IN THE SENATE OF THE UNITED STATES
August 6, 2009
Mr. Dorgan (for himself, Mr. Johanns, Mr. Baucus, Mr. Johnson, Mr. Thune, Mr. Tester, and Mr. Udall of New Mexico) introduced the following bill; which was read twice and referred to the Committee on Indian Affairs
To establish an Indian youth telemental health demonstration project, to enhance the provision of mental health care services to Indian youth, to encourage Indian tribes, tribal organizations, and other mental health care providers serving residents of Indian country to obtain the services of predoctoral psychology and psychiatry interns, and for other purposes.
This Act may be cited as the
7th Generation Promise: Indian Youth
Suicide Prevention Act of 2009.
Findings and purpose
Congress finds that—
the rate of suicide of American Indians and Alaska Natives is 1.9 times higher than the national average rate; and
the rate of suicide of Indian and Alaska Native youth aged 15 through 24 is—
3.5 times the national average rate; and
the highest rate of any population group in the United States;
many risk behaviors and contributing factors for suicide are more prevalent in Indian country than in other areas, including—
history of previous suicide attempts;
family history of suicide;
history of depression or other mental illness;
alcohol or drug abuse;
stressful life events and losses;
easy access to lethal methods;
exposure to the suicidal behavior of others;
according to national data for 2005, suicide was the second-leading cause of death for Indians and Alaska Natives of both sexes aged 10 through 34;
the suicide rates of Indians and Alaska Natives aged 15 through 24, as compared to suicide rates of any other racial group, are—
for males, up to 4 times greater; and
for females, up to 11 times greater; and
data demonstrates that, over their lifetimes, females attempt suicide 2 to 3 times more often than males;
Indian tribes, especially Indian tribes located in the Great Plains, have experienced epidemic levels of suicide, up to 10 times the national average; and
suicide clustering in Indian country affects entire tribal communities;
death rates for Indians and Alaska Natives are statistically underestimated because many areas of Indian country lack the proper resources to identify and monitor the presence of disease;
the Indian Health Service experiences health professional shortages, with physician vacancy rates of approximately 17 percent, and nursing vacancy rates of approximately 18 percent, in 2007;
90 percent of all teens who die by suicide suffer from a diagnosable mental illness at time of death;
more than 1⁄2 of teens who commit suicide have never been seen by a mental health provider; and
1/3 of health needs in Indian country relate to mental health;
often, the lack of resources of Indian tribes and the remote nature of Indian reservations make it difficult to meet the requirements necessary to access Federal assistance, including grants;
the Substance Abuse and Mental Health Services Administration and the Service have established specific initiatives to combat youth suicide in Indian country and among Indians and Alaska Natives throughout the United States, including the National Suicide Prevention Initiative of the Service, which has worked with Service, tribal, and urban Indian health programs since 2003;
the National Strategy for Suicide Prevention was established in 2001 through a Department of Health and Human Services collaboration among—
the Substance Abuse and Mental Health Services Administration;
the Centers for Disease Control and Prevention;
the National Institutes of Health; and
the Health Resources and Services Administration; and
the Service and other agencies of the Department of Health and Human Services use information technology and other programs to address the suicide prevention and mental health needs of Indians and Alaska Natives.
The purposes of this Act are—
to authorize the Secretary to carry out a demonstration project to test the use of telemental health services in suicide prevention, intervention, and treatment of Indian youth, including through—
the use of psychotherapy, psychiatric assessments, diagnostic interviews, therapies for mental health conditions predisposing to suicide, and alcohol and substance abuse treatment;
the provision of clinical expertise to, consultation services with, and medical advice and training for frontline health care providers working with Indian youth;
training and related support for community leaders, family members, and health and education workers who work with Indian youth;
the development of culturally relevant educational materials on suicide; and
data collection and reporting;
to encourage Indian tribes, tribal organizations, and other mental health care providers serving residents of Indian country to obtain the services of predoctoral psychology and psychiatry interns; and
to enhance the provision of mental health care services to Indian youth through existing grant programs of the Substance Abuse and Mental Health Services Administration.
In this Act:
The term Administration means the Substance Abuse and Mental Health Services Administration.
The term demonstration project means the Indian youth telemental health demonstration project authorized under section 4(a).
The term Indian means any individual who is—
a member of an Indian tribe; or
eligible for health services under the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.).
The term Indian country has the meaning given the term in section 1151 of title 18, United States Code.
The term Indian tribe has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).
The term Secretary means the Secretary of Health and Human Services.
The term Service means the Indian Health Service.
The term telemental health means the use of electronic information and telecommunications technologies to support long-distance mental health care, patient and professional-related education, public health, and health administration.
The term tribal organization has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).
Indian youth telemental health demonstration project
The Secretary, acting through the Service, is authorized to carry out a demonstration project to award grants for the provision of telemental health services to Indian youth who—
have expressed suicidal ideas;
have attempted suicide; or
have mental health conditions that increase or could increase the risk of suicide.
Eligibility for grants
Grants under paragraph (1) shall be awarded to Indian tribes and tribal organizations that operate 1 or more facilities—
located in an area with documented disproportionately high rates of suicide;
reporting active clinical telehealth capabilities; or
offering school-based telemental health services to Indian youth.
The Secretary shall award grants under this section for a period of up to 4 years.
Maximum number of grants
Not more than 5 grants shall be provided under paragraph (1), with priority consideration given to Indian tribes and tribal organizations that—
serve a particular community or geographic area in which there is a demonstrated need to address Indian youth suicide;
enter into collaborative partnerships with Service or other tribal health programs or facilities to provide services under this demonstration project;
serve an isolated community or geographic area that has limited or no access to behavioral health services; or
operate a detention facility at which Indian youth are detained.
Consultation with Administration
In developing and carrying out the demonstration project under this subsection, the Secretary shall consult with the Administration as the Federal agency focused on mental health issues, including suicide.
Use of funds
An Indian tribe or tribal organization shall use a grant received under subsection (a) for the following purposes:
To provide telemental health services to Indian youth, including the provision of—
psychiatric assessments and diagnostic interviews, therapies for mental health conditions predisposing to suicide, and treatment; and
alcohol and substance abuse treatment.
To provide clinician-interactive medical advice, guidance and training, assistance in diagnosis and interpretation, crisis counseling and intervention, and related assistance to Service or tribal clinicians and health services providers working with youth being served under the demonstration project.
To assist, educate, and train community leaders, health education professionals and paraprofessionals, tribal outreach workers, and family members who work with the youth receiving telemental health services under the demonstration project, including with identification of suicidal tendencies, crisis intervention and suicide prevention, emergency skill development, and building and expanding networks among those individuals and with State and local health services providers.
To develop and distribute culturally appropriate community educational materials regarding—
suicide intervention; and
ways to mobilize communities with respect to the identification of risk factors for suicide.
To conduct data collection and reporting relating to Indian youth suicide prevention efforts.
Traditional health care practices
In carrying out the purposes described in paragraph (1), an Indian tribe or tribal organization may use and promote the traditional health care practices of the Indian tribes of the youth to be served.
Subject to paragraph (2), to be eligible to receive a grant under subsection (a), an Indian tribe or tribal organization shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including—
a description of the project that the Indian tribe or tribal organization will carry out using the funds provided under the grant;
a description of the manner in which the project funded under the grant would—
meet the telemental health care needs of the Indian youth population to be served by the project; or
improve the access of the Indian youth population to be served to suicide prevention and treatment services;
evidence of support for the project from the local community to be served by the project;
a description of how the families and leadership of the communities or populations to be served by the project would be involved in the development and ongoing operations of the project;
a plan to involve the tribal community of the youth who are provided services by the project in planning and evaluating the mental health care and suicide prevention efforts provided, in order to ensure the integration of community, clinical, environmental, and cultural components of the treatment; and
a plan for sustaining the project after Federal assistance for the demonstration project has terminated.
Efficiency of grant application process
The Secretary shall carry out such measures as the Secretary determines to be necessary to maximize the time and workload efficiency of the process by which Indian tribes and tribal organizations apply for grants under paragraph (1).
The Secretary, acting through the Service, shall encourage Indian tribes and tribal organizations receiving grants under this section to collaborate to enable comparisons regarding best practices across projects.
Each grant recipient shall submit to the Secretary an annual report that—
describes the number of telemental health services provided; and
includes any other information that the Secretary may require.
Reports to Congress
Not later than 2 years after the date on which the first grant is awarded under this section, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources and the Committee on Energy and Commerce of the House of Representatives a report that—
describes each project funded by a grant under this section during the preceding 2-year period, including a description of the level of success achieved by the project; and
evaluates whether the demonstration project should be continued during the period beginning on the date of termination of funding for the demonstration project under subsection (g) and ending on the date on which the final report is submitted under paragraph (2).
Continuation of demonstration project
On a determination by the Secretary under clause (ii) of subparagraph (A) that the demonstration project should be continued, the Secretary may carry out the demonstration project during the period described in that clause using such sums otherwise made available to the Secretary as the Secretary determines to be appropriate.
Not later than 270 days after the date of termination of funding for the demonstration project under subsection (g), the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources and the Committee on Energy and Commerce of the House of Representatives a final report that—
describes the results of the projects funded by grants awarded under this section, including any data available that indicate the number of attempted suicides;
evaluates the impact of the telemental health services funded by the grants in reducing the number of completed suicides among Indian youth;
evaluates whether the demonstration project should be—
expanded to provide more than 5 grants; and
designated as a permanent program; and
evaluates the benefits of expanding the demonstration project to include urban Indian organizations.
Authorization of appropriations
There is authorized to be appropriated to carry out this section $1,500,000 for each of fiscal years 2010 through 2013.
Substance Abuse and Mental Health Services Administration grants
Efficiency of grant application process
The Secretary, acting through the Administration, shall carry out such measures as the Secretary determines to be necessary to maximize the time and workload efficiency of the process by which Indian tribes and tribal organizations apply for grants under any program administered by the Administration, including by providing methods other than electronic methods of submitting applications for those grants, if necessary.
Priority for certain grants
To fulfill the trust responsibility of the United States to Indian tribes, in awarding relevant grants pursuant to a program described in subparagraph (B), the Secretary shall give priority consideration to the applications of Indian tribes or tribal organizations, as applicable, that serve populations with documented high suicide rates, regardless of whether those Indian tribes or tribal organizations possess adequate personnel or infrastructure to fulfill all applicable requirements of the relevant program.
Description of grant programs
A grant program referred to in subparagraph (A) is a grant program—
administered by the Administration to fund activities relating to mental health, suicide prevention, or suicide-related risk factors; and
under which an Indian tribe is an eligible recipient.
Clarification regarding Indian tribes and tribal organizations
Notwithstanding any other provision of law, in applying for a grant under any program administered by the Administration, no Indian tribe or tribal organization shall be required to apply through a State or State agency.
Requirements for affected States
In this paragraph:
The term affected State means a State—
the boundaries of which include 1 or more Indian tribes; and
the application for a grant under any program administered by the Administration of which includes statewide data.
The term Indian population means the total number of residents of an affected State who are members of 1 or more Indian tribes located within the affected State.
As a condition of receipt of a grant under any program administered by the Administration, each affected State shall—
describe in the grant application—
the Indian population of the affected State; and
the contribution of that Indian population to the statewide data used by the affected State in the application; and
demonstrate to the satisfaction of the Secretary that—
of the total amount of the grant, the affected State will allocate for use for the Indian population of the affected State an amount equal to the proportion that—
the Indian population of the affected State; bears to
the total population of the affected State; and
the affected State will offer to enter into a partnership with each Indian tribe located within the affected State to carry out youth suicide prevention and treatment measures for members of the Indian tribe.
Not later than 1 year after the date of receipt of a grant described in subparagraph (B), an affected State shall submit to the Secretary a report describing the measures carried out by the affected State to ensure compliance with the requirements of subparagraph (B)(ii).
No non-Federal share requirement
Notwithstanding any other provision of law, no Indian tribe or tribal organization shall be required to provide a non-Federal share of the cost of any project or activity carried out using a grant provided under any program administered by the Administration.
Outreach for rural and isolated Indian tribes
Due to the rural, isolated nature of most Indian reservations and communities (especially those reservations and communities in the Great Plains region), the Secretary shall conduct outreach activities, with a particular emphasis on the provision of telemental health services, to achieve the purposes of this Act with respect to Indian tribes located in rural, isolated areas.
Provision of other assistance
The Secretary, acting through the Administration, shall carry out such measures (including monitoring and the provision of required assistance) as the Secretary determines to be necessary to ensure the provision of adequate suicide prevention and mental health services to Indian tribes described in paragraph (2), regardless of whether those Indian tribes possess adequate personnel or infrastructure—
to submit an application for a grant under any program administered by the Administration, including due to problems relating to access to the Internet or other electronic means that may have resulted in previous obstacles to submission of a grant application; or
to fulfill all applicable requirements of the relevant program.
Description of Indian tribes
An Indian tribe referred to in paragraph (1) is an Indian tribe—
the members of which experience—
a high rate of youth suicide;
low socioeconomic status; and
extreme health disparity;
that is located in a remote and isolated area; and
that lacks technology and communication infrastructure.
Authorization of appropriations
There are authorized to be appropriated to the Secretary such sums as the Secretary determines to be necessary to carry out this subsection.
Early intervention and assessment services
Definition of affected entity
In this subsection, the term affected entity means any entity—
that receives a grant for suicide intervention, prevention, or treatment under a program administered by the Administration; and
the population to be served by which includes Indian youth.
The Secretary, acting through the Administration, shall ensure that each affected entity carrying out a youth suicide early intervention and prevention strategy described in section 520E(c)(1) of the Public Health Service Act (42 U.S.C. 290bb–36(c)(1)), or any other youth suicide-related early intervention and assessment activity, provides training or education to individuals who interact frequently with the Indian youth to be served by the affected entity (including parents, teachers, coaches, and mentors) on identifying warning signs of Indian youth who are at risk of committing suicide.
Use of predoctoral psychology and psychiatry interns
The Secretary shall carry out such activities as the Secretary determines to be necessary to encourage Indian tribes, tribal organizations, and other mental health care providers serving residents of Indian country to obtain the services of predoctoral psychology and psychiatry interns—
to increase the quantity of patients served by the Indian tribes, tribal organizations, and other mental health care providers; and
for purposes of recruitment and retention.