II 

Calendar No. 108 

110TH CONGRESS 

1ST SESSION S. 322 

[Report No. 110–43] 

To establish an Indian youth telemental health demonstration project. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 17, 2007 

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

BINGAMAN, Mr. BAUCUS, Mr. SMITH, Mr. INOUYE, and Mr. THOMAS) introduced the following bill; which was read twice and referred to the Committee on Indian Affairs 

APRIL 10, 2007 

Reported by Mr. DORGAN, with an amendment 

[Insert the part printed in italic] 

A BILL 

To establish an Indian youth telemental health demonstration 

project. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Indian Youth Tele5 mental Health Demonstration Project Act of 2007’’. 


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1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—Congress finds that— 

3 (1) suicide for Indians and Alaska Natives is 

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

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

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

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

8 through 24, according to data for 2002; 

9 (2) according to national data for 2004, suicide 

10 was the second-leading cause of death for Indians 

11 and Alaska Natives of both sexes aged 10 through 

12 34; 

13 (3) the suicide rates of Indian and Alaska Na14 tive males aged 15 through 24 are nearly 4 times 

15 greater than suicide rates of Indian and Alaska Na16 tive females of that age group; 

17 (4)(A) 90 percent of all teens who die by sui18 cide suffer from a diagnosable mental illness at the 

19 time of death; and 

(B) more than 1 20 ⁄2 of the people who commit 

21 suicide in Indian Country have never been seen by 

22 a mental health provider; 

23 (5) death rates for Indians and Alaska Natives 

24 are statistically underestimated; 

25 (6) suicide clustering in Indian Country affects 

26 entire tribal communities; and 


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

2 carried out a National Suicide Prevention Initiative 

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

4 programs. 

5 (b) PURPOSE.—The purpose of this Act is to author6 ize the Secretary to carry out a demonstration project to 

7 test the use of telemental health services in suicide preven8 tion, intervention, and treatment of Indian youth, includ9 ing through— 

10 (1) the use of psychotherapy, psychiatric assess11 ments, diagnostic interviews, therapies for mental 

12 health conditions predisposing to suicide, and alcohol 

13 and substance abuse treatment; 

14 (2) the provision of clinical expertise to, con15 sultation services with, and medical advice and train16 ing for frontline health care providers working with 

17 Indian youth; 

18 (3) training and related support for community 

19 leaders, family members and health and education 

20 workers who work with Indian youth; 

21 (4) the development of culturally-relevant edu22 cational materials on suicide; and 

23 (5) data collection and reporting. 

24 SEC. 3. DEFINITIONS. 

25 In this Act: 


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1 (1) DEMONSTRATION PROJECT.—The term 

2 ‘‘demonstration project’’ means the Indian youth 

3 telemental health demonstration project authorized 

4 under section 4(a). 

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

6 means the Department of Health and Human Serv7 ices. 

8 (3) INDIAN.—The term ‘‘Indian’’ means any in9 dividual who is a member of an Indian tribe or is 

10 eligible for health services under the Indian Health 

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

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

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

14 Indian Self-Determination and Education Assistance 

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

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

17 the Secretary of Health and Human Services. 

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

19 Indian Health Service. 

20 (7) TELEMENTAL HEALTH.—The term ‘‘tele21 mental health’’ means the use of electronic informa22 tion and telecommunications technologies to support 

23 long distance mental health care, patient and profes24 sional-related education, public health, and health 

25 administration. 


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1 (8) TRIBAL ORGANIZATION.—The term ‘‘tribal 

2 organization’’ has the meaning given the term in 

3 section 4 of the Indian Self-Determination and Edu4 cation Assistance Act (25 U.S.C. 450b). 

5 SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRA6 TION PROJECT. 

7 (a) AUTHORIZATION.— 

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

9 to carry out a demonstration project to award grants 

10 for the provision of telemental health services to In11 dian youth who— 

12 (A) have expressed suicidal ideas; 

13 (B) have attempted suicide; or 

14 (C) have mental health conditions that in15 crease or could increase the risk of suicide. 

16 (2) ELIGIBILITY FOR GRANTS.—Grants de17 scribed in paragraph (1) shall be awarded to Indian 

18 tribes and tribal organizations that operate 1 or 

19 more facilities— 

20 (A) located in Alaska and part of the Alas21 ka Federal Health Care Access Network; 

22 (B) reporting active clinical telehealth ca23 pabilities; or 

24 (C) offering school-based telemental health 

25 services relating to psychiatry to Indian youth. 


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1 (3) GRANT PERIOD.—The Secretary shall 

2 award grants under this section for a period of up 

3 to 4 years. 

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

5 than 5 grants shall be provided under paragraph 

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

7 and tribal organizations that— 

8 (A) serve a particular community or geo9 graphic area in which there is a demonstrated 

10 need to address Indian youth suicide; 

11 (B) enter into collaborative partnerships 

12 with Service or other tribal health programs or 

13 facilities to provide services under this dem14 onstration project; 

15 (C) serve an isolated community or geo16 graphic area which has limited or no access to 

17 behavioral health services; or 

18 (D) operate a detention facility at which 

19 Indian youth are detained. 

20 (b) USE OF FUNDS.— 

21 (1) IN GENERAL.—An Indian tribe or tribal or22 ganization shall use a grant received under sub23 section (a) for the following purposes: 

24 (A) To provide telemental health services 

25 to Indian youth, including the provision of— 


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1 (i) psychotherapy; 

2 (ii) psychiatric assessments and diag3 nostic interviews, therapies for mental 

4 health conditions predisposing to suicide, 

5 and treatment; and 

6 (iii) alcohol and substance abuse 

7 treatment. 

8 (B) To provide clinician-interactive medical 

9 advice, guidance and training, assistance in di10 agnosis and interpretation, crisis counseling and 

11 intervention, and related assistance to Service 

12 or tribal clinicians and health services providers 

13 working with youth being served under the 

14 demonstration project. 

15 (C) To assist, educate, and train commu16 nity leaders, health education professionals and 

17 paraprofessionals, tribal outreach workers, and 

18 family members who work with the youth re19 ceiving telemental health services under the 

20 demonstration project, including with identifica21 tion of suicidal tendencies, crisis intervention 

22 and suicide prevention, emergency skill develop23 ment, and building and expanding networks 

24 among those individuals and with State and 

25 local health services providers. 


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1 (D) To develop and distribute culturally2 appropriate community educational materials 

3 on— 

4 (i) suicide prevention; 

5 (ii) suicide education; 

6 (iii) suicide screening; 

7 (iv) suicide intervention; and 

8 (v) ways to mobilize communities with 

9 respect to the identification of risk factors 

10 for suicide. 

11 (E) To conduct data collection and report12 ing relating to Indian youth suicide prevention 

13 efforts. 

14 (2) TRADITIONAL HEALTH CARE PRACTICES.— 

15 In carrying out the purposes described in paragraph 

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

17 and promote the traditional health care practices of 

18 the Indian tribes of the youth to be served. 

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

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

21 shall prepare and submit to the Secretary an application, 

22 at such time, in such manner, and containing such infor23 mation as the Secretary may require, including— 


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

2 tribe or tribal organization will carry out using the 

3 funds provided under the grant; 

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

5 project funded under the grant would— 

6 (A) meet the telemental health care needs 

7 of the Indian youth population to be served by 

8 the project; or 

9 (B) improve the access of the Indian youth 

10 population to be served to suicide prevention 

11 and treatment services; 

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

13 local community to be served by the project; 

14 (4) a description of how the families and leader15 ship of the communities or populations to be served 

16 by the project would be involved in the development 

17 and ongoing operations of the project; 

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

19 the youth who are provided services by the project 

20 in planning and evaluating the mental health care 

21 and suicide prevention efforts provided, in order to 

22 ensure the integration of community, clinical, envi23 ronmental, and cultural components of the treat24 ment; and 


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1 (6) a plan for sustaining the project after Fed2 eral assistance for the demonstration project has ter3 minated. 

4 (d) COLLABORATION.—The Secretary, acting 

5 through the Service, shall encourage Indian tribes and 

6 tribal organizations receiving grants under this section to 

7 collaborate to enable comparisons about best practices 

8 across projects. 

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

10 submit to the Secretary an annual report that— 

11 (1) describes the number of telemental health 

12 services provided; and 

13 (2) includes any other information that the Sec14 retary may require. 

15 (f) REPORT TO CONGRESS.—Not later than 270 days 

16 after the date of termination of the demonstration project, 

17 the Secretary shall submit to the Committee on Indian Af18 fairs of the Senate and the Committee on Natural Re19 sources and the Committee on Energy and Commerce of 

20 the House of Representatives a final report that— 

21 (1) describes the results of the projects funded 

22 by grants awarded under this section, including any 

23 data available that indicate the number of attempted 

24 suicides; 


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1 (2) evaluates the impact of the telemental 

2 health services funded by the grants in reducing the 

3 number of completed suicides among Indian youth; 

4 (3) evaluates whether the demonstration project 

5 should be— 

6 (A) expanded to provide more than 5 

7 grants; and 

8 (B) designated a permanent program; and 

9 (4) evaluates the benefits of expanding the 

10 demonstration project to include urban Indian orga11 nizations. 

12 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to carry out this section 

14 $1,500,000 for each of fiscal years 2008 through 2011. 


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Calendar No. 108 

110TH CONGRESS 

1ST SESSION S. 322 

[Report No. 110

–43] 

A BILL 

To establish an Indian youth telemental health 

demonstration project. 

APRIL 10, 2007 

Reported with an amendment 


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