[Senate Hearing 112-616]
[From the U.S. Government Publishing Office]
S. Hrg. 112-616
EMPOWERING NATIVE YOUTH TO RECLAIM THEIR FUTURE
=======================================================================
FIELD HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
__________
AUGUST 9, 2011
__________
Printed for the use of the Committee on Indian Affairs
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COMMITTEE ON INDIAN AFFAIRS
DANIEL K. AKAKA, Hawaii, Chairman
JOHN BARRASSO, Wyoming, Vice Chairman
DANIEL K. INOUYE, Hawaii JOHN McCAIN, Arizona
KENT CONRAD, North Dakota LISA MURKOWSKI, Alaska
TIM JOHNSON, South Dakota JOHN HOEVEN, North Dakota
MARIA CANTWELL, Washington MIKE CRAPO, Idaho
JON TESTER, Montana MIKE JOHANNS, Nebraska
TOM UDALL, New Mexico
AL FRANKEN, Minnesota
Loretta A. Tuell, Majority Staff Director and Chief Counsel
David A. Mullon Jr., Minority Staff Director and Chief Counsel
C O N T E N T S
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Page
Hearing held on August 9, 2011................................... 1
Statement of Senator Tester...................................... 7
Witnesses
Gourneau, Roxanne, Tribal Judge, Fort Peck's Tribal Family Court. 5
Halliday, Deborah, MPA, Policy Advisor, Community Learning
Partnerships, Montana Office of Public Instruction............. 9
Prepared statement........................................... 11
Jackson, Fanci, Member, Fort Peck Youth Council.................. 17
Manning, Richard, Research Associate, National Native Children's
Trauma Center, University of Montana........................... 12
Prepared statement........................................... 14
Mckeon, Richard T., Ph.D., Lead Public Health Advisor, Suicide
Prevention Team, Substance Abuse and Mental Health Services
Administration, U.S. Department of Health and Human Services... 33
Prepared statement........................................... 35
Parisian, Edward, Director, Rocky Mountain Regional Office,
Bureau of Indian Affairs, United States Department of Interior. 29
Prepared statement........................................... 31
Stafne, Hon. A.T. ``Rusty'', Chairman, Assiniboine and Sioux
Tribes of the Fort Peck Indian Reservation..................... 1
Prepared statement........................................... 2
Weahkee, Rose, Ph.D., Director, Division of Behavioral Health,
Indian Health Service.......................................... 22
Prepared statement........................................... 24
White Tail Feather, Walter, Director. Office of Economic
Development, Fort Peck Assiniboine and Sioux Tribes; on behalf
of Roxann Smith, Vice Chairman, Fort Peck Tribes............... 3
Appendix
Belcourt-Dittloff, Annie, Ph.D., Missoula, Montana, prepared
statement...................................................... 43
Zimmerman, Marilyn Bruguier, Director, National Native Children's
Trauma Center and Richard van den Pol, Director, Institute for
Educational Research and Service, University of Montana........ 48
EMPOWERING NATIVE YOUTH TO RECLAIM THEIR FUTURE
----------
TUESDAY, AUGUST 9, 2011
U.S. Senate,
Committee on Indian Affairs,
Poplar, MT.
The Committee met, pursuant to notice, at 1:30 p.m. at
Poplar High School, 400 4th Avenue West, Poplar, Montana,
Honorable Jon Tester, Acting Chairman of the Committee,
presiding.
*Due to audio technical difficulties; the following hearing
transcript has [indiscernible] printed in place of a lot of
missing text*
The Committee apologizes for the inconvenience.
OPENING STATEMENT OF HON. A.T. ``RUSTY'' STAFNE,
CHAIRMAN, ASSINIBOINE AND SIOUX TRIBES OF THE FORT PECK INDIAN
RESERVATION
Mr. Stafne. Good afternoon, Senator Tester.
Senator Tester. Mr. Chairman.
Mr. Stafne. My name is Rusty Stafne, and I am Chairman of
the Assiniboine Sioux Tribe, Fort Peck Reservation.
On behalf of the tribal council and the tribal membership,
we welcome you to the Fort Peck Indian Reservation.
We also thank you for holding this hearing to address the
epidemic levels of youth suicide on our reservation and the
ways our community can empower our children to rise above this
crisis and reclaim their future.
Senator, it is my honor to stand before you today. Please
understand that I do so with a heavy heart. It is difficult for
me to know where to begin or how to begin. You are familiar
with the statistics. Yet, as you are aware, these numbers do
not paint the full picture. We are under attack and our future
is the target.
Like any nation facing such great threat to our most
vulnerable citizens, we have acted to the best of our ability
to combat this epidemic. But how can you fight what you cannot
begin to understand?
Just over a year ago, the United States Public Health
Service deployed six teams of behavioral health officers to
help us better understand and join in the battle our youth are
fighting. After the 12-week effort, final recommendations were
made to the tribal executive board in October in Montana. Since
then, our communities have worked tirelessly to implement these
recommendations, and keep those considering ending their lives
from taking that final step. We have brought on skilled staff
and involved multiple generations, collaborated with local
school districts and heightened community awareness. We have
tackled upstream issues such as bullying and boredom, while
training parents and peers to recognize the signs and increase
the available activities for youth across the reservation.
We have also developed response command and protocol for
streamlining and minimizing response time in the event of
another tragic attempt. Of course, in our communities,
resources are always an issue. I would like to thank you,
Senator, for your support in our application for a $1.4 million
grant awarded just two weeks ago to continue our efforts with
the University of Montana and National Native Children's Trauma
Center. It joins other grant funding we have relied upon to
support these efforts.
We are doing all that we can. Yet at an agency level, a
lack of communication, staffing shortages and budget shortfalls
continue to hinder our efforts. Senator, we thank you for all
your hard work and the support you have provided us in our time
of need. But the threat of more lost young lives looms. Today I
come before you as Chairman of the Assiniboine Sioux Tribes
asking that the testimony shared here grows into productive
collaboration and increased interagency communication.
There is much work yet to be done. Our people deserve
healthy bodies and healthy minds. Our children deserve a
future. Thank you.
[The prepared statement of Mr. Stafne follows:]
Prepared Statement of Hon. A.T. ``Rusty'' Stafne, Chairman, Assiniboine
and Sioux Tribes of the Fort Peck Indian Reservation
Good afternoon, Senator Tester. My name is Rusty Stafne, and I am
the Chairman of the Fort Peck Tribes. On behalf of my Tribal Council
and our Tribal members, I would like to welcome you to the Fort Peck
Indian Reservation and thank you for holding this hearing to address
the epidemic levels of youth suicide on our reservation and the ways
our community can empower our children to rise above this crisis and
reclaim their future.
I would first like to recognize those who spoke before me. Vice
Chairwoman Roxann Smith and Judge Roxanne Gourneau, thank you for
selflessly sharing the stories of your sons. Even though unimaginable
tragedy has touched your lives, you stand strong for your people.
Nothing can bring your boys back, but your bravery reminds us that this
is not a hopeless place. Thank you.
Senator, it is my honor to testify before you, but please
understand that I do so with a heavy heart. It's difficult for me to
know where to begin. You're familiar with the statistics, you cited
them in your remarks. Yet even these numbers don't paint the full
picture: we are under attack, and our future is the target. Like any
nation facing such a grave threat to our most vulnerable citizens, we
have acted to the best of our ability to combat this epidemic; but how
can you fight what you cannot begin to understand?
Just over a year ago, the United States Public Health Service
deployed six teams of behavioral health officers to help us better
understand and join the battle our youth are fighting. After the 12-
week effort, final recommendations were made to the Tribal Executive
Board in October, 2010. Since then, our communities have worked
tirelessly to implement these recommendations, to keep those
considering ending their lives from taking that final step. We've
brought on skilled staff, involved multiple generations, collaborated
with local school districts, and heightened community awareness. We've
tackled upstream issues such as bullying and boredom by training
parents and peers to recognize the signs, and increasing available
activities for youth across the reservation. And we've developed a
response plan and protocol to streamline agencies and minimize response
time in the event of another tragic attempt.
Of course, in our communities, resources are always an issue. I
would like to thank you for your support in our application for a $1.4
million grant awarded just two weeks ago to continue our efforts with
the University of Montana and National Native Children's Trauma Center.
It joins other gsrant funding we've relied upon to support these
efforts--we are doing all that we can.
Yet at the agency level, a lack of communication, staffing
shortages, and budget shortfalls continue to hinder our efforts. The
IHS Behavioral Health Department here has no director, and its
facilities are lacking. Repeated efforts to contact the Bureau of
Indian Affairs and Indian Health Service for technical and financial
assistance to build and implement ``safe houses'' across the
reservation seem to have fallen on deaf ears, as neither agency has
responded. Indian Health Service constant shortfalls impact these
efforts as well. We cannot stress strongly enough the need for fully
funded health services: to afford preventative and reliable behavior
health services, treat substance abuse issues, and prevent early and
unwanted pregnancies.
Senator, we thank you for all your hard work and the support you
have provided us in our time of need, but the threat of more lost young
lives looms. Today I come before you as a leader of my people asking
that the testimony shared here grows into productive collaboration and
increased interagency communication. There is much work yet to be done.
Our people deserve healthy bodies and healthy minds. Our children
deserve a future. Thank you.
Senator Tester. Thanks, Rusty. Thank you.
[Applause.]
Senator Tester. Thank you very much. I appreciate everybody
being here this afternoon on a glorious day in northeastern
Montana.
Before I start, I would like to get comments from Walter
White Tail Feather.
STATEMENT OF WALTER WHITE TAIL FEATHER DIRECTOR. OFFICE OF
ECONOMIC DEVELOPMENT, FORT PECK
ASSINIBOINE AND SIOUX TRIBES; ON BEHALF OF HON. ROXANN SMITH,
VICE CHAIRMAN
Mr. White Tail Feather. Thank you. I bring the testimony of
the Vice Chairman. So these are from her, Roxann Smith, Vice
Chairman, Fort Peck Tribes.
One of the Fort Peck's needs to address [indiscernible]. We
have [indiscernible] suicides among primarily our young people.
My connection here is that I have lost a son and a cousin and
some precious [indiscernible] for our communities. This very
remote location that we live in is our home. Our families are
here and they are [indiscernible] here. For the young people,
there are not a lot of healthy activities for [indiscernible].
What we need is more opportunities for our youth to learn and
prosper so that they can become productive members of our
reservation.
The schools have done the best they can with what resources
they have. However, some of our reservation schools have
operating budget deficits. To alleviate this situation, they
have been forced to downsize their counselors so that they can
maintain their budget constraints.
Built into our tribe a youth program, the solution is to
put funding priorities into those existing programs, not to
reinvent the wheel. Everybody needs to participate.
At the Federal level, make existing grant funding
opportunities more flexible to include youth activities as
allowable costs. Our communities are impoverished, and in a lot
of cases have little to look forward to. The outcome I would
like to see is increased resources and collaboration within
programs to provide outreach programs and collaboration with
OPI, health providers and other entities. Perhaps a solution is
to have a contract person that will be available to provide
mental health and substance abuse counseling to local
[indiscernible].
Health care providers must be available and visible in the
community to earn the respect of our young people. Our
community is small and everybody knows everyone. So it is
imperative that our caretakers are clean and sober and have
integrity in each of our communities. A possible solution would
be to have a shelter workshop in a location where people may be
productive members of our reservation. At this location,
cultural teachings, counseling and recreation could take place
with an emphasis on building esteem, hands-on crafts,
horsemanship, hunting, et cetera. Families maybe included in
the activities.
Organized recreation is another topic that we have
[indiscernible] and since it is a healthy alternative to
drinking and partying, it too can be incorporated throughout
the [indiscernible]. We have a [indiscernible] oil and
[indiscernible] opportunity knocking on our doors. And we need
assistance on how to deal with the rush of people as well as
opportunities coming our way. How will we protect our future
without this [indiscernible] foster our communities
[indiscernible] grow into the existing work force as well as
future [indiscernible] these children that will lead them and
[indiscernible] and [indiscernible] into the next generation.
So those are the words of the Vice Chair. And James Miller
asked me to talk about my experience. I have never talked about
it [indiscernible] for me. But I left home when I was 13 years
old [indiscernible]. My parents wanted to get me away from the
drugs and alcohol and that is where they sent me. Little did
they know that that is where I encountered [indiscernible] high
school [indiscernible].
I landed a job in Washington, D.C. And subsequently just
lived that life there. There came a very serious point in my
life when I, there was nothing to look forward to. Absolutely
nothing. Even living in the city, [indiscernible] my friends,
the job that I had. And there was a lot of [indiscernible] that
was going on at the time. When I was a child, even here and in
high school, I always wanted to find that party, the bright
lights and the city.
And that is what goes on here, it happens here too. It got
to the point where I didn't see anything [indiscernible] and I
realized that the apartment that I was living in, I had a gas
stove. And it got to the point where I said, I can just go to
sleep. I don't ever have to wake up again, I don't ever have to
deal with any of this. Nothing. And not being around my parents
[indiscernible] my family. And the only reason I didn't do it
was because my roommate at the time, he was in Boston. And it
was his [indiscernible]. And I didn't want him to come back and
find a body. And it [indiscernible] after that I turned myself
in to rehab and it didn't work. I had to go back again
[indiscernible].
So those memories are there. And there are some young
people in the audience today, and you can survive anything,
absolutely anything [indiscernible] if you want to. And you
don't have to live that life.
And there is sometimes I got some calls from people who
have, who know this about me and have asked my advice. I know
what that feels like, when you are right at that point. There
is some people who don't, they don't understand
[indiscernible].
[indiscernible] allowing the chairman and all those people
[indiscernible] eyes and everywhere else, there is hope. There
is. It does get better. It absolutely does. Thank you.
[Applause.]
Senator Tester. Thank you, Walter.
Roxanne Gourneau, Tribal Judge, could I get her to make a
few comments?
STATEMENT OF ROXANNE GOURNEAU, TRIBAL JUDGE, FORT PECK'S TRIBAL
FAMILY COURT
Ms. Gourneau. I know that I have two nieces in the
audience, where are you? Will you come up for a minute, please.
I know that those of you who know me that I will
[indiscernible] and that is two [indiscernible].
Senator, I am in mourning right now and I want you to know
that, so I will weep. My son couldn't come today because I
buried my son November 23rd, 2010, my only son. This is who he
is. This is his family. My son was loved by many of you. My son
took his life. But I want you, I am not going to stand here and
tell you that things are great, and I want you to understand
that our young, and I want you to know something, my son did
not plan his death. His death was abrupt.
There are so many people across this beautiful reservation,
[indiscernible] my son could have called anybody, anybody, and
they would have been there. I am talking about friends and I am
talking about children that would have saved his life. But
Senator, I am telling you, what took my son's life was the
public school systems. My son was [indiscernible] upon. In
three hours, my son, who stood 6 foot 4 and 260 pounds and he
was invincible, he was my boy, he was kind, he was generous, he
was truthful and he was honest. He would give the shirt off his
back.
And I want you to know, Senator, that I am here today to
tell you anything you ask me. But we need regulations in the
school systems. Let's don't pretend any longer for three
decades that suicide is the second leading cause of death in
the State of Montana and on our reservations, let's don't
pretend any more. Let's don't pretend that we have titles that
we have to speak in a certain way. Let's don't pretend any
longer that our Native American children and [indiscernible]
children that [indiscernible] and special ed. I don't want to
pretend.
My son had a learning disability. They accused him of
having chewing tobacco. My son was a contender for a state
championship for wrestling. My son went to wrestling two years.
Contrary to what people say, and my heart is beating just as
hard as that drum, but contrary to what people say in that
report, it was nay, I am not an alcoholic, Senator. I don't
abuse drugs. I have been blessed by my tribe and by my people
to make an income that is 10 percent of the nation.
And I can tell you, and I can't speak for other parents who
have lost their children, but I can speak for me and I can
speak for my son, but I can tell you, Senator, they themselves
love their children. They were middle class people. They
weren't foster children. But I am telling you, Senator, that
these [indiscernible] we didn't need a $300 million report.
What we needed was proper investigation for audit
[indiscernible]. That is what we needed. We needed to head
these problems off before they started.
I want to make a difference in the school systems. I have
worked 30 years, Senator, and I have enjoyed opportunity and I
have benefitted in so many ways as an individual. And I am
still very young in wisdom. But I have worked in the executive
branch, I have worked in the judicial and the legislative. I
have held the title of vice chairman, first vice chairman. I
have been on the tribal council. I am presently a judge. I have
worked in so many of the social programs and I graduated in
this school.
So don't tell me, people, and don't let anybody say how
poor this reservation is. This was a beautiful playground for
my son. And he loved being Native American and he absolutely
loved all people. But I am telling you, Senator, that days
without recognition in the school what they did to my son and
not contacting me was a direct result of my son taking his
life. Those policies weren't placed by great wisdom. And I know
that people have rumors out there that think differently. But
that was my only son. Who in this reservation didn't know who I
was? I made sure that that school knew my contact information.
Why was my son targeted?
But it wasn't just my son. As many of you that sit her, you
always said you have got to accept that is the way it is. I
won't accept the death of my son. I won't. I will not celebrate
him until I have closure. But it isn't for me, because he's
gone now. It is for you and your children and your
grandchildren. No other mother should feel how I feel. No other
family, this family right here cries every day.
There is no such thing as substitution for love. As many of
you [indiscernible] titles, you need to take the titles off and
you need to do what's right. Be that leader. That is what we
are asking you, Senator Tester. That is what I am asking you. I
am asking you to be a leader for the State of Montana. And you
have to ask yourself, what do we have in common. Your children,
Senator. There is a severe expulsion and suspension rate,
dropout rate, high suicide rate. These records have been on
notice.
This isn't new information, folks, and I am telling you
that. It is been here. Do you really think that anybody really
cares that our children are taking their lives? They won't care
until you start caring, until we start caring. Don't tell me
about another policy. I don't want to hear about another
policy. What I want, Senator, is, I work in a field, I know
about this [indiscernible] act. We have been recently trained
on the Adam Walsh Act. And you know what Adam Walsh is, you all
do.
Many laws have been named because of an isolated situation
for one person. Well, let me tell you, our tribe is being
affected. And some of you know what manifest destiny means.
Today we can't pick out the next 10 years' leaders because you
can't be getting through the schools. Because their spirit is
broken. Schools are where dreams are made. That is where they
are at. How did it turn to be where it got today? Because that
is what it is. They are destroying them and they are breaking
them. Nobody cares about the dropout rate. The children that
need education.
Tribalizing education was done by this tribe, but nobody
saw fit to pass it. We got so many dignitaries in this room
that all you have to do is just do it. Senator Tester, what I
am asking you, and I want you to understand my son's story and
I want you to understand that morning he got up and he told me,
he said, I love you, mom. I won't apologize for crying.
But I am not the only mother who walks with arms that hurt.
And I am not the only family member who walks around and says,
I need to know. But I know what you can do, Senator. You can
remove tenure from the State of Montana. You can have
accountability in the schools, access to equal education.
My son was a citizen of the United States. He deserved to
be protected under the law. My son was a citizen of the State
of Montana that should have enjoyed equal access and benefitted
from education. My son is an enrolled member of a tribe, Turtle
Mountain. He should have enjoyed the trust responsibility that
guarantees education and protection. My son had a learning
disability.
With all of that, my son should have never died. But he
did. And so did many other children here. And it won't stop. It
won't stop until somebody tells you the truth. And the truth
is, you need accountability in the school systems. The feuds
and the friction that is going on there, it is an atrocity. And
everyone is going to tell you, and I know some of these fine
folks out here are going to tell you that we need more money.
And I am going to tell you I don't need any money. You need to
roll up your sleeves and you need to be counted on. Because we
have been paying for a long time, and it is time that you start
stepping outside yourself and building an extension of our
home. I am not going anywhere, I am going to die here. So
Senator, these are the things that I ask of you. And I don't
apologize for wearing my emotion on my sleeve. I haven't made
any public speeches in a long time. But I am coming, and I want
you to know, Senator, that I have filed a civil lawsuit against
the State of Montana, the school board and the superintendent,
just to begin with, for the gross, indifferent negligence that
they demonstrated toward my son. And I can substantiate and
prove every bit of it.
So thank you, Senator.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Roxanne. And I want to thank
everybody who's testified to this point. This is a field
hearing of the U.S. Senate Committee on Indian Affairs. We are
here today, and pleased to be here with the members of the
Assiniboine Sioux Tribe of the Fort Peck Reservation and our
distinguished panelists.
The title of this hearing is Empowering Native Youth to
Reclaim Their Future. We are here to acknowledge the
devastating problem of youth suicide that occurs in Indian
Country. And more importantly, as Roxanne pointed out, to find
solutions to solving it.
Over the past year we have heard a lot of stories in the
news about fights in Congress over the economy and celebrities
who get themselves into trouble. But America's 24-hour news
anchors forgot one painful story here in Montana. And we are
here to acknowledge that the rate of suicide for American
Indian youth is far higher than any other ethnic or racial
group in the United States. On some reservations, including
this one and others in Montana, the incidence of suicide has
been 10 times, 10 times the national average. Right here, the
folks in this room know this much better than I, right here
over the last year six children took their own lives. One of
those children was only 10 years old. And there is more, at
least 20 other members of the Fort Peck community attempted
suicide. That is totally unacceptable in any community. Because
these kids, as has been pointed out earlier, are our future.
Leaders in Montana, specifically at Fort Peck, have tried
to do their very best to respond aggressively. The Chairman and
his administration I think have done good work under difficult
conditions. And so has Gordon Belcourt and Donnie Wetzel of the
Montana-Wyoming Tribal Leaders Council. Their Planting Seeds of
Hope project us helping every Montana tribe to build resilience
in Native American youth. They are empowering tribes to prevent
suicides.
This is also a good opportunity to remember a friend that
left us all too soon. Darryl Red Eagle was a friend of mine and
many of you folks in this room. Darryl was a council member for
the Fort Peck Tribes from 2005 until he died in June. He was
chair of the Health and Human Services Committee. In that role,
Darryl was a tireless advocate for improving the health
conditions of his people. I had the opportunity to visit with
him many, many times. Those of you who knew him, you can
imagine he was very vocal about the need to prevent native
youth suicide.
Working together, we have taken some steps. Permanently
reauthorizing the Indian Health Care Improvement Act means that
better health care, physical and mental, is on the way for
Indian communities. This bill opens up grants for tribes and
organizations for suicide prevention efforts.
In fact, earlier this summer, as Chairman Stafne pointed
out, Senator Boxer and I announced that the U.S. Center for
Mental Health Services had ordered a $1.4 million grant to
address youth suicide and to promote activities that emphasize
resilience and leadership on this reservation. That is a good
start. But we need to do more.
In geographically isolated parts of rural America,
including right here in Eastern Montana, resources aren't
readily available. Recruiting health care professionals to
serve frontier communities is very challenging. And in Indian
Country, these challenges are compounded by poverty, inadequate
infrastructure and sadly, a sense of hopelessness that should
never afflict a 10 year old child, or any child for that
matter. Hopelessness is not what this Country is about. We live
in the greatest Nation in the world, where we work hard to make
the future better for the future generations and have better
opportunities than we have had. All America's kids and their
families should have somewhere to turn, especially in places
resources are slim and hope can be scarce.
Although resources are slim in many parts of Indian
Country, you have something many others do not have, and that
is the greatest strength in Indian Country, family, kinship.
More than anything else, Indian families are a bond that not
only help you survive, but thrive. As community leaders and
family members, we all have to do our part. Leaders make policy
decisions and community members make role models. Role models
include mothers and fathers, extended family and friends,
teachers, business leaders and cultural figures. The Fort Peck
community has a lot of good role models, a couple that I will
just bring up. One of them is here today, a kid like April
Youpee Roll. April grew up here, went to Harvard and interned
in my Washington, D.C. office. April, congratulations on being
a great role model.
Richard Dionne, a young man who grew up here, he resisted
peer pressure and chose never to take a drink of alcohol or try
a drug. After playing basketball in the Continental Basketball
Association, he is now a guidance counselor for Native youth.
And there are many, many more. And I wish we had time to talk
about them all, but we don't.
But the point is that as a community, we have to give hope
to kids. We have to give them the belief that they can become
anything they want. That if they resist the peer pressure and
the dangerous distractions, as was pointed out earlier here
today, that they live in a country where their dreams can come
true. As community members, we need to fight to make sure all
our kids, no matter where they live, understand that
hopelessness and despair doesn't belong in any community.
Another important step to addressing this tragedy is to
make sure folks understand the story from Fort Peck
Reservation, right here, is real. The more people understand
the challenges facing many of our rural communities, many of
our frontier communities, the better able we are to make sure
that all of our young folks are able to live up to their
fullest potential.
I am happy to welcome our distinguished panel to share
their thoughts on this crisis. And we are going to do things a
little bit different today. Usually at these hearings we hear
from Administration witnesses first. That is not going to be
the case today. We are going to hear from local witnesses
first, witnesses from Montana, and then the agency officials
will be on the second panel.
As always, we have limited time. Your complete statements
will be entered into the record of the hearing. I would ask you
to be concise and shorten your testimony to be as close to five
minutes as you can, although I won't be too harsh on you if you
run over a bit.
First we are going to hear from Deb Halliday. Ms. Halliday
is Policy Advisor on Community Learning Partnerships in
Montana's Office of Public Instruction. The committee invited
OP to testify because schools are absolutely critical, as has
already been pointed out, to solving this problem.
So if you want to start out, Deb, and we will go to Mr.
Manning in a bit.
STATEMENT OF DEBORAH HALLIDAY, MPA, POLICY ADVISOR, COMMUNITY
LEARNING PARTNERSHIPS, MONTANA OFFICE OF PUBLIC INSTRUCTION
Ms. Halliday. Good afternoon. Thank you for inviting the
Montana Office of Public Instruction to participate in this
hearing. I look forward to sharing our work and our
observations related to the vitally important task of
supporting and strengthening our American Indian youth.
Thank you, Chairman Stafne, for hosting the gathering. I
too have in my mind today Councilman Darryl Red Eagle, who so
deeply believed in the beauty and the promise of children and
who worked so wisely to change how we do our work to better
support American Indian youth.
I am here representing our State Superintendent, Denise
Juneau, who is unable to attend today. I am also here to speak
of the ground-breaking work we are doing in partnership with
tribal governments, school districts, community members and
families who truly improve the quality of education in our
State's most struggling schools.
Under State Superintendent Denise Juneau's leadership, the
Office of Public Instruction has launched an initiative called
Montana Schools of Promise, which is working to significantly
improve the quality of education in Montana's most struggling
schools. Schools where a mere 15 to 25 percent of high school
tenth graders showed proficiency in reading and dropout rates
are double those of the general population.
In Montana, the most struggling schools are all located on
our State's Indian reservations. Schools of Promise seeks to
turn these schools around, providing intensive supports to all
components of the school system and engaging community, family
and tribal government in the effort.
Last year, the Schools of Promise received a substantial
boost through a three-year U.S. Department of Education school
improvement grant and we are now working intensively with four
school systems, here in Fort Peck, on the Crow Reservation and
the Northern Cheyenne Reservation. From the get-go, based on
research, we knew that our efforts must be comprehensive and
must include support for the mental health and well-being of
students. It is common knowledge that students learn better
when their mental health needs are met. This is particularly
important in communities that are grappling with the long-term
damaging effects of trauma, disruptive family environments and
poverty.
Recent school improvement research clearly connect the
students' well-being and their readiness to learn as central to
the work of making schools better. Every child needs a trusting
adult to turn to who will provoke and inspire that child to do
their best. And that unmet health and mental health needs
impair a child's learning process. From a brain physiological
perspective, we now know that the brain itself cannot receive
or retain new information if it is in a post-traumatic state:
for example, when a student is re-experiencing or has not yet
recovered from the traumatic event in their lives.
The Office of Public Instruction is addressing these
challenges in several ways. We have partnered with the
University of Montana National Native Children's Trauma Center,
which you will hear about in a few moments, to support the
adults working in schools so that they can better understand
the critical role they play in a child's well-being and give
them specific tools to do that better. We have brought
mentoring and student advisory time into the school day. We are
working with schools to create a safer school environment.
We are also the recipient of a Montana Mental Health Trust
grant. Through this two-year, $600,000 grant, the OPI is
partnering with tribal governments on the Fort Peck, Crow and
Northern Cheyenne and with Indian Health Services, the Bureau
of Indian Affairs, the State Department of Health and Human
Services and public school districts on all three reservations
to develop community-based school mental health wraparound
services.
There is a lot of great work going on, and it is hard work.
Yet we are seeing early results that are promising. After one
year of our Schools of Promise work, all four school systems
showed marked improvement in student test scores, such by as
much as 15 points, and dropout rates are improving.
I will conclude my comments with a few observations, which
I hope will help you in your discussions on how to best support
the work being done to strengthen the American Indian youth.
Number one, build on existing core community strengths. In
every community, there is a small group of people working
miracle every day. Many of those who work here at Fort Peck are
here in this room. Find these folks, understand what they care
about, how the community works when children return home from
school, and office lights are turned off, the natural rhythms
of life take over.
Number two, listen to what works. Montana is a rural,
frontier State. We struggle with Federal policy and programs
that are built with skyscrapers and city economies in mind.
Here in Montana, we develop effective strategies that work in a
vast, rural, poor State. Learn from that and take our lessons
into the national debate.
And finally, we can't do it alone. The Office of Public
Instruction is partnering with local communities, tribal
governments, State and Federal allies. It is the only way we
can see that lasting change will occur. The vast majority of
funds we rely on to do this work comes from Federal funds. Keep
them coming. Our State literally can't afford to fund the
intensive work that needs to be done, and yet our communities
and our Nation can't afford us to not do that work every day as
best we can.
Thank you.
[The prepared statement of Ms. Halliday follows:]
Prepared Statement of Deborah Halliday, MPA, Policy Advisor, Community
Learning Partnerships, Montana Office of Public Instruction
Good afternoon. Thank you for inviting the Montana Office of Public
Instruction to participate in this hearing. I look forward to sharing
our work and observations as they relate to the vitally important task
of supporting and strengthening American Indian youth.
Thank you to Chairman Stafne for hosting this gathering. I have in
my mind today Councilman Darryl Red Eagle, who so deeply believed in
the beauty and promise of children, and who worked so wisely to change
how we do our work to better support American Indian youth.
I am here representing State Superintendent Denise Juneau, who is
unable to attend today. I am also here to speak of the ground-breaking
work we are doing, in partnership with Tribal Governments, school
districts, community members and families to truly improve the quality
of education in our state's most struggling schools.
Under State Superintendent Denise Juneau's leadership, the Office
of Public Instruction has launched an initiative called Montana Schools
of Promise, which is working to significantly improve the quality of
education in Montana's most struggling schools. Schools where a mere
15-25 percent of high school tenth graders are proficient in math and
reading, and dropout rates are double those of the general population.
In Montana, the most struggling schools are all located on our
state's Indian Reservations. Schools of Promise seeks to turn these
schools around:
1. Providing intensive supports to all components of the
school system, and engaging community, families and tribal
government in the effort.
2. Listen to what works. Montana is a rural, frontier state.
We struggle with federal policies and programs that are built
with sky scrapers and city economies in mind. Here in Montana,
we develop effective strategies that work in a vast, rural,
poor state. Learn from that, and take our lessons into the
national debate. And finally,
3. We can't do it alone. The Office of Public Instruction is
partnering with local communities, tribal governments, state
and federal allies. It's t he only way we can see that lasting
change will occur. Yet the vast majority of funds we rely on to
do this work come from federal funds. Keep them coming: our
state literally can't afford to fund the intensive work that
needs to be done, and yet our communities and our nation can't
afford for us not to do that work, every day, as best we can.
Thank you. I am happy to answer any questions.
Senator Tester. Thank you, Deb. Thank you very much for
your testimony. We will have some questions after we get done
with the panel for each of the panel members.
Next we get to hear from Dick Manning. Dick is a Research
Associate at the National Native Children's Trauma Center at
the University of Montana. Dick and the folks in his office
have developed methods for tribal communities to address these
strategies. He will share some of those recommendations with
us.
On a side note, I will just tell you this. Dick is a
special friend of mine. He's one of those people that, from my
perspective, looks at life from a different perspective and is
able to find solutions that people like me don't often see
readily. So Dick, I want to thank you for being here today, and
I look forward to your testimony. Once again, try to keep it as
close to five minutes as you can.
STATEMENT OF RICHARD MANNING, RESEARCH ASSOCIATE, NATIONAL
NATIVE CHILDREN'S TRAUMA CENTER,
UNIVERSITY OF MONTANA
Mr. Manning. Thank you, Senator, and thanks to Chairman
Stafne.
I am here representing the National Native Children's
Trauma Center, whose director is Marilyn Zimmerman. She would
be here today, but she is in Washington, D.C., presenting
[indiscernible]. In other words, she got the short straw and
had to go to D.C.
I would like to begin by saying first of all, we have been
engaged in this community for seven years. We are very grateful
to the tribal council. We would like to express that gratitude
to the Chairman's staff and the tribal council [indiscernible]
in allowing us to learn from this community over the years
[indiscernible] learning process. That engagement has greatly
enriched our work with the work that we [indiscernible].
I would also like to thank Senator Tester, of course. I am
very glad that he remarked today about that $1.4 million grant.
I can tell you, I personally had a hand in writing that grant.
I saw it go through the bureaucracy and it clearly wouldn't be
here without the support we continually get from Senator
Tester's office and his staff in negotiating this for us. It is
very important work that goes on behind the scenes and is not
often [indiscernible] it is a big deal.
Deb hit on some of the points I would like to hit on, and I
would like to stress two points here today. The reports in the
news, concrete examples that have grown out of our
understanding, and by our work, I mean this community as a
whole, that has been building as we struggle with these issues.
Believe me, I use the word issue in plural. It is tempting of
course to focus on the issue of suicide, headline-grabbing as
it is. It is urgent that we do focus on it.
But we need to keep a few things in mind [indiscernible]
this problem of suicide tends to be part of a lot of problems,
a whole threat that is all tangled up, problems on problems,
drug and alcohol abuse, assault and violence, poor academic
performance, dropouts, teen pregnancies. These problems kind of
run together. We see them together and they are not speaking to
individual cases [indiscernible] teen suicide. When we see them
together we know we have a much larger problem than suicide,
and we have to think about that.
We also have to think about causes. And again, there is no
single cause. Causes themselves are very complex as well, and
this is borne out by the research nationally. This is what we
see on a community level when we work day to day. And those
causes are not limited to but include things like child abuse,
[indiscernible], absent parents, parents simply challenged by
the difficulties [indiscernible] and in cases [indiscernible]
historic [indiscernible].
This complexity of cause, in effect, dictates something
very important and gives us our marching orders. Our marching
orders are this: that no single agency, no single institution,
no single level fo government has a comprehensive solution.
None of us can do it alone, we are all in this together. This
virtually dictates that we have to learn to cooperate. Believe
me, that is hard work. That is the work that has been going on.
This is not some platitude that we are just bearing lip
service to. We have to learn to actively tear down the barriers
between institutions so we can work together to solve this
problem. We are all in this together.
Now, having set up those two principles, I want to report
on good news, things that are happening, and we will get back
to that $1.4 million grant, and the way it worked. The way it
worked, it did not begin with a grant-writing class. It began
with a tribal consult declaring a state of emergency and then
leading to the deployment of the Indian Health Service. The
Indian Health Service deployed people to this community who did
very hard State work. They researched and asked questions to
find out what was going on.
Now, in lesser communities, the report that they generated
would end up a shelf collecting dust as reports often do. That
was not the case. We had already begun conversations with James
Belcourt and under his leadership and tribal health people we
understood that we needed that report as a way forward. So we
took it as an information base. That information base, what we
learned from that community or that Federal report told us as a
university to do allowed us to write a grant that was far more
compelling than we would have been able to do alone.
So it is that leadership, IHS, tribal health, tribal
council and the schools, people working together, sharing
information that allowed us to write a very strong grant and
then the leadership of Senator Tester's office to make it
happen. Those things [indiscernible] together.
That is probably [indiscernible] what is to us something we
have learned. And this is a small thing [indiscernible]. During
the IHS deployment, the people doing that work did a very smart
thing and something we have a lot here today. They took kids
aside and asked them what they thought we should do. They
talked to children, they said, what do you need. Now, that
sounds [indiscernible] be surprised at how often it doesn't
happen. It happened in this case.
One of the things kids told us as a group, a common answer
was, we had like more adult contact, one on one contact. So
when we began our work in Poplar Schools in response to the
initial suicide [indiscernible] schools and [indiscernible]
university, we asked kids the same question, what do you need
as a result of [indiscernible]. We got the same answer: we had
like more one on one contact. We said, that sounds simple
enough, let's do that.
So we started a mentorship program at Poplar Schools. We
simply asked the kids to identify, identify an adult they
trusted in the school. We took the kids' advice, someone you
trust, a licensed therapist, a counselor, we don't care, just
so you trust that person. The group we are talking about is 47
kids who were identified at risk for suicide. At risk. We are
dealing with them intensively.
So those 47 kids went through the mentorship program and
they also had a common history of assault. We had a lot of
assault in that group. And then [indiscernible]. At the end of
the mentorship, I am sorry, before the mentorship program, that
group of 10 students had a rate of assault of .35, almost an
assault every other month, .35 assaults per student per month.
At the end of the mentorship program, it was .05. In other
words, we effected a seven-fold decrease in assaults.
We have calculated out, if they do that mentorship program
with every student in the school, and the school now has a rate
of about 300 assaults per year, we would take that rate to
about 116 by simple mentorship, checking into those kids three
times a year, one on one adult contact. That is pretty good
news. It is a simple program. It is the kind of thing that can
be replicated and can be [indiscernible]. We think that
justifies the kind of Federal investment that is being made
[indiscernible] other people [indiscernible].
[The prepared statement of Mr. Manning follows:]
Prepared Statement of Richard Manning, Research Associate, National
Native Children's Trauma Center, University of Montana
The National Native Children's Trauma Center and the Institute for
Educational Research and Service, both at the University of Montana,
thank you for the opportunity to present our information on this issue
of vital importance, not just to this community, but throughout Indian
Country and to the nation as a whole. Much of what you will hear in
overall testimony today will focus on the severity of a single
problem--teen suicide--here at Fort Peck. While we do not minimize that
single problem, we would like to report that through seven years of
engagement between our group at the university and this community, all
of us have learned a great deal about some of the broader issues,
again, of vital interest throughout Indian Country and to the nation as
a whole. One of those lessons is that showing up matters. Throughout
our engagement here, working groups both large and small have traveled
from the University in Missoula to this community on average every two
months. But then we can't help but note and appreciate that the Indian
Affairs Committee already knows this rule and proves it by showing up
here for field hearings. We believe this community views this as a
positive development.
All of what we have learned here with the help of this community
cannot be adequately summarized in this short testimony, but in service
of the Committee's work, we would like to emphasize two over-arching
lessons that we believe ought to guide everyone's efforts in these
issues. In addition, we would like to report an encouraging new finding
that demonstrates how attention to these two fundamental points
succeeds.
In convening this hearing, the Indian Affairs Committee, in fact,
demonstrated the first important bit of knowledge by titling it:
``Empowering Native Youth to Reclaim their Future.'' Everyone here
today knows the headline-grabbing issue in this very school district
has been a cluster of teen suicides, and the understandable urge is to
do something now about that specific problem. In fact, our group from
the university is engaged in exactly that, in doing something about
suicide now. Nonetheless, as urgent as this issue is, the Committee's
title urges us to not lose sight of the larger issues, and we agree.
This is really about the future of Native youth, all youth. Teen
suicide is not a single problem in isolation, but is part of a tangle
of challenges that includes drug and alcohol abuse, family, community
and gang violence, poor academic performance and a high drop-put rate,
teen pregnancy, diabetes and obesity. Pulling a single thread will not
untangle the larger Gordian knot of problems.
Likewise, our nation now has a solid body of science compiled by
both the Centers for Disease Control and the National Childhood
Traumatic Stress Network sanctioned by Congress in 2001. Our National
Native Children's Trauma Center is a Category II Center in that
national network, charged with addressing these issues on reservations
throughout the nation. The overwhelming evidence from those efforts
concludes that the knot of problems we face here and in impoverished
communities nationwide stem from child abuse, neglect and domestic and
community violence, and in the case of reservation communities,
historical trauma. We do have some evidence that some forms of abuse
are particularly damaging. For instance, our researchers expect to soon
publish data indicating a particularly strong link between childhood
sexual abuse and teen suicide. Nonetheless, this does not negate our
primary lesson here, that the knot of problems is wound up in a knot of
causes, and we make little progress in these issues unless we recognize
the complexity of the total picture.
This presents a daunting challenge, but also leads to our second
key point: Because the larger issue is a series of complex problems
stemming from complex causes, no single agency, institution or
bureaucracy can solve this alone. The hydra heads of challenges
preventing Native youth from reclaiming their future must be dealt with
by tribal health, social services, schools, juvenile justice and by
families, especially families. The complexity dictates that all of
these diverse elements and interests in the tribal community come
together to share information and common strategy. We are all in this
together. Federal, state, tribal, school district, and--yes, even
academics from the university--must learn to cooperate in a common
effort. That may be the most important lesson this community is
learning and teaching the rest of us, not just that cooperation is
necessary, but exactly how to tear down the barriers to cooperation so
we can get to the hard work that faces us. These are not just
platitudes; we have concrete examples of real success that stems from
real cooperation.
As you know, in response to the widely reported suicide cluster
more than a year ago, the Fort Peck and Assiniboine Sioux Tribal
Council declared a state of emergency in May of 2010, which triggered a
deployment by the Office of Force Readiness of the U.S. Public Health
Service and the Indian Health Service. IHS sent twenty-two officers,
who rotated through the community in six separate teams, each in two-
week deployments. The incident commander of the deployment was James
Melbourne, Director of Tribal Health Service. This extraordinary effort
led to a formal report from IHS, which could have, in a lesser
community, been sent to a shelf somewhere to gather dust. Not here. Our
group at UM had already begun working with Director Melbourne on these
issues, and agreed to cooperate on a way forward, using the IHS report
as an information base. We built on their knowledge. Cooperatively, we
wrote an application for a $1.4 million grant from the Substance Abuse
and Mental Health Services Administration to pay for suicide prevention
on the Fort Peck reservation. Senator Tester's office supported us and
announced that our application was successful on July 28, and now a
local agency--Tribal Health--a state university and a local school
district will go to work fulfilling needs identified by the federal IHS
and the tribes. This is what we mean by interagency cooperation and
shared information. Further, because of this structure and the spirit
of cooperation, our university has agreed to waive any indirect costs,
a burden that can run as high as 41 percent on federal grants.
Yet embedded in this is a development there is, we think, an even
more revealing and encouraging bit of news. As part of its
investigation, IHS took the rare and laudable step of actually
interviewing the community's youth to solicit their ideas on how we
might better serve them. The students gave us some common and revealing
insights, and one of those was identifying a need for more meaningful
adult contact, one-on-one relationships we might call mentoring. As
part of the university's work at Poplar Schools, we repeated that
question with a group of forty-seven students that screening had
identified as being at-risk for suicide. We got a similar answer, so
took the simple step of taking these children at their word. But in
analyzing the data, we also noticed that a significant subset of the
forty-seven also showed a pattern of assaulting other students and
teachers, of violence. As we said, these problems are entangled, and
often one problem like violence stemming from anger is a warning sign
of another, like suicide.
Listening closely to what the young people were telling us caused
us to do something very simple, but responsive: to begin a mentorship
program. Each student identified someone on school staff that he or she
could trust--a pivotal step--and in every case the identified staffer
agreed to check in with the student at least three times during a
school year--just three times. They talked about issues like academic
progress and attendance, but more to the point, mentors took an
interest in students' well-being. The program effected simple human
contact between a student and a caring adult, not someone specially
trained or licensed or delivering a particular therapy, just someone
the student herself identified as someone she trusted.
The subset of ten students with a history of violence in the
school, on average, accounted for 4.5 assaults per month in the two
years and several months before teaming up with a mentor. That is,
these kids, also at risk for suicide, accounted for a significant
portion of the violence in the school. But more importantly, after
these students participated in the simple program of mentoring, their
assaults fell from an average of 4.5 per month to 0.71 per month.
Conversely, three students identified as ``at risk'' of suicide and
with a history of assault were denied parental permission to
participate in the mentorship program. Their assaults decreased also,
but not nearly as dramatically as those mentored. Seldom do those of us
in this field see such a robust and dramatic result so quickly.
The bonus in all of this is that of the larger group of 47 students
identified as ``at risk,'' those who were mentored also showed
significant gains in academic achievement. In fact, the difference
between the two groups--mentored and not--amounted to the difference
between earning enough credits to graduate and failing to do so, one of
the more significant predictors of a student's future.
This is not to say this is a magic bullet that will solve the
community's problems overnight, but there are a couple of points in all
this worth emphasizing. The gains shown here occurred as a result of an
open exchange of information and knowledge among various agencies,
particularly IHS, the Tribal Health Service and Poplar Schools. But
they also occurred because Poplar Schools staff has spent many years
learning to recognize and deal with at-risk youth. That is to say, the
community has built capacity, and it has paid off.
Second, though, this is a cost-effective and simple program that
rests on strengthening meaningful relationships between children and
adults in this community, and now we have some evidence it works. It's
the sort of work that can be easily and immediately replicated in
similar communities with similar challenges, so the nation really can
learn from Fort Peck. This, we think, helps justify the federal
investment in this place and in these young people.
Senator Tester. Thank you, Dick. We appreciate that.
Thank you for your comments, and I as I told Deb earlier,
we will have questions.
Rounding out the first panel, we have Fanci Jackson, maybe
the most important member of this panel. No offense to Deb or
Dick. But the fact is that Fanci Jackson is a member of the
Fort Peck Youth Council, and she is going to provide us a
perspective from the youth side of things and what it is like
growing up here on Fort Peck.
Thank you for being here, Fanci.
STATEMENT OF FANCI JACKSON, MEMBER, FORT PECK YOUTH COUNCIL
Ms. Jackson. Hi, my name is Fanci Jackson and
[indiscernible].
I don't mean to [indiscernible] but from my perspective, I
[indiscernible]. I went [indiscernible] and I was a over there
for a half a year. It was very hard, actually.
And the following year, it was really hard [indiscernible]
no one knows how hard it is for you, you never tell anybody
[indiscernible] because you are scared of what they will think
of you. You are scared to tell anybody, because [indiscernible]
you know people and you have to be [indiscernible] maybe
[indiscernible] by that. And you don't want to do it and you
get scared, you get terrified [indiscernible].
But my [indiscernible] at school [indiscernible] so mean,
they call me mean names and make fun of me [indiscernible] call
me a [indiscernible]. I really was [indiscernible] I felt
[indiscernible] because all my friends were there, and we were
all the same, we were no different. When I went to
[indiscernible] and so easy problems [indiscernible] could do
in five seconds [indiscernible] that I was too not smart
[indiscernible] that I couldn't do anything. But in that school
I felt so stupid, I felt, why am I here, they don't want me
here. The teachers don't want me here, the students don't want
me. So why am I here? I was afraid to go to school sometimes
[indiscernible]. I was [indiscernible].
What I would like to bring to your attention is that we
only got one [indiscernible] out of the whole year
[indiscernible] had one B. I had straight As all across,
distinguished honors and I got that B, it was the only one B I
got for the last two years. I have never got a B
[indiscernible]. I was proud, but scared [indiscernible] don't
know [indiscernible] larger than happens [indiscernible]. Many
of us don't have [indiscernible] hurts, even though we don't
trust them. We don't tell a lot of people. Our friends see it,
we see it but what do they do? They do nothing. They don't
speak up. They don't talk about it. When someone talks, when
someone makes fun of you, when someone hurts you so bad you
want to cry, we don't talk to anybody, because we are afraid.
And we don't know what to do. It is like [indiscernible]
everybody embarrassment. You feel so embarrassed that you just
want to cry and it hurts you so bad you don't know what to do.
You are just sitting there [indiscernible] and you don't know
what to say. So you just try to walk away but it just keeps
coming back. They will keep following you and keep pushing you
and pushing you and you still don't know what to do. And you
are afraid [indiscernible] really hard.
But [indiscernible] that is why I tried to stand up for my
friends when they get bullied by other people. I see that and I
don't like it one bit. I hate when people bully people. The
bullies don't see how people that are being bullied, how they
feel. I see my friends cry [indiscernible]. I told
[indiscernible] I don't know who it was, but I told one of
[indiscernible] half hour I told them [indiscernible] and that
they should just leave them alone [indiscernible] do something
else. My friend cried for a whole half hour she was so hurt.
She didn't know what to do.
And I was scared for her. Because sometimes bullying leads
to suicide. A lot of my friends talk about it, suicide. They
think, it is my way out. If I do this, I can get out of here,
maybe it will be a better place. Maybe [indiscernible]. Only
thing [indiscernible] we always think about getting out of
here. When you are so deep down hurt that you don't know what
to do or where to go, you don't think you have any other
choice, you just want to die. But I am like, you really do, you
want to leave this and you don't want to look back. That is
when you are so deep down and you don't really care any more.
I have some friends, one friend that I was actually like
that when I got depressed. When I got depressed, my dad passed
away in August, his memorial is coming up this weekend on the
10th, he passed away [indiscernible] was so alone. I felt so
alone in school, just knowing I had no one to talk to. I felt
so alone deep down, I thought no one cared about me.
I got so depressed I started lashing out at my sisters, I
got angry at them [indiscernible] over something that was
completely not even important, maybe a pop, maybe she walked by
me and maybe looked at me the wrong way. I would just get mad
and then [indiscernible] my mom told me that [indiscernible]
she thought [indiscernible] and I was really getting bad into
it. I was lashing out. I started picking [indiscernible].
I thought if I leave [indiscernible] maybe I won't be
alone, maybe I will see them then, he will care that I am
there, maybe [indiscernible] see who I am. I felt so alone
[indiscernible] and nobody talked to me. I told her
[indiscernible] for maybe a few hours but [indiscernible]. I
was hurting so bad nobody knew [indiscernible] just smile and
act like nothing was wrong. I smiled for six months without
telling anybody I was really, really depressed. I smiled
through everything.
But then I just wanted to cry. Every day I was just tired,
didn't want to get up. Every day [indiscernible] just looking
at that [indiscernible] outside each [indiscernible] woke up
and go to school [indiscernible]. But then I thought of my mom,
how much my mom loved me, how much my sisters loved me, how
much my brother loves me, how much everyone loves me so much.
And I couldn't leave them. What would they do without me? There
is only one me. There is not going to be another me.
So there is never going to be [indiscernible]. And I
thought that I could be [indiscernible]. But some kids just
don't [indiscernible] just give up. They just don't think
[indiscernible]. But [indiscernible] I want to what my friends
wanted to do but I tried to stop them, because I know that I
love them too much for them to go. Some of my friends, one did
[indiscernible] very silent and I was very sad, I barely
[indiscernible] but I was very said that he passed away.
[indiscernible] no one [indiscernible] my cousins passed away
in April [indiscernible] almost [indiscernible]. I was coming
back from a field trip and then I get the call that
[indiscernible] and I just cried. I didn't know what to do. He
was 23 years old, he has his whole life in front of him
[indiscernible]. He was my best [indiscernible] and I love him
so much [indiscernible].
But sometimes being bullied doesn't mean being bullied in
school but sometimes it can be outside of school. It can also
be by family [indiscernible]. Sometimes [indiscernible] people
you don't even know. You can get bullied everywhere, no matter
what. He was bullied so much that he hung himself. And I walk
by that garage every day, going to [indiscernible] and look in
there wondering why, why did you have to leave, why. And it is
all hurt so bad just knowing that he couldn't live any more.
And knowing that I felt that way too. Then after
[indiscernible] cried so much I wanted to kill myself, yes, but
after I saw that, how many people got hurt by it, I wanted
[indiscernible].
Most people get really [indiscernible] some of my friends.
Some people I don't even know, I will be walking down the road
and I will see someone, they are pushing a kid around. I mean,
we are all human, we are all the same color. Sometimes we are
[indiscernible] we can actually resolve the conflict, but they
don't, no one does. They just watch these kids beat each other,
they just watch these kids beat each other up all the time and
no one stops it. No one speaks up. No one tells that kid that
they are not supposed to do that to that child.
Because one day, what if tomorrow that little boy that got
beat up [indiscernible] and that happens. It really does. I
know it does. I have seen it happen. It [indiscernible] just
knowing that your friend tomorrow [indiscernible] tomorrow is
your friend that [indiscernible] yesterday [indiscernible] in
the morning when I wake up and say hello [indiscernible] be
there and say hello to him any more. He's gone.
You have to [indiscernible] that what if all these people
are being hurt, no one looks at them, no one eve sees them.
Sometimes it is hard to see it. But they are hurt and you have
to help them. If you don't help them, they are not going to be
there tomorrow. There is only [indiscernible] what if tomorrow
you don't see them. There is so many of them no one sees them.
[indiscernible] but [indiscernible].
Senator Tester. Thank you, Fanci. I appreciate that very
much.
I would like to start with Fanci, if I might, it is kind of
reverse order. Your testimony was very good, and you are right,
there is only one you. And people need to understand that. And
to give up, it talks about the dire straits, you could be
there.
As you were giving your testimony, I was thinking about the
peers that are around you, you talked about that, the family
that is around you. Are you able to encourage, through the Fort
Peck Youth Council, when people get bullied or for whatever
reason and they get to feeling rejected, that there are people
out there to go to talk to, kind of a support group, so to
speak, to help them get back right with the world? Is that
available to kids, whether you are in Poplar or Wolf Point or
Frazier or wherever? Is there any kind of effort to try to make
a group of your peers or a group of parents available?
Ms. Jackson. Actually, I was just talked to my parents, but
I don't know who to talk to about it. I mean, I didn't
[indiscernible]. You don't think that anybody will believe you,
you don't think that they will care.
Senator Tester. But the fact is, there are people who care,
right? You talked about your cousin.
Ms. Jackson. Yes, [indiscernible] at the time I didn't
[indiscernible].
Senator Tester. Okay. That is fine.
Dick Manning, the grant that you spoke of, and you talked
about working together, you talked about partnerships, the $1.4
million grant, what kinds of programs do you think would be
available to develop with this in the end? Where are you going
to focus the effort?
Mr. Manning. It is actually about the 6th of November, and
in the first phase, that has already happened, the initial
grant a year ago. That is almost like a triage, we zoom in and
identify as rapidly as possible the kids who are at risk of
suicide. And they tend to be in a cluster, they tend to be kids
who knew the kid who completed suicide. For instance, they tend
to be very angry about that, they didn't see that as
[indiscernible] those kids almost on a triage basis as rapidly
as possible.
And that step, that [indiscernible]. The other thing you do
with that is, you try to train staff to recognize. And some
evidence based on steps that we have seen in other places, for
instance, the staff now are very sensitive to a missing child.
When a child is not in school on a given day, we are calling
the house trying to find out. In some cases, if they get no
response at the house they go, literally, they take it that
seriously. We think, we think that we have prevented two
completions as a result of that work.
But beyond that, as the effort continues, we can take it on
a broader basis across the school and deal with some of the
tougher issues that are out there, like bullying. Make people
sensitive to bullying, take it seriously, it can happen. At
least those kinds of things.
And we try to concentrate initially on that suicide
problem. Then we go spread out to the broader community and the
broader setting of problems [indiscernible.]
Senator Tester. One more question. There is been recent
legislation that talks about tele-health as a method to be used
for issues that revolve around mental health problems,
psychological health, however you might want to put it. I just
want to get your opinion. Is this an issue where tele-health
can help? Tele-health, tele-medicine health. For instance, you
have a health care professional in Boston, Massachusetts or
Missoula, Montana or Billings or wherever talking to areas that
are rural or frontier where you have a hard time getting health
professionals, like right here.
Mr. Manning. On a short-term basis, certainly. In this
case, when we are worried about a suicide [indiscernible] I
understand is not implemented but will be implemented in the
spring. Suicide hot line [indiscernible] somebody to call in
the [indiscernible]. But ultimately these issues resolve on
something as simple as [indiscernible] and it really takes a
village, the people who will support not somebody out
[indiscernible] away. That first day it can be that. But
ultimately, long term, one on one [indiscernible] works, it is
the community support, it is creating an environment where
people feel safe and welcomed [indiscernible].
Senator Tester. Thanks.
Deb, we send our kids to school and they spend a lot of
time in school. And so even though the family is hugely
important in this, and it is critically important, I think part
of Fanci's testimony revolved around that, are there things
that the school districts are doing or can do as it revolves
around mental health?
Ms. Halliday. Absolutely. As I was saying earlier, to look
at a school system and know that kids aren't getting their
rightful access to a quality education, and not understand that
they feel [indiscernible] safe to [indiscernible] flourish in a
school environment, that is a very central piece of our work.
There are infrastructure pieces at schools. A lot of
schools have school counselors who are trained to work with
mental health. We have in our State a program where third party
non-profit and for-profit mental health providers partner with
the school systems to provide some care and then they go
Medicaid for that, which is trying to get some of the
challenges of getting services into a rural area.
I think this is a lot of work that can be done though
around, as they were saying, relationship-building, encouraging
teachers and staff to see themselves as a very important, safe,
consistent adult in a child's life. And there is a lot of
really great work that is happening in our State through
something called Montana Behavioral Initiative, which is part
of the Office of Public Instruction, that teaches adults in the
school system how to just have a very consistent, caring way
with kids. We are doing some of that work through the Schools
of Promise work as well.
Senator Tester. In areas where there is a real problem with
teen suicide, and you talked about the role that counselors
play, and what a critical role they can play, and the classroom
teacher, as far as that goes. Does OPI have the resources or
the ability, either one, to be able to give help to a school
district where they are seeing an influx in problems?
Ms. Halliday. Suicide particularly?
Senator Tester. Yes, in suicide particularly.
Ms. Halliday. Well, we are very strong local control State,
so a tremendous amount of decisions of personnel and program
and budget are decided at the school board level. So this
[indiscernible] one of our [indiscernible] legislation is going
to be put forward was to require school districts to have
baseline for what the anti-bullying policy would look like, the
four components of it, definition, and that would be readily
available to any parent or student who would want to know what
the policy was. That was defeated.
But what we are doing anyway is creating a model bullying
policy. I know that several of the public schools here in Fort
Peck have been working, I think as a result of the IHS work
[indiscernible] to try and revamp their bullying policies. But
change really only happens when people change their behaviors.
So I really, it resonated with me when Roxanne said, I don't
want to hear about another policy, I want to know our kids are
going to be loved and taken care of [indiscernible].
Senator Tester. I want to thank you all for your
contribution to this hearing. I very much appreciate your
testimony and your forthrightness. We have some issues here
that need to be dealt with, and we appreciate your leadership,
whether it is leadership with our youth, or leadership in the
capacity that you are in in your jobs. Thank you for that.
So I will release you now. In the meantime, I will ask Dr.
Weahkee to come up, Ed Parisian to come up, and Dr. McKeon.
While they are getting set down, I will just tell you that
our next panel represents the Federal Government's response to
this crisis. They are going to tell us not only what they are
doing, but also what communities throughout Indian Country can
do to address this. We are going to first hear from Dr. Rose
Weahkee, who is Director of Behavioral Health and the Indian
Health Service. Rose has dedicated years to preventing these
tragedies from occurring. We thank all three of you for being
here today. We very much appreciate your presence at this
Indian Affairs Committee hearing.
And we will hear from Rose first.
STATEMENT OF ROSE WEAHKEE, Ph.D., DIRECTOR, DIVISION OF
BEHAVIORAL HEALTH, INDIAN HEALTH SERVICE
Ms. Weahkee. Thank you, Mr. Chairman, Senator Tester. Good
afternoon. I am Dr. Rose Weahkee, Director of the Indian Health
Service Division of Behavioral Health.
I am pleased and honored to have this opportunity to
testify on the Indian Health System's response to youth suicide
in Indian Country.
As you know, IHS plays a unique role in the U.S. Department
of Health and Human Services to meet the Federal trust
responsibility to provide health care to American Indians and
Alaska Natives. In this ongoing effort to meet the health and
behavioral health challenges, there is of course a trend toward
tribal management and delivery of behavioral health services.
Currently 54 percent of mental health and 84 percent of alcohol
and substance abuse programs are tribally-operated. This
evolution in behavioral health care delivery and management is
changing the face of behavioral health services in Indian
Country.
Where IHS was previously the principal behavioral health
care delivery system, there is now a more diverse network of
care provided by Federal, tribal and urban Indian health
programs. This ``Indian health system'' denotes this larger
network of programs and the evolving care delivery system
across Indian Country.
Suicide is a complicated public health challenge with many
contributing risk factors. In the case of American Indians and
Alaska Natives, they face, on average, a greater number of
these risk factors and the risk factors are more severe in
nature. For years, several communities in Indian Country
experienced suicide contagion, often referred to as suicide
clusters. In these communities, the suicidal act becomes a
regular and transmittal form of expression of the despair and
hopelessness experienced by some Indian youth.
On a national level, American Indian and Alaska Native
communities are also affected by very high levels of poverty,
unemployment, accidental death, domestic violence, alcoholism
and child abuse. American Indian and Alaska Native people
suffer significantly from mental health disparities. While the
need for mental health care is great, services are lacking and
access to these services can be difficult and costly. The
availability and adequacy of mental health programs for
American Indians varies considerably across communities.
IHS has devoted considerable efforts to develop and share
effective programs. Developing programs that are collaborative,
community-driven and nationally supported offer the most
promising potential for long-term success and sustainment. The
IHS National Tribal Advisory Committee on Behavioral Health,
which is made up of elected tribal leaders from each of the IHS
areas, provides recommendations and advice on the range of
behavioral health issues in Indian Country. The IHS Behavioral
Health Work Group is the technical advisory group to IHS and is
made up of mental health professionals from across Indian
Country. They provide expert advice and recommendations for
services and program delivery.
The Indian Health Service Suicide Prevention Committee was
established and tasked with identifying and defining the steps
needed to prevent suicide and suicide-related behaviors. The
Indian Health Service methamphetamine and Suicide Prevention
Initiative is a nationally coordinated pilot program, which
supports 127 IHS, tribal and urban Indian health programs that
are providing methamphetamine and suicide prevention resources
to communities with the greatest need.
Just this past week, on August 1st, in partnership with
tribes, IHS released the American Indian/Alaska Native National
Behavioral Health and Suicide Prevention Strategic Plans. These
strategic plans will foster collaboration and other key
community resources.
Also, in November 2010 to February 2011, IHS, SAMHSA, BIA
and BIE held ten suicide prevention listening sessions to seek
input from tribes on how our agencies can most effectively work
in partnership with tribes to prevent suicide. This information
was used to form the agenda for the Action Summit for Suicide
Prevention which was held just this past week with over 1,000
in attendance. The IHS and the Veterans Health Adminsitration
Suicide Prevention office have also developed a joint plan to
address suicide among our Native veterans and their families.
VA has also participated in many of the suicide prevention
listening sessions and also in the Action Summit last week.
Also, on December 30th, 2010, the National Action Alliance
for Suicide Prevention announced an American Indian and Alaska
Native task force to address the issue of suicide in Indian
Country, and also to advance a national strategy for suicide
prevention. Jointly leading this task force are Dr. Yvette
Roubideaux, the Director for IHS, Mr. Larry Echo Hawk,
Assistant Secretary of Indian Affairs, Department of the
Interior, and Mr. McClellan Hall, the Executive Director of the
National Indian Youth Leadership Program.
In summary, we look forward to addressing the issue of
mental health care needs in Indian Country. Our partnership and
our consultation with tribes has shown that we are working
together to improve the health of American Indian and Alaska
Native communities. As you heard today, together we can instill
culture, language and spirituality, together we can instill
hope.
Mr. Chairman, this concludes my statement. Thank you again
for allowing me to testify. I would be happy to answer any
questions that you might have.
[The prepared statement of Ms. Weahkee follows:]
Prepared Statement of Rose Weahkee, Ph.D., Director, Division of
Behavioral Health, Indian Health Service
Mr. Chairman and Members of the Committee:
Good Afternoon, I am Dr. Rose Weahkee, Director of the Indian
Health Service (IHS) Division of Behavioral Health. I am pleased to
have this opportunity to testify on the Indian health system's response
to youth suicide in Indian Country.
The IHS plays a unique role in the U.S. Department of Health and
Human Services to meet the Federal trust responsibility to provide
health care to American Indians and Alaska Natives (AI/AN). The IHS
provides comprehensive health service delivery to approximately 1.9
million Federally-recognized American Indians and Alaska Natives
through a system of IHS, Tribal, and Urban facilities and programs
based on treaties, judicial determinations, and Acts of Congress. The
mission of the agency is to raise the physical, mental, social, and
spiritual health of AI/ANs to the highest level, in partnership with
the population served. The agency aims to assure that comprehensive,
culturally acceptable personal and public health services are available
and accessible to the service population. Our goal is to promote
healthy AI/AN people, communities, and cultures, and to honor the
inherent sovereign rights of Tribes.
The IHS is responsible for providing mental health services to the
AI/AN population it serves. The IHS Mental Health/Social Service (MH/
SS) program is a community-oriented clinical and preventive mental
health service program that provides primarily outpatient mental health
and related services, crisis triage, case management, prevention
programming, and outreach services. The most common MH/SS program model
is an acute, crisis-oriented outpatient services staffed by one or more
mental health professionals. Many of the IHS, Tribal, and urban mental
health programs that provide services are not open 24/7. Therefore,
when an emergency or crisis occurs, the clinic and service units will
often contract out such services to non-IHS hospitals and crisis
centers.
In the ongoing effort to meet the health and behavioral health
challenges, there is a trend toward Tribal management and delivery of
behavioral health services in AI/AN communities. Particularly in the
last decade, Tribes have increasingly contracted or compacted via the
Indian Self Determination and Education Assistance Act, Public Law 93-
638, to provide those services themselves. Currently, 54 percent of the
mental health and 84 percent of the alcohol and substance abuse
programs are operated by Tribes. This evolution in behavioral health
care delivery and management is changing the face of behavioral health
services in Indian Country.
Where IHS was previously the principal behavioral health care
delivery system for AI/ANs, there is now a less centralized and more
diverse network of care provided by Federal, Tribal, and Urban Indian
health programs. The ``Indian health system'' denotes this larger
network of programs and the evolving care delivery system across Indian
Country. Meeting the needs of this system will require an evolution in
IHS and Tribal collaboration as well, particularly as Tribal programs
take more direct responsibility for services and IHS supports them in
doing so.
Introduction
Suicide is a complicated public health challenge with many
contributing risk factors. In the case of AI/ANs, they face, on
average, a greater number of these risk factors individually or the
risk factors are more severe in nature for them. In prior years,
several communities in Indian Country experienced suicide contagion,
often referred to as suicide clusters. In these communities, the
suicidal act becomes a regular and transmittable form of expression of
the despair and hopelessness experienced by some Indian youth.
The AI/AN suicide rate (17.9 per 100,000) for the three year period
(2002-2004) in the IHS service areas is 1.7 times that of U.S. all
races rate (10.8 per 100,000) for 2003. Suicide is the second leading
cause of death behind unintentional injuries for Indian youth ages 15-
24 residing in IHS service areas and is 3.5 times more frequently in
those areas than the national average. Suicide is the sixth leading
cause of death overall for males residing in IHS service areas and
ranks ahead of homicide. AI/AN young people ages 15-34 comprise 64
percent of all suicides in Indian Country. \1\ Suicide mortality rates
have increased from 45.9 per 100,000 to 55.2 per 100,000 among AI/AN
youth ages 15-24, comparing data from 2003-2005 to those from 1999-
2001. Overall, suicide mortality is 73 percent greater in AI/AN
populations in IHS service areas compared to U.S.--All races. \2\
---------------------------------------------------------------------------
\1\ Indian Health Service. Office of Public Health Support.
Division of Program Statistics. Trends in Indian Health, 2002-2003.
Rockville, MD: Indian Health Service.
\2\ Unpublished data, Office of Public Health Support. Division of
Program Statistics. Indian Health Service.
---------------------------------------------------------------------------
On a national level, many AI/AN communities are also affected by
very high levels of poverty, unemployment, accidental death, domestic
violence, alcoholism, and child neglect. \3\ AI/AN people suffer
significantly and disproportionately from mental health disparities and
lack access to culturally appropriate care. Each of these serious
health issues has a profound impact on the health of individual,
family, and community well being both on- and off-reservations.
---------------------------------------------------------------------------
\3\ Manson, S.M. (2004). Cultural Diversity Series: Meeting the
Mental Health Needs of American Indians and Alaska Natives. National
Association of State Mental Health Program Directors (NASMHPD) and the
National Technical Assistance Center for State Mental Health Planning.
---------------------------------------------------------------------------
According to a 2001 mental health supplemental report of the U. S.
Surgeon General, ``Mental Health: Culture, Race, and Ethnicity,'' there
are limited mental health services in Tribal and urban Indian
communities. \4\ While the need for mental health care is great,
services are lacking, and access to these services can be difficult and
costly. \5\ The current system of services for treating mental health
problems of AI/ANs is a complex and often fragmented system of Tribal,
Federal, State, local, and community-based services. The availability
and adequacy of mental health programs for AI/ANs varies considerably
across communities. \6\ Navigating complex or fragmented combinations
of Tribal, Federal, State, local, and community-based services can be
confusing and discouraging, making it difficult to access care even if
it is available. In addition, severe provider shortages are common. \7\
---------------------------------------------------------------------------
\4\ U.S. Department of Health and Human Services. (2001). Mental
Health: Cultural, race, and ethnicity supplement to mental health:
Report of the Surgeon General. Rockville, MD: U.S. Department of Health
and Human Services, Substance Abuse and Mental Health Services
Administration, Center for Mental Health Services, National Institutes
of Health, National Institute of Mental Health.
\5\ Manson, S.M. (2004). Cultural Diversity Series: Meeting the
Mental Health Needs of American Indians and Alaska Natives. National
Association of State Mental Health Program Directors (NASMHPD) and the
National Technical Assistance Center for State Mental Health Planning.
\6\ Ibid.
\7\ More Mental Health Resources Needed to Battle Teen Suicides in
American Indian and Alaska Native Communities. (2010, May). U.S.
Medicine: The Voice of Federal Medicine. Retrieved March 28, 2010 from
http://www.usmedicine.com/articles/more-mental-health-resources-needed-
to-battle-teen-suicides-in-american-indian-and-alaska-native-
communities.html
---------------------------------------------------------------------------
There are many reasons for a lack of access to care and services.
Indian Country is predominantly rural and remote, and this brings with
it the struggles of recruiting and retaining providers. Rural practice
is often isolating for its practitioners. The broad range of clinical
conditions faced with limited local resources challenges even seasoned
providers. Some providers are so overwhelmed by the continuous demand
for services, particularly during suicide outbreaks, that even
experienced and hard working providers become at-risk for burn-out.
In addition to clinical care, the importance of public health and
community- and culture-based interventions is becoming more widely
recognized. \8\ One factor that makes community- and culture-based
interventions especially important is the role of historical trauma in
the increased risk of suicide among AI/AN people. Historical trauma,
exacerbated by re-traumatization of the community from the high rates
of injury and death, continues to plague Indian communities. \9\
Historical trauma is also linked to increased suicide risk because
anger, aggression, and violence felt in response to experiences of
victimization can be turned against oneself. \10\
---------------------------------------------------------------------------
\8\ Grim, C.W. (2006, May 17). Testimony of Charles W. Grim,
Director of the Indian Health Service, before the Senate Committee on
Indian Affairs on Suicide Prevention Programs and Their Application in
Indian Country. Washington, DC. Retrieved from http://
www.indian.senate.gov/public/_files/Grim051706.pdf
\9\ Brave Heart, M. Y. H. and DeBruyn, L. M. (1998). The American
Indian Holocaust: Healing Historical Unresolved Grief. American Indian
and Alaska Native Mental Health Research, 8(2), 61.
\10\ Subia BigFoot, D. (n.d.) History of Victimization in Native
Communities [Monograph]. Retrieved March 28, 2010 from http://
icctc.org/History%20of%20Victimization%20Issues-%20Final.pdf
---------------------------------------------------------------------------
Addressing Suicide in Indian Country
Since 2008, IHS has devoted considerable effort to develop and
share effective programs throughout the Indian health system. In
particular, developing programs that are collaborative, community
driven, and nationally supported, we believe, offer the most promising
potential for long term success and sustainment. As an example of this,
IHS regularly relies on Tribal leadership and expertise to collaborate
on a range of behavioral health problems and programs.
The IHS National Tribal Advisory Committee (NTAC) on Behavioral
Health, which is made up of elected Tribal leaders from each IHS Area,
provides recommendations and advice on the range of behavioral health
issues in Indian Country. From making recommendations on significant
funding allocations and service programs, to developing long term
strategic plans for Tribal and Federal behavioral health programs for
the future, the NTAC is the principal Tribal advisory group for all
behavioral health services to IHS. They ensure collaboration among
Tribal and Federal health programs, provide Tribal input into the
development of programs and services, and also provide the inclusive
and transparent development of processes and programs so important to
all our communities and programs.
The IHS National Behavioral Health Work Group (BHWG) is the
technical advisory group to IHS. Comprised of mental health
professionals from across the country, the BHWG furthers the agency
priorities to strengthen partnerships with Tribes, improve quality and
access to care for patients, and provide direct collaboration and input
for accountable, fair, and inclusive services across the Indian
behavioral health system. They provide expert advice and
recommendations for services, programs, and intervention models, as
well as long term strategic planning and goal development. As the
national technical advisory group to the agency, they also work very
closely with the elected Tribal leaders on the NTAC to provide
collaborative links between the professional community and national
Tribal leadership.
The IHS Suicide Prevention Committee (SPC) was established and
tasked with identifying and defining the steps needed to significantly
reduce and prevent suicide and suicide-related behaviors in AI/AN
communities. It is the responsibility of the SPC to provide
recommendations and guidance to the Indian health system regarding
suicide prevention, intervention, and postvention in Indian Country.
IHS Methamphetamine and Suicide Prevention Initiative
The IHS Methamphetamine and Suicide Prevention Initiative (MSPI) is
a nationally-coordinated demonstration pilot program, focusing on
providing targeted methamphetamine and suicide prevention and
intervention resources to communities in Indian Country with the
greatest need for these programs. IHS, Tribes, Tribal programs, and
other Federal agencies concurrently coordinate the development and
implementation of the MSPI project, which now provides support to 127
IHS, Tribal, and urban Indian health programs nationally. The strategic
goal is to support Tribal programs in their prevention, treatment, and
infrastructure development as they increasingly are delivering their
own services. The MSPI implemented by IHS and its Tribal partners
nationally, marks a significant milestone in suicide prevention efforts
in Indian Country as well as Tribal and Federal partnerships for health
that embraces the Administration's commitment to Tribal engagement and
partnership.
To create the overall MSPI approach, IHS engaged in close
collaboration with Tribes and Tribal leaders over the course of almost
a year. During this time, Tribal leaders developed a model and
recommendations, which were accepted by IHS, for approaches and funding
allocations. It was and remains a creation of close collaboration and
partnership with Tribes. The program is community driven from
conception through execution for each program in each community. Indian
communities decide what they need and establish programs to meet those
needs.
The MSPI data currently available indicate that a total of 289,066
persons have been served through both prevention and treatment
activities. Prevention activities include, but are not limited to
evidence-based practice training, knowledge dissemination, development
of public service announcements and publications, coalition
development, and crisis hotline enhancement. There were 42,895 youth
participating in evidence-based and/or promising practice prevention or
intervention programs. There were 674 persons trained in suicide crisis
response teams.
American Indian/Alaska Native National Behavioral Health and Suicide
Prevention Strategic Plans
On August, 1, 2011, in partnership with Tribes, IHS released the
American Indian/Alaska Native National Behavioral Health and Suicide
Prevention Strategic Plans. These strategic plans will foster
collaborations among Tribes, Tribal organizations, urban Indian
organizations, and other key community resources. These collaborations
will provide tools needed to adapt the shared wisdom of these
perspectives, consolidate our experience, target our efforts towards
meeting the changing needs of our population, and develop the framework
that will serve to pave the way over the coming years to address
suicide and behavioral health in Indian Country.
The American Indian/Alaska Native National Behavioral Health
Strategic Plan is the culmination of over two years of close
collaborative work, and contains three overarching strategic directions
which are operationalized into 77 action steps, most of which are
already in progress. It is the strategic framework for the continuing
development of programs and services across the AI/AN behavioral health
system, with an added emphasis on Tribal, Federal, and Urban program
collaboration.
The American Indian/Alaska Native National Suicide Prevention
Strategic Plan represents the combined efforts of Tribal, Federal,
Urban, and other representatives across the country to develop
strategic goals and objectives to address the ongoing suicide epidemic
in so many of our communities. The suicide epidemic is the single most
significant cause of concern across our communities and requires
specific planning and program implementation, which this plan
represents in eight strategic goals and 41 objectives.
The importance of including culture, cultural and traditional
practices, and a variety of learning approaches is included in these
strategic plans and should not be underestimated. AI/ANs see behavioral
health as supporting their historic and continuing reliance on elders,
languages, community, culture, and traditional practices as protective
factors that restore balance and serve as both prevention and
treatment.
IHS Partnerships
Strategies to address mental health and suicide include
collaborations and partnerships with consumers and their families,
Tribes and Tribal organizations, urban Indian health programs, Federal,
State, and local agencies, as well as public and private organizations.
This effort seeks to establish effective long-term strategic approaches
to address mental health and suicide prevention in Indian Country.
IHS and the Substance Abuse and Mental Health Services
Administration (SAMHSA) work closely together to formulate long term
strategic approaches to address the issues of suicide and mental health
care in Indian Country more effectively. For example, IHS and SAMHSA
are actively involved on the Federal Partners for Suicide Prevention
Workgroup. In 2001, the Office of the Surgeon General coordinated the
efforts of numerous agencies, including IHS, SAMHSA, Centers for
Disease Control and Prevention (CDC), National Institute for Mental
Health (NIMH), Health Resources and Services Administration (HRSA), and
other public and private partners to develop the first, comprehensive,
integrated, public health approach to reducing deaths by suicide and
suicide attempts in the United States in the National Strategy for
Suicide Prevention. This resulted in the formation of the ongoing
Federal Partners for Suicide Prevention Workgroup.
IHS, SAMHSA, Bureau of Indian Affairs (BIA), and Bureau of Indian
Education (BIE) held ten regional suicide prevention listening sessions
across Indian Country over the last twelve months to seek input on how
the agencies can most effectively work in partnership with Tribes to
prevent suicide. The Tribal listening sessions provided important
information on suicide prevention needs, concerns, programs, and
practices. This information was used to form the agenda for the Action
Summit for Suicide Prevention held from August 1-4, 2011 in Scottsdale,
AZ with over 1,000 in attendance. This collaborative work also paved
the way for other Federal partners to join in the effort to prevent
suicide among AI/ANs. For example, IHS and the Veterans Health
Administration (VHA) Suicide Prevention Office have developed a joint
plan to address suicide among Native veterans. VHA Suicide Prevention
Coordinators participated in several of the listening sessions.
On September 10, 2010, Department of Health and Human Services
Secretary Kathleen Sebelius and Department of Defense Secretary Robert
M. Gates announced the creation of the National Action Alliance for
Suicide Prevention. The Action Alliance is expected to provide an
operating structure to prompt planning, implementation and
accountability for updating and advancing the National Strategy for
Suicide Prevention. On December 30, 2010, the National Action Alliance
for Suicide Prevention announced three new task forces to address
suicide prevention efforts within high-risk populations including
American Indians/Alaska Natives. Jointly leading the American Indian/
Alaska Native Task Force are Yvette Roubideaux, M.D., M.P.H., Director
of the Indian Health Service; Larry Echo Hawk, J.D., Assistant
Secretary of Indian Affairs, Department of the Interior; and McClellan
Hall, M.A., Executive Director, National Indian Youth Leadership
Project.
Tribes also look to SAMHSA for help in addressing youth suicides.
Through its Garrett Lee Smith State and Tribal Grants, Tribes and
Tribal organizations have received grants ranging from $400,000 to
$500,000 a year to prevent suicide. In addition, SAMHSA:
Funds the Native Aspirations project which is a national
project designed to address youth violence, bullying, and
suicide prevention through evidence-based interventions and
community efforts. Through the Native Aspirations project, AI/
AN communities determined to be the most ``at risk'' develop or
enhance a community-based prevention plan.
Supports the Suicide Prevention Resource Center which is a
national resource and technical assistance center that advances
the field by working with Tribes, States, territories, and
grantees by developing and disseminating suicide prevention
resources.
Funds the National Suicide Prevention Lifeline, a network of
crisis centers across the United States that receives calls
from the national, toll-free suicide prevention hotline number,
800-273-TALK. The National Suicide Prevention Lifeline's
American Indian initiative has promoted access to suicide
prevention hotline services in Indian Country by supporting
communication and collaboration between Tribes and local crisis
centers as well as providing outreach materials customized for
each Tribe.
Summary
In summary, we look forward to opportunities to address the suicide
and mental health care needs in Indian Country. For the IHS, our
business is helping our communities and families achieve the highest
level of wellness possible. IHS has devoted considerable effort to
develop and share effective programs throughout the Indian health
system. We believe developing programs that are collaborative,
community driven, and nationally supported offer the most promising
potential for long term success and sustainment. Our partnership and
consultation with Tribes ensure that we are working together in
improving the health of AI/AN communities.
Mr. Chairman, this concludes my statement. Thank you for the
opportunity to testify. I will be happy to answer any questions that
you may have.
Senator Tester. Thank you, Rose. We will have some
questions a little later. Thank you very much for your
testimony.
Next we are going to hear from Ed Parisian. Ed is the
Billings Regional Director of the Bureau of Indian Affairs. Ed
is responsible for improving upon many of the risk factors that
contribute to youth suicide, primarily safe communities and
violence issues. He will tell us how the new Tribal Law and
Order Act is going to impact reservation communities and make
them a better place. Thank you for being here, Ed.
STATEMENT OF EDWARD PARISIAN, DIRECTOR, ROCKY
MOUNTAIN REGIONAL OFFICE, BUREAU OF INDIAN
AFFAIRS, UNITED STATES DEPARTMENT OF INTERIOR
Mr. Parisian. Thank you, Senator Tester. I am pleased to be
here to talk on the topic of empowering Native youth to reclaim
their future. I also want to thank your staff.
American Indian and Alaska Native youth suicide is a
devastating, serious problem in Indian Country. Data and
research have shown that social factors such as poverty,
alcoholism, gangs and violence contribute in the manifestation
of suicide ideation, suicidal behavior and suicide attempts by
American Indian youth in Indian Country. As the members of this
Committee are aware, BIA programs assist tribal communities in
developing their natural and social-economic infrastructures or
provide services to fill infrastructure gaps.
For the BIA, suicidal events significantly impact law
enforcement personnel since they are the most likely first
responders to suicide events. There is also a significant
impact on students, teachers, administrators and other school
staff when handling suicide ideation, gestures, attempts and
completions within the Bureau of Indian Education school
system.
The BIE has developed a Suicide Prevention, Early
Intervention and Postvention Policy to promote suicide
prevention in BIE schools. The policy mandates specific actions
in all schools, dormitories and the two post-secondary
institutions and encourages tribally-operated schools to
develop similar policies. These actions create a safety net for
students at risk of suicide and promotes proactive involvement
of school personnel and communities in intervention, prevention
and postvention activities. There are also ongoing efforts to
address these issues through partnerships with behavioral
health and social services organizations at both the tribal and
national level with SAMHSA and the Indian Health Service.
Within the Indian Affairs, BIA's Law Enforcement and Tribal
Services programs, along with BIE continue to seek ways to
collaborate and to support activities directed at suicide
prevention and services coordination. The BIE utilizes the
Youth Risk Behavior Survey, the Native American Student
Information System, local BIA law enforcement and IHS data to
develop interventions and track trends for program
implementation and is committed to seeking out and enacting
prevention strategies while ensuring a safe and secure
environment for our students.
Indian Affairs' most direct action in youth suicide
prevention is through the BIE, the Bureau of Indian Education.
The BIE's Division of Performance and Accountability ha been
providing suicide prevention activities through funds provided
by the U.S. Department of Education's Title IV Part A Safe and
Drug-Free Schools and Communities program. Serving in a similar
capacity as a State educational agency, the BIA is required to
use these funds to provide technical assistance to the schools
to reduce drug and alcohol abuse and violence by 2 percent
annually. The BIE's DPA has provided technical assistance in
the development and implementation of data-driven programs and
evidence-based curriculum.
While the SDFS program has been discontinued, ongoing
technical assistance and monitoring is provided by regional
school safety specialists to ensure schools are compliant with
intervention strategies and reporting protocols to further
ensure student safety. BIE's partnering with other Federal
agencies, including SAMHSA and IHS and the Department of
Education has enabled BIE to address the unique needs of
students within these schools in the areas of behavioral health
and suicide prevention efforts.
Additionally, BIE schools and dormitories use NASIS to
track and identify specific behavior trends to develop
interventions to address school-specific behavior issues. BIE
has developed two technical assistance training sessions that
include both a basic and coaching level course. The basic
course covers initial program development, policy development,
best practices and implementation and the coaching level course
focuses on adult wellness issues and youth development. The
framework of the session is based on Native resiliency and
cultural practices that support a positive school climate.
On November 12th, 2010, Larry Echo Hawk, Assistant
Secretary, Indian Affairs, Yvette Roubideaux, Director, Indian
Health Service, and Pamela Hyde, Administrator of SAMHSA,
announced to tribal leaders that BIA, IHS and SAMHSA would
sponsor listening sessions to hear the needs and concerns
regarding youth suicide in Indian Country. The purpose of the
listening sessions were to gather tribal input on how we can
best support the goals and programs of tribes for preventing
suicide in tribal communities.
The listening sessions began on November 15th, 2010, and
ended on February 10th, 2011. Over this four-month period, BIA,
IHS and SAMHSA met with several tribes from all the BIA
regions. We held these listening sessions in Indian Country to
gain first-hand knowledge from the American Indian and Alaska
Native communities to see how best we can all, as partners,
prevent youth suicide and to identify specific needs expressed
by tribal community leaders, clinicians, practitioners and
youth.
Information gathered from these listening sessions was used
at the Action Summit for Suicide Prevention held in Scottsdale,
Arizona last week from August 1st through 4th. I attended the
Action Summit, along with other Indian Affairs staff and key
leadership in the Office of the Assistant Secretary. A lot of
what we have heard this afternoon about, we can't do it by,
just one tribe can't do it, one office, I just can't do it, one
of the messages I took from that was that it is going to take a
community. It is going to take all resources. We have to give
up a little bit here and a little bit there, and we have to put
our resources together if we are going to make this happen. We
can't have ownership, it has to be flexibility on our
resources. That way we will prevent duplication. This is one of
the major things that I took away from that conference. It is
one of the things we have heard across the Country from the
listening sessions that they held.
I kind of got a little bit off of my testimony, but it is
there for the record, Senator. And I will end because I feel my
hook coming. I will be happy to answer any questions that you
may have.
[The prepared statement of Mr. Parisian follows:]
Prepared Statement of Edward Parisian, Director, Rocky Mountain
Regional Office, Bureau of Indian Affairs, United States Department of
Interior
Good Afternoon Mr. Chairman, Mr. Vice Chairman and Members of the
Committee, my name is Edward Parisian and I am the Regional Director
for the Bureau of Indian Affairs (BIA) Rocky Mountain Regional Office
in Billings, Montana. I have served in this capacity since April 1,
2008. I am pleased to be here today to provide the Department's
statement on the topic of ``Empowering Native Youth to Reclaim Their
Future,'' which relates to American Indian and Alaska Native youth
suicide prevention.
American Indian and Alaska Native youth suicide is a serious
problem in Indian Country. Data and research have shown that social
factors such as poverty, alcoholism, gangs, and violence contribute in
the manifestation of suicide ideation, suicidal behavior and suicide
attempts by American Indian youth in Indian Country. See To Live To See
the Great Day That Dawns: Preventing Suicide by American Indian and
Alaska Native Youth and Young Adults, 2010 Publication by Substance
Abuse and Mental Health Services Administration (SAMHSA), U.S.
Department of Health and Human Services.
According to the Centers for Disease Control (CDC) data on
``Leading Causes of Death by Age Group, American Indian or Alaska
Native Males--United States, 2006,'' suicide was the second leading
cause of death for ages 10-34. The same 2006 data from the CDC for
American Indian or Alaska Native females showed that suicide was the
first leading cause of death for ages 10-14, the second leading cause
of death for ages 15-24, and the third leading cause of death for ages
25-34. Additionally, SAMHSA in its 2010 publication, To Live To See the
Great Day That Dawns: Preventing Suicide by American Indian and Alaska
Native Youth and Young Adults, states that young people account for
forty percent (40 percent) of all suicides in Indian Country.
As the members of this Committee are aware, BIA programs assist
tribal communities in developing their natural and social-economic
infrastructures (i.e., tribal governments, tribal courts, cultural
vitalization, community capabilities, etc.) or provide services to fill
infrastructure gaps (i.e., education, law enforcement, social services,
housing improvement, transportation, etc.). For the BIA, suicidal
events significantly impact law enforcement personnel since they are
the most likely first responders to suicidal events. There is also a
significant impact on students, teachers, administrators and other
school staff when handling suicide ideation, gestures, attempts and
completions within the Bureau of Indian Education (BIE) school system.
The BIE has developed a Suicide Prevention, Early Intervention and
Postvention Policy to promote suicide prevention in BIE schools. The
policy mandates specific actions in all schools, dormitories and the
two post-secondary institutions; and encourages tribally-operated
schools to develop similar policies. These actions create a safety net
for students at risk of suicide and promotes proactive involvement of
school personnel and communities in intervention, prevention and
postvention activities. There are also ongoing efforts to address these
issues through partnerships with behavioral health and social services
organizations at both the tribal and national level with SAMSHA and the
Indian Health Service (IHS).
Within Indian Affairs, the BIA's Law Enforcement and Tribal
Services programs, along with the BIE, continually seek ways to
collaborate and to support activities directed at suicide prevention
and services coordination. The BIE utilizes the Youth Risk Behavior
Survey, Native American Student Information System (NASIS), local BIA
Law Enforcement and IHS data to develop interventions and track trends
for program implementation and is committed to seeking out and enacting
prevention strategies while ensuring a safe and secure environment for
our students.
The Office of Justice Services (OJS) in the BIA has partnered with
numerous health and social service programs to assist in educating and
presenting at schools, seminars, workshops and community events to the
youth and the community on suicide prevention. Corroborated by
statistics from the Resource Patient Management System (RPMS), BIA Law
Enforcement has seen a history of high rates of suicide completions in
the Great Plains Region alone. The statistics show that, in this
region, there were 24 American Indian suicide completions in 2008, 36
in 2009, 15 in 2010 and 6 so far in 2011. The majority of these suicide
completions were for individuals in the age range of 15 to 24. In the
Great Plains Region, OJS has signed a Memorandum of Understanding (MOU)
with the ``Circles of Care'' program. The Circles of Care program
provides youth prevention activities for families, which are held in
their tribal communities. During these events BIA Law Enforcement
participates by setting up an educational booth designed to interact
with families and other service agencies and provide information on
suicide prevention. The OJS will continue to gather statistical data
and identify youth suicide trends within Indian Country, as well as
look for ways to expand suicide prevention training with other
stakeholders in the future.
Indian Affairs' most direct action in youth suicide prevention is
through the BIE. The BIE's Division of Performance and Accountability
(DPA) has been providing suicide prevention activities through funds
provided by the U.S. Department of Education's Title IV Part-A Safe and
Drug-Free Schools and Communities Program (SDFS). Serving in a similar
capacity as a State educational agency, the BIE is required to use
these funds to provide technical assistance to the schools to reduce
drug and alcohol use and violence incidence by two percent, annually.
The BIE's DPA has provided technical assistance in the development and
implementation of data driven programs and evidence-based curriculum.
While the SDFS program has been discontinued, ongoing technical
assistance and monitoring is provided by regional School Safety
Specialists to ensure schools are compliant with intervention
strategies and reporting protocols to further ensure student safety.
BIE's partnering with other federal agencies, including SAMHSA and IHS
and ED, has enabled BIE to address the unique needs of students within
these schools in the areas of behavioral health and suicide prevention
efforts.
Additionally, BIE schools and dormitories use NASIS to track and
identify specific behavior trends to develop interventions to address
school specific behavior issues. BIE has developed two technical
assistance training sessions that include both a basic and coaching
level course. The basic course covers initial program development,
policy development, best practices, and implementation, and the
coaching level course focuses on adult wellness issues and youth
development. The framework of the session is based on Native resiliency
and cultural practices that support a positive school climate.
On November 12, 2010, Larry Echo Hawk, Assistant Secretary--Indian
Affairs, Yvette Roubideaux, Director, Indian Health Service, and Pamela
Hyde, Administrator, SAMHSA, announced to Tribal Leaders that BIA, IHS
and SAMHSA would sponsor listening sessions to hear the needs and
concerns regarding youth suicide in Indian Country. The purpose of the
listening sessions were to gather Tribal input on how we can best
support the goals and programs of tribes for preventing suicide in
Tribal communities. The listening sessions began on November 15, 2010
in Window Rock, Arizona on the Navajo Nation and concluded on February
10, 2011 in Arlington, Virginia at the United South Eastern Tribes
(USET) Annual Conference. Over this four month period, the BIA, IHS and
SAMHSA met with several Tribes from all of the BIA Regions. We held
these listening sessions in Indian Country to gain first-hand knowledge
from the American Indian and Alaska Native communities to see how best
we can all, as partners, prevent youth suicide; and to identify
specific needs expressed by tribal community leaders, clinicians,
practitioners, and youth.
The information gathered from these listening sessions was used at
the Action Summit for Suicide Prevention held in Scottsdale, Arizona
last week from August 1-4. I attended the Action Summit, along with
other Indian Affairs staff and key leadership in the office of the
Assistant Secretary for Indian Affairs. The Action Summit was jointly
sponsored and attended by BIA, BIE, IHS and SAMHSA to discuss what we
heard during our joint listening sessions with Tribes, their members,
and especially the tribal youth. One of the goals of the Action Summit
on Youth Suicide was to develop policy and future action items to
address youth suicide and prevent youth suicide in Tribal communities.
In summary, the BIA, BIE, IHS, SAMHSA, other Federal agencies, and
Indian tribes must continue to work together to address all aspects of
suicide prevention and response. I want to thank this Committee for its
continued concern for the wellbeing of Indian children, teens and young
adults, especially on the subject of suicide prevention. I am happy to
answer any questions you may have.
Senator Tester. Thank you, Ed. I always appreciate your
being here. Thank you very much.
Last but certainly not least, we will hear from Dr. McKeon,
of the Substance Abuse and Mental Health Services
Administration. Dr. McKeon will tell us about his agency's work
to reduce the two most important risk factors involved with
youth suicide, and those are mental health and substance abuse.
So with that, Dr. McKeon, you can go forward. Please begin.
STATEMENT OF RICHARD T. McKEON, Ph.D., LEAD PUBLIC HEALTH
ADVISOR, SUICIDE PREVENTION TEAM, SUBSTANCE ABUSE AND MENTAL
HEALTH SERVICES ADMINISTRATION, U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Mr. McKeon. Thanks, Senator Tester. Thank you for allowing
SAMHSA to testify at this important hearing on prevention of
suicide among American Indian and Alaska Native youth.
I serve as the lead public health advisor on suicide
prevention at SAMHSA. I am pleased to testify here, along with
my colleagues at the Indian Health Service and the Department
of Interior, as well as the tribal leaders, tribal youth and
others.
The problem of suicide in Indian Country is a shared and
urgent concern. Efforts to reduce suicide and suicide attempts
among American Indian and Alaska Native youth must be a shared
effort.
Today I will share with you some of the efforts SAMHSA is
undertaking to reduce suicide and suicide attempts in Indian
Country, both through SAMHSA-led programs as well as work we
conduct in conjunction with other Federal, State and tribal
partners. You all know the tragic statistics. In 2007, suicide
was the second leading cause of death among American Indian and
Alaska Native youth age 10 to 24, with rates of suicide
significantly higher than for other ethnic groups.
According to unpublished Indian Health Service data,
suicide mortality is 73 percent greater in American Indian and
Alaska Native populations in IHS service areas compared to the
general U.S. population. American Indians and Alaska Natives
have the highest rates of suicide, Senator, at least until the
age of 40.
SAMHSA's number one strategic initiative is prevention of
substance abuse and mental illness. Included in this initiative
is the prevention of suicide and suicide attempts. The
prevention of suicide is a public heth issue and necessitates a
comprehensive public health approach.
SAMHSA is addressing youth suicide through a range of
efforts, including the National Action Alliance for Suicide
Prevention, a new Tribal Behavioral Health formulary grant
program, grants to tribes through the Garrett Lee Smith
Memorial Act youth suicide prevention program, implementation
of the Indian Healthcare Improvement law, the Native
Aspirations program, technical assistance provided by the
Suicide Prevention Resource Center, and 24/7 crisis support
through the National Suicide Prevention Lifeline.
Also through the recently signed memorandum of agreement
between HHS, the Department of Justice and Department of
Interior as required by the Tribal Law and Order Act, and
inclusion of requests that States engage in tribal consultation
as part of their plans submitted to SAMHSA in conjunction with
the new Uniform Mental Health and Substance Abuse Block Grant
Application.
You also heard how we spent just last week, over 1,000
people came together to work together and to learn together at
the Action Summit for Suicide Prevention that was jointly
hosted by IHS, Bureau of Indian Affairs, Bureau of Indian
Education and SAMHSA. The most important thing that the
research and the efforts showed was the effort to learn from
each other. No one of us can do this alone. We can't start from
the beginning, we have to learn from [indiscernible] of what
has been helpful [indiscernible]. So that was the important
part of what happened last week.
Let me also reference National Action Alliance for Suicide
Prevention, which was launched September 10th, 2010 by the
United States Department of Health and Human Services, Kathleen
Sebelius, and former Defense Secretary, Robert Gates. The
National Action Alliance is a public-private collaborative
effort to promote suicide prevention in the United States, to
implement and to update United States national strategy for
suicide prevention. The private sector co-chair is former U.S.
Senator Gordon Smith, who tragically lost his own son to
suicide, and the public sector co-chair is the Secretary of the
Army, John McHugh. Members of the National Action Alliance
include but are not limited to SAMHSA Administrator Hyde,
Department of Interior Assistant Secretary Larry Echo Hawk,
McClellan Hall from the National Indian Youth Leadership
Project. In addition, IHS Director Roubideaux serves as ex
officio member of the Action Alliance.
You have heard about the task force that was set up as part
of the National Action Alliance to focus on [indiscernible]
specific suicide prevention for tribal youth, regarding suicide
prevention, intervention and postvention strategies, including
positive youth development.
The President's fiscal year 2012 budget for SAMHSA proposes
a new grant program entitled Behavioral Health--Tribal
Prevention Grant, which is intended to increase SAMHSA's
efficacy in working with tribes and tribal entities. The
program will focus on the prevention of alcohol abuse,
substance abuse, and suicides in the 656 federally-recognized
tribes. Recognize the Federal obligation to help tribes deal
with physical and behavioral health issues, SAMHSA will work in
consultation with tribes and [indiscernible] partners to
establish a single coordinated mental health and substance
abuse prevention effort for all federally-recognized tribes.
SAMHSA will also consult and work closely with tribes and
tribal leaders to develop a comprehensive, data-driven planning
process to identify and address the most serious issues in each
tribal community.
You have heard about the Garrett lee Smith Memorial grant
that we have recently received. [indiscernible] 19 tribes and
tribal organizations receiving multi-year grants to address
suicide prevention among tribal youth. This year, in the last
two weeks, 21 additional tribal grants have been made for a
total of 40 tribal grants [indiscernible].
Let me just mention the innovative work in the grant that
we have done here at Fort Peck. That grant has done a number of
things that includes innovative efforts from a program called
Sources of Strength. Promising results are coming from
[indiscernible] as well as efforts and follow-up to address
people being discharged from emergency departments.
Thank you for this opportunity to share with you efforts
SAMHSA is making with respect to our American Indian and Alaska
Native youth suicide prevention. I will be happy to answer any
questions you may have.
[The prepared statement of Mr. McKeon follows:]
Prepared Statement of Richard T. Mckeon, Ph.D., Lead Public Health
Advisor, Suicide Prevention Team, Substance Abuse and Mental Health
Services Administration, U.S. Department of Health and Human Services
Chairman Akaka, Ranking Member Barrasso and Senator Tester, thank
you for inviting me to testify at this important hearing on the
prevention of suicide among American Indian/Alaska Native (AI/AN)
youth. I am Dr. Richard McKeon and I serve as the lead Public Health
Advisor on suicide prevention at the Substance Abuse and Mental Health
Services Administration (SAMHSA) within the U.S. Department of Health
and Human Services (HHS). I am pleased to testify along with my
colleague at the Indian Health Service (IHS) and tribal leaders, as
well as AI/AN youth. The problem of suicide in Indian Country is a
shared concern and efforts to reduce suicide and suicide attempts among
AI/AN youth must be a shared effort.
SAMHSA has played an integral role in the nation's efforts to
reduce suicide in Indian Country and I want to acknowledge the
tremendous efforts of SAMHSA's Deputy Administrator Eric Broderick who
has testified before this Committee several times related to suicide
prevention. Dr. Broderick will be retiring later this month after 38
years of services in the U.S. Public Health Commissioned Corps. He
brought his passion, leadership and skill to IHS and SAMHSA and will be
greatly missed.
Today, I will share with you some of the efforts SAMHSA is
undertaking to reduce suicide and suicide attempts in Indian Country
both through SAMHSA-led programs, as well as work we conduct in
conjunction with other Federal, State, and tribal partners. As you know
all too well, the rate of suicide among AI/AN individuals is higher
than the national average. In 2007, suicide was the second leading
cause of death for AI/AN youth aged 10-24 with rates of suicide
significantly higher for AI/AN youth aged 15-24 (20.04 per 100,000)
than for the national average (11.47 per 100,000) (CDC, 2010.) Injuries
and violence account for 75 percent of all deaths among Native
Americans ages 1 to 19 (Wallace, 2000). Overall, according to
unpublished Indian Health Service (IHS) data, suicide mortality is 73
percent greater in AI/AN populations in IHS service areas compared to
the general U.S. population.
SAMHSA's number one strategic initiative is Prevention of Substance
Abuse and Mental Illness. Included in this initiative is the prevention
of suicide and suicide attempts. The prevention of suicide is a public
health issue and necessitates a public health approach that works at
the primary, secondary and tertiary levels. In line with SAMHSA's
Prevention strategic initiative, the Administration is addressing AI/AN
youth suicide through a range of efforts including: the National Action
Alliance for Suicide Prevention; a new Tribal Behavioral Health
formulary grant program; grants to tribes through the Garrett Lee Smith
Memorial Act (GLSMA) youth suicide prevention program; implementation
of the Indian Healthcare Improvement law; the Native Aspirations
program; technical assistance by the Suicide Prevention Resource Center
(SPRC); 24/7 crisis support through the National Suicide Prevention
Lifeline; the recently signed Memorandum of Agreement between HHS (with
SAMHSA as the lead agency), the Department of Justice (DOJ) and the
Department of the Interior (DOI) as required by the Tribal Law and
Order Act; and inclusion of requests that states engage in tribal
consultation as part of their plans submitted in conjunction with the
new Uniform Mental Health and Substance Abuse Block Grant Application.
In order to highlight the plethora of activity around efforts to
prevent suicide and suicide attempts among AI/AN individuals, just last
week in Scottsdale, Arizona over 1,000 individuals came together for
The Action Summit for Suicide Prevention hosted by IHS, Bureau of
Indian Affairs (BIA), Bureau of Indian Education (BIE) and SAMHSA. The
title of the Summit was ``Partnering with Tribes to Protect the Circle
of Life,'' and objectives for the event included strengthening tribal,
Federal, State and community partnerships; creating an opportunity to
collaborate, network, and share effective strategies on topics in
suicide and substance abuse prevention in Native American communities;
and providing the most up-to-date research related to suicide and
substance abuse in Indian Country.
National Action Alliance for Suicide Prevention
On September 10, 2010, the National Action Alliance for Suicide
Prevention (NASSP) was launched by the U.S. Department of Health and
Human Services Secretary, Kathleen Sebelius, and former Defense
Secretary, Robert Gates. The NASSP has a private sector Co-Chair,
former U.S. Senator Gordon Smith (R-OR), and a public sector Co-Chair,
Army Secretary John McHugh. Members of the NAASP include, but are not
limited to, the Surgeon General, Regina Benjamin; the SAMHSA
Administrator, Pamela Hyde; Department of Interior Assistant Secretary
of Indian Affairs, Larry Echo Hawk; HHS Assistant Secretary for Health,
Dr. Howard Koh; and National Indian Youth Leadership Project Executive
Director, McClellan Hall. In addition, the IHS Director, Dr. Yvette
Roubideaux, serves as an ex officio Member of the NAASP. Mr. Echo Hawk,
Mr. Hall and Dr. Roubideaux serve as the leaders of the NAASP AI/AN
Task Force which will establish specific priorities for Tribal youth
regarding suicide prevention, intervention, and postvention strategies,
including positive youth development. The Task Force also helped
develop the agenda and strategy for the National Suicide Prevention
Summit and will also do so for the Alaska Suicide Prevention Summit for
AI/AN communities, leaders, service providers, educators, and law
enforcement.
Behavioral Health--Tribal Prevention Grants
The President's FY 2012 Budget for SAMHSA proposes a new grant
program titled Behavioral Health--Tribal Prevention Grant (BH-TPG),
which is intended to increase SAMHSA's efficacy in working with tribes
and tribal entities. The BH-TPG represents a significant advance in the
Nation's approach to substance abuse and suicide prevention, based in a
recognition of behavioral health as a part of overall health. The
program will focus on the prevention of alcohol abuse, substance abuse
and suicides in the 565 Federally-recognized Tribes. Recognizing the
Federal obligation to help Tribes deal with physical and behavioral
health issues, SAMHSA will work in consultation with Tribes,
establishing a single coordinated mental health and substance abuse
program for all Federally-recognized Tribes. SAMHSA also will consult
and work closely with Tribes and Tribal leaders to develop a
comprehensive, data-driven planning process to identify and address the
most serious behavioral health issues in each Tribal community.
Tribes will be allowed to use a set percentage (determined after
consultation with Tribes) of the Behavioral Health--Tribal Prevention
Grant funds for a combination of service and service-related
activities, development and dissemination of prevention messages, and
provider development and linkage building to support the Tribes in
achieving outcomes. Funding for infrastructure activities will enable
the Tribe to build service capacity. The Tribe will present data to
support how the allocation will support infrastructure and/or provision
of services. In carrying out these activities, the Tribe will be
required to use comprehensive, evidence-based programming, and/or
proven successful programming, based on either mainstream science or
proven Tribal traditions. Up to 20 percent of the grant funds may be
used to fund key support and development activities, such as operation
of a Tribal prevention advisory group, support for a Tribal community
coalition, access to an epidemiological work group, training and
technical assistance to communities, data collection and evaluation,
and oversight and monitoring of activities. The details of the funds
distribution will be determined in consultation with Tribes.
Garrett Lee Smith Grants
Since passage of the GLSMA (P.L. 108-355) in 2004, 19 tribes have
received multi-years grants to address suicide prevention among tribal
youth, with 21 additional tribal grants to start this year. This number
represents 39 percent of the total State and Tribal Youth Suicide
Prevention Grants authorized by the GLSMA. These grants have provided
the tribes funding to help implement a tribe-wide suicide prevention
network. The first tribal grantee was the Native American
Rehabilitation Association in Oregon, which was one of three GLSMA
grantees in the first cohort to be awarded additional evaluation
funding. They will use the funding to enhance their evaluations to
maximize what could be learned from their important suicide prevention
activities.
One of the Nation's most innovative systems for intervening with
youth at risk for suicide, the White Mountain Apache's suicide
prevention program (funded by SAMHSA through the GLSMA grant program),
includes the evaluation of two culturally adapted interventions that
target youth who have attempted suicide. These interventions are linked
to a unique tribally mandated suicide surveillance system that
identifies youth who have exhibited suicidal behavior. The
interventions focus on in-home follow-up with youth who have attempted
or thought of attempting suicide and were treated and discharged from
emergency departments. The first intervention, New Hope, is an
emergency department-linked intervention conducted over one to two
sessions. The sessions comprise of a locally produced video and
workbook curriculum that develops a safety plan for the youth and
problem-solves barriers to their engagement in treatment. The second
intervention, Re-Embracing Life, was adapted from the American Indian
Life Skills Development Curriculum and consists of nine curricular
sessions conducted weekly in home or office settings. The intervention
targets problem solving, anger/conflict management, self-
destructiveness, emotional regulation, coping, social interactions, and
help-seeking behaviors.
In the most recent cohort of GLSMA grantees which were announced
over the last 2 weeks, I am pleased to note that SAMHSA provided
funding for the ``Sister National Empowerment Partnership'' which will
be administered by the Fort Peck Tribal Health Service and the
University of Montana. This grant of $480,000 per year for 3 years will
be utilized to design and deploy a comprehensive system of youth
suicide prevention on the Fort Peck Reservation in northeast Montana.
The partnership will build on existing work in response to a
devastating suicide cluster in 2010. Particular attention will be given
to needs identified in a deployment report by the U.S. Public Health
Service in response to a state of emergency declared by the Fort Peck
Tribes in May 2010. During the period identified in the report, the
suicide completion rate on the reservation was three times the Montana
average and more than six times the rates for the nation as a whole.
The goals of the grant include increasing the number of primary health
care and mental health providers trained to assess, manage, and treat
youth at risk for suicide; increase the number of youth, school staff,
parents and community members trained to identify and refer for care a
youth at risk for suicide; to increase the number of youth receiving
mental health and substance abuse services by improving access to care;
and to promote the National Suicide Prevention Lifeline in all
activities.
In addition, the Confederated Salish & Kootenai Tribes in Pablo,
Montana also received a GLSMA grant in Fiscal Year (FY) 2011. Finally,
I would like to note that this year funds from the Prevention and
Public Health Trust Fund established by the Affordable Care Act (ACA)
will be utilized to enhance SAMHSA's youth suicide prevention efforts
and all four of these $1.44 million grants have been awarded to tribes
or tribal entities.
Implementation of the Indian Youth Suicide Prevention Provisions of
Indian Health Care Improvement Reauthorization and Extension
Act of 2009
On March 23, 2010, as part of the ACA, President Obama also signed
into law the Indian Health Care Improvement Reauthorization and
Extension Act of 2009. Title VII, Subtitle B includes provisions
related to Indian Youth Suicide Prevention. SAMHSA is dedicated to
undertaking measures to improve the process by which Indian tribes and
tribal organizations apply for grants. One such example is that SAMHSA
does not require tribal entities applying for agency electronically.
In the FY 2011 cohort of GLSMA State/Tribal grantees, 21 of 37, or
57 percent, grantees are tribes, tribal organizations, or entities that
have indicated the grant will be used specifically for AI/AN youth
suicide prevention activities. SAMHSA has made significant efforts to
take into consideration the needs of Indian tribes or tribal
organizations. Furthermore, SAMHSA does not require any Indian tribe or
tribal organization to apply through a State or State agency for any of
the agency's grant programs.
Native Aspirations Program
SAMHSA has funded 49 tribal communities through Native Aspirations
(NA), a national project designed to address youth violence, bullying,
and suicide prevention through evidence-based interventions and
community efforts. NA is unique among SAMHSA suicide prevention
programs in that it is based on the concepts and values that reflect
the AI/AN community: that solutions to AI/AN youth violence, bullying,
and suicide must come from and be embraced by the community; leadership
must be involved and invested in the solution; it is up to the
community to determine the approaches that would be most effective for
them; traditional approaches that are used in non-AI/AN communities in
America don't always work in AI/AN communities; and that the community
Elders are crucial to the success of the project.
To date, nearly 200,000 Tribal members in 20 communities and 2,100
Alaska Natives in five villages have been provided specialized
technical assistance and support in suicide prevention and related
topic areas for these communities. In addition, over 750 community
members were trained in prevention and mental health promotion in these
communities.
Suicide Prevention Resource Center
SAMHSA funds the Suicide Prevention Resource Center (SPRC), which
provides prevention support, training, and resources to assist
organizations and individuals to develop suicide prevention programs,
interventions and policies, and to advance the National Strategy for
Suicide Prevention. SPRC supports the technical assistance and
information needs of SAMHSA State/Tribal Youth Suicide Prevention and
Campus Suicide Prevention grantees and State, Territorial, and Tribal
(STT) suicide prevention coordinators and coalition members with
customized assistance and technical resources. SPRC has two senior
tribal prevention specialists available to provide technical assistance
to those seeking information, evidence-based programs and awareness
tools specifically geared for suicide prevention among AI/AN
individual. Included on SPRC's Web page dedicated to AI/AN suicide
prevention is a SAMHSA funded guide titled, ``To Live To See the Great
Day That Dawns: Preventing Suicide by American Indian and Alaska Native
Youth and Young Adults.''
National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline (Lifeline) 1-800-273-TALK
(8255) is a 24-hour, toll-free, confidential suicide prevention hotline
available to anyone in suicidal crisis or emotional distress. By
dialing 1-800-273-TALK, the call is routed to the nearest crisis center
in our national network of more than 150 crisis centers. The Lifeline's
national network of local crisis centers, provide crisis counseling and
mental health referrals day and night.
The Lifeline has a Native American Initiative that includes
objectives such as:
1. Establishing and maintaining working relationships between
crisis center staff and key stakeholders in tribal communities.
2. Developing and delivering cultural awareness and
sensitivity trainings as per the direction of the designated
tribal community for crisis center telephone workers.
3. Strengthening the effectiveness of the local Reservation
referrals for suicide prevention supports by identifying
relevant, available resources in the tribal community.
4. Promoting culturally sensitive social media and educational
materials in tribal communities, as determined by tribal
stakeholders.
5. Identifying similarities and differences that can inform
serving Native American communities on a national level in a
culturally and respectful manner.
In Montana, the Fort Peck, Blackfeet, Northern Cheyenne, Crow, Fort
Belknap, Flathead and Rocky Boy reservations are served by Lifeline's
Voices of Hope crisis call center.
Tribal Law and Order Act
As you are aware, through the Tribal Law and Order Act of 2010
Congress sought to engage new federal partners to build upon previous
efforts in addressing alcohol and substance abuse in Indian country. As
a result, the Secretary of Health and Human Services, the Secretary of
the Interior, and the Attorney General, recently signed a Memorandum of
Agreement (MOA) to, among other things:
1. Determine the scope of the alcohol and substance abuse
problems faced by American Indians and Alaska Natives;
2. Identify the resources and programs of each agency that
would be relevant to a coordinated effort to combat alcohol and
substance abuse among American Indians and Alaska Natives; and
3. Coordinate existing agency programs with those established
under the Act.
The MOA specifically takes into consideration that suicide may be
an outcome of, and has a connection to, substance abuse. To accomplish
the above stated goals, SAMHSA sought to establish an Interdepartmental
Coordinating Committee (Indian Alcohol and Substance Abuse Committee)
to include key agency representation from SAMHSA, IHS, Office of
Justice Programs, Office of Tribal Justice, BIA, BIE, and the
Department of Education. The Administration on Aging and Administration
for Children and Families within HHS are also represented on the IASA
Committee. The IASA Committee has created an organizational structure
to include workgroups to carry out its work.
Uniform Block Grant Application
On July 26, SAMHSA announced a new application process for its
major block grant programs the Substance Abuse Prevention and Treatment
Block Grant and the Community Mental Health Services Block Grant
(MHBG). The change is designed to provide states greater flexibility to
allocate resources for substance abuse and mental illness prevention,
treatment and recovery services in their communities. One of the key
changes to the block grant application is the expectation that States
will provide a description of their tribal consultation activities.
Specifically, the new application's planning sections note that States
with Federally-recognized tribal governments or tribal lands within
their borders will be expected to show evidence of tribal consultation
as part of their Block Grant planning processes. However, tribal
governments shall not be required to waive sovereign immunity as a
condition of receiving Block Grant funds or services.
Included within the MHBG application SAMHSA notes that States
should identify strategies for the MHBG that reflect the priorities
identified from the needs assessment process. Goals that are focused on
emotional health and the prevention of mental illnesses should be
consistent with the National Academies--Institute of Medicine report on
``Preventing Mental, Emotional, and Behavioral Disorders Among Young
People: Progress and Possibilities.'' More specifically, they also
should include Strategies that implement suicide prevention activities
to identify youth at risk of suicide and improve the effectiveness of
services and support available to them, including educating frontline
workers in emergency, health and other social services settings about
mental health and suicide prevention. Finally, the uniform application
requests that States attach to the Block Grant application the most
recent copy of the State's suicide prevention plan. It notes that if
the State does not have a suicide prevention plan or if it has not been
updated in the past 3 years, the State should describe when it will
create or update its plan.
Conclusion
Thank you again for this opportunity to share with you the
extensive efforts SAMHSA is undertaking with respect to AI/AN youth
suicide prevention specifically, as well as other efforts relating to
tribal behavioral health issues. I would be pleased to answer any
questions that you may have.
Senator Tester. Thank you, Dr. McKeon. You can hand the mic
down to Rose. In the meantime, I want to thank you for your
testimony. As with everybody who testified today, your entire
testimony will go into the official record. So thank you very
much.
Rose, past Indian Affairs Committee hearings have revealed
that tribal communities are sometimes unwilling to talk about
suicide, especially youth suicide. Has that been in your
experience, and if it has, is it better to talk about it or is
it better to keep quiet?
Ms. Weahkee. Yes, that has been brought up, and even just
this past week at the Action Summit for Suicide Prevention,
that was addressed as one of the issues from tribal communities
speaking at the Summitt. So it is important for us to work
jointly with the tribe elders and traditional practitioners in
the community to help us address the issue of suicide.
But it is important and something that we have been hearing
from tribal communities is that there needs to be more
communication and more awareness to all systems throughout the
tribal health system, through the education system, law
enforcement, first responders, to parents and grandparents, and
to peers. So if someone does come to them with thoughts of
suicide, that they know what to do to respond to that issue.
Senator Tester. Okay. Does talking about it or not talking
about it affect suicide clusters, and if so, how?
Ms. Weahkee. I think that is one of the myths, that talking
about suicide will increase the number of suicides. It is
important for us to bring education and awareness and be able
to learn how we can respond when someone is coming to us, maybe
expressing that they want to harm themselves. That is a skill
that we are trying to develop and awareness we are trying to
bring with the suicide summit that was held last week, and the
one that we will be holding in Alaska next month, to bring more
awareness about how to deal with that.
Senator Tester. Are you familiar with a program the
Montana-Wyoming Tribal Leadership Council is doing called
Planting Seeds of Hope?
Ms. Weahkee. Yes, absolutely.
Senator Tester. One of their goals is to train gatekeepers
in every community. Can you tell me what a gatekeeper is and
why it is important?
Ms. Weahkee. A gatekeeper is and can be anyone in the
community. It can be a peer, it can be a teacher, it can be a
parent, someone that that young person or that youth may come
in contact with that could be trained about how to listen and
know what to do, understand what the risk factors are,
understand what suicide is and basically how to intervene. So
we have a lot of gatekeeper training programs that are out
there, and a lot that we shared last week. And they need to be
developed and they need to be trained. Native HOPE is one of
those gatekeeper programs that many of our tribal communities
are implementing. So the short answer is yes it is important.
Senator Tester. So those would be people that a student or
an adult could go talk to if they are having some issues, being
bullied or whatever?
Ms. Weahkee. Yes, absolutely. But I also want to stress the
point, I think one of the things that we heard from our youth,
our youth panel last week, is that we need to listen and that
we need to reach out more as adults. A lot of our youth are
afraid, I think we heard that here today.
Senator Tester. We sure did.
Ms. Weahkee. Sometimes it is scary for a youth to come to
an adult and explain when something like that is happening, for
whatever reason. So it is very important for us as adults to go
to our youth and listen to them.
Senator Tester. Okay. Thank you, Rose.
Ed, we passed Tribal Law and Order Act last Congress. It
was, I think, a pretty good piece of legislation. I want to
know from your perspective, it was supposed to reduce violence
in Indian Country. Have we been into the program long enough
where we can say it has worked or it hasn't worked or do we
need more time?
Mr. Parisian. I am trying to think about how to answer
this, because I am not the expert when it comes to law
enforcement. But I am familiar with the program, and the
meetings that we have attended. I know that they are in the
planning process. I am not sure if it is made that big a
difference yet. I think that it is going to need some time,
particularly training, education, more involvement from the
tribal side, so that it would work. But the program, I do
believe, will make a difference.
Senator Tester. Good.
Dr. McKeon, you talked about suicide prevention grant
programs. Whenever grant programs are brought up, from my
perspective, I am always wondering if they are skewed against
rural communities. I would say for, but typically they are
skewed against them. So I guess specifically, with the programs
you referenced, specifically to Indian Country, how can we be
assured that the playing field is level as it supplies to
access to those grant dollars for frontier Indian communities?
Mr. McKeon. That's a very important point. SAMHSA has
worked hard to try to maximize the availability of these grants
to tribal communities. Currently with the new awards that were
just made, 40 percent of the grants that have been awarded
through the State and tribal component of the Garrett Lee Smith
Memorial Act have gone to tribes and to tribal organizations.
We have tried to do a couple of things to try to help
tribes be competitive in that process. One is our Native
Aspirations program, which looks at risk factors for violence,
bullying and suicide and how to [indiscernible] focus on the
planning effort. Nine of our Native Aspirations communities
have gone on afterwards to successfully compete for Garrett Lee
Smith Memorial grants.
Also, we make sure to have specific technical system
session when the requests for applications or grants are
[indiscernible] for tribal communities and to make sure that
there are no barriers around things like electronic access,
which could disadvantage tribal communities in some places.
Senator Tester. Okay. Thank you.
We are pressed for time, because we are over by about 20
minutes already. This is an important issue. I want to thank
all of you for your testimony and your commitment, as well as
the previous panel, to the issue.
As I have said to the tribal council earlier today, this is
about, all these hearings, whether they are in Washington, D.C.
or whether they are in Poplar, is about gathering information
and utilizing information to make a difference. We heard some
pretty moving testimony here today from people who have been
directly impacted by horrific events, quite honestly. And we
also heard some good testimony from folks up here about what
works, and maybe what doesn't work, and some of the issues that
we need to address, whether it is bullying, or it is working
together in partnership, getting everybody on the same page or
whatever it might be, moving forward.
We have those on record and we can utilize them and staff
will be moving over those and hopefully we will be able to come
up with some things in Washington, D.C. that is not going to
solve the problem but will help solve the problem. Because I do
believe, as many people have testified today, communities play
such an incredibly important role with their buy-in. It is
absolutely critically important.
I want to thank the folks here at Poplar High School for
the use of the venue. Very, very nice. I want to thank Chairman
Stafne for not only his testimony but for his hospitality. I
want to thank all the participants who participated today.
I want to thank all of you for coming to this hearing. You
need to know that the hearing record will remain open for two
weeks. And this doesn't apply just to the folks who are here,
this applies to all of you and your neighbors. The hearing
record will be open for two weeks. If you would like to
contribute your comments, the easiest way to do it is to get on
the internet, providing you have access to it,
indianaffairs.gov, and we can take your input to the testimony
at this hearing, you can add to the testimony if you so choose.
It is one of those things. Technology can help make a
difference.
I want to thank you all for being here once again. I very,
very much appreciate the participation, very, very much
appreciate the heartfelt testimony. And with that, this Indian
Affairs Committee meeting is adjourned.
[Whereupon, at 3:00 p.m., the hearing was adjourned.]
A P P E N D I X
Prepared Statement of Annie Belcourt-Dittloff, Ph.D., Missoula, Montana
Honorable Senator Tester and Committee Members,
Suicide is clearly one of the most significant problems facing
Native American communities in Montana. I would first like to take this
opportunity to thank Senator Tester for the work he has done to address
this problem. Native Americans in Montana are nearly twice as likely to
take their own lives (21.4 per 100,000-Native Americans in Montana
versus 11.0 per 100,000-U.S. rate). This rate is even higher in
specific Native reservations in our state. This is unacceptable. We
must all join together to improve the health and hope of our native
communities and youth. As we have seen, the youth are the population
most at risk. However, as we all appreciate our children and youth are
our most important resource and hope for healthier communities in the
future.
Reducing the problem of suicide among our Native American
communities in Montana will require collaborative efforts aimed at
improving our collective understanding of the problems associated with
suicide and potential solutions. I have multiple connections to the
tribal communities and I am personally committed to improving the
overall health of Native American communities. I was trained as a
clinical psychologist and completed my doctorate at the University of
Montana in 2006. I went on to complete an internship year at the Denver
Veterans Affairs Medical Center and a 4-year postdoctoral faculty
position at the Centers for American Indian and Alaska Native Health
concentrating on posttraumatic stress and mental health disparities
(suicide, trauma, PTSD, depression, and cultural factors) in Native
American populations. My research and clinical practice experiences
have focused upon mental health disparities, trauma, depression,
anxiety, posttraumatic stress reactions and disorders, risk factors,
and resiliency.
I write to you today from both a professional and a personal
perspective. As a researcher and faculty member in the state of
Montana, I am interested in advancing knowledge, science, and practice
to improve health disparities facing American Indians. I know the vital
importance of science, intervention, and community collaboration in
this process. My comments reflect my beliefs that we must all invest in
quality collaborative intervention, prevention, science, education, and
health care practice within our Native communities. My comments reflect
these beliefs and commitment towards working to address the problem of
suicide. While some Montana reservation communities have received a lot
of recent media attention, it is important to note that the problem of
youth suicide has been impacting every Native American community in
Montana. As such, it is important that each community receive access to
scientific, clinical, educational, and prevention opportunities.
In addition to my role as a researcher and clinician, I also write
today as a family member of a Native youth lost to suicide. This is a
devastating loss for our family and I can tell you that I personally
would have done anything to prevent this loss from happening. My nephew
fell through the cracks that have become all too evident within our
reservation health care and educational systems. I cannot bring him
back, but I can work to honor his brief life through the work that I do
advocating for science, practice, education, and policy efforts aimed
at preventing suicide. I feel that it is important to advance our
knowledge regarding the impact of trauma and poverty within our Native
American communities. I also feel that it is important to invest in
prevention efforts that promote resiliency, sobriety, education,
physical health, and improved access to mental health care within our
Native communities. We can all do more to work to prevent any other
families from experiencing the loss of family members to suicide.
Federal agencies, Tribal leaders, community members, healthcare
providers, researchers, elders, youth, and academic partners need to
work toward improving the health and hopes of our Native youth. The
growing crisis of suicide facing our Native communities in Montana and
the nation demands that we all take a stand and work to prevent any
more losses.
I include below responses to recent questions posed in a regional
suicide prevention listening session held in conjunction with key
federal agencies. The responses were created in collaboration with the
Montana-Wyoming Tribal Leaders Council. I hope that the responses help
to generate potential ideas for how to improve our collective response
to suicide within Montana's Native communities. It is with great hope
that I look to your leadership to provide us with innovative solutions
to the problem of suicide within our Native communities.
Please let me know how I can help in these efforts.
Question 1. What can federal agencies do together to help
communities reduce suicide and suicide-related problems in Indian
country?
Answer. Policy and legislation needs to prioritize suicide
prevention, risk identification, referral, mental health access,
education, inter and intra agency collaboration, and funding for Native
communities. Mental health needs to be funded more adequately for both
reservation and urban communities to target Native youth who are most
at risk. Funding needs to directly address the needs of those most at
risk: Native youth, rural reservation populations, and those
experiencing mental health problems are primary examples of vulnerable
populations. Primary high risk is associated with Native American males
who have a history of substance abuse, physical or sexual abuse,
incarceration, relationship problems, and academic problems. Working
with educators, mental health professionals, and academic partners to
advance early detection and prevention efforts is one example of
innovative work that needs to occur. These efforts need to occur at
both the community and individual level. Mental health problems are
compounded by the rural nature of reservations and the stigma that can
be attached to mental disorders. As a result, prevention and
intervention efforts need to focus on reducing barriers to accessing
mental healthcare including improving access options, improving
confidentiality, improving available mental health services, improving
community mental health services, improving public health information
availability and access, and reducing stigma. In addition, substance
use is frequently a proximal antecedent to suicide; consequently,
treatment options need to be improved for all Native youth and
community members. In most completed suicides, hopelessness paired with
alcohol and drug use is the most frequently identified risk factor for
self-harm and suicide completion. We must work to increase both
individual and community protective factors (self-esteem, social
support, cultural factors and beliefs, traditional medicine and
traditional healer access, mentorship, sobriety, and familial support).
We must also work to decrease poverty, discrimination, trauma,
substance abuse, and crime. What has been done toward addressing these
issues in the past has not been sufficient.
Funding to increase protective and resiliency factors and
simultaneously decrease risk factors should be prioritized. Information
should be shared between federal agencies, health care agencies,
communities, Tribes, and Native researchers to work to address risk and
protective factors for Native Americans in Montana. The Rocky Mountain
Tribal Epicenter and collaborative efforts should be supported as a
continued part of Tribal data and information technological resources.
Indian Health Services must provide surveillance data to the Rocky
Mountain Tribal Epicenter and individual tribes. We are all accountable
for the health and well-being of Native youth and children. We must all
work toward reducing the stress and trauma that our most vulnerable
Native Americans face and this will require collaboration and
perseverance.
Legislation that would allow school systems to acquire and
provide or refer children who exhibit bullying behaviors or
signs of maltreatment (peer or familial) to therapy rather than
punishment or expulsion. Provide incentives to schools for
implementing programs that institute healthy relationship
building, character development and values clarification in a
systematic way.
Funding that would support such an alternative program and
supplement regular educational structures including summer
camps, after school or weekend activities that are designed to
increase character and social skill development.)
Educated Leadership--mandatory training and education on
best practices (for health promotion and disease prevention) as
well as how to talk and how not to talk about the issue at hand
as well as the underlying causes or feelings.
Contagion risk-Media in Montana require training in
available guidelines available from the American Psychological
Association to avoid or mitigate potential risk associated with
sensationalized media depictions of suicide in Montana.
Information technology- could provide telemedicine and
telepsychiatry options as well as instruction and education to
tribal communities. Building the clinical and educational
capacity of tribal communities would reduce the isolation
confronting many tribal communities, educators, and health
providers. We must establish ways to develop community support
and technological access to our most rural reservations. Youth
need access to information and options about healthy living
options and educational opportunities.
Cross-agency coordination and collaboration--must come from
the top down as well as from communities. Schools and Tribal
colleges and health professionals as well as Tribal leaders or
health committees need paid on-the-job time to ensure
information sharing and collaborative initiatives.
Data sharing--The reporting system is inadequate and the
problem of agency ``silos'' only exacerbates the problem. The
relationship between state, federal, and tribal entities needs
to be improved in an equitable manner that does not serve as a
detriment of the Tribes. Currently, the Indian Health Service
does not have a data sharing agreement with the Rocky Mountain
Tribal Epicenter. This limits surveillance data available to
tribal communities in Montana.
Accountability--If this does not become everyone's issue,
then it will continue to belong only to those who are already
isolated and most at risk. If we are going to be genuinely
accountable to each other we each must hold ourselves
accountable for finding effective remedies for this horrific
situation.
Question 2. What is the best way for federal agencies to coordinate
suicide prevention activities with tribal groups? For example, in what
ways can we assist in addressing the problem (i.e., prevention,
response, mitigation, and recovery)?
Answer. The best way to coordinate suicide prevention activities
with tribal groups is to work with all key stakeholders within diverse
aspects of tribal communities and leadership. This collaborative
process must be directed to identify best practices for prevention,
response, mitigation, and recovery. Tribal leaders, mental health
providers, educators, researchers, administrators, community members,
tribal youth, and academic partners are examples of key groups that
require representation at the Billings area level. Federal agencies
should consider creating positions (ideally led by Native personnel
with expertise in mental health) specifically devoted to suicide
prevention, response, and recovery. However, these individuals would
need to be very active in coordinating the response of all stakeholders
not just one component of the tribal community. A note of caution: the
last thing we need is to have this position bogged down by excessive
bureaucratic barriers. The immediacy of the problem should guide the
immediacy of our collaborative response. Federal funding agencies need
to make solid commitments and be required to expedite and support the
suicide prevention efforts at an agency level. The problem is occurring
now and the solution must therefore occur now. Every day that passes
signifies the loss of more members of our Native communities. Tribal
communities have recommended the use of immediate crisis response teams
comprised of mental health providers and trained community members (who
are well supported to prevent burn-out and just being overwhelmed).
Other ideas include establishing safe houses for youth; improving
access to crisis mental health services including daily walk-in hours
for those in crisis; law enforcement training in mental health
identification and referral; training for educational providers
(teachers, principals, coaches, and aids); and improving after-school
and alternative activities for youth (skateparks, basketball open gyms,
extra-curricular events, and healthy options for activities). These
activities should also have available information about healthy coping
and available help for those who may be in crisis.
Question 3. What are some ways that we can improve communities'
understanding of suicide as a ``public health issue?''
Answer. Work with educational systems on each reservation or urban
center to work to educate teachers, families, students, and communities
about the public health aspects of suicide and ways to cope with
stress, trauma, and loss. Grants that work to promote public health
education would be a good idea to develop collaboratively with
communities. Involving communities and youth in these efforts is
critical. Engaging communities in empowering and creative ways is
critical to ensure the success of these efforts. More focus needs to be
placed upon what it means to be a healthy and successful member of
Native communities. Traditional culture, beliefs, and practices are all
positive aspects that can promote resiliency and healthy coping. Too
often, we fall victim to petty jealousy and or political pressures and
end up focusing on negative aspects of communities or individuals. We
must all work to promote resiliency, protective factors, and mental
health within our youth and communities. Native spirituality,
traditional medicine, and cultural practices are important factors that
could be incorporated into any public health initiatives.
Question 4. Are there ways technology could be used to address gaps
in services or community education?
Answer. Telehealth and telemedicine should be explored,
particularly for our rural communities in Montana. Many of our most
rural and remote reservation communities appear to experience more risk
for suicide. Any innovative ways to establish support for individuals,
communities, and providers in rural settings would be helpful. We also
need to create a sense of community and systematically cultivate the
perspective that life can improve for our Native youth. We need a
nationwide ``It gets better'' effort analogous to the efforts being
made for the LGBT youth in this country. Identifying health Native
American role models could help improve community pride and hope for
youth. Feelings of sadness and hopelessness can happen to anyone, we
have to work to create a sense of hope for youth in particular. We also
need to look at creating healthy opportunities to develop community for
our isolated and rural reservations. One idea is to create an online
community that has access to mental health educational material and
health mentors. Hobbies, creative arts, music, theater, games,
astronomy, learning about taxonomies are just a few of the activities
that are virtually unavailable on the reservations, this is prime
example of how Poverty can stifle imagination and consume all one's
energy or interest. Poverty is too often the direct result of a lack of
employment opportunities, hiring youth to come up with safe activities
might spark imagination.
Question 5. In what ways can federal agencies better support and
help sustain local programs? Specifically, what technical assistance
and program evaluation support is needed to illustrate program success
and extend successful programs? How is success measured?
Answer. Programs that do not adequately involve communities,
families, and youth do not have sustainability. In addition, adequate
funding for long-term programs and to support key personnel is
required. Short-term grant funded programs that do not include a
meaningful community collaboration do not have good chances of
continued success. In addition, Native Mental Health providers,
physicians, and educators need to be increased. Native youth need to
have healthy and successful role models within their communities.
Success can be measured quantitatively and qualitatively. Including
communities and Native professionals in the evaluation and technical
assistance aspects of programming is vital.
Question 6. How can the various disciplines work collaboratively to
address suicide within your communities?
Healthcare
Law enforcement
Tribal governments
Federal government
State governments
County systems
First responders
School personnel (BIE and Public Schools)
Families and communities
Answer. All can and should work collaboratively to prevent youth
suicide and improve our collective response to those at risk. The
problems identified associated with suicide risk are complex and
involve each of the identified disciplines. Improving knowledge of risk
factors and available mental health options can help to integrate
education, health, and familial resources to improve early
identification and treatment for Native Youth at risk.
Question 7. What are some of the specific challenges to addressing
suicide in your region?
Answer. Montana is a very rural and isolated state. It also has
very limited options for mental health care access. The poverty faced
by our Native communities can be quite extreme. Unemployment and
poverty are severe in many reservations and these factors increase the
risk experienced by all members of Native communities. Substance use
problems, trauma exposure, inadequate healthcare access, and extremely
limited access to mental healthcare are all additional barriers to
Native Americans in Montana. Treatment programs should be expanded and
professional interventions for all behavioral health issues (including
obesity). These efforts require additional resources. Educational
disparities in Montana are significant and translate to increased area
of risk. Drop-out rates are very high among Native Youth and very few
make it through college. These factors all need to be improved to
promote suicide prevention here in Montana.
Question 8. What are some of the community strategies that have
worked to prevent suicide?
Answer. In the past, I have observed that there have been stronger
links between healthy older mentors in the community and youth.
Ceremony, language, familial support, peer support, sports,
extracurricular activities, and access to community-wide event access
(pow-wows, sobriety events, open supervised gyms, cultural educational
events/activities, rodeo, skate parks, and other events aimed at youth)
have been helpful in prevention. Poverty on many reservations limits
access to the opportunities and these could be helpful areas to invest
in for the future.
Question 8a. What can we learn from tribes that have been
implementing successful prevention and intervention models?
Answer. Planting the Seeds of Hope and the Montana Suicide
prevention initiative have exemplified important programs working
within tribal communities, but they are relatively short term grant
funded initiatives that will disappear when the grant period ends and
they are not funded to be comprehensive prevention programs. Engaging
communities, individuals, and leadership have all marked successful
efforts. Collaborative efforts between key agencies, scientists, and
healthcare providers demonstrate promise of improving suicide
prevention in this state.
Question 9. How can federal agencies work collaboratively to
promote youth success, wellness, and resilience (i.e., bullying
prevention)?
What makes certain youth resilient and some youth high risk?
Answer. I grew up on the Blackfeet reservation and went on to
obtain a doctorate from the University of Montana. I can tell you that
when I was a youth I was probably considered high risk (as was the
majority of our high school population), but I was able to build upon
the resiliency factors within my life to create a good life for me and
for my children. The primary factors that helped me succeed were family
support, social and community support, having stable and healthy
parents, traditional cultural beliefs and spirituality, and access to
educational opportunities and academic scholarships. My family and
children have been my primary protective factor. I think that efforts
to support building a safe and supportive environment for our children
to learn within-- such as bullying prevention and mentorship programs
can help to improve resiliency. Matching healthy mentors with youth can
be a powerful force to promote health and suicide prevention. We need
to develop a system to identify those most at risk to connect them with
the mental health services they may need. Cultivating connections is a
key component of this process. I feel strongly that the solutions to
our problems reside within our communities, but we must be creative and
persistent in our quest to develop healthier communities.
Question 10. What steps need to be taken to develop a comprehensive
strategy that addresses suicide in your community?
Answer:
Identify Key stakeholders (community, leadership, youth,
mental health providers, academic partners, Native providers,
and federal agency representatives)
Build strategic plans and implementation timelines
Create early identification, screening, and referral
programs on each reservation
Increase mental health access and educational opportunities
for youth
Increase Native healthcare providers and partnerships
between tribal colleges, high schools, and Universities
Increase Native researchers working to promote suicide
prevention
Funding for Native youth suicide prevention programs
Creation of support networks for those at elevated risk
______
Joint prepared Statement of Marilyn Bruguier Zimmerman, Director,
National Native Children's Trauma Center and Richard van den Pol,
Director, Institute for Educational Research and Service, University of
Montana