[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1854 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1854

 To amend the Social Security Act and the Public Health Service Act to 
 improve elderly suicide early intervention and prevention strategies, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 23, 2007

    Mr. Reid (for himself, Mr. Kerry, and Mr. Dodd) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Social Security Act and the Public Health Service Act to 
 improve elderly suicide early intervention and prevention strategies, 
                        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 ``Stop Senior Suicide Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The rate of suicide among older adults is higher than 
        that for any other age group, and the suicide rate for 
        individuals 85 years of age and older is the highest of all. In 
        2004, 6,860 older Americans (age 60 and older) died by suicide 
        (Centers for Disease Control and Prevention, 2007).
            (2) In 2004, the elderly (age 65 and older) made up only 
        12.4 percent of the population but accounted for 16 percent of 
        all suicides.
            (3) According to the Centers for Disease Control and 
        Prevention, from 1980 to 1992, the suicide rate rose 9 percent 
        for Americans 65 years of age and above, and rose 35 percent 
        for men and women ages 80 to 84.
            (4) Older adults have a considerably higher rate of 
        completed suicide than other groups. While for all age groups 
        combined there is one suicide for every 20 attempts, there is 
        one suicide for every 4 attempts among those 65 years of age 
        and older.
            (5) Of the nearly 35,000,000 Americans age 65 and older, it 
        is estimated that 2,000,000 have a depressive illness and 
        another 5,000,000 suffer from depressive symptoms and syndromes 
        that fall short of meeting full diagnostic criteria for a 
        disorder (Mental Health: A Report of the Surgeon General, 
        1999).
            (6) Seniors covered by Medicare are required to pay a 50 
        percent co-pay for outpatient mental health services while they 
        are only required to pay a 20 percent co-pay for physical 
        health services.
            (7) It is estimated that 20 percent of older adults who 
        complete suicide visited a physician within the prior 24 hours, 
        41 percent within the past week, and 75 percent within the past 
        month (Surgeon General's Call to Action to Prevent Suicide, 
        1999).
            (8) A substantial proportion of older patients receive no 
        treatment or inadequate treatment for their depression in 
        primary care settings (National Institutes of Health Consensus 
        Development Panel on Depression in Late Life, 1992; Lebowitz et 
        al., 1997).
            (9) Suicide in older adults is most associated with late-
        onset depression. Among patients 75 years of age and older, 60 
        to 75 percent of suicides have diagnosable depression (Mental 
        Health: A Report of the Surgeon General, 1999).
            (10) Research suggests that many seniors receive mental 
        health assistance from their primary care providers or other 
        helping professionals versus specialty mental health 
        professionals (Mental Health: A Report of the Surgeon General, 
        1999).
            (11) Objective 4.6 of the National Strategy for Suicide 
        Prevention calls for increasing the proportion of State Aging 
        Networks that have evidence-based suicide prevention programs 
        designed to identify and refer for treatment elderly people at 
        risk for suicidal behavior.
            (12) Objective 1.1 of the President's New Freedom 
        Commission on Mental Health calls for advancing and 
        implementing a national campaign to reduce the stigma of 
        seeking care and a national strategy for suicide prevention. 
        The report addresses targeting to distinct and often hard-to-
        reach populations, such as ethnic and racial minorities, older 
        men, and adolescents (NFC Report, 2003).
            (13) One of the top 10 resolutions at the 2005 White House 
        Conference on Aging called for improving the recognition, 
        assessment, and treatment of mental illness and depression 
        among older Americans.

SEC. 3. ESTABLISHMENT OF A FEDERAL INTERAGENCY GERIATRIC MENTAL HEALTH 
              PLANNING COUNCIL.

    (a) In General.--The Secretary of Health and Human Services shall 
establish an Interagency Geriatric Mental Health Planning Council 
(referred to in this section as the ``Council'') to coordinate and 
collaborate on the planning for the delivery of mental health services, 
to include suicide prevention, to older adults.
    (b) Members.--The members of the Council shall include 
representatives of--
            (1) the Substance Abuse and Mental Health Services 
        Administration;
            (2) the Indian Health Service;
            (3) the Health Resources and Services Administration;
            (4) the Centers for Medicare & Medicaid Services;
            (5) the National Institute of Mental Health;
            (6) the National Institute on Aging;
            (7) the Centers for Disease Control and Prevention;
            (8) the Department of Veterans Affairs; and
            (9) older adults, family members of older adults with 
        mental illness, and geriatric mental health experts or 
        advocates for elderly mental health concerns, to be appointed 
        by the Secretary of Health and Human Services in consultation 
        with a national advocacy organization focused on suicide 
        prevention, including senior suicide prevention.
    (c) Co-Chairs.--The Assistant Secretary for Health and the 
Assistant Secretary for Aging of the Department of Health and Human 
Services shall serve as the co-chairs of the Council.
    (d) Activities.--The Council shall--
            (1) carry out an interagency planning process to foster the 
        integration of mental health, suicide prevention, health, and 
        aging services, which is critical for effective service 
        delivery for older adults;
            (2) make recommendations to the heads of relevant Federal 
        agencies to improve the delivery of mental health and suicide 
        prevention services for older adults; and
            (3) submit an annual report to the President and Congress 
        concerning the activities of the Council.

SEC. 4. ELIMINATION OF DISCRIMINATORY COPAYMENT RATES FOR MEDICARE 
              OUTPATIENT MENTAL HEALTH SERVICES.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by striking subsection (c).
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after January 1, 2008.

SEC. 5. ELDERLY SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.

    Title V of the Public Health Service Act is amended by inserting 
after section 520E-2 (42 U.S.C. 290bb-36b) the following:

``SEC. 520E-3. ELDERLY SUICIDE EARLY INTERVENTION AND PREVENTION 
              STRATEGIES.

    ``(a) In General.--The Secretary shall award grants or cooperative 
agreements to eligible entities to develop strategies for addressing 
suicide among the elderly.
    ``(b) Eligible Entities.--To be eligible for a grant or cooperative 
agreement under subsection (a) an entity shall--
            ``(1) be a--
                    ``(A) State or local government agency, a 
                territory, or a federally recognized Indian tribe, 
                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); or
                    ``(B) a public or private nonprofit organization; 
                and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant or cooperative agreement under this section to--
            ``(1) develop and implement elderly suicide early 
        intervention and prevention strategies in 1 or more settings 
        that serve seniors, including senior centers, nutrition sites, 
        primary care settings, veterans' facilities, nursing 
        facilities, assisted living facilities, and aging information 
        and referral sites, such as those operated by area agencies on 
        aging or Aging and Disability Resource Centers (as those terms 
        are defined in section 102 of the Older Americans Act of 1965);
            ``(2) collect and analyze data on elderly suicide early 
        intervention and prevention services for purposes of 
        monitoring, research and policy development; and
            ``(3) assess the outcomes and effectiveness of such 
        services.
    ``(d) Requirements.--An applicant for a grant or cooperative 
agreement under this section shall demonstrate how such applicant 
will--
            ``(1) collaborate with other State and local public and 
        private nonprofit organizations;
            ``(2) offer immediate support, information, and referral to 
        seniors or their families who are at risk for suicide, and 
        appropriate postsuicide intervention services care, and 
        information to families and friends of seniors who recently 
        completed suicide and other interested individuals; and
            ``(3) conduct annual self-evaluations concerning the goals, 
        outcomes, and effectiveness of the activities carried out under 
        the grant or agreement, in consultation with interested 
        families and national advocacy organizations focused on suicide 
        prevention, including senior suicide prevention.
    ``(e) Preference.--In awarding a grant or cooperative agreement 
under this section, the Secretary shall give preference to applicants 
with demonstrated expertise and capability in providing--
            ``(1) early intervention and assessment services, including 
        voluntary screening programs, education, and outreach to 
        elderly who are at risk for mental or emotional disorders that 
        may lead to a suicide attempt and that are integrated with 
        aging services support organizations;
            ``(2) early intervention and prevention practices and 
        strategies adapted to the community it will serve, with equal 
        preference given to applicants that are already serving the 
        same community, and applicants that will serve a new community 
        under a grant or agreement under this section, if the applicant 
        has already demonstrated expertise and capability in providing 
        early intervention and prevention practices and strategies 
        adapted to the community or communities it currently serves;
            ``(3) access to services and care for seniors with diverse 
        linguistic and cultural backgrounds; and
            ``(4) services in States or geographic regions with rates 
        of elder suicide that exceed the national average as determined 
        by the Centers for Disease Control and Prevention.
    ``(f) Requirement for Direct Services.--Not less than 85 percent of 
amounts received under a grant or cooperative agreement under this 
section shall be used to provide direct services.
    ``(g) Coordination and Collaboration.--
            ``(1) In general.--In carrying out this section (including 
        awarding grants and cooperative agreements under subsection 
        (a)), the Secretary shall collaborate with the Interagency 
        Geriatric Mental Health Planning Council.
            ``(2) Consultation.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), in developing and implementing 
                Federal policy to carry out this section, the Secretary 
                shall consult with--
                            ``(i) State and local agencies, including 
                        agencies comprising the aging network;
                            ``(ii) national advocacy organizations 
                        focused on suicide prevention, including senior 
                        suicide prevention;
                            ``(iii) relevant national medical and other 
                        health specialty organizations;
                            ``(iv) seniors who are at risk for suicide, 
                        who have survived suicide attempts, or who are 
                        currently receiving care from early 
                        intervention and prevention services;
                            ``(v) families and friends of seniors who 
                        are at risk for suicide, who have survived 
                        attempts, who are currently receiving care from 
                        early intervention and prevention services, or 
                        who have completed suicide;
                            ``(vi) qualified professionals who possess 
                        the specialized knowledge, skills, experience, 
                        and relevant attributes needed to serve seniors 
                        at risk for suicide and their families; and
                            ``(vii) other entities as determined by the 
                        Secretary.
                    ``(B) Limitation.--The Secretary shall not consult 
                with the entities described in subparagraph (A) for the 
                purpose of awarding grants and cooperative agreements 
                under subsection (a).
    ``(h) Evaluations and Reports.--
            ``(1) Evaluations by grantees.--
                    ``(A) Evaluation design.--Not later than 1 year 
                after receiving a grant or cooperative agreement under 
                this section, an eligible entity shall submit to the 
                Secretary a plan on the design of an evaluation 
                strategy to assess the effectiveness of results of the 
                activities carried out under the grant or agreement.
                    ``(B) Evaluation of effectiveness.--Not later than 
                2 years after receiving a grant or cooperative 
                agreement under this section, an eligible entity shall 
                submit to the Secretary an effectiveness evaluation on 
                the implementation and results of the activities 
                carried out by the eligible entity under the grant or 
                agreement.
            ``(2) Report.--Not later than 3 years after the date that 
        the initial grants or cooperative agreements are awarded to 
        eligible entities under this section, the Secretary shall 
        submit to the appropriate committees of Congress a report 
        describing the projects funded under this section and include 
        an evaluation plan for future activities. The report shall--
                    ``(A) be a coordinated response by all 
                representatives on the Interagency Geriatric Mental 
                Health Advisory Council; and
                    ``(B) include input from consumers and family 
                members of consumers on progress being made and actions 
                that need to be taken.
    ``(i) Definition.--In this section:
            ``(1) Aging network.--The term `aging network' has the 
        meaning given such term in section 102(5) of the Older 
        Americans Act of 1965.
            ``(2) 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.
            ``(3) Prevention.--The term `prevention' means a strategy 
        or approach that reduces the likelihood of risk or onset, or 
        delays the onset, of adverse health problems that have been 
        known to lead to suicide.
            ``(4) Senior.--The term `senior' means--
                    ``(A) an individual who is 60 years of age or older 
                and being served by aging network programs; or
                    ``(B) an individual who is 65 years of age or older 
                and covered under Medicare.
    ``(j) Authorization of Appropriations.---
            ``(1) In general.--For the purpose of carrying out this 
        section there is authorized to be appropriated $4,000,000 for 
        fiscal year 2008, $6,000,000 for fiscal year 2009 and 
        $8,000,000 for fiscal year 2010.
            ``(2) Preference.--If less than $3,500,000 is appropriated 
        for any fiscal year to carry out this section, in awarding 
        grants and cooperative agreements under this section during 
        such fiscal year, the Secretary shall give preference to 
        applicants in States that have rates of elderly suicide that 
        significantly exceed the national average as determined by the 
        Centers for Disease Control and Prevention.''.

SEC. 6. INTERAGENCY TECHNICAL ASSISTANCE CENTER.

    (a) Interagency Research, Training, and Technical Assistance 
Centers.--Section 520C(d) of the Public Health Service Act (42 U.S.C. 
290bb-34(d)) is amended--
            (1) in paragraph (1), by striking ``youth suicide early 
        intervention and prevention strategies'' and inserting 
        ``suicide early intervention and prevention strategies for all 
        ages, particularly for groups that are at a high risk for 
        suicide'';
            (2) in paragraph (2), by striking ``youth suicide early 
        intervention and prevention strategies'' and inserting 
        ``suicide early intervention and prevention strategies for all 
        ages, particularly for groups that are at a high risk for 
        suicide'';
            (3) in paragraph (3)--
                    (A) by striking ``youth''; and
                    (B) by inserting before the semicolon the 
                following: ``for all ages, particularly for groups that 
                are at a high risk for suicide'';
            (4) in paragraph (4), by striking ``youth suicide'' and 
        inserting ``suicide for all ages, particularly among groups 
        that are at a high risk for suicide'';
            (5) in paragraph (5), by striking ``youth suicide early 
        intervention techniques and technology'' and inserting 
        ``suicide early intervention techniques and technology for all 
        ages, particularly for groups that are at a high risk for 
        suicide'';
            (6) in paragraph (7)--
                    (A) by striking ``youth''; and
                    (B) by inserting ``for all ages, particularly for 
                groups that are at a high risk for suicide,'' after 
                ``strategies''; and
            (7) in paragraph (8)--
                    (A) by striking ``youth suicide'' each place that 
                such appears and inserting ``suicide''; and
                    (B) by striking ``in youth'' and inserting ``among 
                all ages, particularly among groups that are at a high 
                risk for suicide''.
    (b) Conforming Amendment.--Section 520C of the Public Health 
Service Act (42 U.S.C. 290bb-34) is amended in the heading by striking 
``youth''.
    (c) Authorization of Appropriations.--
            (1) In general.--In addition to any other funds made 
        available, there are authorized to be appropriated for each of 
        fiscal years 2008 through 2010, such sums as may be necessary 
        to carry out the amendments made by subsection (a).
            (2) Supplement not supplant.--Any funds appropriated under 
        paragraph (1) shall be used to supplement and not supplant 
        other Federal, State, and local public funds expended to carry 
        out other activities under section 520C(d) of the Public Health 
        Service Act (42 U.S.C. 290bb-34(d)) (as amended by subsection 
        (a)).
            (3) Result of increase in funding.--If, as a result of the 
        enactment of this Act, a recipient of a grant under subsection 
        (a)(2) of section 520C of the Public Health Service Act (42 
        U.S.C. 290bb-34) receives an increase in funding to carry out 
        activities under subsection (d) of such section related to 
        suicide prevention and intervention among groups that are at a 
        high risk for suicide, then, notwithstanding any other 
        provision of such section, such recipient shall provide 
        technical assistance to all grantees receiving funding under 
        such section or section 520E-3 of such Act (as added by section 
        5).
                                 <all>