II 

111TH CONGRESS 

1ST SESSION S. 1635 

To establish an Indian youth telemental health demonstration project, to 

enhance the provision of mental health care services to Indian youth, 

to encourage Indian tribes, tribal organizations, and other mental health 

care providers serving residents of Indian country to obtain the services 

of predoctoral psychology and psychiatry interns, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 6, 2009 

Mr. DORGAN (for himself, Mr. JOHANNS, Mr. BAUCUS, Mr. JOHNSON, Mr. 

THUNE, Mr. TESTER, and Mr. UDALL of New Mexico) introduced the following bill; which was read twice and referred to the Committee on Indian Affairs 

A BILL 

To establish an Indian youth telemental health demonstration 

project, to enhance the provision of mental health care 

services to Indian youth, to encourage Indian tribes, 

tribal organizations, and other mental health care providers serving residents of Indian country to obtain the 

services of predoctoral psychology and psychiatry interns, 

and for other purposes. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘7th Generation Prom3 ise: Indian Youth Suicide Prevention Act of 2009’’. 

4 SEC. 2. FINDINGS AND PURPOSE. 

5 (a) FINDINGS.—Congress finds that— 

6 (1)(A) the rate of suicide of American Indians 

7 and Alaska Natives is 1.9 times higher than the na8 tional average rate; and 

9 (B) the rate of suicide of Indian and Alaska 

10 Native youth aged 15 through 24 is— 

11 (i) 3.5 times the national average rate; and 

12 (ii) the highest rate of any population 

13 group in the United States; 

14 (2) many risk behaviors and contributing fac15 tors for suicide are more prevalent in Indian country 

16 than in other areas, including— 

17 (A) history of previous suicide attempts; 

18 (B) family history of suicide; 

19 (C) history of depression or other mental 

20 illness; 

21 (D) alcohol or drug abuse; 

22 (E) health disparities; 

23 (F) stressful life events and losses; 

24 (G) easy access to lethal methods; 

25 (H) exposure to the suicidal behavior of 

26 others; 


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1 (I) isolation; and 

2 (J) incarceration; 

3 (3) according to national data for 2005, suicide 

4 was the second-leading cause of death for Indians 

5 and Alaska Natives of both sexes aged 10 through 

6 34; 

7 (4)(A) the suicide rates of Indians and Alaska 

8 Natives aged 15 through 24, as compared to suicide 

9 rates of any other racial group, are— 

10 (i) for males, up to 4 times greater; and 

11 (ii) for females, up to 11 times greater; 

12 and 

13 (B) data demonstrates that, over their lifetimes, 

14 females attempt suicide 2 to 3 times more often 

15 than males; 

16 (5)(A) Indian tribes, especially Indian tribes lo17 cated in the Great Plains, have experienced epidemic 

18 levels of suicide, up to 10 times the national aver19 age; and 

20 (B) suicide clustering in Indian country affects 

21 entire tribal communities; 

22 (6) death rates for Indians and Alaska Natives 

23 are statistically underestimated because many areas 

24 of Indian country lack the proper resources to iden25 tify and monitor the presence of disease; 


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1 (7)(A) the Indian Health Service experiences 

2 health professional shortages, with physician vacancy 

3 rates of approximately 17 percent, and nursing va4 cancy rates of approximately 18 percent, in 2007; 

5 (B) 90 percent of all teens who die by suicide 

6 suffer from a diagnosable mental illness at time of 

7 death; 

(C) more than 1 8 ⁄2 of teens who commit suicide 

9 have never been seen by a mental health provider; 

10 and 

(D) 1 11 ⁄3 of health needs in Indian country relate 

12 to mental health; 

13 (8) often, the lack of resources of Indian tribes 

14 and the remote nature of Indian reservations make 

15 it difficult to meet the requirements necessary to ac16 cess Federal assistance, including grants; 

17 (9) the Substance Abuse and Mental Health 

18 Services Administration and the Service have estab19 lished specific initiatives to combat youth suicide in 

20 Indian country and among Indians and Alaska Na21 tives throughout the United States, including the 

22 National Suicide Prevention Initiative of the Service, 

23 which has worked with Service, tribal, and urban In24 dian health programs since 2003; 


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1 (10) the National Strategy for Suicide Preven2 tion was established in 2001 through a Department 

3 of Health and Human Services collaboration 

4 among— 

5 (A) the Substance Abuse and Mental 

6 Health Services Administration; 

7 (B) the Service; 

8 (C) the Centers for Disease Control and 

9 Prevention; 

10 (D) the National Institutes of Health; and 

11 (E) the Health Resources and Services Ad12 ministration; and 

13 (11) the Service and other agencies of the De14 partment of Health and Human Services use infor15 mation technology and other programs to address 

16 the suicide prevention and mental health needs of 

17 Indians and Alaska Natives. 

18 (b) PURPOSES.—The purposes of this Act are— 

19 (1) to authorize the Secretary to carry out a 

20 demonstration project to test the use of telemental 

21 health services in suicide prevention, intervention, 

22 and treatment of Indian youth, including through— 

23 (A) the use of psychotherapy, psychiatric 

24 assessments, diagnostic interviews, therapies for 

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1 cide, and alcohol and substance abuse treat2 ment; 

3 (B) the provision of clinical expertise to, 

4 consultation services with, and medical advice 

5 and training for frontline health care providers 

6 working with Indian youth; 

7 (C) training and related support for com8 munity leaders, family members, and health 

9 and education workers who work with Indian 

10 youth; 

11 (D) the development of culturally relevant 

12 educational materials on suicide; and 

13 (E) data collection and reporting; 

14 (2) to encourage Indian tribes, tribal organiza15 tions, and other mental health care providers serving 

16 residents of Indian country to obtain the services of 

17 predoctoral psychology and psychiatry interns; and 

18 (3) to enhance the provision of mental health 

19 care services to Indian youth through existing grant 

20 programs of the Substance Abuse and Mental 

21 Health Services Administration. 

22 SEC. 3. DEFINITIONS. 

23 In this Act: 


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1 (1) ADMINISTRATION.—The term ‘‘Administra2 tion’’ means the Substance Abuse and Mental 

3 Health Services Administration. 

4 (2) DEMONSTRATION PROJECT.—The term 

5 ‘‘demonstration project’’ means the Indian youth 

6 telemental health demonstration project authorized 

7 under section 4(a). 

8 (3) INDIAN.—The term ‘‘Indian’’ means any in9 dividual who is— 

10 (A) a member of an Indian tribe; or 

11 (B) eligible for health services under the 

12 Indian Health Care Improvement Act (25 

13 U.S.C. 1601 et seq.). 

14 (4) INDIAN COUNTRY.—The term ‘‘Indian coun15 try’’ has the meaning given the term in section 1151 

16 of title 18, United States Code. 

17 (5) INDIAN TRIBE.—The term ‘‘Indian tribe’’ 

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

19 Indian Self-Determination and Education Assistance 

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

21 (6) SECRETARY.—The term ‘‘Secretary’’ means 

22 the Secretary of Health and Human Services. 

23 (7) SERVICE.—The term ‘‘Service’’ means the 

24 Indian Health Service. 


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1 (8) TELEMENTAL HEALTH.—The term ‘‘tele2 mental health’’ means the use of electronic informa3 tion and telecommunications technologies to support 

4 long-distance mental health care, patient and profes5 sional-related education, public health, and health 

6 administration. 

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

8 organization’’ has the meaning given the term in 

9 section 4 of the Indian Self-Determination and Edu10 cation Assistance Act (25 U.S.C. 450b). 

11 SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRA12 TION PROJECT. 

13 (a) AUTHORIZATION.— 

14 (1) IN GENERAL.—The Secretary, acting 

15 through the Service, is authorized to carry out a 

16 demonstration project to award grants for the provi17 sion of telemental health services to Indian youth 

18 who— 

19 (A) have expressed suicidal ideas; 

20 (B) have attempted suicide; or 

21 (C) have mental health conditions that in22 crease or could increase the risk of suicide. 

23 (2) ELIGIBILITY FOR GRANTS.—Grants under 

24 paragraph (1) shall be awarded to Indian tribes and 


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1 tribal organizations that operate 1 or more facili2 ties— 

3 (A) located in an area with documented 

4 disproportionately high rates of suicide; 

5 (B) reporting active clinical telehealth ca6 pabilities; or 

7 (C) offering school-based telemental health 

8 services to Indian youth. 

9 (3) GRANT PERIOD.—The Secretary shall 

10 award grants under this section for a period of up 

11 to 4 years. 

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

13 than 5 grants shall be provided under paragraph 

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

15 and tribal organizations that— 

16 (A) serve a particular community or geo17 graphic area in which there is a demonstrated 

18 need to address Indian youth suicide; 

19 (B) enter into collaborative partnerships 

20 with Service or other tribal health programs or 

21 facilities to provide services under this dem22 onstration project; 

23 (C) serve an isolated community or geo24 graphic area that has limited or no access to 

25 behavioral health services; or 


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1 (D) operate a detention facility at which 

2 Indian youth are detained. 

3 (5) CONSULTATION WITH ADMINISTRATION.— 

4 In developing and carrying out the demonstration 

5 project under this subsection, the Secretary shall 

6 consult with the Administration as the Federal agen7 cy focused on mental health issues, including suicide. 

8 (b) USE OF FUNDS.— 

9 (1) IN GENERAL.—An Indian tribe or tribal or10 ganization shall use a grant received under sub11 section (a) for the following purposes: 

12 (A) To provide telemental health services 

13 to Indian youth, including the provision of— 

14 (i) psychotherapy; 

15 (ii) psychiatric assessments and diag16 nostic interviews, therapies for mental 

17 health conditions predisposing to suicide, 

18 and treatment; and 

19 (iii) alcohol and substance abuse 

20 treatment. 

21 (B) To provide clinician-interactive medical 

22 advice, guidance and training, assistance in di23 agnosis and interpretation, crisis counseling and 

24 intervention, and related assistance to Service 

25 or tribal clinicians and health services providers 


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1 working with youth being served under the 

2 demonstration project. 

3 (C) To assist, educate, and train commu4 nity leaders, health education professionals and 

5 paraprofessionals, tribal outreach workers, and 

6 family members who work with the youth re7 ceiving telemental health services under the 

8 demonstration project, including with identifica9 tion of suicidal tendencies, crisis intervention 

10 and suicide prevention, emergency skill develop11 ment, and building and expanding networks 

12 among those individuals and with State and 

13 local health services providers. 

14 (D) To develop and distribute culturally 

15 appropriate community educational materials 

16 regarding— 

17 (i) suicide prevention; 

18 (ii) suicide education; 

19 (iii) suicide screening; 

20 (iv) suicide intervention; and 

21 (v) ways to mobilize communities with 

22 respect to the identification of risk factors 

23 for suicide. 


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1 (E) To conduct data collection and report2 ing relating to Indian youth suicide prevention 

3 efforts. 

4 (2) TRADITIONAL HEALTH CARE PRACTICES.— 

5 In carrying out the purposes described in paragraph 

6 (1), an Indian tribe or tribal organization may use 

7 and promote the traditional health care practices of 

8 the Indian tribes of the youth to be served. 

9 (c) APPLICATIONS.— 

10 (1) IN GENERAL.—Subject to paragraph (2), to 

11 be eligible to receive a grant under subsection (a), 

12 an Indian tribe or tribal organization shall prepare 

13 and submit to the Secretary an application, at such 

14 time, in such manner, and containing such informa15 tion as the Secretary may require, including— 

16 (A) a description of the project that the 

17 Indian tribe or tribal organization will carry out 

18 using the funds provided under the grant; 

19 (B) a description of the manner in which 

20 the project funded under the grant would— 

21 (i) meet the telemental health care 

22 needs of the Indian youth population to be 

23 served by the project; or 


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1 (ii) improve the access of the Indian 

2 youth population to be served to suicide 

3 prevention and treatment services; 

4 (C) evidence of support for the project 

5 from the local community to be served by the 

6 project; 

7 (D) a description of how the families and 

8 leadership of the communities or populations to 

9 be served by the project would be involved in 

10 the development and ongoing operations of the 

11 project; 

12 (E) a plan to involve the tribal community 

13 of the youth who are provided services by the 

14 project in planning and evaluating the mental 

15 health care and suicide prevention efforts pro16 vided, in order to ensure the integration of com17 munity, clinical, environmental, and cultural 

18 components of the treatment; and 

19 (F) a plan for sustaining the project after 

20 Federal assistance for the demonstration 

21 project has terminated. 

22 (2) EFFICIENCY OF GRANT APPLICATION PROC23 ESS.—The Secretary shall carry out such measures 

24 as the Secretary determines to be necessary to maxi25 mize the time and workload efficiency of the process 


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1 by which Indian tribes and tribal organizations apply 

2 for grants under paragraph (1). 

3 (d) COLLABORATION.—The Secretary, acting 

4 through the Service, shall encourage Indian tribes and 

5 tribal organizations receiving grants under this section to 

6 collaborate to enable comparisons regarding best practices 

7 across projects. 

8 (e) ANNUAL REPORT.—Each grant recipient shall 

9 submit to the Secretary an annual report that— 

10 (1) describes the number of telemental health 

11 services provided; and 

12 (2) includes any other information that the Sec13 retary may require. 

14 (f) REPORTS TO CONGRESS.— 

15 (1) INITIAL REPORT.— 

16 (A) IN GENERAL.—Not later than 2 years 

17 after the date on which the first grant is award18 ed under this section, the Secretary shall sub19 mit to the Committee on Indian Affairs of the 

20 Senate and the Committee on Natural Re21 sources and the Committee on Energy and 

22 Commerce of the House of Representatives a 

23 report that— 

24 (i) describes each project funded by a 

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1 ceding 2-year period, including a descrip2 tion of the level of success achieved by the 

3 project; and 

4 (ii) evaluates whether the demonstra5 tion project should be continued during the 

6 period beginning on the date of termi7 nation of funding for the demonstration 

8 project under subsection (g) and ending on 

9 the date on which the final report is sub10 mitted under paragraph (2). 

11 (B) CONTINUATION OF DEMONSTRATION

12 PROJECT.—On a determination by the Sec13 retary under clause (ii) of subparagraph (A) 

14 that the demonstration project should be con15 tinued, the Secretary may carry out the dem16 onstration project during the period described 

17 in that clause using such sums otherwise made 

18 available to the Secretary as the Secretary de19 termines to be appropriate. 

20 (2) FINAL REPORT.—Not later than 270 days 

21 after the date of termination of funding for the dem22 onstration project under subsection (g), the Sec23 retary shall submit to the Committee on Indian Af24 fairs of the Senate and the Committee on Natural 

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1 merce of the House of Representatives a final report 

2 that— 

3 (A) describes the results of the projects 

4 funded by grants awarded under this section, 

5 including any data available that indicate the 

6 number of attempted suicides; 

7 (B) evaluates the impact of the telemental 

8 health services funded by the grants in reducing 

9 the number of completed suicides among Indian 

10 youth; 

11 (C) evaluates whether the demonstration 

12 project should be— 

13 (i) expanded to provide more than 5 

14 grants; and 

15 (ii) designated as a permanent pro16 gram; and 

17 (D) evaluates the benefits of expanding the 

18 demonstration project to include urban Indian 

19 organizations. 

20 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

21 authorized to be appropriated to carry out this section 

22 $1,500,000 for each of fiscal years 2010 through 2013. 

23 SEC. 5. SUBSTANCE ABUSE AND MENTAL HEALTH SERV24 ICES ADMINISTRATION GRANTS. 

25 (a) GRANT APPLICATIONS.— 


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1 (1) EFFICIENCY OF GRANT APPLICATION PROC2 ESS.—The Secretary, acting through the Adminis3 tration, shall carry out such measures as the Sec4 retary determines to be necessary to maximize the 

5 time and workload efficiency of the process by which 

6 Indian tribes and tribal organizations apply for 

7 grants under any program administered by the Ad8 ministration, including by providing methods other 

9 than electronic methods of submitting applications 

10 for those grants, if necessary. 

11 (2) PRIORITY FOR CERTAIN GRANTS.— 

12 (A) IN GENERAL.—To fulfill the trust re13 sponsibility of the United States to Indian 

14 tribes, in awarding relevant grants pursuant to 

15 a program described in subparagraph (B), the 

16 Secretary shall give priority consideration to the 

17 applications of Indian tribes or tribal organiza18 tions, as applicable, that serve populations with 

19 documented high suicide rates, regardless of 

20 whether those Indian tribes or tribal organiza21 tions possess adequate personnel or infrastruc22 ture to fulfill all applicable requirements of the 

23 relevant program. 


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1 (B) DESCRIPTION OF GRANT PROGRAMS.— 

2 A grant program referred to in subparagraph 

3 (A) is a grant program— 

4 (i) administered by the Administration 

5 to fund activities relating to mental health, 

6 suicide prevention, or suicide-related risk 

7 factors; and 

8 (ii) under which an Indian tribe is an 

9 eligible recipient. 

10 (3) CLARIFICATION REGARDING INDIAN TRIBES

11 AND TRIBAL ORGANIZATIONS.—Notwithstanding any 

12 other provision of law, in applying for a grant under 

13 any program administered by the Administration, no 

14 Indian tribe or tribal organization shall be required 

15 to apply through a State or State agency. 

16 (4) REQUIREMENTS FOR AFFECTED STATES.— 

17 (A) DEFINITIONS.—In this paragraph: 

18 (i) AFFECTED STATE.—The term ‘‘af19 fected State’’ means a State— 

20 (I) the boundaries of which in21 clude 1 or more Indian tribes; and 

22 (II) the application for a grant 

23 under any program administered by 

24 the Administration of which includes 

25 statewide data. 


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1 (ii) INDIAN POPULATION.—The term 

2 ‘‘Indian population’’ means the total num3 ber of residents of an affected State who 

4 are members of 1 or more Indian tribes lo5 cated within the affected State. 

6 (B) REQUIREMENTS.—As a condition of 

7 receipt of a grant under any program adminis8 tered by the Administration, each affected State 

9 shall— 

10 (i) describe in the grant application— 

11 (I) the Indian population of the 

12 affected State; and 

13 (II) the contribution of that In14 dian population to the statewide data 

15 used by the affected State in the ap16 plication; and 

17 (ii) demonstrate to the satisfaction of 

18 the Secretary that— 

19 (I) of the total amount of the 

20 grant, the affected State will allocate 

21 for use for the Indian population of 

22 the affected State an amount equal to 

23 the proportion that— 

24 (aa) the Indian population 

25 of the affected State; bears to 


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1 (bb) the total population of 

2 the affected State; and 

3 (II) the affected State will offer 

4 to enter into a partnership with each 

5 Indian tribe located within the af6 fected State to carry out youth suicide 

7 prevention and treatment measures 

8 for members of the Indian tribe. 

9 (C) REPORT.—Not later than 1 year after 

10 the date of receipt of a grant described in sub11 paragraph (B), an affected State shall submit 

12 to the Secretary a report describing the meas13 ures carried out by the affected State to ensure 

14 compliance with the requirements of subpara15 graph (B)(ii). 

16 (b) NO NON-FEDERAL SHARE REQUIREMENT.—Not17 withstanding any other provision of law, no Indian tribe 

18 or tribal organization shall be required to provide a non19 Federal share of the cost of any project or activity carried 

20 out using a grant provided under any program adminis21 tered by the Administration. 

22 (c) OUTREACH FOR RURAL AND ISOLATED INDIAN

23 TRIBES.—Due to the rural, isolated nature of most Indian 

24 reservations and communities (especially those reserva25 tions and communities in the Great Plains region), the 


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1 Secretary shall conduct outreach activities, with a par2 ticular emphasis on the provision of telemental health 

3 services, to achieve the purposes of this Act with respect 

4 to Indian tribes located in rural, isolated areas. 

5 (d) PROVISION OF OTHER ASSISTANCE.— 

6 (1) IN GENERAL.—The Secretary, acting 

7 through the Administration, shall carry out such 

8 measures (including monitoring and the provision of 

9 required assistance) as the Secretary determines to 

10 be necessary to ensure the provision of adequate sui11 cide prevention and mental health services to Indian 

12 tribes described in paragraph (2), regardless of 

13 whether those Indian tribes possess adequate per14 sonnel or infrastructure— 

15 (A) to submit an application for a grant 

16 under any program administered by the Admin17 istration, including due to problems relating to 

18 access to the Internet or other electronic means 

19 that may have resulted in previous obstacles to 

20 submission of a grant application; or 

21 (B) to fulfill all applicable requirements of 

22 the relevant program. 

23 (2) DESCRIPTION OF INDIAN TRIBES.—An In24 dian tribe referred to in paragraph (1) is an Indian 

25 tribe— 


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1 (A) the members of which experience— 

2 (i) a high rate of youth suicide; 

3 (ii) low socioeconomic status; and 

4 (iii) extreme health disparity; 

5 (B) that is located in a remote and isolated 

6 area; and 

7 (C) that lacks technology and communica8 tion infrastructure. 

9 (3) AUTHORIZATION OF APPROPRIATIONS.— 

10 There are authorized to be appropriated to the Sec11 retary such sums as the Secretary determines to be 

12 necessary to carry out this subsection. 

13 (e) EARLY INTERVENTION AND ASSESSMENT SERV14 ICES.— 

15 (1) DEFINITION OF AFFECTED ENTITY.—In 

16 this subsection, the term ‘‘affected entity’’ means 

17 any entity— 

18 (A) that receives a grant for suicide inter19 vention, prevention, or treatment under a pro20 gram administered by the Administration; and 

21 (B) the population to be served by which 

22 includes Indian youth. 

23 (2) REQUIREMENT.—The Secretary, acting 

24 through the Administration, shall ensure that each 

25 affected entity carrying out a youth suicide early 


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1 intervention and prevention strategy described in 

2 section 520E(c)(1) of the Public Health Service Act 

3 (42 U.S.C. 290bb–36(c)(1)), or any other youth sui4 cide-related early intervention and assessment activ5 ity, provides training or education to individuals who 

6 interact frequently with the Indian youth to be 

7 served by the affected entity (including parents, 

8 teachers, coaches, and mentors) on identifying warn9 ing signs of Indian youth who are at risk of commit10 ting suicide. 

11 SEC. 6. USE OF PREDOCTORAL PSYCHOLOGY AND PSYCHI12 ATRY INTERNS. 

13 The Secretary shall carry out such activities as the 

14 Secretary determines to be necessary to encourage Indian 

15 tribes, tribal organizations, and other mental health care 

16 providers serving residents of Indian country to obtain the 

17 services of predoctoral psychology and psychiatry in18 terns— 

19 (1) to increase the quantity of patients served 

20 by the Indian tribes, tribal organizations, and other 

21 mental health care providers; and 

22 (2) for purposes of recruitment and retention. 

Æ 


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