[Congressional Record Volume 150, Number 28 (Monday, March 8, 2004)]
[Senate]
[Pages S2305-S2308]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DODD (for himself, Mr. DeWine, Mr. Smith, and Mr. Reid):
  S. 2175. A bill 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, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. DODD. Mr. President, I rise today to speak on an important issue 
that holds great meaning to me--the issue of youth suicide in our 
country.
  Youth suicide is both a public and mental health tragedy--an acute 
crisis that knows no geographic, racial, ethnic, cultural, or 
socioeconomic boundaries. According to the Centers for Disease Control 
and Prevention (CDC), over 3,000 young people take their lives each 
year, making suicide the third overall cause of death between the ages 
of 10 and 24. Young people under the age of 25 accounted for 15 percent 
of all suicides completed in 2000. In fact, more children and young 
adults died from their own hand than from cancer, heart disease, AIDS, 
birth defects, stroke and chronic lung disease combined.
  Equally alarming are the numbers of young people who consider taking 
or attempt to take their lives. Recent CDC figures estimate that almost 
three million high school students, or twenty percent of young adults 
between the ages of 15 and 19, consider suicide every year. And over 
two million children and young adults actually attempt suicide. I find 
these figures to be staggering and simply unacceptable.
  And, sadly, we rarely find these facts disseminated widely amongst 
public audiences. We rarely read them in newspapers or hear them on 
television. We know that youth suicide is intricately linked to mental 
health issues like depression and substance abuse. Yet, we also know 
all too well that both youth suicide and children's mental health 
continue to carry an unfortunate stigma--a stigma that all too often 
keeps these crucial issues unspoken and discourages children and young 
adults from seeking the help they so desperately need.
  We have a societal obligation to break through the stigma attached to 
youth suicide and children's mental health. We have an obligation to 
reach out to our young people--to help them understand that whatever 
difficulties or illnesses they might be experiencing are only temporary 
and treatable in a comfortable setting. And, most importantly, we have 
an obligation to instill in our young people a sense of value, self-
worth, and resilience. All too often, children and young adults 
considering suicide lose sight of themselves, their talents, and their 
potential in life. All too often they lose sight of the love their 
families, friends, and communities have for them.
  I am pleased that our Nation has already taken several positive steps 
toward better understanding the tragedy of youth suicide and its 
emotional and behavioral risk factors. Several recent reports like the 
President's New Freedom Commission on Mental Health, the National 
Strategy for Suicide Prevention, and the Surgeon General's Call to 
Action To Prevent Suicide have made youth suicide a top national public 
and mental health priority. Today, hundreds of community-based programs 
across the country offer a variety of early intervention and prevention 
services to thousands of children and young adults--services that 
include comprehensive screening, assessment, and individualized 
counseling. Nearly thirty states, including my home State of 
Connecticut, have developed or already implemented statewide youth 
suicide early intervention and prevention strategies that coordinate 
appropriate services in schools, juvenile justice systems, foster care 
systems, mental health programs, substance abuse programs, and other 
youth-oriented settings. Furthermore, the Federal Government has 
stepped up its role in both supporting these community-based activities 
and conducting relevant research and data collection. Several mental 
and public health agencies have shown a growing interest in youth 
suicide, including the Substance Abuse and Mental Health Services 
Administration, the Health Resources Services Administration, the 
Centers for Disease Control and Prevention, and the National Institute 
of Mental Health.

  However, despite these important gains, we still face significant 
challenges. Today, a large number of states and localities are finding 
themselves with unprecedented budget deficits--making the establishment 
of new services and the retention of existing services increasingly 
more difficult. Statewide strategies are often underfunded or 
understaffed to be properly effective. And while a number of Federal 
agencies have supported youth suicide

[[Page S2306]]

activities, there has been no comprehensive inter-agency strategy 
implemented to share data, disseminate research, or evaluate the 
efficacy of youth suicide early intervention and prevention programs.
  Today, I am introducing bipartisan legislation with my colleagues 
Senator DeWine and Senator Smith. The Youth Suicide Early Intervention 
and Prevention Act of 2004 will further support the good work being 
done on the community level, the State level, and the Federal level 
with regards to youth suicide. This legislation will support, through 
new grant initiatives, the further development and expansion of 
statewide youth suicide early intervention and prevention strategies 
and the community-based services they seek to coordinate. It will 
encourage greater Federal support in the planning, implementation, and 
evaluation of these strategies and services. And it will create a new 
inter-agency collaboration that will focus on research, policy 
development, and the dissemination of data specifically pertaining to 
youth suicide.
  Finding concrete, comprehensive and effective remedies to the 
epidemic of youth suicide cannot be done by lawmakers on Capitol Hill 
alone. Those remedies must also come from individuals--doctors, 
psychiatrists, psychologists, counselors, nurses, teachers, advocates, 
survivors, and affected families--who are dedicated to this issue or 
spend each day with children and young adults that suffer from 
illnesses related to suicide. I feel that we have made an important 
first step with this legislation today. However, I also know that our 
work is not done. I hope that, as a society, we can continue working 
collectively to both better understand the tragedy of youth suicide and 
develop innovative and effective public and mental health initiatives 
that reach every child and young adult in this country--compassionate 
initiatives that give them encouragement, hope, and above all, life.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2175

       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 ``Youth Suicide Early 
     Intervention and Prevention Expansion Act of 2004''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (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 youth 
     suicide early intervention and prevention strategies that 
     seek to provide effective early intervention and prevention 
     services.

     SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICES ACT.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.) is amended by adding at the end the 
     following:

     ``SEC. 399O. SUICIDE PREVENTION FOR CHILDREN AND ADOLESCENTS.

       ``(a) Youth Suicide Early Intervention and Prevention 
     Strategies.--
       ``(1) In general.--The Secretary shall award grants or 
     cooperative agreements to eligible entities to--
       ``(A) develop and implement statewide 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) collect and analyze data on statewide 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
       ``(C) assist States, through statewide youth suicide early 
     intervention and prevention strategies, in achieving their 
     targets for youth suicide reductions under title V of the 
     Social Security Act (42 U.S.C. 701 et seq.).
       ``(2) Eligible Entity Defined.--In this subsection, the 
     term `eligible entity' means a State, political subdivision 
     of a State, Federally-recognized Indian tribe, tribal 
     organization, public organization, or private nonprofit 
     organization actively involved in youth suicide early 
     intervention and prevention activities and in the development 
     and continuation of statewide youth suicide early 
     intervention and prevention strategies.
       ``(3) Preference.--The Secretary shall give preference to 
     eligible entities that--
       ``(A) provide early intervention services to youth in, 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 engage in an evaluative process the best evidence-based or 
     promising youth suicide early intervention and prevention 
     practices and strategies adapted to the local community;
       ``(D) provide for the timely assessment of youth who are at 
     risk for emotional disorders which may lead to suicide 
     attempts;
       ``(E) provide timely referrals for appropriate community-
     based mental health care and treatment of youth in all child-
     serving settings and agencies who are at risk for suicide;
       ``(F) provide immediate support and information resources 
     to families of youth who are at risk for emotional behavioral 
     disorders which may lead to suicide attempts;
       ``(G) offer equal access to services and care to youth with 
     diverse linguistic and cultural backgrounds;
       ``(H) offer appropriate postvention 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;
       ``(I) 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;
       ``(J) 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;
       ``(K) 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;
       ``(L) provide continuous training activities for child care 
     professionals and community care providers on the latest best 
     evidence-based youth suicide early intervention and 
     prevention services practices and strategies; and
       ``(M) work with interested families and advocacy 
     organizations to conduct annual self-evaluations of outcomes 
     and activities on the State level, according to standards 
     established by the Secretary.
       ``(b) Technical Assistance, Data Management, and 
     Research.--
       ``(1) Technical assistance and data management.--
       ``(A) In general.--The Secretary shall award technical 
     assistance grants and cooperative agreements to State 
     agencies to conduct assessments independently or in 
     collaboration with educational institutions related to the 
     development of statewide youth suicide early intervention and 
     prevention strategies.
       ``(B) Authorized activities.--Grants awarded under 
     subparagraph (A) shall be used to establish programs for the 
     development of standardized procedures for data management, 
     such as--
       ``(i) ensuring the quality surveillance of youth suicide 
     early intervention and prevention strategies;

[[Page S2307]]

       ``(ii) providing technical assistance on data collection 
     and management;
       ``(iii) studying the costs and effectiveness of statewide 
     youth suicide early intervention and prevention strategies in 
     order to answer relevant issues of importance to State and 
     national policymakers;
       ``(iv) further identifying and understanding causes of and 
     associated risk factors for youth suicide;
       ``(v) ensuring the quality surveillance of suicidal 
     behaviors and nonfatal suicidal attempts;
       ``(vi) studying the effectiveness of statewide youth 
     suicide early intervention and prevention strategies on the 
     overall wellness and health promotion strategies related to 
     suicide attempts; and
       ``(vii) promoting the sharing of data regarding youth 
     suicide with Federal agencies involved with youth suicide 
     early intervention and prevention, and statewide 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.
       ``(2) Research.--
       ``(A) In general.--The Secretary shall conduct a program of 
     research and development on the efficacy of new and existing 
     youth suicide early intervention techniques and technology, 
     including clinical studies and evaluations of early 
     intervention methods, and related research aimed at reducing 
     youth suicide and offering support for emotional and 
     behavioral disorders which may lead to suicide attempts.
       ``(B) Disseminating research.--The Secretary shall promote 
     the sharing of research and development data developed 
     pursuant to subparagraph (A) with the Federal agencies 
     involved in youth suicide early intervention and prevention, 
     and entities involved in statewide youth suicide early 
     intervention and prevention strategies for the purpose of 
     applying and integrating new techniques and technology into 
     existing statewide youth suicide early intervention and 
     strategies systems.
       ``(c) Coordination and Collaboration.--
       ``(1) In general.--In carrying out this section, the 
     Secretary shall collaborate and consult with--
       ``(A) other Federal agencies and 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.), and the 
     National Strategy for Suicide Prevention Federal Steering 
     Group;
       ``(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.
       ``(2) Policy development.--The Secretary shall coordinate 
     and collaborate on policy development at the Federal and 
     State levels and with the private sector, including consumer, 
     medical, suicide prevention advocacy groups, and other health 
     and education professional-based organizations, with respect 
     to statewide youth suicide early intervention and prevention 
     strategies.
       ``(e) 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.
       ``(f) Evaluation.--
       ``(1) In general.--The Secretary shall conduct an 
     evaluation to analyze the effectiveness and efficacy of the 
     activities conducted with grants under this section.
       ``(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 the evaluation conducted under paragraph (1).
       ``(g) Definitions.--In this section:
       ``(1) Best evidence-based.--The term `best evidence-based' 
     with respect to programs, means programs that have undergone 
     scientific evaluation and have proven to be effective.
       ``(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) Educational institution.--The term `educational 
     institution' means a high school, vocational school, or an 
     institution of higher education.
       ``(4) 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 or reduces the 
     harm resulting from conditions or behaviors.
       ``(5) School.--The term `school' means a nonprofit 
     institutional day or residential school that provides an 
     elementary, middle, or secondary education, as determined 
     under applicable State law, except that such term does not 
     include any education beyond the 12th grade.
       ``(6) Youth.--The term `youth' means individuals who are 
     between 6 and 24 years of age.
       ``(h) Authorization of Appropriations.--
       ``(1) Statewide youth suicide early intervention and 
     prevention strategies.--For the purpose of carrying out 
     subsection (a), there are authorized to be appropriated 
     $25,000,000 for fiscal year 2004, $25,000,000 for fiscal year 
     2005, $25,000,000 for fiscal year 2006, and such sums as may 
     be necessary for each subsequent fiscal year.
       ``(2) Technical assistance, data management, and 
     research.--For the purpose of carrying out subsection (b), 
     there are authorized to be appropriated $5,000,000 for fiscal 
     year 2003, $5,000,000 for fiscal year 2004, $5,000,000 for 
     fiscal year 2005, and such sums as may be necessary for each 
     subsequent fiscal year.''.

  Mr. DeWINE. Mr. President, today I join my good friends and 
colleagues Senator Chris Dodd and Senator Gordon Smith in introducing 
the Youth Suicide Early Intervention and Prevention Expansion Act of 
2004. As Chairman of the Subcommittee on Substance Abuse and Mental 
Health Services, I recently held a hearing on youth suicide. At that 
hearing, it became painfully clear that we need thorough and actionable 
plans to deal with this tragic issue.
  Statistics tell us that approximately every 2 hours a person under 
the age of 25 commits suicide. We also know that from 1952 to 1995, the 
rate of suicide in children and young adults has tripled and that 
between 1980 and 1997, alone, the rate of suicide in 15 to 19 year olds 
increased by 11 percent. According to the National Institute of Mental 
Health, suicide was the 11th leading cause overall for death in the 
United States in 2001. However, it was the 3rd leading cause of death 
for youth ages 15 to 24. We also know that more boys are killing 
themselves than girls at a ratio of 5 to 1 in the 15 to 19 year old age 
group and at a ratio of 7 to 1 in the 20 to 24 year old age group. 
However, while boys are dying at a higher rate, girls in these age 
groups are attempting at a much higher rate. Estimates suggest that 
there may be from 8 to 25 attempts made for every suicide death.
  These alarming numbers emphasize the need for early intervention and 
prevention efforts. Too often, the signs may be subtle or hidden until 
it is too late. While research has created improved medications and 
methods for helping those with mental health problems to recover, there 
is still much work to be done in the identifying those who need help.
  A great deal of study has focused on identifying and categorizing the 
risk factors related to suicide. In children and youth, these risk 
factors include depression, alcohol or drug use, physical or sexual 
abuse, and disruptive behavior. Of people who die from and who attempt 
suicide, many suffer from co-occurring mental health and substance 
abuse disorders. Children with these risk factors, as well as children 
who are know to be in situations at risk for acquiring them, should be 
included in comprehensive state plans. Children and youth specifically 
addressed in State plans should include those who attend school, 
including colleges and universities, those already receiving substance 
abuse or mental health services, those involved in the juvenile justice 
system, and foster children.
  As a result of the need for increased attention to the problem of 
suicide and access to help, I am pleased to join Senators Dodd and 
Smith in introducing the Youth Suicide Early Intervention and 
Prevention Expansion Act of 2004. With the establishment of a $25 
million grant initiative, this bill would encourage the development of 
statewide youth suicide early intervention and prevention strategies 
that coordinate agencies and non-profits in providing mental health 
services to and screening of youth in a variety of settings. The 
settings would include schools, substance abuse and mental health 
service programs, the juvenile justice system, and foster care 
programs. The bill would also provide $5

[[Page S2308]]

million for relevant technical assistance and research.
  Candidly, State plans for suicide intervention and prevention need to 
be created and expanded to help stop these heartbreaking losses. We 
commend the States that already have created such plans and encourage 
all states to take this important step. I thank Senators Dodd and Smith 
for their leadership on this issue, as well as others like Senator Jack 
Reed, who is dedicated to helping increase and improve much-needed 
mental health services for our Nation's youth.
                                 ______