S 1635 IS

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.CommentsClose CommentsPermalink

August 6, 2009CommentsClose CommentsPermalink

Mr. DORGAN (for himself, Mr. JOHANNS, Mr. BAUCUS, Mr. JOHNSON, Mr. THUNE, Mr. TESTER, and Mr. UDALL of New Mexico, Mr. CONRAD, Ms. MURKOWSKI, and Mr. BEGICH) introduced the following bill; which was read twice and referred to the Committee on Indian AffairsCommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘7th Generation Promise: Indian Youth Suicide Prevention Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. FINDINGS AND PURPOSE.

(a) Findings- Congress finds that--CommentsClose CommentsPermalink





(1)(A) the rate of suicide of American Indians and Alaska Natives is 1.9 times higher than the national average rate; andCommentsClose CommentsPermalink





(B) the rate of suicide of Indian and Alaska Native youth aged 15 through 24 is--CommentsClose CommentsPermalink





(i) 3.5 times the national average rate; andCommentsClose CommentsPermalink





(ii) the highest rate of any population group in the United States;CommentsClose CommentsPermalink





(2) many risk behaviors and contributing factors for suicide are more prevalent in Indian country than in other areas, including--CommentsClose CommentsPermalink





(A) history of previous suicide attempts;CommentsClose CommentsPermalink





(B) family history of suicide;CommentsClose CommentsPermalink





(C) history of depression or other mental illness;CommentsClose CommentsPermalink





(D) alcohol or drug abuse;CommentsClose CommentsPermalink





(E) health disparities;CommentsClose CommentsPermalink





(F) stressful life events and losses;CommentsClose CommentsPermalink





(G) easy access to lethal methods;CommentsClose CommentsPermalink





(H) exposure to the suicidal behavior of others;CommentsClose CommentsPermalink





(I) isolation; andCommentsClose CommentsPermalink





(J) incarceration;CommentsClose CommentsPermalink





(3) 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;CommentsClose CommentsPermalink





(4)(A) the suicide rates of Indians and Alaska Native males aged 15 through 24, are-- CommentsClose CommentsPermalink





(i) as compared to suicide rates of males of any other racial group, are--(i) for males, up to 4 times greater; and CommentsClose CommentsPermalink





(ii) for femalesas compared to suicide rates of females of any other racial group, up to 11 times greater; and CommentsClose CommentsPermalink





(B) data demonstrates that, over their lifetimes, females attempt suicide 2 to 3 times more often than males; CommentsClose CommentsPermalink





(5)(A) Indian tribes, especially Indian tribes located in the Great Plains, have experienced epidemic levels of suicide, up to 10 times the national average; andCommentsClose CommentsPermalink





(B) suicide clustering in Indian country affects entire tribal communities;CommentsClose CommentsPermalink





(6) 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;CommentsClose CommentsPermalink





(7)(A) 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;CommentsClose CommentsPermalink





(B) 90 percent of all teens who die by suicide suffer from a diagnosable mental illness at time of death;CommentsClose CommentsPermalink





(C) more than 1/2 of teens whocommit [Struck out->]commit[<-Struck out] die by suicide have never been seen by a mental health provider; andCommentsClose CommentsPermalink





(D) 1/3 of health needs in Indian country relate to mental health;CommentsClose CommentsPermalink





(8) 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;CommentsClose CommentsPermalink





(9) 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;CommentsClose CommentsPermalink





(10) the National Strategy for Suicide Prevention was established in 2001 through a Department of Health and Human Services collaboration among--CommentsClose CommentsPermalink





(A) the Substance Abuse and Mental Health Services Administration;CommentsClose CommentsPermalink





(B) the Service;CommentsClose CommentsPermalink





(C) the Centers for Disease Control and Prevention;CommentsClose CommentsPermalink





(D) the National Institutes of Health; andCommentsClose CommentsPermalink





(E) the Health Resources and Services Administration; andCommentsClose CommentsPermalink





(11) 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.CommentsClose CommentsPermalink





(b) Purposes- The purposes of this Act are--CommentsClose CommentsPermalink





(1) 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--CommentsClose CommentsPermalink





(A) the use of psychotherapy, psychiatric assessments, diagnostic interviews, therapies for mental health conditions predisposing to suicide, and alcohol and substance abuse treatment;CommentsClose CommentsPermalink





(B) the provision of clinical expertise to, consultation services with, and medical advice and training for frontline health care providers working with Indian youth;CommentsClose CommentsPermalink





(C) training and related support for community leaders, family members, and health and education workers who work with Indian youth;CommentsClose CommentsPermalink





(D) the development of culturally relevant educational materials on suicide; andCommentsClose CommentsPermalink





(E) data collection and reporting;CommentsClose CommentsPermalink





(2) 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; andCommentsClose CommentsPermalink





(3) 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.CommentsClose CommentsPermalink

SEC. 3. DEFINITIONS.

In this Act:CommentsClose CommentsPermalink





(1) ADMINISTRATION- The term ‘Administration’ means the Substance Abuse and Mental Health Services Administration.CommentsClose CommentsPermalink





(2) DEMONSTRATION PROJECT- The term ‘demonstration project’ means the Indian youth telemental health demonstration project authorized under section 4(a).CommentsClose CommentsPermalink





(3) INDIAN- The term ‘Indian’ means any individual who is--CommentsClose CommentsPermalink





(A) a member of an Indian tribe; orCommentsClose CommentsPermalink





(B) eligible for health services under the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.).CommentsClose CommentsPermalink





[Struck out->](5)[<-Struck out] (4) INDIAN COUNTRY- The term ‘Indian country’ has the meaning given the term in section 1151 of title 18, United States Code.(5) INDIAN TRIBE- 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).CommentsClose CommentsPermalink





(6[Struck out->](6)[<-Struck out] (5) SECRETARY- The term ‘Secretary’ means the Secretary of Health and Human Services.CommentsClose CommentsPermalink





(7[Struck out->](7)[<-Struck out] (6) SERVICE- The term ‘Service’ means the Indian Health Service.CommentsClose CommentsPermalink





(8[Struck out->](8)[<-Struck out] (7) TELEMENTAL HEALTH- 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.CommentsClose CommentsPermalink





(9[Struck out->](9)[<-Struck out] (8) TRIBAL ORGANIZATION- 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).CommentsClose CommentsPermalink

SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

(a) Authorization-CommentsClose CommentsPermalink





(1) IN GENERAL- 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--CommentsClose CommentsPermalink





(A) have expressed suicidal ideas;CommentsClose CommentsPermalink





(B) have attempted suicide; orCommentsClose CommentsPermalink





(C) have mental health conditions that increase or could increase the risk of suicide.CommentsClose CommentsPermalink





(2) ELIGIBILITY FOR GRANTS- Grants under paragraph (1) shall be awarded to Indian tribes and tribal organizations that operate 1 or more facilities--CommentsClose CommentsPermalink





(A) located in an area with documented disproportionately high rates of suicide;CommentsClose CommentsPermalink





(B) reporting active clinical telehealth capabilities; orCommentsClose CommentsPermalink





(C) offering school-based telemental health services to Indian youth.CommentsClose CommentsPermalink





(3) GRANT PERIOD- The Secretary shall award grants under this section for a period of up to 4 years.CommentsClose CommentsPermalink





(4) 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--CommentsClose CommentsPermalink





(A) serve a particular community or geographic area in which there is a demonstrated need to address Indian youth suicide;CommentsClose CommentsPermalink





(B) enter into collaborative partnerships with Service or other tribal health programs or facilities to provide services under this demonstration project;CommentsClose CommentsPermalink





(C) serve an isolated community or geographic area that has limited or no access to behavioral health services; orCommentsClose CommentsPermalink





(D) operate a detention facility at which Indian youth are detained.CommentsClose CommentsPermalink





(5) 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.CommentsClose CommentsPermalink





(b) Use of Funds-CommentsClose CommentsPermalink





(1) IN GENERAL- An Indian tribe or tribal organization shall use a grant received under subsection (a) for the following purposes:CommentsClose CommentsPermalink





(A) To provide telemental health services to Indian youth, including the provision of--CommentsClose CommentsPermalink





(i) psychotherapy;CommentsClose CommentsPermalink





(ii) psychiatric assessments and diagnostic interviews, therapies for mental health conditions predisposing to suicide, and treatment; andCommentsClose CommentsPermalink





(iii) alcohol and substance abuse treatment.CommentsClose CommentsPermalink





(B) 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.CommentsClose CommentsPermalink





(C) 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.CommentsClose CommentsPermalink





(D) To develop and distribute culturally appropriate community educational materials regarding--CommentsClose CommentsPermalink





(i) suicide prevention;CommentsClose CommentsPermalink





(ii) suicide education;CommentsClose CommentsPermalink





(iii) suicide screening;CommentsClose CommentsPermalink





(iv) suicide intervention; andCommentsClose CommentsPermalink





(v) ways to mobilize communities with respect to the identification of risk factors for suicide.CommentsClose CommentsPermalink





(E) To conduct data collection and reporting relating to Indian youth suicide prevention efforts.CommentsClose CommentsPermalink





(2) 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.CommentsClose CommentsPermalink





(c) Applications-CommentsClose CommentsPermalink





(1) IN GENERAL- 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--CommentsClose CommentsPermalink





(A) a description of the project that the Indian tribe or tribal organization will carry out using the funds provided under the grant;CommentsClose CommentsPermalink





(B) a description of the manner in which the project funded under the grant would--CommentsClose CommentsPermalink





(i) meet the telemental health care needs of the Indian youth population to be served by the project; orCommentsClose CommentsPermalink





(ii) improve the access of the Indian youth population to be served to suicide prevention and treatment services;CommentsClose CommentsPermalink





(C) evidence of support for the project from the local community to be served by the project;CommentsClose CommentsPermalink





(D) 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;CommentsClose CommentsPermalink





(E) 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; andCommentsClose CommentsPermalink





(F) a plan for sustaining the project after Federal assistance for the demonstration project has terminated.CommentsClose CommentsPermalink





(2) 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).CommentsClose CommentsPermalink





(d) Collaboration- 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.CommentsClose CommentsPermalink





(e) Annual Report- Each grant recipient shall submit to the Secretary an annual report that--CommentsClose CommentsPermalink





(1) describes the number of telemental health services provided; andCommentsClose CommentsPermalink





(2) includes any other information that the Secretary may require.CommentsClose CommentsPermalink





(f) Reports to Congress-CommentsClose CommentsPermalink





(1) INITIAL REPORT-CommentsClose CommentsPermalink





(A) IN GENERAL- 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--CommentsClose CommentsPermalink





(i) 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; andCommentsClose CommentsPermalink





(ii) 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).CommentsClose CommentsPermalink





(B) 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.CommentsClose CommentsPermalink





(2) FINAL REPORT- 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--CommentsClose CommentsPermalink





(A) describes the results of the projects funded by grants awarded under this section, including any data available that indicate the number of attempted suicides;CommentsClose CommentsPermalink





(B) evaluates the impact of the telemental health services funded by the grants in reducing the number of completed suicides among Indian youth;CommentsClose CommentsPermalink





(C) evaluates whether the demonstration project should be--CommentsClose CommentsPermalink





(i) expanded to provide more than 5 grants; andCommentsClose CommentsPermalink





(ii) designated as a permanent program; andCommentsClose CommentsPermalink





(D) evaluates the benefits of expanding the demonstration project to include urban Indian organizations.CommentsClose CommentsPermalink





(g) 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.CommentsClose CommentsPermalink

SEC. 5. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION GRANTS.

(a) Grant Applications-CommentsClose CommentsPermalink





(1) 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.CommentsClose CommentsPermalink





(2) PRIORITY FOR CERTAIN GRANTS-CommentsClose CommentsPermalink





(A) IN GENERAL- 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 [Struck out->]give priority consideration to the applications[<-Struck out] take into consideration the needs 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.CommentsClose CommentsPermalink





(B) DESCRIPTION OF GRANT PROGRAMS- A grant program referred to in subparagraph (A) is a grant program--CommentsClose CommentsPermalink





(i) administered by the Administration to fund activities relating to mental health, suicide prevention, or suicide-related risk factors; andCommentsClose CommentsPermalink





(ii) under which an Indian tribe is an eligible or tribal organization is an eligible recipient.CommentsClose CommentsPermalink





(3) 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.CommentsClose CommentsPermalink





(4) REQUIREMENTS FOR AFFECTED STATES-CommentsClose CommentsPermalink





(A) DEFINITIONS- In this paragraph:CommentsClose CommentsPermalink





(i) AFFECTED STATE- The term ‘affected State’ means a State--CommentsClose CommentsPermalink





(I) the boundaries of which include 1 or more Indian tribes; andCommentsClose CommentsPermalink





(II) the application for a grant under any program administered by the Administration of which includes statewide data.CommentsClose CommentsPermalink





(ii) INDIAN POPULATION- The term ‘Indian population’ means the total number of residents of an affected State who [Struck out->]are members of 1 or more Indian tribes located within the affected State.(B)[<-Struck out] are Indian.CommentsClose CommentsPermalink





(B) REQUIREMENTS- As a condition of receipt of a grant under any program administered by the Administration, each affected State shall--CommentsClose CommentsPermalink





(i) describe in the grant application--CommentsClose CommentsPermalink





(I) the Indian population of the affected State; andCommentsClose CommentsPermalink





(II) the contribution of that Indian population to the statewide data used by the affected State in the application; andCommentsClose CommentsPermalink





(ii) demonstrate to the satisfaction of the Secretary that--CommentsClose CommentsPermalink





(I) 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--CommentsClose CommentsPermalink

(aa) the Indian population of the affected State; bears toCommentsClose CommentsPermalink

(bb) the total population of the affected State; andCommentsClose CommentsPermalink

(II) the affected State will offer to enter into a partnershiptake reasonable efforts to collaborate with each Indian tribe located within the affected State to carry out youth suicide prevention and treatment measures for members of the Indian tribe. CommentsClose CommentsPermalink





(C) REPORT- 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).CommentsClose CommentsPermalink





(b) 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.CommentsClose CommentsPermalink





(c) 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.CommentsClose CommentsPermalink





(d) Provision of Other Assistance-CommentsClose CommentsPermalink





(1) IN GENERAL- 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--CommentsClose CommentsPermalink





(A) 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; orCommentsClose CommentsPermalink





(B) to fulfill all applicable requirements of the relevant program.CommentsClose CommentsPermalink





(2) DESCRIPTION OF INDIAN TRIBES- An Indian tribe referred to in paragraph (1) is an Indian tribe--CommentsClose CommentsPermalink





(A) the members of which experience--CommentsClose CommentsPermalink





(i) a high rate of youth suicide;CommentsClose CommentsPermalink





(ii) low socioeconomic status; andCommentsClose CommentsPermalink





(iii) extreme health disparity;CommentsClose CommentsPermalink





(B) that is located in a remote and isolated area; andCommentsClose CommentsPermalink





(C) that lacks technology and communication infrastructure.CommentsClose CommentsPermalink





(3) 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.CommentsClose CommentsPermalink





(e) Early Intervention and Assessment Services-CommentsClose CommentsPermalink





(1) DEFINITION OF AFFECTED ENTITY- In this subsection, the term ‘affected entity’ means any entity--CommentsClose CommentsPermalink





(A) that receives a grant for suicide intervention, prevention, or treatment under a program administered by the Administration; andCommentsClose CommentsPermalink





(B) the population to be served by which includes Indian youth.CommentsClose CommentsPermalink





(2) REQUIREMENT- 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.CommentsClose CommentsPermalink

SEC. 6. 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 [Struck out->]serving residents of Indian country[<-Struck out] to obtain the services of predoctoral psychology and psychiatry interns--CommentsClose CommentsPermalink





(1) to increase the quantity of patients served by the Indian tribes, tribal organizations, and other mental health care providers; andCommentsClose CommentsPermalink





(2) for purposes of recruitment and retention.CommentsClose CommentsPermalink