1.This Act may be cited as
the Stop Senior Suicide
Act
.
2.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.
3.Establishment of
a Federal Interagency Geriatric Mental Health Planning Council
(a)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)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)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)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.
4.Elimination of
discriminatory copayment rates for medicare outpatient mental health
services
(a)Section 1833 of the Social Security Act (42 U.S.C. 1395l)
is amended by striking subsection (c).
(b)The amendment made by subsection (a) shall apply to items
and services furnished on or after January 1, 2008.
5.Elderly suicide
early intervention and prevention strategiesTitle V of the Public Health Service Act is
amended by inserting after section 520E–2 (42 U.S.C. 290bb–36b) the
following:
520E–3.Elderly
suicide early intervention and prevention strategies
(a)The Secretary shall award grants or cooperative
agreements to eligible entities to develop strategies for addressing suicide
among the elderly.
(b)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)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)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)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 servicesNot 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 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)
(A)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)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)
(1)
(A)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
effectivenessNot 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)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)In
this section:
(1)The term aging network has the meaning given
such term in section 102(5) of the Older Americans Act of 1965.
(2)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)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)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)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)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.
.
6.Interagency
technical assistance center
(a)Interagency
research, training, and technical assistance centersSection
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)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 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)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 fundingIf, 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).