[Congressional Record Volume 153, Number 9 (Wednesday, January 17, 2007)]
[Senate]
[Pages S693-S695]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DORGAN (for himself, Ms. Murkowski, Mr. McCain, Mr. 
        Conrad, Mr. Bingaman, Mr. Baucus, Mr. Smith, and Mr. Inouye):
  S. 322. A bill to establish an Indian youth telemental health 
demonstration project; to the Committee on Indian Affairs.
  Mr. DORGAN. Mr. President, I rise today to re-introduce legislation 
which would provide a first important step in dealing with the crisis 
of youth suicide in Indian Country.
  The legislation I am introducing today is almost identical to 
legislation that the Senate passed in May, 2006, to establish an Indian 
youth telemental health demonstration project. The Indian Youth 
Telemental Health Demonstration Project Act of 2007 would authorize the 
Secretary of Health and Human Services to carry out a 4-year 
demonstration project under which five tribes and tribal organizations 
with telehealth capabilities could use telemental health services in 
youth suicide prevention, intervention, and treatment. Demonstration 
project grantees would provide services through telemental health for 
such purposes as counseling of Indian youth; providing medical advice 
and other assistance to frontline tribal health providers; training for 
community members, tribal

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elected officials, tribal educators, and health workers and others who 
work with Indian youth; developing culturally sensitive materials on 
suicide prevention and intervention; and collecting and reporting of 
data.
  The Committee on Indian Affairs held three hearings during the 109th 
Congress on the issue of Indian youth suicide, including one hearing 
that I convened in Bismarck, ND. Although on the Indian reservations of 
the northern Great Plains, the rate of Indian youth suicide is 10 times 
higher than it is anywhere else in the country, this tragic issue is 
not limited to these locations. The committee has heard testimony from 
people from tribal communities in Arizona, Oregon, Washington, Alaska, 
New Mexico, and Wyoming, as well.
  According to 2004 statistics from the National Center for Injury 
Prevention and Control, suicide is the second leading cause of death, 
behind unintentional injury, for American Indian and Alaska Native 
young adults 15 to 24 years old, of both sexes--a statistic that has 
sadly been true for the past 20 years. For North Dakota Indian girls 15 
to 24 years old in 2004, suicide was the number one leading cause of 
death.
  I am grateful for the efforts of the Indian Health Service and the 
Substance Abuse and Mental Health Services Administration, in 
particular, both of which have, in a host of ways, sought to address 
the reservation youth suicide crisis. SAMHSA is providing a 4-year 
grant to the Standing Rock Sioux Tribe of North and South Dakota--a 
tribe that had 12 Indian youth die by suicide over a 6-month period--to 
provide mental health outreach workers. In addition, across the 
country, tribal leaders, tribal health professionals, and service 
providers and family members are working together to implement early 
intervention plans, improve access to prevention programs, promote 
community training and awareness, and reinstate traditional tribal 
practices and culture-based interventions to address Native youth 
suicides.
  Many Indian reservations and Native villages in Alaska are remote and 
isolated, and everyone who lives in those communities experiences much 
more limited access to mental health services than in our Nation's 
metropolitan areas. The testimony received by the Indian Affairs 
Committee indicates that it is particularly in these remote Native 
communities that there is a crisis among the youth. I believe that the 
use of telemedicine--or, for purposes of this legislation, telemental 
health--will prove a useful resource for the several tribes or tribal 
organizations that will participate in this demonstration project in 
assisting their youth.
  In addition to introducing this legislation, I will include 
authorization of this Indian Youth Telemental Health Demonstration 
Project in legislation to reauthorize and amend the Indian Health Care 
Improvement Act, which I intend to introduce soon.
  I thank my colleagues who have joined me in sponsoring this 
legislation and in being willing to talk and think hard about an issue 
that many believe should be kept hidden. We must find ways to prevent 
the needless loss of young Native American boys and girls whose whole 
lives lie ahead of them, and from whom their tribal communities and all 
of this country stand to benefit as these youth blossom in to their 
potential as adults. I look forward to continuing our efforts to 
address this sensitive and very important issue. I urge my colleagues 
to support this legislation. I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 322

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Indian Youth Telemental 
     Health Demonstration Project Act of 2007''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds that--
       (1) suicide for Indians and Alaska Natives is 2\1/2\ times 
     higher than the national average and the highest for all 
     ethnic groups in the United States, at a rate of more than 16 
     per 100,000 males of all age groups, and 27.9 per 100,000 for 
     males aged 15 through 24, according to data for 2002;
       (2) according to national data for 2004, suicide was the 
     second-leading cause of death for Indians and Alaska Natives 
     of both sexes aged 10 through 34;
       (3) the suicide rates of Indian and Alaska Native males 
     aged 15 through 24 are nearly 4 times greater than suicide 
     rates of Indian and Alaska Native females of that age group;
       (4)(A) 90 percent of all teens who die by suicide suffer 
     from a diagnosable mental illness at the time of death; and
       (B) more than \1/2\ of the people who commit suicide in 
     Indian Country have never been seen by a mental health 
     provider;
       (5) death rates for Indians and Alaska Natives are 
     statistically underestimated;
       (6) suicide clustering in Indian Country affects entire 
     tribal communities; and
       (7) since 2003, the Indian Health Service has carried out a 
     National Suicide Prevention Initiative to work with Service, 
     tribal, and urban Indian health programs.
       (b) Purpose.--The purpose of this Act is to authorize the 
     Secretary to carry out a demonstration project to test the 
     use of telemental health services in suicide prevention, 
     intervention, and treatment of Indian youth, including 
     through--
       (1) the use of psychotherapy, psychiatric assessments, 
     diagnostic interviews, therapies for mental health conditions 
     predisposing to suicide, and alcohol and substance abuse 
     treatment;
       (2) the provision of clinical expertise to, consultation 
     services with, and medical advice and training for frontline 
     health care providers working with Indian youth;
       (3) training and related support for community leaders, 
     family members and health and education workers who work with 
     Indian youth;
       (4) the development of culturally-relevant educational 
     materials on suicide; and
       (5) data collection and reporting.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Demonstration project.--The term ``demonstration 
     project'' means the Indian youth telemental health 
     demonstration project authorized under section 4(a).
       (2) Department.--The term ``Department'' means the 
     Department of Health and Human Services.
       (3) Indian.--The term ``Indian'' means any individual who 
     is a member of an Indian tribe or is eligible for health 
     services under the Indian Health Care Improvement Act (25 
     U.S.C. 1601 et seq.).
       (4) Indian tribe.--The term ``Indian tribe'' has the 
     meaning given the term in section 4 of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450b).
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (6) Service.--The term ``Service'' means the Indian Health 
     Service.
       (7) Telemental health.--The term ``telemental health'' 
     means the use of electronic information and 
     telecommunications technologies to support long distance 
     mental health care, patient and professional-related 
     education, public health, and health administration.
       (8) Tribal organization.--The term ``tribal organization'' 
     has the meaning given the term in section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450b).

     SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

       (a) Authorization.--
       (1) In general.--The Secretary is authorized to carry out a 
     demonstration project to award grants for the provision of 
     telemental health services to Indian youth who--
       (A) have expressed suicidal ideas;
       (B) have attempted suicide; or
       (C) have mental health conditions that increase or could 
     increase the risk of suicide.
       (2) Eligibility for grants.--Grants described in paragraph 
     (1) shall be awarded to Indian tribes and tribal 
     organizations that operate 1 or more facilities--
       (A) located in Alaska and part of the Alaska Federal Health 
     Care Access Network;
       (B) reporting active clinical telehealth capabilities; or
       (C) offering school-based telemental health services 
     relating to psychiatry to Indian youth.
       (3) Grant period.--The Secretary shall award grants under 
     this section for a period of up to 4 years.
       (4) Maximum number of grants.--Not more than 5 grants shall 
     be provided under paragraph (1), with priority consideration 
     given to Indian tribes and tribal organizations that--
       (A) serve a particular community or geographic area in 
     which there is a demonstrated need to address Indian youth 
     suicide;
       (B) enter into collaborative partnerships with Service or 
     other tribal health programs or facilities to provide 
     services under this demonstration project;
       (C) serve an isolated community or geographic area which 
     has limited or no access to behavioral health services; or
       (D) operate a detention facility at which Indian youth are 
     detained.
       (b) Use of Funds.--
       (1) In general.--An Indian tribe or tribal organization 
     shall use a grant received under subsection (a) for the 
     following purposes:
       (A) To provide telemental health services to Indian youth, 
     including the provision of--
       (i) psychotherapy;
       (ii) psychiatric assessments and diagnostic interviews, 
     therapies for mental health conditions predisposing to 
     suicide, and treatment; and

[[Page S695]]

       (iii) alcohol and substance abuse treatment.
       (B) To provide clinician-interactive medical advice, 
     guidance and training, assistance in diagnosis and 
     interpretation, crisis counseling and intervention, and 
     related assistance to Service or tribal clinicians and health 
     services providers working with youth being served under the 
     demonstration project.
       (C) To assist, educate, and train community leaders, health 
     education professionals and paraprofessionals, tribal 
     outreach workers, and family members who work with the youth 
     receiving telemental health services under the demonstration 
     project, including with identification of suicidal 
     tendencies, crisis intervention and suicide prevention, 
     emergency skill development, and building and expanding 
     networks among those individuals and with State and local 
     health services providers.
       (D) To develop and distribute culturally-appropriate 
     community educational materials on--
       (i) suicide prevention;
       (ii) suicide education;
       (iii) suicide screening;
       (iv) suicide intervention; and
       (v) ways to mobilize communities with respect to the 
     identification of risk factors for suicide.
       (E) To conduct data collection and reporting relating to 
     Indian youth suicide prevention efforts.
       (2) Traditional health care practices.--In carrying out the 
     purposes described in paragraph (1), an Indian tribe or 
     tribal organization may use and promote the traditional 
     health care practices of the Indian tribes of the youth to be 
     served.
       (c) Applications.--To be eligible to receive a grant under 
     subsection (a), an Indian tribe or tribal organization shall 
     prepare and submit to the Secretary an application, at such 
     time, in such manner, and containing such information as the 
     Secretary may require, including--
       (1) a description of the project that the Indian tribe or 
     tribal organization will carry out using the funds provided 
     under the grant;
       (2) a description of the manner in which the project funded 
     under the grant would--
       (A) meet the telemental health care needs of the Indian 
     youth population to be served by the project; or
       (B) improve the access of the Indian youth population to be 
     served to suicide prevention and treatment services;
       (3) evidence of support for the project from the local 
     community to be served by the project;
       (4) a description of how the families and leadership of the 
     communities or populations to be served by the project would 
     be involved in the development and ongoing operations of the 
     project;
       (5) a plan to involve the tribal community of the youth who 
     are provided services by the project in planning and 
     evaluating the mental health care and suicide prevention 
     efforts provided, in order to ensure the integration of 
     community, clinical, environmental, and cultural components 
     of the treatment; and
       (6) a plan for sustaining the project after Federal 
     assistance for the demonstration project has terminated.
       (d) Collaboration.--The Secretary, acting through the 
     Service, shall encourage Indian tribes and tribal 
     organizations receiving grants under this section to 
     collaborate to enable comparisons about best practices across 
     projects.
       (e) Annual Report.--Each grant recipient shall submit to 
     the Secretary an annual report that--
       (1) describes the number of telemental health services 
     provided; and
       (2) includes any other information that the Secretary may 
     require.
       (f) Report to Congress.--Not later than 270 days after the 
     date of termination of the demonstration project, the 
     Secretary shall submit to the Committee on Indian Affairs of 
     the Senate and the Committee on Resources and the Committee 
     on Energy and Commerce of the House of Representatives a 
     final report that--
       (1) describes the results of the projects funded by grants 
     awarded under this section, including any data available that 
     indicate the number of attempted suicides;
       (2) evaluates the impact of the telemental health services 
     funded by the grants in reducing the number of completed 
     suicides among Indian youth;
       (3) evaluates whether the demonstration project should be--
       (A) expanded to provide more than 5 grants; and
       (B) designated a permanent program; and
       (4) evaluates the benefits of expanding the demonstration 
     project to include urban Indian organizations.
       (g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,500,000 for 
     each of fiscal years 2008 through 2011.
                                 ______