MENTAL HEALTH PREVENTION AND TREATMENT SERVICES.

SEC. 503. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. (a) Purposes.—The purposes of this section are to— (1) authorize and direct the Indian Health Service to develop a comprehensive mental health prevention and treatment program; (2) provide direction and guidance relating to mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, to those Federal, tribal, State, and local agencies responsible for programs in Indian communities in areas of health care, education, social services, child and 104 STAT. 4557 family welfare, alcohol and substance abuse, law enforcement, and judicial services; (3) assist Indian tribes to identify services and resources available to address mental illness and dysfunctional and self--destructive behavior; (4) provide authority and opportunities for Indian tribes to develop and implement, and coordinate with, community-based mental health programs which include identification, prevention, education, referral, and treatment services, including through multidisciplinary resource teams; (5) ensure that Indians, as citizens of the United States and of the States in which they reside, have the same access to mental health services to which all such citizens have access; and (6) modify or supplement existing programs and authorities in the areas identified in paragraph (2). (b) Amendment.—Title II of the Act is amended by adding at the end thereof the following new section: “SEC. 209. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. “(a) National Plan for Indian Mental Health Services.— (1) Not later than 120 days after the date of enactment of this section, the Secretary, acting through the Service, shall develop and publish in the Federal Register a final national plan for Indian Mental Health Services. The plan shall include— “(A) an assessment of the scope of the problem of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians, including— “(i) the number of Indians served by the Service who are directly or indirectly affected by such illness or behavior, and “(ii) an estimate of the financial and human cost attributable to such illness or behavior; “(B) an assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior; and “(C) an estimate of the additional funding needed by the Service to meet its responsibilities under the plan. “(2) The Secretary shall submit a copy of the national plan to the Congress. “(c) Memorandum of Agreement.—Not later than 180 days after the date of enactment of this section, the Secretary and the Secretary of the Interior shall develop and enter into a memorandum of agreement under which the Secretaries shall, among other things— “(1) determine and define the scope and nature of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians; “(2) make an assessment of the existing Federal, tribal, State, local, and private services, resources, and programs available to provide mental health services for Indians; “(3) make an initial determination of the unmet need for additional services, resources, and programs necessary to meet the needs identified pursuant to paragraph (1); “(4) (A) ensure that Indians, as citizens of the United States and of the States in which they reside, have access to mental health services to which all citizens have access; “(B) determine the right of Indians to participate in, and receive the benefit of, such services; and 104 STAT. 4558 “(C) take actions necessary to protect the exercise of such right; “(5) delineate the responsibilities of the Bureau of Indian Affairs and the Service, including mental health identification, prevention, education, referral, and treatment services (including services through multidisciplinary resource teams), at the central, area, and agency and service unit levels to address the problems identified in paragraph (1); “(6) provide a strategy for the comprehensive coordination of the mental health services provided by the Bureau of Indian Affairs and the Service to meet the needs identified pursuant to paragraph (1), including— “(A) the coordination of alcohol and substance abuse programs of the Service, the Bureau of Indian Affairs, and the various tribes (developed under the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986) with the mental health initiatives pursuant to this Act, particularly with respect to the referral and treatment of duallydiagnosed individuals requiring mental health and substance abuse treatment; and “(B) ensuring that Bureau of Indian Affairs and Service programs and services (including multidisciplinary resource teams) addressing child abuse and family violence are coordinated with such non-Federal programs and services; “(7) direct appropriate officials of the Bureau of Indian Affairs and the Service, particularly at the agency and service unit levels, to cooperate fully with tribal requests made pursuant to subsection (d); and “(8) provide for an annual review of such agreement by the two Secretaries. “(d) Community Mental Health Plan.— (1) The governing body of any Indian tribe may, at its discretion, adopt a resolution for the establishment of a community mental health plan providing for the identification and coordination of available resources and programs to identify, prevent, or treat mental illness or dysfunctional and self-destructive behavior, including child abuse and family violence, among its members. “(2) In furtherance of a plan established pursuant to paragraph (1) and at the request of a tribe, the appropriate agency, service unit, or other officials of the Bureau of Indian Affairs and the Service shall cooperate with, and provide technical assistance to, the tribe in the development of such plan. Upon the establishment of such a plan and at the request of the tribe, such officials, as directed by the memorandum of agreement developed pursuant to subsection (c), shall cooperate with the tribe in the implementation of such plan. “(3) Two or more Indian tribes may form a coalition for the adoption of resolutions and the establishment and development of a joint community mental health plan under this subsection. “(4) The Secretary, acting through the Service, may make grants to Indian tribes adopting a resolution pursuant to paragraph (1) to obtain technical assistance for the development of a community mental health plan and to provide administrative support in the implementation of such plan. “(5) There is hereby authorized to be appropriated $500,000 for fiscal year 1991 and $1,000,000 for fiscal year 1992 to carry out this subsection. 104 STAT. 4559 “(e) Mental Health Training and Community Education Programs.— (1) The Secretary and the Secretary of the Interior, in consultation with representatives of Indian tribes, shall conduct a study and compile a list, of the types of staff positions specified in paragraph (2) whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness or dysfunctional and self-destructive behavior. “(2) The positions referred to in paragraph (1) are— “(A) staff positions within the Bureau of Indian Affairs, including existing positions, in the fields of— “(i) elementary and secondary education; “(ii) social services and family and child welfare; “(iii) law enforcement and judicial services; and “(iv) alcohol and substance abuse; “(B) staff positions with the Service; and “(C) staff positions similar to those identified in subparagraphs (A) and (B) established and maintained by Indian tribes, including positions established in contracts entered into under the Indian Self-Determination Act. “(3) (A) The appropriate Secretary shall provide training criteria appropriate to each type of position identified in paragraph (2)(A) and ensure that appropriate training has been, or will be, provided to any individual in any such position. With respect to any such individual in a position identified pursuant to paragraph (2)(C), the respective Secretaries shall provide appropriate training to, or provide funds to an Indian tribe for the training of, such individual. In the case of positions funded under a contract entered into under the Indian Self-Determination Act, the appropriate Secretary shall ensure that such training costs are included in the contract, if necessary. “(B) Funds authorized to be appropriated pursuant to this subsection may be used to provide training authorized by this paragraph for community education programs described in paragraph (5) if a plan adopted pursuant to subsection (d) identifies individuals or employment categories, other than those identified pursuant to paragraph (1), for which such training or community education is deemed necessary or desirable. “(4) Position-specific training criteria described in paragraph (3) shall be culturally relevant to Indians and Indian tribes and shall ensure that appropriate information regarding traditional Indian healing and treatment practices is provided. “(5) The Service shall develop and implement or, upon the request of an Indian tribe, assist such tribe to develop and implement, a program of community education on mental illness and dysfunctional and self-destructive behavior for individuals, as determined in a plan adopted pursuant to subsection (d). In carrying out this paragraph, the Service shall provide, upon the request of an Indian tribe, technical assistance to the Indian tribe to obtain or develop community education and training materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior. “(6) There is hereby authorized to be appropriated— “(A) $500,000 for fiscal year 1991 to carry out this subsection, of which $100,000 shall be allocated for community education under paragraph (5); and 104 STAT. 4560 “(B) $5,000,000 for fiscal year 1992 to carry out this subsection, of which $1,200,000 shall be allocated for community education under paragraph (5). “(f) Staffing.— (1) Within 90 days after the date of enactment of this section, the Secretary shall develop a plan under which the Service will increase the health care staff providing mental health services by at least 500 positions within five years after the date of enactment of this section, with at least 200 of such positions devoted to child, adolescent, and family services. Such additional staff shall be primarily assigned to the service unit level for services which shall include outpatient, emergency, aftercare and follow-up, and prevention and education services. “(2) The plan developed under paragraph (1) shall be implemented under the Act of November 2, 1921 (25 U.S.C. 13) popularly known as the “Snyder Act”. “(g) Staff Recruitment and Retention.— (1) The Secretary shall provide for the recruitment of the additional personnel required by subsection (f) and the retention of all Service personnel providing mental health services. In carrying out this subsection, the Secretary shall give priority to practitioners providing mental health services to children and adolescents with mental health problems. “(2) In carrying out paragraph (1), the Secretary shall develop a program providing for— “(A) the payment of bonuses (which shall not be more favor-able than those provided for under sections 116 and 117) for service in hardship posts; “(B) the repayment of loans (for which the provisions of repayment contracts shall not be more favorable than the repayment contracts under section 108) for health professions education as a recruitment incentive; and “(C) a system of postgraduate rotations as a retention incentive. “(3) This subsection shall be carried out in coordination with the recruitment and retention programs under title I. “(4) There are authorized to be appropriated $1,200,000 for the fiscal year 1992 to carrying out this subsection. “(h) Mental Health Technician Program.— (1) Under the authority of the Snyder Act of November 2, 1921 (25 U.S.C. 13), the Secretary shall establish and maintain a Mental Health Technician program within the Service which— “(A) provides for the training of Indians as mental health technicians; and “(B) employs such technicians in the provision of community- based mental health care that includes identification, prevention, education, referral, and treatment services. “(2) In carrying out paragraph (1)(A), the Secretary 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 curriculum developed or approved by the Secretary which combines education in the theory of mental health care with supervised practical experience in the provision of such care. “(3) The Secretary shall supervise and evaluate the mental health technicians in the training program. “(4) The Secretary shall ensure that the program established pursuant to this subsection involves the utilization and promotion of 104 STAT. 4561the traditional Indian health care and treatment practices of the Indian tribes to be served. “(5) For purposes of providing the training required under this subsection, there are authorized to be appropriated $1,000,000 for the fiscal year 1992, which shall remain available until expended. “(i) Mental Health Research.— (1) The Secretary, acting through the Service and in consultation with the National Institute of Mental Health, shall enter into contracts with, or make grants to, appropriate institutions for the conduct of research on the incidence and prevalence of mental disorders among Indians on Indian reservations and in urban areas. Research priorities under this subsection shall include— “(A) the inter-relationship and inter-dependence of mental disorders with alcoholism, suicide, homicides, accidents, and the incidence of family violence, and “(B) the development of models of prevention techniques. The effect of the inter-relationships and interdependencies referred to in subparagraph (A) on children, and the development of prevention techniques under subparagraph (B) applicable to children, shall be emphasized. “(2) For purposes of carrying out this subsection, there are authorized to be appropriated $2,000,000 for the fiscal year 1992, which shall remain available until expended. “(j) Facilities Assessment.— (1) Within one year after the date of enactment of this section, the Secretary, acting through the Service, shall make an assessment 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 conversion of existing, under-utilized service hospital beds into psychiatric units to meet such need. “(2) There are authorized to be appropriated $500,000 for the fiscal year 1992 to make the assessment required by this subsection. “(k) Annual Report.—The Service shall develop methods for analyzing and evaluating the overall status of mental health programs and services for Indians and shall submit to the Congress an annual report on the mental health status of Indians which shall describe the progress being made to address mental health problems of Indian communities. “(l) Mental Health Demonstration Grant Program.— (1) The Secretary, acting through the Service, is authorized to make grants to Indian tribes and inter-tribal consortia to pay 75 percent of the cost of planning, developing, and implementing programs to deliver innovative community-based mental health services to Indians. The 25 percent tribal share of such cost may be provided in cash or through the provision of property or services. “(2) The Secretary may award a grant for a project under paragraph (1) to an Indian tribe or inter-tribal consortium which meets the following criteria: “(A) The project will address significant unmet mental health needs among Indians. “(B) The project will serve a significant number of Indians. “(C) The project has the potential to deliver services in an efficient and effective manner. “(D) The tribe or consortium has the administrative and financial capability to administer the project. 104 STAT. 4562 “(E) The project will deliver services in a manner consistent with traditional Indian healing and treatment practices. “(F) The project is coordinated with, and avoids duplication of, existing services. “(3) For purposes of this subsection, the Secretary shall, in evaluating applications for grants for projects to be operated under any contract entered into with the Service under the Indian Self--Determination Act, use the same criteria that the Secretary uses in evaluating any other application for such a grant. “(4) The Secretary may only award one grant under this subsection with respect to a service area until the Secretary has awarded grants for all service areas with respect to which the Secretary receives applications during the application period, as determined by the Secretary, which meet the criteria specified in paragraph (2). “(5) Not later than 180 days after the close of the term of the last grant awarded pursuant to this subsection, the Secretary shall submit to the Congress a report evaluating the effectiveness of the innovative community-based projects demonstrated pursuant to this subsection. Such report shall include findings and recommendations, if any, relating to the reorganization of the programs of the Service for delivery of mental health services to Indians. “(6) There is authorized to be appropriated $2,000,000 for fiscal year 1991 and $3,000,000 for fiscal year 1992 to carry out the purposes of this subsection. Grants made pursuant to this subsection may be expended over a period of three years and no grant may exceed $1,000,000 for the fiscal years involved.”.