Tribal Level Response

(Please see Appendix II [PDF - 40 KB] for a definition of "Emergent")

In responding to suicide-related events, the federal facility or tribal Indian health program may:

1. Provide a verbal response to all emergent requests for assistance from the federal facility or tribe within one business day upon receipt of the request. A written response shall follow within three days of receiving the request.
2. Direct a copy of all written requests and the initial written response to the IHS Area Behavioral Health Consultant or designee. A copy of the written request shall be sent to the IHS Headquarters DBH Director. A listing of the IHS Area Behavioral Health Consultants can be found in Appendix II.
3. Serve as the initial POC for emergent suicide-related events.
4. Consult with the Area Behavioral Health Consultant or designee and determine the federal facility or tribe’s internal capacity to manage the emergent suicide-related event.
5. Identify a POC. The federal facilities, or tribal POC may monitor the status of the request on a weekly basis to determine the current status of the request. If a response to the request for assistance has not been received from the Area Behavioral Health Consultant or designee within one (1) week, the federal facility, or tribal POC shall then contact the Area Director. If there is no response from the Area Director or designee within one (1) additional week, then the federal facility or tribal POC shall then contact the IHS Headquarters’ DBH Director, or designee for immediate response.

(Please see Appendix II [PDF - 40 KB] for a definition of "Non-Emergent")

In responding to non-emergent requests for assistance for suicide-related events, the federal facility or tribal Indian health program shall:

1. Direct all written requests for non-emergent assistance to the IHS Area Behavioral Health Consultant or designee. A copy of the written request shall be sent to the IHS Headquarters DBH Director.
2. Serve as the initial POC for non-emergent suicide-related events.
3. Consult with the Area Behavioral Health Consultant, or designee, to determine the federal facility, or tribe’s internal capacity to manage the non-emergent suicide-related event.
4. Identify a POC. The federal facility, or tribal POC shall monitor the status of the request. If the designated POC has not received a response from the Area Behavioral Health Consultant, or designee, within two weeks, the federal facility or tribal POC shall then contact the Area Director. If the federal facility or tribal POC does not receive a response from the Area Director or designee within an additional two weeks, the federal facility or tribal POC may then contact the IHS Headquarters DBH Director, or designee, for assistance and response.

(Please see Appendix II [PDF - 40 KB] for a definition of "Emergent")

In responding to suicide-related events, the Area Office may:

1. Provide a verbal response to all emergent requests for assistance.
2. Direct a copy of all written requests and the initial written response to the IHS Area Behavioral Health Consultant or designee.
3. Appoint the Area Behavioral Health Consultant or designee to act as the POC regarding all requests for assistance.
4. Facility, or tribal POC to determine the extent of the emergent event and the level of assistance needed.
5. Ensure the Area Behavioral Health Consultant or designee coordinates all communication and responses if multiple federal facilities or tribes are involved in their Area.
6. Ensure the Area Behavioral Health Consultant or designee reports the status of the request to Area leadership.
7. If indicated, assist the Area Behavioral Health Consultant or designee to travel to meet with the local community and conduct an incident needs assessment. Ensure the Area Behavioral Health Consultant or designee upon his/her return provides a report detailing the recommendations of the incident needs assessment. This report should be submitted to the Area Director.
8. Make a determination that all Area resources have been exhausted or are inadequate to meet the needs. As a result, determination may be required as to whether a higher level of assistance (i.e. funding) is needed. If so, the Area Behavioral Health Consultant or designee may contact their Area Director. This may be followed by a written request for assistance, if available.
9. Make a determination if an emergency deployment of civilian and/or United States Public Health Service is indicated. If such a determination is made, a formal written request for assistance must be provided by the requesting Tribe to the Area Emergency Management POC, and/or to the Area Director. (Please see Appendix VIII for Tribe’s written request format and instructions.) See Appendices VII [PDF - 82 KB] and VIII [PDF  17 KB] for procedures for requests for emergency deployment.

(Please see Appendix II [PDF - 40 KB] for a definition of "Non-Emergent")

In responding to non-emergent requests for assistance for suicide-related events, the Area Office, or designee shall:

1. Assist the Tribe and local federal facility staff in identifying the community’s needs and resources. These resources may include the Tribe and Tribal community, local Indian health programs, County, State, Federal, private, and non-profit resources.
2. Provide technical assistance to the community (i.e. conduct an incident needs assessment, if indicated). Please see Appendix V [PDF - 48 KB] for a sample community assessment process.

(Please see Appendix II [PDF - 40 KB] for a definition of "Emergent")

In responding to suicide-related events, the IHS Headquarters may:

1. Provide verbal responses to all written emergent requests for assistance
2. Appoint the IHS Area Director or designee to act as the POC regarding all requests for assistance.
3. Report, through the IHS Area Director or designee, on the status of the request and response monthly or as needed to the IHS Director.
4. Notify the Area Director and Behavioral Health Consultant of any request for assistance, which comes directly from the Tribe and/or federal facility. A copy of the written request shall be sent to the Area Director and Behavioral Health Consultant, requesting a response be provided, in accordance with "The Area Office Response Protocol" (see above).

(Please see Appendix II [PDF - 40 KB] for a definition of "Non-Emergent")

In responding to non-emergent requests for assistance for suicide-related events, the IHS Headquarters, through the IHS Area offices, shall:

1. Consult the Area Behavioral Health Consultant on the community needs and resources.
2. Consult the Area Behavioral Health Consultant regarding the provision of technical assistance to the community.
3. Review the Area Behavioral Health Consultant monthly status reports including potential suicide crisis or clusters identified by the Area Behavioral Health Consultant communicated through the Area Director.

(Please see Appendix II [PDF - 40 KB] for a definition of "Emergent")

In responding to suicide-related events, the IHS recommends that Tribes and/or Tribal Organizations may:

1. Notify the Area Director through a written request when it has been determined that the Tribal community’s resources have been overwhelmed by the suicide-related event and/or the resources have been exhausted. A courtesy copy of the written request may be sent to the IHS Director.
2. Identify a Tribal POC. The POC’s role is to report on the status of the response to the request to the Tribal leadership.
3. If a response has not been received from the Area Director, then the Tribe or Tribal Organization may then contact the Area BH consultant.

(Please see Appendix II [PDF - 40 KB] for a definition of "Non-Emergent")

In responding to non-emergent requests for assistance for suicide-related events, the IHS recommends that Tribes and/or Tribal Organizations may:

1. Submit a written request to the Area Director.
2. Follow-up with the Area Director if a response has not been received.
3. If a response has not been received from the Area Director, then the Tribe or Tribal Organization may then contact the Area BH consultant or designee for immediate assistance and response.