[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2634 Engrossed in Senate (ES)]
108th CONGRESS
2d Session
S. 2634
_______________________________________________________________________
AN ACT
To amend the Public Health Service Act to support the planning,
implementation, and evaluation of organized activities involving
statewide youth suicide early intervention and prevention strategies,
to provide funds for campus mental and behavioral health service
centers, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Garrett Lee Smith Memorial Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) More children and young adults die from suicide each
year than from cancer, heart disease, AIDS, birth defects,
stroke, and chronic lung disease combined.
(2) Over 4,000 children and young adults tragically take
their lives every year, making suicide the third overall cause
of death between the ages of 10 and 24. According to the
Centers for Disease Control and Prevention suicide is the third
overall cause of death among college-age students.
(3) According to the National Center for Injury Prevention
and Control of the Centers for Disease Control and Prevention,
children and young adults accounted for 15 percent of all
suicides completed in 2000.
(4) From 1952 to 1995, the rate of suicide in children and
young adults has tripled.
(5) From 1980 to 1997, the rate of suicide among young
adults ages 15 to 19 increased 11 percent.
(6) From 1980 to 1997, the rate of suicide among children
ages 10 to 14 increased 109 percent.
(7) According to the National Center of Health Statistics,
suicide rates among Native Americans range from 1.5 to 3 times
the national average for other groups, with young people ages
15 to 34 making up 64 percent of all suicides.
(8) Congress has recognized that youth suicide is a public
health tragedy linked to underlying mental health problems and
that youth suicide early intervention and prevention activities
are national priorities.
(9) Youth suicide early intervention and prevention have
been listed as urgent public health priorities by the
President's New Freedom Commission in Mental Health (2002), the
Institute of Medicine's Reducing Suicide: A National Imperative
(2002), the National Strategy for Suicide Prevention: Goals and
Objectives for Action (2001), and the Surgeon General's Call to
Action To Prevent Suicide (1999).
(10) Many States have already developed comprehensive
Statewide youth suicide early intervention and prevention
strategies that seek to provide effective early intervention
and prevention services.
(11) In a recent report, a startling 85 percent of college
counseling centers revealed an increase in the number of
students they see with psychological problems. Furthermore, the
American College Health Association found that 61 percent of
college students reported feeling hopeless, 45 percent said
they felt so depressed they could barely function, and 9
percent felt suicidal.
(12) There is clear evidence of an increased incidence of
depression among college students. According to a survey
described in the Chronicle of Higher Education (February 1,
2002), depression among freshmen has nearly doubled (from 8.2
percent to 16.3 percent). Without treatment, researchers
recently noted that ``depressed adolescents are at risk for
school failure, social isolation, promiscuity, self medication
with drugs and alcohol, and suicide--now the third leading
cause of death among 10-24 year olds.''.
(13) Researchers who conducted the study ``Changes in
Counseling Center Client Problems Across 13 Years'' (1989-2001)
at Kansas State University stated that ``students are
experiencing more stress, more anxiety, more depression than
they were a decade ago.'' (The Chronicle of Higher Education,
February 14, 2003).
(14) According to the 2001 National Household Survey on
Drug Abuse, 20 percent of full-time undergraduate college
students use illicit drugs.
(15) The 2001 National Household Survey on Drug Abuse also
reported that 18.4 percent of adults aged 18 to 24 are
dependent on or abusing illicit drugs or alcohol. In addition,
the study found that ``serious mental illness is highly
correlated with substance dependence or abuse. Among adults
with serious mental illness in 2001, 20.3 percent were
dependent on or abused alcohol or illicit drugs, while the rate
among adults without serious mental illness was only 6.3
percent.''.
(16) A 2003 Gallagher's Survey of Counseling Center
Directors found that 81 percent were concerned about the
increasing number of students with more serious psychological
problems, 67 percent reported a need for more psychiatric
services, and 63 percent reported problems with growing demand
for services without an appropriate increase in resources.
(17) The International Association of Counseling Services
accreditation standards recommend 1 counselor per 1,000 to
1,500 students. According to the 2003 Gallagher's Survey of
Counseling Center Directors, the ratio of counselors to
students is as high as 1 counselor per 2,400 students at
institutions of higher education with more than 15,000
students.
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICES ACT.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq)
is amended--
(1) in section 520E (42 U.S.C. 290bb-36)--
(A) in the section heading by striking ``CHILDREN
AND ADOLESCENTS'' and inserting ``YOUTH'';
(B) by striking subsection (a) and inserting the
following:
``(a) In General.--The Secretary shall award grants or cooperative
agreements to public organizations, private nonprofit organizations,
political subdivisions, and Federally recognized Indian tribes or
tribal organizations to implement the State-sponsored statewide or
tribal youth suicide early intervention and prevention strategy as
developed under section 596A.'';
(C) in subsection (b), by striking all after
``coordinated'' and inserting ``with the Strategy for
Suicide Prevention Federal Steering Group and the
suicide prevention resource center provided for under
section 596B.'';
(D) in subsection (c)--
(i) in the matter preceding paragraph (1),
by striking ``A State'' and all that follows
through ``desiring'' and inserting ``A public
organization, private nonprofit organization,
political subdivision, and Federally recognized
Indian tribes or tribal organization
desiring'';
(ii) by redesignating paragraphs (1)
through (9) as paragraphs (2) through (10),
respectively;
(iii) by inserting before paragraph (2) (as
so redesignated), the following:
``(1) comply with the State-sponsored statewide early
intervention and prevention strategy as developed under section
596A;'';
(iv) in paragraph (2) (as so redesignated),
by striking ``children and adolescents'' and
inserting ``youth'';
(v) in paragraph (3) (as so redesignated),
by striking ``best evidence-based,'';
(vi) in paragraph (4) (as so redesignated),
by striking ``primary'' and all that follows
and inserting ``general, mental, and behavioral
health services, and substance abuse
services;'';
(vii) in paragraph (5) (as so
redesignated), by striking ``children and'' and
all that follows and inserting ``youth
including the school systems, educational
institutions, juvenile justice system,
substance abuse programs, mental health
programs, foster care systems, and community
child and youth support organizations;'';
(viii) by striking paragraph (8) (as so
redesignated), and inserting the following:
``(8) offer access to services and care to youth with
diverse linguistic and cultural backgrounds;''; and
(ix) by striking paragraph (9) (as so
redesignated), and inserting the following:
``(9) conduct annual self-evaluations of outcomes and
activities, including consulting with interested families and
advocacy organizations;'';
(E) by striking subsection (d) and inserting the
following:
``(d) Use of Funds.--Amounts provided under a grant or cooperative
agreement under this section shall be used to supplement, and not
supplant, Federal and non-Federal funds available for carrying out the
activities described in this section. Applicants shall provide
financial information to demonstrate compliance with this section.'';
(F) in subsection (e)--
(i) by striking ``contract,''; and
(ii) by inserting after ``Secretary that
the'' the following: ``application complies
with the State-sponsored statewide early
intervention and prevention strategy as
developed under section 596A and'';
(G) in subsection (f), by striking ``contracts,'';
(H) in subsection (g)--
(i) by striking ``A State'' and all that
follows through ``organization receiving'' and
inserting ``A public organization, private
nonprofit organization, political subdivision,
and Federally recognized Indian tribes or
tribal organization receiving''; and
(ii) by striking ``contract,'' each place
that such appears;
(I) in subsection (h), by striking ``contracts,'';
(J) in subsection (i)--
(i) by striking ``A State'' and all that
follows through ``organization receiving'' and
inserting ``A public organization, private
nonprofit organization, political subdivision,
and Federally recognized Indian tribes or
tribal organization receiving''; and
(ii) by striking ``contract,'';
(K) in subsection (k), by striking ``5 years'' and
inserting ``3 years'';
(L) in subsection (l)(2), by striking ``21'' and
inserting ``24''; and
(M) in subsection (m)--
(i) by striking ``Appropriation.--'' and
all that follows through ``For'' in paragraph
(1) and inserting ``Appropriation.--For''; and
(ii) by striking paragraph (2);
(2) by inserting after part I (42 U.S.C. 290jj et seq), the
following:
``PART J--SUICIDE EARLY INTERVENTION AND PREVENTION'';
(3) by redesignating section 520E (42 U.S.C. 290bb-36), as
amended by paragraph (1), as section 596 and transferring such
section to part J (as added by paragraph (2)); and
(4) by adding at the end of part J (as added by paragraph
(2) and amended by paragraph (3)), the following:
``SEC. 596A. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION
STRATEGIES, TRAINING, AND TECHNICAL ASSISTANCE.
``(a) Youth Suicide Early Intervention and Prevention Strategies.--
``(1) In general.--The Secretary acting through the
Administrator of the Substance Abuse and Mental Health Services
Administration, shall award grants or cooperative agreements to
eligible entities to--
``(A) develop and implement State-sponsored
statewide or tribal youth suicide early intervention
and prevention strategies in schools, educational
institutions, juvenile justice systems, substance abuse
programs, mental health programs, foster care systems,
and other child and youth support organizations;
``(B) support public organizations and private
nonprofit organizations actively involved in State-
sponsored statewide or tribal youth suicide early
intervention and prevention strategies and in the
development and continuation of State-sponsored
statewide youth suicide early intervention and
prevention strategies;
``(C) collect and analyze data on State-sponsored
statewide or tribal youth suicide early intervention
and prevention services that can be used to monitor the
effectiveness of such services and for research,
technical assistance, and policy development; and
``(D) assist eligible entities, through State-
sponsored statewide or tribal youth suicide early
intervention and prevention strategies, in achieving
targets for youth suicide reductions under title V of
the Social Security Act (42 U.S.C. 701 et seq.).
``(2) Eligible entity.--
``(A) Definition.--In this subsection, the term
`eligible entity' means--
``(i) a State;
``(ii) a public organization or private
nonprofit organization designated by a State to
develop or direct the State-sponsored statewide
youth suicide early intervention and prevention
strategy; and
``(iii) a Federally-recognized Indian tribe
or tribal organization (as defined in the
Indian Self-Determination and Education
Assistance Act) or an urban Indian organization
(as defined in the Indian Health Care
Improvement Act) that is actively involved in
the development and continuation of a tribal
youth suicide early intervention and prevention
strategy.
``(B) Preference.--In awarding grants and
cooperative agreements under this section, the
Secretary shall give preference to States that have
rates of youth suicide that significantly exceed the
national average as determined by the Centers for
Disease Control and Prevention.
``(C) Limitation.--In carrying out this section,
the Secretary shall ensure that each State is awarded
only one grant or cooperative agreement under this
section. For purposes of the preceding sentence, a
State shall be considered to have been awarded a grant
or cooperative agreement if the eligible entity
involved is the State or an entity designated by the
State under subparagraph (A)(ii). Nothing in this
subparagraph shall be construed to apply to entities
described in subparagraph (A)(iii).
``(3) Preference.--In providing assistance under a grant or
cooperative agreement under this subsection, an eligible entity
shall give preference to public organizations, private
nonprofit organizations, political subdivisions, and tribal
organizations actively involved with the State-sponsored
statewide or tribal youth suicide early intervention and
prevention strategy that--
``(A) provide early intervention and assessment
services, including screening programs, to youth who
are at risk for mental or emotional disorders that may
lead to a suicide attempt, and that are integrated
with, school systems, educational institutions,
juvenile justice systems, substance abuse programs,
mental health programs, foster care systems, and other
child and youth support organizations;
``(B) demonstrate collaboration among early
intervention and prevention services or certify that
entities will engage in future collaboration;
``(C) employ or include in their applications a
commitment to evaluate youth suicide early intervention
and prevention practices and strategies adapted to the
local community;
``(D) provide timely referrals for appropriate
community-based mental health care and treatment of
youth who are at risk for suicide in child-serving
settings and agencies;
``(E) provide immediate support and information
resources to families of youth who are at risk for
suicide;
``(F) offer access to services and care to youth
with diverse linguistic and cultural backgrounds;
``(G) offer appropriate post-suicide intervention
services, care, and information to families, friends,
schools, educational institutions, juvenile justice
systems, substance abuse programs, mental health
programs, foster care systems, and other child and
youth support organizations of youth who recently
completed suicide;
``(H) offer continuous and up-to-date information
and awareness campaigns that target parents, family
members, child care professionals, community care
providers, and the general public and highlight the
risk factors associated with youth suicide and the
life-saving help and care available from early
intervention and prevention services;
``(I) ensure that information and awareness
campaigns on youth suicide risk factors, and early
intervention and prevention services, use effective
communication mechanisms that are targeted to and reach
youth, families, schools, educational institutions, and
youth organizations;
``(J) provide a timely response system to ensure
that child-serving professionals and providers are
properly trained in youth suicide early intervention
and prevention strategies and that child-serving
professionals and providers involved in early
intervention and prevention services are properly
trained in effectively identifying youth who are at
risk for suicide;
``(K) provide continuous training activities for
child care professionals and community care providers
on the latest youth suicide early intervention and
prevention services practices and strategies;
``(L) conduct annual self-evaluations of outcomes
and activities, including consulting with interested
families and advocacy organizations; and
``(M) provide services in areas or regions with
rates of youth suicide that exceed the national average
as determined by the Centers for Disease Control and
Prevention.
``(4) Requirement for direct services.--Not less than 85
percent of grant funds received under this subsection shall be
used to provide direct services.
``(b) Suicide Prevention Resource Center; Training and Technical
Assistance.--
``(1) Operation of center.--The Secretary, acting through
the Administrator of the Substance Abuse and Mental Health
Services Administration and in consultation with the National
Strategy for Suicide Prevention Federal Steering Group, shall
award a competitive grant or contract to a public or private
nonprofit entity for the establishment of a Suicide Prevention
Resource Center to carry out the activities described in
paragraph (3).
``(2) Application.--To be eligible for a grant or contract
under paragraph (1), an entity shall prepare and submit to the
Secretary an application at such time, in such manner, and
containing such information as the Secretary may require.
``(3) Authorized activities.--The Suicide Prevention
Resource Center shall provide appropriate information,
training, and technical assistance to States, political
subdivisions of a State, Federally recognized Indian tribes,
tribal organizations, public organizations, or private
nonprofit organizations for--
``(A) the development or continuation of statewide
or tribal youth suicide early intervention and
prevention strategies;
``(B) ensuring the surveillance of youth suicide
early intervention and prevention strategies;
``(C) studying the costs and effectiveness of
statewide youth suicide early intervention and
prevention strategies in order to provide information
concerning relevant issues of importance to State,
tribal, and national policymakers;
``(D) further identifying and understanding causes
and associated risk factors for youth suicide;
``(E) analyzing the efficacy of new and existing
youth suicide early intervention techniques and
technology;
``(F) ensuring the surveillance of suicidal
behaviors and nonfatal suicidal attempts;
``(G) studying the effectiveness of State-sponsored
statewide and tribal youth suicide early intervention
and prevention strategies on the overall wellness and
health promotion strategies related to suicide
attempts;
``(H) promoting the sharing of data regarding youth
suicide with Federal agencies involved with youth
suicide early intervention and prevention, and State-
sponsored statewide or tribal youth suicide early
intervention and prevention strategies for the purpose
of identifying previously unknown mental health causes
and associated risk-factors for suicide in youth; and
``(I) other activities determined appropriate by
the Secretary.
``(5) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, $3,000,000 for
fiscal year 2005, $4,000,000 for fiscal year 2006, and
$5,000,000 for fiscal year 2007.
``(c) Coordination and Collaboration.--
``(1) In general.--In carrying out this section, the
Secretary shall collaborate with the National Strategy for
Suicide Prevention Federal Steering Group and other Federal
agencies responsible for early intervention and prevention
services relating to youth suicide.
``(2) Consultation.--In carrying out this section, the
Secretary shall consult with--
``(A) State and local agencies, including agencies
responsible for early intervention and prevention
services under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.), the State Children's Health
Insurance Program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.), programs
funded by grants under title V of the Social Security
Act (42 U.S.C. 701 et seq.), and programs under part C
of the Individuals with Disabilities Education Act (20
U.S.C. 1431 et seq.);
``(B) local and national organizations that serve
youth at risk for suicide and their families;
``(C) relevant national medical and other health
and education specialty organizations;
``(D) youth who are at risk for suicide, who have
survived suicide attempts, or who are currently
receiving care from early intervention services;
``(E) families and friends of youth who are at risk
for suicide, who have survived suicide attempts, who
are currently receiving care from early intervention
and prevention services, or who have completed suicide;
``(F) qualified professionals who possess the
specialized knowledge, skills, experience, and relevant
attributes needed to serve youth at risk for suicide
and their families; and
``(G) third-party payers, managed care
organizations, and related commercial industries.
``(3) Policy development.--The Secretary shall--
``(A) coordinate and collaborate on policy
development at the Federal level with the National
Strategy for Suicide Prevention Federal Steering Group;
and
``(B) consult on policy development at the Federal
level with the private sector, including consumer,
medical, suicide prevention advocacy groups, and other
health and education professional-based organizations,
with respect to State-sponsored statewide or tribal
youth suicide early intervention and prevention
strategies.
``(d) Rule of Construction; Religious Accommodation.--Nothing in
this section shall be construed to preempt any State law, including any
State law that does not require the suicide early intervention for
youth whose parents or legal guardians object to such early
intervention based on the parents' or legal guardians' religious
beliefs.
``(e) Evaluations and report.--
``(1) Evaluations by eligible entities.--Not later than 18
months after receiving a grant or cooperative agreement under
subsection (a), an eligible entity shall submit to the
Secretary the results of an evaluation to be conducted by the
entity concerning the effectiveness of the activities carried
out under the grant or agreement.
``(2) Report.--Not later than 2 years after the date of
enactment of this section, the Secretary shall submit to the
appropriate committees of Congress a report concerning the
results of--
``(A) the evaluations conducted under paragraph
(1); and
``(B) an evaluation conducted by the Secretary to
analyze the effectiveness and efficacy of the
activities conducted with grants, collaborations, and
consultations under this section.
``(f) Authorization of Appropriations.--For the purpose of carrying
out subsection (a), there are authorized to be appropriated $7,000,000
for fiscal year 2005, $16,000,000 for fiscal year 2006, $25,000,000 for
fiscal year 2007, and such sums as may be necessary for each of fiscal
years 2008 and 2009.
``SEC. 596B. MENTAL AND BEHAVIORAL HEALTH SERVICES ON CAMPUS.
``(a) Purpose.--It is the purpose of this section to increase
access to, and enhance the range of, services for students with mental
and behavioral health problems that can lead to school failure, such as
depression, substance abuse, and suicide attempts, so as to ensure that
college students have the support necessary to successfully complete
their studies.
``(b) Program Authorized.--From funds appropriated under subsection
(j), the Secretary shall award competitive grants to institutions of
higher education to create or expand mental and behavioral health
services to students at such institutions, to provide such services,
and to develop best practices for the delivery of such services. Such
grants shall, subject to the availability of such appropriations, be
for a period of 3 years.
``(c) Eligible Grant Recipients.--Any institution of higher
education that seeks to provide, or provides, mental and behavioral
health services to students is eligible to apply for a grant under this
section. Services may be provided at--
``(1) college counseling centers;
``(2) college and university psychological service centers;
``(3) mental health centers;
``(4) psychology training clinics; and
``(5) institution of higher education supported, evidence-
based, mental health and substance abuse screening programs.
``(d) Applications.--Each institution of higher education seeking
to obtain a grant under this section shall submit an application to the
Secretary. Each such application shall include--
``(1) a description of identified mental and behavioral
health needs of students at the institution of higher
education;
``(2) a description of currently available Federal, State,
local, private, and institutional resources to address the
needs described in paragraph (1) at the institution of higher
education;
``(3) an outline of program objectives and anticipated
program outcomes, including an explanation of how the treatment
provider at the institution of higher education will coordinate
activities under this section with existing programs and
services;
``(4) the anticipated impact of funds provided under this
section in improving the mental and behavioral health of
students attending the institution of higher education;
``(5) outreach strategies, including ways in which the
treatment provider at the institution of higher education
proposes to reach students, promote access to services, and
address the range of needs of students;
``(6) a proposed plan for reaching those students most in
need of services;
``(7) a plan to evaluate program outcomes and assess the
services provided with funds under this section;
``(8) financial information concerning the applicant to
demonstrate compliance with subsection (h); and
``(9) such additional information as is required by the
Secretary.
``(e) Peer Review of Applications.--The Secretary, in consultation
with the Secretary of Education, shall provide the applications
submitted under this section to a peer review panel for evaluation.
With respect to each application, the peer review panel shall recommend
the application for funding or for disapproval.
``(f) Use of Funds.--Funds provided by a grant under this section
may be used for 1 or more of the following activities:
``(1) Prevention, screening, early intervention,
assessment, treatment, management, and education of mental and
behavioral health problems that can lead to school failure,
such as depression, substance abuse, and suicide attempts by
students enrolled at the institution of higher education.
``(2) Education of families to increase awareness of
potential mental and behavioral health issues of students
enrolled at the institution of higher education.
``(3) Hiring staff trained to identify and treat mental and
behavioral health problems, including residents and interns
such as those in psychological doctoral and post doctoral
programs.
``(4) Evaluating and disseminating outcomes and best
practices of mental and behavioral health services.
``(g) Additional required elements.--Each institution of higher
education that receives a grant under this section shall--
``(1) provide annual reports to the Secretary describing
the use of funds, the program's objectives, and how the
objectives were met, including a description of program
outcomes;
``(2) perform such additional evaluations as the Secretary
may require, which may include--
``(A) increases in range of services provided;
``(B) increases in the quality of services
provided;
``(C) increases in access to services;
``(D) college continuation rates;
``(E) decreases in college dropout rates;
``(F) increases in college graduation rates; and
``(G) accepted and valid measurements and
assessments of improved mental health functionality;
and
``(3) coordinate such institution's program under this
section with other related efforts on campus by entities
concerned with the general mental and behavioral health needs
of students.
``(h) Supplement not Supplant.--Grant funds provided under this
section shall be used to supplement, and not supplant, Federal and non-
Federal funds available for carrying out the activities described in
this section. Grantees shall provide financial information to
demonstrate compliance with this subsection.
``(i) Requirement for Direct Services and Limitations.--
``(1) Direct services.--Not less than 75 percent of grant
funds received under this section shall be used to provide
direct services.
``(2) Administrative costs.--Not more than 5 percent of
grant funds received under this section shall be used for
administrative costs.
``(3) Prohibition on use for construction or renovation.--
Grant funds received under this section shall not be used for
construction or renovation of facilities or buildings.
``(j) Authorization of Appropriations.--There are authorized to be
appropriated for grants under this section, $5,000,000 for fiscal year
2005, $7,000,000 for fiscal year 2006, $10,000,000 for fiscal year
2007, and such sums as may be necessary for each fiscal years 2008 and
2009.
``SEC. 596C. DEFINITIONS.
``In this part:
``(1) Early intervention.--The term `early intervention'
means a strategy or approach that is intended to prevent an
outcome or to alter the course of an existing condition.
``(2) Educational institution; institution of higher
education; school.--The term--
``(A) `educational institution' means a school or
institution of higher education;
``(B) `institution of higher education' has the
meaning given such term in section 101 of the Higher
Education Act of 1965; and
``(C) `school' means an elementary or secondary
school (as such terms are defined in section 901 of the
Elementary and Secondary Education Act of 1965).
``(3) Prevention.--The term `prevention' means a strategy
or approach that reduces the likelihood or risk of onset, or
delays the onset, of adverse health problems.
``(4) Youth.--The term `youth' means individuals who are
between 6 and 24 years of age.''.
Passed the Senate July 8, 2004.
Attest:
Secretary.
108th CONGRESS
2d Session
S. 2634
_______________________________________________________________________
AN ACT
To amend the Public Health Service Act to support the planning,
implementation, and evaluation of organized activities involving
statewide youth suicide early intervention and prevention strategies,
to provide funds for campus mental and behavioral health service
centers, and for other purposes.