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S. HRG. 112–616

EMPOWERING NATIVE YOUTH TO RECLAIM THEIR

FUTURE

FIELD HEARING

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED TWELFTH CONGRESS

FIRST SESSION

AUGUST 9, 2011

Printed for the use of the Committee on Indian Affairs

(

(II)

COMMITTEE ON INDIAN AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN BARRASSO, Wyoming, Vice Chairman 

DANIEL K. INOUYE, Hawaii 

KENT CONRAD, North Dakota 

TIM JOHNSON, South Dakota 

MARIA CANTWELL, Washington 

JON TESTER, Montana 

TOM UDALL, New Mexico 

AL FRANKEN, Minnesota 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

JOHN HOEVEN, North Dakota 

MIKE CRAPO, Idaho 

MIKE JOHANNS, Nebraska 

LORETTA A. TUELL, Majority Staff Director and Chief Counsel 

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

(III)

C O N T E N T S 

Page 

Hearing held on August 9, 2011 ............................................................................. 1

Statement of Senator Tester ................................................................................... 7 

WITNESSES

Gourneau, Roxanne, Tribal Judge, Fort Peck’s Tribal Family Court ................. 5 

Halliday, Deborah, MPA, Policy Advisor, Community Learning Partnerships, 

Montana Office of Public Instruction ................................................................. 9 

Prepared statement .......................................................................................... 11

Jackson, Fanci, Member, Fort Peck Youth Council .............................................. 17

Manning, Richard, Research Associate, National Native Children’s Trauma 

Center, University of Montana ........................................................................... 12

Prepared statement .......................................................................................... 14

Mckeon, Richard T., Ph.D., Lead Public Health Advisor, Suicide Prevention 

Team, Substance Abuse and Mental Health Services Administration, U.S. 

Department of Health and Human Services ...................................................... 33

Prepared statement .......................................................................................... 35

Parisian, Edward, Director, Rocky Mountain Regional Office, Bureau of Indian Affairs, United States Department of Interior .......................................... 29

Prepared statement .......................................................................................... 31

Stafne, Hon. A.T. ‘‘Rusty’’, Chairman, Assiniboine and Sioux Tribes of the 

Fort Peck Indian Reservation ............................................................................. 1

Prepared statement .......................................................................................... 2

Weahkee, Rose, Ph.D., Director, Division of Behavioral Health, Indian Health 

Service ................................................................................................................... 22

Prepared statement .......................................................................................... 24

White Tail Feather, Walter, Director. Office of Economic Development, Fort 

Peck Assiniboine and Sioux Tribes; on behalf of Roxann Smith, Vice Chairman, Fort Peck Tribes ......................................................................................... 3

APPENDIX

Belcourt-Dittloff, Annie, Ph.D., Missoula, Montana, prepared statement .......... 43

Zimmerman, Marilyn Bruguier, Director, National Native Children’s Trauma 

Center and Richard van den Pol, Director, Institute for Educational Research and Service, University of Montana ....................................................... 48

(1)

EMPOWERING NATIVE YOUTH TO RECLAIM 

THEIR FUTURE 

TUESDAY, AUGUST 9, 2011

U.S. SENATE, COMMITTEE ON INDIAN AFFAIRS, Poplar, MT. 

The Committee met, pursuant to notice, at 1:30 p.m. at Poplar 

High School, 400 4th Avenue West, Poplar, Montana, Honorable 

Jon Tester, Acting Chairman of the Committee, presiding.

*Due to audio technical difficulties; the following hearing 

transcript has [indiscernible] printed in place of a lot of 

missing text*

The Committee apologizes for the inconvenience.

OPENING STATEMENT OF HON. A.T. ‘‘RUSTY’’ STAFNE,

CHAIRMAN, ASSINIBOINE AND SIOUX TRIBES OF THE FORT 

PECK INDIAN RESERVATION 

Mr. STAFNE. Good afternoon, Senator Tester. 

Senator TESTER. Mr. Chairman. 

Mr. STAFNE. My name is Rusty Stafne, and I am Chairman of 

the Assiniboine Sioux Tribe, Fort Peck Reservation. 

On behalf of the tribal council and the tribal membership, we 

welcome you to the Fort Peck Indian Reservation. 

We also thank you for holding this hearing to address the epidemic levels of youth suicide on our reservation and the ways our 

community can empower our children to rise above this crisis and 

reclaim their future. 

Senator, it is my honor to stand before you today. Please understand that I do so with a heavy heart. It is difficult for me to know 

where to begin or how to begin. You are familiar with the statistics. Yet, as you are aware, these numbers do not paint the full picture. We are under attack and our future is the target. 

Like any nation facing such great threat to our most vulnerable 

citizens, we have acted to the best of our ability to combat this epidemic. But how can you fight what you cannot begin to understand? 

Just over a year ago, the United States Public Health Service deployed six teams of behavioral health officers to help us better understand and join in the battle our youth are fighting. After the 12-

week effort, final recommendations were made to the tribal executive board in October in Montana. Since then, our communities 

have worked tirelessly to implement these recommendations, and 

2

keep those considering ending their lives from taking that final 

step. We have brought on skilled staff and involved multiple generations, collaborated with local school districts and heightened 

community awareness. We have tackled upstream issues such as 

bullying and boredom, while training parents and peers to recognize the signs and increase the available activities for youth across 

the reservation. 

We have also developed response command and protocol for 

streamlining and minimizing response time in the event of another 

tragic attempt. Of course, in our communities, resources are always 

an issue. I would like to thank you, Senator, for your support in 

our application for a $1.4 million grant awarded just two weeks ago 

to continue our efforts with the University of Montana and National Native Children’s Trauma Center. It joins other grant funding we have relied upon to support these efforts. 

We are doing all that we can. Yet at an agency level, a lack of 

communication, staffing shortages and budget shortfalls continue 

to hinder our efforts. Senator, we thank you for all your hard work 

and the support you have provided us in our time of need. But the 

threat of more lost young lives looms. Today I come before you as 

Chairman of the Assiniboine Sioux Tribes asking that the testimony shared here grows into productive collaboration and increased interagency communication. 

There is much work yet to be done. Our people deserve healthy 

bodies and healthy minds. Our children deserve a future. Thank 

you. 

[The prepared statement of Mr. Stafne follows:]

PREPARED STATEMENT OF HON. A.T. ‘‘RUSTY’’ STAFNE, CHAIRMAN, ASSINIBOINE AND

SIOUX TRIBES OF THE FORT PECK INDIAN RESERVATION

Good afternoon, Senator Tester. My name is Rusty Stafne, and I am the Chairman of the Fort Peck Tribes. On behalf of my Tribal Council and our Tribal members, I would like to welcome you to the Fort Peck Indian Reservation and thank 

you for holding this hearing to address the epidemic levels of youth suicide on our 

reservation and the ways our community can empower our children to rise above 

this crisis and reclaim their future. 

I would first like to recognize those who spoke before me. Vice Chairwoman 

Roxann Smith and Judge Roxanne Gourneau, thank you for selflessly sharing the 

stories of your sons. Even though unimaginable tragedy has touched your lives, you 

stand strong for your people. Nothing can bring your boys back, but your bravery 

reminds us that this is not a hopeless place. Thank you. 

Senator, it is my honor to testify before you, but please understand that I do so 

with a heavy heart. It’s difficult for me to know where to begin. You’re familiar with 

the statistics, you cited them in your remarks. Yet even these numbers don’t paint 

the full picture: we are under attack, and our future is the target. Like any nation 

facing such a grave threat to our most vulnerable citizens, we have acted to the best 

of our ability to combat this epidemic; but how can you fight what you cannot begin 

to understand? 

Just over a year ago, the United States Public Health Service deployed six teams 

of behavioral health officers to help us better understand and join the battle our 

youth are fighting. After the 12-week effort, final recommendations were made to 

the Tribal Executive Board in October, 2010. Since then, our communities have 

worked tirelessly to implement these recommendations, to keep those considering 

ending their lives from taking that final step. We’ve brought on skilled staff, involved multiple generations, collaborated with local school districts, and heightened 

community awareness. We’ve tackled upstream issues such as bullying and boredom 

by training parents and peers to recognize the signs, and increasing available activities for youth across the reservation. And we’ve developed a response plan and protocol to streamline agencies and minimize response time in the event of another 

tragic attempt. 

3

Of course, in our communities, resources are always an issue. I would like to 

thank you for your support in our application for a $1.4 million grant awarded just 

two weeks ago to continue our efforts with the University of Montana and National 

Native Children’s Trauma Center. It joins other gsrant funding we’ve relied upon 

to support these efforts—we are doing all that we can. 

Yet at the agency level, a lack of communication, staffing shortages, and budget 

shortfalls continue to hinder our efforts. The IHS Behavioral Health Department 

here has no director, and its facilities are lacking. Repeated efforts to contact the 

Bureau of Indian Affairs and Indian Health Service for technical and financial assistance to build and implement ‘‘safe houses’’ across the reservation seem to have 

fallen on deaf ears, as neither agency has responded. Indian Health Service constant 

shortfalls impact these efforts as well. We cannot stress strongly enough the need 

for fully funded health services: to afford preventative and reliable behavior health 

services, treat substance abuse issues, and prevent early and unwanted pregnancies. 

Senator, we thank you for all your hard work and the support you have provided 

us in our time of need, but the threat of more lost young lives looms. Today I come 

before you as a leader of my people asking that the testimony shared here grows 

into productive collaboration and increased interagency communication. There is 

much work yet to be done. Our people deserve healthy bodies and healthy minds. 

Our children deserve a future. Thank you.

Senator TESTER. Thanks, Rusty. Thank you. 

[Applause.] 

Senator TESTER. Thank you very much. I appreciate everybody 

being here this afternoon on a glorious day in northeastern Montana. 

Before I start, I would like to get comments from Walter White 

Tail Feather. 

STATEMENT OF WALTER WHITE TAIL FEATHER DIRECTOR. 

OFFICE OF ECONOMIC DEVELOPMENT, FORT PECK

ASSINIBOINE AND SIOUX TRIBES; ON BEHALF OF HON. 

ROXANN SMITH, VICE CHAIRMAN 

Mr. White Tail Feather. Thank you. I bring the testimony of the 

Vice Chairman. So these are from her, Roxann Smith, Vice Chairman, Fort Peck Tribes. 

One of the Fort Peck’s needs to address [indiscernible]. We have 

[indiscernible] suicides among primarily our young people. My connection here is that I have lost a son and a cousin and some precious [indiscernible] for our communities. This very remote location 

that we live in is our home. Our families are here and they are [indiscernible] here. For the young people, there are not a lot of 

healthy activities for [indiscernible]. What we need is more opportunities for our youth to learn and prosper so that they can become 

productive members of our reservation. 

The schools have done the best they can with what resources 

they have. However, some of our reservation schools have operating 

budget deficits. To alleviate this situation, they have been forced to 

downsize their counselors so that they can maintain their budget 

constraints. 

Built into our tribe a youth program, the solution is to put funding priorities into those existing programs, not to reinvent the 

wheel. Everybody needs to participate. 

At the Federal level, make existing grant funding opportunities 

more flexible to include youth activities as allowable costs. Our 

communities are impoverished, and in a lot of cases have little to 

look forward to. The outcome I would like to see is increased resources and collaboration within programs to provide outreach proVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00007 Fmt 6633 Sfmt 6601 S:\DOCS\76838.TXT JACK
4

grams and collaboration with OPI, health providers and other entities. Perhaps a solution is to have a contract person that will be 

available to provide mental health and substance abuse counseling 

to local [indiscernible]. 

Health care providers must be available and visible in the community to earn the respect of our young people. Our community is 

small and everybody knows everyone. So it is imperative that our 

caretakers are clean and sober and have integrity in each of our 

communities. A possible solution would be to have a shelter workshop in a location where people may be productive members of our 

reservation. At this location, cultural teachings, counseling and 

recreation could take place with an emphasis on building esteem, 

hands-on crafts, horsemanship, hunting, et cetera. Families maybe 

included in the activities. 

Organized recreation is another topic that we have [indiscernible] and since it is a healthy alternative to drinking and partying, 

it too can be incorporated throughout the [indiscernible]. We have 

a [indiscernible] oil and [indiscernible] opportunity knocking on our 

doors. And we need assistance on how to deal with the rush of people as well as opportunities coming our way. How will we protect 

our future without this [indiscernible] foster our communities [indiscernible] grow into the existing work force as well as future [indiscernible] these children that will lead them and [indiscernible] 

and [indiscernible] into the next generation. 

So those are the words of the Vice Chair. And James Miller 

asked me to talk about my experience. I have never talked about 

it [indiscernible] for me. But I left home when I was 13 years old 

[indiscernible]. My parents wanted to get me away from the drugs 

and alcohol and that is where they sent me. Little did they know 

that that is where I encountered [indiscernible] high school [indiscernible]. 

I landed a job in Washington, D.C. And subsequently just lived 

that life there. There came a very serious point in my life when I, 

there was nothing to look forward to. Absolutely nothing. Even living in the city, [indiscernible] my friends, the job that I had. And 

there was a lot of [indiscernible] that was going on at the time. 

When I was a child, even here and in high school, I always wanted 

to find that party, the bright lights and the city. 

And that is what goes on here, it happens here too. It got to the 

point where I didn’t see anything [indiscernible] and I realized that 

the apartment that I was living in, I had a gas stove. And it got 

to the point where I said, I can just go to sleep. I don’t ever have 

to wake up again, I don’t ever have to deal with any of this. Nothing. And not being around my parents [indiscernible] my family. 

And the only reason I didn’t do it was because my roommate at the 

time, he was in Boston. And it was his [indiscernible]. And I didn’t 

want him to come back and find a body. And it [indiscernible] after 

that I turned myself in to rehab and it didn’t work. I had to go 

back again [indiscernible]. 

So those memories are there. And there are some young people 

in the audience today, and you can survive anything, absolutely 

anything [indiscernible] if you want to. And you don’t have to live 

that life. 

5

And there is sometimes I got some calls from people who have, 

who know this about me and have asked my advice. I know what 

that feels like, when you are right at that point. There is some people who don’t, they don’t understand [indiscernible]. 

[indiscernible] allowing the chairman and all those people [indiscernible] eyes and everywhere else, there is hope. There is. It does 

get better. It absolutely does. Thank you. 

[Applause.] 

Senator TESTER. Thank you, Walter. 

Roxanne Gourneau, Tribal Judge, could I get her to make a few 

comments? 

STATEMENT OF ROXANNE GOURNEAU, TRIBAL JUDGE, FORT 

PECK’S TRIBAL FAMILY COURT 

Ms. GOURNEAU. I know that I have two nieces in the audience, 

where are you? Will you come up for a minute, please. 

I know that those of you who know me that I will [indiscernible] 

and that is two [indiscernible]. 

Senator, I am in mourning right now and I want you to know 

that, so I will weep. My son couldn’t come today because I buried 

my son November 23rd, 2010, my only son. This is who he is. This 

is his family. My son was loved by many of you. My son took his 

life. But I want you, I am not going to stand here and tell you that 

things are great, and I want you to understand that our young, and 

I want you to know something, my son did not plan his death. His 

death was abrupt. 

There are so many people across this beautiful reservation, [indiscernible] my son could have called anybody, anybody, and they 

would have been there. I am talking about friends and I am talking 

about children that would have saved his life. But Senator, I am 

telling you, what took my son’s life was the public school systems. 

My son was [indiscernible] upon. In three hours, my son, who stood 

6 foot 4 and 260 pounds and he was invincible, he was my boy, he 

was kind, he was generous, he was truthful and he was honest. He 

would give the shirt off his back. 

And I want you to know, Senator, that I am here today to tell 

you anything you ask me. But we need regulations in the school 

systems. Let’s don’t pretend any longer for three decades that suicide is the second leading cause of death in the State of Montana 

and on our reservations, let’s don’t pretend any more. Let’s don’t 

pretend that we have titles that we have to speak in a certain way. 

Let’s don’t pretend any longer that our Native American children 

and [indiscernible] children that [indiscernible] and special ed. I 

don’t want to pretend. 

My son had a learning disability. They accused him of having 

chewing tobacco. My son was a contender for a state championship 

for wrestling. My son went to wrestling two years. Contrary to 

what people say, and my heart is beating just as hard as that 

drum, but contrary to what people say in that report, it was nay, 

I am not an alcoholic, Senator. I don’t abuse drugs. I have been 

blessed by my tribe and by my people to make an income that is 

10 percent of the nation. 

And I can tell you, and I can’t speak for other parents who have 

lost their children, but I can speak for me and I can speak for my 

6

son, but I can tell you, Senator, they themselves love their children. They were middle class people. They weren’t foster children. 

But I am telling you, Senator, that these [indiscernible] we didn’t 

need a $300 million report. What we needed was proper investigation for audit [indiscernible]. That is what we needed. We needed 

to head these problems off before they started. 

I want to make a difference in the school systems. I have worked 

30 years, Senator, and I have enjoyed opportunity and I have benefitted in so many ways as an individual. And I am still very young 

in wisdom. But I have worked in the executive branch, I have 

worked in the judicial and the legislative. I have held the title of 

vice chairman, first vice chairman. I have been on the tribal council. I am presently a judge. I have worked in so many of the social 

programs and I graduated in this school. 

So don’t tell me, people, and don’t let anybody say how poor this 

reservation is. This was a beautiful playground for my son. And he 

loved being Native American and he absolutely loved all people. 

But I am telling you, Senator, that days without recognition in the 

school what they did to my son and not contacting me was a direct 

result of my son taking his life. Those policies weren’t placed by 

great wisdom. And I know that people have rumors out there that 

think differently. But that was my only son. Who in this reservation didn’t know who I was? I made sure that that school knew my 

contact information. Why was my son targeted? 

But it wasn’t just my son. As many of you that sit her, you always said you have got to accept that is the way it is. I won’t accept the death of my son. I won’t. I will not celebrate him until I 

have closure. But it isn’t for me, because he’s gone now. It is for 

you and your children and your grandchildren. No other mother 

should feel how I feel. No other family, this family right here cries 

every day. 

There is no such thing as substitution for love. As many of you 

[indiscernible] titles, you need to take the titles off and you need 

to do what’s right. Be that leader. That is what we are asking you, 

Senator Tester. That is what I am asking you. I am asking you to 

be a leader for the State of Montana. And you have to ask yourself, 

what do we have in common. Your children, Senator. There is a severe expulsion and suspension rate, dropout rate, high suicide rate. 

These records have been on notice. 

This isn’t new information, folks, and I am telling you that. It 

is been here. Do you really think that anybody really cares that our 

children are taking their lives? They won’t care until you start caring, until we start caring. Don’t tell me about another policy. I 

don’t want to hear about another policy. What I want, Senator, is, 

I work in a field, I know about this [indiscernible] act. We have 

been recently trained on the Adam Walsh Act. And you know what 

Adam Walsh is, you all do. 

Many laws have been named because of an isolated situation for 

one person. Well, let me tell you, our tribe is being affected. And 

some of you know what manifest destiny means. Today we can’t 

pick out the next 10 years’ leaders because you can’t be getting 

through the schools. Because their spirit is broken. Schools are 

where dreams are made. That is where they are at. How did it turn 

to be where it got today? Because that is what it is. They are deVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00010 Fmt 6633 Sfmt 6601 S:\DOCS\76838.TXT JACK
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stroying them and they are breaking them. Nobody cares about the 

dropout rate. The children that need education. 

Tribalizing education was done by this tribe, but nobody saw fit 

to pass it. We got so many dignitaries in this room that all you 

have to do is just do it. Senator Tester, what I am asking you, and 

I want you to understand my son’s story and I want you to understand that morning he got up and he told me, he said, I love you, 

mom. I won’t apologize for crying. 

But I am not the only mother who walks with arms that hurt. 

And I am not the only family member who walks around and says, 

I need to know. But I know what you can do, Senator. You can remove tenure from the State of Montana. You can have accountability in the schools, access to equal education. 

My son was a citizen of the United States. He deserved to be protected under the law. My son was a citizen of the State of Montana 

that should have enjoyed equal access and benefitted from education. My son is an enrolled member of a tribe, Turtle Mountain. 

He should have enjoyed the trust responsibility that guarantees 

education and protection. My son had a learning disability. 

With all of that, my son should have never died. But he did. And 

so did many other children here. And it won’t stop. It won’t stop 

until somebody tells you the truth. And the truth is, you need accountability in the school systems. The feuds and the friction that 

is going on there, it is an atrocity. And everyone is going to tell 

you, and I know some of these fine folks out here are going to tell 

you that we need more money. And I am going to tell you I don’t 

need any money. You need to roll up your sleeves and you need to 

be counted on. Because we have been paying for a long time, and 

it is time that you start stepping outside yourself and building an 

extension of our home. I am not going anywhere, I am going to die 

here. So Senator, these are the things that I ask of you. And I don’t 

apologize for wearing my emotion on my sleeve. I haven’t made any 

public speeches in a long time. But I am coming, and I want you 

to know, Senator, that I have filed a civil lawsuit against the State 

of Montana, the school board and the superintendent, just to begin 

with, for the gross, indifferent negligence that they demonstrated 

toward my son. And I can substantiate and prove every bit of it. 

So thank you, Senator. 

STATEMENT OF HON. JON TESTER,

U.S. SENATOR FROM MONTANA 

Senator TESTER. Thank you, Roxanne. And I want to thank everybody who’s testified to this point. This is a field hearing of the 

U.S. Senate Committee on Indian Affairs. We are here today, and 

pleased to be here with the members of the Assiniboine Sioux Tribe 

of the Fort Peck Reservation and our distinguished panelists. 

The title of this hearing is Empowering Native Youth to Reclaim 

Their Future. We are here to acknowledge the devastating problem 

of youth suicide that occurs in Indian Country. And more importantly, as Roxanne pointed out, to find solutions to solving it. 

Over the past year we have heard a lot of stories in the news 

about fights in Congress over the economy and celebrities who get 

themselves into trouble. But America’s 24-hour news anchors forgot 

one painful story here in Montana. And we are here to acknowlVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00011 Fmt 6633 Sfmt 6601 S:\DOCS\76838.TXT JACK
8

edge that the rate of suicide for American Indian youth is far higher than any other ethnic or racial group in the United States. On 

some reservations, including this one and others in Montana, the 

incidence of suicide has been 10 times, 10 times the national average. Right here, the folks in this room know this much better than 

I, right here over the last year six children took their own lives. 

One of those children was only 10 years old. And there is more, at 

least 20 other members of the Fort Peck community attempted suicide. That is totally unacceptable in any community. Because these 

kids, as has been pointed out earlier, are our future. 

Leaders in Montana, specifically at Fort Peck, have tried to do 

their very best to respond aggressively. The Chairman and his administration I think have done good work under difficult conditions. And so has Gordon Belcourt and Donnie Wetzel of the Montana-Wyoming Tribal Leaders Council. Their Planting Seeds of 

Hope project us helping every Montana tribe to build resilience in 

Native American youth. They are empowering tribes to prevent suicides. 

This is also a good opportunity to remember a friend that left us 

all too soon. Darryl Red Eagle was a friend of mine and many of 

you folks in this room. Darryl was a council member for the Fort 

Peck Tribes from 2005 until he died in June. He was chair of the 

Health and Human Services Committee. In that role, Darryl was 

a tireless advocate for improving the health conditions of his people. I had the opportunity to visit with him many, many times. 

Those of you who knew him, you can imagine he was very vocal 

about the need to prevent native youth suicide. 

Working together, we have taken some steps. Permanently reauthorizing the Indian Health Care Improvement Act means that better health care, physical and mental, is on the way for Indian communities. This bill opens up grants for tribes and organizations for 

suicide prevention efforts. 

In fact, earlier this summer, as Chairman Stafne pointed out, 

Senator Boxer and I announced that the U.S. Center for Mental 

Health Services had ordered a $1.4 million grant to address youth 

suicide and to promote activities that emphasize resilience and 

leadership on this reservation. That is a good start. But we need 

to do more. 

In geographically isolated parts of rural America, including right 

here in Eastern Montana, resources aren’t readily available. Recruiting health care professionals to serve frontier communities is 

very challenging. And in Indian Country, these challenges are compounded by poverty, inadequate infrastructure and sadly, a sense 

of hopelessness that should never afflict a 10 year old child, or any 

child for that matter. Hopelessness is not what this Country is 

about. We live in the greatest Nation in the world, where we work 

hard to make the future better for the future generations and have 

better opportunities than we have had. All America’s kids and their 

families should have somewhere to turn, especially in places resources are slim and hope can be scarce. 

Although resources are slim in many parts of Indian Country, 

you have something many others do not have, and that is the 

greatest strength in Indian Country, family, kinship. More than 

anything else, Indian families are a bond that not only help you 

9

survive, but thrive. As community leaders and family members, we 

all have to do our part. Leaders make policy decisions and community members make role models. Role models include mothers and 

fathers, extended family and friends, teachers, business leaders 

and cultural figures. The Fort Peck community has a lot of good 

role models, a couple that I will just bring up. One of them is here 

today, a kid like April Youpee Roll. April grew up here, went to 

Harvard and interned in my Washington, D.C. office. April, congratulations on being a great role model. 

Richard Dionne, a young man who grew up here, he resisted peer 

pressure and chose never to take a drink of alcohol or try a drug. 

After playing basketball in the Continental Basketball Association, 

he is now a guidance counselor for Native youth. And there are 

many, many more. And I wish we had time to talk about them all, 

but we don’t. 

But the point is that as a community, we have to give hope to 

kids. We have to give them the belief that they can become anything they want. That if they resist the peer pressure and the dangerous distractions, as was pointed out earlier here today, that 

they live in a country where their dreams can come true. As community members, we need to fight to make sure all our kids, no 

matter where they live, understand that hopelessness and despair 

doesn’t belong in any community. 

Another important step to addressing this tragedy is to make 

sure folks understand the story from Fort Peck Reservation, right 

here, is real. The more people understand the challenges facing 

many of our rural communities, many of our frontier communities, 

the better able we are to make sure that all of our young folks are 

able to live up to their fullest potential. 

I am happy to welcome our distinguished panel to share their 

thoughts on this crisis. And we are going to do things a little bit 

different today. Usually at these hearings we hear from Administration witnesses first. That is not going to be the case today. We 

are going to hear from local witnesses first, witnesses from Montana, and then the agency officials will be on the second panel. 

As always, we have limited time. Your complete statements will 

be entered into the record of the hearing. I would ask you to be 

concise and shorten your testimony to be as close to five minutes 

as you can, although I won’t be too harsh on you if you run over 

a bit. 

First we are going to hear from Deb Halliday. Ms. Halliday is 

Policy Advisor on Community Learning Partnerships in Montana’s 

Office of Public Instruction. The committee invited OP to testify because schools are absolutely critical, as has already been pointed 

out, to solving this problem. 

So if you want to start out, Deb, and we will go to Mr. Manning 

in a bit. 

STATEMENT OF DEBORAH HALLIDAY, MPA, POLICY ADVISOR, 

COMMUNITY LEARNING PARTNERSHIPS, MONTANA OFFICE 

OF PUBLIC INSTRUCTION 

Ms. HALLIDAY. Good afternoon. Thank you for inviting the Montana Office of Public Instruction to participate in this hearing. I 

look forward to sharing our work and our observations related to 

10

the vitally important task of supporting and strengthening our 

American Indian youth. 

Thank you, Chairman Stafne, for hosting the gathering. I too 

have in my mind today Councilman Darryl Red Eagle, who so 

deeply believed in the beauty and the promise of children and who 

worked so wisely to change how we do our work to better support 

American Indian youth. 

I am here representing our State Superintendent, Denise Juneau, who is unable to attend today. I am also here to speak of the 

ground-breaking work we are doing in partnership with tribal governments, school districts, community members and families who 

truly improve the quality of education in our State’s most struggling schools. 

Under State Superintendent Denise Juneau’s leadership, the Office of Public Instruction has launched an initiative called Montana 

Schools of Promise, which is working to significantly improve the 

quality of education in Montana’s most struggling schools. Schools 

where a mere 15 to 25 percent of high school tenth graders showed 

proficiency in reading and dropout rates are double those of the 

general population. 

In Montana, the most struggling schools are all located on our 

State’s Indian reservations. Schools of Promise seeks to turn these 

schools around, providing intensive supports to all components of 

the school system and engaging community, family and tribal government in the effort. 

Last year, the Schools of Promise received a substantial boost 

through a three-year U.S. Department of Education school improvement grant and we are now working intensively with four 

school systems, here in Fort Peck, on the Crow Reservation and the 

Northern Cheyenne Reservation. From the get-go, based on research, we knew that our efforts must be comprehensive and must 

include support for the mental health and well-being of students. 

It is common knowledge that students learn better when their 

mental health needs are met. This is particularly important in 

communities that are grappling with the long-term damaging effects of trauma, disruptive family environments and poverty. 

Recent school improvement research clearly connect the students’ 

well-being and their readiness to learn as central to the work of 

making schools better. Every child needs a trusting adult to turn 

to who will provoke and inspire that child to do their best. And 

that unmet health and mental health needs impair a child’s learning process. From a brain physiological perspective, we now know 

that the brain itself cannot receive or retain new information if it 

is in a post-traumatic state: for example, when a student is re-experiencing or has not yet recovered from the traumatic event in 

their lives. 

The Office of Public Instruction is addressing these challenges in 

several ways. We have partnered with the University of Montana 

National Native Children’s Trauma Center, which you will hear 

about in a few moments, to support the adults working in schools 

so that they can better understand the critical role they play in a 

child’s well-being and give them specific tools to do that better. We 

have brought mentoring and student advisory time into the school 

11

day. We are working with schools to create a safer school environment. 

We are also the recipient of a Montana Mental Health Trust grant. Through this two-year, $600,000 grant, the OPI is 

partnering with tribal governments on the Fort Peck, Crow and 

Northern Cheyenne and with Indian Health Services, the Bureau 

of Indian Affairs, the State Department of Health and Human 

Services and public school districts on all three reservations to develop community-based school mental health wraparound services. 

There is a lot of great work going on, and it is hard work. Yet 

we are seeing early results that are promising. After one year of 

our Schools of Promise work, all four school systems showed 

marked improvement in student test scores, such by as much as 15 

points, and dropout rates are improving. 

I will conclude my comments with a few observations, which I 

hope will help you in your discussions on how to best support the 

work being done to strengthen the American Indian youth. Number 

one, build on existing core community strengths. In every community, there is a small group of people working miracle every day. 

Many of those who work here at Fort Peck are here in this room. 

Find these folks, understand what they care about, how the community works when children return home from school, and office 

lights are turned off, the natural rhythms of life take over. 

Number two, listen to what works. Montana is a rural, frontier 

State. We struggle with Federal policy and programs that are built 

with skyscrapers and city economies in mind. Here in Montana, we 

develop effective strategies that work in a vast, rural, poor State. 

Learn from that and take our lessons into the national debate. 

And finally, we can’t do it alone. The Office of Public Instruction 

is partnering with local communities, tribal governments, State 

and Federal allies. It is the only way we can see that lasting 

change will occur. The vast majority of funds we rely on to do this 

work comes from Federal funds. Keep them coming. Our State literally can’t afford to fund the intensive work that needs to be done, 

and yet our communities and our Nation can’t afford us to not do 

that work every day as best we can. 

Thank you. 

[The prepared statement of Ms. Halliday follows:]

PREPARED STATEMENT OF DEBORAH HALLIDAY, MPA, POLICY ADVISOR, COMMUNITY

LEARNING PARTNERSHIPS, MONTANA OFFICE OF PUBLIC INSTRUCTION

Good afternoon. Thank you for inviting the Montana Office of Public Instruction 

to participate in this hearing. I look forward to sharing our work and observations 

as they relate to the vitally important task of supporting and strengthening American Indian youth. 

Thank you to Chairman Stafne for hosting this gathering. I have in my mind 

today Councilman Darryl Red Eagle, who so deeply believed in the beauty and 

promise of children, and who worked so wisely to change how we do our work to 

better support American Indian youth. 

I am here representing State Superintendent Denise Juneau, who is unable to attend today. I am also here to speak of the ground-breaking work we are doing, in 

partnership with Tribal Governments, school districts, community members and 

families to truly improve the quality of education in our state’s most struggling 

schools. 

Under State Superintendent Denise Juneau’s leadership, the Office of Public Instruction has launched an initiative called Montana Schools of Promise, which is 

working to significantly improve the quality of education in Montana’s most strugVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 S:\DOCS\76838.TXT JACK
12

gling schools. Schools where a mere 15–25 percent of high school tenth graders are 

proficient in math and reading, and dropout rates are double those of the general 

population. 

In Montana, the most struggling schools are all located on our state’s Indian Reservations. Schools of Promise seeks to turn these schools around:

1. Providing intensive supports to all components of the school system, and engaging community, families and tribal government in the effort.

2. Listen to what works. Montana is a rural, frontier state. We struggle with 

federal policies and programs that are built with sky scrapers and city economies in mind. Here in Montana, we develop effective strategies that work in 

a vast, rural, poor state. Learn from that, and take our lessons into the national debate. And finally,

3. We can’t do it alone. The Office of Public Instruction is partnering with local 

communities, tribal governments, state and federal allies. It’s t he only way 

we can see that lasting change will occur. Yet the vast majority of funds we 

rely on to do this work come from federal funds. Keep them coming: our state 

literally can’t afford to fund the intensive work that needs to be done, and 

yet our communities and our nation can’t afford for us not to do that work, 

every day, as best we can.

Thank you. I am happy to answer any questions.

Senator TESTER. Thank you, Deb. Thank you very much for your 

testimony. We will have some questions after we get done with the 

panel for each of the panel members. 

Next we get to hear from Dick Manning. Dick is a Research Associate at the National Native Children’s Trauma Center at the 

University of Montana. Dick and the folks in his office have developed methods for tribal communities to address these strategies. 

He will share some of those recommendations with us. 

On a side note, I will just tell you this. Dick is a special friend 

of mine. He’s one of those people that, from my perspective, looks 

at life from a different perspective and is able to find solutions that 

people like me don’t often see readily. So Dick, I want to thank you 

for being here today, and I look forward to your testimony. Once 

again, try to keep it as close to five minutes as you can. 

STATEMENT OF RICHARD MANNING, RESEARCH ASSOCIATE, 

NATIONAL NATIVE CHILDREN’S TRAUMA CENTER,

UNIVERSITY OF MONTANA 

Mr. MANNING. Thank you, Senator, and thanks to Chairman 

Stafne. 

I am here representing the National Native Children’s Trauma 

Center, whose director is Marilyn Zimmerman. She would be here 

today, but she is in Washington, D.C., presenting [indiscernible]. In 

other words, she got the short straw and had to go to D.C. 

I would like to begin by saying first of all, we have been engaged 

in this community for seven years. We are very grateful to the tribal council. We would like to express that gratitude to the Chairman’s staff and the tribal council [indiscernible] in allowing us to 

learn from this community over the years [indiscernible] learning 

process. That engagement has greatly enriched our work with the 

work that we [indiscernible]. 

I would also like to thank Senator Tester, of course. I am very 

glad that he remarked today about that $1.4 million grant. I can 

tell you, I personally had a hand in writing that grant. I saw it go 

through the bureaucracy and it clearly wouldn’t be here without 

the support we continually get from Senator Tester’s office and his 

13

staff in negotiating this for us. It is very important work that goes 

on behind the scenes and is not often [indiscernible] it is a big deal. 

Deb hit on some of the points I would like to hit on, and I would 

like to stress two points here today. The reports in the news, concrete examples that have grown out of our understanding, and by 

our work, I mean this community as a whole, that has been building as we struggle with these issues. Believe me, I use the word 

issue in plural. It is tempting of course to focus on the issue of suicide, headline-grabbing as it is. It is urgent that we do focus on it. 

But we need to keep a few things in mind [indiscernible] this 

problem of suicide tends to be part of a lot of problems, a whole 

threat that is all tangled up, problems on problems, drug and alcohol abuse, assault and violence, poor academic performance, dropouts, teen pregnancies. These problems kind of run together. We 

see them together and they are not speaking to individual cases 

[indiscernible] teen suicide. When we see them together we know 

we have a much larger problem than suicide, and we have to think 

about that. 

We also have to think about causes. And again, there is no single 

cause. Causes themselves are very complex as well, and this is 

borne out by the research nationally. This is what we see on a community level when we work day to day. And those causes are not 

limited to but include things like child abuse, [indiscernible], absent parents, parents simply challenged by the difficulties [indiscernible] and in cases [indiscernible] historic [indiscernible]. 

This complexity of cause, in effect, dictates something very important and gives us our marching orders. Our marching orders are 

this: that no single agency, no single institution, no single level fo 

government has a comprehensive solution. None of us can do it 

alone, we are all in this together. This virtually dictates that we 

have to learn to cooperate. Believe me, that is hard work. That is 

the work that has been going on. 

This is not some platitude that we are just bearing lip service to. 

We have to learn to actively tear down the barriers between institutions so we can work together to solve this problem. We are all 

in this together. 

Now, having set up those two principles, I want to report on good 

news, things that are happening, and we will get back to that $1.4 

million grant, and the way it worked. The way it worked, it did not 

begin with a grant-writing class. It began with a tribal consult declaring a state of emergency and then leading to the deployment 

of the Indian Health Service. The Indian Health Service deployed 

people to this community who did very hard State work. They researched and asked questions to find out what was going on. 

Now, in lesser communities, the report that they generated 

would end up a shelf collecting dust as reports often do. That was 

not the case. We had already begun conversations with James 

Belcourt and under his leadership and tribal health people we understood that we needed that report as a way forward. So we took 

it as an information base. That information base, what we learned 

from that community or that Federal report told us as a university 

to do allowed us to write a grant that was far more compelling 

than we would have been able to do alone. 

14

So it is that leadership, IHS, tribal health, tribal council and the 

schools, people working together, sharing information that allowed 

us to write a very strong grant and then the leadership of Senator 

Tester’s office to make it happen. Those things [indiscernible] together. 

That is probably [indiscernible] what is to us something we have 

learned. And this is a small thing [indiscernible]. During the IHS 

deployment, the people doing that work did a very smart thing and 

something we have a lot here today. They took kids aside and 

asked them what they thought we should do. They talked to children, they said, what do you need. Now, that sounds [indiscernible] 

be surprised at how often it doesn’t happen. It happened in this 

case. 

One of the things kids told us as a group, a common answer was, 

we had like more adult contact, one on one contact. So when we 

began our work in Poplar Schools in response to the initial suicide 

[indiscernible] schools and [indiscernible] university, we asked kids 

the same question, what do you need as a result of [indiscernible]. 

We got the same answer: we had like more one on one contact. We 

said, that sounds simple enough, let’s do that. 

So we started a mentorship program at Poplar Schools. We simply asked the kids to identify, identify an adult they trusted in the 

school. We took the kids’ advice, someone you trust, a licensed therapist, a counselor, we don’t care, just so you trust that person. The 

group we are talking about is 47 kids who were identified at risk 

for suicide. At risk. We are dealing with them intensively. 

So those 47 kids went through the mentorship program and they 

also had a common history of assault. We had a lot of assault in 

that group. And then [indiscernible]. At the end of the mentorship, 

I am sorry, before the mentorship program, that group of 10 students had a rate of assault of .35, almost an assault every other 

month, .35 assaults per student per month. At the end of the 

mentorship program, it was .05. In other words, we effected a 

seven-fold decrease in assaults. 

We have calculated out, if they do that mentorship program with 

every student in the school, and the school now has a rate of about 

300 assaults per year, we would take that rate to about 116 by simple mentorship, checking into those kids three times a year, one on 

one adult contact. That is pretty good news. It is a simple program. 

It is the kind of thing that can be replicated and can be [indiscernible]. We think that justifies the kind of Federal investment that 

is being made [indiscernible] other people [indiscernible]. 

[The prepared statement of Mr. Manning follows:]

PREPARED STATEMENT OF RICHARD MANNING, RESEARCH ASSOCIATE, NATIONAL

NATIVE CHILDREN’S TRAUMA CENTER, UNIVERSITY OF MONTANA

The National Native Children’s Trauma Center and the Institute for Educational 

Research and Service, both at the University of Montana, thank you for the opportunity to present our information on this issue of vital importance, not just to this 

community, but throughout Indian Country and to the nation as a whole. Much of 

what you will hear in overall testimony today will focus on the severity of a single 

problem—teen suicide—here at Fort Peck. While we do not minimize that single 

problem, we would like to report that through seven years of engagement between 

our group at the university and this community, all of us have learned a great deal 

about some of the broader issues, again, of vital interest throughout Indian Country 

and to the nation as a whole. One of those lessons is that showing up matters. 

15

Throughout our engagement here, working groups both large and small have traveled from the University in Missoula to this community on average every two 

months. But then we can’t help but note and appreciate that the Indian Affairs 

Committee already knows this rule and proves it by showing up here for field hearings. We believe this community views this as a positive development. 

All of what we have learned here with the help of this community cannot be adequately summarized in this short testimony, but in service of the Committee’s work, 

we would like to emphasize two over-arching lessons that we believe ought to guide 

everyone’s efforts in these issues. In addition, we would like to report an encouraging new finding that demonstrates how attention to these two fundamental points 

succeeds. 

In convening this hearing, the Indian Affairs Committee, in fact, demonstrated 

the first important bit of knowledge by titling it: ‘‘Empowering Native Youth to Reclaim their Future.’’ Everyone here today knows the headline-grabbing issue in this 

very school district has been a cluster of teen suicides, and the understandable urge 

is to do something now about that specific problem. In fact, our group from the university is engaged in exactly that, in doing something about suicide now. Nonetheless, as urgent as this issue is, the Committee’s title urges us to not lose sight of 

the larger issues, and we agree. This is really about the future of Native youth, all 

youth. Teen suicide is not a single problem in isolation, but is part of a tangle of 

challenges that includes drug and alcohol abuse, family, community and gang violence, poor academic performance and a high drop-put rate, teen pregnancy, diabetes and obesity. Pulling a single thread will not untangle the larger Gordian knot 

of problems. 

Likewise, our nation now has a solid body of science compiled by both the Centers 

for Disease Control and the National Childhood Traumatic Stress Network sanctioned by Congress in 2001. Our National Native Children’s Trauma Center is a 

Category II Center in that national network, charged with addressing these issues 

on reservations throughout the nation. The overwhelming evidence from those efforts concludes that the knot of problems we face here and in impoverished communities nationwide stem from child abuse, neglect and domestic and community violence, and in the case of reservation communities, historical trauma. We do have 

some evidence that some forms of abuse are particularly damaging. For instance, 

our researchers expect to soon publish data indicating a particularly strong link between childhood sexual abuse and teen suicide. Nonetheless, this does not negate 

our primary lesson here, that the knot of problems is wound up in a knot of causes, 

and we make little progress in these issues unless we recognize the complexity of 

the total picture. 

This presents a daunting challenge, but also leads to our second key point: Because the larger issue is a series of complex problems stemming from complex 

causes, no single agency, institution or bureaucracy can solve this alone. The hydra 

heads of challenges preventing Native youth from reclaiming their future must be 

dealt with by tribal health, social services, schools, juvenile justice and by families, 

especially families. The complexity dictates that all of these diverse elements and 

interests in the tribal community come together to share information and common 

strategy. We are all in this together. Federal, state, tribal, school district, and—yes, 

even academics from the university—must learn to cooperate in a common effort. 

That may be the most important lesson this community is learning and teaching 

the rest of us, not just that cooperation is necessary, but exactly how to tear down 

the barriers to cooperation so we can get to the hard work that faces us. These are 

not just platitudes; we have concrete examples of real success that stems from real 

cooperation. 

As you know, in response to the widely reported suicide cluster more than a year 

ago, the Fort Peck and Assiniboine Sioux Tribal Council declared a state of emergency in May of 2010, which triggered a deployment by the Office of Force Readiness of the U.S. Public Health Service and the Indian Health Service. IHS sent 

twenty-two officers, who rotated through the community in six separate teams, each 

in two-week deployments. The incident commander of the deployment was James 

Melbourne, Director of Tribal Health Service. This extraordinary effort led to a formal report from IHS, which could have, in a lesser community, been sent to a shelf 

somewhere to gather dust. Not here. Our group at UM had already begun working 

with Director Melbourne on these issues, and agreed to cooperate on a way forward, 

using the IHS report as an information base. We built on their knowledge. Cooperatively, we wrote an application for a $1.4 million grant from the Substance Abuse 

and Mental Health Services Administration to pay for suicide prevention on the 

Fort Peck reservation. Senator Tester’s office supported us and announced that our 

application was successful on July 28, and now a local agency—Tribal Health—a 

state university and a local school district will go to work fulfilling needs identified 

16

by the federal IHS and the tribes. This is what we mean by interagency cooperation 

and shared information. Further, because of this structure and the spirit of cooperation, our university has agreed to waive any indirect costs, a burden that can run 

as high as 41 percent on federal grants. 

Yet embedded in this is a development there is, we think, an even more revealing 

and encouraging bit of news. As part of its investigation, IHS took the rare and 

laudable step of actually interviewing the community’s youth to solicit their ideas 

on how we might better serve them. The students gave us some common and revealing insights, and one of those was identifying a need for more meaningful adult contact, one-on-one relationships we might call mentoring. As part of the university’s 

work at Poplar Schools, we repeated that question with a group of forty-seven students that screening had identified as being at-risk for suicide. We got a similar answer, so took the simple step of taking these children at their word. But in analyzing the data, we also noticed that a significant subset of the forty-seven also 

showed a pattern of assaulting other students and teachers, of violence. As we said, 

these problems are entangled, and often one problem like violence stemming from 

anger is a warning sign of another, like suicide. 

Listening closely to what the young people were telling us caused us to do something very simple, but responsive: to begin a mentorship program. Each student 

identified someone on school staff that he or she could trust—a pivotal step—and 

in every case the identified staffer agreed to check in with the student at least three 

times during a school year—just three times. They talked about issues like academic 

progress and attendance, but more to the point, mentors took an interest in students’ well-being. The program effected simple human contact between a student 

and a caring adult, not someone specially trained or licensed or delivering a particular therapy, just someone the student herself identified as someone she trusted. 

The subset of ten students with a history of violence in the school, on average, 

accounted for 4.5 assaults per month in the two years and several months before 

teaming up with a mentor. That is, these kids, also at risk for suicide, accounted 

for a significant portion of the violence in the school. But more importantly, after 

these students participated in the simple program of mentoring, their assaults fell 

from an average of 4.5 per month to 0.71 per month. Conversely, three students 

identified as ‘‘at risk’’ of suicide and with a history of assault were denied parental 

permission to participate in the mentorship program. Their assaults decreased also, 

but not nearly as dramatically as those mentored. Seldom do those of us in this field 

see such a robust and dramatic result so quickly.

The bonus in all of this is that of the larger group of 47 students identified as 

‘‘at risk,’’ those who were mentored also showed significant gains in academic 

achievement. In fact, the difference between the two groups—mentored and not—

amounted to the difference between earning enough credits to graduate and failing 

to do so, one of the more significant predictors of a student’s future. 

This is not to say this is a magic bullet that will solve the community’s problems 

overnight, but there are a couple of points in all this worth emphasizing. The gains 


809a1.eps
17

shown here occurred as a result of an open exchange of information and knowledge 

among various agencies, particularly IHS, the Tribal Health Service and Poplar 

Schools. But they also occurred because Poplar Schools staff has spent many years 

learning to recognize and deal with at-risk youth. That is to say, the community has 

built capacity, and it has paid off. 

Second, though, this is a cost-effective and simple program that rests on strengthening meaningful relationships between children and adults in this community, and 

now we have some evidence it works. It’s the sort of work that can be easily and 

immediately replicated in similar communities with similar challenges, so the nation really can learn from Fort Peck. This, we think, helps justify the federal investment in this place and in these young people.

Senator TESTER. Thank you, Dick. We appreciate that. 

Thank you for your comments, and I as I told Deb earlier, we 

will have questions. 

Rounding out the first panel, we have Fanci Jackson, maybe the 

most important member of this panel. No offense to Deb or Dick. 

But the fact is that Fanci Jackson is a member of the Fort Peck 

Youth Council, and she is going to provide us a perspective from 

the youth side of things and what it is like growing up here on Fort 

Peck. 

Thank you for being here, Fanci. 

STATEMENT OF FANCI JACKSON, MEMBER, FORT PECK 

YOUTH COUNCIL 

Ms. JACKSON. Hi, my name is Fanci Jackson and [indiscernible]. 

I don’t mean to [indiscernible] but from my perspective, I [indiscernible]. I went [indiscernible] and I was a over there for a half 

a year. It was very hard, actually. 

And the following year, it was really hard [indiscernible] no one 

knows how hard it is for you, you never tell anybody [indiscernible] 

because you are scared of what they will think of you. You are 

scared to tell anybody, because [indiscernible] you know people and 

you have to be [indiscernible] maybe [indiscernible] by that. And 

you don’t want to do it and you get scared, you get terrified [indiscernible]. 

But my [indiscernible] at school [indiscernible] so mean, they call 

me mean names and make fun of me [indiscernible] call me a [indiscernible]. I really was [indiscernible] I felt [indiscernible] because all my friends were there, and we were all the same, we were 

no different. When I went to [indiscernible] and so easy problems 

[indiscernible] could do in five seconds [indiscernible] that I was too 

not smart [indiscernible] that I couldn’t do anything. But in that 

school I felt so stupid, I felt, why am I here, they don’t want me 

here. The teachers don’t want me here, the students don’t want me. 

So why am I here? I was afraid to go to school sometimes [indiscernible]. I was [indiscernible]. 

What I would like to bring to your attention is that we only got 

one [indiscernible] out of the whole year [indiscernible] had one B. 

I had straight As all across, distinguished honors and I got that B, 

it was the only one B I got for the last two years. I have never got 

a B [indiscernible]. I was proud, but scared [indiscernible] don’t 

know [indiscernible] larger than happens [indiscernible]. Many of 

us don’t have [indiscernible] hurts, even though we don’t trust 

them. We don’t tell a lot of people. Our friends see it, we see it but 

what do they do? They do nothing. They don’t speak up. They don’t 

18

talk about it. When someone talks, when someone makes fun of 

you, when someone hurts you so bad you want to cry, we don’t talk 

to anybody, because we are afraid. 

And we don’t know what to do. It is like [indiscernible] everybody 

embarrassment. You feel so embarrassed that you just want to cry 

and it hurts you so bad you don’t know what to do. You are just 

sitting there [indiscernible] and you don’t know what to say. So you 

just try to walk away but it just keeps coming back. They will keep 

following you and keep pushing you and pushing you and you still 

don’t know what to do. And you are afraid [indiscernible] really 

hard. 

But [indiscernible] that is why I tried to stand up for my friends 

when they get bullied by other people. I see that and I don’t like 

it one bit. I hate when people bully people. The bullies don’t see 

how people that are being bullied, how they feel. I see my friends 

cry [indiscernible]. I told [indiscernible] I don’t know who it was, 

but I told one of [indiscernible] half hour I told them [indiscernible] 

and that they should just leave them alone [indiscernible] do something else. My friend cried for a whole half hour she was so hurt. 

She didn’t know what to do. 

And I was scared for her. Because sometimes bullying leads to 

suicide. A lot of my friends talk about it, suicide. They think, it is 

my way out. If I do this, I can get out of here, maybe it will be 

a better place. Maybe [indiscernible]. Only thing [indiscernible] we 

always think about getting out of here. When you are so deep down 

hurt that you don’t know what to do or where to go, you don’t think 

you have any other choice, you just want to die. But I am like, you 

really do, you want to leave this and you don’t want to look back. 

That is when you are so deep down and you don’t really care any 

more. 

I have some friends, one friend that I was actually like that 

when I got depressed. When I got depressed, my dad passed away 

in August, his memorial is coming up this weekend on the 10th, 

he passed away [indiscernible] was so alone. I felt so alone in 

school, just knowing I had no one to talk to. I felt so alone deep 

down, I thought no one cared about me. 

I got so depressed I started lashing out at my sisters, I got angry 

at them [indiscernible] over something that was completely not 

even important, maybe a pop, maybe she walked by me and maybe 

looked at me the wrong way. I would just get mad and then [indiscernible] my mom told me that [indiscernible] she thought [indiscernible] and I was really getting bad into it. I was lashing out. I 

started picking [indiscernible]. 

I thought if I leave [indiscernible] maybe I won’t be alone, maybe 

I will see them then, he will care that I am there, maybe [indiscernible] see who I am. I felt so alone [indiscernible] and nobody 

talked to me. I told her [indiscernible] for maybe a few hours but 

[indiscernible]. I was hurting so bad nobody knew [indiscernible] 

just smile and act like nothing was wrong. I smiled for six months 

without telling anybody I was really, really depressed. I smiled 

through everything. 

But then I just wanted to cry. Every day I was just tired, didn’t 

want to get up. Every day [indiscernible] just looking at that [indiscernible] outside each [indiscernible] woke up and go to school [inVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00022 Fmt 6633 Sfmt 6601 S:\DOCS\76838.TXT JACK
19

discernible]. But then I thought of my mom, how much my mom 

loved me, how much my sisters loved me, how much my brother 

loves me, how much everyone loves me so much. And I couldn’t 

leave them. What would they do without me? There is only one me. 

There is not going to be another me. 

So there is never going to be [indiscernible]. And I thought that 

I could be [indiscernible]. But some kids just don’t [indiscernible] 

just give up. They just don’t think [indiscernible]. But [indiscernible] I want to what my friends wanted to do but I tried to stop 

them, because I know that I love them too much for them to go. 

Some of my friends, one did [indiscernible] very silent and I was 

very sad, I barely [indiscernible] but I was very said that he passed 

away. [indiscernible] no one [indiscernible] my cousins passed away 

in April [indiscernible] almost [indiscernible]. I was coming back 

from a field trip and then I get the call that [indiscernible] and I 

just cried. I didn’t know what to do. He was 23 years old, he has 

his whole life in front of him [indiscernible]. He was my best [indiscernible] and I love him so much [indiscernible]. 

But sometimes being bullied doesn’t mean being bullied in school 

but sometimes it can be outside of school. It can also be by family 

[indiscernible]. Sometimes [indiscernible] people you don’t even 

know. You can get bullied everywhere, no matter what. He was 

bullied so much that he hung himself. And I walk by that garage 

every day, going to [indiscernible] and look in there wondering 

why, why did you have to leave, why. And it is all hurt so bad just 

knowing that he couldn’t live any more. And knowing that I felt 

that way too. Then after [indiscernible] cried so much I wanted to 

kill myself, yes, but after I saw that, how many people got hurt by 

it, I wanted [indiscernible]. 

Most people get really [indiscernible] some of my friends. Some 

people I don’t even know, I will be walking down the road and I 

will see someone, they are pushing a kid around. I mean, we are 

all human, we are all the same color. Sometimes we are [indiscernible] we can actually resolve the conflict, but they don’t, no one 

does. They just watch these kids beat each other, they just watch 

these kids beat each other up all the time and no one stops it. No 

one speaks up. No one tells that kid that they are not supposed to 

do that to that child. 

Because one day, what if tomorrow that little boy that got beat 

up [indiscernible] and that happens. It really does. I know it does. 

I have seen it happen. It [indiscernible] just knowing that your 

friend tomorrow [indiscernible] tomorrow is your friend that [indiscernible] yesterday [indiscernible] in the morning when I wake up 

and say hello [indiscernible] be there and say hello to him any 

more. He’s gone. 

You have to [indiscernible] that what if all these people are being 

hurt, no one looks at them, no one eve sees them. Sometimes it is 

hard to see it. But they are hurt and you have to help them. If you 

don’t help them, they are not going to be there tomorrow. There is 

only [indiscernible] what if tomorrow you don’t see them. There is 

so many of them no one sees them. [indiscernible] but [indiscernible]. 

Senator TESTER. Thank you, Fanci. I appreciate that very much. 

20

I would like to start with Fanci, if I might, it is kind of reverse 

order. Your testimony was very good, and you are right, there is 

only one you. And people need to understand that. And to give up, 

it talks about the dire straits, you could be there. 

As you were giving your testimony, I was thinking about the 

peers that are around you, you talked about that, the family that 

is around you. Are you able to encourage, through the Fort Peck 

Youth Council, when people get bullied or for whatever reason and 

they get to feeling rejected, that there are people out there to go 

to talk to, kind of a support group, so to speak, to help them get 

back right with the world? Is that available to kids, whether you 

are in Poplar or Wolf Point or Frazier or wherever? Is there any 

kind of effort to try to make a group of your peers or a group of 

parents available? 

Ms. JACKSON. Actually, I was just talked to my parents, but I 

don’t know who to talk to about it. I mean, I didn’t [indiscernible]. 

You don’t think that anybody will believe you, you don’t think that 

they will care. 

Senator TESTER. But the fact is, there are people who care, right? 

You talked about your cousin. 

Ms. JACKSON. Yes, [indiscernible] at the time I didn’t [indiscernible]. 

Senator TESTER. Okay. That is fine. 

Dick Manning, the grant that you spoke of, and you talked about working together, you talked about partnerships, the $1.4 million 

grant, what kinds of programs do you think would be available to 

develop with this in the end? Where are you going to focus the effort? 

Mr. MANNING. It is actually about the 6th of November, and in 

the first phase, that has already happened, the initial grant a year 

ago. That is almost like a triage, we zoom in and identify as rapidly 

as possible the kids who are at risk of suicide. And they tend to 

be in a cluster, they tend to be kids who knew the kid who completed suicide. For instance, they tend to be very angry about that, 

they didn’t see that as [indiscernible] those kids almost on a triage 

basis as rapidly as possible. 

And that step, that [indiscernible]. The other thing you do with 

that is, you try to train staff to recognize. And some evidence based 

on steps that we have seen in other places, for instance, the staff 

now are very sensitive to a missing child. When a child is not in 

school on a given day, we are calling the house trying to find out. 

In some cases, if they get no response at the house they go, literally, they take it that seriously. We think, we think that we have 

prevented two completions as a result of that work. 

But beyond that, as the effort continues, we can take it on a 

broader basis across the school and deal with some of the tougher 

issues that are out there, like bullying. Make people sensitive to 

bullying, take it seriously, it can happen. At least those kinds of 

things. 

And we try to concentrate initially on that suicide problem. Then 

we go spread out to the broader community and the broader setting 

of problems [indiscernible.] 

Senator TESTER. One more question. There is been recent legislation that talks about tele-health as a method to be used for issues 

21

that revolve around mental health problems, psychological health, 

however you might want to put it. I just want to get your opinion. 

Is this an issue where tele-health can help? Tele-health, tele-medicine health. For instance, you have a health care professional in 

Boston, Massachusetts or Missoula, Montana or Billings or wherever talking to areas that are rural or frontier where you have a 

hard time getting health professionals, like right here. 

Mr. MANNING. On a short-term basis, certainly. In this case, 

when we are worried about a suicide [indiscernible] I understand 

is not implemented but will be implemented in the spring. Suicide 

hot line [indiscernible] somebody to call in the [indiscernible]. But 

ultimately these issues resolve on something as simple as [indiscernible] and it really takes a village, the people who will support 

not somebody out [indiscernible] away. That first day it can be 

that. But ultimately, long term, one on one [indiscernible] works, 

it is the community support, it is creating an environment where 

people feel safe and welcomed [indiscernible]. 

Senator TESTER. Thanks. 

Deb, we send our kids to school and they spend a lot of time in 

school. And so even though the family is hugely important in this, 

and it is critically important, I think part of Fanci’s testimony revolved around that, are there things that the school districts are 

doing or can do as it revolves around mental health? 

Ms. HALLIDAY. Absolutely. As I was saying earlier, to look at a 

school system and know that kids aren’t getting their rightful access to a quality education, and not understand that they feel [indiscernible] safe to [indiscernible] flourish in a school environment, 

that is a very central piece of our work. 

There are infrastructure pieces at schools. A lot of schools have 

school counselors who are trained to work with mental health. We 

have in our State a program where third party non-profit and forprofit mental health providers partner with the school systems to 

provide some care and then they go Medicaid for that, which is trying to get some of the challenges of getting services into a rural 

area. 

I think this is a lot of work that can be done though around, as 

they were saying, relationship-building, encouraging teachers and 

staff to see themselves as a very important, safe, consistent adult 

in a child’s life. And there is a lot of really great work that is happening in our State through something called Montana Behavioral 

Initiative, which is part of the Office of Public Instruction, that 

teaches adults in the school system how to just have a very consistent, caring way with kids. We are doing some of that work 

through the Schools of Promise work as well. 

Senator TESTER. In areas where there is a real problem with 

teen suicide, and you talked about the role that counselors play, 

and what a critical role they can play, and the classroom teacher, 

as far as that goes. Does OPI have the resources or the ability, either one, to be able to give help to a school district where they are 

seeing an influx in problems? 

Ms. HALLIDAY. Suicide particularly? 

Senator TESTER. Yes, in suicide particularly. 

Ms. HALLIDAY. Well, we are very strong local control State, so a 

tremendous amount of decisions of personnel and program and 

22

budget are decided at the school board level. So this [indiscernible] 

one of our [indiscernible] legislation is going to be put forward was 

to require school districts to have baseline for what the anti-bullying policy would look like, the four components of it, definition, 

and that would be readily available to any parent or student who 

would want to know what the policy was. That was defeated. 

But what we are doing anyway is creating a model bullying policy. I know that several of the public schools here in Fort Peck 

have been working, I think as a result of the IHS work [indiscernible] to try and revamp their bullying policies. But change really 

only happens when people change their behaviors. So I really, it 

resonated with me when Roxanne said, I don’t want to hear about 

another policy, I want to know our kids are going to be loved and 

taken care of [indiscernible]. 

Senator TESTER. I want to thank you all for your contribution to 

this hearing. I very much appreciate your testimony and your 

forthrightness. We have some issues here that need to be dealt 

with, and we appreciate your leadership, whether it is leadership 

with our youth, or leadership in the capacity that you are in in 

your jobs. Thank you for that. 

So I will release you now. In the meantime, I will ask Dr. 

Weahkee to come up, Ed Parisian to come up, and Dr. McKeon. 

While they are getting set down, I will just tell you that our next 

panel represents the Federal Government’s response to this crisis. 

They are going to tell us not only what they are doing, but also 

what communities throughout Indian Country can do to address 

this. We are going to first hear from Dr. Rose Weahkee, who is Director of Behavioral Health and the Indian Health Service. Rose 

has dedicated years to preventing these tragedies from occurring. 

We thank all three of you for being here today. We very much appreciate your presence at this Indian Affairs Committee hearing. 

And we will hear from Rose first. 

STATEMENT OF ROSE WEAHKEE, PH.D., DIRECTOR, DIVISION 

OF BEHAVIORAL HEALTH, INDIAN HEALTH SERVICE 

Ms. WEAHKEE. Thank you, Mr. Chairman, Senator Tester. Good 

afternoon. I am Dr. Rose Weahkee, Director of the Indian Health 

Service Division of Behavioral Health. 

I am pleased and honored to have this opportunity to testify on 

the Indian Health System’s response to youth suicide in Indian 

Country. 

As you know, IHS plays a unique role in the U.S. Department 

of Health and Human Services to meet the Federal trust responsibility to provide health care to American Indians and Alaska Natives. In this ongoing effort to meet the health and behavioral 

health challenges, there is of course a trend toward tribal management and delivery of behavioral health services. Currently 54 percent of mental health and 84 percent of alcohol and substance 

abuse programs are tribally-operated. This evolution in behavioral 

health care delivery and management is changing the face of behavioral health services in Indian Country. 

Where IHS was previously the principal behavioral health care 

delivery system, there is now a more diverse network of care provided by Federal, tribal and urban Indian health programs. This 

23

‘‘Indian health system’’ denotes this larger network of programs 

and the evolving care delivery system across Indian Country. 

Suicide is a complicated public health challenge with many contributing risk factors. In the case of American Indians and Alaska 

Natives, they face, on average, a greater number of these risk factors and the risk factors are more severe in nature. For years, several communities in Indian Country experienced suicide contagion, 

often referred to as suicide clusters. In these communities, the suicidal act becomes a regular and transmittal form of expression of 

the despair and hopelessness experienced by some Indian youth. 

On a national level, American Indian and Alaska Native communities are also affected by very high levels of poverty, unemployment, accidental death, domestic violence, alcoholism and child 

abuse. American Indian and Alaska Native people suffer significantly from mental health disparities. While the need for mental 

health care is great, services are lacking and access to these services can be difficult and costly. The availability and adequacy of 

mental health programs for American Indians varies considerably 

across communities. 

IHS has devoted considerable efforts to develop and share effective programs. Developing programs that are collaborative, community-driven and nationally supported offer the most promising potential for long-term success and sustainment. The IHS National 

Tribal Advisory Committee on Behavioral Health, which is made 

up of elected tribal leaders from each of the IHS areas, provides 

recommendations and advice on the range of behavioral health 

issues in Indian Country. The IHS Behavioral Health Work Group 

is the technical advisory group to IHS and is made up of mental 

health professionals from across Indian Country. They provide expert advice and recommendations for services and program delivery. 

The Indian Health Service Suicide Prevention Committee was established and tasked with identifying and defining the steps needed to prevent suicide and suicide-related behaviors. The Indian 

Health Service methamphetamine and Suicide Prevention Initiative is a nationally coordinated pilot program, which supports 127 

IHS, tribal and urban Indian health programs that are providing 

methamphetamine and suicide prevention resources to communities with the greatest need. 

Just this past week, on August 1st, in partnership with tribes, 

IHS released the American Indian/Alaska Native National Behavioral Health and Suicide Prevention Strategic Plans. These strategic plans will foster collaboration and other key community resources. 

Also, in November 2010 to February 2011, IHS, SAMHSA, BIA 

and BIE held ten suicide prevention listening sessions to seek 

input from tribes on how our agencies can most effectively work in 

partnership with tribes to prevent suicide. This information was 

used to form the agenda for the Action Summit for Suicide Prevention which was held just this past week with over 1,000 in attendance. The IHS and the Veterans Health Adminsitration Suicide 

Prevention office have also developed a joint plan to address suicide among our Native veterans and their families. VA has also 

24

participated in many of the suicide prevention listening sessions 

and also in the Action Summit last week. 

Also, on December 30th, 2010, the National Action Alliance for 

Suicide Prevention announced an American Indian and Alaska Native task force to address the issue of suicide in Indian Country, 

and also to advance a national strategy for suicide prevention. 

Jointly leading this task force are Dr. Yvette Roubideaux, the Director for IHS, Mr. Larry Echo Hawk, Assistant Secretary of Indian 

Affairs, Department of the Interior, and Mr. McClellan Hall, the 

Executive Director of the National Indian Youth Leadership Program. 

In summary, we look forward to addressing the issue of mental 

health care needs in Indian Country. Our partnership and our consultation with tribes has shown that we are working together to 

improve the health of American Indian and Alaska Native communities. As you heard today, together we can instill culture, language and spirituality, together we can instill hope. 

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

allowing me to testify. I would be happy to answer any questions 

that you might have. 

[The prepared statement of Ms. Weahkee follows:]

PREPARED STATEMENT OF ROSE WEAHKEE, PH.D., DIRECTOR, DIVISION OF

BEHAVIORAL HEALTH, INDIAN HEALTH SERVICE

Mr. Chairman and Members of the Committee: 

Good Afternoon, I am Dr. Rose Weahkee, Director of the Indian Health Service 

(IHS) Division of Behavioral Health. I am pleased to have this opportunity to testify 

on the Indian health system’s response to youth suicide in Indian Country. 

The IHS plays a unique role in the U.S. Department of Health and Human Services to meet the Federal trust responsibility to provide health care to American Indians and Alaska Natives (AI/AN). The IHS provides comprehensive health service delivery to approximately 1.9 million Federally-recognized American Indians and Alaska Natives through a system of IHS, Tribal, and Urban facilities and programs 

based on treaties, judicial determinations, and Acts of Congress. The mission of the 

agency is to raise the physical, mental, social, and spiritual health of AI/ANs to the 

highest level, in partnership with the population served. The agency aims to assure 

that comprehensive, culturally acceptable personal and public health services are 

available and accessible to the service population. Our goal is to promote healthy 

AI/AN people, communities, and cultures, and to honor the inherent sovereign rights 

of Tribes. 

The IHS is responsible for providing mental health services to the AI/AN population it serves. The IHS Mental Health/Social Service (MH/SS) program is a community-oriented clinical and preventive mental health service program that provides 

primarily outpatient mental health and related services, crisis triage, case management, prevention programming, and outreach services. The most common MH/SS 

program model is an acute, crisis-oriented outpatient services staffed by one or more 

mental health professionals. Many of the IHS, Tribal, and urban mental health programs that provide services are not open 24/7. Therefore, when an emergency or crisis occurs, the clinic and service units will often contract out such services to nonIHS hospitals and crisis centers. 

In the ongoing effort to meet the health and behavioral health challenges, there 

is a trend toward Tribal management and delivery of behavioral health services in 

AI/AN communities. Particularly in the last decade, Tribes have increasingly contracted or compacted via the Indian Self Determination and Education Assistance 

Act, Public Law 93–638, to provide those services themselves. Currently, 54 percent 

of the mental health and 84 percent of the alcohol and substance abuse programs 

are operated by Tribes. This evolution in behavioral health care delivery and management is changing the face of behavioral health services in Indian Country. 

Where IHS was previously the principal behavioral health care delivery system 

for AI/ANs, there is now a less centralized and more diverse network of care provided by Federal, Tribal, and Urban Indian health programs. The ‘‘Indian health 

25

1 Indian Health Service. Office of Public Health Support. Division of Program Statistics. 

Trends in Indian Health, 2002–2003. Rockville, MD: Indian Health Service. 2 Unpublished data, Office of Public Health Support. Division of Program Statistics. Indian 

Health Service. 3Manson, S.M. (2004). Cultural Diversity Series: Meeting the Mental Health Needs of American Indians and Alaska Natives. National Association of State Mental Health Program Directors (NASMHPD) and the National Technical Assistance Center for State Mental Health Planning. 4 U.S. Department of Health and Human Services. (2001). Mental Health: Cultural, race, and 

ethnicity supplement to mental health: Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute 

of Mental Health. 5Manson, S.M. (2004). Cultural Diversity Series: Meeting the Mental Health Needs of American Indians and Alaska Natives. National Association of State Mental Health Program Directors (NASMHPD) and the National Technical Assistance Center for State Mental Health Planning. 6 Ibid. 

7More Mental Health Resources Needed to Battle Teen Suicides in American Indian and Alaska Native Communities. (2010, May). U.S. Medicine: The Voice of Federal Medicine. Retrieved 

March 28, 2010 from http://www.usmedicine.com/articles/more-mental-health-resources-neededto-battle-teen-suicides-in-american-indian-and-alaska-native-communities.html

system’’ denotes this larger network of programs and the evolving care delivery system across Indian Country. Meeting the needs of this system will require an evolution in IHS and Tribal collaboration as well, particularly as Tribal programs take 

more direct responsibility for services and IHS supports them in doing so. 

Introduction 

Suicide is a complicated public health challenge with many contributing risk factors. In the case of AI/ANs, they face, on average, a greater number of these risk 

factors individually or the risk factors are more severe in nature for them. In prior 

years, several communities in Indian Country experienced suicide contagion, often 

referred to as suicide clusters. In these communities, the suicidal act becomes a regular and transmittable form of expression of the despair and hopelessness experienced by some Indian youth. 

The AI/AN suicide rate (17.9 per 100,000) for the three year period (2002–2004) 

in the IHS service areas is 1.7 times that of U.S. all races rate (10.8 per 100,000) 

for 2003. Suicide is the second leading cause of death behind unintentional injuries 

for Indian youth ages 15–24 residing in IHS service areas and is 3.5 times more 

frequently in those areas than the national average. Suicide is the sixth leading 

cause of death overall for males residing in IHS service areas and ranks ahead of 

homicide. AI/AN young people ages 15–34 comprise 64 percent of all suicides in Indian Country. 1 Suicide mortality rates have increased from 45.9 per 100,000 to 55.2 

per 100,000 among AI/AN youth ages 15–24, comparing data from 2003–2005 to 

those from 1999–2001. Overall, suicide mortality is 73 percent greater in AI/AN populations in IHS service areas compared to U.S.—All races. 2

On a national level, many AI/AN communities are also affected by very high levels of poverty, unemployment, accidental death, domestic violence, alcoholism, and 

child neglect. 3 AI/AN people suffer significantly and disproportionately from mental 

health disparities and lack access to culturally appropriate care. Each of these serious health issues has a profound impact on the health of individual, family, and 

community well being both on- and off-reservations. 

According to a 2001 mental health supplemental report of the U. S. Surgeon General, ‘‘Mental Health: Culture, Race, and Ethnicity,’’ there are limited mental health 

services in Tribal and urban Indian communities. 4 While the need for mental health 

care is great, services are lacking, and access to these services can be difficult and 

costly. 5 The current system of services for treating mental health problems of AI/

ANs is a complex and often fragmented system of Tribal, Federal, State, local, and 

community-based services. The availability and adequacy of mental health programs 

for AI/ANs varies considerably across communities. 6 Navigating complex or fragmented combinations of Tribal, Federal, State, local, and community-based services 

can be confusing and discouraging, making it difficult to access care even if it is 

available. In addition, severe provider shortages are common. 7

There are many reasons for a lack of access to care and services. Indian Country 

is predominantly rural and remote, and this brings with it the struggles of recruiting and retaining providers. Rural practice is often isolating for its practitioners. 

The broad range of clinical conditions faced with limited local resources challenges 

even seasoned providers. Some providers are so overwhelmed by the continuous deVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00029 Fmt 6633 Sfmt 6621 S:\DOCS\76838.TXT JACK
26

8Grim, C.W. (2006, May 17). Testimony of Charles W. Grim, Director of the Indian Health 

Service, before the Senate Committee on Indian Affairs on Suicide Prevention Programs and 

Their Application in Indian Country. Washington, DC. Retrieved from http://

www.indian.senate.gov/public/lfiles/Grim051706.pdf 9 Brave Heart, M. Y. H. and DeBruyn, L. M. (1998). The American Indian Holocaust: Healing 

Historical Unresolved Grief. American Indian and Alaska Native Mental Health Research, 8(2),

61. 10Subia BigFoot, D. (n.d.) History of Victimization in Native Communities [Monograph]. Retrieved March 28, 2010 from http://icctc.org/History%20of%20Victimization%20Issues-

%20Final.pdf 

mand for services, particularly during suicide outbreaks, that even experienced and 

hard working providers become at-risk for burn-out. 

In addition to clinical care, the importance of public health and community- and 

culture-based interventions is becoming more widely recognized. 8 One factor that 

makes community- and culture-based interventions especially important is the role 

of historical trauma in the increased risk of suicide among AI/AN people. Historical 

trauma, exacerbated by re-traumatization of the community from the high rates of 

injury and death, continues to plague Indian communities. 9 Historical trauma is 

also linked to increased suicide risk because anger, aggression, and violence felt in 

response to experiences of victimization can be turned against oneself. 10

Addressing Suicide in Indian Country 

Since 2008, IHS has devoted considerable effort to develop and share effective programs throughout the Indian health system. In particular, developing programs that 

are collaborative, community driven, and nationally supported, we believe, offer the 

most promising potential for long term success and sustainment. As an example of 

this, IHS regularly relies on Tribal leadership and expertise to collaborate on a 

range of behavioral health problems and programs. 

The IHS National Tribal Advisory Committee (NTAC) on Behavioral Health, 

which is made up of elected Tribal leaders from each IHS Area, provides recommendations and advice on the range of behavioral health issues in Indian Country. From making recommendations on significant funding allocations and service 

programs, to developing long term strategic plans for Tribal and Federal behavioral 

health programs for the future, the NTAC is the principal Tribal advisory group for 

all behavioral health services to IHS. They ensure collaboration among Tribal and 

Federal health programs, provide Tribal input into the development of programs 

and services, and also provide the inclusive and transparent development of processes and programs so important to all our communities and programs. 

The IHS National Behavioral Health Work Group (BHWG) is the technical advisory group to IHS. Comprised of mental health professionals from across the country, the BHWG furthers the agency priorities to strengthen partnerships with 

Tribes, improve quality and access to care for patients, and provide direct collaboration and input for accountable, fair, and inclusive services across the Indian behavioral health system. They provide expert advice and recommendations for services, 

programs, and intervention models, as well as long term strategic planning and goal 

development. As the national technical advisory group to the agency, they also work 

very closely with the elected Tribal leaders on the NTAC to provide collaborative 

links between the professional community and national Tribal leadership. 

The IHS Suicide Prevention Committee (SPC) was established and tasked with 

identifying and defining the steps needed to significantly reduce and prevent suicide 

and suicide-related behaviors in AI/AN communities. It is the responsibility of the 

SPC to provide recommendations and guidance to the Indian health system regarding suicide prevention, intervention, and postvention in Indian Country. 

IHS Methamphetamine and Suicide Prevention Initiative 

The IHS Methamphetamine and Suicide Prevention Initiative (MSPI) is a nationally-coordinated demonstration pilot program, focusing on providing targeted methamphetamine and suicide prevention and intervention resources to communities in 

Indian Country with the greatest need for these programs. IHS, Tribes, Tribal programs, and other Federal agencies concurrently coordinate the development and implementation of the MSPI project, which now provides support to 127 IHS, Tribal, 

and urban Indian health programs nationally. The strategic goal is to support Tribal 

programs in their prevention, treatment, and infrastructure development as they increasingly are delivering their own services. The MSPI implemented by IHS and its 

Tribal partners nationally, marks a significant milestone in suicide prevention efforts in Indian Country as well as Tribal and Federal partnerships for health that 

embraces the Administration’s commitment to Tribal engagement and partnership. 

27

To create the overall MSPI approach, IHS engaged in close collaboration with 

Tribes and Tribal leaders over the course of almost a year. During this time, Tribal 

leaders developed a model and recommendations, which were accepted by IHS, for 

approaches and funding allocations. It was and remains a creation of close collaboration and partnership with Tribes. The program is community driven from conception 

through execution for each program in each community. Indian communities decide 

what they need and establish programs to meet those needs. 

The MSPI data currently available indicate that a total of 289,066 persons have 

been served through both prevention and treatment activities. Prevention activities 

include, but are not limited to evidence-based practice training, knowledge dissemination, development of public service announcements and publications, coalition development, and crisis hotline enhancement. There were 42,895 youth participating 

in evidence-based and/or promising practice prevention or intervention programs. 

There were 674 persons trained in suicide crisis response teams. 

American Indian/Alaska Native National Behavioral Health and Suicide 

Prevention Strategic Plans 

On August, 1, 2011, in partnership with Tribes, IHS released the American Indian/Alaska Native National Behavioral Health and Suicide Prevention Strategic 

Plans. These strategic plans will foster collaborations among Tribes, Tribal organizations, urban Indian organizations, and other key community resources. These collaborations will provide tools needed to adapt the shared wisdom of these perspectives, consolidate our experience, target our efforts towards meeting the changing 

needs of our population, and develop the framework that will serve to pave the way 

over the coming years to address suicide and behavioral health in Indian Country. 

The American Indian/Alaska Native National Behavioral Health Strategic Plan is 

the culmination of over two years of close collaborative work, and contains three 

overarching strategic directions which are operationalized into 77 action steps, most 

of which are already in progress. It is the strategic framework for the continuing 

development of programs and services across the AI/AN behavioral health system, 

with an added emphasis on Tribal, Federal, and Urban program collaboration. 

The American Indian/Alaska Native National Suicide Prevention Strategic Plan 

represents the combined efforts of Tribal, Federal, Urban, and other representatives 

across the country to develop strategic goals and objectives to address the ongoing 

suicide epidemic in so many of our communities. The suicide epidemic is the single 

most significant cause of concern across our communities and requires specific planning and program implementation, which this plan represents in eight strategic 

goals and 41 objectives. 

The importance of including culture, cultural and traditional practices, and a variety of learning approaches is included in these strategic plans and should not be 

underestimated. AI/ANs see behavioral health as supporting their historic and continuing reliance on elders, languages, community, culture, and traditional practices 

as protective factors that restore balance and serve as both prevention and treatment. 

IHS Partnerships 

Strategies to address mental health and suicide include collaborations and partnerships with consumers and their families, Tribes and Tribal organizations, urban 

Indian health programs, Federal, State, and local agencies, as well as public and 

private organizations. This effort seeks to establish effective long-term strategic approaches to address mental health and suicide prevention in Indian Country. 

IHS and the Substance Abuse and Mental Health Services Administration 

(SAMHSA) work closely together to formulate long term strategic approaches to address the issues of suicide and mental health care in Indian Country more effectively. For example, IHS and SAMHSA are actively involved on the Federal Partners for Suicide Prevention Workgroup. In 2001, the Office of the Surgeon General 

coordinated the efforts of numerous agencies, including IHS, SAMHSA, Centers for 

Disease Control and Prevention (CDC), National Institute for Mental Health 

(NIMH), Health Resources and Services Administration (HRSA), and other public 

and private partners to develop the first, comprehensive, integrated, public health 

approach to reducing deaths by suicide and suicide attempts in the United States 

in the National Strategy for Suicide Prevention. This resulted in the formation of 

the ongoing Federal Partners for Suicide Prevention Workgroup. 

IHS, SAMHSA, Bureau of Indian Affairs (BIA), and Bureau of Indian Education 

(BIE) held ten regional suicide prevention listening sessions across Indian Country 

over the last twelve months to seek input on how the agencies can most effectively 

work in partnership with Tribes to prevent suicide. The Tribal listening sessions 

provided important information on suicide prevention needs, concerns, programs, 

28

and practices. This information was used to form the agenda for the Action Summit 

for Suicide Prevention held from August 1–4, 2011 in Scottsdale, AZ with over 1,000 

in attendance. This collaborative work also paved the way for other Federal partners to join in the effort to prevent suicide among AI/ANs. For example, IHS and 

the Veterans Health Administration (VHA) Suicide Prevention Office have developed a joint plan to address suicide among Native veterans. VHA Suicide Prevention 

Coordinators participated in several of the listening sessions. 

On September 10, 2010, Department of Health and Human Services Secretary 

Kathleen Sebelius and Department of Defense Secretary Robert M. Gates announced the creation of the National Action Alliance for Suicide Prevention. The Action Alliance is expected to provide an operating structure to prompt planning, implementation and accountability for updating and advancing the National Strategy 

for Suicide Prevention. On December 30, 2010, the National Action Alliance for Suicide Prevention announced three new task forces to address suicide prevention efforts within high-risk populations including American Indians/Alaska Natives. 

Jointly leading the American Indian/Alaska Native Task Force are Yvette 

Roubideaux, M.D., M.P.H., Director of the Indian Health Service; Larry Echo Hawk, 

J.D., Assistant Secretary of Indian Affairs, Department of the Interior; and McClellan Hall, M.A., Executive Director, National Indian Youth Leadership Project. 

Tribes also look to SAMHSA for help in addressing youth suicides. Through its 

Garrett Lee Smith State and Tribal Grants, Tribes and Tribal organizations have 

received grants ranging from $400,000 to $500,000 a year to prevent suicide. In addition, SAMHSA:

• Funds the Native Aspirations project which is a national project designed to address youth violence, bullying, and suicide prevention through evidence-based 

interventions and community efforts. Through the Native Aspirations project, 

AI/AN communities determined to be the most ‘‘at risk’’ develop or enhance a 

community-based prevention plan.

• Supports the Suicide Prevention Resource Center which is a national resource 

and technical assistance center that advances the field by working with Tribes, 

States, territories, and grantees by developing and disseminating suicide prevention resources.

• Funds the National Suicide Prevention Lifeline, a network of crisis centers 

across the United States that receives calls from the national, toll-free suicide 

prevention hotline number, 800–273–TALK. The National Suicide Prevention 

Lifeline’s American Indian initiative has promoted access to suicide prevention 

hotline services in Indian Country by supporting communication and collaboration between Tribes and local crisis centers as well as providing outreach materials customized for each Tribe.

Summary 

In summary, we look forward to opportunities to address the suicide and mental 

health care needs in Indian Country. For the IHS, our business is helping our communities and families achieve the highest level of wellness possible. IHS has devoted considerable effort to develop and share effective programs throughout the Indian health system. We believe developing programs that are collaborative, community driven, and nationally supported offer the most promising potential for long 

term success and sustainment. Our partnership and consultation with Tribes ensure 

that we are working together in improving the health of AI/AN communities. 

Mr. Chairman, this concludes my statement. Thank you for the opportunity to testify. I will be happy to answer any questions that you may have.

Senator TESTER. Thank you, Rose. We will have some questions 

a little later. Thank you very much for your testimony. 

Next we are going to hear from Ed Parisian. Ed is the Billings 

Regional Director of the Bureau of Indian Affairs. Ed is responsible 

for improving upon many of the risk factors that contribute to 

youth suicide, primarily safe communities and violence issues. He 

will tell us how the new Tribal Law and Order Act is going to impact reservation communities and make them a better place. 

Thank you for being here, Ed. 

29

STATEMENT OF EDWARD PARISIAN, DIRECTOR, ROCKY

MOUNTAIN REGIONAL OFFICE, BUREAU OF INDIAN

AFFAIRS, UNITED STATES DEPARTMENT OF INTERIOR 

Mr. PARISIAN. Thank you, Senator Tester. I am pleased to be 

here to talk on the topic of empowering Native youth to reclaim 

their future. I also want to thank your staff. 

American Indian and Alaska Native youth suicide is a devastating, serious problem in Indian Country. Data and research 

have shown that social factors such as poverty, alcoholism, gangs 

and violence contribute in the manifestation of suicide ideation, suicidal behavior and suicide attempts by American Indian youth in 

Indian Country. As the members of this Committee are aware, BIA 

programs assist tribal communities in developing their natural and 

social-economic infrastructures or provide services to fill infrastructure gaps. 

For the BIA, suicidal events significantly impact law enforcement 

personnel since they are the most likely first responders to suicide 

events. There is also a significant impact on students, teachers, administrators and other school staff when handling suicide ideation, 

gestures, attempts and completions within the Bureau of Indian 

Education school system. 

The BIE has developed a Suicide Prevention, Early Intervention 

and Postvention Policy to promote suicide prevention in BIE 

schools. The policy mandates specific actions in all schools, dormitories and the two post-secondary institutions and encourages 

tribally-operated schools to develop similar policies. These actions 

create a safety net for students at risk of suicide and promotes 

proactive involvement of school personnel and communities in 

intervention, prevention and postvention activities. There are also 

ongoing efforts to address these issues through partnerships with 

behavioral health and social services organizations at both the tribal and national level with SAMHSA and the Indian Health Service. 

Within the Indian Affairs, BIA’s Law Enforcement and Tribal 

Services programs, along with BIE continue to seek ways to collaborate and to support activities directed at suicide prevention 

and services coordination. The BIE utilizes the Youth Risk Behavior Survey, the Native American Student Information System, local 

BIA law enforcement and IHS data to develop interventions and 

track trends for program implementation and is committed to seeking out and enacting prevention strategies while ensuring a safe 

and secure environment for our students. 

Indian Affairs’ most direct action in youth suicide prevention is 

through the BIE, the Bureau of Indian Education. The BIE’s Division of Performance and Accountability ha been providing suicide 

prevention activities through funds provided by the U.S. Department of Education’s Title IV Part A Safe and Drug-Free Schools 

and Communities program. Serving in a similar capacity as a State 

educational agency, the BIA is required to use these funds to provide technical assistance to the schools to reduce drug and alcohol 

abuse and violence by 2 percent annually. The BIE’s DPA has provided technical assistance in the development and implementation 

of data-driven programs and evidence-based curriculum. 

While the SDFS program has been discontinued, ongoing technical assistance and monitoring is provided by regional school safeVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00033 Fmt 6633 Sfmt 6601 S:\DOCS\76838.TXT JACK
30

ty specialists to ensure schools are compliant with intervention 

strategies and reporting protocols to further ensure student safety. 

BIE’s partnering with other Federal agencies, including SAMHSA 

and IHS and the Department of Education has enabled BIE to address the unique needs of students within these schools in the 

areas of behavioral health and suicide prevention efforts. 

Additionally, BIE schools and dormitories use NASIS to track 

and identify specific behavior trends to develop interventions to address school-specific behavior issues. BIE has developed two technical assistance training sessions that include both a basic and 

coaching level course. The basic course covers initial program development, policy development, best practices and implementation 

and the coaching level course focuses on adult wellness issues and 

youth development. The framework of the session is based on Native resiliency and cultural practices that support a positive school 

climate. 

On November 12th, 2010, Larry Echo Hawk, Assistant Secretary, 

Indian Affairs, Yvette Roubideaux, Director, Indian Health Service, 

and Pamela Hyde, Administrator of SAMHSA, announced to tribal 

leaders that BIA, IHS and SAMHSA would sponsor listening sessions to hear the needs and concerns regarding youth suicide in Indian Country. The purpose of the listening sessions were to gather 

tribal input on how we can best support the goals and programs 

of tribes for preventing suicide in tribal communities. 

The listening sessions began on November 15th, 2010, and ended 

on February 10th, 2011. Over this four-month period, BIA, IHS and 

SAMHSA met with several tribes from all the BIA regions. We held 

these listening sessions in Indian Country to gain first-hand knowledge from the American Indian and Alaska Native communities to 

see how best we can all, as partners, prevent youth suicide and to 

identify specific needs expressed by tribal community leaders, clinicians, practitioners and youth. 

Information gathered from these listening sessions was used at 

the Action Summit for Suicide Prevention held in Scottsdale, Arizona last week from August 1st through 4th. I attended the Action 

Summit, along with other Indian Affairs staff and key leadership 

in the Office of the Assistant Secretary. A lot of what we have 

heard this afternoon about, we can’t do it by, just one tribe can’t 

do it, one office, I just can’t do it, one of the messages I took from 

that was that it is going to take a community. It is going to take 

all resources. We have to give up a little bit here and a little bit 

there, and we have to put our resources together if we are going 

to make this happen. We can’t have ownership, it has to be flexibility on our resources. That way we will prevent duplication. This 

is one of the major things that I took away from that conference. 

It is one of the things we have heard across the Country from the 

listening sessions that they held. 

I kind of got a little bit off of my testimony, but it is there for 

the record, Senator. And I will end because I feel my hook coming. 

I will be happy to answer any questions that you may have. 

[The prepared statement of Mr. Parisian follows:]

31

PREPARED STATEMENT OF EDWARD PARISIAN, DIRECTOR, ROCKY MOUNTAIN

REGIONAL OFFICE, BUREAU OF INDIAN AFFAIRS, UNITED STATES DEPARTMENT OF

INTERIOR

Good Afternoon Mr. Chairman, Mr. Vice Chairman and Members of the Committee, my name is Edward Parisian and I am the Regional Director for the Bureau 

of Indian Affairs (BIA) Rocky Mountain Regional Office in Billings, Montana. I have 

served in this capacity since April 1, 2008. I am pleased to be here today to provide 

the Department’s statement on the topic of ‘‘Empowering Native Youth to Reclaim 

Their Future,’’ which relates to American Indian and Alaska Native youth suicide 

prevention. 

American Indian and Alaska Native youth suicide is a serious problem in Indian 

Country. Data and research have shown that social factors such as poverty, alcoholism, gangs, and violence contribute in the manifestation of suicide ideation, suicidal behavior and suicide attempts by American Indian youth in Indian Country. See 

To Live To See the Great Day That Dawns: Preventing Suicide by American Indian 

and Alaska Native Youth and Young Adults, 2010 Publication by Substance Abuse 

and Mental Health Services Administration (SAMHSA), U.S. Department of Health 

and Human Services. 

According to the Centers for Disease Control (CDC) data on ‘‘Leading Causes of 

Death by Age Group, American Indian or Alaska Native Males—United States, 

2006,’’ suicide was the second leading cause of death for ages 10–34. The same 2006 

data from the CDC for American Indian or Alaska Native females showed that suicide was the first leading cause of death for ages 10–14, the second leading cause 

of death for ages 15–24, and the third leading cause of death for ages 25–34. Additionally, SAMHSA in its 2010 publication, To Live To See the Great Day That 

Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young 

Adults, states that young people account for forty percent (40 percent) of all suicides 

in Indian Country. 

As the members of this Committee are aware, BIA programs assist tribal communities in developing their natural and social-economic infrastructures (i.e., tribal 

governments, tribal courts, cultural vitalization, community capabilities, etc.) or provide services to fill infrastructure gaps (i.e., education, law enforcement, social services, housing improvement, transportation, etc.). For the BIA, suicidal events significantly impact law enforcement personnel since they are the most likely first responders to suicidal events. There is also a significant impact on students, teachers, 

administrators and other school staff when handling suicide ideation, gestures, attempts and completions within the Bureau of Indian Education (BIE) school system. 

The BIE has developed a Suicide Prevention, Early Intervention and Postvention 

Policy to promote suicide prevention in BIE schools. The policy mandates specific 

actions in all schools, dormitories and the two post-secondary institutions; and encourages tribally-operated schools to develop similar policies. These actions create 

a safety net for students at risk of suicide and promotes proactive involvement of 

school personnel and communities in intervention, prevention and postvention activities. There are also ongoing efforts to address these issues through partnerships 

with behavioral health and social services organizations at both the tribal and national level with SAMSHA and the Indian Health Service (IHS). 

Within Indian Affairs, the BIA’s Law Enforcement and Tribal Services programs, 

along with the BIE, continually seek ways to collaborate and to support activities 

directed at suicide prevention and services coordination. The BIE utilizes the Youth 

Risk Behavior Survey, Native American Student Information System (NASIS), local 

BIA Law Enforcement and IHS data to develop interventions and track trends for 

program implementation and is committed to seeking out and enacting prevention 

strategies while ensuring a safe and secure environment for our students. 

The Office of Justice Services (OJS) in the BIA has partnered with numerous 

health and social service programs to assist in educating and presenting at schools, 

seminars, workshops and community events to the youth and the community on suicide prevention. Corroborated by statistics from the Resource Patient Management 

System (RPMS), BIA Law Enforcement has seen a history of high rates of suicide 

completions in the Great Plains Region alone. The statistics show that, in this region, there were 24 American Indian suicide completions in 2008, 36 in 2009, 15 

in 2010 and 6 so far in 2011. The majority of these suicide completions were for 

individuals in the age range of 15 to 24. In the Great Plains Region, OJS has signed 

a Memorandum of Understanding (MOU) with the ‘‘Circles of Care’’ program. The 

Circles of Care program provides youth prevention activities for families, which are 

held in their tribal communities. During these events BIA Law Enforcement participates by setting up an educational booth designed to interact with families and 

other service agencies and provide information on suicide prevention. The OJS will 

32

continue to gather statistical data and identify youth suicide trends within Indian 

Country, as well as look for ways to expand suicide prevention training with other 

stakeholders in the future. 

Indian Affairs’ most direct action in youth suicide prevention is through the BIE. 

The BIE’s Division of Performance and Accountability (DPA) has been providing suicide prevention activities through funds provided by the U.S. Department of Education’s Title IV Part-A Safe and Drug-Free Schools and Communities Program 

(SDFS). Serving in a similar capacity as a State educational agency, the BIE is required to use these funds to provide technical assistance to the schools to reduce 

drug and alcohol use and violence incidence by two percent, annually. The BIE’s 

DPA has provided technical assistance in the development and implementation of 

data driven programs and evidence-based curriculum. 

While the SDFS program has been discontinued, ongoing technical assistance and 

monitoring is provided by regional School Safety Specialists to ensure schools are 

compliant with intervention strategies and reporting protocols to further ensure student safety. BIE’s partnering with other federal agencies, including SAMHSA and 

IHS and ED, has enabled BIE to address the unique needs of students within these 

schools in the areas of behavioral health and suicide prevention efforts. 

Additionally, BIE schools and dormitories use NASIS to track and identify specific 

behavior trends to develop interventions to address school specific behavior issues. 

BIE has developed two technical assistance training sessions that include both a 

basic and coaching level course. The basic course covers initial program development, policy development, best practices, and implementation, and the coaching 

level course focuses on adult wellness issues and youth development. The framework 

of the session is based on Native resiliency and cultural practices that support a 

positive school climate. 

On November 12, 2010, Larry Echo Hawk, Assistant Secretary—Indian Affairs, 

Yvette Roubideaux, Director, Indian Health Service, and Pamela Hyde, Administrator, SAMHSA, announced to Tribal Leaders that BIA, IHS and SAMHSA would 

sponsor listening sessions to hear the needs and concerns regarding youth suicide 

in Indian Country. The purpose of the listening sessions were to gather Tribal input 

on how we can best support the goals and programs of tribes for preventing suicide 

in Tribal communities. The listening sessions began on November 15, 2010 in Window Rock, Arizona on the Navajo Nation and concluded on February 10, 2011 in 

Arlington, Virginia at the United South Eastern Tribes (USET) Annual Conference. 

Over this four month period, the BIA, IHS and SAMHSA met with several Tribes 

from all of the BIA Regions. We held these listening sessions in Indian Country to 

gain first-hand knowledge from the American Indian and Alaska Native communities to see how best we can all, as partners, prevent youth suicide; and to identify 

specific needs expressed by tribal community leaders, clinicians, practitioners, and 

youth. 

The information gathered from these listening sessions was used at the Action 

Summit for Suicide Prevention held in Scottsdale, Arizona last week from August 

1–4. I attended the Action Summit, along with other Indian Affairs staff and key 

leadership in the office of the Assistant Secretary for Indian Affairs. The Action 

Summit was jointly sponsored and attended by BIA, BIE, IHS and SAMHSA to discuss what we heard during our joint listening sessions with Tribes, their members, 

and especially the tribal youth. One of the goals of the Action Summit on Youth Suicide was to develop policy and future action items to address youth suicide and prevent youth suicide in Tribal communities. 

In summary, the BIA, BIE, IHS, SAMHSA, other Federal agencies, and Indian 

tribes must continue to work together to address all aspects of suicide prevention 

and response. I want to thank this Committee for its continued concern for the 

wellbeing of Indian children, teens and young adults, especially on the subject of 

suicide prevention. I am happy to answer any questions you may have.

Senator TESTER. Thank you, Ed. I always appreciate your being 

here. Thank you very much. 

Last but certainly not least, we will hear from Dr. McKeon, of 

the Substance Abuse and Mental Health Services Administration. 

Dr. McKeon will tell us about his agency’s work to reduce the two 

most important risk factors involved with youth suicide, and those 

are mental health and substance abuse. So with that, Dr. McKeon, 

you can go forward. Please begin. 

33

STATEMENT OF RICHARD T. McKEON, PH.D., LEAD PUBLIC 

HEALTH ADVISOR, SUICIDE PREVENTION TEAM, SUBSTANCE 

ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION, 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. McKeon. Thanks, Senator Tester. Thank you for allowing 

SAMHSA to testify at this important hearing on prevention of suicide among American Indian and Alaska Native youth. 

I serve as the lead public health advisor on suicide prevention at 

SAMHSA. I am pleased to testify here, along with my colleagues 

at the Indian Health Service and the Department of Interior, as 

well as the tribal leaders, tribal youth and others. 

The problem of suicide in Indian Country is a shared and urgent 

concern. Efforts to reduce suicide and suicide attempts among 

American Indian and Alaska Native youth must be a shared effort. 

Today I will share with you some of the efforts SAMHSA is undertaking to reduce suicide and suicide attempts in Indian Country, both through SAMHSA-led programs as well as work we conduct in conjunction with other Federal, State and tribal partners. 

You all know the tragic statistics. In 2007, suicide was the second 

leading cause of death among American Indian and Alaska Native 

youth age 10 to 24, with rates of suicide significantly higher than 

for other ethnic groups. 

According to unpublished Indian Health Service data, suicide 

mortality is 73 percent greater in American Indian and Alaska Native populations in IHS service areas compared to the general U.S. 

population. American Indians and Alaska Natives have the highest 

rates of suicide, Senator, at least until the age of 40. 

SAMHSA’s number one strategic initiative is prevention of substance abuse and mental illness. Included in this initiative is the 

prevention of suicide and suicide attempts. The prevention of suicide is a public heth issue and necessitates a comprehensive public 

health approach. 

SAMHSA is addressing youth suicide through a range of efforts, 

including the National Action Alliance for Suicide Prevention, a 

new Tribal Behavioral Health formulary grant program, grants to 

tribes through the Garrett Lee Smith Memorial Act youth suicide 

prevention program, implementation of the Indian Healthcare Improvement law, the Native Aspirations program, technical assistance provided by the Suicide Prevention Resource Center, and 24/

7 crisis support through the National Suicide Prevention Lifeline. 

Also through the recently signed memorandum of agreement between HHS, the Department of Justice and Department of Interior 

as required by the Tribal Law and Order Act, and inclusion of requests that States engage in tribal consultation as part of their 

plans submitted to SAMHSA in conjunction with the new Uniform 

Mental Health and Substance Abuse Block Grant Application. 

You also heard how we spent just last week, over 1,000 people 

came together to work together and to learn together at the Action 

Summit for Suicide Prevention that was jointly hosted by IHS, Bureau of Indian Affairs, Bureau of Indian Education and SAMHSA. 

The most important thing that the research and the efforts showed 

was the effort to learn from each other. No one of us can do this 

alone. We can’t start from the beginning, we have to learn from [inVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00037 Fmt 6633 Sfmt 6601 S:\DOCS\76838.TXT JACK
34

discernible] of what has been helpful [indiscernible]. So that was 

the important part of what happened last week. 

Let me also reference National Action Alliance for Suicide Prevention, which was launched September 10th, 2010 by the United 

States Department of Health and Human Services, Kathleen 

Sebelius, and former Defense Secretary, Robert Gates. The National Action Alliance is a public-private collaborative effort to promote suicide prevention in the United States, to implement and to 

update United States national strategy for suicide prevention. The 

private sector co-chair is former U.S. Senator Gordon Smith, who 

tragically lost his own son to suicide, and the public sector co-chair 

is the Secretary of the Army, John McHugh. Members of the National Action Alliance include but are not limited to SAMHSA Administrator Hyde, Department of Interior Assistant Secretary 

Larry Echo Hawk, McClellan Hall from the National Indian Youth 

Leadership Project. In addition, IHS Director Roubideaux serves as 

ex officio member of the Action Alliance. 

You have heard about the task force that was set up as part of 

the National Action Alliance to focus on [indiscernible] specific suicide prevention for tribal youth, regarding suicide prevention, 

intervention and postvention strategies, including positive youth 

development. 

The President’s fiscal year 2012 budget for SAMHSA proposes a 

new grant program entitled Behavioral Health—Tribal Prevention 

Grant, which is intended to increase SAMHSA’s efficacy in working 

with tribes and tribal entities. The program will focus on the prevention of alcohol abuse, substance abuse, and suicides in the 656 

federally-recognized tribes. Recognize the Federal obligation to help 

tribes deal with physical and behavioral health issues, SAMHSA 

will work in consultation with tribes and [indiscernible] partners to 

establish a single coordinated mental health and substance abuse 

prevention effort for all federally-recognized tribes. SAMHSA will 

also consult and work closely with tribes and tribal leaders to develop a comprehensive, data-driven planning process to identify 

and address the most serious issues in each tribal community. 

You have heard about the Garrett lee Smith Memorial grant that 

we have recently received. [indiscernible] 19 tribes and tribal organizations receiving multi-year grants to address suicide prevention 

among tribal youth. This year, in the last two weeks, 21 additional 

tribal grants have been made for a total of 40 tribal grants [indiscernible]. 

Let me just mention the innovative work in the grant that we 

have done here at Fort Peck. That grant has done a number of 

things that includes innovative efforts from a program called 

Sources of Strength. Promising results are coming from [indiscernible] as well as efforts and follow-up to address people being discharged from emergency departments. 

Thank you for this opportunity to share with you efforts 

SAMHSA is making with respect to our American Indian and Alaska Native youth suicide prevention. I will be happy to answer any 

questions you may have. 

[The prepared statement of Mr. McKeon follows:]

35

PREPARED STATEMENT OF RICHARD T. MCKEON, PH.D., LEAD PUBLIC HEALTH

ADVISOR, SUICIDE PREVENTION TEAM, SUBSTANCE ABUSE AND MENTAL HEALTH

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

Chairman Akaka, Ranking Member Barrasso and Senator Tester, thank you for 

inviting me to testify at this important hearing on the prevention of suicide among 

American Indian/Alaska Native (AI/AN) youth. I am Dr. Richard McKeon and I 

serve as the lead Public Health Advisor on suicide prevention at the Substance 

Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (HHS). I am pleased to testify along with 

my colleague at the Indian Health Service (IHS) and tribal leaders, as well as AI/

AN youth. The problem of suicide in Indian Country is a shared concern and efforts 

to reduce suicide and suicide attempts among AI/AN youth must be a shared effort. 

SAMHSA has played an integral role in the nation’s efforts to reduce suicide in 

Indian Country and I want to acknowledge the tremendous efforts of SAMHSA’s 

Deputy Administrator Eric Broderick who has testified before this Committee several times related to suicide prevention. Dr. Broderick will be retiring later this 

month after 38 years of services in the U.S. Public Health Commissioned Corps. He 

brought his passion, leadership and skill to IHS and SAMHSA and will be greatly 

missed. 

Today, I will share with you some of the efforts SAMHSA is undertaking to reduce suicide and suicide attempts in Indian Country both through SAMHSA-led programs, as well as work we conduct in conjunction with other Federal, State, and 

tribal partners. As you know all too well, the rate of suicide among AI/AN individuals is higher than the national average. In 2007, suicide was the second leading 

cause of death for AI/AN youth aged 10–24 with rates of suicide significantly higher 

for AI/AN youth aged 15–24 (20.04 per 100,000) than for the national average (11.47 

per 100,000) (CDC, 2010.) Injuries and violence account for 75 percent of all deaths 

among Native Americans ages 1 to 19 (Wallace, 2000). Overall, according to unpublished Indian Health Service (IHS) data, suicide mortality is 73 percent greater in 

AI/AN populations in IHS service areas compared to the general U.S. population. 

SAMHSA’s number one strategic initiative is Prevention of Substance Abuse and 

Mental Illness. Included in this initiative is the prevention of suicide and suicide 

attempts. The prevention of suicide is a public health issue and necessitates a public 

health approach that works at the primary, secondary and tertiary levels. In line 

with SAMHSA’s Prevention strategic initiative, the Administration is addressing AI/

AN youth suicide through a range of efforts including: the National Action Alliance 

for Suicide Prevention; a new Tribal Behavioral Health formulary grant program; 

grants to tribes through the Garrett Lee Smith Memorial Act (GLSMA) youth suicide prevention program; implementation of the Indian Healthcare Improvement 

law; the Native Aspirations program; technical assistance by the Suicide Prevention 

Resource Center (SPRC); 24/7 crisis support through the National Suicide Prevention Lifeline; the recently signed Memorandum of Agreement between HHS (with 

SAMHSA as the lead agency), the Department of Justice (DOJ) and the Department 

of the Interior (DOI) as required by the Tribal Law and Order Act; and inclusion 

of requests that states engage in tribal consultation as part of their plans submitted 

in conjunction with the new Uniform Mental Health and Substance Abuse Block 

Grant Application. 

In order to highlight the plethora of activity around efforts to prevent suicide and 

suicide attempts among AI/AN individuals, just last week in Scottsdale, Arizona 

over 1,000 individuals came together for The Action Summit for Suicide Prevention 

hosted by IHS, Bureau of Indian Affairs (BIA), Bureau of Indian Education (BIE) 

and SAMHSA. The title of the Summit was ‘‘Partnering with Tribes to Protect the 

Circle of Life,’’ and objectives for the event included strengthening tribal, Federal, 

State and community partnerships; creating an opportunity to collaborate, network, 

and share effective strategies on topics in suicide and substance abuse prevention 

in Native American communities; and providing the most up-to-date research related to suicide and substance abuse in Indian Country. 

National Action Alliance for Suicide Prevention 

On September 10, 2010, the National Action Alliance for Suicide Prevention 

(NASSP) was launched by the U.S. Department of Health and Human Services Secretary, Kathleen Sebelius, and former Defense Secretary, Robert Gates. The NASSP 

has a private sector Co-Chair, former U.S. Senator Gordon Smith (R–OR), and a 

public sector Co-Chair, Army Secretary John McHugh. Members of the NAASP include, but are not limited to, the Surgeon General, Regina Benjamin; the SAMHSA 

Administrator, Pamela Hyde; Department of Interior Assistant Secretary of Indian 

Affairs, Larry Echo Hawk; HHS Assistant Secretary for Health, Dr. Howard Koh; 

36

and National Indian Youth Leadership Project Executive Director, McClellan Hall. 

In addition, the IHS Director, Dr. Yvette Roubideaux, serves as an ex officio Member of the NAASP. Mr. Echo Hawk, Mr. Hall and Dr. Roubideaux serve as the leaders of the NAASP AI/AN Task Force which will establish specific priorities for Tribal youth regarding suicide prevention, intervention, and postvention strategies, including positive youth development. The Task Force also helped develop the agenda 

and strategy for the National Suicide Prevention Summit and will also do so for the 

Alaska Suicide Prevention Summit for AI/AN communities, leaders, service providers, educators, and law enforcement. 

Behavioral Health—Tribal Prevention Grants 

The President’s FY 2012 Budget for SAMHSA proposes a new grant program titled Behavioral Health—Tribal Prevention Grant (BH–TPG), which is intended to 

increase SAMHSA’s efficacy in working with tribes and tribal entities. The BH–TPG 

represents a significant advance in the Nation’s approach to substance abuse and 

suicide prevention, based in a recognition of behavioral health as a part of overall 

health. The program will focus on the prevention of alcohol abuse, substance abuse 

and suicides in the 565 Federally-recognized Tribes. Recognizing the Federal obligation to help Tribes deal with physical and behavioral health issues, SAMHSA will 

work in consultation with Tribes, establishing a single coordinated mental health 

and substance abuse program for all Federally-recognized Tribes. SAMHSA also will 

consult and work closely with Tribes and Tribal leaders to develop a comprehensive, 

data-driven planning process to identify and address the most serious behavioral 

health issues in each Tribal community. 

Tribes will be allowed to use a set percentage (determined after consultation with 

Tribes) of the Behavioral Health—Tribal Prevention Grant funds for a combination 

of service and service-related activities, development and dissemination of prevention messages, and provider development and linkage building to support the Tribes 

in achieving outcomes. Funding for infrastructure activities will enable the Tribe to 

build service capacity. The Tribe will present data to support how the allocation will 

support infrastructure and/or provision of services. In carrying out these activities, 

the Tribe will be required to use comprehensive, evidence-based programming, and/

or proven successful programming, based on either mainstream science or proven 

Tribal traditions. Up to 20 percent of the grant funds may be used to fund key support and development activities, such as operation of a Tribal prevention advisory 

group, support for a Tribal community coalition, access to an epidemiological work 

group, training and technical assistance to communities, data collection and evaluation, and oversight and monitoring of activities. The details of the funds distribution 

will be determined in consultation with Tribes. 

Garrett Lee Smith Grants 

Since passage of the GLSMA (P.L. 108–355) in 2004, 19 tribes have received 

multi-years grants to address suicide prevention among tribal youth, with 21 additional tribal grants to start this year. This number represents 39 percent of the total 

State and Tribal Youth Suicide Prevention Grants authorized by the GLSMA. These 

grants have provided the tribes funding to help implement a tribe-wide suicide prevention network. The first tribal grantee was the Native American Rehabilitation 

Association in Oregon, which was one of three GLSMA grantees in the first cohort 

to be awarded additional evaluation funding. They will use the funding to enhance 

their evaluations to maximize what could be learned from their important suicide 

prevention activities. 

One of the Nation’s most innovative systems for intervening with youth at risk 

for suicide, the White Mountain Apache’s suicide prevention program (funded by 

SAMHSA through the GLSMA grant program), includes the evaluation of two culturally adapted interventions that target youth who have attempted suicide. These 

interventions are linked to a unique tribally mandated suicide surveillance system 

that identifies youth who have exhibited suicidal behavior. The interventions focus 

on in-home follow-up with youth who have attempted or thought of attempting suicide and were treated and discharged from emergency departments. The first intervention, New Hope, is an emergency department-linked intervention conducted over 

one to two sessions. The sessions comprise of a locally produced video and workbook 

curriculum that develops a safety plan for the youth and problem-solves barriers to 

their engagement in treatment. The second intervention, Re-Embracing Life, was 

adapted from the American Indian Life Skills Development Curriculum and consists 

of nine curricular sessions conducted weekly in home or office settings. The intervention targets problem solving, anger/conflict management, self-destructiveness, 

emotional regulation, coping, social interactions, and help-seeking behaviors. 

37

In the most recent cohort of GLSMA grantees which were announced over the last 

2 weeks, I am pleased to note that SAMHSA provided funding for the ‘‘Sister National Empowerment Partnership’’ which will be administered by the Fort Peck 

Tribal Health Service and the University of Montana. This grant of $480,000 per 

year for 3 years will be utilized to design and deploy a comprehensive system of 

youth suicide prevention on the Fort Peck Reservation in northeast Montana. The 

partnership will build on existing work in response to a devastating suicide cluster 

in 2010. Particular attention will be given to needs identified in a deployment report 

by the U.S. Public Health Service in response to a state of emergency declared by 

the Fort Peck Tribes in May 2010. During the period identified in the report, the 

suicide completion rate on the reservation was three times the Montana average 

and more than six times the rates for the nation as a whole. The goals of the grant 

include increasing the number of primary health care and mental health providers 

trained to assess, manage, and treat youth at risk for suicide; increase the number 

of youth, school staff, parents and community members trained to identify and refer 

for care a youth at risk for suicide; to increase the number of youth receiving mental 

health and substance abuse services by improving access to care; and to promote 

the National Suicide Prevention Lifeline in all activities. 

In addition, the Confederated Salish & Kootenai Tribes in Pablo, Montana also 

received a GLSMA grant in Fiscal Year (FY) 2011. Finally, I would like to note that 

this year funds from the Prevention and Public Health Trust Fund established by 

the Affordable Care Act (ACA) will be utilized to enhance SAMHSA’s youth suicide prevention efforts and all four of these $1.44 million grants have been awarded to 

tribes or tribal entities. 

Implementation of the Indian Youth Suicide Prevention Provisions of

Indian Health Care Improvement Reauthorization and Extension Act of 

2009

On March 23, 2010, as part of the ACA, President Obama also signed into law 

the Indian Health Care Improvement Reauthorization and Extension Act of 2009.

Title VII, Subtitle B includes provisions related to Indian Youth Suicide Prevention. 

SAMHSA is dedicated to undertaking measures to improve the process by which Indian tribes and tribal organizations apply for grants. One such example is that 

SAMHSA does not require tribal entities applying for agency electronically. 

In the FY 2011 cohort of GLSMA State/Tribal grantees, 21 of 37, or 57 percent, 

grantees are tribes, tribal organizations, or entities that have indicated the grant 

will be used specifically for AI/AN youth suicide prevention activities. SAMHSA has 

made significant efforts to take into consideration the needs of Indian tribes or tribal organizations. Furthermore, SAMHSA does not require any Indian tribe or tribal 

organization to apply through a State or State agency for any of the agency’s grant 

programs. 

Native Aspirations Program 

SAMHSA has funded 49 tribal communities through Native Aspirations (NA), a 

national project designed to address youth violence, bullying, and suicide prevention 

through evidence-based interventions and community efforts. NA is unique among 

SAMHSA suicide prevention programs in that it is based on the concepts and values 

that reflect the AI/AN community: that solutions to AI/AN youth violence, bullying, 

and suicide must come from and be embraced by the community; leadership must 

be involved and invested in the solution; it is up to the community to determine 

the approaches that would be most effective for them; traditional approaches that 

are used in non-AI/AN communities in America don’t always work in AI/AN communities; and that the community Elders are crucial to the success of the project. 

To date, nearly 200,000 Tribal members in 20 communities and 2,100 Alaska Natives in five villages have been provided specialized technical assistance and support 

in suicide prevention and related topic areas for these communities. In addition, 

over 750 community members were trained in prevention and mental health promotion in these communities. 

Suicide Prevention Resource Center 

SAMHSA funds the Suicide Prevention Resource Center (SPRC), which provides 

prevention support, training, and resources to assist organizations and individuals 

to develop suicide prevention programs, interventions and policies, and to advance 

the National Strategy for Suicide Prevention. SPRC supports the technical assistance and information needs of SAMHSA State/Tribal Youth Suicide Prevention and 

Campus Suicide Prevention grantees and State, Territorial, and Tribal (STT) suicide 

prevention coordinators and coalition members with customized assistance and technical resources. SPRC has two senior tribal prevention specialists available to provide technical assistance to those seeking information, evidence-based programs and 

38

awareness tools specifically geared for suicide prevention among AI/AN individual. 

Included on SPRC’s Web page dedicated to AI/AN suicide prevention is a SAMHSA 

funded guide titled, ‘‘To Live To See the Great Day That Dawns: Preventing Suicide 

by American Indian and Alaska Native Youth and Young Adults.’’

National Suicide Prevention Lifeline 

The National Suicide Prevention Lifeline (Lifeline) 1–800–273–TALK (8255) is a 

24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. By dialing 1–800–273–TALK, the call is routed to 

the nearest crisis center in our national network of more than 150 crisis centers. 

The Lifeline’s national network of local crisis centers, provide crisis counseling and 

mental health referrals day and night. 

The Lifeline has a Native American Initiative that includes objectives such as:

1. Establishing and maintaining working relationships between crisis center 

staff and key stakeholders in tribal communities.

2. Developing and delivering cultural awareness and sensitivity trainings as per 

the direction of the designated tribal community for crisis center telephone 

workers.

3. Strengthening the effectiveness of the local Reservation referrals for suicide 

prevention supports by identifying relevant, available resources in the tribal 

community.

4. Promoting culturally sensitive social media and educational materials in tribal communities, as determined by tribal stakeholders.

5. Identifying similarities and differences that can inform serving Native American communities on a national level in a culturally and respectful manner.

In Montana, the Fort Peck, Blackfeet, Northern Cheyenne, Crow, Fort Belknap, 

Flathead and Rocky Boy reservations are served by Lifeline’s Voices of Hope crisis 

call center. 

Tribal Law and Order Act 

As you are aware, through the Tribal Law and Order Act of 2010 Congress sought 

to engage new federal partners to build upon previous efforts in addressing alcohol 

and substance abuse in Indian country. As a result, the Secretary of Health and 

Human Services, the Secretary of the Interior, and the Attorney General, recently 

signed a Memorandum of Agreement (MOA) to, among other things:

1. Determine the scope of the alcohol and substance abuse problems faced by 

American Indians and Alaska Natives;

2. Identify the resources and programs of each agency that would be relevant 

to a coordinated effort to combat alcohol and substance abuse among American Indians and Alaska Natives; and

3. Coordinate existing agency programs with those established under the Act.

The MOA specifically takes into consideration that suicide may be an outcome of, 

and has a connection to, substance abuse. To accomplish the above stated goals, 

SAMHSA sought to establish an Interdepartmental Coordinating Committee (Indian 

Alcohol and Substance Abuse Committee) to include key agency representation from 

SAMHSA, IHS, Office of Justice Programs, Office of Tribal Justice, BIA, BIE, and 

the Department of Education. The Administration on Aging and Administration for 

Children and Families within HHS are also represented on the IASA Committee. 

The IASA Committee has created an organizational structure to include workgroups 

to carry out its work. 

Uniform Block Grant Application 

On July 26, SAMHSA announced a new application process for its major block 

grant programs the Substance Abuse Prevention and Treatment Block Grant and 

the Community Mental Health Services Block Grant (MHBG). The change is designed to provide states greater flexibility to allocate resources for substance abuse 

and mental illness prevention, treatment and recovery services in their communities. One of the key changes to the block grant application is the expectation that 

States will provide a description of their tribal consultation activities. Specifically, 

the new application’s planning sections note that States with Federally-recognized 

tribal governments or tribal lands within their borders will be expected to show evidence of tribal consultation as part of their Block Grant planning processes. However, tribal governments shall not be required to waive sovereign immunity as a 

condition of receiving Block Grant funds or services. 

39

Included within the MHBG application SAMHSA notes that States should identify 

strategies for the MHBG that reflect the priorities identified from the needs assessment process. Goals that are focused on emotional health and the prevention of 

mental illnesses should be consistent with the National Academies—Institute of 

Medicine report on ‘‘Preventing Mental, Emotional, and Behavioral Disorders 

Among Young People: Progress and Possibilities.’’ More specifically, they also should 

include Strategies that implement suicide prevention activities to identify youth at 

risk of suicide and improve the effectiveness of services and support available to 

them, including educating frontline workers in emergency, health and other social 

services settings about mental health and suicide prevention. Finally, the uniform 

application requests that States attach to the Block Grant application the most recent copy of the State’s suicide prevention plan. It notes that if the State does not 

have a suicide prevention plan or if it has not been updated in the past 3 years, 

the State should describe when it will create or update its plan. 

Conclusion 

Thank you again for this opportunity to share with you the extensive efforts 

SAMHSA is undertaking with respect to AI/AN youth suicide prevention specifically, as well as other efforts relating to tribal behavioral health issues. I would be 

pleased to answer any questions that you may have.

Senator TESTER. Thank you, Dr. McKeon. You can hand the mic 

down to Rose. In the meantime, I want to thank you for your testimony. As with everybody who testified today, your entire testimony 

will go into the official record. So thank you very much. 

Rose, past Indian Affairs Committee hearings have revealed that 

tribal communities are sometimes unwilling to talk about suicide, 

especially youth suicide. Has that been in your experience, and if 

it has, is it better to talk about it or is it better to keep quiet? 

Ms. WEAHKEE. Yes, that has been brought up, and even just this 

past week at the Action Summit for Suicide Prevention, that was 

addressed as one of the issues from tribal communities speaking at 

the Summitt. So it is important for us to work jointly with the tribe 

elders and traditional practitioners in the community to help us address the issue of suicide. 

But it is important and something that we have been hearing 

from tribal communities is that there needs to be more communication and more awareness to all systems throughout the tribal 

health system, through the education system, law enforcement, 

first responders, to parents and grandparents, and to peers. So if 

someone does come to them with thoughts of suicide, that they 

know what to do to respond to that issue. 

Senator TESTER. Okay. Does talking about it or not talking about 

it affect suicide clusters, and if so, how? 

Ms. WEAHKEE. I think that is one of the myths, that talking 

about suicide will increase the number of suicides. It is important 

for us to bring education and awareness and be able to learn how 

we can respond when someone is coming to us, maybe expressing 

that they want to harm themselves. That is a skill that we are trying to develop and awareness we are trying to bring with the suicide summit that was held last week, and the one that we will be 

holding in Alaska next month, to bring more awareness about how 

to deal with that. 

Senator TESTER. Are you familiar with a program the MontanaWyoming Tribal Leadership Council is doing called Planting Seeds 

of Hope? 

Ms. WEAHKEE. Yes, absolutely. 

40

Senator TESTER. One of their goals is to train gatekeepers in 

every community. Can you tell me what a gatekeeper is and why 

it is important? 

Ms. WEAHKEE. A gatekeeper is and can be anyone in the community. It can be a peer, it can be a teacher, it can be a parent, someone that that young person or that youth may come in contact with 

that could be trained about how to listen and know what to do, understand what the risk factors are, understand what suicide is and 

basically how to intervene. So we have a lot of gatekeeper training 

programs that are out there, and a lot that we shared last week. 

And they need to be developed and they need to be trained. Native 

HOPE is one of those gatekeeper programs that many of our tribal 

communities are implementing. So the short answer is yes it is important. 

Senator TESTER. So those would be people that a student or an 

adult could go talk to if they are having some issues, being bullied 

or whatever? 

Ms. WEAHKEE. Yes, absolutely. But I also want to stress the 

point, I think one of the things that we heard from our youth, our 

youth panel last week, is that we need to listen and that we need 

to reach out more as adults. A lot of our youth are afraid, I think 

we heard that here today. 

Senator TESTER. We sure did. 

Ms. WEAHKEE. Sometimes it is scary for a youth to come to an 

adult and explain when something like that is happening, for whatever reason. So it is very important for us as adults to go to our 

youth and listen to them. 

Senator TESTER. Okay. Thank you, Rose. 

Ed, we passed Tribal Law and Order Act last Congress. It was, 

I think, a pretty good piece of legislation. I want to know from your 

perspective, it was supposed to reduce violence in Indian Country. 

Have we been into the program long enough where we can say it 

has worked or it hasn’t worked or do we need more time? 

Mr. PARISIAN. I am trying to think about how to answer this, because I am not the expert when it comes to law enforcement. But 

I am familiar with the program, and the meetings that we have attended. I know that they are in the planning process. I am not sure 

if it is made that big a difference yet. I think that it is going to 

need some time, particularly training, education, more involvement 

from the tribal side, so that it would work. But the program, I do 

believe, will make a difference. 

Senator TESTER. Good. 

Dr. McKeon, you talked about suicide prevention grant programs. Whenever grant programs are brought up, from my perspective, I am always wondering if they are skewed against rural communities. I would say for, but typically they are skewed against 

them. So I guess specifically, with the programs you referenced, 

specifically to Indian Country, how can we be assured that the 

playing field is level as it supplies to access to those grant dollars 

for frontier Indian communities? 

Mr. McKeon. That’s a very important point. SAMHSA has 

worked hard to try to maximize the availability of these grants to 

tribal communities. Currently with the new awards that were just 

made, 40 percent of the grants that have been awarded through 

41

the State and tribal component of the Garrett Lee Smith Memorial 

Act have gone to tribes and to tribal organizations. 

We have tried to do a couple of things to try to help tribes be 

competitive in that process. One is our Native Aspirations program, 

which looks at risk factors for violence, bullying and suicide and 

how to [indiscernible] focus on the planning effort. Nine of our Native Aspirations communities have gone on afterwards to successfully compete for Garrett Lee Smith Memorial grants. 

Also, we make sure to have specific technical system session 

when the requests for applications or grants are [indiscernible] for 

tribal communities and to make sure that there are no barriers 

around things like electronic access, which could disadvantage tribal communities in some places. 

Senator TESTER. Okay. Thank you. 

We are pressed for time, because we are over by about 20 minutes already. This is an important issue. I want to thank all of you 

for your testimony and your commitment, as well as the previous 

panel, to the issue. 

As I have said to the tribal council earlier today, this is about, 

all these hearings, whether they are in Washington, D.C. or whether they are in Poplar, is about gathering information and utilizing 

information to make a difference. We heard some pretty moving 

testimony here today from people who have been directly impacted 

by horrific events, quite honestly. And we also heard some good 

testimony from folks up here about what works, and maybe what 

doesn’t work, and some of the issues that we need to address, 

whether it is bullying, or it is working together in partnership, getting everybody on the same page or whatever it might be, moving 

forward. 

We have those on record and we can utilize them and staff will 

be moving over those and hopefully we will be able to come up with 

some things in Washington, D.C. that is not going to solve the 

problem but will help solve the problem. Because I do believe, as 

many people have testified today, communities play such an incredibly important role with their buy-in. It is absolutely critically important. 

I want to thank the folks here at Poplar High School for the use 

of the venue. Very, very nice. I want to thank Chairman Stafne for 

not only his testimony but for his hospitality. I want to thank all 

the participants who participated today. 

I want to thank all of you for coming to this hearing. You need 

to know that the hearing record will remain open for two weeks. 

And this doesn’t apply just to the folks who are here, this applies 

to all of you and your neighbors. The hearing record will be open 

for two weeks. If you would like to contribute your comments, the 

easiest way to do it is to get on the internet, providing you have 

access to it, indianaffairs.gov, and we can take your input to the 

testimony at this hearing, you can add to the testimony if you so 

choose. It is one of those things. Technology can help make a difference. 

I want to thank you all for being here once again. I very, very 

much appreciate the participation, very, very much appreciate the 

heartfelt testimony. And with that, this Indian Affairs Committee 

meeting is adjourned. 

42

[Whereupon, at 3:00 p.m., the hearing was adjourned.] 

(43)

APPENDIX

PREPARED STATEMENT OF ANNIE BELCOURT-DITTLOFF, PH.D., MISSOULA, MONTANA

Honorable Senator Tester and Committee Members, 

Suicide is clearly one of the most significant problems facing Native American 

communities in Montana. I would first like to take this opportunity to thank Senator Tester for the work he has done to address this problem. Native Americans in 

Montana are nearly twice as likely to take their own lives (21.4 per 100,000–Native 

Americans in Montana versus 11.0 per 100,000–U.S. rate). This rate is even higher 

in specific Native reservations in our state. This is unacceptable. We must all join 

together to improve the health and hope of our native communities and youth. As 

we have seen, the youth are the population most at risk. However, as we all appreciate our children and youth are our most important resource and hope for healthier 

communities in the future. 

Reducing the problem of suicide among our Native American communities in Montana will require collaborative efforts aimed at improving our collective understanding of the problems associated with suicide and potential solutions. I have multiple connections to the tribal communities and I am personally committed to improving the overall health of Native American communities. I was trained as a clinical psychologist and completed my doctorate at the University of Montana in 2006. 

I went on to complete an internship year at the Denver Veterans Affairs Medical 

Center and a 4-year postdoctoral faculty position at the Centers for American Indian 

and Alaska Native Health concentrating on posttraumatic stress and mental health 

disparities (suicide, trauma, PTSD, depression, and cultural factors) in Native 

American populations. My research and clinical practice experiences have focused 

upon mental health disparities, trauma, depression, anxiety, posttraumatic stress 

reactions and disorders, risk factors, and resiliency. 

I write to you today from both a professional and a personal perspective. As a researcher and faculty member in the state of Montana, I am interested in advancing 

knowledge, science, and practice to improve health disparities facing American Indians. I know the vital importance of science, intervention, and community collaboration in this process. My comments reflect my beliefs that we must all invest in quality collaborative intervention, prevention, science, education, and health care practice within our Native communities. My comments reflect these beliefs and commitment towards working to address the problem of suicide. While some Montana reservation communities have received a lot of recent media attention, it is important 

to note that the problem of youth suicide has been impacting every Native American 

community in Montana. As such, it is important that each community receive access 

to scientific, clinical, educational, and prevention opportunities. 

In addition to my role as a researcher and clinician, I also write today as a family 

member of a Native youth lost to suicide. This is a devastating loss for our family 

and I can tell you that I personally would have done anything to prevent this loss 

from happening. My nephew fell through the cracks that have become all too evident within our reservation health care and educational systems. I cannot bring him 

back, but I can work to honor his brief life through the work that I do advocating 

for science, practice, education, and policy efforts aimed at preventing suicide. I feel 

that it is important to advance our knowledge regarding the impact of trauma and 

poverty within our Native American communities. I also feel that it is important 

to invest in prevention efforts that promote resiliency, sobriety, education, physical 

health, and improved access to mental health care within our Native communities. 

We can all do more to work to prevent any other families from experiencing the loss 

of family members to suicide. 

Federal agencies, Tribal leaders, community members, healthcare providers, researchers, elders, youth, and academic partners need to work toward improving the 

health and hopes of our Native youth. The growing crisis of suicide facing our Native communities in Montana and the nation demands that we all take a stand and 

work to prevent any more losses. 

44

I include below responses to recent questions posed in a regional suicide prevention listening session held in conjunction with key federal agencies. The responses 

were created in collaboration with the Montana-Wyoming Tribal Leaders Council. 

I hope that the responses help to generate potential ideas for how to improve our 

collective response to suicide within Montana’s Native communities. It is with great 

hope that I look to your leadership to provide us with innovative solutions to the 

problem of suicide within our Native communities. 

Please let me know how I can help in these efforts.

Question 1. What can federal agencies do together to help communities reduce suicide and suicide-related problems in Indian country? 

Answer. Policy and legislation needs to prioritize suicide prevention, risk identification, referral, mental health access, education, inter and intra agency collaboration, and funding for Native communities. Mental health needs to be funded more 

adequately for both reservation and urban communities to target Native youth who 

are most at risk. Funding needs to directly address the needs of those most at risk: 

Native youth, rural reservation populations, and those experiencing mental health 

problems are primary examples of vulnerable populations. Primary high risk is associated with Native American males who have a history of substance abuse, physical or sexual abuse, incarceration, relationship problems, and academic problems. 

Working with educators, mental health professionals, and academic partners to advance early detection and prevention efforts is one example of innovative work that 

needs to occur. These efforts need to occur at both the community and individual 

level. Mental health problems are compounded by the rural nature of reservations 

and the stigma that can be attached to mental disorders. As a result, prevention 

and intervention efforts need to focus on reducing barriers to accessing mental 

healthcare including improving access options, improving confidentiality, improving 

available mental health services, improving community mental health services, improving public health information availability and access, and reducing stigma. In 

addition, substance use is frequently a proximal antecedent to suicide; consequently, 

treatment options need to be improved for all Native youth and community members. In most completed suicides, hopelessness paired with alcohol and drug use is 

the most frequently identified risk factor for self-harm and suicide completion. We 

must work to increase both individual and community protective factors (self-esteem, social support, cultural factors and beliefs, traditional medicine and traditional healer access, mentorship, sobriety, and familial support). We must also work 

to decrease poverty, discrimination, trauma, substance abuse, and crime. What has 

been done toward addressing these issues in the past has not been sufficient. 

Funding to increase protective and resiliency factors and simultaneously decrease 

risk factors should be prioritized. Information should be shared between federal 

agencies, health care agencies, communities, Tribes, and Native researchers to work 

to address risk and protective factors for Native Americans in Montana. The Rocky 

Mountain Tribal Epicenter and collaborative efforts should be supported as a continued part of Tribal data and information technological resources. Indian Health Services must provide surveillance data to the Rocky Mountain Tribal Epicenter and individual tribes. We are all accountable for the health and well-being of Native youth 

and children. We must all work toward reducing the stress and trauma that our 

most vulnerable Native Americans face and this will require collaboration and perseverance.

• Legislation that would allow school systems to acquire and provide or refer children who exhibit bullying behaviors or signs of maltreatment (peer or familial) 

to therapy rather than punishment or expulsion. Provide incentives to schools 

for implementing programs that institute healthy relationship building, character development and values clarification in a systematic way.

• Funding that would support such an alternative program and supplement regular educational structures including summer camps, after school or weekend 

activities that are designed to increase character and social skill development.)

• Educated Leadership—mandatory training and education on best practices (for 

health promotion and disease prevention) as well as how to talk and how not 

to talk about the issue at hand as well as the underlying causes or feelings.

• Contagion risk-Media in Montana require training in available guidelines available from the American Psychological Association to avoid or mitigate potential 

risk associated with sensationalized media depictions of suicide in Montana.

• Information technology- could provide telemedicine and telepsychiatry options 

as well as instruction and education to tribal communities. Building the clinical 

and educational capacity of tribal communities would reduce the isolation confronting many tribal communities, educators, and health providers. We must esVerDate 0ct 09 2002 13:03 Nov 26, 2012 Jkt 076838 PO 00000 Frm 00048 Fmt 6601 Sfmt 6621 S:\DOCS\76838.TXT JACK
45

tablish ways to develop community support and technological access to our most 

rural reservations. Youth need access to information and options about healthy 

living options and educational opportunities.

• Cross-agency coordination and collaboration—must come from the top down as 

well as from communities. Schools and Tribal colleges and health professionals 

as well as Tribal leaders or health committees need paid on-the-job time to ensure information sharing and collaborative initiatives.

• Data sharing—The reporting system is inadequate and the problem of agency 

‘‘silos’’ only exacerbates the problem. The relationship between state, federal, 

and tribal entities needs to be improved in an equitable manner that does not 

serve as a detriment of the Tribes. Currently, the Indian Health Service does 

not have a data sharing agreement with the Rocky Mountain Tribal Epicenter. 

This limits surveillance data available to tribal communities in Montana.

• Accountability—If this does not become everyone’s issue, then it will continue 

to belong only to those who are already isolated and most at risk. If we are 

going to be genuinely accountable to each other we each must hold ourselves 

accountable for finding effective remedies for this horrific situation.

Question 2. What is the best way for federal agencies to coordinate suicide prevention activities with tribal groups? For example, in what ways can we assist in addressing the problem (i.e., prevention, response, mitigation, and recovery)? 

Answer. The best way to coordinate suicide prevention activities with tribal 

groups is to work with all key stakeholders within diverse aspects of tribal communities and leadership. This collaborative process must be directed to identify best 

practices for prevention, response, mitigation, and recovery. Tribal leaders, mental 

health providers, educators, researchers, administrators, community members, tribal youth, and academic partners are examples of key groups that require representation at the Billings area level. Federal agencies should consider creating positions 

(ideally led by Native personnel with expertise in mental health) specifically devoted 

to suicide prevention, response, and recovery. However, these individuals would 

need to be very active in coordinating the response of all stakeholders not just one 

component of the tribal community. A note of caution: the last thing we need is to 

have this position bogged down by excessive bureaucratic barriers. The immediacy 

of the problem should guide the immediacy of our collaborative response. Federal 

funding agencies need to make solid commitments and be required to expedite and 

support the suicide prevention efforts at an agency level. The problem is occurring 

now and the solution must therefore occur now. Every day that passes signifies the 

loss of more members of our Native communities. Tribal communities have recommended the use of immediate crisis response teams comprised of mental health 

providers and trained community members (who are well supported to prevent 

burn-out and just being overwhelmed). Other ideas include establishing safe houses 

for youth; improving access to crisis mental health services including daily walk-in 

hours for those in crisis; law enforcement training in mental health identification 

and referral; training for educational providers (teachers, principals, coaches, and 

aids); and improving after-school and alternative activities for youth (skateparks, 

basketball open gyms, extra-curricular events, and healthy options for activities). 

These activities should also have available information about healthy coping and 

available help for those who may be in crisis.

Question 3. What are some ways that we can improve communities’ understanding of suicide as a ‘‘public health issue?’’

Answer. Work with educational systems on each reservation or urban center to 

work to educate teachers, families, students, and communities about the public 

health aspects of suicide and ways to cope with stress, trauma, and loss. Grants 

that work to promote public health education would be a good idea to develop collaboratively with communities. Involving communities and youth in these efforts is 

critical. Engaging communities in empowering and creative ways is critical to ensure the success of these efforts. More focus needs to be placed upon what it means 

to be a healthy and successful member of Native communities. Traditional culture, 

beliefs, and practices are all positive aspects that can promote resiliency and 

healthy coping. Too often, we fall victim to petty jealousy and or political pressures 

and end up focusing on negative aspects of communities or individuals. We must 

all work to promote resiliency, protective factors, and mental health within our 

youth and communities. Native spirituality, traditional medicine, and cultural practices are important factors that could be incorporated into any public health initiatives.

Question 4. Are there ways technology could be used to address gaps in services 

or community education? 

46

Answer. Telehealth and telemedicine should be explored, particularly for our rural 

communities in Montana. Many of our most rural and remote reservation communities appear to experience more risk for suicide. Any innovative ways to establish 

support for individuals, communities, and providers in rural settings would be helpful. We also need to create a sense of community and systematically cultivate the 

perspective that life can improve for our Native youth. We need a nationwide ‘‘It 

gets better’’ effort analogous to the efforts being made for the LGBT youth in this 

country. Identifying health Native American role models could help improve community pride and hope for youth. Feelings of sadness and hopelessness can happen to 

anyone, we have to work to create a sense of hope for youth in particular. We also 

need to look at creating healthy opportunities to develop community for our isolated 

and rural reservations. One idea is to create an online community that has access 

to mental health educational material and health mentors. Hobbies, creative arts, 

music, theater, games, astronomy, learning about taxonomies are just a few of the 

activities that are virtually unavailable on the reservations, this is prime example 

of how Poverty can stifle imagination and consume all one’s energy or interest. Poverty is too often the direct result of a lack of employment opportunities, hiring youth 

to come up with safe activities might spark imagination.

Question 5. In what ways can federal agencies better support and help sustain 

local programs? Specifically, what technical assistance and program evaluation support is needed to illustrate program success and extend successful programs? How 

is success measured? 

Answer. Programs that do not adequately involve communities, families, and 

youth do not have sustainability. In addition, adequate funding for long-term programs and to support key personnel is required. Short-term grant funded programs 

that do not include a meaningful community collaboration do not have good chances 

of continued success. In addition, Native Mental Health providers, physicians, and 

educators need to be increased. Native youth need to have healthy and successful 

role models within their communities. Success can be measured quantitatively and 

qualitatively. Including communities and Native professionals in the evaluation and 

technical assistance aspects of programming is vital.

Question 6. How can the various disciplines work collaboratively to address suicide within your communities?

• Healthcare • Law enforcement • Tribal governments • Federal government • State governments • County systems • First responders • School personnel (BIE and Public Schools) 

• Families and communities

Answer. All can and should work collaboratively to prevent youth suicide and improve our collective response to those at risk. The problems identified associated 

with suicide risk are complex and involve each of the identified disciplines. Improving knowledge of risk factors and available mental health options can help to integrate education, health, and familial resources to improve early identification and 

treatment for Native Youth at risk.

Question 7. What are some of the specific challenges to addressing suicide in your 

region? 

Answer. Montana is a very rural and isolated state. It also has very limited options for mental health care access. The poverty faced by our Native communities 

can be quite extreme. Unemployment and poverty are severe in many reservations 

and these factors increase the risk experienced by all members of Native communities. Substance use problems, trauma exposure, inadequate healthcare access, and 

extremely limited access to mental healthcare are all additional barriers to Native 

Americans in Montana. Treatment programs should be expanded and professional 

interventions for all behavioral health issues (including obesity). These efforts require additional resources. Educational disparities in Montana are significant and 

translate to increased area of risk. Drop-out rates are very high among Native 

Youth and very few make it through college. These factors all need to be improved 

to promote suicide prevention here in Montana.

Question 8. What are some of the community strategies that have worked to prevent suicide? 

Answer. In the past, I have observed that there have been stronger links between 

healthy older mentors in the community and youth. Ceremony, language, familial 

47

support, peer support, sports, extracurricular activities, and access to communitywide event access (pow-wows, sobriety events, open supervised gyms, cultural educational events/activities, rodeo, skate parks, and other events aimed at youth) have 

been helpful in prevention. Poverty on many reservations limits access to the opportunities and these could be helpful areas to invest in for the future.

Question 8a. What can we learn from tribes that have been implementing successful prevention and intervention models? 

Answer. Planting the Seeds of Hope and the Montana Suicide prevention initiative have exemplified important programs working within tribal communities, but 

they are relatively short term grant funded initiatives that will disappear when the 

grant period ends and they are not funded to be comprehensive prevention programs. Engaging communities, individuals, and leadership have all marked successful efforts. Collaborative efforts between key agencies, scientists, and healthcare 

providers demonstrate promise of improving suicide prevention in this state.

Question 9. How can federal agencies work collaboratively to promote youth success, wellness, and resilience (i.e., bullying prevention)?

• What makes certain youth resilient and some youth high risk? 

Answer. I grew up on the Blackfeet reservation and went on to obtain a doctorate 

from the University of Montana. I can tell you that when I was a youth I was probably considered high risk (as was the majority of our high school population), but 

I was able to build upon the resiliency factors within my life to create a good life 

for me and for my children. The primary factors that helped me succeed were family 

support, social and community support, having stable and healthy parents, traditional cultural beliefs and spirituality, and access to educational opportunities and 

academic scholarships. My family and children have been my primary protective factor. I think that efforts to support building a safe and supportive environment for 

our children to learn within— such as bullying prevention and mentorship programs 

can help to improve resiliency. Matching healthy mentors with youth can be a powerful force to promote health and suicide prevention. We need to develop a system 

to identify those most at risk to connect them with the mental health services they 

may need. Cultivating connections is a key component of this process. I feel strongly 

that the solutions to our problems reside within our communities, but we must be 

creative and persistent in our quest to develop healthier communities.

Question 10. What steps need to be taken to develop a comprehensive strategy 

that addresses suicide in your community? 

Answer:

• Identify Key stakeholders (community, leadership, youth, mental health providers, academic partners, Native providers, and federal agency representatives)

• Build strategic plans and implementation timelines

• Create early identification, screening, and referral programs on each reservation

• Increase mental health access and educational opportunities for youth

• Increase Native healthcare providers and partnerships between tribal colleges, 

high schools, and Universities

• Increase Native researchers working to promote suicide prevention

• Funding for Native youth suicide prevention programs

• Creation of support networks for those at elevated risk 

48

JOINT PREPARED STATEMENT OF MARILYN BRUGUIER ZIMMERMAN, DIRECTOR,

NATIONAL NATIVE CHILDREN’S TRAUMA CENTER AND RICHARD VAN DEN POL,

DIRECTOR, INSTITUTE FOR EDUCATIONAL RESEARCH AND SERVICE, UNIVERSITY OF

MONTANA


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CODIDltmity, all ofus have learned a greatrleal about some ofthe broarler i5511t1S, ag:ain, of 

vital interest throughout Iruiiao Counlly and to the nation us a whol(l. One ofthos(l 

lessons is that sbowingup matters. Throughout our engagement here, working groups 

beth large and small have traveled from the University in Missoula to this community on 

avernge every two months. But then W(l can't h(llp but note and appreciate that the Inwan 

Affuirs Committee already knows this rule and proves it by showing up here for field 

hearioss. We believe this communityvicws this as:ll positive development. 

Al! ofwhatwc have lllamed here willI the !J;l!p orthis community cannot be 

adequately summarized in this $hort testimony, butin service of the Commill~'s work, 

we would like to emphasize two over-Ilrohiog lessens Ihatwe believe ought to guide 

everyone's efforts in these issues. In nddltion, we would like to report an eJIeotu'llging 

new finding that demonstrates how attention to tbese two fundamental points succeeds. 

In convening this hearing, the Indian Affairs Committee, in fact, rlemonstrated the 

frrst important bit of knowledge by titling it: "Emp(lwering Native Youth to Relliaim Uleir 

Future." Everyone here today knows the beadline-grabbing issue in this very school 

district has been a cluster ofteeo suicides. and the undeISlandable urge is to do something 

now about that specific problem. In fact, our group from tho university is engaged in 

exactly that, in doing something about mricide now, Nonotheless, as urgent as lliis is~ue 

is, the Committee's title urges us to not lose sight of the larger issues, and we agree. This 

is reatly abontllie future of Native youlb, all youth. Teen suicide is Dot a single problem 

in isolation, but is partofa tangle ofchalleoges that includes drug and alcohol abuse, 

family, community and gang violence, poor academie perfomuUlcc and a high drop-put 

rate, teen pregnanllY, diabetes and obesity. pw.ling II single thread win not untangle tho 

larger Gordian knot of problems. 

Lilrowisa, our nation now has a salJd body »fscioncc compiled by b(lth the 

Centers for Disease Control and the National Chikhood Traumatic Stress Network 

sanctioned by Congess in 2001. Our National Nat:ve Children's Trauma Coater is a 

Category II Cenier in that national network, chEUged with addressing these issues on 

reselVations throughout the nation. The overwhelming evidence from th?se efforts 

concludes that the knot of problems we face here and in imJloverished communities 

nationwide stem from child abuse, neglect and rlomestic and community violence, and in 
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the IlIIse of reservation communities, historienl trmnllEL We do have some evIdenee that 

Borne forms ofnb\l1lc an: particularly damaging. ForinstllDCe, our .researchers CXPC<ltto 

soon puolish data indicating a particUlarly strong lillk between childhood sexual abus:e 

and teen suicide. Nonetheless, this does Dot l'l~te ow: primary l=oo here. that the knot 

ilf problems is Mlund up in a knot of rouses, illld we 1:ml..-e tittle progm:!S in Ih-ese issues 

unles~ we tecognize thecolapiexi1y oftbe ootlll picLll'C. 

'fbis jXesenls a dauntingchllllcnge, but Illsoleads 10 our second. keypoillt: 

Because the l!trgcrissue is B. series ofcQmplex problems stemming from complex cause&, 

!l() single agency, institution or bureaucracy can solve this alone. The hydra heads of 

challenges preventing Nalivc youth from tecl~iming lheir future mu&t 00 deo'llt with by 

triba1 health, social services, rehllols, juvemle jm;l:ioo and hy fllrcil:es, especially fumilies. 

The coruplexW.l dictates !hat !ill of tl:ese diverne e!ermmls and interests in the trlbai 

oomrnlll\ily {:oJne together to share informanoD andcommo.'t strategy. V{p. ~re sill" this 

({)i;trther.PederaL, state, 1ribal, sohool dismtt, ofld -yes, even academics from the 

uniVel'3i1y - must leum to coopcrntc in acommcn clfort. That may be the most 

important lesson this community is leaming end teacbing the rest OfUS,llotjmt that 

cooperation is ncce~sary. but exactly how to lear down the barriers to cooperation so we 

can get to the hard work !hat faces us, Th¢se L"C not just platitudes; we have ~OIJcrete 

examples ofr~ suc-:ess that sle."'lli !tom: real cooperation. 

& you know, in w.;poose to the widelyrepartad :ruicirle cluster more thlln a year 

ago, the Fort Peck andAssiniboine Sioux Tribal Council declared a state (If emergency in 

May of701O, which triggt:rcd a depJoymeat by the Dffice of Force Rcadin(::ss oflhe U.S. 

Public Health Service lind the Indian Hellith Service, ms sent twenty-two officers, who 

rotated through the community in six separatetc.nltl, eaeh in two-week deployments. The 

incident eOllUUlluder oillie deployment was James Melbourne, director of'fribaJ He-aUh 

Setviee. TIJis extrnordl.'1aty effort led to a f¢a:ml report from IHS, wb:c!t oould have, 111 II 

lesser community. been sen. to a shelf somewbere to gatber dust Nol bere. Our group at 

OM: had already begun workIng with Direct()f Ma!boume<ln thcstl issues, and agreed 10 

cooperate on 11 WI;IY forward, using the ms report as an information base. We built on 

Iheir knowledge. Cooperatively. wo wrote Illlllpplication for a $1.4 million grant from tile 

Substance Abuse lind Mental Health Services Administration to pay for SUicide 
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prevention on the Fort Peek r~~ervatlon. Senator Tester's offke supported us nnd 

announced that our application was succc~sful on July 2&, lind now a local agcncyTribal Health - a statcuniversity aud a local schol)l district will go to work fulfiUing 

needs Idcntifi~d by the federal IUS and the tribes. Thig is what we mean by interagency 

lXlopcralioollnd shared information. FurJmr, because of this stru(lture and the spirit (If 

lXloperation, our universi't'/ has agreed to waive any indire;:t C(!;;W, a tnll'doo that call nm 

lIS high as 4l percent 00 federal gmnls. 

Yett:mbedded in tbis is a development filere is, we !hinI; an even nlOrerevenlin,g 

ilIld encl)Ilraglng bit of news. As part of its investigation, IHS took 'the.am and landable 

step of actually interviewing !lIe conlluuwty's youth to solicit their ideas 011 how we 

might better serve them. The studen1.3 !lave us some common and revealing insights, and 

one ofthoflC. was identifYing a need rcnooro ID(;aningful adultoontoot, onc-on-ollC 

relationships we might call menroring. As partortbeuniversity's \vcrk:l.t Popbr Schoo~s. 

we repeated that question with a group of fMty-sevcn students !hat screening had 

idf:ntifiOO IlS being at-risk fur suicide. Wr. got a $imilarullswer, so took the simple step of 

taking these children at their word. But;'l analyzing the datu, weulso ll()tjr.ed tlm( a 

siguificant sulr.lct of the furty-seven also sl\{1wed Il paUem of IIss~ullil\g other students 

3lld reaclJers, ofviolencc. As we Slli(~ thcse probJtIIIls ere entangled, and often one. 

problem like violence stemming from auser is (I W:lming sign ofanotblll',like suidna. 

Us.tening c.lusely 10 what Ih~ youngpooplewl![C t~liRg US caused us to do 

SCIIIlctl!ing vel)' simple, but [e".u:msive: to begin areenroruhipprog.."IlITl. Each student 

id,mu fled somoone on school staff that he CI she wu1d trust-a pivoLal step - and in 

!Wety case the ideutified stiller lIgr!::ed to check in. with the student at least three times 

ducin.g a school year -just three time •. They talked about issues li.l(c academic progress 

and altendam:e, but moIO 10 the point, mentors look an interest in studllnlll' well-bWng. 

The program eITm::ted simple humanC(lnlact between a student and n c:Jring adult, not 

3nm(.lI;me speofullylrnined or licensed (Jrrlelivering n pnrticulnr thcmpy,just someone the 

srndenthcrse!fidentlfux! as someone she tnlSted, 

. The subset of ten students with n history of violence in the school. {til nveroge. 

accotmted for 4.5 nssnults permo!1tb in tile two years und severnlmon6s before ~ming 

up with a men lor_ That is, these !dd~, also at ri~k rOT SIlicide, [lccnunted fora significant 
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portion of the; violence in the school. But more importantly, after th= students 

participated in the simple program ofmetltoring, their assaults fell from an average of 4.5 

per mOllth to 0.71 per month. Conversely, three students identified as "at risk" ofsuiclde 

and with a history of assault were denied pareutal peroJission to participatu in the 

mentership program. Their assaults decreased also, but notncarly as dramatically as 

those mentorcd. Seldom do those orus in this field see sucll a robust and dramatic result 

60 quickly. 

0.' 

0.35 

0.25 

02 

0.15 

0.1 

11.05 

o 

Prelntervention Post Intervention 

_Mentorship 

-N<l MentCIrship 

The bonus in aU oflhis is that oflhe larger group of 47 students identified as "at 

risk,P thosc who were mentored also showed significant gnins in academic achievement. 

In fact, the difference between the two groups - mentored and not- amounted to the 

difference between earning enough credits to gmduatc and failing to do so, onc ofthc 

more significant predictors ora student's future. 

This is nol to say this is a magic bnllet thai will solve tlte conilllUnity's problems 

overnight, but there are a couple ofpoinlS in all this worth emphasizing. The gains sbown 

here()(;curred as a result Ohll open exchange ()fiuformati()n and knowledge among 

VllriOUS ngen(;ies, particularly IH~, the Trib~1 Henlth Servi(;e ~nd Poplar Schools. Bul 

they also occurred because Poplar Schools staffhas spent mallY y~rs learning 10 

recognize [lJtd deal with at-risk yOllth. That is to say, Ihr;l community has built eapocity, 

and it has paid off. 
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Sooood, though, this is a oost-etrective and simple program that :rests on 

stIengtb$niJll!; meaniugful relationships between cIrlldren and adulrs in this~. 

and nowwe futvesqme C\ideooe itworb. It's the sorl:afwork that \Ian be easily and 

immediately replicated iD "imilar ~ with similar chaI~ al) the natian 

really an leara from FM P-eek. 1b!s, we tbint, helpsjustify the fI::denl iuv«tmerrt: m tilis 

place and in ~ ycrung people.