248 
‘‘(B) mental health and substance abuse 
services (emotional, alcohol, drug, inhalant, and 
tobacco), including sex specific services; 
‘‘(C) identification and treatment of co-oc-
curring disorders (dual diagnosis) and comor-
bidity; 
‘‘(D) promotion of healthy approaches to 
managing conditions related to aging; 
‘‘(E) sex specific treatment for sexual as-
sault, domestic violence, neglect, physical and 
mental abuse and exploitation; and 
‘‘(F) identification and treatment of demen-
tias regardless of cause. 
‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 
‘‘(1) ESTABLISHMENT.—The governing body of 
any Indian Tribe, Tribal Organization, or Urban In-
dian Organization may adopt a resolution for the es-
tablishment of a community behavioral health plan 
providing for the identification and coordination of 
available resources and programs to identify, prevent, 
or treat substance abuse, mental illness, or dysfunc-
tional and self-destructive behavior, including child 
abuse and family violence, among its members or its 
service population. This plan should include behav-
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249 
ioral health services, social services, intensive out-
patient services, and continuing aftercare. 
‘‘(2) TECHNICAL ASSISTANCE.—At the request of 
an Indian Tribe, Tribal Organization, or Urban In-
dian Organization, the Bureau of Indian Affairs and 
the Service shall cooperate with and provide technical 
assistance to the Indian Tribe, Tribal Organization, 
or Urban Indian Organization in the development 
and implementation of such plan. 
‘‘(3) FUNDING.—The Secretary, acting through 
the Service, may make funding available to Indian 
Tribes and Tribal Organizations which adopt a reso-
lution pursuant to paragraph (1) to obtain technical 
assistance for the development of a community behav-
ioral health plan and to provide administrative sup-
port in the implementation of such plan. 
‘‘(e) COORDINATION
FOR AVAILABILITY
OF SERV-
ICES.—The Secretary, acting through the Service, Indian 
Tribes, Tribal Organizations, and Urban Indian Organiza-
tions, shall coordinate behavioral health planning, to the 
extent feasible, with other Federal agencies and with State 
agencies, to encourage comprehensive behavioral health serv-
ices for Indians regardless of their place of residence. 
‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 
Not later than 1 year after the date of enactment of the 
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Indian Health Care Improvement Act Amendments of 2007, 
the Secretary, acting through the Service, shall make an as-
sessment of the need for inpatient mental health care among 
Indians and the availability and cost of inpatient mental 
health facilities which can meet such need. In making such 
assessment, the Secretary shall consider the possible conver-
sion of existing, underused Service hospital beds into psy-
chiatric units to meet such need. 
‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPART-
MENT OF THE INTERIOR. 
‘‘(a) CONTENTS.—Not later than 12 months after the 
date of enactment of the Indian Health Care Improvement 
Act Amendments of 2007, the Secretary, acting through the 
Service, and the Secretary of the Interior shall develop and 
enter into a memoranda of agreement, or review and update 
any existing memoranda of agreement, as required by sec-
tion 4205 of the Indian Alcohol and Substance Abuse Pre-
vention and Treatment Act of 1986 (25 U.S.C. 2411) under 
which the Secretaries address the following: 
‘‘(1) The scope and nature of mental illness and 
dysfunctional and self-destructive behavior, including 
child abuse and family violence, among Indians. 
‘‘(2) The existing Federal, tribal, State, local, 
and private services, resources, and programs avail-
able to provide behavioral health services for Indians. 
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‘‘(3) The unmet need for additional services, re-
sources, and programs necessary to meet the needs 
identified pursuant to paragraph (1). 
‘‘(4)(A) The right of Indians, as citizens of the 
United States and of the States in which they reside, 
to have access to behavioral health services to which 
all citizens have access. 
‘‘(B) The right of Indians to participate in, and 
receive the benefit of, such services. 
‘‘(C) The actions necessary to protect the exercise 
of such right. 
‘‘(5) The responsibilities of the Bureau of Indian 
Affairs and the Service, including mental illness iden-
tification, prevention, education, referral, and treat-
ment services (including services through multidisci-
plinary resource teams), at the central, area, and 
agency and Service Unit, Service Area, and head-
quarters levels to address the problems identified in 
paragraph (1). 
‘‘(6) A strategy for the comprehensive coordina-
tion of the behavioral health services provided by the 
Bureau of Indian Affairs and the Service to meet the 
problems identified pursuant to paragraph (1), in-
cluding— 
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‘‘(A) the coordination of alcohol and sub-
stance abuse programs of the Service, the Bureau 
of Indian Affairs, and Indian Tribes and Tribal 
Organizations (developed under the Indian Alco-
hol and Substance Abuse Prevention and Treat-
ment Act of 1986 (25 U.S.C. 2401 et seq.)) with 
behavioral health initiatives pursuant to this 
Act, particularly with respect to the referral and 
treatment of dually diagnosed individuals re-
quiring behavioral health and substance abuse 
treatment; and 
‘‘(B) ensuring that the Bureau of Indian 
Affairs and Service programs and services (in-
cluding multidisciplinary resource teams) ad-
dressing child abuse and family violence are co-
ordinated with such non-Federal programs and 
services. 
‘‘(7) Directing appropriate officials of the Bu-
reau of Indian Affairs and the Service, particularly 
at the agency and Service Unit levels, to cooperate 
fully with tribal requests made pursuant to commu-
nity behavioral health plans adopted under section 
701(c) and section 4206 of the Indian Alcohol and 
Substance Abuse Prevention and Treatment Act of 
1986 (25 U.S.C. 2412). 
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253 
‘‘(8) Providing for an annual review of such 
agreement by the Secretaries which shall be provided 
to Congress and Indian Tribes and Tribal Organiza-
tions. 
‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo-
randa of agreement updated or entered into pursuant to 
subsection (a) shall include specific provisions pursuant to 
which the Service shall assume responsibility for— 
‘‘(1) the determination of the scope of the prob-
lem of alcohol and substance abuse among Indians, 
including the number of Indians within the jurisdic-
tion of the Service who are directly or indirectly af-
fected by alcohol and substance abuse and the finan-
cial and human cost; 
‘‘(2) an assessment of the existing and needed re-
sources necessary for the prevention of alcohol and 
substance abuse and the treatment of Indians affected 
by alcohol and substance abuse; and 
‘‘(3) an estimate of the funding necessary to ade-
quately support a program of prevention of alcohol 
and substance abuse and treatment of Indians affected 
by alcohol and substance abuse. 
‘‘(c) PUBLICATION.—Each memorandum of agreement 
entered into or renewed (and amendments or modifications 
thereto) under subsection (a) shall be published in the Fed-
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254 
eral Register. At the same time as publication in the Fed-
eral Register, the Secretary shall provide a copy of such 
memoranda, amendment, or modification to each Indian 
Tribe, Tribal Organization, and Urban Indian Organiza-
tion. 
‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVEN-
TION AND TREATMENT PROGRAM. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Service, Indian Tribes, and Tribal Orga-
nizations, shall provide a program of comprehensive 
behavioral 
health, 
prevention, 
treatment, 
and 
aftercare, which shall include— 
‘‘(A) prevention, through educational inter-
vention, in Indian communities; 
‘‘(B) acute detoxification, psychiatric hos-
pitalization, residential, and intensive out-
patient treatment; 
‘‘(C) community-based rehabilitation and 
aftercare; 
‘‘(D) community education and involve-
ment, including extensive training of health care, 
educational, and community-based personnel; 
‘‘(E) specialized residential treatment pro-
grams for high-risk populations, including preg-
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255 
nant and postpartum women and their children; 
and 
‘‘(F) diagnostic services. 
‘‘(2) TARGET POPULATIONS.—The target popu-
lation of such programs shall be members of Indian 
Tribes. Efforts to train and educate key members of 
the Indian community shall also target employees of 
health, education, judicial, law enforcement, legal, 
and social service programs. 
‘‘(b) CONTRACT HEALTH SERVICES.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Service, Indian Tribes, and Tribal Orga-
nizations, may enter into contracts with public or 
private providers of behavioral health treatment serv-
ices for the purpose of carrying out the program re-
quired under subsection (a). 
‘‘(2) PROVISION
OF
ASSISTANCE.—In carrying 
out this subsection, the Secretary shall provide assist-
ance to Indian Tribes and Tribal Organizations to 
develop criteria for the certification of behavioral 
health service providers and accreditation of service 
facilities which meet minimum standards for such 
services and facilities. 
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256 
‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 
‘‘(a) IN GENERAL.—Under the authority of the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the 
‘Snyder Act’), the Secretary shall establish and maintain 
a mental health technician program within the Service 
which— 
‘‘(1) provides for the training of Indians as men-
tal health technicians; and 
‘‘(2) employs such technicians in the provision of 
community-based mental health care that includes 
identification, prevention, education, referral, and 
treatment services. 
‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying out 
subsection (a), the Secretary, acting through the Service, In-
dian Tribes, and Tribal Organizations, shall provide high- 
standard paraprofessional training in mental health care 
necessary to provide quality care to the Indian communities 
to be served. Such training shall be based upon a cur-
riculum developed or approved by the Secretary which com-
bines education in the theory of mental health care with 
supervised practical experience in the provision of such 
care. 
‘‘(c) SUPERVISION
AND EVALUATION
OF TECHNI-
CIANS.—The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, shall supervise and 
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257 
evaluate the mental health technicians in the training pro-
gram. 
‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 
Secretary, acting through the Service, shall ensure that the 
program established pursuant to this subsection involves the 
use and promotion of the traditional health care practices 
of the Indian Tribes to be served. 
‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH 
CARE WORKERS. 
‘‘(a) IN GENERAL.—Subject to the provisions of section 
221, and except as provided in subsection (b), any indi-
vidual employed as a psychologist, social worker, or mar-
riage and family therapist for the purpose of providing 
mental health care services to Indians in a clinical setting 
under this Act is required to be licensed as a psychologist, 
social worker, or marriage and family therapist, respec-
tively. 
‘‘(b) TRAINEES.—An individual may be employed as 
a trainee in psychology, social work, or marriage and fam-
ily therapy to provide mental health care services described 
in subsection (a) if such individual— 
‘‘(1) works under the direct supervision of a li-
censed psychologist, social worker, or marriage and 
family therapist, respectively; 
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‘‘(2) is enrolled in or has completed at least 2 
years of course work at a post-secondary, accredited 
education program for psychology, social work, mar-
riage and family therapy, or counseling; and 
‘‘(3) meets such other training, supervision, and 
quality review requirements as the Secretary may es-
tablish. 
‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 
‘‘(a) GRANTS.—The Secretary, consistent with section 
701, may make grants to Indian Tribes, Tribal Organiza-
tions, and Urban Indian Organizations to develop and im-
plement a comprehensive behavioral health program of pre-
vention, intervention, treatment, and relapse prevention 
services that specifically addresses the cultural, historical, 
social, and child care needs of Indian women, regardless 
of age. 
‘‘(b) USE OF GRANT FUNDS.—A grant made pursuant 
to this section may be used to— 
‘‘(1) develop and provide community training, 
education, and prevention programs for Indian 
women relating to behavioral health issues, including 
fetal alcohol disorders; 
‘‘(2) identify and provide psychological services, 
counseling, advocacy, support, and relapse prevention 
to Indian women and their families; and 
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259 
‘‘(3) develop prevention and intervention models 
for Indian women which incorporate traditional 
health care practices, cultural values, and community 
and family involvement. 
‘‘(c) CRITERIA.—The Secretary, in consultation with 
Indian Tribes and Tribal Organizations, shall establish cri-
teria for the review and approval of applications and pro-
posals for funding under this section. 
‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty percent 
of the funds appropriated pursuant to this section shall be 
used to make grants to Urban Indian Organizations. 
‘‘SEC. 707. INDIAN YOUTH PROGRAM. 
‘‘(a) DETOXIFICATION
AND REHABILITATION.—The 
Secretary, acting through the Service, consistent with sec-
tion 701, shall develop and implement a program for acute 
detoxification and treatment for Indian youths, including 
behavioral health services. The program shall include re-
gional treatment centers designed to include detoxification 
and rehabilitation for both sexes on a referral basis and 
programs developed and implemented by Indian Tribes or 
Tribal Organizations at the local level under the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.). Regional centers shall be integrated 
with the intake and rehabilitation programs based in the 
referring Indian community. 
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‘‘(B) to hire behavioral health professionals; 
‘‘(C) to staff, operate, and maintain an in-
termediate mental health facility, group home, 
sober housing, transitional housing or similar fa-
cilities, or youth shelter where intermediate be-
havioral health services are being provided; 
‘‘(D) to make renovations and hire appro-
priate staff to convert existing hospital beds into 
adolescent psychiatric units; and 
‘‘(E) for intensive home- and community- 
based services. 
‘‘(3) CRITERIA.—The Secretary, acting through 
the Service, shall, in consultation with Indian Tribes 
and Tribal Organizations, establish criteria for the 
review and approval of applications or proposals for 
funding made available pursuant to this subsection. 
‘‘(d) FEDERALLY-OWNED STRUCTURES.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with Indian Tribes and Tribal Organizations, 
shall— 
‘‘(A) identify and use, where appropriate, 
federally-owned structures suitable for local resi-
dential or regional behavioral health treatment 
for Indian youths; and 
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264 
‘‘(B) establish guidelines for determining 
the suitability of any such federally-owned struc-
ture to be used for local residential or regional 
behavioral health treatment for Indian youths. 
‘‘(2) TERMS
AND
CONDITIONS
FOR
USE
OF 
STRUCTURE.—Any structure described in paragraph 
(1) may be used under such terms and conditions as 
may be agreed upon by the Secretary and the agency 
having responsibility for the structure and any In-
dian Tribe or Tribal Organization operating the pro-
gram. 
‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
Indian 
Tribes, or Tribal Organizations, in cooperation with 
the Secretary of the Interior, shall develop and imple-
ment within each Service Unit, community-based re-
habilitation and follow-up services for Indian youths 
who are having significant behavioral health prob-
lems, and require long-term treatment, community re-
integration, and monitoring to support the Indian 
youths after their return to their home community. 
‘‘(2) ADMINISTRATION.—Services under para-
graph (1) shall be provided by trained staff within 
the community who can assist the Indian youths in 
their continuing development of self-image, positive 
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problem-solving skills, and nonalcohol or substance 
abusing behaviors. Such staff may include alcohol 
and substance abuse counselors, mental health profes-
sionals, and other health professionals and para-
professionals, including community health representa-
tives. 
‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT 
PROGRAM.—In providing the treatment and other services 
to Indian youths authorized by this section, the Secretary, 
acting through the Service, Indian Tribes, and Tribal Orga-
nizations, shall provide for the inclusion of family members 
of such youths in the treatment programs or other services 
as may be appropriate. Not less than 10 percent of the funds 
appropriated for the purposes of carrying out subsection (e) 
shall be used for outpatient care of adult family members 
related to the treatment of an Indian youth under that sub-
section. 
‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 
acting through the Service, Indian Tribes, Tribal Organiza-
tions, and Urban Indian Organizations, shall provide, con-
sistent with section 701, programs and services to prevent 
and treat the abuse of multiple forms of substances, includ-
ing alcohol, drugs, inhalants, and tobacco, among Indian 
youths residing in Indian communities, on or near reserva-
tions, and in urban areas and provide appropriate mental 
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266 
health services to address the incidence of mental illness 
among such youths. 
‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec-
retary, acting through the Service, shall collect data for the 
report under section 801 with respect to— 
‘‘(1) the number of Indian youth who are being 
provided mental health services through the Service 
and Tribal Health Programs; 
‘‘(2) a description of, and costs associated with, 
the mental health services provided for Indian youth 
through the Service and Tribal Health Programs; 
‘‘(3) the number of youth referred to the Service 
or Tribal Health Programs for mental health services; 
‘‘(4) the number of Indian youth provided resi-
dential treatment for mental health and behavioral 
problems through the Service and Tribal Health Pro-
grams, reported separately for on- and off-reservation 
facilities; and 
‘‘(5) the costs of the services described in para-
graph (4). 
‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM-
ONSTRATION PROJECT. 
‘‘(a) PURPOSE.—The purpose of this section is to au-
thorize the Secretary to carry out a demonstration project 
to test the use of telemental health services in suicide pre-
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vention, intervention and treatment of Indian youth, in-
cluding through— 
‘‘(1) the use of psychotherapy, psychiatric assess-
ments, diagnostic interviews, therapies for mental 
health conditions predisposing to suicide, and alcohol 
and substance abuse treatment; 
‘‘(2) the provision of clinical expertise to, con-
sultation services with, and medical advice and train-
ing for frontline health care providers working with 
Indian youth; 
‘‘(3) training and related support for community 
leaders, family members and health and education 
workers who work with Indian youth; 
‘‘(4) the development of culturally-relevant edu-
cational materials on suicide; and 
‘‘(5) data collection and reporting. 
‘‘(b) DEFINITIONS.—For the purpose of this section, 
the following definitions shall apply: 
‘‘(1) 
DEMONSTRATION
PROJECT.—The 
term 
‘demonstration project’ means the Indian youth tele-
mental health demonstration project authorized under 
subsection (c). 
‘‘(2) TELEMENTAL
HEALTH.—The term ‘tele-
mental health’ means the use of electronic information 
and telecommunications technologies to support long 
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distance mental health care, patient and professional- 
related education, public health, and health adminis-
tration. 
‘‘(c) AUTHORIZATION.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to award grants under the demonstration project for 
the provision of telemental health services to Indian 
youth who— 
‘‘(A) have expressed suicidal ideas; 
‘‘(B) have attempted suicide; or 
‘‘(C) have mental health conditions that in-
crease or could increase the risk of suicide. 
‘‘(2) ELIGIBILITY
FOR
GRANTS.—Such grants 
shall be awarded to Indian Tribes and Tribal Organi-
zations that operate 1 or more facilities— 
‘‘(A) located in Alaska and part of the Alas-
ka Federal Health Care Access Network; 
‘‘(B) reporting active clinical telehealth ca-
pabilities; or 
‘‘(C) offering school-based telemental health 
services relating to psychiatry to Indian youth. 
‘‘(3) 
GRANT
PERIOD.—The 
Secretary 
shall 
award grants under this section for a period of up to 
4 years. 
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‘‘(4) AWARDING OF GRANTS.—Not more than 5 
grants shall be provided under paragraph (1), with 
priority consideration given to Indian Tribes and 
Tribal Organizations that— 
‘‘(A) serve a particular community or geo-
graphic area where there is a demonstrated need 
to address Indian youth suicide; 
‘‘(B) enter in to collaborative partnerships 
with Indian Health Service or Tribal Health 
Programs or facilities to provide services under 
this demonstration project; 
‘‘(C) serve an isolated community or geo-
graphic area which has limited or no access to 
behavioral health services; or 
‘‘(D) operate a detention facility at which 
Indian youth are detained. 
‘‘(d) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—An Indian Tribe or Tribal 
Organization shall use a grant received under sub-
section (c) for the following purposes: 
‘‘(A) To provide telemental health services 
to Indian youth, including the provision of— 
‘‘(i) psychotherapy; 
‘‘(ii) psychiatric assessments and diag-
nostic interviews, therapies for mental 
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