§ 1621h. — Mental health prevention and treatment services.
[Laws in effect as of January 24, 2002]
[Document not affected by Public Laws enacted between
January 24, 2002 and December 19, 2002]
[CITE: 25USC1621h]
TITLE 25--INDIANS
CHAPTER 18--INDIAN HEALTH CARE
SUBCHAPTER II--HEALTH SERVICES
Sec. 1621h. Mental health prevention and treatment services
(a) National plan for Indian Mental Health Services
(1) Not later than 120 days after November 28, 1990, 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.
(b) Memorandum of agreement
Not later than 180 days after November 28, 1990, 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
(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 [25 U.S.C. 2401 et seq.])
with the mental health initiatives pursuant to this chapter,
particularly with respect to the referral and treatment of
dually-diagnosed 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) of this section; and
(8) provide for an annual review of such agreement by the two
Secretaries.
(c) 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) of this section, 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.
(d) 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 [25 U.S.C. 450f et seq.].
(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 section 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) of this section 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) of this section. 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.
(e) Staffing
(1) Within 90 days after November 28, 1990, 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 November 28, 1990, 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 section 13 of this title.
(f) Staff recruitment and retention
(1) The Secretary shall provide for the recruitment of the
additional personnel required by subsection (f) of this section 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 favorable
than those provided for under sections 1616i and 1616j of this
title) 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 1616a of this title) 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 subchapter I of this chapter.
(g) Mental Health Technician program
(1) Under the authority of section 13 of this title, 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 the
traditional Indian health care and treatment practices of the Indian
tribes to be served.
(h) Mental health research
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--
(1) the inter-relationship and inter-dependence of mental
disorders with alcoholism, suicide, homicides, accidents, and the
incidence of family violence, and
(2) the development of models of prevention techniques.
The effect of the inter-relationships and interdependencies referred to
in paragraph (1) on children, and the development of prevention
techniques under paragraph (2) applicable to children, shall be
emphasized.
(i) Facilities assessment
Within one year after November 28, 1990, 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.
(j) 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 President, for inclusion in each report required to
be transmitted to the Congress under section 1671 of this title, a
report on the mental health status of Indians which shall describe the
progress being made to address mental health problems of Indian
communities.
(k) 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.
(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 [25 U.S.C. 450f et seq.], 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) Grants made pursuant to this section may be expended over a
period of three years and no grant may exceed $1,000,000 for the fiscal
years involved.
(l) Licensing requirement for mental health care workers
Any person employed as a psychologist, social worker, or marriage
and family therapist for the purpose of providing mental health care
services to Indians in a clinical setting under the authority of this
chapter or through a contract pursuant to the Indian Self-Determination
Act [25 U.S.C. 450f et seq.] shall--
(1) in the case of a person employed as a psychologist, be
licensed as a clinical psychologist or working under the direct
supervision of a licensed clinical psychologist;
(2) in the case of a person employed as a social worker, be
licensed as a social worker or working under the direct supervision
of a licensed social worker; or
(3) in the case of a person employed as a marriage and family
therapist, be licensed as a marriage and family therapist or working
under the direct supervision of a licensed marriage and family
therapist.
(m) Intermediate adolescent mental health services
(1) The Secretary, acting through the Service, may make grants to
Indian tribes and tribal organizations to provide intermediate mental
health services to Indian children and adolescents, including--
(A) inpatient and outpatient services;
(B) emergency care;
(C) suicide prevention and crisis intervention; and
(D) prevention and treatment of mental illness, and
dysfunctional and self-destructive behavior, including child abuse
and family violence.
(2) Funds provided under this subsection may be used--
(A) to construct or renovate an existing health facility to
provide intermediate mental health services;
(B) to hire mental health professionals;
(C) to staff, operate, and maintain an intermediate mental
health facility, group home, or youth shelter where intermediate
mental health services are being provided; and
(D) to make renovations and hire appropriate staff to convert
existing hospital beds into adolescent psychiatric units.
(3) Funds provided under this subsection may not be used for the
purposes described in section 1621o(b)(1) of this title.
(4) An Indian tribe or tribal organization receiving a grant under
this subsection shall ensure that intermediate adolescent mental health
services are coordinated with other tribal, Service, and Bureau of
Indian Affairs mental health, alcohol and substance abuse, and social
services programs on the reservation of such tribe or tribal
organization.
(5) The Secretary shall establish criteria for the review and
approval of applications for grants made pursuant to this subsection.
(6) There are authorized to be appropriated to carry out this
section $10,000,000 for fiscal year 1993 and such sums as may be
necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998,
1999, and 2000.
(Pub. L. 94-437, title II, Sec. 209, as added Pub. L. 101-630, title V,
Sec. 503(b), Nov. 28, 1990, 104 Stat. 4557; amended Pub. L. 102-573,
title II, Secs. 205, 217(b)(4), title IX, Sec. 902(3), Oct. 29, 1992,
106 Stat. 4547, 4559, 4591.)
References in Text
The Indian Alcohol and Substance Abuse Prevention and Treatment Act
of 1986, referred to in subsec. (b)(6)(A), is subtitle C of title IV of
Pub. L. 99-570, Oct. 27, 1986, 100 Stat. 3207-137, as amended, which is
classified generally to chapter 26 (Sec. 2401 et seq.) of this title.
For complete classification of subtitle C to the Code, see Short Title
note set out under section 2401 of this title and Tables.
The Indian Self-Determination Act, referred to in subsecs.
(d)(2)(C), (3)(A), (k)(3), and (l), is title I of Pub. L. 93-638, Jan.
4, 1975, 88 Stat. 2206, as amended, which is classified principally to
part A (Sec. 450f et seq.) of subchapter II of chapter 14 of this title.
For complete classification of this Act to the Code, see Short Title
note set out under section 450 of this title and Tables.
Amendments
1992--Pub. L. 102-573, Sec. 902(3)(A), made technical amendment to
section catchline.
Subsec. (b). Pub. L. 102-573, Sec. 902(3)(B), redesignated subsec.
(c) as (b). Prior to amendment, no subsec. (b) had been enacted.
Subsec. (c). Pub. L. 102-573, Secs. 217(b)(4)(A), 902(3)(B),
redesignated subsec. (d) as (c) and struck out par. (5) which authorized
appropriations of $500,000 for fiscal year 1991 and $1,000,000 for
fiscal year 1992 to carry out this subsec. Former subsec. (c)
redesignated (b).
Subsec. (d). Pub. L. 102-573, Secs. 217(b)(4)(A), (D), 902(3)(B),
redesignated subsec. (e) as (d), substituted ``this section'' for ``this
subsection'' in par. (3)(B), and struck out par. (6) which authorized
appropriations of $500,000 for fiscal year 1991 and $5,000,000 for
fiscal year 1992 to carry out this subsec., with certain amounts to be
allocated for community education. Former subsec. (d) redesignated (c).
Subsec. (e). Pub. L. 102-573, Sec. 902(3)(B), redesignated subsec.
(f) as (e). Former subsec. (e) redesignated (d).
Subsec. (f). Pub. L. 102-573, Secs. 217(b)(4)(A), 902(3)(B),
redesignated subsec. (g) as (f) and struck out par. (4) which
appropriated $1,200,000 for fiscal year 1992 to carry out this subsec.
Former subsec. (f) redesignated (e).
Subsec. (g). Pub. L. 102-573, Secs. 217(b)(4)(A), 902(3)(B),
redesignated subsec. (h) as (g) and struck out par. (5) which authorized
appropriation of $1,000,000 for fiscal year 1992 for purposes of
providing training required under this subsec. Former subsec. (g)
redesignated (f).
Subsec. (h). Pub. L. 102-573, Secs. 217(b)(4)(B), 902(3)(B),
redesignated subsec. (i) as (h), struck out par. (1) designation before
``The Secretary, acting'', redesignated subpars. (A) and (B) as pars.
(1) and (2), respectively, substituted ``paragraph (1)'' and ``paragraph
(2)'' for ``subparagraph (A)'' and ``subparagraph (B)'', respectively,
in closing provisions, and struck out former par. (2) which authorized
appropriation of $2,000,000 for fiscal year 1992 to carry out this
subsec., to remain available until expended. Former subsec. (h)
redesignated (g).
Subsec. (i). Pub. L. 102-573, Secs. 217(b)(4)(C), 902(3)(B),
redesignated subsec. (j) as (i), struck out par. (1) designation before
``Within one year'', and struck out par. (2) which authorized
appropriation of $500,000 for fiscal year 1992 to make the assessment
required by this subsec. Former subsec. (i) redesignated (h).
Subsec. (j). Pub. L. 102-573, Secs. 205(1), 902(3)(B), redesignated
subsec. (k) as (j) and substituted ``submit to the President, for
inclusion in each report required to be transmitted to the Congress
under section 1671 of this title, a report'' for ``submit to the
Congress an annual report''. Former subsec. (j) redesignated (i).
Subsec. (k). Pub. L. 102-573, Secs. 217(b)(4)(E), 902(3)(B),
redesignated subsec. (l) as (k), and in par. (6) substituted ``section''
for ``subsection'' in second sentence and struck out first sentence
which authorized appropriations of $2,000,000 for fiscal year 1991 and
$3,000,000 for fiscal year 1992 to carry out purposes of this subsec.
Former subsec. (k) redesignated (j).
Subsecs. (l), (m). Pub. L. 102-573, Sec. 205(2), added subsecs. (l)
and (m). Former subsec. (l) redesignated (k).
Statement of Purposes
Section 503(a) of Pub. L. 101-630 provided that: ``The purposes of
this section [enacting 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 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).''
Section Referred to in Other Sections
This section is referred to in sections 1621o, 1621w, 1671 of this
title.
