U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

55–174 PDF 2010

S. HRG. 111–365 

S. 1635, SEVENTH GENERATION PROMISE: INDIAN 

YOUTH SUICIDE PREVENTION ACT OF 2009 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 10, 2009 

Printed for the use of the Committee on Indian Affairs 

( 

(II) 

COMMITTEE ON INDIAN AFFAIRS 

BYRON L. DORGAN, North Dakota, Chairman 

JOHN BARRASSO, Wyoming, Vice Chairman 

DANIEL K. INOUYE, Hawaii 

KENT CONRAD, North Dakota 

DANIEL K. AKAKA, Hawaii 

TIM JOHNSON, South Dakota 

MARIA CANTWELL, Washington 

JON TESTER, Montana 

TOM UDALL, New Mexico 

AL FRANKEN, Minnesota 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

TOM COBURN, M.D., Oklahoma 

MIKE CRAPO, Idaho 

MIKE JOHANNS, Nebraska 

ALLISON C. BINNEY, Majority Staff Director and Chief Counsel 

DAVID A. MULLON JR., Minority Staff Director and Chief Counsel 

(III) 

C O N T E N T S 

Page 

Hearing held on September 10, 2009 ..................................................................... 1 

Statement of Senator Barrasso ............................................................................... 5 

Statement of Senator Dorgan ................................................................................. 1 

Statement of Senator Franken ............................................................................... 6 

Prepared statement .......................................................................................... 6 

Statement of Senator Johanns ............................................................................... 4 

Statement of Senator Udall .................................................................................... 6 

WITNESSES

BigFoot, Dolores Subia, Ph.D., Director, Indian Country Child Trauma Center 

and Project Making Medicine, University of Oklahoma Health Sciences 

Center .................................................................................................................... 19 

Prepared statement with attachment ............................................................. 21 

Broderick, Hon. Eric B., D.D.S., M.P.H., Acting Administrator, Substance 

Abuse and Mental Health Services Administration, U.S. Department of 

Health and Human Services ............................................................................... 13 

Prepared statement .......................................................................................... 15 

Roubideaux, Hon. Yvette, M.D., M.P.H., Director, Indian Health Service ......... 7 

Prepared statement .......................................................................................... 9 

APPENDIX

Franklin, Reno Keoni, Chairman, National Indian Health Board (NIHB), 

prepared statement .............................................................................................. 35 

Keita, Gwendolyn Puryear, Ph.D., Executive Director, Public Interest Directorate, American Psychological Association (APA), prepared statement ......... 41 

National Congress of American Indians (NCAI), prepared statement ................ 37 

Response to written questions submitted by the Committee from Dr. Ellen 

Gerrity ................................................................................................................... 55 

Response to written questions submitted to Dolores Subia BigFoot, Ph.D. 

by: ..........................................................................................................................

Hon. Byron L. Dorgan ...................................................................................... 44 

Hon. Tom Udall ................................................................................................ 51 

Written questions submitted by the Committee to: 

Hon. Eric B. Broderick, D.D.S., M.P.H. .......................................................... 58 

Hon. Yvette Roubideaux, M.D., M.P.H. .......................................................... 61 

(1) 

S. 1635, SEVENTH GENERATION PROMISE: 

INDIAN YOUTH SUICIDE PREVENTION ACT 

OF 2009 

THURSDAY, SEPTEMBER 10, 2009 

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:47 p.m. in room 

628, Dirksen Senate Office Building, Hon. Byron L. Dorgan, 

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. BYRON L. DORGAN, 

U.S. SENATOR FROM NORTH DAKOTA 

The CHAIRMAN. We will now call the hearing to order. 

We are pleased today to have three witnesses join us. This hearing is on the subject of S. 1635, the Indian Youth Suicide Prevention Act. 

We have the Honorable Yvette Roubideaux, who is the Director 

of the Indian Health Service, of the U.S. Department of Health and 

Human Services. We very much appreciate your being here. 

The Honorable Eric Broderick, who is the Acting Administrator 

of SAMHSA, the Substance Abuse and Mental Health Services Administration. 

And Dr. Dolores Subia BigFoot, Ph.D., Associate Professor, University of Oklahoma at the Health Sciences Center, who will testify 

on behalf of the American Psychological Association. 

We appreciate very much your attendance. 

Today we are going to hold this hearing to examine S. 1635, the 

Indian Youth Suicide Prevention Act. We believe this bill will help 

address the high rates of youth suicide on Native American communities and improve access, especially to mental health services. 

Suicide is hitting our Native youth like an epidemic in some areas 

of this Country. And it is critical, I believe, that we move quickly 

and respond aggressively. 

The rate of suicide of Native American youth is not double, it is 

three and a half times higher than the general U.S. population. We 

have a chart that shows the suicide rates by race and gender in 

this Country. You will see the rates of suicide of American Indians. 

2 

Native American male and female teens have a higher rate of 

suicides than Asians, Hispanic, African American, Caucasians. In 

fact, the rate of Native American male youth is almost double that 

of the next highest racial group, which is male Caucasians. Chart 


226c2.eps 226c3.eps
3 

two shows the disparity in the youth suicide rates in my home 

State. The top line shows the rate of suicide for Native Americans 

10 to 24. The bottom line shows the rate for Caucasians. Even 

when the incidence of Native American suicide is the lowest, the 

rate is still more than double that of Caucasian youth. 

These charts show statistics. They fail, however, to show the 

cluster of suicides that can impact a community. The Standing 

Rock Sioux Reservation, which traverses North and South Dakota 

borders, had 53 suicide attempts this year, 10 of them which were 

completed. The members of this community are experiencing extreme trauma and need more resources and help. 

This past February, when we held a hearing on teen suicide, a 

young woman named Dana Lee testified before this Committee 

about the loss of her little sister, Jami Rose. Jami Rose’s picture 

is here on this chart, a beautiful little 14 year old girl from the 

Spirit Lake Nation in my home State of North Dakota. Last year, 

Jami took her life. Jami’s mom had noticed that Jami seemed troubled. She took her daughter to the doctor, had her evaluated by 

mental health professionals from the Indian Health Service. The 

doctors dismissed her mom’s concern and diagnosed her as being 

a typical teenager. 

Jami did not obtain the services she needed last November, and 

Dana Lee found her younger sister hanging in her bedroom. 

Sadly, Jami’s story is one we hear far too often in Indian Country. I have told the story often on the Floor with the consent of relVerDate Nov 24 2008 13:09 Apr 20, 2010 Jkt 055174 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 S:\DOCS\55174.TXT JACK PsN: JACKF

226c4.eps
4 

atives of Avis Little Wind. Actually, Avis was from the same reservation. She laid in a bed for 90 days in a fetal position. Her sister 

had taken her life, her mother was a substance abuser, her father 

had taken his life. And this young lady sort of dropped out and nobody noticed for three months that she wasn’t in school. She was 

lying alone in bed in a dysfunctional family until they found her 

hanging in her closet at age 14. Hopeless, helpless, without the 

ability to get the services that we would expect for most teenage 

children in trouble. 

We need to do much better than that, and that is the reason we 

have put together legislation to try to address these issues. This is 

all too silent an epidemic in this Country, and we aim to try to address it in a significant way. 

I want to, because Senator Johanns has another hearing that he 

is supposed to be at, I want to, with the courtesy of my colleagues, 

call on Senator Johanns for a statement. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEBRASKA 

Senator JOHANNS. Mr. Chairman, thank you very much. And to 

my colleagues, thank you for the courtesy. I appreciate it. I, like 

all Senators, am learning that the biggest challenge we face is 

being in two places at once. So I do appreciate this. 

I would like to offer a few thoughts on what we are doing here 

this afternoon. I think it is enormously important. I would like to 

address the challenges of providing mental health services to our 

Native American youth. I want to issue my strongest, without reservation, support of S. 1635, the Seventh Generation Promise: Indian Youth Suicide Prevention Act of 2009. In my home State, the 

State of Nebraska, we have four Native American tribes. They are 

just the most wonderful people. I have enjoyed working with them 

as a Senator and as a Governor and even as a mayor. 

However, the suicide statistics in Indian Country would have to 

concern anyone. They deeply concern me. Native American young 

people have the highest suicide rate of any population group in the 

United States. The charts really do tell the story. 

Alarmingly, the rate of suicide amongst Indian children in the 

northern Great Plains is 10 times higher, 10 times higher than the 

national average. Ninety percent of all Indian teens who commit 

suicide have a diagnosable mental illness at the time of their 

death. Yet more than half of these young people have never seen 

a mental health professional. 

One effective way to reach these youth who are often in remote 

locations is through tele-medicine. A trained professional, through 

video conference, can do psychiatric assessments, complete diagnostic interviews, intervene with crisis counseling and provide 

needed mental health services. I could not be more pleased to be 

a sponsor of this important legislation. Key provisions of the legislation I believe will help transform how we deliver mental health 

services in this Country. 

It is certainly a step in the right direction. For example, this bill 

authorizes the Department of Health and Human Services to carry 

out a project for tele-mental health services targeted to Native 

American youth. The goal is to provide mental health services to 

5 

those Indian youth who have expressed suicidal thoughts, have attempted suicide or who have mental health conditions that could 

increase the risk of suicide. The legislation would also address the 

barriers Indian tribes and tribal organizations face when applying 

for Substance Abuse and Mental Health Services Administration 

grants. 

The legislation would require that this process be streamlined 

and take into account the unique obstacles that Indian tribes experience when applying for these grants. It would also give priority 

for youth suicide prevention grants to those Indian tribes and tribal organizations that have high youth suicide rates and prevent 

them from being disqualified from the grant application process, 

because they may not have the capability to extensively collect the 

data or have the advanced infrastructure in place to put that data 

there. 

Finally, the bill would encourage the use of pre-doctoral psychology and psychiatry interns to provide mental health services in 

Indian Country where appropriate. Increasing the number of interns will help increase access to services, I believe, and serve as 

a valuable recruitment tool. My hope is that somebody who has 

this experience decides to stay in Indian Country. 

With the impressive advancement technology in tele-medicine 

and with the tools that are at our disposal, living in an isolated 

rural area, which is oftentimes the case in all of our States, should 

not prevent a young person from getting services. I believe, again, 

that this is an important step in the right direction. 

Mr. Chairman, I will wrap up and just say, I so appreciate your 

leadership on this, and the Ranking Member. I said at the first 

hearing I attended on Indian Affairs I thought this was one of our 

key issues to work on. I really think that if we can get started 

today, this will be a step, an important step in the right direction. 

Thank you. 

The CHAIRMAN. Senator Johanns, thank you very much, and 

thanks for your work on and your attention to this issue. It is very 

important to this Committee. 

I am going to call on others here for any statements. I am trying 

to determine, I believe we originally had a vote scheduled at 3:30. 

I am trying to determine whether that is the case. But let me call 

on Senator Barrasso, the Vice Chairman. 

STATEMENT OF HON. JOHN BARRASSO, 

U.S. SENATOR FROM WYOMING 

Senator BARRASSO. Thank you very much, Mr. Chairman. These 

statistics are tragic. The personal stories compel action. It is inconceivable to me now that the Indian Health Service is reporting suicides among children as young as five years old. 

I appreciate this legislation which attempts to address the lack 

of mental health services for these children, especially, as Senator 

Johanns talks about, through the tele-health services. According to 

the Indian Health Service, currently over 30 IHS and tribal facilities in 8 IHS areas are augmenting on-site behavioral health services with tele-behavioral health services. 

This past spring, the previous director of the Indian Health Service testified before this Committee regarding the National Tele-BeVerDate Nov 24 2008 13:09 Apr 20, 2010 Jkt 055174 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 S:\DOCS\55174.TXT JACK PsN: JACKF
6 

havioral Center of Excellence. It was in the planning stages and 

was intended to provide increased access to video-conference-based 

behavioral health services. I hope, Dr. Roubideaux, that you can 

update us on the status of this Center of Excellence. 

I look forward to hearing from all the witnesses on how this legislation can help provide an accountable system for addressing and 

preventing Indian youth suicide. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Senator Barrasso, thank you very much. 

Senator Udall? 

STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM NEW MEXICO 

Senator UDALL. I just wanted to briefly, Chairman Dorgan, say 

thank you again for focusing on this issue, and thank you for focusing our attention on youth suicide in Indian Country. 

The figures that you put up on North Dakota, those figures are 

very similar in New Mexico. We all know we have a national tragedy with this problem. Former Senator Gordon Smith, my cousin, 

also had a young son, Garrett. Garrett committed suicide while 

Gordon was in the Senate. Gordon used that tragedy to provide 

leadership and pass the Garrett Lee Smith Act, which has provided 

grants and momentum to bring some really thoughtful approaches 

to this particular tragedy. 

So I thank you again for bringing our attention to this and really 

look forward to our leaders here giving us the way they see it and 

what they think we need to do. Thank you, Chairman Dorgan. 

The CHAIRMAN. Senator Franken? 

STATEMENT OF HON. AL FRANKEN, 

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. Thank you, Mr. Chairman. 

I have an opening statement that I would like to enter into the 

record, without objection. Because I don’t want to take any more 

time. I, like Senator Johanns, have to leave at a certain point and 

I apologize for that, because this is such an important and tragic 

subject. It is in Minnesota, as well. 

So I would just like to thank the witnesses for being here, and 

I want to thank Senator Johanns for introducing the bill and his 

role in that, and you, Mr. Chairman, and you, Mr. Vice Chairman. 

[The prepared statement of Senator Franken follows:] 

PREPARED STATEMENT OF HON. AL FRANKEN, U.S. SENATOR FROM MINNESOTA

Thank you Chairman Dorgan and Vice-Chair Barrasso for holding this timely and 

important hearing. 

Mr. Chairman, I especially want to thank you—and Senator Johanns—for your 

leadership in introducing the ‘‘7th Generation Promise: Indian Suicide Prevention 

Act of 2009.’’ 

I look forward to working with both of you, and everyone on this Committee, to 

bring this legislation to the floor. 

Over the years, this Committee has held a series of hearings on the issue of Indian youth suicide. I was moved by Chairman Dorgan’s recitation of Dana Lee Jetty’s testimony when he introduced the bill on the Senate floor last month. Ms. Jetty’s testimony about the loss of her 14-year-old sister is just one more sobering reason why this legislation is so badly needed. 

7 

Across the country, American Indian teens commit suicide at a rate at least twice 

the national average. The rate is much higher in the Upper Midwest and Great 

Plains, where it is five to seven times higher than the national average. 

In 2004—one of the most recent years data is available—three teens committed 

suicide on the Red Lake Indian Reservation in Minnesota; and a shocking 69 teems 

attempted it. 

Even more shocking, in a survey of ninth-grade girls at Red Lake High school, 

81 percent said they had thought about suicide at least once in their life; and nearly 

half said they attempted it. 

Sadly, this problem is not just limited to a few reservations. 

Clearly, it is a complex problem with no easy solution. I look forward to hearing 

from our panelists on how to best deal with this. 

The CHAIRMAN. Senator Franken, thank you very much. 

Dr. Roubideaux, I indicated when you took this job, and I was 

very pleased to support your nomination, that you inherited a pretty big task. But I appreciate your doing that, and today we asked 

you to come and talk to us about a very sensitive issue. It is difficult to talk about, and sensitive to talk about the issue of suicide, 

youth suicide. In some cases, some would perhaps sooner not have 

it discussed publicly. But the fact is, we must. We can no longer 

ignore this. 

So let me ask you to begin. We appreciate very much your being 

here. Your entire statement will be a part of the record, I would 

say to all three witnesses. And we would ask that you summarize. 

Dr. Roubideaux? 

STATEMENT OF HON. YVETTE ROUBIDEAUX, M.D., M.P.H., 

DIRECTOR, INDIAN HEALTH SERVICE 

Dr. ROUBIDEAUX. Thank you, Mr. Chairman, Mr. Vice Chairman 

and members of the Committee. 

Good afternoon. My name is Dr. Yvette Roubideaux and I am the 

Director of the Indian Health Service. I appreciate the opportunity 

to testify on S. 1635. 

As you know, the Indian Health Service plays a unique role because it is a health care system that was established to meet the 

Federal trust responsibility to provide health care for the 1.9 million American Indians and Alaska Natives it serves. 

We are acutely aware that many American Indian and Alaska 

Native communities are affected by high rates of suicide. The most 

recent IHS data report that American Indian and Alaska Native 

suicide rate is 1.7 times that of the U.S. all races rate. Suicide is 

the second leading cause of death for Indian youth age 15 to 24, 

and is 3.5 times higher than the national average. American Indian 

and Alaska Native young people age 15 to 34 make up 64 percent 

of all suicides in Indian Country. 

The current system of services for treating mental health problems of American Indians and Alaska Natives 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 American Indians and Alaska Natives varies considerably among tribes. The Indian Health Service Mental Health and 

Social Services program is a community-oriented clinical and preventive mental health services program that provides primarily 

outpatient mental health and related services, crisis triage, case 

management, prevention programming and outreach services. 

8 

As you know, suicide is a complicated public health challenge 

with many contributing factors and barriers to care in American 

Indian and Alaska Native communities. There are many reasons 

for the lack of access to care. Indian Country is predominantly 

rural and remote and local care may be limited. Rural practice is 

often isolating and challenging for its practitioners and even wellseasoned and balanced providers risk burnout. Many of the IHS 

tribal and urban mental health programs that provide services do 

not have enough staff to operate 24/7. Therefore, when an emergency or crisis occurs, the clinics and service units will often contract out such services to non-IHS hospitals and crisis centers. 

Tele-health based behavioral health services are a promising 

strategy to address these access to care issues. We know that these 

services work and are acceptable to many, if not all, of our clinic 

populations. As a system of care, these services are either being 

used or are in planning stages in over 50 Indian Health System 

sites. Services being delivered range from settings including clinics, 

schools, youth and treatment centers. 

We also have the methamphetamine and suicide prevention initiative, which is another coordinated program designed to promote 

the development of evidence-based and promising practices using 

culturally appropriate prevention and treatment to address methamphetamine abuse and suicidal behaviors in a community-driven 

context. IHS is using this funding to establish a national tele-behavioral health center of excellence to provide technical support nationally to programs attempting to implement such services. 

We have preliminary indications that IHS programs are increasingly adopting and using these technologies. IHS is using Recovery 

Act funding to improve our telecommunications infrastructure, to 

increase the reliability and availability of appropriate bandwidth 

across the Indian Health system. We are investing in the infrastructure expansion support and maintenance needed to keep pace 

with potential service demands and to plan for the long-term success of this and any new Indian tele-mental effort. 

We see many benefits of the use of tele-medicine for the treatment of youth suicide. It can connect many isolated programs in a 

web of support with a much larger array of services that is more 

cost-effective and convenient for patients. Such a system could potentially translate into 24/7 access to emergency behavioral health 

services in any setting with an adequate telecommunications service. 

Such a system has other desirable consequences, such as filling 

gaps in provider coverage, allows providers with specialty interests 

to share their skills and knowledge with others in isolated locations, reducing provider burnout and professional isolation and improves recruitment for providers that can live and practice in 

urban areas rather that isolated locations. Families can also participate in care, even when at a distance from their youth. 

We believe tele-health programs can become an integrated part 

of the IHS behavioral health services, strengthen our clinical expertise and expand access to needed behavioral health care. The additional services proposed in this legislation could help facilitate our 

ability to provide needed services. 

9 

In summary, we look forward to opportunities to work with this 

Committee to address the critical problem of youth suicide in Indian Country. 

Mr. Chairman, this concludes my statement. Thank you for the 

opportunity to testify. I will be happy to answer any questions you 

may have. 

[The prepared statement of Dr. Roubideaux follows:] 

PREPARED STATEMENT OF HON. YVETTE ROUBIDEAUX, M.D., M.P.H., DIRECTOR, 

INDIAN HEALTH SERVICE

Mr. Chairman and Members of the Committee: 

Good morning, I am Dr. Yvette Roubideaux, Director of the Indian Health Service 

(IHS). Today, I appreciate the opportunity to testify on S. 1635, 7th Generation 

Promise: Indian Youth Suicide Prevention Act of 2009. 

As you know, the Indian Health Service plays a unique role in the Department 

of Health and Human Services because it is a health care system that was established to meet the federal trust responsibility to provide health care to American 

Indians and Alaska Natives. The IHS provides high-quality, comprehensive primary 

care and public health services through a system of IHS, Tribal, and Urban operated facilities and programs based on treaties, judicial determinations, and Acts of 

Congress. The IHS has the responsibility for the delivery of health services to an 

estimated 1.9 million federally-recognized American Indians and Alaska Natives. 

The mission of the agency is to raise the physical, mental, social, and spiritual 

health of American Indians and Alaska Natives to the highest level, in partnership 

with the population we serve. The agency goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible 

to the service population. Our duty is to uphold the Federal Government’s obligation 

to promote healthy American Indian and Alaska Native people, communities, and 

cultures and to honor and protect the inherent sovereign rights of Tribes. 

Two major pieces of legislation are at the core of the Federal Government’s responsibility for meeting the health needs of American Indians and Alaska Natives: 

The Snyder Act of 1921, P.L. 67–85, and the Indian Health Care Improvement Act 

(IHCIA), P.L. 94–437, as amended. The Snyder Act authorized appropriations for 

‘‘the relief of distress and conservation of health’’ of American Indians and Alaska 

Natives. The IHCIA was enacted ‘‘to implement the Federal responsibility for the 

care and education of the Indian people by improving the services and facilities of 

Federal Indian health programs and encouraging maximum participation of Indians 

in such programs.’’ Like the Snyder Act, the IHCIA provides the authority for the 

provision of programs, services, and activities to address the health needs of American Indians and Alaska Natives. The IHCIA also includes authorities for the recruitment and retention of health professionals serving Indian communities, health 

services for people, and the construction, replacement, and repair of healthcare facilities. 

Background 

Many American Indian and Alaska Native communities are affected by high rates 

of suicide. A wide range of general risk factors contribute to suicide. In the case of 

American Indian and Alaska Native young people, they face, on average, a greater 

number of these risk factors individually or the risk factors are more severe in nature for them. Research suggests that there are factors that protect Native youth 

and young adults against suicidal behavior. These factors are their sense of belonging to their culture, strong tribal spiritual orientation, and cultural continuity. 

The soon to be published IHS ‘‘Trends in Indian Health, 2002–2003’’ reports: 

• The American Indian and Alaska Native suicide rate (17.9) for the three year 

period (2002–2004) in the IHS service areas is 1.7 times that of the U.S. all 

races rate (10.8) 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 higher 

than the national average. 

• Suicide is the 6th leading cause of death overall for males residing in IHS service areas and ranks ahead of homicide. 

• American Indian and Alaska Native young people ages 15–34 make up 64 percent of all suicides in Indian country. 

10 

1Manson, 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. 2 Institute of Medicine (2002). Reducing Suicide: A National Imperative. Goldsmith, S. K., 

Pellmar, T. C., Kleinman, A. M., Bunney, W. E. (Eds.) Washington, DC: National Academies 

Press. 3 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. 4Manson, 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. 5 Ibid. 

6 Ibid. 

On a national level, many American Indian and Alaska Native communities are 

affected by very high levels of suicide, poverty, unemployment, accidental death, domestic violence, alcoholism, and child neglect. 1 According to the Institute of Medicine, an estimated 90 percent of individuals who die by suicide have a mental illness, a substance abuse disorder, or both. 2 According to a 2001 mental health supplement report of the Surgeon General, ‘‘Mental Health: Culture, Race, and Ethnicity’’, there are limited mental health services in Tribal and urban Indian communities. 3 While the need for mental health care is great, services are lacking, and 

access to these services can be difficult and costly. 4

Addressing Suicide Among American Indians 

The current system of services for treating mental health problems of American 

Indians and Alaska Natives 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 American Indians and Alaska Natives varies considerably across communities. 5 American Indian youth are more likely than non-Indian 

children to receive treatment through the juvenile justice system and in-patient facilities. 6

IHS and SAMHSA work closely together to formulate long term strategic approaches to address the issue of suicide 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, CDC, NIMH, 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. 

The Indian Health Service (IHS) is responsible for providing mental health services to the American Indian and Alaska Native 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 service staffed by one or more mental health professionals. 

Many of the IHS, Tribal, and Urban (I/T/U) mental health programs that provide 

services do not have enough staff to operate 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. 

Suicide is a complicated public health challenge with many contributing factors, 

and barriers to care in American Indian and Alaska Native communities. Indian 

Country has communities every year where suicide takes on a particularly ominous 

and seemingly contagious form, 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. While most vividly and painfully expressed in these communities, suicide and suicidal behavior and 

their consequences send shockwaves through many communities in Indian Country, 

including urban communities. The pain only deepens when those seeking help for 

their loved ones in crisis, or those left behind as emotional survivors of such acts, 

are unable to access adequate care. 

There are many reasons for a lack of access to care. Indian Country is predominantly rural and remote, and this brings with it the struggles of providing support 

11 

in settings where appropriate local care may be limited. Rural practice is often isolating for its practitioners. The broad range of clinical conditions faced with limited 

local resources challenge even seasoned providers. Some providers are so overwhelmed by the continuous demand for services, particularly during suicide outbreaks, that even well-seasoned and balanced providers risk burn-out. 

For example, there are situations where the appropriate treatment is known, such 

as counseling therapy for a youth survivor of sexual abuse, but there are simply no 

appropriately trained therapists in the community. One of our IHS Area Behavioral 

Health Consultants told me recently that there was only one psychiatrist in her half 

of a large Western state attempting to serve both the Indian and non-Indian population. Despite years of effort, the IHS Area Office had been unsuccessful in recruiting a fulltime psychiatrist to serve the tribes in that region. 

Over the years, we have attempted to apply a number of remedies to these problems including adopting special pay incentives in order to make reimbursement 

packages more competitive, making loan repayment and scholarship programming 

available for a wide range of behavioral health specialties including social work, 

psychology, and psychiatry, along with active recruitment, development of the Indians into Psychology program, and emergency deployment of the Commissioned 

Corps. 

Indian Tele-health Based Behavioral Health Services 

IHS recognizes the need to support access to services and to create a broader 

range of services tied into a larger network of support and care. As evidenced by 

the Alaska experience, where there are often no workable options other than telehealth based behavioral health services, we know such services work and are acceptable to many if not all of our clinic populations. As another example, a Southwest 

tribe has been providing child and youth-specific tele-behavioral services for the past 

two years and has achieved a show rate of >95 percent for scheduled appointments. 

This is an outstanding rate when other clinics with face to face provider availability 

only achieve a 65–70 percent show rate. 

As a system of care, tele-health based behavioral health services are either actively being used or in planning stages for over 50 Indian health system sites (both 

tribal and federal). They include a range of programming, from a broad variety of 

mental health services, to specific and intermittently available services such as child 

psychiatry consultations. Services are being delivered in a range of settings including clinics, schools, and youth treatment centers. Only within the past five years 

has the telecommunications infrastructure, in some locations, become available and 

reliable enough to be used routinely for clinical care. The lack of infrastructure is 

a significant issue for most tribal communities. 

The Methamphetamine and Suicide Prevention Initiative (MSPI) is another coordinated program designed to provide prevention and intervention resources for Indian Country. This initiative promotes the development of evidence-based and promising practices using culturally appropriate prevention and treatment to address 

methamphetamine abuse and suicidal behaviors in a community-driven context. IHS 

is using the MSPI funding to promote adoption of technologies on a larger, system 

wide basis. For example, in the California and Oklahoma Areas, programs will benefit from MSPI grants supporting increased access through tele-health service delivery. 

MSPI dollars in the amount of $863,000 are also being used to establish a National Tele-Behavioral Health Center of Excellence. An intra-agency agreement was 

signed in early August with our Albuquerque Area Office, which has agreed to take 

the lead on establishing a national center to promote and develop tele-health based 

behavioral health services. They are working in partnership with a number of regional entities including the University of New Mexico and the University of Colorado. The University of New Mexico Center for Rural and Community Psychiatry 

is a leader in the use of tele-health technologies in rural settings. The University 

of Colorado Health Sciences Center and the VA Eastern Colorado Healthcare System are leaders in tele-health outreach to veterans including Indian veterans in the 

northern Plains, the State of New Mexico, and the Tribes and Pueblos of the region. 

Services are provided to a number of settings including school clinics, youth residential treatment centers, health centers, and others. They hope to leverage their ability to use federal service providers and provide technical and program support nationally to programs attempting to implement such services. 

We have been tracking visits to behavioral health clinics using tele-health technology, and have preliminary indications that IHS programs are increasingly adopting and using these technologies. Tele-behavioral health services require adequate 

and reliable bandwidth if they are to be sustainably implemented. Increasing bandwidth utilization strains the telecommunications infrastructure. IHS was fortunate 

12 

to be recipients of ARRA funding to improve our telecommunications infrastructure 

to increase the reliability and availability of appropriate bandwidth across the Indian healthcare system. Approximately $19 million of our Health Information Technology ARRA funding will be spent to provide new routers, switches, and basic 

telecom infrastructure to ensure current needs are met, as well as improve our ability to prioritize traffic over the network. ARRA funding is also supporting a mass 

procurement of state-of-the-art clinical videoconferencing equipment that will be distributed to Tribal, Urban, and Federal care sites depending on need later this fall. 

We are working to improve access to videoconferencing and bandwidth capacity to 

strengthen our telecommunications infrastructure. As one of my providers who is active in telemedicine told me, ‘‘My patients are very patient and are willing to tolerate surprisingly bad connections. But when my image freezes up with regularity 

I may as well be using the telephone.’’ We are investing in the infrastructure expansion, support, and maintenance needed to keep pace with potential service demands 

and to plan for the long term success of this and any new Indian tele-mental effort. 

We see many benefits to the use of telemedicine for the treatment of youth suicide. This technology promises to connect widely separated and often isolated programs of varying sizes together in a web of support. Whereas small clinics would 

need to develop separate contracts for services such as child and adult psychiatric 

support, pooling those needs in a larger pool provides potential access to a much 

larger array of services, and does so more cost-effectively and more conveniently for 

patients. Such a system could potentially move some clinics that are available every 

other Friday afternoon for 4 hours to systems where clinic time for assessments is 

available whenever the patient presents. This could translate into 24/7 access to 

emergency behavioral health service in any setting with adequate telecommunications service and rudimentary clinic staffing. 

Such a system has other desirable consequences such as opportunities for mutual 

provider support. For example, currently when psychiatric providers take vacation,are on sick leave, or are training in places where they are the sole providers, 

there are often either no direct services at that clinic for that time period, or a temporary doctor with limited understanding of the clinic is hired to provide services. 

Sufficient services could be provided via tele-health connections to reduce or eliminate discontinuities in patient care and do so at significantly less expense. Providers 

with particular specialty interests can share those skills and knowledge across a 

broad area even if they themselves are located in an isolated location. Burn out due 

to professional isolation is also decreased as videoconferencing readily supports clinical supervision and case management conferences. Universities providing distancebased learning opportunities have demonstrated for years that educational activities 

can also be facilitated by this technology. Families can participate in care even 

when at a distance from their youth, promoting improved contact and better resolution of home environmental concerns which is often the key issue in a youth 

transitioning successfully from a residential program to home. Recruitment becomes 

less problematic because providers can readily live and practice out of larger urban 

or suburban areas and are thus more likely to continue in service over time with 

sites. The resulting pool of providers accessible for hiring could also increase because relocation to an isolated location may not be necessary. 

It is important to note that the proposed services would require behavioral health 

providers including psychiatrists, psychologists, clinical social workers, and therapists in addition to the telemental health technology. 

The behavioral health services discussed in my testimony today are available or 

will be available to some degree already at 50 federal and tribal sites, or are otherwise unavailable or irregularly available in the Indian health care system. 

As described in my testimony today, IHS supports and indeed is already funding 

many of the activities included in the demonstration grant program outlined in, S. 

1635, the 7th Generation Promise. These activities, including the National Tele-behavioral Health Center of Excellence funded by the MSPI, will also help us understand how to effectively deliver such services, and in particular, will provide more 

focused experience in providing services to Indian youth. We believe tele-behavioral 

programs can become an integral part of the IHS behavioral health services, 

strengthen our clinical expertise in using tele-health services and expand access to 

needed behavioral healthcare. We are working to augment the ability of the IHS 

Tele-behavioral Health Center of Excellence to promote and support such services 

across the Indian health system. The additional services proposed in this legislation 

could help facilitate our ability to provide needed services. 

In summary, we look forward to opportunities to address the critical problem of 

youth suicide in Indian Country. We are committed to using available technologies 

including our growing national telecommunications infrastructure to help increase 

access to sorely needed behavioral health services. For Indian Health Service, our 

13 

business is helping our communities and families achieve the highest level of 

wellness possible. 

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. 

The CHAIRMAN. Dr. Roubideaux, thank you very much for your 

statement and for being here. 

Next we will hear from the Honorable Eric Broderick. Dr. Broderick is the Acting Administrator of the Substance Abuse and Mental Health Services Administration. Dr. Broderick? 

STATEMENT OF HON. ERIC B. BRODERICK, D.D.S., M.P.H., 

ACTING ADMINISTRATOR, SUBSTANCE ABUSE AND 

MENTAL HEALTH SERVICES ADMINISTRATION, U.S. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Dr. BRODERICK. Thank you, Mr. Chairman. 

Mr. Chairman, Mr. Vice Chairman, members of the Committee, 

good afternoon. My name is Eric Broderick. I am the Acting Administrator of the Substance Abuse and Mental Health Services 

Administration within the Department of Health and Human Services. 

Today I am honored to join Dr. Roubideaux as a witness at this 

hearing. I have known Dr. Roubideaux for a number of years, and 

I look forward to expanding our working relationship with the Indian Health Service under her leadership to expand and enhance 

the well-being of American Indians and Alaska Natives. 

Mr. Chairman, I would like to also acknowledge the assistance 

of your staff, specifically John Hart, Erin Bailey and Rhonda Harjo 

for the assistance they provided us at SAMHSA in addressing and 

engaging issues of concern to Indian Country. Thank you for the 

opportunity to testify about suicide in Indian Country. As you have 

said, it is an extremely serious issue. The data are very clear, and 

bear our close attention. 

I regret that since I last testified, as you pointed out, there has 

been a tragic cluster of suicide on the Standing Rock Sioux Reservation. Mr. Chairman, SAMHSA staff, accompanied by your staff, 

visited Standing Rock on the 20th of July of this year, met with 

Chairman His Horse Is Thunder, as well as members of the chairman’s staff, other tribal leaders, reservation program coordinators 

and tribal community members. Based upon this visit, SAMHSA 

has submitted a report to this Committee. The report focuses on 

issues at Standing Rock and is consistent with the testimony I provided at previous hearings. 

During our visit, the director of the Boys and Girls Club of the 

Grand River area of the Standing Rock Reservation reported that 

at Standing Rock, there is an unemployment rate of 74 percent, 85 

percent of the tribal members live in poverty, violent crime is six 

times the national average and the high school graduation rate is 

49 percent, compared with 76 percent nationally. These statistics 

provide a glimpse of the risk factors American Indians and Alaska 

Native youth face in their communities. We know that protective 

factors such as tribal culture, sports, recreation and academic programs can mitigate these risk factors. We also know that adequate 

mental health services and substance abuse services for those in 

need are extremely important. 

14 

Unfortunately, in many communities, these protective factors 

and essential health services are not always available. Federal, 

State and tribal governments must work together to address this 

problem, and we at SAMHSA are committed to the effort. 

In order to create an opportunity for systematic feedback and 

guidance from elected tribal officials, we at SAMHSA created and 

staffed a tribal advisory committee comprised of elected tribal officials from across the Nation. The committee has been in place for 

two years and provides us with valuable assistance in working with 

tribal communities and understanding the issues of importance to 

Indian Country. 

Additionally, over the past three years, SAMHSA has co-hosted 

with the Department of Justice Office of Justice Programs, Office 

of Violence Against Women, Office of Victims of Crime and the 

COPS program, as well as the Department of Interior, Department 

of Housing and Urban Development, the Small Business Administration and the HHS Office of Minority Health and the Indian 

Health Service nine technical assistance and consultation sessions. 

These tribal justice, safety and wellness conferences were created 

at the request of tribal leadership and provide the opportunity to 

both consult with tribal leaders on issues at the nexus of public 

health and public safety that are of concern to them as well as to 

provide technical assistance aimed at raising tribal grantsmanship 

capacity. Youth suicide has been raised as a concern at every one 

of these sessions. 

I believe that this ongoing commitment to the development of 

tribal capacity is largely responsible for the doubling of SAMHSA 

grants awarded to tribes between 2006 and 2008. However, I also 

believe that much more can be done. 

It has been our experience that giving blanket priority to certain 

groups, to specific drug types or to specific mental illnesses in a 

grant application process often fails to produce the desired results. 

As an alternative, I would like to share with you what has proven 

effective for us at SAMHSA. We understand the value of providing 

tribes and tribal organizations additional resources to develop infrastructure needed to submit competitive grant applications and to 

administer grants when funds are awarded. For example, in evaluating the Children’s Mental Health Initiative, we have found that 

many American Indian and Alaska Native tribes were unsuccessful 

in competing for our Systems of Care grants because they did not 

have the infrastructure to draft or to plan for such new programs. 

The Children’s Mental Health Initiative provides funding to local 

communities, including American Indian and Alaska Native communities, to develop systems to care for children with serious mental illness. In response to that finding, SAMHSA developed the Circles of Care grants, which are three-year discretionary infrastructure grant programs for American Indian and Alaska Native tribes 

and tribal organizations to plan for and develop community-based 

systems of care for children with serious mental illness. There have 

been 16 tribes or tribal organizations who have received Circles of 

Care grants. Of those 16, 12 have been successful in becoming Systems of Care grantees and implementing the models they have developed as a result of their Circle of Care grants. 

15 

Mr. Chairman, when we consider ways to help tribal communities prevent youth suicide, I would recommend that we consider 

similar strategies to expand tribal capacity. Currently, fully onethird of our Garrett Lee Smith grants have been awarded to tribes 

and tribal communities. Eighteen of 54 grants now go to tribes. 

They have been successful and very competitive in that environment. 

But to build upon that tremendous success of tribes, I would suggest that the Circles of Care grant model, relative to suicide prevention, is one worthy to consider. Creation of planning grants for 

suicide prevention would build upon SAMHSA’s Native Aspirations 

program, as well as to develop much-needed capacity to develop 

programming and permit tribes to successfully compete for grants 

to implement those programs. These planning grants should target 

communities that currently do not possess the capacity to successfully compete for Federal grants. Not only would this approach direct resources to communities of extremely high need, it would also 

create the capacity for solid administration and implementation of 

those grants. 

Thank you for the opportunity to testify, sir. I would be happy 

to answer any questions for the Committee. 

[The prepared statement of Dr. Broderick follows:] 

PREPARED STATEMENT OF HON. ERIC B. BRODERICK, D.D.S., M.P.H., ACTING

ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

ADMINISTRATION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Mr. Chairman and Members of the Committee, good afternoon. I am Eric B. Broderick, D.D.S., M.P.H., Acting Administrator of the Substance Abuse And Mental 

Health Services Administration (SAMHSA) within the Department of Health and 

Human Services and Assistant Surgeon General. 

SAMHSA and the Indian Health Service (IHS) work closely together to formulate 

long-term strategic approaches to address the issue of suicide in Indian Country 

more effectively. For example, SAMHSA and IHS are actively involved on the Federal Partners for Suicide Prevention Workgroup. In 2001, the Office of the Surgeon 

General coordinated the efforts of numerous HHS agencies, including SAMHSA, 

IHS, the Centers for Disease Control and Prevention, the National Institute of Mental Health within the National Institutes of Health, and the Health Resources and 

Services Administration, along with 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. SAMHSA also helped facilitate and participated in a 

Federal Partners Committee on Telemental Health. 

While I am very pleased to be here today to talk about suicide rates among American Indians and Alaska Natives, I regret that since I testified the last time, the 

problem has not improved. I am saddened to note that we have faced yet another 

episode of suicides among American Indians and Alaska Natives, this time on the 

Standing Rock reservation where there have been ten recorded suicides, primarily 

among the younger population since January of this year. 

Along with representatives of the Chairman, we visited the reservation on July 

20 and met with Chairman Ron His Horse is Thunder as well as members of the 

Chairman’s staff, tribal leaders, reservation program coordinators and tribal community members. Based on this visit, SAMHSA submitted a report to the Committee. The report repeats much of what I and the previous IHS Director have testified about in previous hearings, except due to the recent increased loss of youth to 

suicide, the report is specific to the Standing Rock Sioux Tribe July visit. 

Despite the attention that suicide among American Indians and Alaska Natives 

deserves and gets, especially from the Committee and the Department, we, as a nation, continue to experience very high rates of suicide among Native Americans and 

Alaska Natives. In the case of Standing Rock, a cluster of youth suicide completions 

16 

devastated the reservation despite suicide specific funding from SAMHSA through 

the Garrett Lee Smith (GLS) State/Tribal Suicide Prevention Grants. 

Program staff for the GLS grant, known as Oniyape, are deeply dedicated to their 

suicide prevention program. Community members told us that staff supporting this 

grant have their hands full just trying to intervene with the large number of youth 

and families most at risk for suicide. 

Programs that help increase protective factors to offset the risk factors that exist 

among the tribe—such as sports, recreation, cultural, and academic support programs—are scarce on the Reservation. Where such resources do exist, inadequate 

financial and human resources limit outreach and activity level they can provide. 

During the recent crisis, the Boys and Girls Club of the Grand River Area of the 

Standing Rock Reservation served as the de facto crisis center for the community. 

It provided—and continues to provide—support, meetings with families, and grief 

counseling to the youth following the recent suicides. Parents and grandparents approached Club staff at work, on the street, and at their homes, asking if they could 

help their child or grandchild. Club staff made referrals, ensured the youth were 

involved in the Club’s programs, checked in on the youth, and listened to and supported the adults. 

With the suicide rates so high, tribal members report that many individuals at 

risk struggle with: 

• Maintaining intimate relationships 

• Trusting and being trusted 

• Working in teams with others 

• Persevering when problems arise 

• Functioning as parents 

• Holding a job—if jobs exist 

• Stopping harmful behaviors such as alcohol and drug abuse or family violence. 

These reactions only create a deeper sense of isolation, depression, and substance 

abuse which often lead to suicidal thoughts and actions. 

This problem requires a public health approach that works to decrease risk factors and increase protective factors. This may very well take a concerted effort by 

the Federal, State, and Tribal Governments. It will take time. 

In the meantime, we support programs such as the Garrett Lee Smith State/Tribal Grants and other efforts supported by the SAMHSA and the Indian Health Service and consider ways of intervening such as finding ways to support mental health 

and substance abuse services for American Indian and Alaska Native tribes and 

tribal organizations. 

We provide technical assistance to tribes and encourage them to apply for funding. All of our grants, except those that are restricted by statute, are open to American Indians and Alaska Natives tribes and tribal organizations, and we have been 

working hard to increase funding to American Indian and Alaska Native tribes or 

tribal organizations. They may apply directly for discretionary funds without going 

through the State, and we have facilitated the application process. 

As a result of this effort, the amount of funding to American Indian and Alaskan 

Native tribes and tribal organizations, especially with respect to suicide prevention, 

now totals over $60 million a year. Standing Rock has been very successful in competing and receiving grant funds from SAMHSA. Besides a Garrett Lee Smith State/ 

Tribal grant, they also have a Circles of Care grant, an inter-departmental (HHS 

and Education) Safe Schools/Healthy Students grant, and a Targeted Capacity 

Grant for substance abuse treatment. 

SAMHSA’s Role in Better Serving American Indian and Alaska Native 

Populations 

SAMHSA provides national leadership for suicide prevention, consistent with the 

National Strategy for Suicide Prevention. We have four major suicide prevention initiatives that I will highlight briefly today. These initiatives include the Garrett Lee 

Smith Youth Suicide Prevention Grant Program, the Native Aspirations Project, the 

Suicide Prevention Resource Center, and the Suicide Prevention Lifeline. 

Garrett Lee Smith Youth Suicide Prevention Grant Program 

As a result of the authorization provided by the Garrett Lee Smith Memorial Act 

(P.L. 108–355), SAMHSA has been working with state and local governments and 

community providers to further stem the number of youth suicides in our country. 

In 2005, we awarded the first cohort of grants, 14 in all, under the Garrett Lee 

Smith Memorial Act State/Tribal Suicide Prevention program. These funds are 

available to help States/Tribes implement a State-wide/Tribe-wide suicide prevenVerDate Nov 24 2008 13:09 Apr 20, 2010 Jkt 055174 PO 00000 Frm 00020 Fmt 6633 Sfmt 6621 S:\DOCS\55174.TXT JACK PsN: JACKF
17 

tion network. One of those first set of grants went to the Native American Rehabilitation Association in Oregon. 

Awards were again made in 2006 and 2007, during which six Tribes/Tribal Organizations were awarded grants. In August 2008, 12 Tribes/Tribal Organizations received Garrett Lee Smith grants, totaling one-third of the number of grant awards. 

This is not only a direct result of outreach and technical assistance, but a true indication of the resolve of Tribes and Tribal Organizations to proactively seek Requests 

for Application and then put forward strong, viable applications. Additionally, it is 

important to note that many of the states which received grant awards are 

partnering with and/or reaching out to include suicide prevention efforts in their 

local tribal communities. 

Among the newest cohort of grants the Tribes/Tribal Organizations awardees include: the Gila River Behavioral Health Authority Youth Suicide Prevention Project, 

The Gila River Indian Community, Sacaton, Arizona; Omaha Nation Community 

Response Team—Project Hope, Walthill, Nebraska; Mescalero Apache School Youth 

Suicide Prevention and Early Intervention Initiative, Mescalero, New Mexico; 

Wiconi Wakan Health & Healing Center, Rosebud Sioux Tribe, Rosebud, South Dakota; Circle of Trust Youth Suicide Prevention Program, The Confederated Salish 

Kootenai Tribes of the Flathead Indian Nation, Pablo, Montana; Preserving Life: 

Nevada Tribal Youth Suicide Prevention Initiative, Inter-Tribal Council of Nevada, 

Sparks, Nevada; Youth Suicide Prevention, The Crow Creek Sioux Tribe, Ft. 

Thompson, South Dakota; Tribal Youth Suicide Prevention Program, Oglala Sioux 

Tribe, Pine Ridge, South Dakota; Wiconi Ohitika Project, Cankdeska Cikana Community College, Fort Totten, North Dakota; Sault Tribe Alive Youth (STAY) Project, 

Sault Ste Marie Tribe Chippewa Indians, Sault Ste Marie, Michigan; Bering Strait 

Suicide Prevention Program, Kawerak, Inc., Nome, Alaska; and the Native Youth 

Suicide Prevention Project, Native American Rehabilitation Association, Portland, 

Oregon. 

Overall, 54 states, tribes, and tribal organizations, as well as more than 50 colleges and universities, will be receiving funding for youth suicide prevention 

through this program. Again, it is important to note that with the new tribal grantees, one third of all of the Garrett Lee Smith State and Tribal grants will be going 

to tribes or tribal organizations. 

Native Aspirations Project 

SAMHSA funds the Native Aspirations project, which is a national project designed to address youth violence, bullying, and suicide prevention through evidencebased interventions and community efforts. Through the Native Aspirations project, 

a total of 25 American Indian and Alaska Native communities determined to be the 

most ‘‘at risk’’ develop or enhance a community-based prevention plan. 

After a community is selected, the first step is an initial visit from Native Aspirations project staff members, who share information and help community leaders set 

up an oversight committee. The second step is the Gathering of Native Americans 

(GONA), a 4-day event designed to offer hope, encouragement, and a positive start. 

GONA events are based on each community’s traditional culture and honor American Indian and Alaska Native values. GONA events are a safe place to share, heal, 

and plan for action. 

Within a month of a GONA, Native Aspirations staff facilitate a 2-day planning 

event. At this event, participants receive training about prevention plans and decide 

which model to follow. They outline a customized plan based on actions that have 

worked for others. As the community finalizes and carries out its plan, Native Aspirations provides ongoing training, consultation, technical assistance, and budget 

support. 

Suicide Prevention Resource Center 

Another initiative is the Suicide Prevention Resource Center (SPRC) which is a 

national resource and technical assistance center that advances the field by working 

with states, territories, tribes, and grantees and by developing and disseminating 

suicide prevention resources. The SPRC was established in 2002. It supports suicide 

prevention with the best of available science, skills and practice to advance the National Strategy for Suicide Prevention (NSSP). SPRC provides prevention support, 

training, and resource materials to strengthen suicide prevention networks and is 

the first federally funded center of its kind. 

The Suicide Prevention Lifeline 

The last major initiative I will highlight today is the National Suicide Prevention 

Lifeline. The National Suicide Prevention Lifeline is a network of 141 crisis centers 

across the United States that receives calls from the national, toll-free suicide prevention hotline number, 800–273–TALK. 

18 

The network is administered through a grant from SAMHSA to Link2Health Solutions, an affiliate of the Mental Health Association of New York City. Calls to 

800–273–TALK are automatically routed to the closest of 141 crisis centers across 

the country. Those crisis centers are independently operated and funded (both publicly and privately). They all serve their local communities in 49 states and operate 

their own local suicide prevention hotline numbers. They agree to accept local, state, 

or regional calls from the National Suicide Prevention Lifeline and receive a small 

stipend for doing so. (In Idaho, the only state that does not currently have a participating crisis center, the calls are answered by a crisis center in a neighboring state.) 

Every month, nearly 52,000 people have their calls answered through the National 

Suicide Prevention Lifeline, an average of 1,852 people every day. 

When a caller dials 800–273–TALK, the call is routed to the nearest crisis center, 

based on the caller’s area code. The crisis worker will listen to the person, assess 

the nature and severity of the crisis, and link or refer the caller to services, including Emergency Medical Services when necessary. If the nearest center is unable to 

pick up, the call automatically is routed to the next nearest center. All calls are free 

and confidential and are answered 24 hours a day, 7 days a week. 

By utilizing a national network of crisis centers with trained staff linked through 

a single national, toll-free suicide prevention number, the capacity to effectively respond to all callers, even when a particular crisis center is overwhelmed with calls, 

is maximized. This also provides protection in the event a crisis center’s ability to 

function is adversely impacted, for example, by a natural disaster or a blackout. 

Further, by utilizing the national number 800–273–TALK, national public awareness campaigns and materials can supplement local crisis centers’ efforts to help as 

many people as possible learn about and utilize the National Suicide Prevention 

Lifeline. In fact, SAMHSA has consistently found that when major national efforts 

are made to publicize the number, the volume of callers increases, and this increased call volume is maintained over time. 

The National Suicide Prevention Lifeline’s American Indian initiative has worked 

to promote 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. 

We are pleased that we have been able to work together with the American Indian/Alaskan Native Communities and also with the Department of Veterans Affairs 

(for veterans using the Lifeline) to help deliver the critically important messages 

that suicide is preventable, and that help is available. All Americans have access 

to the National Suicide Prevention Lifeline during times of crisis, and we are committed to sustaining this vital, national resource. 

In addition to the four funding programs outlined above, SAMHSA has also provided funding for an expanded evaluation of Garrett Lee Smith-funded grant activities in the White Mountain Apache tribe, focusing on Emergency Department interventions and follow up with American Indian youth who have made suicide attempts. In this innovative approach, Apache paraprofessionals provide outreach in 

the community to each youth who has been reported to attempt suicide or to experience suicidal thoughts. By electronic means, these outreach workers are provided 

remote supervision by a child psychiatrist, psychologist and clinical team from the 

Johns Hopkins University Center for American Indian Health. In addition, last 

year, SAMHSA sponsored a meeting to examine the tragedy of suicide clusters in 

Indian Country. 

These SAMHSA initiatives are an important start, but we know there is much 

more to be done to reduce the tragic burden of suicide in Indian Country. The problems confronting American Indian and Alaska Natives are taking a toll on the future these communities. 

Mr. Chairman and Members of the Committee, thank you for the opportunity to 

appear today. I will be pleased to answer any questions you may have. 

The CHAIRMAN. Dr. Broderick, thank you very much for being 

here. 

Next we will hear from Dr. Dolores Subia BigFoot, Director of 

the Indian Country Child Trauma Center and the Project Making 

Medicine at the University of Oklahoma Health Sciences Center. 

She is testifying on behalf of the American Psychological Association. 

You may proceed. Thank you for being with us. 

19 

STATEMENT OF DOLORES SUBIA BIGFOOT, PH.D., DIRECTOR, 

INDIAN COUNTRY CHILD TRAUMA CENTER AND PROJECT 

MAKING MEDICINE, UNIVERSITY OF OKLAHOMA HEALTH 

SCIENCES CENTER 

Dr. BIGFOOT. Chairman Dorgan, members of the Committee, this 

is both a personal and a professional effort. First, please allow me 

to express my appreciation for the opportunity to speak on behalf 

of the 150,000 members and affiliates of the American Psychological Association. My name is Dr. Dolores Subia BigFoot, and I 

bring goodwill from the Caddo Nation of Oklahoma in which I am 

enrolled, and from the Northern Cheyenne Tribe in Montana, in 

which my children are enrolled. 

I am a child counseling psychologist by training and have devoted 35 years to addressing health disparities in its many different forms within our tribal nations. Thank you for convening 

this important hearing to discuss the need to reduce, to eliminate 

and to reveal the devastation of suicide within our American Indian and Alaska Native youth through the development of Federal 

legislation. 

As the Director of Project Making Medicine and the Indian Country Child Trauma Center at the University of Oklahoma Health 

Sciences Center, I profoundly understand the need for safety for 

our youth. There are many diligent and dedicated people who are 

concerned and working to address this same need for safety and to 

provide appropriate mental health and other culturally-appropriate 

interventions that can help prevent suicide. 

Project Making Medicine is funded by the Office of Child Abuse 

and Neglect, the Children’s Bureau and the Indian Country Child 

Trauma Center was funded from 2003 to 2007 by the Substance 

Abuse and Mental Health Services Administration as part of the 

National Child Traumatic Stress Network. We currently remain a 

very active affiliate member of this network, which is an important 

Congressional initiative that works to raise the standard of care for 

traumatized children and their families. 

It is also important to acknowledge the critical role of SAMHSA’s 

youth suicide prevention and early intervention programs created 

under the Garrett Lee Smith Memorial Act. The rates of suicide 

among our youth has been drastically illustrated by the charts that 

were shown. They are disproportionately high and we must work 

to address these preventable, yes very preventable, tragedies. 

Mr. Chairman, as I am sure you know, given your steadfast commitment to addressing this tragic problem, high suicide rates have 

significant impact on families, siblings, peers, and the community 

as a whole. While progress has been slow in understanding suicide 

from a cultural perspective, we know that both historical and current traumatic stressors in Indian Country affect our youth. I think 

that by the bill earlier referenced, regarding violence in Indian 

Country, it is very self-evident. 

The self-harm responses that youth may exhibit are much like 

those of other individuals exposed to collective trauma, such as our 

combat veterans that are returning and their high rate of suicide, 

such as the first responders, firefighters and police officers, like 

those involved in the Oklahoma City bombing. I am aware of those 

20 

that committed suicide after that. And of course, those after 9/11. 

Tragedy has an impact. Trauma has an impact. 

Despite the challenges facing our American Indian and Alaska 

Native communities, we remain optimistic and hopeful. Organizations such as the National Congress of American Indians, the National Indian Health Board, National Council of Urban Indian 

Health, along with tribes and the Indian Health Service, has been 

formulating best practices related to suicide prevention that will 

help our youth. These efforts focus on developing a better understanding of what would lead youth to consider suicide. 

While we know that suicide typically occurs as a single individual act, suicide cannot be understood in isolation. Instead, we 

must consider the various precipitating factors, including child 

maltreatment, family violence, mental health problems, trauma, 

loss, grief and pain that are associated with feelings of hopelessness and the lack of safety among our youth. 

Our youth are in desperate need of safe homes, safe families and 

safe communities. Chronic under-funding of tribal and urban programs and a lack of infrastructure and human resources, as described earlier, create barriers for our youth. We must provide appropriate resources and opportunities to immediately empower and 

support our population to build our capacity to address the needs 

of our youth. 

Currently, there are insufficient numbers of psychologists and 

other mental health providers of Indigenous heritage. Two vital 

Federal initiatives in place to help address this problem are the Indians Into Psychology program and the Minority Fellowship program, funded by the Indian Health Service and SAMHSA, respectively. These programs have a strong history of success and are 

critical to building the ethnic minority pipeline. As such, it is important that increased funding is provided for these initiatives. 

At the same time, while we work to build the sufficient professional workforce, tribal communities require immediate and innovative resources to meet the urgent needs of our youth and families. At the University of Oklahoma Health Sciences Center, we 

currently utilize a video-conferencing system through the internet 

in which we are training via real-time mental health providers in 

tribal communities. We have done this in the State of Washington, 

we have done it in California and Utah and Oregon and Alaska 

and across Oklahoma. 

The National Child Traumatic Stress Network is also developing 

a sophisticated distance learning system that can help providers 

access the specific training they need. I strongly recommend the 

continued support and expansion of the National Child Traumatic 

Stress Network as an important resource to ensure that we have 

a national infrastructure of child trauma experts and providers 

who can meet the diverse needs of our youth. 

We appreciate your efforts to develop the Seventh Generation 

Promise: Indian Youth Suicide Prevention Act of 2009. How well it 

is that we should think seven generations ahead. 

This legislation aims to increase and enhance the provision of 

mental health care for American Indians and Alaska Native youth 

by decreasing disparities in access and improving quality of mental 

health care. We look forward to working with Congress, the Indian 

21 

Health Service, the Children’s Bureau and SAMHSA as this proposal moves through the legislative process. 

We cannot be silent and so I will add, my own family loss, my 

beautiful, precious son of 33 years died 10 months ago today. His 

death certificate does not say suicide. However, his self-harm behavior created a situation in which injury resulted in his death. 

The outcome was the same. He was traumatized by someone outside the family that I have no knowledge about until he informed 

me as an adult. And by that time, as we tried to untangle all of 

the webs that tore at his heart, tore at his spirit, tore at his mind. 

It was very difficult. 

So his death was a result of self-harm. He chose not to seek medical care and knew that he would die. There are many of those in 

similar situations beyond what we see in terms of the statistics 

that are taking their own lives, and it is not reported as a suicide. 

Mr. Chairman, members of the Committee, I am honored. My 

family is honored and my tribe is honored by this invitation to join 

you today. But especially my son, Bryce Buffalo Man BigFoot is 

honored that his mother can voice his cry that help is so desperately needed. The American Psychological Association and the 

Psychology Committee looks forward to continuing to work with 

you and the tribal communities to ensure that our youth receive 

the mental and behavioral health care that they urgently need and 

deserve. 

I must also acknowledge and honor the warrior woman that sits 

here and her diligence in bringing so much to this table and to our 

communities. So I honor you. 

I am willing and open and eager to answer any questions you 

have. 

[The prepared statement of Dr. BigFoot follows:] 

PREPARED STATEMENT OF DOLORES SUBIA BIGFOOT, PH.D., DIRECTOR, 

INDIAN COUNTRY CHILD TRAUMA CENTER AND PROJECT MAKING MEDICINE, UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER

Chairman Dorgan, Ranking Member Barrasso, and members of the Committee, 

please allow me to express appreciation for the opportunity to speak on behalf of 

the 150,000 members and affiliates of the American Psychological Association. My 

name is Dr. Dolores Subia BigFoot and I bring good will from the Caddo Nation 

of Oklahoma in which I am enrolled and from the Northern Cheyenne Tribe in Montana in which my children are enrolled. I am a child psychologist by training and 

have devoted 35 years to addressing health disparities in its many forms within our 

Tribal Nations. Thank you for convening this important hearing to discuss the need 

to reduce, eliminate, and reveal the devastation of suicide with our American Indian 

and Alaska Native (AI/AN) youth through the development of federal legislation. 

As Director of Project Making Medicine and the Indian Country Child Trauma 

Center at the University of Oklahoma Health Sciences Center, I profoundly understand the need for safety among our AI/AN youth. There are many diligent and 

dedicated people who are concerned and working to address this same need for safety, and to provide appropriate mental health and other culturally appropriate interventions that can help prevent suicide. Project Making Medicine is funded by the 

Office of Child Abuse and Neglect, Children’s Bureau, and the Indian Country Child 

Trauma Center was funded from 2003–2007 by the Substance Abuse and Mental 

Health Services Administration’s (SAMHSA) National Child Traumatic Stress Network. We currently remain a very active affiliate member of this Network, which 

is an important congressional initiative that works to raise the standard of care for 

traumatized children and families. It is also important to acknowledge the critical 

role of SAMHSA’s Youth Suicide Prevention and Early Intervention Programs created under the Garrett Lee Smith Memorial Act. 

22 

Physical, mental, and behavioral health problems continue to affect the AI/AN 

communities at alarming rates. I am particularly concerned about the disproportionately high prevalence of mental and behavioral health problems among our nation’s 

AI/AN population, including suicide and suicidal ideation. The statistics regarding 

suicide in the AI/AN communities are astonishing. Research indicates that American Indians account for nearly 11 percent of total suicides in the United States. 

The suicide rates among youth are also deeply tragic. Of the approximately five million people who are classified as AI or AN in our country, 1.2 million are under the 

age of 18, which comprises 27 percent of this group. This is particularly significant 

because in 2006, suicide was the second leading cause of death for AI/AN individuals between the ages of 10 and 34. Furthermore, among AI/AN youth attending 

Bureau of Indian Affairs schools in 2001, 16 percent had attempted suicide in the 

12 months preceding the Youth Risk Behavior Survey. 

From 1999 to 2004, AI/AN males between the ages of 15 to 24 had the highest 

rates of suicide as compared to other age or ethnic groups, 27.99 per 100,000. This 

age group accounts for 64 percent of all AI/AN suicides. Unfortunately, more than 

half of all persons who die by suicide in AI/AN communities were never seen by a 

mental health provider. 

Mr. Chairman, as I am sure you know given your steadfast commitment to addressing this tragic problem, high suicide rates have a significant impact on siblings, peers, family members, and communities as a whole. 

It is also important to acknowledge the cultural aspects associated with suicide 

in our AI/AN communities. While progress has been slow in understanding suicide 

from a cultural perspective, we know that both the historical and current traumatic 

stressors in Indian Country affect our youth. The self harm responses that they may 

exhibit are much like those of other individuals exposed to collective trauma, such 

as service members/veterans, prisoners of war, and first responders (e.g., firefighters, police officers). 

Despite the challenges facing our AI/AN communities, we remain optimistic and 

hopeful. The National Congress of American Indians, along with Tribes and the Indian Health Service, has been formulating best practices related to suicide prevention that will help our youth. These efforts focus on developing a better understanding of what would lead youth to consider suicide. While we know that suicide 

typically occurs as a single individual act, suicide cannot be understood in isolation. 

Instead, we must consider a variety of precipitating factors, including child maltreatment, family violence, mental health problems, trauma, loss, grief, and pain 

that are associated with feelings of hopelessness and a lack of safety among our 

youth. 

The unfortunate and often forgotten reality is that there is an epidemic of violence 

and harm directed towards this very vulnerable population. AI/AN children and 

youth experience an increased risk of multiple victimizations. Their capacity to function and to regroup before the next emotional or physical assault diminishes with 

each missed opportunity to intervene. These youth often make the decision to take 

their own lives because they feel a lack of safety in their environment. Our youth 

are in desperate need of safe homes, safe families, and safe communities. 

Chronic underfunding of tribal community programs and a lack of infrastructure 

and human resources create barriers for AI/AN youth. We must provide appropriate 

resources and opportunities to immediately empower and support our population to 

build their capacity to address the needs of our youth. Currently, there are an insufficient number of psychologists and other mental health providers of Indigenous heritage. Two vital federal initiatives in place to help address this problem are the Indians Into Psychology Program and the Minority Fellowship Program, funded by the 

Indian Health Service and SAMHSA, respectively. These programs have a strong 

history of success and are critical to building the ethnic minority pipeline. As such, 

it is important that increased funding is provided to these initiatives to meet the 

current mental and behavioral health needs of our population. At the same time, 

while we work to build a sufficient professional workforce, tribal communities require immediate and innovative resources to meet the urgent needs of our youth 

and families. 

At the University of Oklahoma Health Sciences Center, we are currently utilizing 

a video conferencing system through the Internet in which we are training via real 

time mental health providers in tribal communities in Washington State. In the 

past, we have trained via Internet tribal providers located in Alaska, California, 

Utah, and across Oklahoma. The National Child Traumatic Stress Network is also 

developing a sophisticated distance learning system that can help providers access 

the specific training they need when working with AI/AN youth and families. I 

strongly recommend the continued support and expansion of the National Child 

Traumatic Stress Network as an important resource to ensure that we have a naVerDate Nov 24 2008 13:09 Apr 20, 2010 Jkt 055174 PO 00000 Frm 00026 Fmt 6633 Sfmt 6621 S:\DOCS\55174.TXT JACK PsN: JACKF
23 

tional infrastructure of child trauma experts and providers who can help to meet 

the diverse needs of our youth. 

This past June, we traveled to Anchorage, Alaska to provide a Mental Health 

First Aid training for individuals from the villages or Native corporations who were 

interested in developing basic skills in assisting those experiencing mental or behavioral health problems, including suicide risk. Unfortunately many village providers 

and other village helpers who expressed interest in the training were unable to attend given the lack of transportation resources. With telehealth capability, such barriers might be overcome to enable the delivery of critical mental health and suicide 

prevention education and training in remote or less accessible areas and to large 

groups of community members. 

We appreciate your efforts in developing the 7th Generation Promise: Indian 

Youth Suicide Prevention Act of 2009. This legislation aims to increase and enhance 

the provision of mental health care to AI/AN youth by decreasing disparities in access and improving quality of mental health care. We look forward to working with 

Congress, the Indian Health Service, the Children’s Bureau, and SAMHSA as this 

proposal moves through the legislative process. 

Mr. Chairman, Ranking Member, and members of the Committee, I am honored, 

my family is honored, and my tribe is honored by this invitation to join you here 

today. The American Psychological Association and the psychology community look 

forward to continuing to work with you and the tribal communities to ensure that 

our youth receive the mental and behavioral health care that they urgently need 

and deserve. I would be pleased to answer any questions. 

24 

Attachment 


910a1.eps
25 


910a2.eps
26 


910a3.eps
27 


910a4.eps
28 


910a5.eps
29 

The CHAIRMAN. Dr. BigFoot, thank you very much for being with 

us and for your testimony. I know that the spirit of your son would 

be very proud of his mother today for being with us. 

I think this issue is so difficult, it is especially more difficult 

when it requires a discussion of a loved one. I have, well, first of 

all, I have some experience, having walked into a room and found 

a friend who had taken his own life. So I know something about 

the shock and the trauma of walking into a room and seeing a 

friend who has taken his life, something that you never, ever, ever 

forget. 

It is especially tragic when it is a child, because that is someone 

whose life is in front of them and extinguished because of feelings 

of helplessness and hopelessness. So what we are trying to think 

through is, what causes all of this? We understand that part of the 

roots reflect the difficulties of living in third world conditions. You 

don’t have to go to a third world country to see third world conditions. It too often exists here in America on Indian reservations. I 

have gone to a reservation where there was a cluster of teen suicides and just sat around a large table with a group of teenagers, 

no other adults present. And I said, just tell me about your lives. 

Many of you knew the young kids that took their own lives. Tell 

me about them, tell me about what you think. 

It is an extraordinary lesson to learn from the mouths and the 

minds of young people, to hear about their existence and their concerns. So there are a number of things, I think, that play a role 

here. One of the things that I think is a bright spot are the youth 

clubs and the youth centers and so on that are doing unbelievable 

work with very little funding and very little accolades for what 

they do. 

We are trying today to think through, what is it we can do. Let 

me just tell you one more story, then I will ask you some questions. 

I held a hearing once in Bismarck, North Dakota. It was on the 

subject, again, an extraordinarily difficult, sensitive subject, and 

that was child sexual abuse. A young woman testified from one of 

our reservations. She was in her mid-twenties. And she had been 

hired on that reservation to work on these issues. 


910a6.eps
30 

And she was the recipient, then, of the complaints. She began to 

testify at this hearing. She described that on her desk was a pile 

of complaints of child sexual abuse that had not been investigated 

by law enforcement. And she began to describe that just taking one 

of those complaints and talking to one of those children and finding 

a need to take one of those children to a professional somewhere 

in a medical facility, that in order to do that, she had to try to find 

a way to beg or borrow a car in order to have the transportation 

to get this person to a professional. 

At that point in the discussion she just began to sob and weep, 

I am talking about the woman on the, in this case, the Spirit Lake 

Nation. She just couldn’t continue, thinking about the impossibility 

of her job. She quit her job several months later. 

But the point is, somewhere stacked in those files was, I am certain, tragedy occurring with a young child, not even investigated. 

So when we ask the question, what leads to this feeling of hopelessness and helplessness, what leads to suicide, there are many 

causes, but not the least of which, in my judgment, is just the lack 

of basic resources that exist routinely and are expected to exist routinely by parents in most other areas in our society. When someone 

is missing from school 90 days, somebody, somebody is going to 

track them down, some professional in that school district. But 

when there are not enough people around to do that job, kids get 

lost. That is what happened to 14-year-old Avis Little Wind. 

Dr. Broderick, you indicated that the time previously, when you 

testified before this Committee related to fast-forwarding to this 

point, there has not been any improvement on the subject of Indian 

teen suicide. Can you expand on that and if that is the case, obviously the question is why? 

Dr. BRODERICK. Mr. Chairman, as you know, it is an extremely 

complex topic that requires, I mean, it has taken a long, long time 

and much tragedy, much trauma to get there. Standing Rock is an 

excellent example. We have worked, we at SAMHSA and I know 

the Indian Health Service as well, have worked closely with the 

community. They currently have a Garrett Lee Smith suicide prevention grant and yet they still experience a suicide cluster, in 

spite of the investment of resources. And it tells me that what is 

needed is a holistic approach that cuts across both public safety 

and public health programs to address the fundamental needs and 

the fundamental causes that Dr. BigFoot so eloquently described. 

We know that people who have experienced trauma, be it intergenerational trauma or trauma as children are at extremely high 

risk. Unfortunately, children in Indian communities are oftentimes 

subjected to such trauma. So I believe that if we use Standing Rock 

as a case study, in spite of the investment of some resources and 

establishment of close working relationships with that community, 

those children still remain at risk. It speaks to the need for a dedicated effort to address the multiple causations and the multiple 

risk factors that go to contribute to the high rates of suicide that 

we see. 

So I think it calls for not only a redoubling of our effort, but the 

need to look at all the causes and all the complexities that exist 

in those communities that have existed there for a long, long time 

to actually break that cycle. 

31 

The CHAIRMAN. Dr. Roubideaux, thank you for your testimony. 

You are relatively recently nominated and confirmed to your post. 

But tell me, do you think the issue is substantially additional resources? Condense for me your testimony, if you would, to a couple 

of paragraphs. What do you think, if you had your choice today and 

could make that choice, would be the couple of things you think 

would most affect our ability to reduce the rate of teen suicide on 

Indian reservations? 

Dr. ROUBIDEAUX. I think that the first thing that we need to do 

is to make sure that we are not all working in isolation on this 

problem. We have great partnership with SAMHSA, we have a 

great partnership with our tribes. And working with the local 

schools, the local justice systems, the local community programs, I 

really believe that that is going to be one of the major ways to address this problem. We can’t solve the problem alone. We have to 

have partners in this effort. 

I am really excited about our new meth and suicide prevention 

initiative. Now we have 129 new meth and suicide prevention initiatives across the Country that involve work with tribes and the 

local IHS and other community partners to try to address this 

problem. 

The other major thing we need is just increased access to services. Many of our behavioral health programs are staffed with one 

clinical psychologist. Many of them have vacancies. And we really 

do need to find a way to get more access. 

I am pleased that the legislation includes the tele-behavioral 

health and the tele-mental health. Because that is a way that we 

can increase access to psychiatric and psychological care through a 

network of resources using technology, so that we could potentially 

provide 24/7 crisis care if needed. So I think this is an enormously 

heartbreaking and complex problem. But I think there are things 

that we can do, if we all put our resources together. 

The CHAIRMAN. Are you fighting inside the institution for better 

funding? I mean, you are part of a process by which you send recommendations up to OMB and then it goes to the White House and 

then they decide what you are going to have and then you have to 

come here to this table and say, I support this number, despite the 

fact it may not be your number at all. You may strongly, profoundly disagree, but you come to support it. That is the way the 

budget process works. But the first side of that is to be very aggressive, to say, here is what we need to address these issues, one 

of them being, for example, teen suicide, here is the money, the 

funding we need for these programs to address teen suicide. You 

are new to this process, but I assume you fully understand the 

early role that you will play in this budget process? 

Dr. ROUBIDEAUX. Absolutely. I understand the stakes are high 

and that we play an important role in trying to help understand 

what resources are needed to adequately and effectively meet the 

health needs of this population. I am proud to say that for the new 

budget process, we started by looking at our tribal recommendations for our budget. And I am really pleased with the support that 

I am seeing in the new Administration and in the Department, as 

people are trying to understand what our budget needs are. Again, 

I am also pleased with the support of the President, with his proVerDate Nov 24 2008 13:09 Apr 20, 2010 Jkt 055174 PO 00000 Frm 00035 Fmt 6633 Sfmt 6601 S:\DOCS\55174.TXT JACK PsN: JACKF
32 

posed Fiscal Year 2010 budget, a 13 percent increase, which is the 

highest in over 20 years. 

So I am doing my best to be an advocate for the people we serve. 

The CHAIRMAN. I should say, Dr. Broderick, thank you for sending the resources you did down to the Standing Rock Reservation, 

along with the staff of this Committee. That was very, very helpful. 

We are continuing, and I know with you, continuing to monitor 

what is happening there. 

Dr. BRODERICK. I think, if not today then very shortly, Standing 

Rock will sign an agreement with the Native Aspirations program 

to become one of the communities that are involved in Native Aspirations. That is a direct result of your intervention and our trip 

there. So we are seeing the dedication of additional resources to 

that community. 

The CHAIRMAN. Dr. BigFoot, describe for me, if you would, the 

child trauma center that you are directing. 

Dr. BIGFOOT. The child trauma center is hope. What we have 

done is we have taken evidence-based practices and culturally 

adapted them for the treatment of trauma. We have culturally 

adapted Trauma Focus, Cognitive Behavioral Therapy to Honoring 

Children, Mending the Circle. We have culturally adapted ParentChild Interaction Therapy to Honoring Children, Making Relatives. 

The treatment of Children with Sexual Behavior Problems, we 

have culturally adapted it to Honoring Children, Respectful Ways, 

which has two components. One is a treatment component, one is 

a prevention component. 

And then we have taken the American Indian Life Skills Development, in conjunction with Terese LaFramboise, to revise it for 

lower grades. Because we also discovered that children very, very 

young, in middle school and younger, were having thoughts of suicide. So we wanted to be able to implement a curriculum that was 

for younger ages. Then as part of that, we have the Honoring Children, Honoring the Future, which is a suicide intervention and prevention efforts that we have undertaken through the Indian Country Child Trauma Center, which includes consultation to tribes and 

training. It includes the accessing of resources. 

For example, yesterday I was in the State of Washington where 

they were having an incredible conference with State and tribal 

agreements as part of the innovation center that is funded by 

SAMHSA. So I had a presentation on suicide, and one of the things 

that I did as part of that presentation was bring up the Indian 

Health Service suicide prevention website, and looked at all the resources that were on there. I had a room full of tribal members 

from all different tribes in Washington State, and they had no idea 

of the numerous resources that were available to them, even the 

simple screening that was on that website that you can access and 

get training in. 

So being able to help tribes look at what the resources are, and 

I think we have numerous kinds of resources, we have the American Indian Life Skills, we have the different programs like Native 

Aspirations, we have multiple different programs. But a lot of 

times, tribal communities are not aware. 

The other thing that we do is to assist tribal communities in that 

healing process so that they can become more proactive. So we help 

33 

with healing camps, talking circles, different kinds of culturallybased interventions that are directed to the general population. Because one of the things that we need to recognize is that our tribal 

communities have always had healing ways. 

And even though I am a trained professional, I still am highly 

respectful of the fact that our tribal communities have ceremonies 

that are still viable to help to renew and regenerate and heal some 

of the loss and grief and some of the trauma that individuals and 

tribes have been faced with. And part of this, in terms of the 

project Making Medicine funded by the Office of Child Abuse and 

Neglect of the Children’s Bureau is to take these evidence-based 

practices into tribal communities. 

So the culturally-adapted treatment programs were developed 

under the Indian Country Child Trauma Center funded by 

SAMHSA. But now we have made a wonderful link to be able to 

deliver those training interventions to licensed professionals. The 

problem we have is that we can train about 20 participants a year, 

and we have to do booster training and we need to do other kinds 

of things to support. If we only do 20 a year, we are not doing it 

very sufficiently. But we really try to help tribal communities to 

build their capacity. 

The CHAIRMAN. Thank you very much. It sounds like a really important program that is affecting and improving the lives of a lot 

of people. Thank you for your work. 

I just received a note that a vote is going to start in one minute 

on the Floor of the Senate. So it worked out pretty well that I could 

have an opportunity to hear all of the testimony and have all of 

you be here. We will continue. As you know, Senator Johanns, Senator Barrasso, myself, Senator Tester and many others are very 

concerned about this issue. We wanted to have an initial discussion 

today. We intend to proceed with these discussions on the issue of 

youth suicide. We will continue to work with all of you. We would 

like to get our legislation enacted this year and try to move forward to make some significant improvements. 

So we thank you for testifying. We will hold the record open for 

any additional submissions for two weeks. This hearing is adjourned. 

[Whereupon, at 3:40 p.m., the Committee was adjourned.] 

(35) 

A P P E N D I X 

PREPARED STATEMENT OF RENO KEONI FRANKLIN, CHAIRMAN, NATIONAL INDIAN

HEALTH BOARD (NIHB) 


910b1.eps
36 


910b2.eps
37 

PREPARED STATEMENT OF THE NATIONAL CONGRESS OF AMERICAN INDIANS (NCAI) 


910b3.eps
38 


910b4.eps
39 


910b5.eps
40 


910b6.eps
41 

PREPARED STATEMENT OF GWENDOLYN PURYEAR KEITA, PH.D., EXECUTIVE

DIRECTOR, PUBLIC INTEREST DIRECTORATE, AMERICAN PSYCHOLOGICAL

ASSOCIATION (APA) 


910c1.eps
42 


910c2.eps
43 


910c3.eps
44 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. BYRON L. DORGAN TO

DOLORES SUBIA BIGFOOT, PH.D. 


910b7.eps
45 


910b8.eps
46 


910b9.eps
47 


910b10.eps
48 


910b11.eps
49 


910b12.eps
50 


910b13.eps
51 


910b14.eps
52 


910b15.eps
53 


910b16.eps
54 


910b17.eps
55 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY THE COMMITTEE FROM

DR. ELLEN GERRITY


910b18.eps
56 


910b19.eps
57 


910b20.eps
58 

* Response to written questions was not available at the time this hearing went to press. 

WRITTEN QUESTIONS SUBMITTED BY THE COMMITTEE TO HON. ERIC B. BRODERICK, 

D.D.S., M.P.H. * 


910d1.eps
59 


910d2.eps
60 


910d3.eps
61 

* Response to written questions was not available at the time this hearing went to press. 

WRITTEN QUESTIONS SUBMITTED BY THE COMMITTEE TO HON. YVETTE ROUBIDEAUX, 

M.D., M.P.H. * 


910d4.eps
62 


910d5.eps
63 

Æ 


910d6.eps