really wanted to get into the nitty-gritty of working with substance users that are involved in the criminal justice system. And we finally found a partner that has allowed us to really expand the services that we're offering. The challenge after that was to be able to get them to treatment. One of the things that helped for those that needed lower level of treatment was COVID, because we've learned that some of the telehealth was able to provide some of these treatment services at a level that was working. So that has helped to a degree.

The behavioral health provider that is working with us now is offering transportation to many of these, if they're no more than 30 miles away from their offices where they provide services. So that does limit some of the people that can participate with us. But even in other areas, if they're a veteran, we might be able to put them into our veteran court program. And there, we've partnered with our BFWs and our American Legion offices where they'll have their members provide services if they live outside of those areas where the behavioral health providers will provide the transportation themselves. But it's a continuing problem, and it's a major problem for us to help provide services to some of the Native Americans who live on the—on the Indian lands that are way outside of the behavioral health provider areas.

KAREN FRIEDMAN: Right. In addition to being rural, Navajo County is home to three Native American tribes: the Hoppe, Navajo, and White Mountain. Due to our nation's history, some Native Americans don't trust working with government agencies. How does that make your recovery work more complex, and how are you building trust with tribal communities to ensure equitable access to recovery programs?

BRADLEY CARLYON: Well, there's something that recently happened in Arizona that has created even more barriers and challenge. There was widespread Medicaid scam that just a few months ago, the Arizona attorney general made several arrests. And what was happening is these scam artists would come to the border towns in Navajo County and the other counties in Arizona where they could find these Native Americans who had substance use issues. And they would either talk them into or sometimes forcibly take them to sober living homes down in the Phoenix area. And then, they would bill Medicaid for issues that they weren't even treating for. And, you know, when the AG went after these people a few months ago, to give you a feeling of the scope of this, they seized $75 million in assets by these scam artists. So these tribal governments and the tribal citizens are concerned that if they get into a behavioral health program, especially one where it's not in Navajo County, it’s a part of the scam. We don't have any inpatient treatment facilities in Navajo County. If somebody needs inpatient treatment, we have to send them out of county. And that's where the fear really comes into play nowadays with these people.

So we've reached out to the tribal governments and their behavioral health departments to try to get them to start providing many of these behavioral health services to their members.

We've reached out to Indian health services, trying to get them to provide the services, not only locally but if they need the—if they need inpatient services that [are] not offered within our county, within their tribes, that they will have more faith that they're going somewhere that would truly help them and somewhere that will send them back when their treatment is done.

So it's worth opening up those dialogues and trying to rebuild trust and more importantly, develop relationships with the three tribal governments within Navajo County.

KAREN FRIEDMAN: Got you. Very, very interesting and really interesting dynamic that you have there. So let me ask you a more general question. If another community came to you wanting to implement a similar program, and—and really replicate your diversionary efforts, what advice would you give them?

BRADLEY CARLYON: Partnerships. It can't just be a probation office. It can't just be the courts. It is a joint effort that starts out with law enforcement that includes your behavioral health provider. You need to get everybody on board. You know, the head of our Navajo County Jail came from the Arizona Department of Corrections, and his mindset was different. But as he started to see success with the programs that we initially brought in, he has become a strong advocate of these programs that we're doing. So bring everybody to the table, have everybody have a voice in it, and as they see the successes, they will become even stronger advocates for offering more and more programs to help these people get their lives back together, to help these people get their families back together.

KAREN FRIEDMAN: Well, Brad, thank you so much for your time and your work helping those involved in the criminal justice system but [who] are also suffering from substance use, and helping them get access to the recovery services that they so desperately need. We really appreciate everything that you do.

BRADLEY CARLYON: Thank you for having me on, Karen.