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) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

27–643 PDF 2006

S. HRG. 109–558

INDIAN YOUTH SUICIDE

HEARING

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS

UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

ON

OVERSIGHT HEARING ON THE TRAGEDY OF INDIAN YOUTH SUICIDE

MAY 17, 2006

WASHINGTON, DC

(
COMMITTEE ON INDIAN AFFAIRS

JOHN McCAIN, Arizona, Chairman

BYRON L. DORGAN, North Dakota, Vice Chairman

PETE V. DOMENICI, New Mexico

CRAIG THOMAS, Wyoming

GORDON SMITH, Oregon

LISA MURKOWSKI, Alaska

MICHAEL D. CRAPO, Idaho

RICHARD BURR, North Carolina

TOM COBURN, M.D., Oklahoma

DANIEL K. INOUYE, Hawaii

KENT CONRAD, North Dakota

DANIEL K. AKAKA, Hawaii

TIM JOHNSON, South Dakota

MARIA CANTWELL, Washington

JEANNE BUMPUS, Majority Staff Director

SARA G. GARLAND, Minority Staff Director

(II)
(III)

C O N T E N T S

Page

Statements:

Ashley, Norine, director, Apache Behavorial Health Services, White

Mountain Apache Tribe ................................................................................ 17

Curie, Charles G., administrator, Substance Abuse and Mental Health

Services Administration ............................................................................... 8

Dorgan, Hon. Byron L., U.S. Senator from North Dakota, vice chairman,

Committee on Indian Affairs ....................................................................... 1

Eagleman, Chet, acting chief, Division of Human Services .......................... 4

Gidner, Jerry, deputy director for tribal services, Department of the Interior .................................................................................................................. 4

Grim, Charles W., director, IHS, Department of Health and Humane

Services .......................................................................................................... 6

Hubbard, Frederick L., associate director, Community Relations, White

Mountain Tribe ............................................................................................. 17

Kauffman, Jo Ann, project director, Native Aspirations Project .................. 22

Martin, William E., chairman, Alaska State Suicide Prevention Council,

first vice president, Central Council of the Tlingit and Haida Tribes

of Alaska ........................................................................................................ 19

Maybee, Peter, assistant to the deputy bureau director, Law Enforcement

Services .......................................................................................................... 4

Murkowski, Hon. Lisa, U.S. Senato from Alaska .......................................... 2

Perez, Jon, director, IHS, Division of Behavorial Health ............................. 6

Skenandore, Kevin, acting director, Office of Indian Education Programs . 4

Vigil, Donna, director, Division of Health Programs, White Mountain

Apache tribe .................................................................................................. 17

Walker, R. Dale, director, One Sky Center, Oregon Health and Sciences

University ...................................................................................................... 20

APPENDIX

Prepared statements:

American Academy of Child and Adolescent Psychiatry and the American

Psychiatric Association ................................................................................. 30

American Academy of Pediatrics ..................................................................... 37

Bullard, Loretta, president, Kawerak Inc., Nome, AK .................................. 40

Curie, Charles G. .............................................................................................. 40

Gidner, Jerry ..................................................................................................... 42

Grim, Charles W. .............................................................................................. 45

Kauffman, Jo Ann ............................................................................................ 55

Martin, William E. (with attachment) ............................................................ 65

McCain, Hon. John, U.S. Senator from Arizona chairman, Committee

on Indian Affairs ........................................................................................... 29

Vigil, Donna ...................................................................................................... 164

Walker, R. Dale ................................................................................................ 166

Additional material submitted for the record:

Archambault, Donna, Home School Coordinator, McLaughlin, SD (letter) . 173

Schmeichel, Patricia, McLaughlin, SD (letter) ............................................... 175

(1)

INDIAN YOUTH SUICIDE

WEDNESDAY, MAY 17, 2006

U.S. SENATE, COMMITTEE ON INDIAN AFFAIRS, Washington, DC.

The committee met, pursuant to notice, at 9:30 a.m. in room 485

Senate Russell Building, Hon. John McCain (chairman of the committee) presiding.

Present: Senators McCain, Dorgan, and Murkowski.

STATEMENT OF HON. BYRON L. DORGAN, U.S. SENATOR FROM

NORTH DAKOTA, VICE CHAIRMAN, COMMITTEE ON INDIAN

AFFAIRS

Senator DORGAN. Senator McCain is delayed this morning and

has asked that I convene the hearing. He will be here, however,

shortly.

I want to say good morning to everyone and thank all of you for

being here. This is the cOMMITTEE ON Indian Affairs third hearing on the tragedy of Indian youth suicide. It is a sensitive subject,

one that some perhaps would prefer we not even discuss, but one

I think that we simply cannot ignore.

Today, the committee will hear testimony about what kind of suicide prevention programs are currently available in Indian country;

what programs exist that may not yet be available to certain areas

in our country; whether there are recommendations to apply and

tailor additional programs or resources to address the problem of

Indian youth suicide on reservations and Alaska Native village

communities.

I want to acknowledge the presence of the Indian Health Service.

Dr. Grim is with us and Mr. Perez, and that of the Substance

Abuse and Mental Health Services Administrator, Mr. Curie, is

with us today. You and your staff have been very helpful to this

committee as we have reflected on a good many recommendations

on these issues.

Others of our witnesses have also provided valuable experience

and insight. This is the third hearing that we will have held on

this subject. Last week, during what was called Health Week in the

United States Senate, the full Senate approved legislation that I

had authored with my colleagues, Senator McCain, Senator Murkowski, and others, dealing with telemental health, one avenue to

try to deal with this issue of teen suicide on Indian reservations.

I am very pleased that the Senate has moved that legislation. I

thank Senator McCain, Senator Murkowski, and others of my col-
2

leagues for working with me to put a piece of legislation together.

It was very helpful.

The legislation I think is a positive step, but there is so much

more yet to be done, and that is the purpose of holding this hearing.

We have a number of witnesses today. The first panel is a panel

that is composed of Jerry Gidner, the deputy director for tribal

services at the Bureau of Indian Affairs, U.S. Department of the

Interior. Mr. Gidner is accompanied by Chet Eagleman, acting

chief, Division of Human Services; Kevin Skenandore, acting director, Office of Indian Education Programs; and Peter Maybee,

aAssistant to the deputy bureau director, of the Law Enforcement

Services.

We have Dr. Charles Grim, the director of the Indian Health

Service, Department of HHS, accompanied by Jon Perez, the director of Indian Health Services Division of Behavior Health; and

Charles Curie, administrator of substance abuse, Mental Health

Services Administration.

So we want to thank everyone who has changed their schedule

to be with us this morning. Mr. Curie, I understand that you were

scheduled to be elsewhere, but have changed your schedule to be

with us. Thank you very much.

Why don’t we begin? I would like to call on Senator Murkowski

if she has opening comments, and then we will begin to hear from

the first panel.

STATEMENT OF HON. LISA MURKOWSKI, U.S. SENATOR FROM

ALASKA

Senator MURKOWSKI. Thank you, Mr. Chairman.

I appreciate your attention, as well as that of Chairman McCain,

to this very important issue. As you have pointed out, it is an issue

that we don’t like to talk about. It is sensitive. It is personal, but

it is very, very real.

I am pleased to welcome to the committee this morning First

Vice President, Bill Martin. Bill is Tlingit and Haida. He is with

us today. He is a tribal leader and the chair of Alaska’s Suicide

Prevention Council. He has a big job in that role and we certainly

appreciate all the work that he does.

In August 2003, the Centers for Disease Control reported that

the Alaska region of the Indian Health Service had a higher rate

of suicide among Native youth under age 19 for the period of 1989

to 1998, so a 10-year period, higher than any other IHS region in

the country. Ours was 23.8 per 100,000 population. You can compare that to the next highest, the Aberdeen region in the plains,

they were second at 19.1 per 100,000.

These are statistics that are terrible. These are statistics that

should concern us all. Death by suicide in Alaska rose 4 percent

in 2005 over the previous year. We know. We don’t need to continue to listen to the stories about how they affect the communities,

the families, but it is important to hear those stories and understand the devastation that the suicide is causing in too many of our

Native villages in our communities on our reservations.

Mr. Chairman, I want to commend you for your efforts and all

that you have done to bring attention to this issue. The passage of
3

the Indian Youth Telemental Health bill now pending in the House

of Representatives, I think that is something that we all want to

continue to encourage to make positive steps in the direction that

that legislation leads us.

We have some issues in Alaska that present great challenges,

our distance, our geography, but we share many characteristics

with Indian country in the lower 48. We are isolated in terms of

our road infrastructure. In many cases, our telecommunications infrastructure needs improvement. We have serious needs for medical professionals in the areas, particularly in the behavioral health

area. It is tough to get professionals to move out there to provide

the services that we so desperately need.

We recognize that for the rural telemedicine project, we can help

bridge this gap that is so necessary. The Native health system in

the State I think has proven to be a pretty innovative. This has

been helpful to us, training the community members as behavioral

health aids providing this bridge between the Native people needing the services and the professionals in the cities.

So we are making serious headway there, but we recognize that

we have so very hard to go. So I appreciate the good works of most

of you at the table, those of you in the room, that are focusing on

this, and the focus that this committee has placed on this issue

that is such a concern.

With that, Mr. Chairman, I just want to welcome everyone and

look forward to their testimony.

Senator DORGAN. Senator Murkowski, thank you very much.

At a recent hearing dealing with methamphetamine addiction,

we had a tribal chair come to this committee and describe the devastation of addiction to methamphetamine, but also the number of

attempted suicides on her reservation. As a tribal chair, she described it in some detail, and it was startling, absolutely startling.

What got me interested in this issue was a rash of suicide or a

cluster of teen suicides on the Standing Rock Sioux Reservation in

North Dakota. Even prior to that, I have used on the floor of the

Senate, with the consent of relatives, the name of a young woman.

I understand it is sensitive, and that is why I asked the relatives

if I could do it, but a young woman, 14 years old, named Avis Little

Wind. Avis Little Wind killed herself. She was 14. Her sister had

killed herself, taken her own life 2 years before.

At age 14, she had missed 90 days of school, lay in her bed in

a fetal position, with obviously serious emotional issues, and somehow no one caught it. This young girl lay in her bed for 3 months,

not going to school, at age 14, and it didn’t raise any red flags anywhere, apparently.

And so I went to meet with the school administrators, with the

tribal council. I met with the classmates of this young women. And

then just recently I went to the Standing Rock Reservation and

had a meeting with Indian kids, high school kids, just us, nobody

else was around, just myself and about 1 dozen or 11⁄2 dozen Indian

kids, just talking for about 1 hour about their lives, about what

they see in their school, about the issue of teen suicide, teen pregnancy, methamphetamine.

What is happening is pretty unbelievable in many areas. This

issue of suicide is so tragic, particularly with respect to youth. It
4

is young people I think feeling that their life is hopeless; that they

are helpless. They decide that the only way out is to take their own

life. Some young kids have told me that some of their acquaintances who took their lives really didn’t want to die, they just wanted attention, and they were trying to get attention, to scream out

and beg for attention.

I think as a result of all of this, in our region Indian teens are

10 times more likely to take their lives than in the population as

a whole. I think my colleague just described the circumstance in

Alaska.

So the purpose of this is not to exploit or to be sensational. The

purpose of this is to see if we can find some way that is going to

save some lives; that is going to say to these kids that things are

not hopeless and there are people that want to help. That is the

purpose of having these discussions and trying to think through

what are the policy choices for us to address what is a very serious

issue.

Let me begin the first panel. Jerry Gidner is the deputy director

for tribal services at the BIA. Mr. Gidner, your entire statement

will be part of the record. You may proceed with your testimony.

STATEMENT OF JERRY GIDNER, DEPUTY DIRECTOR FOR

TRIBAL SERVICES, DEPARTMENT OF THE INTERIOR, ACCOMPANIED BY CHET EAGLEMAN, ACTING CHIEF, DIVISION

OF HUMAN SERVICES; KEVIN SKENANDORE, ACTING DIRECTOR, OFFICE OF INDIAN EDUCATION PROGRAMS; AND

PETER MAYBEE, ASSISTANT TO THE DEPUTY BUREAU DIRECTOR, LAW ENFORCEMENT SERVICES

Mr. GIDNER. Thank you, Mr. Chairman, Mr. Vice Chairman,

members of the committee. With your permission, I will put the

testimony in the record and just give a brief statement.

My name is Jerry Gidner. I am the deputy bureau director for

tribal services at the BIA. You mentioned my colleagues who are

here today with me. I did want to mention that Bureau Director,

Pat Ragsdale, is here today in the audience because of his interest

in the topic.

As the committee knows, Mr. Chairman, teen suicide is a serious

problem in Indian country. The suicide rate is 2.5 times greater

than the nationwide rate. IHS statistics show that it is the third

leading cause of death in Indian children 5 to 14 years old and the

second leading cause of death among teens and young adults 15 to

24 years old.

Every 2 years, our Office of Indian Education Programs does a

youth risk behavior survey, and that survey shows some fairly startling results. The last survey results that are available are those

from 2003. Those results show that one-third of Indian children

and teens feel sad or hopeless at some point in a given year, and

that of course is a beginning stage in those children who might

commit suicide.

In high school, the surveys show that 21 percent seriously considered suicide in the last year and 18 percent actually attempted,

made some attempt in the past year. I invite you to think about

that for just 1 minute. That is a very stunning statistic. It means
5

that nearly one-fifth of students in BIA schools or BIA-funded

schools made some attempt at suicide.

Senator DORGAN. Mr. Gidner, tell us again where that data

comes from?

Mr. GIDNER. That comes from a survey conducted by our BIA’s

Office of Indian Education Programs, which is conducted every 2

years in high schools and middle schools. As I said, that data is

from 2003 and I understand the survey was conducted again in

2005. That data is not yet available. In middle school, the younger

children, 26 percent seriously considered suicide and 15 percent actually attempted it. Mr. Chairman, as you pointed out, the youth

of Indian country are crying out for help.

Research shows that many social factors such as poverty, alcohol,

and substance abuse can lead to suicidal behavior and these social

factors as we all know are present in Indian country. So the question you are rightfully asking is what can be done about this. Our

colleagues here at the table from HHS provide most of the suicide

prevention and treatment behaviors.

The role of the BIA is somewhat less than that. We do work on

some of those societal factors. We help tribes develop the infrastructure of government, the infrastructure of schools and law enforcement, where that does not otherwise exist. We participate in

several multiagency efforts. For example, in the Rocky Mountain

region, there is a Native American youth suicide prevention initiative where we partner with IHS and others in that effort.

Our law enforcement office, where they have jurisdiction, are

very often the first responders to suicides and investigate the suicide. We also train our detention center staff, particularly for the

youth detention facilities, in suicide prevention efforts.

Our Office of Indian Education programs again receives funding.

All bureau-funded schools receive funding through the Department

of Education to operate safe and drug free school programs, and

those are used to prevent violence and substance and alcohol

abuse, which of course can be precursors to suicide attempts.

In 2004, our education program launched a suicide prevention

initiative using the question, persuade and respond model, where

people are trained to question students that may be harboring

ideas about suicide, persuade them to get help, and refer them to

the appropriate help if they will go. All 184 BIA-funded schools and

dormitories received this training, and the administrators were instructed to ensure that all of their staff had that training as well.

With that, I will conclude my statement. I will be happy to take

your questions.

[Prepared statement of Mr. Gidner appears in appendix.]

Senator DORGAN. Mr. Gidner, thank you very much for your testimony.

Next, we will hear from Dr. Charles Grim, the director of the Indian Health Service at the Department of Health and Human Services. Dr. Grim, thank you for joining us again.
6

STATEMENT OF CHARLES W. GRIM, DIRECTOR, INDIAN

HEALTH SERVICES, DEPARTMENT OF HEALTH AND HUMAN

SERVICES, ACCOMPANIED BY JON PEREZ, DIRECTOR, INDIAN HEALTH SERVICE DIVISION OF BEHAVIOR HEALTH

Mr. GRIM. Thank you, Mr. Vice Chairman, and Senator Murkowski. I continue to appreciate working with this committee and your

willingness to raise issues like this that we in Indian Health deal

with on a daily basis. This is a very important issue, and we are

very appreciative that you have chosen to hold another hearing

about it. I applaud you for getting the bill that you all introduced

passed. I think telehealth is one of the ways that we are going to

be able to get into some of the most rural parts of the country the

kind of care that you receive in urban areas.

Today, I am accompanied by Dr. Jon Perez, our national behavioral health consultant, who has been before you as well today. I

am honored to be able to testify on behalf of Secretary Leavitt on

suicide prevention programs in Indian country.

I am also honored to testify alongside Charlie Curie, a strong

supporter of addressing substance abuse and mental health issues

in Indian country, something that I personally witnessed and

watched him do during his tenure at SAMHSA. It is also always

a privilege for me to testify alongside my colleagues at the BIA,

today Jerry Gidner, because our two agencies play such a large role

in Indian country.

I would ask that my written testimony be made a part of the

record. In it, you will find a much more detailed analysis of the statistics and some of the partnerships and things going on in Indian

country. Today, I am just going to summarize a few things in my

oral comments.

Suicide in Indian country, as I have said before, in contrast to

most of the rest of the United States, is characterized by higher

rates for younger people, and affecting entire communities because

suicide, much like an infectious disease, often spreads rapidly

among families and peer groups in what you and others have called

suicide clusters in Indian country.

The latest information that we have, which has been cited by

yourself, Senator Murkowski and the BIA, I won’t go through all

those statistics, but suffice it to say they are startling. I am glad

that we, that the Senate, that the tribal leadership have brought

this issue to the forefront and talked about it.

I am also appreciative that the Surgeon General was here at the

last hearing held here in Washington to raise the issue not only in

the Nation, but the high rates in Indian country.

The most important thing to remember is that suicide is not a

single problem. It is a single response to multiple problems. Neither is it strictly a clinical or an individual problem, but one that

is affected by the entire community. I think the panel that you

have put here today is going to bring all those perspectives into

play.

Let me quote from the Institute of Medicine’s landmark 2002

publication called ‘‘Reducing Suicide.’’ They stated that suicide may

have a basis in depression or substance abuse, but it simultaneously may relate to social factors like community breakdown,

loss of key social relations, economic depressions, or political vio-
7

lence, much of which we know occurs in many of our Indian communities.

To address it appropriately, we have worked on both public

health and community interventions as much as we have the direct

clinical ones. As you know, much of the Indian Health Service

budget in alcohol and substance abuse and in mental health goes

directly to clinical care.

In late September 2003, I announced the Indian Health Service

National Suicide Prevention Initiative. It was designed directly to

support our Indian Health Service tribal and urban programs in

three major areas associated with suicide in our communities:

First, to mobilize tribes and tribal programs to address suicide in

a systematic evidence-based manner; second, to expand and enrich

research and program bases around suicide in Indian country,

something that is lacking; and third, to support and promote programmatic collaboration on suicide prevention.

While we have made progress in developing plans and delivering

programs to Indian country, we all realize that this is only the beginning of a long-term concerted and coordinated effort among not

only the Federal programs here at the table, but tribal communities, states, and other local and county community efforts around

the country that we need to address the crisis.

The initiative that we put together, along with tribal leadership

and tribal providers, addressed all 11 goals around HHS’s national

strategy for suicide prevention. That work represented the combined work of advocates, clinicians, researchers and survivors of

suicide and their families all around the Nation. It lays out a

framework of action to help prevent suicide and also guide us in

the development of an array of services that we are developing.

In our headquarters office right now, we are currently working

with the areas, tribes and communities, as well as States, to establish area-wide suicide surveillance and prevention systems, in collaboration with the BIA and States to collect information from law

enforcement and medical examiner databases. We are also establishing partnerships between IHS and BIA to increase access to

health and mental health care for children attending BIA-funded

schools, and strengthening partnerships between State and Federal

agencies in the area of suicide prevention.

We have also been working closely over the last several years in

collaboration with SAMHSA and other HHS agencies and nongovernmental organizations and States to address and reduce suicide. We continue to train community members in the QPR model

that was mentioned by Mr. Gidner, to involve American Indian and

Alaska Native youth in suicide prevention efforts primarily through

school products and Boys and Girls Clubs. We have been utilizing

tribal colleges to provide suicide prevention training and programs

that are culturally appropriate to our population.

For the first time, we have far more accurate data that is being

gathered and shared from our clinicians in our communities, and

those national policymakers and programs, all of which are extremely important to discuss the prevalence and the effects of suicide in Indian communities. No longer are we extrapolating data or

estimating data, because we have data now that we feel is representative of Indian country and the communities affected.
8

We are continuing to upgrade those systems. For the first time,

our electronic health record that we have had for many years is

going to be fully integrated with the behavioral health documentation that many communities keep on suicide and other behavioral

health issues.

Mr. Chairman, I will conclude my statement now by noting that,

as I said earlier, my written statement goes into much more detail

about the efforts that we have done. I want to thank you and this

Committee again for continuing to raise this issue. I will be happy

to discuss any of these issues that we have brought up today with

you during the question and answer.

Thank you.

[Prepared statement of Dr. Grim appears in appendix.]

Senator DORGAN. Dr. Grim, thank you very much.

Finally, we will hear in this panel from Charles Curie. He is the

administrator of the Substance Abuse and Mental Health Services

Administration. Mr. Curie, thank you again for being here.

STATEMENT OF CHARLES G. CURIE, ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

Mr. CURIE. Thank you, Mr. Chairman and Senator Murkowski.

Good morning. I am Charles Curie, the administrator of SAMHSA,

the Substance Abuse and Mental Health Services Administration

within the Department of Health and Human Services. I am

pleased to be here today to describe how SAMHSA is working to

address the issue of suicide among American Indians and Alaska

Natives.

Senator Dorgan, as you kindly mentioned earlier, I was scheduled to speak at a suicide prevention conference actually in Casper,

WY today, but I am so personally concerned about suicide rates, especially in Indian country, and the work that we must continue to

do there, that I wanted to provide this testimony myself.

It is a privilege also to testify with my friend and colleague, Dr.

Charles Grim, director of the Indian Health Service [IHS].

SAMHSA and IHS have developed a strong partnership and a lot

of collaborations that we are working on. It is reflected in our current interagency agreement to work efficiently and effectively together to help meet the public health needs of American Indians

and Alaska Natives.

It is also a privilege to be here with Jerry Gidner, deputy bureau

director for tribal services at the Bureau of Indian Affairs [BIA].

Suicide is not only a serious public health challenge, but it is a

tragedy that is only now receiving the attention and degree of national priority it deserves. As you indicated, Senator, many people

have difficulty discussing this issue and many times it is easier to

put it out of the realm of consciousness. Many Americans are unaware of suicide’s toll and its global impact.

Suicide makes up 49.1 percent of all violent deaths worldwide. It

surpasses homicide as the leading cause of violent deaths. In the

United States, suicide claims approximately 30,000 lives each year.

When faced with the fact that the annual number of suicides in our

country now outnumber homicides by 3 to 2, approximately 30,000

and 18,000 respectively, the relevance of our work becomes very
9

clear. When we know, based on SAMHSA’s household survey for

2003, that approximately 900,000 youth have made a plan to commit suicide during their worst or most recent episode of major depression, and an estimated 712,000 attempted suicide during such

an episode of depression, it is time to intensify activity to prevent

further suicides.

The household survey data, the countless personal stories of loss

and tragedy, are why we have made suicide prevention a priority

at SAMHSA.

Last year, as you mentioned, a suicide cluster occurred on the

Standing Rock Reservation in North Dakota; 10 young people took

their own lives, and dozens more attempted to do so. The Red Lake

Indian Tribe in Minnesota is experiencing high suicide rates following the deaths of 9 individuals at the hand of a 16-year old high

school junior. Tragically, many other reservations have similar stories to tell. Suicide is the second leading cause of death for American Indian and Alaska Native youth ages 15–24. In 2003, the suicide rate for this population was between 2 and 21⁄2 times the national average, and the highest among all ethnic groups in the

United States, with a rate of 18 suicides per 100,000 individuals.

SAMHSA’s policy is to level the playing field and to ensure that

tribal entities are eligible for all competitive grants for which

States are eligible, unless there is a compelling reason to the contrary. Currently, SAMHSA consistently is funding around $34 million of grants to award tribal behavioral health issues.

In 2005, we made the first cohort of awards, 14 in all, including

a grant to Arizona under the Garrett Lee Smith Memorial Act.

These funds are available to help States and tribes implement effective suicide prevention networks. One of those first grants went

to the Native American Rehabilitation Association in Oregon.

Today, I am announcing almost $9.6 million in funding for eight

new grants, each for approximately $400,000 per year for 3 years

under this program to support national suicide prevention efforts.

Grants have been awarded to programs in Oregon, Connecticut,

Utah, Wisconsin, and Idaho. In addition, grants specifically geared

to American Indians and Alaska Natives have been awarded to the

Manniilaq Association of Alaska, the United Indian Involvement,

Inc., and the Montana-Wyoming Tribal Leaders Council. An announcement for a third cohort of grants under this program closed

yesterday. SAMHSA again invited all tribes to apply and provided

technical assistance to tribal organizations to encourage more applicants.

The Garrett Lee Smith Memorial Act also authorized a National

Suicide Prevention Resource Center. We are requiring the center to

address how they would expand the current youth suicide prevention technical assistance to go toward tribes and tribal organizations.

SAMHSA has long supported a national suicide hotline, 1-800-

273-TALK. Funding for the current hotline grantee was increased

by $369,000 in fiscal year 2006, and the grantee has been asked

to submit an application that indicates how they will expand their

access to tribes.

In the Administration’s request for the fiscal year 2007 budget,

the one currently in front of Congress, SAMHSA is asking for near-
10

ly $3 million for a new American Indian-Alaska Native Initiative

to provide evidence-based programming to prevent suicide and reduce the risk factors that contribute to youth suicide and violence. SAMHSA has also transferred $200,000 to IHS to support programming and service contracts, technical assistance, and related

services for suicide cluster response and suicide prevention. One

example is the development of a community suicide prevention tool

kit. This tool kit includes information on suicide prevention, which

can be made readily available via the web.

SAMHSA also has issued emergency response grants in the

aftermath of suicides, both on the Standing Rock Reservation as

well as at Red Lake. Those dollars are still available to those two

entities and we are still working in close collaboration to ensure

those dollars are used in the best way possible.

SAMHSA is proud of what we have done, while knowing that

this is not nearly enough. There is much more to do. The problems

confronting American Indian and Alaska Native youth are taking

their toll on the future of tribal communities.

I ask also that my written testimony be made part of the record,

which does go into much more detail. I want to thank you again

for the opportunity to appear today and I would be pleased to answer any questions you may have.

[Prepared statement of Mr. Curie appears in appendix.]

Senator DORGAN. Mr. Curie, thank you very much.

The Senate now has a vote in progress. I understand there are

about 6 minutes remaining, so I think we will have no choice but

to have a brief recess. We do want to ask some questions, and I

believe Senator McCain will be joining us as well. But I think in

the interest of time here, we will take about a 10-minute recess,

and we will reconvene, we expect, at 10:15.

[Recess.]

Senator DORGAN. The hearing will come to order again.

Let me thank the panel for their testimony, and let me ask a few

questions, if I might.

The hearings that I have held and the discussions that I have

had paint a pretty dismal picture in most areas and with most reservations. The resources available, for example, when I went to the

Spirit Lake Nation Tribe and talked to the school administrators,

the tribal council, parents, students, and others, what I discovered

with respect to the death of Avis Little Wind and others who had

committed suicide is that they had very few resources. Mental

health resources were virtually nonexistent. To the extent that

they were accessible, they were accessible only with great difficulty,

only then if you were able to borrow a vehicle from someone, if

someone would loan you a vehicle that you could use, then the

transport. It was unbelievable to me to see how few resources area

available.

Now, Mr. Curie, today you have described grants and I appreciate your announcement today of those grants. I think it is going

to be helpful. But I would like all three of you to tell me, you know,

you have told us what is happening; tell us what isn’t happening

that has to happen in order for us to fully address this.

Let me describe why I say that. Dr. Grim, you talked about the

resources that are important in rural areas to address this. But
11

you know, the President’s budget recommends zeroing out the Indian Urban Health Centers in urban areas, zero them out. So even

in urban areas, we have problems with the resources.

So I appreciate all that you say that you are doing. Tell me, as

professionals, and as people who visit reservations and understand

these issues, what is not being done that has to be done in order

to really address this issue? Mr. Curie, would you go first?

Mr. CURIE. Yes; I will. Senator, I couldn’t agree with you more

that the issue around resources and accessibility to care is really

part of the fundamental problem that we are seeing here. In fact,

when we take a look at suicide rates, whether it is in Indian country or in general, untreated depression, lack of intervention many

times is the root cause.

I think when we look at Indian country, we look at the remoteness of many of the reservations we see especially in Alaska with

the Alaska Native villages, and this is an ongoing problem. We

need to be thinking in terms of how to have the resources available

to people where they live. There are models that are now being developed.

One, I would point out, is at the University of Alaska in which

individuals who are from the tribe, young people in particular who

are looking for a potential career, are trained as behavioral health,

mental health, substance abuse aides and have the supervision,

then, of a graduate degree professional that they would be connected with. We think this offers a pathway that we need to examine and see how we can expand and bring that to some sort of systemic level. Because again, when you have virtually hundreds of

miles to go before you find a professional, it is unlikely that the

interventions are going to be timely and appropriate.

This is tied, I think, to the greater workforce development issue

that is facing the field as a whole, both in mental health and substance abuse, attracting people, keeping people in the field. Then

again it is compounded even further when you are talking about

rural frontier remote areas, and we are talking about Indian country.

So we need to be thinking in terms of how individuals themselves can be engaged and get the training and support they need.

I think it is also very critical for us to do what we can in collaboration with agencies that work not only on the treatment end of

things, but in helping the young people in those villages find both

an anchor, and I was discussing this with Senator Murkowski earlier, and a line of sight of where they are going to end up being

someday.

I think those villages where we have seen a real focus on getting

a sense of their cultural heritage, having strong youth initiatives

to give them a sense of family, heritage, tradition, and helping

them see what their future can hold, are establishing clear protective factors that can help address these risk factors. So we believe

a public health model in identifying risk factors and increasing protective factors also will be critical in this process.

Senator DORGAN. Thank you.

Dr. Grim.

Mr. GRIM. I would agree with everything Charlie said. Let me

just start out by saying that. Second, since we focus on direct clini-
12

cal and preventive, as well as public health care in our settings, we

need to continue to do that. We need to have those sorts of services

available. I think the expansion of, and we are doing this in telehealth, the expansion of tele-mental health capabilities. We don’t

have that across all of our areas yet. I think that will also lead to

some increase in services.

We face the same thing that Charlie said at a national level, you

know, the recruitment and retention of the right types of health

care professionals. But also I think I want to play up the partnership issue a lot. I don’t think any one agency right now has the full

answer to this, nor has all the money that they need to address it.

But I think we are seeing a lot of partnerships emerge around this

issue.

A lot of it is coming from the Administration, asking the Indian

Health Service and SAMHSA and BIA to work together. A lot of

it is coming from the Congress in stimulating activity through

funding or through bills like you all just passed. I think the partnerships that we have with SAMHSA, with BIA right now, are

critically important partnerships.

We have also worked with Canada. My counterpart from Canada,

the Director for First Nations and Inuit Health Branch, they have

a very similar problem up there. We had a recent meeting in Albuquerque, New Mexico where their National Institute of Health Research, our National Institute of Mental Health, people from Indian

Health Service, and First Nations and Inuit Health Branch, the

Wisdom Keepers and traditional healers from communities, all got

together.

We partnered to come up with a research agenda in Indian country over the next 5 or so years. We know there is a lack of information about, as Charlie said, some of the risk factors, as well as the

protective factors. Ever since Charlie and I have been in our positions, we have held a joint meeting between the State block grant

coordinators, the Indian programs, and the Indian Health Service

and SAMHSA staff. That meeting has continued to grow in both

importance, as well as in attendance. We are even having people

from other countries come now. There is a part that spins off on

that about suicide to a work group.

So I think partnerships with others beyond just the ones I mentioned, because the socially complex factors of housing, education,

safety in the communities, all those are part of it. It is just such

a complex issue that we have to have more partnerships, I believe.

Senator DORGAN. Mr. Gidner.

Mr. GIDNER. Thank you. I would agree with Dr. Grim and Mr.

Curie as well. From the BIA perspective, on the micro level, I

would say there are not enough trained people on the ground to observe and work with the youth, to identify those who may be thinking about suicide, and to get them into the appropriate health

model to prevent that. BIA does have a cadre of social workers

throughout the country. They are spread very thin and spend most

of their time working with child abuse and adoptions, foster care,

things of that nature.

On the macro level, though, I would suggest that what needs to

happen is there has to be a way to give these children hope that

there is some better future for them. That would involve more job
13

creation, better law enforcement, other things that are going to improve the health of their community so that they know there is

something waiting for them, and that they have a reason to live.

Senator DORGAN. Mr. Chairman, welcome. We are just finishing

up the first panel. Senator Murkowski has not yet asked questions.

I have to be down at an Appropriations hearing in a few minutes

with the Defense Secretary to question him. I just wanted to make

a point at the end of this panel. I think these partnerships are important. I especially appreciate the fact that you are all providing

focus to this. I also think that we have to provide funding as well.

For example, we have an Indians in Psychology Program trying

to encourage Indians into psychology in colleges. That gets zeroed

out every year by the Administration and they are zeroing out the

Urban Indian Health Centers. So we do have to provide funding.

We need youth centers. We need trained mental health professionals and so on.

I have been sensitive to this issue of suicide for a long, long time.

I walked in one morning and found a very close friend of mine had

taken his life, a co-worker. I found him at his desk at 8 o’clock in

the morning. With him, as it is, you say, with Indian youth, it is

the single act in response to multiple causes, almost always the

case regardless of age.

But especially with respect to Indian youth, there is a very serious problem, and I appreciate the partnerships. We need the funding. We need strategies. I appreciate Chairman McCain also providing focus to this issue with this committee, and Senator Murkowski’s attention and interest in it as well. I look forward to continuing to work with you and exchanging views with you and developing strategies with you to address it.

Mr. Chairman, thank you very much.

The CHAIRMAN. Thank you very much, Senator Dorgan. Thank

you for your leadership. Thank you for your attention and your

continued commitment to this issue.

I know that a lot has been covered. I just wanted to ask, Mr.

Curie, I keep hearing from Indian country that methamphetamine

is having a significant effect on this issue, not just suicide, but on

a whole lot of other aspects of Indian country. Can you comment

specifically on the epidemic of methamphetamine and how it has

affected this specific issue?

Mr. CURIE. Yes, Mr. Chairman; Methamphetamine is undoubtedly from what we have seen the most dangerous drug that has

been on the street and available. In terms of its addictive quality,

one use and addiction can occur. In terms of the devastating impact

it has on the individual, in terms of their brain. Their whole life

begins to get focused on one thing, and that is the desire to have

more methamphetamine.

The challenge and why it is in many parts of the country, while

national prevalence data shows that actually opiates and painkillers are growing at a faster rate overall nationally, there are

places in the country, in Indian country and rural and frontier

areas in Western and Midwestern States where methamphetamine

is the number one problem. That is because of the accessibility of

the ingredients to make meth. It is available, of course, readily
14

available in hardware stores, in various retail outlets, and there

are recipes, of course, available through the Internet today.

The CHAIRMAN. And some of it is coming across our Indian reservations from Mexico?

Mr. CURIE. Yes; and that is also another factor. Absolutely. So

there is accessibility to it. And there is an undeniable link between

substance abuse, especially when we talk about how dangerous

meth is, and suicide. A high percentage of suicides are linked to

drug and alcohol use.

So to approach this, we believe that it has to be a multifaceted

approach to the suicide problem, that we have to consider our substance abuse treatment and prevention efforts to be part of the suicide prevention efforts. We need to be working specifically with

tribes in the context of their culture and the context of what their

needs are to identify those risk factors that continue to contribute

to the substance abuse problem, and to develop protective factors.

We are finding many of them are the same that relate directly to

the suicide problem and issue. So they do go hand in hand.

We are looking very closely now in California, where the tribal

organization, the California Rural Indian Health Board, received

one of our access to recovery grants in which vouchers are being

used and to expand their capacity for substance abuse treatment.

We are going to be looking very much at the link there in terms

of the impact that additional resource is having in helping address

this issue.

The CHAIRMAN. Senator Murkowski.

Senator MURKOWSKI. Thank you, Mr. Chairman.

Mr. Gidner, you mentioned in your testimony this high school,

middle school youth risk behavior survey, where you have gotten

some pretty compelling data about what our young people are contemplating. What do you do with that data once you receive it? I

understand how these surveys work and the confidentiality aspect

of the survey, but if you have statistics coming out of a middle

school that show a disproportionate number of our young people

are contemplating suicide, is there any opportunity through the

BIA or for the school itself to have some kind of an intervention

with a group of young people that are clearly at risk because they

have indicated to you, they are asking for help. What do you do

with the information?

Mr. GIDNER. What we have done, Senator, is launch, I believe I

mentioned, the question-persuade-response model, where all the

bureau-funded schools are trained, the administrators and staff, to

intervene on behalf of individual students when they observe problems and to try to talk to those students and persuade them to get

help and to refer them to the appropriate place to get that help.

Senator MURKOWSKI. But you are dealing with, again, you are

not able to pinpoint who your students are. You just have a recognition that in this particular school we have an issue. With these

surveys, you have a lag time between the time the students respond and the data is compiled and the results then get back. Are

these surveys helping us do something? Or are they just an indicator of how bad the situation may be getting?
15

Mr. GIDNER. I actually don’t know the answer to that question.

I will have to make inquiries and find out exactly what we do do

with that information.

Senator MURKOWSKI. I think when we ask our kids how they are

feeling and how they are thinking, we need to be in a position to

then respond and not respond eight or nine months after the fact

in some generic way. These surveys have value, but we do want to

know that we are able to get to the kids, particularly when you

have statistics coming back that say one-fifth of our high schoolers

have contemplated suicide at some point in time.

Mr. Curie, you mentioned a grant to Manniilaq Association,

which we greatly appreciate. Can you tell me the terms of that

grant, what we are talking about, and exactly how you anticipate

that we will be able to utilize that to stem the suicide rate?

Mr. CURIE. Absolutely, Senator. It is a total of $1.2 million over

a 3-year period, $400,000 per year. It is to be utilized to begin to

implement evidence-based suicide prevention strategies that are

community-wide types of strategies. Again, more clearly identifying

what risk factors are contributing to the suicide issue, risk factors

such as students not having enough activity, young people and

families not being fully engaged. There are going to be a variety

of those types of risk factors.

And then developing strategies and begin to put into place evidence-based programs that reflect the protective factors that can

begin to address those particular risk factors, and of course a required evaluation of that over the 3-year period as to how effective

it is working.

Again, it is to put in a prevention framework and have it be community-based engaging all elements of the community.

Senator MURKOWSKI. Which is the appropriate response, the appropriate way to proceed in my opinion. We had an opportunity to

speak a little bit during the break about, it is a societal issue. It

is an economic issue. There are so many things that come into it.

When I have asked young Alaskans out in the villages, are you

happy, what would make your life better, it is some very simple responses. They are bored; we are looking for something to do; we

have no community meeting place.

And yet when we try to address that by providing for a Boys and

Girls Club or some form of a community center, that doesn’t necessarily fit your model in terms of where grant funding goes. We

need it to be in some form of a service, and yet we need the flexibility to work with the communities.

Manniilaq has, I was out there over the Easter break, and they

have an incredible program out in the remote area where literally

the whole family is taken out to be treated for substance abuse and

other issues. But the family as a whole is addressed, not just the

one individual that is suffering from the addiction or the depression. I don’t know if we are set up to deal with a response in this

broad a manner, but when we are looking at statistics like we are

seeing now, it seems to me we have to do something different. The

Manniilaq approach hopefully will shed some light there.

Mr. CURIE. I think that type of model has a lot of merit and applicability. In fact, I think one of the challenges and barriers that

we have found in Alaska in particular is the fact that when treat-
16

ment is offered that someone is taken out of a village, around 200,

300, or 400 miles to residential treatment centers, spends a period

of maybe a few months there even, but goes right back. There has

been very little intervention for the family or the community. The

results are not good.

Senator MURKOWSKI. The results are predictable.

Mr. CURIE. Exactly. So what we need to do is find resources

within the community and have the supports put in place so that

people have an anchor to rely on. They need, again, to be community-based. It should be no surprise to us. We believe in community-based care throughout this Nation in what we are doing. We

find that those give the best results. The same would be true in

Indian country.

Senator MURKOWSKI. One question for you, Dr. Grim, and then

you can comment here. As far as Alaska’s behavioral health aid

program, it is something that has been working in the State. Do

you see this perhaps as a model to be used in other areas of Indian

country? And if you would comment on what Mr. Curie and I were

talking about.

Mr. GRIM. If you would permit me, Senator Murkowski, to respond to his question first. I wanted to say that I think the tack

that SAMHSA is taking is a very appropriate on, too. One of the

things I talked about in our partnerships together that we have

with them. They are taking and asking communities to use evidence-based sorts of practices and try to put them in place in real

life communities and see how they work.

One of the things the Indian Health Service is doing with some

of our resources is to go to the community level and ask them what

needs to be done. We have been targeting communities that have

some of the highest need. So we are doing basically what you said.

SAMHSA is attacking it from one direction. We are using some of

our resources to attack it from just the direction you said. We go

into an individual community and say, okay, what is it you think

you need; we have specialists that help; that can help guide the

process. Then we try to tailor it for that community.

So I think, again in combination with multiple agencies working

together, we are trying to tackle it from different perspectives.

To be more direct to your second question or your question to me,

I have watched in awe and respect as Alaska has continued to push

the frontier to try to deal with some of the issues that they have

to deal with in their communities. I think the next step, the community behavioral health aid therapist that they are looking at is

going to be another model program. As Charlie said, we are looking

at shortages in many of the professional areas.

He also noted, as I noted, that I think we have under-diagnosed

mental health issues, depression and others, in many of our communities, not just Indian communities around the country. Now

that mental health care is becoming more acceptable, people are

willing to seek it out. We are starting to see more chronic diseases

that are being affected by some of the underlying mental health

conditions people have. I think we are all becoming much more

aware of it and the role that it is playing in not just mental health

issues and suicide, but in chronic disease issues as well.

Senator MURKOWSKI. I appreciate your support.
17

Thank you, Mr. Chairman.

The CHAIRMAN. Thank you very much.

I thank the witnesses. I appreciate your prioritizing this very important issue. We look forward to working with you. Thank you.

Our next panel is Donna Vigil, who is director of the Division of

Health Programs at the White Mountain Apache Tribe, Whiteriver,

AZ. She is accompanied by Dr. Norine Ashley, who is the director

of the Apache Behavioral Health Services. William E. Martin is

chairman of the Alaska State Suicide Prevention Council and First

Vice President of the Central Council of the Tlingit and Haida

Tribes of Alaska. Dr. Dale Walker is director of One Sky Center,

Oregon Health and Science University. Jo Anne Kauffman is the

project director of Native Aspirations Project in Spokane, WA.

Welcome to our witnesses. Ms. Vigil, welcome. We are glad to see

you. Please proceed with your statement.

STATEMENT OF DONNA VIGIL, DIRECTOR, DIVISION OF

HEALTH PROGRAMS, WHITE MOUNTAIN APACHE TRIBE, ACCOMPANIED BY NORINE ASHLEY, DIRECTOR, APACHE BEHAVIORAL HEALTH SERVICES; AND FREDERICK L. HUBBARD, ASSOCIATE DIRECTOR, COMMUNITY RELATIONS

Ms. VIGIL. Good morning, Mr. Chairman and members of the

committee. My name is Donna Vigil. I represent the White Mountain Apache Tribe. I am the executive director of the Division of

Health Programs. I have with me here Dr. Norine Ashley.

The CHAIRMAN. Welcome

Ms. VIGIL. She is the director of the Apache Behavioral Health

Center.

The White Mountain Apache Tribe has 17,000 members with

15,000 members living on the reservation. Before I go any further,

I would like to say that Ronnie Lupe, chairman of the White Mountain Apache Tribe, sends his highest regards to all the members of

the committee, especially to his friend, Chairman McCain. He considers all the members of the committee friends to the Apache people.

The CHAIRMAN. Thank you.

Ms. VIGIL. Suicide is a great challenge to the White Mountain

Apache Tribe, particularly among children and young adults. With

very little outside funding, the White Mountain Apache Tribe has

come together to address this issue. We started up in 2001 with a

suicide task force established by the tribal council. It is headed by

a community member who is an IHS employee and a member of

the tribe. This committee, the suicide task force, has worked with

Johns Hopkins University. It is working on research through the

NARCH program, which stands for Native American Research Center for Health.

Through that, the tribal council passed a resolution to begin a

registry of suicides, and through the suicide registry our mental

health center, Apache Behavioral Health Center, sees all the people who are suicidal, or who are at high risk. Within a 1-year period, there were 300 referrals from the task force. We have two

tribal members who are working on the task force, assisting and

helping with case management.
18

Another committee we have formed is the High Risk Response

Alliance through the Apache Behavioral Health Services. The Behavioral Health Alliance is really an effort to get community members involved in our efforts with suicide prevention.

With that, we started a Ministers Alliance. You know, as Apache

people, we are deeply spiritual, and we wanted to include spirituality in our suicide prevention program, so the Apache Behavioral

Health Center did incorporate a component of spirituality. We have

over 60 Christian denominations on our reservation. The ministers

had a walk recently and had prayer services in a location where

we had several suicides.

Another part of the Alliance is the traditional part, our traditional healers. They formed a group and are planning a ceremony

for the reservation.

These are only some of our efforts. We have limited funds and

are trying whatever we can to work on the suicide issue, but we

have some barriers. I am going to mention them quickly because

they are very important. One is that there are not enough professionals and paraprofessionals who can provide training or skills to

respond to suicidal persons. Apache Behavioral Health Services is

partly funded by Public Law 93–638. It also receives funding from

third-party billing, through Medicare [which is Medicaid of Arizona].

But we fear that we may not be able to continue billing for our

Native American counselors, those who are not doctors. They are

good workers who go out into the community and help the people

in crisis. Yet our Medicaid program is in jeopardy because of the

certifications and degrees that are required. So we ask that this

doesnt happen; that we are able to continue to bill for services provided by these non-professional people. This is very important for

the continued success of our suicide prevention program.

Another thing we need is a 24-hour response center. That would

allow us to have a place where people can call any time.

Underlying our challenge with suicide is the main problem of

substance abuse. Without any culturally sensitive centers to which

we can send our young Apache people, it is difficult to work on the

problems that they have. So we are asking that we get funds for

culturally sensitive substance abuse prevention centers, to provide

this much-needed service for our youth.

In conclusion, our needs are great, and our resources are few.

Our suicide rate is among the highest in this country. So I am very

happy and I am grateful that the Senate Committee on Indian Affairs has taken an interest in hearing about suicide in the hopes

that you will help us to implement and fund suicide prevention

programs.

Thank you.

]Prepared statement of Ms. Vigil appears in appendix.]

The CHAIRMAN. Thank you very much.

Mr. Martin, welcome.
19

STATEMENT OF WILLIAM E. MARTIN, CHAIRMAN, ALASKA

STATE SUICIDE PREVENTION COUNCIL, AND FIRST VICE

PRESIDENT, CENTRAL COUNCIL OF THE TLINGIT AND

HAIDA TRIBES OF ALASKA

Mr. MARTIN. Chairman McCain, Senator Murkowski, other members of the committee, thank you for inviting me to testify at this

hearing.

My name is William Martin and I am chairman of the State Suicide Prevention Council in Alaska. I am also first vice president of

Tlingit and Haida Indian Tribes of Alaska.

The State Suicide Prevention Council serves in an advisory capacity to the Governor with respect to what actions can be taken

to improve health and wellness; broaden the public’s awareness of

suicide; enhance suicide prevention services and programs; develop

healthy communities; and develop and implement a statewide suicide prevention plans, copies of those plans I have brought with me

and have distributed to your aides; and to strengthen existing and

build new partnerships between public and private entities that

will advance suicide prevention efforts in the State.

Let me briefly outline the magnitude of our problem and then report on what seems to be working at preventing suicide. For the

past decade, Alaska has had the second highest rate of suicide in

the United States, twice the national average. Alaska Natives commit suicide two to three times that of non-Natives in Alaska. In my

written testimony is an even more startling statistic.

Our Suicide Prevention Council has offered the workplans to prevent suicide. We distribute it within many diverse communities

throughout the State. With no one answer that fits our many cultures, we believe there are tools that make suicide preventable.

Our workplan combines analysis of the problem with words of wisdom from our Alaskan elders. It sets 13 prevention goals that a

community can use to meet its specific suicide prevention needs.

I submit with my written testimony a copy of our workplan and

ask that it be included in the record of the hearing.

The CHAIRMAN. Without objection, it will be made part of the

record.

Mr. MARTIN. Our Suicide Prevention Council has increased its

suicide prevention and awareness efforts through a media campaign and through effective use of the Gatekeeper program. Gatekeeper programs reduce suicide rates by training first responders

such as emergency personnel, public safety officers, clergy and others who may be approached in a suicidal crisis, but who typically

lack specific suicide prevention experience.

The Gatekeeper program results in much more effective crisis

intervention. We could do far more Gatekeeper training if we could

gain greater access to Federal funding for these programs. This

cost-effective approach works and deserves more financial support.

As an Alaska Native leader, I have become convinced that my

people must go back to study the lessons of our ancestors. They

lived in a time before alcohol was introduced to our communities.

Suicide then was an unheard of event, typically in rare cases where

one has grievously shamed his family or has caused despicable hurt

upon others. Although my stance may not make me very popular,

I am convinced that tribal leaders should set an example to our
20

people by abstaining from alcohol. Whether or not alcohol is a problem for us as individuals, we leaders need to demonstrate to our

people that alcohol is the cause of most of our social problems.

Suicides in a community tend to go in streaks and I think I know

why. I believe that there is a copycat effect that is encouraged by

how we talk about people after they kill themselves. For example,

at a funeral for someone, we never say bad things about a person

who has died, but there may be a person listening in the audience,

a young person who might think to himself that this is all I need

to do to gain respect for my family and my friends and for my elders. So it starts a compounding effect.

We need to talk to our young people before this happens. We

need to praise their good qualities while we are living. Natives

don’t usually openly demonstrate day to day affection and love for

our children because of some of our cultural ways. We just don’t

do that. We need to change this. Our Native cultures are living entities that need to be shaped by Natives alive today.

To change this culture, to change our ways, we need to find

funds from outside our own private communities to support suicide

prevention programs that assist our elders and leaders in changing

the attitudes of our people. Native communities simply cannot compete on the same playing field for funds from SAMHSA and from

the Centers for Disease Control.

One of our regions hit hard by suicide is the Yukon-Kuskokwim

Delta. Through the Association of Village Council Presidents, a

plan has been organized which in Eskimo means ‘‘securing a future

for our children.’’ This mission is to create a well community in

which all entities work together under the direction of elders to restore healthy communities, strong in culture and language.

Like my own community in Juneau, the Tlingit and Haida community has developed a modest program that involves Native

teachers in button-blanket making, weaving, and carving to pass

on this knowledge to our youth. This has shown to be a great success in bringing back Native pride and Native values, the key defense mechanisms against hopelessness and depression that can

lead to suicide.

To fund a program such as this in the Juneau area requires

funding of approximately $15,000 to $20,000. Funds like this

should be made available to our smaller communities that could

bid on plans and programs that we can use to discourage suicide.

Mr. Chairman, my time has expired and I would be happy to answer questions and will be available for that.

[Prepared statement of Mr. Martin appears in appendix.]

The CHAIRMAN. Thank you very much, Mr. Martin.

Dr. Walker.

STATEMENT OF R. DALE WALKER, DIRECTOR, ONE SKY

CENTER, OREGON HEALTH AND SCIENCES UNIVERSITY

Mr. WALKER. Thank you very much, Mr. Chairman. It is a pleasure to be here.

Senator Murkowski, I also appreciate being here as a witness for

you.

My name is Dale Walker. I am a psychiatrist. I am also a Cherokee. I direct a program called the One Sky Center. The One Sky
21

Center is the only national resource center for American Indian alcohol, drug and mental health in the country. In the last year, we

have been at 59 different sites. We are a small group. We have

partners across the country who work closely with us.

We have heard a little bit about the discussion of interagency

support and coordination, and I would tell you that the development of partnerships at the level of a resource center is a critical

next step in trying to do these issues as well.

We have been at many sites, first looking at alcohol and drug

issues, but everywhere we went, it was the issue of family violence,

suicide, disorganization, and disconnection with culture that were

issues of great concern. You have heard already today the fact that

these issues are interrelated, that indeed trying to wrestle with

this issue in a pointed directive way is not as effective as working

with the tribe and getting an overall plan on how to deal with the

many circumstances that lead to the problems.

You have heard some discussion also about indigenous knowledge or traditional knowledge about how to keep the family intact

and about how to restore values. All of these are critical and quite

important. Evidence-based work is also critical, but communitybased treatment and management requires that the values within

the community are a part of the care.

We have been looking and working with areas also and finding

out that you don’t do a visit, a consult or technical assistance once;

that when you visit, you stay. You work with the tribes continuously through the process.

Sometimes, that is not in sync with the funding cycles of how

programs work within the system, so we are very interested in if

things are set up to help develop. By the way, I want to add, you

already know that there is underfunding of mental health, addictions, and education. There are three reports, two from Congress,

about the underfunding. You are aware of the disparities that exist

in these areas.

In order to address those, we know there needs to be more bottom-line funding to help with these problems. Then when you develop special programs with grants, you can actually advance the

best practices for a community so that everybody can learn together.

Our experience has been that if we can work with and train people, the behavioral health aide program in Alaska is a very good

example, they are able, the community is empowered to select their

people. They decide who gets the training for triage assessment

and follow-up after-care in their programs. That empowers the

community to be involved.

They also have the trust and that kind of goes quickly with the

process of care. We support that. I think it is a remarkable next

step in training for IHS programs, as well as, frankly, third world

programs that are in the same situation. These efforts are quite

important.

In the proposed bill, we took a serious look at the training issues

and maintaining the expertise out in the field. How you get the

care there, and how you maintain the care becomes critical. You

have to maintain the care for licensure so that billing and work

under the logical health care circumstances. That maintenance of
22

license and certification to do the training is very difficult if you

are in a remote area.

We think that the telemedicine is not only for clinical care, but

it is for training of the people who go out into the area. It would

be wonderful to have in place modules for training in addictions

and mental health and suicide so that people could take courses on

Web sites and be able to do that. We are working with the tribal

colleges and universities to help establish that kind of approach.

The other position I would just mention is that the interagency

task forces and partnerships work if the people understand that we

have to look at the total funding across agencies and get together

to figure out how to focus the dollars as a group. If you look at it

as individual silos, that is what you get.

We have much else to say in the discussion, but I am going to

end the conversation here.

Thank you very much.

[Prepared statement of Dr. Walker appears in appendix.]

The CHAIRMAN. Thank you very much, Dr. Walker.

Ms. Kauffman, welcome.

STATEMENT OF JO ANN KAUFFMAN, PROJECT DIRECTOR,

NATIVE ASPIRATIONS PROJECT

Ms. KAUFFMAN. Thank you, Mr. Chairman. I want to thank you

and Vice Chairman Dorgan for your work on this issue, and also

thank you, Senator Murkowski for your presence here and your interest in this very difficult topic.

My name is Jo Ann Kauffman. I am a member of the Nez Perce

Tribe. I have been involved in Indian health issues for the last 30

years. I have a master’s in public health from the University of

California at Berkeley.

I was invited here to testify today as a contractor for SAMHSA

and the work that we are doing currently on their behalf to bring

evidence-based interventions to high risk communities in prevention mode.

I must say, first of all, that this hearing is important and it was

interesting coming on the heels of Mother’s Day. I spent the weekend thinking about the importance of what can come out of this

hearing and the work that you are doing to bring resources to communities, and my heart goes out to all of those parents for whom

this issue is very personal.

We were asked last year by the Substance Abuse Mental Health

and Services Administration to consider an emergency contract. As

a Federal contractor, we prepared a response for them, specifically

to look at nine of the highest risk communities across the United

States in Indian country for purposes of preventing some of the disasters that we saw last year with regard to youth violence in Minnesota and some of the suicide clusters across the Plains States.

We pulled that together primarily as a prevention model to prevent youth violence, youth bullying and suicide. We targeted those

communities most at risk through a quantitative assessment. We

are engaging those nine communities in a grassroots, bottom up

planning approach, and bringing the curriculum or the evidencebased interventions to those communities to implement according
23

to their wishes over the remainder of this contract which runs until

March 2007.

The nine communities that were selected include, well first of all,

in selecting the nine communities that was a quantitative analysis

of mortality data related to violence for Indian youth in comparison

with behavioral health funding and poverty rates. We looked at

three areas primarily: The Aberdeen area, the Alaska area, and the

Billings area. Then we did a series of interviews with professionals

in each of those areas to identify three communities within each

area to come up with the nine.

In the Aberdeen area, we have agreements to work with the

Cheyenne River Reservation, Crow Creek Reservation, and the

Pine Ridge Reservation. In Alaska, we will be working with the

Native Village of Alakanuk, the Noorvik Native community, and

the Native village of Savoonga. In the Billings area, we will be

working with Fort Belknap Indian Reservation, Fort Peck Indian

Reservation, and the Wind River Reservation in Wyoming.

Because youth violence is a complex historical, cultural and family issue that has economic and geographic and access to care kinds

of issues overlaying that, our effort really is to reduce risks by promoting supportive and protective factors within each of those communities, and to allow each community to identify its own strategy.

We did conduct a review of evidence-based interventions and I

want to note that the National Registry of Evidence-Based Programs and Practices, known as NREPP, is provided through

SAMHSA as a registry of evidence-based interventions. It contains

only two Native American-focused evidence-based interventions

that have received that seal of approval by NREPP.

There are a host of other interventions that are called practicebased interventions. And then as you heard earlier, there are many

cultural-based interventions that bring forward the traditions and

values and ceremoneys of particular tribes and cultures as a way

to protect Indian youth and to prevent violence.

I am happy to report that last week, we conducted our first two

community engagements. We worked with the communities at Pine

Ridge and at Cheyenne River. Each of those communities conducted their own planning process. They learned about the evidence-based interventions. What emerged from that was their own

very unique application of cultural knowledge and values and tradition and ceremony to come up with a plan for this next year for

working within their school districts and their communities to prevent youth violence.

All nine communities are very motivated. This effort is, as I described, is an emergency effort of a prevention mode to prevent further incidents like we heard of last year. But it is a short-term effort and each of the communities has been very active in seeking

additional alternative resources through their States, through the

Garrett Lee Smith opportunities for funding, and through other resources.

So in closing, Mr. Chairman, I have a few recommendations.

First, that the committee consider expanding support for tribal

communities seeking assistance through SAMHSA or IHS. It is difficult for short-term demonstration efforts to have time to prove results. Second is that in looking the quantitative data, it is clear
24

that many more communities require this type of preventive assistance through whatever channels are available.

Third is that the NREPP process of sanctioning certain evidencebased interventions may inadvertently be leaving out many traditional tribal or practice-based interventions. That is important only

because it seems that funding now is being tied closer and closer

to that status of NREPP evidence-based interventions, including

Medicaid reimbursement at the State level.

So it would be important to provide whatever support to get

more tribally based or culturally based interventions through that

status.

I support everything that has been said already with regard to

workforce development in the paraprofessional field and increased

access to services.

In closing, Mr. Chairman, thank you very much for this time.

[Prepared statement of Ms. Kauffman appears in appendix.]

The CHAIRMAN. Thank you very much.

I would like to ask the witnesses how serious in the overall issue

of suicide is the issue of methamphetamine, the accompanying epidemic of methamphetamine. I will begin with you, Ms. Vigil.

Ms. VIGIL. Well, in the last year we have noticed a 30-percent increase of methamphetamine use. When we recently tested our regular employees who work for the tribe there was a 30-percent use.

The CHAIRMAN. What percent?

Ms. VIGIL. Thirty percent. In the past, there was no methamphetamine abuse on the reservation; there was just alcohol. And

now methamphetamine abuse is climbing even among the work

force of the tribe. Methamphetamine abuse is related to alcohol

abuse, and substance abuse is related to more than 50 percent of

the suicide cases.

The CHAIRMAN. Mr. Martin.

Mr. MARTIN. Mr. Chairman, it is a huge problem in Alaska because it is easily made. It can be made any place. Also, the effects

of it are quicker in bringing down barriers in people, even more so

than alcohol. It is a problem we are focusing hard on in villages,

but without law enforcement in remote villages, it is very difficult.

And besides, with the secrecy involved in each of those communities, it makes it very difficult to bring it out in the open and expose it to the law enforcement people.

The CHAIRMAN. Dr. Walker.

Mr. WALKER. If suicidal intent and alcohol are a crisis, suicidal

intent coupled with methamphetamine is a disaster. I say that in

studying and working on suicide issues, 90 percent of the time substance use is a part of the suicide attempt, so it is a huge connection. The fact is that methamphetamine now is more and more

available, and most kids use what is available. There is not a staggered way of doing it. They use what is available. Methamphetamine is everywhere in every Indian reservation. Therefore, it is

used.

The reason I say it is a disaster is that methamphetamine also

causes psychosis. You actually lose control of your ability to use

your own logical thinking.

The CHAIRMAN. And there is a period of exhilaration and a period of depression.
25

Mr. WALKER. That’s right. And so with all of that connected, the

psychosis and the depression and the loss, all of those feelings are

magnified, making risk for suicide much, much higher.

The CHAIRMAN. Dr. Walker, before I leave you, is most of this in

Indian County manufactured in Indian country? We know how

easy it is to obtain the materials. Or is it like in the rest of the

country, where you have really this flood of Mexican methamphetamine, which is even cheaper than making it yourself?

Mr. WALKER. What I hear across the country is the import, the

bringing in from out of the country and out of the area. There are

users, and many times by the way, the manufacturing is not by Indians out in isolated areas. It is by other people who know that is

a good place to hide.

The fact is, though, there is a huge problem with the movement

of methamphetamine and other drugs into Indian country from out

of this country.

The CHAIRMAN. Now, we all know that the suicide rate is up,

right?

Mr. WALKER. Yes.

The CHAIRMAN. How much of that would you attribute to the

methamphetamine problem?

Mr. WALKER. Difficult question. I would quickly tell you that we

need to understand what is happening out in our Indian communities with methamphetamine. There is actually very little science.

There are lots of facts and experience. But to answer your question,

to make that relationship, I think it is a wonderful point that

needs to be addressed. It reminds me that another recommendation

we had is that perhaps in this bill some support from the National

Institutes of Health might be useful to actually study these problems much, much more thoroughly.

The CHAIRMAN. Maybe we can seek for that to happen. I think

that is a very good recommendation.

Ms. Kauffman.

Ms. KAUFFMAN. Thank you, Mr. Chairman.

I think the only thing that I would add here with regard to methamphetamine is what we have heard is the difficulty in treatment

of individuals who are addicted to methamphetamine, and that it

is much more difficult and intense than I think the treatment programs that have evolved around alcohol addiction or even drug addiction. And so that we are hearing from drug treatment providers.

The other thing that we have also heard is the difficulty in terms

of law enforcement if there is ever jurisdictional ambiguities, I

guess, that tend to work in favor of those who are hiding underneath the radar screen of law enforcement.

The CHAIRMAN. Thank you very much. We are in agreement on

lack of funding. We are in agreement there needs to be more interagency coordination and effort. What else do we agree on, Dr.

Walker?

Mr. WALKER. Well, first of all, I think that the consistency of

three hearings in 1 year is raising the visibility and the ability for

communities to talk about the issues. If I could give a very, very

direct comment, it would have to do with how we maintain connections with our communities when we do technical assistance and

do the kinds of work in providing best practices in those commu-
26

nities. That connection is so critical to maintain. Letting the communities alone or letting them drift is not an effective way, and we

know that.

I think that the integration and support that we have seen from

SAMHSA has been marvelous; the fact that we try to put, as you

well know, if you talk about addictions and mental health, and prevention and treatment, those can also become isolated from each

other. The fact that Mr. Curie states there is one SAMHSA is a

wonderful message. The people are now starting to work together

to move those things in partnership with the community.

The partnership, by the way, starts with the leadership of the

tribe. We need much, much more influence and ability to provide

information so the tribal councils can actually make decisions

about their own health care.

The CHAIRMAN. Ms. Kauffinan.

Ms. KAUFFMAN. Thank you, Mr. Chairman.

One of the points that Dale just made with regard to tribal leadership we use with our communities, it is called a community readiness model to assess where a community is before coming in with

interventions or assistance. Across the board so far, it has been too

little awareness on the issue, too vague awareness on the issue. I

think that so much energy and resources are taken responding to

tragedies and events, as they should be, but so much more needs

to be done with regard to prevention and awareness and training

at the local level.

The CHAIRMAN. Mr. Martin.

Mr. MARTIN. We agree that we need to get the programs into the

villages, but more with the cooperation of the people in the villages.

Sometimes there is a stigma involved where they feel that we are

coming in and telling them how to do things, when in effect we

should be able to be working with them, with the leaders of the villages, along with the elders. We already have the commitment from

the elders, who are always standing by ready to assist in the youth

programs, but we need to be able to work from the, like in our case,

central council. Tlingit and Haida needs to work with the individual communities to be able to set up programs.

The State Suicide Council is also willing to adapt its plan to any

of the villages that would require assistance in setting up how to

customize it for each individual village.

The CHAIRMAN. Ms. Vigil.

Ms. VIGIL. I think we all agree that we need more paraprofessionals and professional Native Americans who can provide services. We need Medicaid of our State to continue to pay us for providing those services because that is one of the major sources of

funding for us.

Another thing we agree on is that treatment for Native Americans should be tailored specifically for them, to address all their

issues.Thank you.

The CHAIRMAN. I want to thank the witnesses. Senator Thune

had some records that need to be included as part of the hearing

record. The letters are from South Dakota Native Americans who

have lost relatives to suicide, to be made part of the record.

I want to thank the witnesses. I appreciate your commitment to

trying to address this terrible and tragic issue. I am very grateful
27

for the leadership and conunitment of Senator Dorgan and other

members of this committee. We will not quit, nor will you, and

hopefully we can make some progress over time and bring more attention to this ongoing national tragedy.

Thank you. This hearing is adjourned.

[Whereupon, at 11:25 a.m., the committee was adjourned, to reconvene at the call of the chair.]

(29)

APPENDIX

ADDITIONAL MATERIAL SUBMITTED FOR THE RECORD

PREPARED STATEMENT OF HON. JOHN MCCAIN, U.S. SENATOR FROM ARIZONA,

CHAIRMAN, COMMITTEE ON INDIAN AFFAIRS

This is the third hearing in the 109th Congress that this committee has held on

youth suicide among Native Americans. At a field hearing Senator Dorgan chaired

in North Dakota last year, and at a subsequent hearing here, we learned that the

suicide rate for Native Americans continues to escalate and is many times the national average for other population groups. The tragedy of young people taking their

own lives has particularly impacted various native communities around the country

that have experienced ‘‘clusters’’ of suicides among their school-aged children.

Legislation has been introduced to try to address the problem. Senator Dorgan introduced, and I co-sponsored, S. 2245, the Indian Youth Telemental Health Demonstration Project Act of 2006, which passed the Senate just last week. The bill authorizes a demonstration project to test the use of telemental health services in suicide prevention, intervention, and treatment of Indian youth. S. 1057, the Indian

Health Care Improvement Act of 2006, which has been reported out of the committee

but which has not yet passed the Senate, includes the development of a comprehensive behavioral health prevention and treatment program for Indian Behavioral

Health Services; an assessment of the scope of the suicide problem; and a grant program to provide research on the multiple causes of Indian youth suicide.

Today, the committee meets to examine how suicide prevention programs and resources that exist outside of Indian country might be applied to American Indians

and Alaska Natives. To this end, committee staff has put together draft legislation

to add a native component to existing Federal suicide prevention and related programs, and I welcome witnesses’ comments today on these proposals.

I am pleased that representatives from the White Mountain Apache Tribe could

be here today. Last year, committee staff traveled to White Mountain to meet with

Apache Behavioral Health Services, where they learned that, in the tribe of about

15,000 members, there had been over 500 attempted suicides in 1 year. Even accounting for the different ways in which suicide attempts are counted, this number

is both shocking and heart rending. I am pleased that the thoughtful and informed,

if overwhelmed, people who helped to educate my staff in December are here today

to again share their experience.

Again, I commend the vice chairman for his leadership on this issue, and look forward to the testimony of the witnesses.
30
31
32
33
34
35
36
37
38
39
40

PREPARED STATEMENT OF LORETTA BULLARD, PRESIDENT, KAWERAK INC.

Kawerak, Inc. is encouraging the Senate Indian Affairs Committee to introduce

and support passage of language that would dedicate funds for tribal suicide prevention programs.

Kawerak is a tribal consortium and non-profit in northwest Alaska. We provide

services throughout the Bering Straits Region. Our region encompasses 26,000

square miles, has 16 distinct communities and 20 federally recognized tribes. We

have very few roads in the region, so most in-region travel is by small airplane,

snow machine in winter, or small boats in the summer. We are authorized by resolution to provide BIA services to 18 of our tribes and 2 of our tribes compact independently. Our Board consists of the presidents of each of the 20 tribal councils in

the region, two elder representatives and the chair of Norton Sound Health Corporation, a tribally authorized health consortium.

The incidence of suicide in the Bering Strait Region is staggering. The regional

population is about 9,000 individuals of which 7,500 are Alaska Native. All suicides

in the Bering Straits Region have been Alaska Native. The Bering Straits Region

suicide rate is double the rate in Alaska and is six times the national rate. Suicide

accounts for 17 percent of all deaths in the Bering Straits Region. Our population

is small, but our problem is large. In regions such as ours, we know the individuals

that commit suicide. They are our relatives, our friends, our tribal members, our

children and young adults. Because our population is small and we know each

other, I believe the suicides have a cumulative impact on our young people. In the

last 3 years [2003–05], 20 people committed suicide in 11 of our 16 communities.

The majority of individuals who committed suicide were between the ages of 15–

29 years old. At least 122 individuals took their own lives from 1979–2004 [1991

statistics were not available]. 75 other individuals attempted suicide between 2003–

05, and it is reported that 175 individuals talked about taking their own lives.

[These are individuals who went through Norton Sound Health Corporation’s Behavioral Health On Call system and do not include the number of attempts that

went unreported or individuals who did not call for help.]

Nome Public Schools conducted a Youth Risk Behavior Survey in 2005 for ages

12–18 year old junior high and high school students and compared them to the same

survey in 1999. To put this in perspective, there were only 203 students in the survey group. Fifty-three students [26 percent] who responded to the survey said they

had seriously thought of killing themselves and 29 [14 percent] actually tried to kill

themselves at one time.

Behavioral health providers in many rural areas of Alaska are either in short supply or are less than optimally trained for their duties [or both]. There is also a high

turnover. It is difficult to provide comprehensive services in so many communities.

Training local service providers would be an effective solution but funds are needed

to do so.

Kawerak is recommending funds be set aside for tribal suicide prevention programs because of the epidemic proportions of suicide among our youth. Tribes and

tribal consortiums currently compete with the States for SAMHSA’s suicide prevention grant funds. When Kawerak talked to State Behavioral Health Services Division Suicide Prevention staff, we were encouraged not to apply for the SAMHSA

grant because the State was going after the same grant funds. Statewide suicide

prevention efforts tend to focus on broad planning and prevention activities that

have had limited success in village Alaska. The State of Alaska has made funds

available for some communities to hire village suicide prevention coordinators. This

has been more successful.

Suicide is a serious problem in our rural villages. It is going to take time and

money to address. We would like to design and implement a grass roots, hands

problem—in keeping with the unique cultures and conditions in northwest Alaska.

We encourage this committee to make funds available such that we can begin to

reduce the high rate of suicide among our youth.

For further information, contact:

Loretta Bullard, president, Kewerak Inc., PO Box 948 Nome, AK 99762, Phone:

907–443–5231 Fax: 907–443–4452

PREPARED STATEMENT OF CHARLES G. CURIE, ADMINISTRATOR, SUBSTANCE ABUSE

AND MENTAL HEALTH SERVICES ADMINISTRATION

Mr. Chairman and members of the committee, good morning. I am Charles G.

Curie, M.A., A.C.S.W., Administrator of the Substance Abuse And Mental Health

Services Administration [SAMHSA] within the Department of Health and Human
41

Services. I am very pleased to be here today to describe how SAMHSA is working

to address suicide among American Indians and Alaskan Natives.

I was scheduled to speak at a suicide prevention conference in Casper, WY today,

but I am so personally concerned about suicide rates especially among American Indians and Alaskan Natives that I wanted to provide this testimony myself.

It is a privilege to testify along with Dr. Charles Grim, director of the Indian

Health Service [IHS] this morning. SAMHSA and IHS have developed a strong partnership reflected in our current Intra-Agency Agreement to work efficiently and effectively together to help meet the public health needs of American Indians and

Alaska Natives. It is also a privilege to be with Jerry Gidner, Deputy Bureau Director for Tribal Services at the BIA.

It was just over a year ago that Kathryn Power, Director of SAMHSA’s Center

for Mental Health Services, testified before this committee on my behalf, and

Ulonda Shamwell, Director of Policy Coordination at SAMHSA, testified at a field

hearing in North Dakota on suicide and violence among American Indians and Alaskan Natives. We have accomplished a great deal since then that I want to share

this with you today.

Suicide

Suicide is a serious public health challenge that is only now receiving the attention and degree of national priority it deserves. Many Americans are unaware of

suicide’s toll and its global impact. Suicides make up 49.1 percent of all violent

deaths worldwide, making suicide the leading cause of violent deaths, outnumbering

homicide. In the United States, suicide claims approximately 30,000 lives each year.

When faced with the fact that the annual number of suicides in our country now

outnumbers homicides by three to two—approximately 30,000 and 18,000, respectively—the relevance of our work becomes clear. When we know, based on

SAMHSA’s National Survey on Drug Use and Health [NSDUH] for 2003, that approximately 900,000 youth had made a plan to commit suicide during their worst

or most recent episode of major depression and an estimated 712,000 attempted suicide during such an episode of depression, it is time to intensify activity to prevent

further suicides. The NSDUH data and the countless personal stories of loss and

tragedy are why I have made suicide prevention a priority at SAMHSA.

Suicide Among American Indian and Alaska Native Youth

Last year, a suicide cluster occurred on the Standing Rock Reservation in North

Dakota and South Dakota. Ten young people took their own lives, and dozens more

attempted to do so. The Red Lake Indian Tribe in Minnesota is experiencing high

suicide rates following the deaths of nine individuals at the hand of a 16-year-old

high school junior. Tragically, many other reservations have similar stories to tell.

Suicide is now the second leading cause of death (behind unintentional injury and

accidents) for American Indian and Alaska Native youth aged 15–24. In 2003, the

suicide rate for this population was almost twice the national average. American Indian youth have the highest rate of suicide among all ethnic groups in the United

States, with a rate of 18.01 per 100,000 as reported in 2003. What is sad to report

is that more than one-half of all persons who commit suicide in the United States,

and an even higher fraction in tribal communities, have never received treatment

from mental health providers.

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

Populations

SAMHSA focuses attention, programs, and funding on improving the lives of people with or at risk for mental or substance use disorders. Consistent with President

Bush’s New Freedom Initiative, SAMHSA’s vision is ‘‘a life in the community for

everyone.’’ The agency is achieving that vision through its mission ‘‘building resilience and facilitating recovery.’’ SAMHSA’s direction in policy, program, and budget

is guided by a matrix of priority programs and crosscutting principles that include

the related issues of cultural competency and eliminating disparities.

To achieve the agency’s vision and mission for all Americans, SAMHSA supported

services are provided within the most relevant and meaningful cultural, gender-sensitive, and age-appropriate context for the people being served. SAMHSA has put

this understanding into action for the American Indian and Alaska Native communities it serves. SAMHSA’s policy is to level the playing field in order to ensure that

Tribal entities are eligible for all competitive grants for which States are eligible unless there is a compelling 4 reason to the contrary.

Since CMHS Director Power testified before the committee last year, and as a result of the Garrett Lee Smith Memorial Act [Public Law 108–355], SAMHSA is now

working with State and local governments and community providers to stem the

number of youth suicides in our country. In 2005, we awarded the first cohort of
42

grants, 14 in all, including a grant to Arizona, under the Garrett Lee Smith Memorial Act State/Tribal Suicide Prevention program. These funds are available to help

States/Tribes implement a Statewide/Tribe-wide suicide prevention network. One of

those first set of grants went to the Native American Rehabilitation Association in

Oregon.

Today I am announcing almost $9.6 million in funding for 8 additional new grants

[each for approximately $400,000 per year for 3 years] under this program to support national suicide prevention efforts. Grants have been awarded to programs in

Oregon, Connecticut, Utah, Wisconsin, and Idaho, and grants specifically geared to

American Indians and Alaskan Natives have been awarded to:

• Manniilaq Association of Alaska to provide a variety of suicide 5 prevention approaches to a region that has one of the highest youth suicide rates in the

world;

• United Indian Involvement, Inc. to implement a Youth Suicide Prevention and

Early Intervention Project targeting American Indian and Alaskan Native children and youth ages 10 to 24 in Los Angeles County; and

• Montana Wyoming Tribal Leaders Council to provide suicide prevention efforts

to six Montana and Wyoming American Indian reservations, serving Blackfeet,

Crow, Northern Cheyenne, Fort Peck, Fort Belknap, and Wind River populations.

An announcement for a third cohort of grants of $400,000 per year for 3 years

under this program closed yesterday. SAMHSA again invited all American Indian

and Native Alaskan tribes to apply for these grants. In an effort to increase the

number of applicants from American Indian and Alaskan Native tribes, we provided

technical assistance specifically for them.

The Garrett Lee Smith Memorial Act also authorized a National Suicide Prevention Resource Center, and for fiscal year 2006 we received an additional $1 million

in supplemental funds for the center. We recently requested an application from the

existing center for use of these supplemental funds, requiring them to address how

they would expand the current youth suicide prevention technical assistance to

tribes and tribal organizations.

Though not a part of the Garrett Lee Smith Memorial Act, SAMHSA has long

supported a national suicide hotline—1-800 273-TALK. Funding to the current hotline grantee was increased by $369,000 in fiscal year 2006, and the grantee has

been requested to submit an application that indicates how they will expand access

to American Indians and Alaskan Natives.

The Administration’s request for fiscal year 2007 for SAMHSA asks for nearly $3

million for a new American Indian/Alaska Native initiative, which provides evidence

based programming on reservations and Alaskan Native villages to prevent suicide

and reduce the risk factors that contribute to youth suicide and violence. We plan

to continue our collaboration with IHS as we have done in the past in this initiative.

SAMHSA has also transferred $200,000 to IHS to support programming and service contracts, technical assistance, and related services for suicide cluster response

and suicide prevention among American Indians and Alaska Natives. One example

is the development of a community suicide prevention toolkit. This tool-kit includes

information on suicide prevention, education, screening, intervention, and community mobilization, which can be readily available to American Indian and Alaska

Native communities via the Web and other digitally based media for ‘‘off the shelf’’

use.

SAMHSA is proud of what we have done while knowing that this is not nearly

enough. The problems confronting American Indian and Alaskan Native youth are

taking their toll on the future of American Indian and Native Alaskan tribes.

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.

PREPARED STATEMENT OF JERRY GIDNER, DEPUTY BUREAU DIRECTOR FOR TRIBAL

SERVICES, BIA, DEPARTMENT OF THE INTERIOR

Mr. Chairman, Mr. Vice Chairman and members of the committee, my name is

Jerry Gidner and I am the deputy bureau director for tribal services in the Bureau

of Indian Affairs [BIA] at the Department of the Interior. I am pleased to be here

today to provide the Department’s testimony on suicide prevention programs and

their application in Indian country. Several of my BIA colleagues accompanied me

today. They are Chet Eagleman, acting chief, Division of Human Services; Kevin

Skenandore, acting director, Office of Indian Education Programs [OIEP]; and Peter

Maybee, assistant to the deputy bureau director, Law Enforcement Services [OLES].
43

Each is a member of a federally recognized tribe, is a senior BIA program manager,

and has invaluable field experience.

I would like to take the opportunity to share the BIA’s concern about Indian teen

suicide and the emotionally wrenching impact it has on Indian country.

Teen suicide is a serious long-standing problem in Indian country. Research has

shown that social factors such as poverty, alcoholism, gangs, and violence contribute

in the manifestation of suicidal ideation, suicidal behavior and suicide attempts by

Indian children and teenagers.

The Indian Health Service [IHS] data document that suicide is the third leading

cause of death in Indian children age 5–14, and the second leading cause of death

in Indian teenagers and young adults age 15–24. In addition, the IHS data indicate

that Indian teenagers/young adults’ suicide rate is 2.5 times greater than the nationwide U.S. rate. Young Indian men are more at risk to completed suicides,

whereas young Indian women are more at risk to suicide ideation or thoughts.

In addition, data from the biennial BIA High School and Middle School Youth

Risk Behavior Surveys [YRBS] provide insight into the progression Indian children

and teens go through from feeling sad or hopeless, to seriously considering suicide,

to making a suicide plan, to actually attempting suicide, to incurring serious injury

requiring treatment by a medical professional. The data demonstrate that approximately one-third of Indian children and teens feel sad or hopeless, in a given year,

which is an early stage in a suicidal event. The most recent BIA YRBS data for Indian students enrolled in 2003 show that for Indian high school students:

• 21 percent seriously considered attempting suicide in the last year, and • 18 percent actually attempted suicide one or more times in the last year.

For Indian middle school students, the data show that:

• 26 percent seriously considered attempting suicide, at some time in their life,

and • 15 percent had attempted suicide.

Furthermore, statistics from the 2002 Annual Report of the Alaska Bureau of

Vital Statistics show that between 1990 and 1999, Alaska Native teens committed

suicide at a rate of 110 per 100,000 or over 5 times greater than the rate of 20 per

100,000 non-Native teenagers in Alaska.

Although national hard data are not available on Indian country residents, the

professional literature strongly suggests a close association between parental alcohol

and drug abuse, child abuse [whether emotional, physical, or sexual], domestic violence and suicide in children and teens. Often suicide may be the only way a child

or teen sees of extricating him/herself from a hostile or threatening environment.

However, the following can help prevent suicide in Indian country:

• Improved housing conditions. • Increased prevention and treatment services. • Increased identification of at-risk individuals and families and referral to services. • Enhanced community development and capacity building through technical assistance and training for tribal leaders and staff.

BIA programs assist tribal communities to develop their natural and social-economic infrastructures [that is, tribal governments, tribal courts, cultural vitalization, community capabilities, et cetera] or provide services to fill infrastructure gaps

[that is, education, law enforcement, social services, housing improvement, transportation, and so on]. For the BIA, suicidal events significantly impact law enforcement

personnel since they are the most likely first responders and have a significant impact on BIA/tribal school teachers and students when the suicidal individual is a

child or teenager.

BIA’s Law Enforcement, Education, and Tribal Services programs continually

seek ways to collaborate and to support activities directed at suicide prevention and

services coordination. An example of this type of coordination is the BIA Rocky

Mountain Region [Montana and Wyoming] Native American Youth Suicide Prevention Health Initiative developed and presented by BIA, IHS, and Indian Development and Education Alliance [IDEA]. The region also hosted a workshop on Native

American Youth Suicide Prevention Training of Trainers in 2005, which included

‘‘natural healers’’ to provide referral and support.

Within the BIA’s OIEP school system all Bureau-funded schools receive supplemental program funds, through the U.S. Department of Education, to operate a Safe

and Drug-free School program. Schools use these funds to address a myriad of

issues to make their schools safe places for students and staff. BIA schools receive

about $92 per student enrolled and use these funds to address a myriad of issues

to make their schools safe places for students and staff. Past initiatives included the
44

Comprehensive School Health Program where OIEP partnered with IHS and the

National Centers for Disease Control to assist schools in developing plans that

brought together the involvement of their community partners such as local law enforcement, social services, and mental and physical health providers.

OlEP is committed to ensuring a safe and secure environment for our students.

Our focus is the implementation of suicide prevention strategies. The OIEP’s Center

of School Improvement launched a Suicide Prevention Initiative using the IHS endorsed scientifically researched based Question Persuade Respond [QPR] model.

QPR is an aggressive intervention program focused on suicide prevention. An initial

training in QPR was held in Denver, CO. in August 2004 and provided training on

the QPR model to all 184 BIA funded schools and dormitories. Administrators at

the school and dorm level were instructed to complete 100 percent training in the

QPR suicide prevention model for staff at their respective schools. Additional sets

of training material have been distributed to the schools and dorms through the

Education Line Offices on an annual basis. In 2004, OIEP provided training opportunities for schools to establish crisis intervention teams to address potential suicide

incidents, using the QPR model.

OIEP has provided training almost yearly on prevention of risky behaviors as well

as preparation required to address almost any emergency situation. Most recently

OIEP sponsored a nationwide event whereby students were dismissed for the afternoon while staff met to review their policies and procedures addressing emergency

situations. Just last week, the majority of Bureau funded schools attended a 2-day

‘‘Safe Schools’’ training in Denver, CO. The focus of the training was on emergency

preparedness for any type of emergency situation that would include what to do in

an attempted suicide or suicide incident.

In summary, the BIA, IHS, Substance Abuse and Mental Health Services Administration, other Federal agencies, and Indian tribes must continue to work together

to address all aspects of suicidal events—both before and after the event happens.

Because most Indian programs fall within the respective missions of the BIA or the

IHS, it is essential that the programs, in each respective agency, that directly or

indirectly relate to suicidal events are coordinated and function collaboratively. BIA

invites other Federal, state and tribal organizations and agencies to contact BIA regarding programmatic information, to coordinate efforts and resources, and to collaborate in addressing suicidal Indian children, teens and young adults.

This concludes my statement. I want to thank you for your concern for the

wellbeing of Indian children, teens and young adults. My BIA colleagues and I will

be happy to answer any questions you may have.
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164

PREPARED STATEMENT OF DONNA VIGIL, EXECUTIVE DIRECTOR, DIVISION OF HEALTH

PROGRAMS, WHITE MOUNTAIN APACHE TRIBE, NORTHERN ARIZONA

My name is Donna Vigil, I represent the White Mountain Apache Tribe in northern Arizona in my capacity as executive director of the Division of Health Programs.

I am a member of the White Mountain Apache Tribe, being born and raised on the

reservation. I have here with me Dr. Noreen Ashley, director of the Apache Behavioral Services. Our tribe has approximately 17,000 members, of which close to

15,000 live on the reservation.

Before I go any further, I would like to say Ronnie Lupe, chairman of the White

Mountain Apache Tribe sends his highest regards to all of you, especially to his

close friend Senator McCain. He considers all the members of the U.S. Senate Committee on Indian Affairs as friends to the White Mountain Apache people.

Suicide is one of the greatest challenges facing our people, particularly our children and young adults. Our rates of attempted and completed suicide are 17 times

higher than those of all other races in the United States, and five [5] times higher

than all other American Indian and Alaskan Native tribes. Attempts among our

youth have increased 11 percent in 1 year. In 2001, our tribe experienced the loss

of four young people to suicide in a very short time period. Each suicide attempt

or completion sends a ripple through our small tribal community of incalculable suffering, grief and years of productive life lost. I often wonder what would happen if

Falls Church, VA were to suddenly experience an unemployment rate of over 50 percent, a high school drop out rate of over 54 percent, a substance abuse rate reaching

epidemic proportions, and a suicide rate over 17 times the national average. What

kind of Federal and State support would be forthcoming?

With little Federal support, our community has come together to address the issue

of suicide on many fronts. Showing considerable foresight, the tribal council appointed a Suicide Task Force in 2001. The task force is headed by an employee of

Indian Health Service who is a community member and a member of the tribe. The

Suicide Task Force worked with Johns Hopkins University to obtain a NARCH

grant to do research on suicide. Through the encouragement of the Task Force and

NARCH the tribal council passed a resolution to establish a suicide registry. Those

who have been identified as being at high risk are provided with referrals to our

mental health facility for treatment and periodic case management. In a 1-year period, there have been over 300 referrals to two full time workers, who are monitoring and providing assistance.

In addition to the Suicide Task Force, a High Risk Response Alliance was established in October 2005 through the tribe’s mental health clinic, Apache Behavioral

Health Services. This was a grassroots effort to involve the community in responding to the suicides.

Our mental health center has attempted to tap into the cultural and spiritual

underpinnings of Apache life to suicidal people. They have sponsored a Minister’s

Alliance, a group of ministers and pastors from the 60 churches on our reservation.

One recent activity organized by the Minister’s Alliance was a community prayer

walk that focused on visiting the places where people had successfully killed themselves. More recently, a Traditional Alliance has formed and is in the process of

planning a reservation-wide ceremony to engage those Tribal members who adhere

to traditional beliefs. As Apaches, we are deeply spiritual people all efforts to combat suicide must include spirituality to be successful. As you have-heard, we are

taking steps to address our suicide problem. However, our efforts are limited due

to several critical barriers.

First, there are not enough professional and paraprofessional health care providers trained and skilled in suicide response that is also familiar with the Apache way

of life and Native spirituality. Our desire is to train and employ more tribal members to meet this need. We need Apache speakers, people who know the culture and

the community to work with our suicidal tribal members. Thus, we want to train

more Apache people to reach out to our suicidal family members, friends and neighbors. Unlike the majority culture, we do not have a professional class to do this

work. We must do it ourselves. Our mental health center, Apache Behavioral Health

Services, is partially funded by a Public Law 638 contract agreement with Indian

Health Service. It is also supported though third-party billing of Arizona’s Medicaid

programs. We are fearful that because of new professional and educational certification requirements in counseling and substance abuse treatment, our paraprofessional workers will eventually lose their ability to receive reimbursement for their

good work. This must not happen. Even though he or she may not possess a doctorate in psychology, a well-trained Apache mental health outreach worker with a high

school diploma who visits suicidal people in the field can often do more to decrease

the risk of suicide of an Apache person than any doctor-degreed non-Apache person.
165

Therefore, we must retain our ability to bill Medicaid programs for services provided

by qualified, non-degreed paraprofessional mental health workers.

Second, we need to develop a 24-hour crisis response center whereby family members, friends and any concerned person can contact a trained crisis response professional or trained volunteer to provide immediate assistance. By necessity, this center would need to have satellite locations throughout the 1.7 million acre Fort

Apache Reservation in order to be able to provide the rapid response needed when

persons are considering suicide as a solution to their immediate problems.

Third, substance abuse is a major underlying causal factor of suicide among our

people. Data indicates that more than 30 percent of White Mountain Apache adults

abuse drugs and more than 50 percent abuse alcohol. This is also related to the high

morbidity and mortality rates among the WMAT people. Fundamentally, we need

resources to expand outpatient and residential substance abuse treatment on our

reservation. The current system for substance abuse treatment in the State of Arizona cannot meet the unique needs of White Mountain Apache adults and youth requiring services. In fact, it is nearly impossible to locate a culturally appropriate

residential substance abuse center for Native American adults and teenagers in Arizona.

In conclusion, our needs are great and our resources are few. Our suicide rates

are among the nations’ highest and continue to escalate. While we have made great

strides in responding to suicide attempts, we lack the resources to implement widescale prevention. Specifically, we need Federal support to:

1. Provide 24-hour culturally competent crisis intervention for youth and adults

suffering with suicide ideation;

2. Create community-based substance abuse prevention and early intervention initiatives;

3. Establish a culturally competent substance abuse treatment facility on the reservation for adults and youth; and

4. Ensure Medicaid reimbursement for qualified, non-degreed paraprofessionals

working in suicide response.

The White Mountain Apache Tribe and I are grateful that the U.S. Senate Committee on Indian Affairs has taken the time to investigate the needs of our people

in the area of suicide prevention. It is our hope that this testimony has served to

help define what measures must be enacted to assist us in reducing the number of

suicide attempts and completions amongst Native American people.
166
167
168
169
170
171
172
173
174
175
176

Æ