II 

Calendar No. 412 

109TH CONGRESS 

2D SESSION S. 2245 

[Report No. 109–250] 

To establish an Indian youth telemental health demonstration project. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 6, 2006 

Mr. DORGAN (for himself, Mr. CONRAD, Mr. BINGAMAN, Ms. MURKOWSKI, 

Mr. MCCAIN, Mr. JOHNSON, and Mr. SMITH) introduced the following 

bill; which was read twice and referred to the Committee on Indian Affairs 

APRIL 24, 2006 

Reported by Mr. MCCAIN, without amendment 

A BILL 

To establish an Indian youth telemental health demonstration 

project. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Indian Youth Tele5 mental Health Demonstration Project Act of 2006’’. 


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1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—Congress finds that— 

3 (1) suicide for Indians and Alaska Natives is 

21 4 ⁄2 times higher than the national average and the 

5 highest for all ethnic groups in the United States, at 

6 a rate of more than 16 per 100,000 males of all age 

7 groups, and 27.9 per 100,000 for males aged 15 

8 through 24, according to data for 2002; 

9 (2) according to national data for 2002, suicide 

10 was the second-leading cause of death for Indians 

11 and Alaska Natives aged 15 through 34 and the 

12 fourth-leading cause of death for Indians and Alaska 

13 Natives aged 10 through 14; 

14 (3) the suicide rates of Indian and Alaska Na15 tive males aged 15 through 24 are nearly 4 times 

16 greater than suicide rates of Indian and Alaska Na17 tive females of that age group; 

18 (4)(A) 90 percent of all teens who die by sui19 cide suffer from a diagnosable mental illness at the 

20 time of death; and 

(B) more than 1 21 ⁄2 of the people who commit 

22 suicide in Indian Country have never been seen by 

23 a mental health provider; 

24 (5) death rates for Indians and Alaska Natives 

25 are statistically underestimated; 


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1 (6) suicide clustering in Indian Country affects 

2 entire tribal communities; and 

3 (7) since 2003, the Indian Health Service has 

4 carried out a National Suicide Prevention Initiative 

5 to work with Service, tribal, and urban Indian health 

6 programs. 

7 (b) PURPOSE.—The purpose of this Act is to author8 ize the Secretary to carry out a demonstration project to 

9 test the use of telemental health services in suicide preven10 tion, intervention, and treatment of Indian youth, includ11 ing through— 

12 (1) the use of psychotherapy, psychiatric assess13 ments, diagnostic interviews, therapies for mental 

14 health conditions predisposing to suicide, and alcohol 

15 and substance abuse treatment; 

16 (2) the provision of clinical expertise to, con17 sultation services with, and medical advice and train18 ing for frontline health care providers working with 

19 Indian youth; 

20 (3) training and related support for community 

21 leaders, family members and health and education 

22 workers who work with Indian youth; 

23 (4) the development of culturally-relevant edu24 cational materials on suicide; and 

25 (5) data collection and reporting. 


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1 SEC. 3. DEFINITIONS. 

2 In this Act: 

3 (1) DEMONSTRATION PROJECT.—The term 

4 ‘‘demonstration project’’ means the Indian youth 

5 telemental health demonstration project authorized 

6 under section 4(a). 

7 (2) DEPARTMENT.—The term ‘‘Department’’ 

8 means the Department of Health and Human Serv9 ices. 

10 (3) INDIAN.—The term ‘‘Indian’’ means any in11 dividual who is a member of an Indian tribe or is 

12 eligible for health services under the Indian Health 

13 Care Improvement Act (25 U.S.C. 1601 et seq.). 

14 (4) INDIAN TRIBE.—The term ‘‘Indian tribe’’ 

15 has the meaning given the term in section 4 of the 

16 Indian Self-Determination and Education Assistance 

17 Act (25 U.S.C. 450b). 

18 (5) SECRETARY.—The term ‘‘Secretary’’ means 

19 the Secretary of Health and Human Services. 

20 (6) SERVICE.—The term ‘‘Service’’ means the 

21 Indian Health Service. 

22 (7) TELEMENTAL HEALTH.—The term ‘‘tele23 mental health’’ means the use of electronic informa24 tion and telecommunications technologies to support 

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1 sional-related education, public health, and health 

2 administration. 

3 (8) TRADITIONAL HEALTH CARE PRACTICES.— 

4 The term ‘‘traditional health care practices’’ means 

5 the application by Native healing practitioners of the 

6 Native healing sciences (as opposed or in contra7 distinction to Western healing sciences) that— 

8 (A) embody the influences or forces of in9 nate Tribal discovery, history, description, ex10 planation and knowledge of the states of 

11 wellness and illness; and 

12 (B) call upon those influences or forces in 

13 the promotion, restoration, preservation, and 

14 maintenance of health, well-being, and life’s 

15 harmony. 

16 (9) TRIBAL ORGANIZATION.—The term ‘‘tribal 

17 organization’’ has the meaning given the term in 

18 section 4 of the Indian Self-Determination and Edu19 cation Assistance Act (25 U.S.C. 450b). 

20 SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRA21 TION PROJECT. 

22 (a) AUTHORIZATION.— 

23 (1) IN GENERAL.—The Secretary is authorized 

24 to carry out a demonstration project to award grants 


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1 for the provision of telemental health services to In2 dian youth who— 

3 (A) have expressed suicidal ideas; 

4 (B) have attempted suicide; or 

5 (C) have mental health conditions that in6 crease or could increase the risk of suicide. 

7 (2) ELIGIBILITY FOR GRANTS.—Grants de8 scribed in paragraph (1) shall be awarded to Indian 

9 tribes and tribal organizations that operate 1 or 

10 more facilities— 

11 (A) located in Alaska and part of the Alas12 ka Federal Health Care Access Network; 

13 (B) reporting active clinical telehealth ca14 pabilities; or 

15 (C) offering school-based telemental health 

16 services relating to psychiatry to Indian youth. 

17 (3) GRANT PERIOD.—The Secretary shall 

18 award grants under this section for a period of up 

19 to 4 years. 

20 (4) MAXIMUM NUMBER OF GRANTS.—Not more 

21 than 5 grants shall be provided under paragraph 

22 (1), with priority consideration given to Indian tribes 

23 and tribal organizations that— 


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1 (A) serve a particular community or geo2 graphic area in which there is a demonstrated 

3 need to address Indian youth suicide; 

4 (B) enter into collaborative partnerships 

5 with Service or other tribal health programs or 

6 facilities to provide services under this dem7 onstration project; 

8 (C) serve an isolated community or geo9 graphic area which has limited or no access to 

10 behavioral health services; or 

11 (D) operate a detention facility at which 

12 Indian youth are detained. 

13 (b) USE OF FUNDS.—An Indian tribe or tribal orga14 nization shall use a grant received under subsection (a) 

15 for the following purposes: 

16 (1) To provide telemental health services to In17 dian youth, including the provision of— 

18 (A) psychotherapy; 

19 (B) psychiatric assessments and diagnostic 

20 interviews, therapies for mental health condi21 tions predisposing to suicide, and treatment; 

22 and 

23 (C) alcohol and substance abuse treatment. 

24 (2) To provide clinician-interactive medical ad25 vice, guidance and training, assistance in diagnosis 


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1 and interpretation, crisis counseling and interven2 tion, and related assistance to Service or tribal clini3 cians and health services providers working with 

4 youth being served under the demonstration project. 

5 (3) To assist, educate, and train community 

6 leaders, health education professionals and para7 professionals, tribal outreach workers, and family 

8 members who work with the youth receiving tele9 mental health services under the demonstration 

10 project, including with identification of suicidal ten11 dencies, crisis intervention and suicide prevention, 

12 emergency skill development, and building and ex13 panding networks among those individuals and with 

14 State and local health services providers. 

15 (4) To develop and distribute culturally-appro16 priate community educational materials on— 

17 (A) suicide prevention; 

18 (B) suicide education; 

19 (C) suicide screening; 

20 (D) suicide intervention; and 

21 (E) ways to mobilize communities with re22 spect to the identification of risk factors for sui23 cide. 

24 (5) To conduct data collection and reporting re25 lating to Indian youth suicide prevention efforts. 


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1 (c) APPLICATIONS.—To be eligible to receive a grant 

2 under subsection (a), an Indian tribe or tribal organization 

3 shall prepare and submit to the Secretary an application, 

4 at such time, in such manner, and containing such infor5 mation as the Secretary may require, including— 

6 (1) a description of the project that the Indian 

7 tribe or tribal organization will carry out using the 

8 funds provided under the grant; 

9 (2) a description of the manner in which the 

10 project funded under the grant would— 

11 (A) meet the telemental health care needs 

12 of the Indian youth population to be served by 

13 the project; or 

14 (B) improve the access of the Indian youth 

15 population to be served to suicide prevention 

16 and treatment services; 

17 (3) evidence of support for the project from the 

18 local community to be served by the project; 

19 (4) a description of how the families and leader20 ship of the communities or populations to be served 

21 by the project would be involved in the development 

22 and ongoing operations of the project; 

23 (5) a plan to involve the tribal community of 

24 the youth who are provided services by the project 

25 in planning and evaluating the mental health care 


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1 and suicide prevention efforts provided, in order to 

2 ensure the integration of community, clinical, envi3 ronmental, and cultural components of the treat4 ment; and 

5 (6) a plan for sustaining the project after Fed6 eral assistance for the demonstration project has ter7 minated. 

8 (d) TRADITIONAL HEALTH CARE PRACTICES.—The 

9 Secretary, acting through the Service, shall ensure that 

10 the demonstration project involves the use and promotion 

11 of the traditional health care practices of the Indian tribes 

12 of the youth to be served. 

13 (e) COLLABORATION.—The Secretary, acting through 

14 the Service, shall encourage Indian tribes and tribal orga15 nizations receiving grants under this section to collaborate 

16 to enable comparisons about best practices across projects. 

17 (f) ANNUAL REPORT.—Each grant recipient shall 

18 submit to the Secretary an annual report that— 

19 (1) describes the number of telemental health 

20 services provided; and 

21 (2) includes any other information that the Sec22 retary may require. 

23 (g) REPORT TO CONGRESS.—Not later than 270 days 

24 after the date of termination of the demonstration project, 

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1 fairs of the Senate and the Committee on Resources and 

2 the Committee on Energy and Commerce of the House 

3 of Representatives a final report that— 

4 (1) describes the results of the projects funded 

5 by grants awarded under this section, including any 

6 data available that indicate the number of attempted 

7 suicides; 

8 (2) evaluates the impact of the telemental 

9 health services funded by the grants in reducing the 

10 number of completed suicides among Indian youth; 

11 (3) evaluates whether the demonstration project 

12 should be— 

13 (A) expanded to provide more than 5 

14 grants; and 

15 (B) designated a permanent program; and 

16 (4) evaluates the benefits of expanding the 

17 demonstration project to include urban Indian orga18 nizations. 

19 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to carry out this section 

21 $1,500,000 for each of fiscal years 2007 through 2010. 


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Calendar No. 412 

109TH CONGRESS 

2D SESSION S. 2245 

[Report No. 109

–250] 

A BILL 

To establish an Indian youth telemental health 

demonstration project. 

APRIL 24, 2006 

Reported without amendment 


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