; and (ii) as compared to suicide rates of females of any other racial group, up to 11 times greater; and (B) data demonstrates that, over their lifetimes, 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 epidemic levels of suicide, up to 10 times the national average; and (B) suicide clustering in Indian country affects entire tribal communities; (6) death rates for Indians and Alaska Natives are statistically underestimated because many areas of Indian country lack the proper resources to identify 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 vacancy 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 relate 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 established specific initiatives to combat youth suicide in Indian country and among Indians and Alaska Natives throughout the United States, including the National Suicide Prevention Initiative of the Service, which has worked with Service, tribal, and urban Indian health programs since 2003; (10) the National Strategy for Suicide Prevention 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