184 
‘‘(B) to improve forensic examinations and 
collection; 
‘‘(C) to identify problems or obstacles in 
the prosecution of domestic violence or sexual 
abuse; and 
‘‘(D) to meet other needs or carry out 
other activities required to prevent, treat, and 
improve prosecutions of domestic violence and 
sexual abuse. 
‘‘(2) REPORT.—Not later than 2 years after the 
date of enactment of the Indian Healthcare Im-
provement Act of 2011, the Secretary shall submit 
to the Committee on Indian Affairs of the Senate 
and the Committee on Natural Resources of the 
House of Representatives a report that describes, 
with respect to the matters described in paragraph 
(1), the improvements made and needed, problems 
or obstacles identified, and costs necessary to ad-
dress the problems or obstacles, and any other rec-
ommendations that the Secretary determines to be 
appropriate. 
‘‘SEC. 715. BEHAVIORAL HEALTH RESEARCH. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with appropriate Federal agencies, shall make grants to, 
or enter into contracts with, Indian tribes, tribal organiza-
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tions, and urban Indian organizations or enter into con-
tracts with, or make grants to appropriate institutions for, 
the conduct of research on the incidence and prevalence 
of behavioral health problems among Indians served by the 
Service, Indian tribes, or tribal organizations and among 
Indians in urban areas. Research priorities under this sec-
tion shall include— 
‘‘(1) the multifactorial causes of Indian youth 
suicide, including— 
‘‘(A) protective and risk factors and sci-
entific data that identifies those factors; and 
‘‘(B) the effects of loss of cultural identity 
and the development of scientific data on those 
effects; 
‘‘(2) the interrelationship and interdependence 
of behavioral health problems with alcoholism and 
other substance abuse, suicide, homicides, other in-
juries, and the incidence of family violence; and 
‘‘(3) the development of models of prevention 
techniques. 
‘‘(b) EMPHASIS.—The effect of the interrelationships 
and interdependencies referred to in subsection (a)(2) on 
children, and the development of prevention techniques 
under subsection (a)(3) applicable to children, shall be em-
phasized. 
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‘‘Subtitle B—Indian Youth Suicide 
Prevention 
‘‘SEC. 721. FINDINGS AND PURPOSE. 
‘‘(a) FINDINGS.—Congress finds that— 
‘‘(1)(A) the rate of suicide of American Indians 
and Alaska Natives is 1.9 times higher than the na-
tional average rate; and 
‘‘(B) the rate of suicide of Indian and Alaska 
Native youth aged 15 through 24 is— 
‘‘(i) 3.5 times the national average rate; 
and 
‘‘(ii) the highest rate of any population 
group in the United States; 
‘‘(2) many risk behaviors and contributing fac-
tors for suicide are more prevalent in Indian country 
than in other areas, including— 
‘‘(A) history of previous suicide attempts; 
‘‘(B) family history of suicide; 
‘‘(C) history of depression or other mental 
illness; 
‘‘(D) alcohol or drug abuse; 
‘‘(E) health disparities; 
‘‘(F) stressful life events and losses; 
‘‘(G) easy access to lethal methods; 
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‘‘(H) exposure to the suicidal behavior of 
others; 
‘‘(I) isolation; and 
‘‘(J) incarceration; 
‘‘(3) according to national data for 2005, sui-
cide was the second-leading cause of death for Indi-
ans and Alaska Natives of both sexes aged 10 
through 34; 
‘‘(4)(A) the suicide rates of Indian and Alaska 
Native males aged 15 through 24 are— 
‘‘(i) as compared to suicide rates of males 
of any other racial group, up to 4 times greater; 
and 
‘‘(ii) as compared to suicide rates of fe-
males of any other racial group, up to 11 times 
greater; and 
‘‘(B) data demonstrates that, over their life-
times, females attempt suicide 2 to 3 times more 
often than males; 
‘‘(5)(A) Indian tribes, especially Indian tribes 
located in the Great Plains, have experienced epi-
demic levels of suicide, up to 10 times the national 
average; and 
‘‘(B) suicide clustering in Indian country affects 
entire tribal communities; 
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‘‘(6) death rates for Indians and Alaska Natives 
are statistically underestimated because many areas 
of Indian country lack the proper resources to iden-
tify and monitor the presence of disease; 
‘‘(7)(A) the Indian Health Service experiences 
health professional shortages, with physician vacancy 
rates of approximately 17 percent, and nursing va-
cancy rates of approximately 18 percent, in 2007; 
‘‘(B) 90 percent of all teens who die by suicide 
suffer from a diagnosable mental illness at time of 
death; 
‘‘(C) more than 1⁄2 of teens who die by suicide 
have never been seen by a mental health provider; 
and 
‘‘(D) 1⁄3 of health needs in Indian country re-
late to mental health; 
‘‘(8) often, the lack of resources of Indian 
tribes and the remote nature of Indian reservations 
make it difficult to meet the requirements necessary 
to access Federal assistance, including grants; 
‘‘(9) the Substance Abuse and Mental Health 
Services Administration and the Service have estab-
lished specific initiatives to combat youth suicide in 
Indian country and among Indians and Alaska Na-
tives throughout the United States, including the 
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National Suicide Prevention Initiative of the Service, 
which has worked with Service, tribal, and urban In-
dian health programs since 2003; 
‘‘(10) the National Strategy for Suicide Preven-
tion was established in 2001 through a Department 
of Health and Human Services collaboration 
among— 
‘‘(A) the Substance Abuse and Mental 
Health Services Administration; 
‘‘(B) the Service; 
‘‘(C) the Centers for Disease Control and 
Prevention; 
‘‘(D) the National Institutes of Health; 
and 
‘‘(E) the Health Resources and Services 
Administration; and 
‘‘(11) the Service and other agencies of the De-
partment of Health and Human Services use infor-
mation technology and other programs to address 
the suicide prevention and mental health needs of 
Indians and Alaska Natives. 
‘‘(b) PURPOSES.—The purposes of this subtitle are— 
‘‘(1) to authorize the Secretary to carry out a 
demonstration project to test the use of telemental 
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programs of the Substance Abuse and Mental 
Health Services Administration. 
‘‘SEC. 722. DEFINITIONS. 
‘‘In this subtitle: 
‘‘(1) ADMINISTRATION.—The term ‘Administra-
tion’ means the Substance Abuse and Mental Health 
Services Administration. 
‘‘(2) DEMONSTRATION
PROJECT.—The term 
‘demonstration project’ means the Indian youth tele-
mental health demonstration project authorized 
under section 723(a). 
‘‘(3) TELEMENTAL HEALTH.—The term ‘tele-
mental health’ means the use of electronic informa-
tion and telecommunications technologies to support 
long-distance mental health care, patient and profes-
sional-related education, public health, and health 
administration. 
‘‘SEC. 723. INDIAN YOUTH TELEMENTAL HEALTH DEM-
ONSTRATION PROJECT. 
‘‘(a) AUTHORIZATION.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, is authorized to carry out a 
demonstration project to award grants for the provi-
sion of telemental health services to Indian youth 
who— 
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‘‘(A) have expressed suicidal ideas; 
‘‘(B) have attempted suicide; or 
‘‘(C) have behavioral health conditions that 
increase or could increase the risk of suicide. 
‘‘(2) ELIGIBILITY FOR GRANTS.—Grants under 
paragraph (1) shall be awarded to Indian tribes and 
tribal organizations that operate 1 or more facili-
ties— 
‘‘(A) located in an area with documented 
disproportionately high rates of suicide; 
‘‘(B) reporting active clinical telehealth ca-
pabilities; or 
‘‘(C) 
offering 
school-based 
telemental 
health services to Indian youth. 
‘‘(3) GRANT
PERIOD.—The Secretary shall 
award grants under this section for a period of up 
to 4 years. 
‘‘(4) MAXIMUM
NUMBER
OF
GRANTS.—Not 
more than 5 grants shall be provided under para-
graph (1), with priority consideration given to In-
dian tribes and tribal organizations that— 
‘‘(A) serve a particular community or geo-
graphic area in which there is a demonstrated 
need to address Indian youth suicide; 
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‘‘(B) enter into collaborative partnerships 
with Service or other tribal health programs or 
facilities to provide services under this dem-
onstration project; 
‘‘(C) serve an isolated community or geo-
graphic area that has limited or no access to 
behavioral health services; or 
‘‘(D) operate a detention facility at which 
Indian youth are detained. 
‘‘(5) CONSULTATION WITH ADMINISTRATION.— 
In developing and carrying out the demonstration 
project under this subsection, the Secretary shall 
consult with the Administration as the Federal agen-
cy focused on mental health issues, including suicide. 
‘‘(b) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—An Indian tribe or tribal 
organization shall use a grant received under sub-
section (a) for the following purposes: 
‘‘(A) To provide telemental health services 
to Indian youth, including the provision of— 
‘‘(i) psychotherapy; 
‘‘(ii) psychiatric assessments and di-
agnostic interviews, therapies for mental 
health conditions predisposing to suicide, 
and treatment; and 
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‘‘(iii) alcohol and substance abuse 
treatment. 
‘‘(B) To provide clinician-interactive med-
ical advice, guidance and training, assistance in 
diagnosis and interpretation, crisis counseling 
and intervention, and related assistance to 
Service or tribal clinicians and health services 
providers working with youth being served 
under the demonstration project. 
‘‘(C) To assist, educate, and train commu-
nity leaders, health education professionals and 
paraprofessionals, tribal outreach workers, and 
family members who work with the youth re-
ceiving telemental health services under the 
demonstration project, including with identifica-
tion of suicidal tendencies, crisis intervention 
and suicide prevention, emergency skill develop-
ment, and building and expanding networks 
among those individuals and with State and 
local health services providers. 
‘‘(D) To develop and distribute culturally 
appropriate community educational materials 
regarding— 
‘‘(i) suicide prevention; 
‘‘(ii) suicide education; 
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‘‘(iii) suicide screening; 
‘‘(iv) suicide intervention; and 
‘‘(v) ways to mobilize communities 
with respect to the identification of risk 
factors for suicide. 
‘‘(E) To conduct data collection and re-
porting relating to Indian youth suicide preven-
tion efforts. 
‘‘(2) 
TRADITIONAL
HEALTH
CARE
PRAC-
TICES.—In carrying out the purposes described in 
paragraph (1), an Indian tribe or tribal organization 
may use and promote the traditional health care 
practices of the Indian tribes of the youth to be 
served. 
‘‘(c) APPLICATIONS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
to be eligible to receive a grant under subsection (a), 
an Indian tribe or tribal organization shall prepare 
and submit to the Secretary an application, at such 
time, in such manner, and containing such informa-
tion as the Secretary may require, including— 
‘‘(A) a description of the project that the 
Indian tribe or tribal organization will carry out 
using the funds provided under the grant; 
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‘‘(B) a description of the manner in which 
the project funded under the grant would— 
‘‘(i) meet the telemental health care 
needs of the Indian youth population to be 
served by the project; or 
‘‘(ii) improve the access of the Indian 
youth population to be served to suicide 
prevention and treatment services; 
‘‘(C) evidence of support for the project 
from the local community to be served by the 
project; 
‘‘(D) a description of how the families and 
leadership of the communities or populations to 
be served by the project would be involved in 
the development and ongoing operations of the 
project; 
‘‘(E) a plan to involve the tribal commu-
nity of the youth who are provided services by 
the project in planning and evaluating the be-
havioral health care and suicide prevention ef-
forts provided, in order to ensure the integra-
tion of community, clinical, environmental, and 
cultural components of the treatment; and 
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‘‘(F) a plan for sustaining the project after 
Federal 
assistance 
for 
the 
demonstration 
project has terminated. 
‘‘(2) EFFICIENCY
OF
GRANT
APPLICATION 
PROCESS.—The Secretary shall carry out such meas-
ures as the Secretary determines to be necessary to 
maximize the time and workload efficiency of the 
process by which Indian tribes and tribal organiza-
tions apply for grants under paragraph (1). 
‘‘(d) 
COLLABORATION.—The 
Secretary, 
acting 
through the Service, shall encourage Indian tribes and 
tribal organizations receiving grants under this section to 
collaborate to enable comparisons regarding best practices 
across projects. 
‘‘(e) ANNUAL REPORT.—Each grant recipient shall 
submit to the Secretary an annual report that— 
‘‘(1) describes the number of telemental health 
services provided; and 
‘‘(2) includes any other information that the 
Secretary may require. 
‘‘(f) REPORTS TO CONGRESS.— 
‘‘(1) INITIAL REPORT.— 
‘‘(A) IN GENERAL.—Not later than 2 years 
after the date on which the first grant is award-
ed under this section, the Secretary shall sub-
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mit to the Committee on Indian Affairs of the 
Senate and the Committee on Natural Re-
sources and the Committee on Energy and 
Commerce of the House of Representatives a 
report that— 
‘‘(i) describes each project funded by 
a grant under this section during the pre-
ceding 2-year period, including a descrip-
tion of the level of success achieved by the 
project; and 
‘‘(ii) evaluates whether the demonstra-
tion project should be continued during the 
period beginning on the date of termi-
nation of funding for the demonstration 
project under subsection (g) and ending on 
the date on which the final report is sub-
mitted under paragraph (2). 
‘‘(B) CONTINUATION OF DEMONSTRATION 
PROJECT.—On a determination by the Sec-
retary under clause (ii) of subparagraph (A) 
that the demonstration project should be con-
tinued, the Secretary may carry out the dem-
onstration project during the period described 
in that clause using such sums otherwise made 
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199 
available to the Secretary as the Secretary de-
termines to be appropriate. 
‘‘(2) FINAL REPORT.—Not later than 270 days 
after the date of termination of funding for the dem-
onstration project under subsection (g), the Sec-
retary shall submit to the Committee on Indian Af-
fairs of the Senate and the Committee on Natural 
Resources and the Committee on Energy and Com-
merce of the House of Representatives a final report 
that— 
‘‘(A) describes the results of the projects 
funded by grants awarded under this section, 
including any data available that indicate the 
number of attempted suicides; 
‘‘(B) evaluates the impact of the tele-
mental health services funded by the grants in 
reducing the number of completed suicides 
among Indian youth; 
‘‘(C) evaluates whether the demonstration 
project should be— 
‘‘(i) expanded to provide more than 5 
grants; and 
‘‘(ii) designated as a permanent pro-
gram; and 
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‘‘(D) evaluates the benefits of expanding 
the demonstration project to include urban In-
dian organizations. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$1,500,000 for each of fiscal years 2011 through 2013. 
‘‘SEC. 724. SUBSTANCE ABUSE AND MENTAL HEALTH SERV-
ICES ADMINISTRATION GRANTS. 
‘‘(a) GRANT APPLICATIONS.— 
‘‘(1) EFFICIENCY
OF
GRANT
APPLICATION 
PROCESS.—The Secretary, acting through the Ad-
ministration, shall carry out such measures as the 
Secretary determines to be necessary to maximize 
the time and workload efficiency of the process by 
which Indian tribes and tribal organizations apply 
for grants under any program administered by the 
Administration, including by providing methods 
other than electronic methods of submitting applica-
tions for those grants, if necessary. 
‘‘(2) PRIORITY FOR CERTAIN GRANTS.— 
‘‘(A) IN GENERAL.—To fulfill the trust re-
sponsibility of the United States to Indian 
tribes, in awarding relevant grants pursuant to 
a program described in subparagraph (B), the 
Secretary shall take into consideration the 
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needs of Indian tribes or tribal organizations, 
as applicable, that serve populations with docu-
mented high suicide rates, regardless of whether 
those Indian tribes or tribal organizations pos-
sess adequate personnel or infrastructure to ful-
fill all applicable requirements of the relevant 
program. 
‘‘(B) 
DESCRIPTION
OF
GRANT
PRO-
GRAMS.—A grant program referred to in sub-
paragraph (A) is a grant program— 
‘‘(i) administered by the Administra-
tion to fund activities relating to mental 
health, suicide prevention, or suicide-re-
lated risk factors; and 
‘‘(ii) under which an Indian tribe or 
tribal organization is an eligible recipient. 
‘‘(3) 
CLARIFICATION
REGARDING
INDIAN 
TRIBES
AND
TRIBAL
ORGANIZATIONS.—Notwith-
standing any other provision of law, in applying for 
a grant under any program administered by the Ad-
ministration, no Indian tribe or tribal organization 
shall be required to apply through a State or State 
agency. 
‘‘(4) 
REQUIREMENTS
FOR
AFFECTED 
STATES.— 
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‘‘(A) DEFINITIONS.—In this paragraph: 
‘‘(i) AFFECTED
STATE.—The term 
‘affected State’ means a State— 
‘‘(I) the boundaries of which in-
clude 1 or more Indian tribes; and 
‘‘(II) the application for a grant 
under any program administered by 
the Administration of which includes 
statewide data. 
‘‘(ii) INDIAN POPULATION.—The term 
‘Indian population’ means the total num-
ber of residents of an affected State who 
are Indian. 
‘‘(B) REQUIREMENTS.—As a condition of 
receipt of a grant under any program adminis-
tered by the Administration, each affected State 
shall— 
‘‘(i) describe in the grant applica-
tion— 
‘‘(I) the Indian population of the 
affected State; and 
‘‘(II) the contribution of that In-
dian population to the statewide data 
used by the affected State in the ap-
plication; and 
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‘‘(ii) demonstrate to the satisfaction 
of the Secretary that— 
‘‘(I) of the total amount of the 
grant, the affected State will allocate 
for use for the Indian population of 
the affected State an amount equal to 
the proportion that— 
‘‘(aa) the Indian population 
of the affected State; bears to 
‘‘(bb) the total population of 
the affected State; and 
‘‘(II) the affected State will take 
reasonable efforts to collaborate with 
each Indian tribe located within the 
affected State to carry out youth sui-
cide prevention and treatment meas-
ures for members of the Indian tribe. 
‘‘(C) REPORT.—Not later than 1 year 
after the date of receipt of a grant described in 
subparagraph (B), an affected State shall sub-
mit to the Secretary a report describing the 
measures carried out by the affected State to 
ensure compliance with the requirements of 
subparagraph (B)(ii). 
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‘‘(b) NO NON-FEDERAL SHARE REQUIREMENT.— 
Notwithstanding any other provision of law, no Indian 
tribe or tribal organization shall be required to provide a 
non-Federal share of the cost of any project or activity 
carried out using a grant provided under any program ad-
ministered by the Administration. 
‘‘(c) OUTREACH FOR RURAL AND ISOLATED INDIAN 
TRIBES.—Due to the rural, isolated nature of most Indian 
reservations and communities (especially those reserva-
tions and communities in the Great Plains region), the 
Secretary shall conduct outreach activities, with a par-
ticular emphasis on the provision of telemental health 
services, to achieve the purposes of this subtitle with re-
spect to Indian tribes located in rural, isolated areas. 
‘‘(d) PROVISION OF OTHER ASSISTANCE.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administration, shall carry out such 
measures (including monitoring and the provision of 
required assistance) as the Secretary determines to 
be necessary to ensure the provision of adequate sui-
cide prevention and mental health services to Indian 
tribes described in paragraph (2), regardless of 
whether those Indian tribes possess adequate per-
sonnel or infrastructure— 
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‘‘(A) to submit an application for a grant 
under any program administered by the Admin-
istration, including due to problems relating to 
access to the Internet or other electronic means 
that may have resulted in previous obstacles to 
submission of a grant application; or 
‘‘(B) to fulfill all applicable requirements 
of the relevant program. 
‘‘(2) DESCRIPTION OF INDIAN TRIBES.—An In-
dian tribe referred to in paragraph (1) is an Indian 
tribe— 
‘‘(A) the members of which experience— 
‘‘(i) a high rate of youth suicide; 
‘‘(ii) low socioeconomic status; and 
‘‘(iii) extreme health disparity; 
‘‘(B) that is located in a remote and iso-
lated area; and 
‘‘(C) that lacks technology and commu-
nication infrastructure. 
‘‘(3) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to the Sec-
retary such sums as the Secretary determines to be 
necessary to carry out this subsection. 
‘‘(e) EARLY INTERVENTION AND ASSESSMENT SERV-
ICES.— 
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‘‘(1) DEFINITION
OF
AFFECTED
ENTITY.—In 
this subsection, the term ‘affected entity’ means any 
entity— 
‘‘(A) that receives a grant for suicide inter-
vention, prevention, or treatment under a pro-
gram administered by the Administration; and 
‘‘(B) the population to be served by which 
includes Indian youth. 
‘‘(2) REQUIREMENT.—The Secretary, acting 
through the Administration, shall ensure that each 
affected entity carrying out a youth suicide early 
intervention and prevention strategy described in 
section 520E(c)(1) of the Public Health Service Act 
(42 U.S.C. 290bb–36(c)(1)), or any other youth sui-
cide-related early intervention and assessment activ-
ity, provides training or education to individuals who 
interact frequently with the Indian youth to be 
served by the affected entity (including parents, 
teachers, coaches, and mentors) on identifying warn-
ing signs of Indian youth who are at risk of commit-
ting suicide. 
‘‘SEC. 725. USE OF PREDOCTORAL PSYCHOLOGY AND PSY-
CHIATRY INTERNS. 
‘‘The Secretary shall carry out such activities as the 
Secretary determines to be necessary to encourage Indian 
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tribes, tribal organizations, and other mental health care 
providers to obtain the services of predoctoral psychology 
and psychiatry interns— 
‘‘(1) to increase the quantity of patients served 
by the Indian tribes, tribal organizations, and other 
mental health care providers; and 
‘‘(2) for purposes of recruitment and retention. 
‘‘SEC. 726. INDIAN YOUTH LIFE SKILLS DEVELOPMENT 
DEMONSTRATION PROGRAM. 
‘‘(a) PURPOSE.—The purpose of this section is to au-
thorize the Secretary, acting through the Administration, 
to carry out a demonstration program to test the effective-
ness of a culturally compatible, school-based, life skills 
curriculum for the prevention of Indian and Alaska Native 
adolescent suicide, including through— 
‘‘(1) the establishment of tribal partnerships to 
develop and implement such a curriculum, in co-
operation with— 
‘‘(A) behavioral health professionals, with 
a priority for tribal partnerships cooperating 
with mental health professionals employed by 
the Service; 
‘‘(B) tribal or local school agencies; and 
‘‘(C) parent and community groups; 
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208 
‘‘(2) the provision by the Administration or the 
Service of— 
‘‘(A) technical expertise; and 
‘‘(B) clinicians, analysts, and educators, as 
appropriate; 
‘‘(3) training for teachers, school administra-
tors, and community members to implement the cur-
riculum; 
‘‘(4) the establishment of advisory councils com-
posed of parents, educators, community members, 
trained peers, and others to provide advice regarding 
the curriculum and other components of the dem-
onstration program; 
‘‘(5) the development of culturally appropriate 
support measures to supplement the effectiveness of 
the curriculum; and 
‘‘(6) projects modeled after evidence-based 
projects, such as programs evaluated and published 
in relevant literature. 
‘‘(b) DEMONSTRATION GRANT PROGRAM.— 
‘‘(1) DEFINITIONS.—In this subsection: 
‘‘(A) 
CURRICULUM.—The 
term 
‘cur-
riculum’ means the culturally compatible, 
school-based, life skills curriculum for the pre-
vention of Indian and Alaska Native adolescent 
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