[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1635 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1635

 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.


_______________________________________________________________________


                   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

_______________________________________________________________________

                                 A BILL


 
 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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``7th Generation Promise: Indian Youth 
Suicide Prevention Act of 2009''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds that--
            (1)(A) the rate of suicide of American Indians and Alaska 
        Natives is 1.9 times higher than the national average rate; and
            (B) the rate of suicide of Indian and Alaska Native youth 
        aged 15 through 24 is--
                    (i) 3.5 times the national average rate; and
                    (ii) the highest rate of any population group in 
                the United States;
            (2) many risk behaviors and contributing factors for 
        suicide are more prevalent in Indian country than in other 
        areas, including--
                    (A) history of previous suicide attempts;
                    (B) family history of suicide;
                    (C) history of depression or other mental illness;
                    (D) alcohol or drug abuse;
                    (E) health disparities;
                    (F) stressful life events and losses;
                    (G) easy access to lethal methods;
                    (H) exposure to the suicidal behavior of others;
                    (I) isolation; and
                    (J) incarceration;
            (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;
            (4)(A) the suicide rates of Indians and Alaska Natives aged 
        15 through 24, as compared to suicide rates of any other racial 
        group, are--
                    (i) for males, up to 4 times greater; and
                    (ii) for females, up to 11 times greater; and
            (B) data demonstrates that, over their lifetimes, females 
        attempt suicide 2 to 3 times more often than males;
            (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; and
            (B) suicide clustering in Indian country affects entire 
        tribal communities;
            (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;
            (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;
            (B) 90 percent of all teens who die by suicide suffer from 
        a diagnosable mental illness at time of death;
            (C) more than \1/2\ of teens who commit suicide have never 
        been seen by a mental health provider; and
            (D) \1/3\ of health needs in Indian country relate to 
        mental health;
            (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;
            (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;
            (10) the National Strategy for Suicide Prevention was 
        established in 2001 through a Department of Health and Human 
        Services collaboration among--
                    (A) the Substance Abuse and Mental Health Services 
                Administration;
                    (B) the Service;
                    (C) the Centers for Disease Control and Prevention;
                    (D) the National Institutes of Health; and
                    (E) the Health Resources and Services 
                Administration; and
            (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.
    (b) Purposes.--The purposes of this Act are--
            (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--
                    (A) the use of psychotherapy, psychiatric 
                assessments, diagnostic interviews, therapies for 
                mental health conditions predisposing to suicide, and 
                alcohol and substance abuse treatment;
                    (B) the provision of clinical expertise to, 
                consultation services with, and medical advice and 
                training for frontline health care providers working 
                with Indian youth;
                    (C) training and related support for community 
                leaders, family members, and health and education 
                workers who work with Indian youth;
                    (D) the development of culturally relevant 
                educational materials on suicide; and
                    (E) data collection and reporting;
            (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; and
            (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.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Administration.--The term ``Administration'' means the 
        Substance Abuse and Mental Health Services Administration.
            (2) Demonstration project.--The term ``demonstration 
        project'' means the Indian youth telemental health 
        demonstration project authorized under section 4(a).
            (3) Indian.--The term ``Indian'' means any individual who 
        is--
                    (A) a member of an Indian tribe; or
                    (B) eligible for health services under the Indian 
                Health Care Improvement Act (25 U.S.C. 1601 et seq.).
            (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).
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) Service.--The term ``Service'' means the Indian Health 
        Service.
            (8) 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.
            (9) 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).

SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

    (a) Authorization.--
            (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--
                    (A) have expressed suicidal ideas;
                    (B) have attempted suicide; or
                    (C) have mental health conditions that increase or 
                could increase the risk of suicide.
            (2) Eligibility for grants.--Grants under paragraph (1) 
        shall be awarded to Indian tribes and tribal organizations that 
        operate 1 or more facilities--
                    (A) located in an area with documented 
                disproportionately high rates of suicide;
                    (B) reporting active clinical telehealth 
                capabilities; or
                    (C) offering school-based telemental health 
                services to Indian youth.
            (3) Grant period.--The Secretary shall award grants under 
        this section for a period of up to 4 years.
            (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--
                    (A) serve a particular community or geographic area 
                in which there is a demonstrated need to address Indian 
                youth suicide;
                    (B) enter into collaborative partnerships with 
                Service or other tribal health programs or facilities 
                to provide services under this demonstration project;
                    (C) serve an isolated community or geographic area 
                that has limited or no access to behavioral health 
                services; or
                    (D) operate a detention facility at which Indian 
                youth are detained.
            (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.
    (b) Use of Funds.--
            (1) In general.--An Indian tribe or tribal organization 
        shall use a grant received under subsection (a) for the 
        following purposes:
                    (A) To provide telemental health services to Indian 
                youth, including the provision of--
                            (i) psychotherapy;
                            (ii) psychiatric assessments and diagnostic 
                        interviews, therapies for mental health 
                        conditions predisposing to suicide, and 
                        treatment; and
                            (iii) alcohol and substance abuse 
                        treatment.
                    (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.
                    (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.
                    (D) To develop and distribute culturally 
                appropriate community educational materials regarding--
                            (i) suicide prevention;
                            (ii) suicide education;
                            (iii) suicide screening;
                            (iv) suicide intervention; and
                            (v) ways to mobilize communities with 
                        respect to the identification of risk factors 
                        for suicide.
                    (E) To conduct data collection and reporting 
                relating to Indian youth suicide prevention efforts.
            (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.
    (c) Applications.--
            (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--
                    (A) a description of the project that the Indian 
                tribe or tribal organization will carry out using the 
                funds provided under the grant;
                    (B) a description of the manner in which the 
                project funded under the grant would--
                            (i) meet the telemental health care needs 
                        of the Indian youth population to be served by 
                        the project; or
                            (ii) improve the access of the Indian youth 
                        population to be served to suicide prevention 
                        and treatment services;
                    (C) evidence of support for the project from the 
                local community to be served by the project;
                    (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;
                    (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; and
                    (F) a plan for sustaining the project after Federal 
                assistance for the demonstration project has 
                terminated.
            (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).
    (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.
    (e) Annual Report.--Each grant recipient shall submit to the 
Secretary an annual report that--
            (1) describes the number of telemental health services 
        provided; and
            (2) includes any other information that the Secretary may 
        require.
    (f) Reports to Congress.--
            (1) Initial report.--
                    (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--
                            (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; and
                            (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).
                    (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.
            (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--
                    (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;
                    (B) evaluates the impact of the telemental health 
                services funded by the grants in reducing the number of 
                completed suicides among Indian youth;
                    (C) evaluates whether the demonstration project 
                should be--
                            (i) expanded to provide more than 5 grants; 
                        and
                            (ii) designated as a permanent program; and
                    (D) evaluates the benefits of expanding the 
                demonstration project to include urban Indian 
                organizations.
    (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.

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

    (a) Grant Applications.--
            (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.
            (2) Priority for certain grants.--
                    (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 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.
                    (B) Description of grant programs.--A grant program 
                referred to in subparagraph (A) is a grant program--
                            (i) administered by the Administration to 
                        fund activities relating to mental health, 
                        suicide prevention, or suicide-related risk 
                        factors; and
                            (ii) under which an Indian tribe is an 
                        eligible recipient.
            (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.
            (4) Requirements for affected states.--
                    (A) Definitions.--In this paragraph:
                            (i) Affected state.--The term ``affected 
                        State'' means a State--
                                    (I) the boundaries of which include 
                                1 or more Indian tribes; and
                                    (II) the application for a grant 
                                under any program administered by the 
                                Administration of which includes 
                                statewide data.
                            (ii) Indian population.--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.
                    (B) Requirements.--As a condition of receipt of a 
                grant under any program administered by the 
                Administration, each affected State shall--
                            (i) describe in the grant application--
                                    (I) the Indian population of the 
                                affected State; and
                                    (II) the contribution of that 
                                Indian population to the statewide data 
                                used by the affected State in the 
                                application; and
                            (ii) demonstrate to the satisfaction of the 
                        Secretary that--
                                    (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--
                                            (aa) the Indian population 
                                        of the affected State; bears to
                                            (bb) the total population 
                                        of the affected State; and
                                    (II) 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.
                    (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).
    (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.
    (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.
    (d) Provision of Other Assistance.--
            (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--
                    (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; or
                    (B) to fulfill all applicable requirements of the 
                relevant program.
            (2) Description of indian tribes.--An Indian tribe referred 
        to in paragraph (1) is an Indian tribe--
                    (A) the members of which experience--
                            (i) a high rate of youth suicide;
                            (ii) low socioeconomic status; and
                            (iii) extreme health disparity;
                    (B) that is located in a remote and isolated area; 
                and
                    (C) that lacks technology and communication 
                infrastructure.
            (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.
    (e) Early Intervention and Assessment Services.--
            (1) Definition of affected entity.--In this subsection, the 
        term ``affected entity'' means any entity--
                    (A) that receives a grant for suicide intervention, 
                prevention, or treatment under a program administered 
                by the Administration; and
                    (B) the population to be served by which includes 
                Indian youth.
            (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.

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 serving residents 
of Indian country to obtain the services of predoctoral psychology and 
psychiatry interns--
            (1) to increase the quantity of patients served by the 
        Indian tribes, tribal organizations, and other mental health 
        care providers; and
            (2) for purposes of recruitment and retention.
                                 <all>