[Congressional Record Volume 155, Number 122 (Thursday, August 6, 2009)]
[Senate]
[Pages S9038-S9041]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DORGAN (for himself, Mr. Johanns, Mr. Baucus, Mr. Johnson, 
        Mr. Thune, Mr. Tester, and Mr. Udall of New Mexico):
  S. 1635. A bill to establish an Indian Youth telemental health 
demonstration project, to enhance the provision of mental health care 
services to Indian youth, to encourage Indian tribes, tribal 
organizations, and other mental health care providers serving residents 
of Indian country to obtain the services of predoctoral psychology and 
psychiatry interns, and for other purposes; to the Committee on Indian 
Affairs.
  Mr. DORGAN. Mr. President, today I introduced a bill entitled 7th 
Generation Promise: Indian Youth Suicide Prevention Act, to address the 
crisis of youth suicide in Indian Country. I introduce this legislation 
on behalf of myself and Senators Johanns, Johnson, Udall of New Mexico, 
Baucus, and Tester, in hopes that it will help provide prevention and 
intervention services to Native American youth.
  Over the past 25 years, youth suicides in Native American communities 
have reached epidemic levels. Suicide ranks as the second leading cause 
of death for Native American youth ages 15 to 35--a rate 3.5 times 
higher than the national average. In fact, adolescent Native American 
males have the highest suicide rate of any population group in the 
United States.
  Over the years, the Indian Affairs Committee, which I chair, has held 
a series of hearings on the issue of Indian youth suicide. This past 
February, the Committee explored the progress made in youth suicide 
prevention in Indian Country. We heard from agencies and organizations, 
such as the Indian Health Service and the Substance Abuse and Mental 
Health Services Administration, SAMHSA, who provide worthy prevention 
and emergency response services.
  During the February hearing, we also heard from a courageous 16-year-
old young woman named Dana Lee Jetty who testified about the loss of 
her 14-year-old sister, Jami Rose Jetty. Her story illustrates the 
continued need for suicide prevention.
  In November 2008, Dana Lee found her beautiful little sister, Jami 
Rose, hanging in her bedroom, on the Spirit Lake Reservation in North 
Dakota. Dana and Jami's Mom had done all the right things--noticing 
Jami was troubled, they took her to the doctor at the Indian Health 
Service clinic. The doctors dismissed the mom's concern and said Jami 
was just being a ``typical teenager.'' Dana told me that she believes 
her sister would be alive if there had been adequate mental health 
professionals to diagnose and treat Jami's depression. Jami Rose Jetty 
serves as a tragic example of the inadequate mental health services in 
Indian Country and why we need legislation like the one I introduced 
today.
  This year, the Standing Rock Sioux Reservation, located in North 
Dakota and South Dakota, is experiencing epidemic levels of youth 
suicide. There have already been 10 suicides and an additional 53 
attempted suicides. The majority of these suicides have been among 
tribal members under the age of 24. Clearly, we must do more for the 
mental health and suicide prevention in our Native American communities 
across the United States.
  The bill I introduced includes three main sections to improve youth 
suicide prevention services in Indian Country: a youth telemental 
health demonstration project; language to streamline and improve the 
process by which Tribes apply for grants through SAMHSA; and 
encouragement of post-doctoral mental health intern programs in an 
effort to increase the availability of services in Indian Country.
  The Indian Youth Telemental Health Demonstration Project Act has been 
introduced in previous Congresses. This project would authorize the 
Secretary of Health and Human Services to carry out a four-year 
demonstration project for the use of telemental health services in 
youth suicide prevention, intervention and treatment. Telemental health 
services refer to those health care services provided from a remote 
location through technological means. These types of services are 
especially important in remote, isolated communities like those in my 
home state of North Dakota where mental health professionals are 
scarce.
  The bill also includes new language to enhance available mental 
health resources by addressing the many issues and barriers Tribes and 
tribal organizations face when applying for federal assistance through 
SAMHSA. For example, this provision requires SAMHSA to monitor the 
incidence of youth suicide in Indian Country, accept non-electronic 
grant applications from Tribes, give priority to disadvantaged tribal 
applicants with high rates of suicide, prohibit cost-sharing 
requirements, and prevent Tribes and tribal organizations from being 
required to apply through a state. In addition, this section requires 
states that apply for a SAMHSA grant using Tribal data to consult with 
Tribes and include them in any implemented programs.
  Lastly, the bill includes encouragement for Tribes to use post-
doctoral mental health professionals. Post-doctoral psychology and 
psychiatry interns are able to see patients and provide mental health 
services under the supervision of a certified mental health 
professional. The Veterans Administration is currently utilizing post-
doctoral psychology intern programs, which have been successful in 
expanding the availability of mental health services to veterans. We 
need to promote innovative programs like this to increase the mental 
health services available in Indian Country.
  The 7th Generation Promise in the bill's title is the Native American 
concept that we need to consider the impacts of our actions on our 
descendants seven generations in the future. Suicide is devastating our 
current generation of Native Americans, and we need to do something to 
protect them and

[[Page S9039]]

our Native Americans seven generations down the road.
  I would like to thank Senator Johanns for working with me on this 
important piece of legislation. Health care, and especially mental 
health issues, remain a top priority for me as Chairman of the Indian 
Affairs Committee. I look forward to continuing this important work so 
that we may stop the high levels of youth suicide and other health 
disparities among Native Americans.
  I would like to end by saying that one youth suicide is one tragedy 
too many. My hope is that passage of this bill will bring some aid to 
our Native American communities experiencing this crisis.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1635

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

     SECTION 1. SHORT TITLE.

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

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds that--
       (1)(A) the rate of suicide of American Indians and Alaska 
     Natives is 1.9 times higher than the national average rate; 
     and
       (B) the rate of suicide of Indian and Alaska Native youth 
     aged 15 through 24 is--
       (i) 3.5 times the national average rate; and
       (ii) the highest rate of any population group in the United 
     States;
       (2) many risk behaviors and contributing factors for 
     suicide are more prevalent in Indian country than in other 
     areas, including--
       (A) history of previous suicide attempts;
       (B) family history of suicide;
       (C) history of depression or other mental illness;
       (D) alcohol or drug abuse;
       (E) health disparities;
       (F) stressful life events and losses;
       (G) easy access to lethal methods;
       (H) exposure to the suicidal behavior of others;
       (I) isolation; and
       (J) incarceration;
       (3) according to national data for 2005, suicide was the 
     second-leading cause of death for Indians and Alaska Natives 
     of both sexes aged 10 through 34;
       (4)(A) the suicide rates of Indians and Alaska Natives aged 
     15 through 24, as compared to suicide rates of any other 
     racial group, are--
       (i) for males, up to 4 times greater; and
       (ii) for females, up to 11 times greater; and
       (B) data demonstrates that, over their lifetimes, females 
     attempt suicide 2 to 3 times more often than males;
       (5)(A) Indian tribes, especially Indian tribes located in 
     the Great Plains, have experienced epidemic levels of 
     suicide, up to 10 times the national average; and
       (B) suicide clustering in Indian country affects entire 
     tribal communities;
       (6) death rates for Indians and Alaska Natives are 
     statistically underestimated because many areas of Indian 
     country lack the proper resources to identify and monitor the 
     presence of disease;
       (7)(A) the Indian Health Service experiences health 
     professional shortages, with physician vacancy rates of 
     approximately 17 percent, and nursing vacancy rates of 
     approximately 18 percent, in 2007;
       (B) 90 percent of all teens who die by suicide suffer from 
     a diagnosable mental illness at time of death;
       (C) more than \1/2\ of teens who commit suicide have never 
     been seen by a mental health provider; and
       (D) \1/3\ of health needs in Indian country relate to 
     mental health;
       (8) often, the lack of resources of Indian tribes and the 
     remote nature of Indian reservations make it difficult to 
     meet the requirements necessary to access Federal assistance, 
     including grants;
       (9) the Substance Abuse and Mental Health Services 
     Administration and the Service have established specific 
     initiatives to combat youth suicide in Indian country and 
     among Indians and Alaska Natives throughout the United 
     States, including the National Suicide Prevention Initiative 
     of the Service, which has worked with Service, tribal, and 
     urban Indian health programs since 2003;
       (10) the National Strategy for Suicide Prevention was 
     established in 2001 through a Department of Health and Human 
     Services collaboration among--
       (A) the Substance Abuse and Mental Health Services 
     Administration;
       (B) the Service;
       (C) the Centers for Disease Control and Prevention;
       (D) the National Institutes of Health; and
       (E) the Health Resources and Services Administration; and
       (11) the Service and other agencies of the Department of 
     Health and Human Services use information technology and 
     other programs to address the suicide prevention and mental 
     health needs of Indians and Alaska Natives.
       (b) Purposes.--The purposes of this Act are--
       (1) to authorize the Secretary to carry out a demonstration 
     project to test the use of telemental health services in 
     suicide prevention, intervention, and treatment of Indian 
     youth, including through--
       (A) the use of psychotherapy, psychiatric assessments, 
     diagnostic interviews, therapies for mental health conditions 
     predisposing to suicide, and alcohol and substance abuse 
     treatment;
       (B) the provision of clinical expertise to, consultation 
     services with, and medical advice and training for frontline 
     health care providers working with Indian youth;
       (C) training and related support for community leaders, 
     family members, and health and education workers who work 
     with Indian youth;
       (D) the development of culturally relevant educational 
     materials on suicide; and
       (E) data collection and reporting;
       (2) to encourage Indian tribes, tribal organizations, and 
     other mental health care providers serving residents of 
     Indian country to obtain the services of predoctoral 
     psychology and psychiatry interns; and
       (3) to enhance the provision of mental health care services 
     to Indian youth through existing grant programs of the 
     Substance Abuse and Mental Health Services Administration.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Administration.--The term ``Administration'' means the 
     Substance Abuse and Mental Health Services Administration.
       (2) Demonstration project.--The term ``demonstration 
     project'' means the Indian youth telemental health 
     demonstration project authorized under section 4(a).
       (3) Indian.--The term ``Indian'' means any individual who 
     is--
       (A) a member of an Indian tribe; or
       (B) eligible for health services under the Indian Health 
     Care Improvement Act (25 U.S.C. 1601 et seq.).
       (4) Indian country.--The term ``Indian country'' has the 
     meaning given the term in section 1151 of title 18, United 
     States Code.
       (5) Indian tribe.--The term ``Indian tribe'' has the 
     meaning given the term in section 4 of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450b).
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (7) Service.--The term ``Service'' means the Indian Health 
     Service.
       (8) Telemental health.--The term ``telemental health'' 
     means the use of electronic information and 
     telecommunications technologies to support long-distance 
     mental health care, patient and professional-related 
     education, public health, and health administration.
       (9) Tribal organization.--The term ``tribal organization'' 
     has the meaning given the term in section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450b).

     SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

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

[[Page S9040]]

       (iii) alcohol and substance abuse treatment.
       (B) To provide clinician-interactive medical advice, 
     guidance and training, assistance in diagnosis and 
     interpretation, crisis counseling and intervention, and 
     related assistance to Service or tribal clinicians and health 
     services providers working with youth being served under the 
     demonstration project.
       (C) To assist, educate, and train community leaders, health 
     education professionals and paraprofessionals, tribal 
     outreach workers, and family members who work with the youth 
     receiving telemental health services under the demonstration 
     project, including with identification of suicidal 
     tendencies, crisis intervention and suicide prevention, 
     emergency skill development, and building and expanding 
     networks among those individuals and with State and local 
     health services providers.
       (D) To develop and distribute culturally appropriate 
     community educational materials regarding--
       (i) suicide prevention;
       (ii) suicide education;
       (iii) suicide screening;
       (iv) suicide intervention; and
       (v) ways to mobilize communities with respect to the 
     identification of risk factors for suicide.
       (E) To conduct data collection and reporting relating to 
     Indian youth suicide prevention efforts.
       (2) Traditional health care practices.--In carrying out the 
     purposes described in paragraph (1), an Indian tribe or 
     tribal organization may use and promote the traditional 
     health care practices of the Indian tribes of the youth to be 
     served.
       (c) Applications.--
       (1) In general.--Subject to paragraph (2), to be eligible 
     to receive a grant under subsection (a), an Indian tribe or 
     tribal organization shall prepare and submit to the Secretary 
     an application, at such time, in such manner, and containing 
     such information as the Secretary may require, including--
       (A) a description of the project that the Indian tribe or 
     tribal organization will carry out using the funds provided 
     under the grant;
       (B) a description of the manner in which the project funded 
     under the grant would--
       (i) meet the telemental health care needs of the Indian 
     youth population to be served by the project; or
       (ii) improve the access of the Indian youth population to 
     be served to suicide prevention and treatment services;
       (C) evidence of support for the project from the local 
     community to be served by the project;
       (D) a description of how the families and leadership of the 
     communities or populations to be served by the project would 
     be involved in the development and ongoing operations of the 
     project;
       (E) a plan to involve the tribal community of the youth who 
     are provided services by the project in planning and 
     evaluating the mental health care and suicide prevention 
     efforts provided, in order to ensure the integration of 
     community, clinical, environmental, and cultural components 
     of the treatment; and
       (F) a plan for sustaining the project after Federal 
     assistance for the demonstration project has terminated.
       (2) Efficiency of grant application process.--The Secretary 
     shall carry out such measures as the Secretary determines to 
     be necessary to maximize the time and workload efficiency of 
     the process by which Indian tribes and tribal organizations 
     apply for grants under paragraph (1).
       (d) Collaboration.--The Secretary, acting through the 
     Service, shall encourage Indian tribes and tribal 
     organizations receiving grants under this section to 
     collaborate to enable comparisons regarding best practices 
     across projects.
       (e) Annual Report.--Each grant recipient shall submit to 
     the Secretary an annual report that--
       (1) describes the number of telemental health services 
     provided; and
       (2) includes any other information that the Secretary may 
     require.
       (f) Reports to Congress.--
       (1) Initial report.--
       (A) In general.--Not later than 2 years after the date on 
     which the first grant is awarded under this section, the 
     Secretary shall submit to the Committee on Indian Affairs of 
     the Senate and the Committee on Natural Resources and the 
     Committee on Energy and Commerce of the House of 
     Representatives a report that--
       (i) describes each project funded by a grant under this 
     section during the preceding 2-year period, including a 
     description of the level of success achieved by the project; 
     and
       (ii) evaluates whether the demonstration project should be 
     continued during the period beginning on the date of 
     termination of funding for the demonstration project under 
     subsection (g) and ending on the date on which the final 
     report is submitted under paragraph (2).
       (B) Continuation of demonstration project.--On a 
     determination by the Secretary under clause (ii) of 
     subparagraph (A) that the demonstration project should be 
     continued, the Secretary may carry out the demonstration 
     project during the period described in that clause using such 
     sums otherwise made available to the Secretary as the 
     Secretary determines to be appropriate.
       (2) Final report.--Not later than 270 days after the date 
     of termination of funding for the demonstration project under 
     subsection (g), the Secretary shall submit to the Committee 
     on Indian Affairs of the Senate and the Committee on Natural 
     Resources and the Committee on Energy and Commerce of the 
     House of Representatives a final report that--
       (A) describes the results of the projects funded by grants 
     awarded under this section, including any data available that 
     indicate the number of attempted suicides;
       (B) evaluates the impact of the telemental health services 
     funded by the grants in reducing the number of completed 
     suicides among Indian youth;
       (C) evaluates whether the demonstration project should be--
       (i) expanded to provide more than 5 grants; and
       (ii) designated as a permanent program; and
       (D) evaluates the benefits of expanding the demonstration 
     project to include urban Indian organizations.
       (g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,500,000 for 
     each of fiscal years 2010 through 2013.

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

       (a) Grant Applications.--
       (1) Efficiency of grant application process.--The 
     Secretary, acting through the Administration, shall carry out 
     such measures as the Secretary determines to be necessary to 
     maximize the time and workload efficiency of the process by 
     which Indian tribes and tribal organizations apply for grants 
     under any program administered by the Administration, 
     including by providing methods other than electronic methods 
     of submitting applications for those grants, if necessary.
       (2) Priority for certain grants.--
       (A) In general.--To fulfill the trust responsibility of the 
     United States to Indian tribes, in awarding relevant grants 
     pursuant to a program described in subparagraph (B), the 
     Secretary shall give priority consideration to the 
     applications of Indian tribes or tribal organizations, as 
     applicable, that serve populations with documented high 
     suicide rates, regardless of whether those Indian tribes or 
     tribal organizations possess adequate personnel or 
     infrastructure to fulfill all applicable requirements of the 
     relevant program.
       (B) Description of grant programs.--A grant program 
     referred to in subparagraph (A) is a grant program--
       (i) administered by the Administration to fund activities 
     relating to mental health, suicide prevention, or suicide-
     related risk factors; and
       (ii) under which an Indian tribe is an eligible recipient.
       (3) Clarification regarding indian tribes and tribal 
     organizations.--Notwithstanding any other provision of law, 
     in applying for a grant under any program administered by the 
     Administration, no Indian tribe or tribal organization shall 
     be required to apply through a State or State agency.
       (4) Requirements for affected states.--
       (A) Definitions.--In this paragraph:
       (i) Affected state.--The term ``affected State'' means a 
     State--

       (I) the boundaries of which include 1 or more Indian 
     tribes; and
       (II) the application for a grant under any program 
     administered by the Administration of which includes 
     statewide data.

       (ii) Indian population.--The term ``Indian population'' 
     means the total number of residents of an affected State who 
     are members of 1 or more Indian tribes located within the 
     affected State.
       (B) Requirements.--As a condition of receipt of a grant 
     under any program administered by the Administration, each 
     affected State shall--
       (i) describe in the grant application--

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

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

       (I) of the total amount of the grant, the affected State 
     will allocate for use for the Indian population of the 
     affected State an amount equal to the proportion that--

       (aa) the Indian population of the affected State; bears to
       (bb) the total population of the affected State; and

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

       (C) Report.--Not later than 1 year after the date of 
     receipt of a grant described in subparagraph (B), an affected 
     State shall submit to the Secretary a report describing the 
     measures carried out by the affected State to ensure 
     compliance with the requirements of subparagraph (B)(ii).
       (b) No Non-Federal Share Requirement.--Notwithstanding any 
     other provision of law, no Indian tribe or tribal 
     organization shall be required to provide a non-Federal share 
     of the cost of any project or activity carried out using a 
     grant provided under any program administered by the 
     Administration.
       (c) Outreach for Rural and Isolated Indian Tribes.--Due to 
     the rural, isolated nature of most Indian reservations and 
     communities (especially those reservations and communities in 
     the Great Plains region), the

[[Page S9041]]

     Secretary shall conduct outreach activities, with a 
     particular emphasis on the provision of telemental health 
     services, to achieve the purposes of this Act with respect to 
     Indian tribes located in rural, isolated areas.
       (d) Provision of Other Assistance.--
       (1) In general.--The Secretary, acting through the 
     Administration, shall carry out such measures (including 
     monitoring and the provision of required assistance) as the 
     Secretary determines to be necessary to ensure the provision 
     of adequate suicide prevention and mental health services to 
     Indian tribes described in paragraph (2), regardless of 
     whether those Indian tribes possess adequate personnel or 
     infrastructure--
       (A) to submit an application for a grant under any program 
     administered by the Administration, including due to problems 
     relating to access to the Internet or other electronic means 
     that may have resulted in previous obstacles to submission of 
     a grant application; or
       (B) to fulfill all applicable requirements of the relevant 
     program.
       (2) Description of indian tribes.--An Indian tribe referred 
     to in paragraph (1) is an Indian tribe--
       (A) the members of which experience--
       (i) a high rate of youth suicide;
       (ii) low socioeconomic status; and
       (iii) extreme health disparity;
       (B) that is located in a remote and isolated area; and
       (C) that lacks technology and communication infrastructure.
       (3) Authorization of appropriations.--There are authorized 
     to be appropriated to the Secretary such sums as the 
     Secretary determines to be necessary to carry out this 
     subsection.
       (e) Early Intervention and Assessment Services.--
       (1) Definition of affected entity.--In this subsection, the 
     term ``affected entity'' means any entity--
       (A) that receives a grant for suicide intervention, 
     prevention, or treatment under a program administered by the 
     Administration; and
       (B) the population to be served by which includes Indian 
     youth.
       (2) Requirement.--The Secretary, acting through the 
     Administration, shall ensure that each affected entity 
     carrying out a youth suicide early intervention and 
     prevention strategy described in section 520E(c)(1) of the 
     Public Health Service Act (42 U.S.C. 290bb-36(c)(1)), or any 
     other youth suicide-related early intervention and assessment 
     activity, provides training or education to individuals who 
     interact frequently with the Indian youth to be served by the 
     affected entity (including parents, teachers, coaches, and 
     mentors) on identifying warning signs of Indian youth who are 
     at risk of committing suicide.

     SEC. 6. USE OF PREDOCTORAL PSYCHOLOGY AND PSYCHIATRY INTERNS.

       The Secretary shall carry out such activities as the 
     Secretary determines to be necessary to encourage Indian 
     tribes, tribal organizations, and other mental health care 
     providers serving residents of Indian country to obtain the 
     services of predoctoral psychology and psychiatry interns--
       (1) to increase the quantity of patients served by the 
     Indian tribes, tribal organizations, and other mental health 
     care providers; and
       (2) for purposes of recruitment and retention.
                                 ______