1.This Act may be cited as the
7th Generation Promise: Indian Youth
Suicide Prevention Act of 2009
.
2.
(a)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;
(4)(A)the suicide rates of Indian and Alaska
Native males aged 15 through 24 are—
(i)as compared to suicide rates of males of
any other racial group, up to 4 times greater; and
(ii)as compared to suicide rates of females of
any other racial group, 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 commitdie by 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)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.
3.In this Act:
(1)The term
Administration means the Substance Abuse and Mental Health
Services Administration.
(2)The term demonstration project
means the Indian youth telemental health demonstration project authorized under
section 4(a).
(3)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)The term Indian country has the meaning
given the term in section 1151 of title 18, United States Code.
(5)(4)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)(5)The term Secretary means the
Secretary of Health and Human Services.
(7)(6)The term Service means the
Indian Health Service.
(8)(7)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)(8)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).
4.Indian youth telemental health
demonstration project
(a)
(1)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)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)The Secretary shall award grants under this
section for a period of up to 4 years.
(4)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 AdministrationIn 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)
(1)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
practicesIn 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)
(1)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 processThe 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)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)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)
(1)
(A)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 projectOn 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)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
appropriationsThere is
authorized to be appropriated to carry out this section $1,500,000 for each of
fiscal years 2010 through 2013.
5.Substance Abuse
and Mental Health Services Administration grants
(a)
(1)Efficiency of
grant application processThe 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)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 applicationstake 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.
(B)Description of
grant programsA 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 or tribal
organization is an eligible recipient.
(3)Clarification
regarding Indian tribes and tribal organizationsNotwithstanding
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)In
this paragraph:
(i)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)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.are Indian.
(B)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.
(II)the affected State will
take 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.
(C)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 requirementNotwithstanding 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 tribesDue 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)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 tribesAn 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 appropriationsThere 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 entityIn 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)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.
6.Use of
predoctoral psychology and psychiatry internsThe 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.
7.Indian youth life skills
development demonstration program
(a)The
purpose of this section is to authorize the Secretary, acting through the
Administration, to carry out a demonstration program to test the effectiveness
of a culturally compatible, school-based, life skills curriculum for the
prevention of Indian and Alaska Native adolescent suicide, including
through—
(1)the establishment of
tribal partnerships to develop and implement such a curriculum, in cooperation
with—
(A)behavioral health
professionals, with a priority for tribal partnerships cooperating with
behavioral health professionals employed by the Service;
(B)tribal or local school
agencies; and
(C)parent and community
groups;
(2)the provision by the
Administration or the Service of—
(A)technical expertise;
and
(B)clinicians, analysts, and
educators, as appropriate;
(3)training for teachers,
school administrators, and community members to implement the
curriculum;
(4)the establishment of
advisory councils composed of parents, educators, community members, trained
peers, and others to provide advice regarding the curriculum and other
components of the demonstration program;
(5)the development of
culturally appropriate support measures to supplement the effectiveness of the
curriculum; and
(6)projects modeled after
evidence-based projects, such as programs evaluated and published in relevant
literature.
(b)Demonstration grant
program
(1)In
this subsection:
(A)The
term curriculum means the culturally compatible, school-based,
life skills curriculum for the prevention of Indian and Alaska Native
adolescent suicide identified by the Secretary under paragraph (2)(A).
(B)The term eligible entity means—
(i)an Indian tribe;
(ii)a tribal
organization;
(iii)any other tribally
authorized entity; and
(iv)any partnership composed
of 2 or more entities described in clause (i), (ii), or (iii).
(2)The
Secretary, acting through the Administration, may establish and carry out a
demonstration program under which the Secretary shall—
(A)identify a culturally
compatible, school-based, life skills curriculum for the prevention of Indian
and Alaska Native adolescent suicide;
(B)identify the Indian
tribes that are at greatest risk for adolescent suicide;
(C)invite those Indian
tribes to participate in the demonstration program by—
(i)responding to a
comprehensive program requirement request of the Secretary; or
(ii)submitting, through an
eligible entity, an application in accordance with paragraph (4); and
(D)provide grants to the
Indian tribes identified under subparagraph (B) and eligible entities to
implement the curriculum with respect to Indian and Alaska Native youths
who—
(i)are between the ages of
10 and 19; and
(ii)attend school in a
region that is at risk of high youth suicide rates, as determined by the
Administration.
(3)
(A)The
term of a grant provided under the demonstration program under this section
shall be not less than 4 years.
(B)The Secretary may provide not more than 5 grants under the
demonstration program under this section.
(C)The
grants provided under this section shall be of equal amounts.
(D)In selecting eligible entities to receive grants under
this section, the Secretary shall ensure that not less than 1 demonstration
program shall be carried out at each of—
(i)a school operated by the
Bureau of Indian Education;
(ii)a Tribal school;
and
(iii)a school receiving
payments under section 8002 or 8003 of the Elementary and Secondary Education
Act of 1965 (20 U.S.C. 7702, 7703).
(4)To
be eligible to receive a grant under the demonstration program, an eligible
entity shall submit to the Secretary an application, at such time, in such
manner, and containing such information as the Secretary may require,
including—
(A)an assurance that, in
implementing the curriculum, the eligible entity will collaborate with 1 or
more local educational agencies, including elementary schools, middle schools,
and high schools;
(B)an assurance that the
eligible entity will collaborate, for the purpose of curriculum development,
implementation, and training and technical assistance, with 1 or more—
(i)nonprofit entities with
demonstrated expertise regarding the development of culturally sensitive,
school-based, youth suicide prevention and intervention programs; or
(ii)institutions of higher
education with demonstrated interest and knowledge regarding culturally
sensitive, school-based, life skills youth suicide prevention and intervention
programs;
(C)an assurance that the
curriculum will be carried out in an academic setting in conjunction with at
least 1 classroom teacher not less frequently than twice each school week for
the duration of the academic year;
(D)a description of the
methods by which curriculum participants will be—
(i)screened for behavioral
health at-risk indicators; and
(ii)if needed and on a
case-by-case basis, referred to a behavioral health clinician for further
assessment and treatment and with crisis response capability; and
(E)an assurance that
supportive services will be provided to curriculum participants identified as
high-risk participants, including referral, counseling, and follow-up services
for—
(i)drug or alcohol
abuse;
(ii)sexual or domestic
abuse; and
(iii)depression and other
relevant behavioral health concerns.
(5)An Indian tribe identified under paragraph (2)(B) or an
eligible entity may use a grant provided under this subsection—
(A)to develop and implement
the curriculum in a school-based setting;
(B)to establish an advisory
council—
(i)to advise the Indian
tribe or eligible entity regarding curriculum development; and
(ii)to provide support
services identified as necessary by the community being served by the Indian
tribe or eligible entity;
(C)to appoint and train a
school- and community-based cultural resource liaison, who will act as an
intermediary among the Indian tribe or eligible entity, the applicable school
administrators, and the advisory council established by the Indian tribe or
eligible entity;
(D)to establish an on-site,
school-based, MA- or PhD-level behavioral health practitioner (employed by the
Service, if practicable) to work with tribal educators and other
personnel;
(E)to provide for the
training of peer counselors to assist in carrying out the curriculum;
(F)to procure technical and
training support from nonprofit or State entities or institutions of higher
education identified by the community being served by the Indian tribe or
eligible entity as the best suited to develop and implement the
curriculum;
(G)to train teachers and
school administrators to effectively carry out the curriculum;
(H)to establish an effective
referral procedure and network;
(I)to identify and develop
culturally compatible curriculum support measures;
(J)to obtain educational
materials and other resources from the Administration or other appropriate
entities to ensure the success of the demonstration program; and
(K)to evaluate the
effectiveness of the curriculum in preventing Indian and Alaska Native
adolescent suicide.
(c)Using
such amounts made available pursuant to subsection (e) as the Secretary
determines to be appropriate, the Secretary shall conduct, directly or through
a grant, contract, or cooperative agreement with an entity that has experience
regarding the development and operation of successful culturally compatible,
school-based, life skills suicide prevention and intervention programs or
evaluations, an annual evaluation of the demonstration program under this
section, including an evaluation of—
(1)the effectiveness of the
curriculum in preventing Indian and Alaska Native adolescent suicide;
(2)areas for program
improvement; and
(3)additional development of
the goals and objectives of the demonstration program.
(d)
(1)Subject to paragraph (2), not later than 180 days after
the date of termination of the demonstration program, the Secretary shall
submit to the Committee on Indian Affairs and the Committee on Health,
Education, Labor, and Pensions of the Senate and the Committee on Natural
Resources and the Committee on Education and Labor of the House of
Representatives a final report that—
(A)describes the results of
the program of each Indian tribe or eligible entity under this section;
(B)evaluates the
effectiveness of the curriculum in preventing Indian and Alaska Native
adolescent suicide;
(C)makes recommendations
regarding—
(i)the expansion of the
demonstration program under this section to additional eligible
entities;
(ii)designating the
demonstration program as a permanent program; and
(iii)identifying and
distributing the curriculum through the Suicide Prevention Resource Center of
the Administration; and
(D)incorporates any public
comments received under paragraph (2).
(2)The Secretary shall provide a notice of the report under
paragraph (1) and an opportunity for public comment on the report for a period
of not less than 90 days before submitting the report to Congress.
(e)Authorization of
appropriationsThere is authorized to be appropriated to carry
out this section $1,000,000 for each of fiscal years 2010 through 2014.
Amend the title so as to read:
A bill to establish an Indian youth telemental health demonstration
program, to enhance the provision of behavioral health care services to Indian
youth, to encourage Indian tribes, tribal organizations, and other behavioral
health care providers serving residents of Indian country to obtain the
services of predoctoral psychology and psychiatry interns, and for other
purposes.
.
March 25, 2010
Reported with amendments and an amendment to the
title