II 

109TH CONGRESS 

2D SESSION S. 2245 

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 

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’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds that— 

8 (1) suicide for Indians and Alaska Natives is 2 

1 9 ⁄2 times higher than the national average and the 

10 highest for all ethnic groups in the United States, at 
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1 a rate of more than 16 per 100,000 males of all age 

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

3 through 24, according to data for 2002; 

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

5 was the second-leading cause of death for Indians 

6 and Alaska Natives aged 15 through 34 and the 

7 fourth-leading cause of death for Indians and Alaska 

8 Natives aged 10 through 14; 

9 (3) the suicide rates of Indian and Alaska Na10 tive males aged 15 through 24 are nearly 4 times 

11 greater than suicide rates of Indian and Alaska Na12 tive females of that age group; 

13 (4)(A) 90 percent of all teens who die by sui14 cide suffer from a diagnosable mental illness at the 

15 time of death; and 

(B) more than 1 16 ⁄2 of the people who commit 

17 suicide in Indian Country have never been seen by 

18 a mental health provider; 

19 (5) death rates for Indians and Alaska Natives 

20 are statistically underestimated; 

21 (6) suicide clustering in Indian Country affects 

22 entire tribal communities; and 

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

24 carried out a National Suicide Prevention Initiative 
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1 to work with Service, tribal, and urban Indian health 

2 programs. 

3 (b) PURPOSE.—The purpose of this Act is to author4 ize the Secretary to carry out a demonstration project to 

5 test the use of telemental health services in suicide preven6 tion, intervention, and treatment of Indian youth, includ7 ing through— 

8 (1) the use of psychotherapy, psychiatric assess9 ments, diagnostic interviews, therapies for mental 

10 health conditions predisposing to suicide, and alcohol 

11 and substance abuse treatment; 

12 (2) the provision of clinical expertise to, con13 sultation services with, and medical advice and train14 ing for frontline health care providers working with 

15 Indian youth; 

16 (3) training and related support for community 

17 leaders, family members and health and education 

18 workers who work with Indian youth; 

19 (4) the development of culturally-relevant edu20 cational materials on suicide; and 

21 (5) data collection and reporting. 

22 SEC. 3. DEFINITIONS. 

23 In this Act: 

24 (1) DEMONSTRATION PROJECT.—The term 

25 ‘‘demonstration project’’ means the Indian youth 
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1 telemental health demonstration project authorized 

2 under section 4(a). 

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

4 means the Department of Health and Human Serv5 ices. 

6 (3) INDIAN.—The term ‘‘Indian’’ means any in7 dividual who is a member of an Indian tribe or is 

8 eligible for health services under the Indian Health 

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

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

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

12 Indian Self-Determination and Education Assistance 

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

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

15 the Secretary of Health and Human Services. 

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

17 Indian Health Service. 

18 (7) TELEMENTAL HEALTH.—The term ‘‘tele19 mental health’’ means the use of electronic informa20 tion and telecommunications technologies to support 

21 long distance mental health care, patient and profes22 sional-related education, public health, and health 

23 administration. 

24 (8) TRADITIONAL HEALTH CARE PRACTICES.— 

25 The term ‘‘traditional health care practices’’ means 
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1 the application by Native healing practitioners of the 

2 Native healing sciences (as opposed or in contra3 distinction to Western healing sciences) that— 

4 (A) embody the influences or forces of in5 nate Tribal discovery, history, description, ex6 planation and knowledge of the states of 

7 wellness and illness; and 

8 (B) call upon those influences or forces in 

9 the promotion, restoration, preservation, and 

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

11 harmony. 

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

13 organization’’ has the meaning given the term in 

14 section 4 of the Indian Self-Determination and Edu15 cation Assistance Act (25 U.S.C. 450b). 

16 SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRA17 TION PROJECT. 

18 (a) AUTHORIZATION.— 

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

20 to carry out a demonstration project to award grants 

21 for the provision of telemental health services to In22 dian youth who— 

23 (A) have expressed suicidal ideas; 

24 (B) have attempted suicide; or 
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1 (C) have mental health conditions that in2 crease or could increase the risk of suicide. 

3 (2) ELIGIBILITY FOR GRANTS.—Grants de4 scribed in paragraph (1) shall be awarded to Indian 

5 tribes and tribal organizations that operate 1 or 

6 more facilities— 

7 (A) located in Alaska and part of the Alas8 ka Federal Health Care Access Network; 

9 (B) reporting active clinical telehealth ca10 pabilities; or 

11 (C) offering school-based telemental health 

12 services relating to psychiatry to Indian youth. 

13 (3) GRANT PERIOD.—The Secretary shall 

14 award grants under this section for a period of up 

15 to 4 years. 

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

17 than 5 grants shall be provided under paragraph 

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

19 and tribal organizations that— 

20 (A) serve a particular community or geo21 graphic area in which there is a demonstrated 

22 need to address Indian youth suicide; 

23 (B) enter into collaborative partnerships 

24 with Service or other tribal health programs or 
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1 facilities to provide services under this dem2 onstration project; 

3 (C) serve an isolated community or geo4 graphic area which has limited or no access to 

5 behavioral health services; or 

6 (D) operate a detention facility at which 

7 Indian youth are detained. 

8 (b) USE OF FUNDS.—An Indian tribe or tribal orga9 nization shall use a grant received under subsection (a) 

10 for the following purposes: 

11 (1) To provide telemental health services to In12 dian youth, including the provision of— 

13 (A) psychotherapy; 

14 (B) psychiatric assessments and diagnostic 

15 interviews, therapies for mental health condi16 tions predisposing to suicide, and treatment; 

17 and 

18 (C) alcohol and substance abuse treatment. 

19 (2) To provide clinician-interactive medical ad20 vice, guidance and training, assistance in diagnosis 

21 and interpretation, crisis counseling and interven22 tion, and related assistance to Service or tribal clini23 cians and health services providers working with 

24 youth being served under the demonstration project. 
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1 (3) To assist, educate, and train community 

2 leaders, health education professionals and para3 professionals, tribal outreach workers, and family 

4 members who work with the youth receiving tele5 mental health services under the demonstration 

6 project, including with identification of suicidal ten7 dencies, crisis intervention and suicide prevention, 

8 emergency skill development, and building and ex9 panding networks among those individuals and with 

10 State and local health services providers. 

11 (4) To develop and distribute culturally-appro12 priate community educational materials on— 

13 (A) suicide prevention; 

14 (B) suicide education; 

15 (C) suicide screening; 

16 (D) suicide intervention; and 

17 (E) ways to mobilize communities with re18 spect to the identification of risk factors for sui19 cide. 

20 (5) To conduct data collection and reporting re21 lating to Indian youth suicide prevention efforts. 

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

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

24 shall prepare and submit to the Secretary an application, 
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1 at such time, in such manner, and containing such infor2 mation as the Secretary may require, including— 

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

4 tribe or tribal organization will carry out using the 

5 funds provided under the grant; 

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

7 project funded under the grant would— 

8 (A) meet the telemental health care needs 

9 of the Indian youth population to be served by 

10 the project; or 

11 (B) improve the access of the Indian youth 

12 population to be served to suicide prevention 

13 and treatment services; 

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

15 local community to be served by the project; 

16 (4) a description of how the families and leader17 ship of the communities or populations to be served 

18 by the project would be involved in the development 

19 and ongoing operations of the project; 

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

21 the youth who are provided services by the project 

22 in planning and evaluating the mental health care 

23 and suicide prevention efforts provided, in order to 

24 ensure the integration of community, clinical, envi-
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1 ronmental, and cultural components of the treat2 ment; and 

3 (6) a plan for sustaining the project after Fed4 eral assistance for the demonstration project has ter5 minated. 

6 (d) TRADITIONAL HEALTH CARE PRACTICES.—The 

7 Secretary, acting through the Service, shall ensure that 

8 the demonstration project involves the use and promotion 

9 of the traditional health care practices of the Indian tribes 

10 of the youth to be served. 

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

12 the Service, shall encourage Indian tribes and tribal orga13 nizations receiving grants under this section to collaborate 

14 to enable comparisons about best practices across projects. 

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

16 submit to the Secretary an annual report that— 

17 (1) describes the number of telemental health 

18 services provided; and 

19 (2) includes any other information that the Sec20 retary may require. 

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

22 after the date of termination of the demonstration project, 

23 the Secretary shall submit to the Committee on Indian Af24 fairs of the Senate and the Committee on Resources and 
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1 the Committee on Energy and Commerce of the House 

2 of Representatives a final report that— 

3 (1) describes the results of the projects funded 

4 by grants awarded under this section, including any 

5 data available that indicate the number of attempted 

6 suicides; 

7 (2) evaluates the impact of the telemental 

8 health services funded by the grants in reducing the 

9 number of completed suicides among Indian youth; 

10 (3) evaluates whether the demonstration project 

11 should be— 

12 (A) expanded to provide more than 5 

13 grants; and 

14 (B) designated a permanent program; and 

15 (4) evaluates the benefits of expanding the 

16 demonstration project to include urban Indian orga17 nizations. 

18 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

19 authorized to be appropriated to carry out this section 

20 $1,500,000 for each of fiscal years 2007 through 2010. 

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