[Congressional Record Volume 153, Number 118 (Monday, July 23, 2007)]
[Senate]
[Pages S9779-S9781]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REID (for himself, Mr. Kerry, and Mr. Dodd):
  S. 1854. 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; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. REID. Mr. President, I rise today to introduce the Stop Senior 
Suicide Act.
  As many of you know, suicide prevention is an issue close to my heart 
for personal reasons. In 1972, I lost my own father to suicide. Over 
the years that followed, my family did not talk about it and instead 
carried the pain in a very private and lonely way.
  Sadly, this continued until I was contacted by Jerry and Elsie 
Weyrauch from the Suicide Prevention Action Network USA, a national 
advocacy organization focused on suicide prevention. Knowing that I had 
lost my dad to suicide, they asked if I would speak at their second 
annual suicide awareness event. I was also asked to sponsor a suicide 
resolution to focus much needed attention on the issue of suicide in 
America. On May 6, 1997, I introduced such a resolution and saw it pass 
the Senate that same day with unanimous support. I was heartened that 
my work on suicide prevention had begun on this auspicious note, but it 
was also clear that much more work remained to be done.
  Today, 10 years later, I rise to address one of those challenges 
before us: the unacceptably high suicide rates among the elderly. While 
the public is increasingly aware of suicide as a leading cause of death 
in America, what is less well-known is the vulnerability of older 
adults. Suicide is disproportionately a killer of seniors, with the 
risk climbing steadily with age. In fact, the suicide rate for men 85 
years of age and older is the highest of all. Moreover, older adults 
who attempt suicide are much more likely than younger people to carry 
it out to completion.
  As shocks to the national conscience, these statistics point us to 
the despair, hopelessness, and desperation that predispose so many 
seniors to suicide. They also lead to the question: Why are older 
Americans more vulnerable? Compared to other age groups, they often 
must deal with social isolation, financial hardship, and debilitating 
illnesses. We also know that far too many have mental health care needs 
that go unrecognized and unmet. Tragically, one-third of older adults 
who die from suicide had seen their primary care physician in the week 
before their deaths, and 70 percent during the prior month.
  These findings do not just constitute a serious public health 
problem. They also conflict with America's belief in living our golden 
years in dignity. The ``bankruptcy of hope and resources'' affecting 
those at risk ultimately affect us all as a nation.
  I am introducing the Stop Senior Suicide Act to take action on this 
issue. As a start, this legislation would create an Interagency 
Geriatric Mental Health Planning Council to improve the geriatric 
mental health and social services delivery system. Composed of 
representatives from the health Federal agencies and the community of 
older adults, the council will make recommendations and foster the 
integration of mental health, suicide prevention, health, and aging 
services. In doing so, the council will ensure that senior suicide and 
geriatric mental health receive the attention befitting a national 
priority.
  As another step, my legislation would authorize a grant program for 
suicide prevention and early intervention programs focused on seniors. 
Many of the risk factors and challenges facing the elderly, after all, 
are unique. Through these grants, public and private nonprofit entities 
would be able to build innovative approaches and implement them in 
settings that serve seniors, such as Older Americans Act delivery 
sites. To help grantees achieve their goals, the bill also would 
authorize additional funding for the Suicide Prevention Technical 
Assistance Center to offer guidance and training.

  Finally, the Stop Senior Suicide Act would eliminate a major barrier 
to receiving and affording mental health care. Clinical depression and 
suicidal feelings are not a normal part of aging, yet these treatable 
conditions are often misdiagnosed, untreated, or ignored in far too 
many seniors. Out-of-pocket expenses under Medicare, the health 
insurance program for 37 million Americans aged 65 years and older, is 
a key reason. Medicare currently imposes a 50 percent coinsurance 
payment for outpatient mental health services,

[[Page S9780]]

even though it charges just a 20 percent coinsurance for all other 
outpatient care. The resulting coverage inequity discourages 
beneficiaries, especially low-income and fixed-income retirees, from 
seeking mental health treatment. It keeps some from getting treatment 
altogether. The Stop Senior Suicide Act would thus adjust the 50 
percent coinsurance to 20 percent.
  Together, the provisions in the legislation I am introducing today 
are designed to take an important step forward in our efforts to 
prevent senior suicides. That is why the Stop Senior Suicide Act is 
endorsed by the American Association for Geriatric Psychiatry, the 
American Geriatrics Society, the American Psychiatric Association, the 
American Public Health Association, Mental Health America, the National 
Alliance on Mental Illness, the National Association of Social Workers, 
the National Council on Aging, and the Older Women's League. I would 
like to thank the Suicide Prevention Action Network USA in particular 
for all its hard work on this issue.
  Anyone, regardless of age, can be at risk of suicide, but older 
Americans are especially vulnerable. The resulting call to action will 
only grow in importance and urgency as more of America's 77 million 
baby boomers enter their 60s in the coming years. As such, I hope that 
my Senate colleagues will join me in supporting the Stop Senior Suicide 
Act.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1854

       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 of 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) and 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

[[Page S9781]]

       ``(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).
                                 ______