[Congressional Record Volume 166, Number 169 (Tuesday, September 29, 2020)]
[House]
[Pages H5017-H5019]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




EFFECTIVE SUICIDE SCREENING AND ASSESSMENT IN THE EMERGENCY DEPARTMENT 
                              ACT OF 2019

  Mr. PALLONE. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 4861) to amend the Public Health Service Act to establish a 
program to improve the identification, assessment, and treatment of 
patients in the emergency department who are at risk of suicide, and 
for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4861

       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 ``Effective Suicide Screening 
     and Assessment in the Emergency Department Act of 2020''.

     SEC. 2. PROGRAM TO IMPROVE THE CARE PROVIDED TO PATIENTS IN 
                   THE EMERGENCY DEPARTMENT WHO ARE AT RISK OF 
                   SUICIDE.

       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 new section:

     ``SEC. 399V-7. PROGRAM TO IMPROVE THE CARE PROVIDED TO 
                   PATIENTS IN THE EMERGENCY DEPARTMENT WHO ARE AT 
                   RISK OF SUICIDE.

       ``(a) In General.--The Secretary shall establish a program 
     (in this section referred to as the `Program') to improve the 
     identification, assessment, and treatment of patients in 
     emergency departments who are at risk for suicide, including 
     by--
       ``(1) developing policies and procedures for identifying 
     and assessing individuals who are at risk of suicide; and
       ``(2) enhancing the coordination of care for such 
     individuals after discharge.
       ``(b) Grant Establishment and Participation.--
       ``(1) In general.--In carrying out the Program, the 
     Secretary shall award grants on a competitive basis to not 
     more than 40 eligible health care sites described in 
     paragraph (2).
       ``(2) Eligibility.--To be eligible for a grant under this 
     section, a health care site shall--
       ``(A) submit an application to the Secretary at such time, 
     in such manner, and containing such information as the 
     Secretary may specify;
       ``(B) be a hospital (as defined in section 1861(e) of the 
     Social Security Act);
       ``(C) have an emergency department; and
       ``(D) deploy onsite health care or social service 
     professionals to help connect and integrate patients who are 
     at risk of suicide with treatment and mental health support 
     services.
       ``(3) Preference.--In awarding grants under this section, 
     the Secretary may give preference to eligible health care 
     sites described in paragraph (2) that meet at least one of 
     the following criteria:
       ``(A) The eligible health care site is a critical access 
     hospital (as defined in section 1861(mm)(1) of the Social 
     Security Act).
       ``(B) The eligible health care site is a sole community 
     hospital (as defined in section 1886(d)(5)(D)(iii) of the 
     Social Security Act).
       ``(C) The eligible health care site is operated by the 
     Indian Health Service, by an Indian tribe or tribal 
     organization (as such terms are defined in section 4 of the 
     Indian Self-Determination and Education Assistance Act), or 
     by an urban Indian organization (as defined in section 4 of 
     the Indian Health Care Improvement Act).
       ``(D) The eligible health care site is located in a 
     geographic area with a suicide rate that is higher than the 
     national rate, as determined by the Secretary based on the 
     most recent data from the Centers for Disease Control and 
     Prevention.
       ``(c) Period of Grant.--A grant awarded to an eligible 
     health care site under this section shall be for a period of 
     at least 2 years.
       ``(d) Grant Uses.--
       ``(1) Required uses.--A grant awarded under this section to 
     an eligible health care site shall be used for the following 
     purposes:
       ``(A) To train emergency department health care 
     professionals to identify, assess, and treat patients who are 
     at risk of suicide.
       ``(B) To establish and implement policies and procedures 
     for emergency departments to improve the identification, 
     assessment and treatment of individuals who are at risk of 
     suicide.
       ``(C) To establish and implement policies and procedures 
     with respect to care coordination, integrated care models, or 
     referral to evidence-based treatment to be used upon the 
     discharge from the emergency department of patients who are 
     at risk of suicide.
       ``(2) Additional permissible uses.--In addition to the 
     required uses listed in paragraph (1), a grant awarded under 
     this section to an eligible health care site may be used for 
     any of the following purposes:
       ``(A) To hire emergency department psychiatrists, 
     psychologists, nurse practitioners, counselors, therapists, 
     or other licensed health care and behavioral health 
     professionals specializing in the treatment of individuals at 
     risk of suicide.
       ``(B) To develop and implement best practices for the 
     follow-up care and long-term treatment of individuals who are 
     at risk of suicide.
       ``(C) To increase the availability of and access to 
     evidence-based treatment for individuals who are at risk of 
     suicide, including through telehealth services and strategies 
     to reduce the boarding of these patients in emergency 
     departments.
       ``(D) To offer consultation with and referral to other 
     supportive services that provide evidence-based treatment and 
     recovery for individuals who are at risk of suicide.
       ``(e) Reporting Requirements.--
       ``(1) Reports by grantees.--Each eligible health care site 
     receiving a grant under this section shall submit to the 
     Secretary an annual report for each year for which the grant 
     is received on the progress of the program funded through the 
     grant. Each such report shall include information on--
       ``(A) the number of individuals screened in the site's 
     emergency department for being at risk of suicide;
       ``(B) the number of individuals identified in the site's 
     emergency department as being--
       ``(i) survivors of an attempted suicide; or
       ``(ii) are at risk of suicide;
       ``(C) the number of individuals who are identified in the 
     site's emergency department as being at risk of suicide by a 
     health care or behavioral health professional hired pursuant 
     to subsection (d)(2)(A);
       ``(D) the number of individuals referred by the site's 
     emergency department to other treatment facilities, the types 
     of such other facilities, and the number of such individuals 
     admitted to such other facilities pursuant to such referrals;
       ``(E) the effectiveness of programs and activities funded 
     through the grant in preventing suicides and suicide 
     attempts; and
       ``(F) any other relevant additional data regarding the 
     programs and activities funded through the grant.
       ``(2) Report by secretary.--Not later than one year after 
     the end of fiscal year 2025, the Secretary shall submit to 
     Congress a report that includes--
       ``(A) findings on the Program;
       ``(B) overall patient outcomes achieved through the 
     Program;
       ``(C) an evaluation of the effectiveness of having a 
     trained health care or behavioral health professional onsite 
     to identify, assess, and treat patients who are at risk of 
     suicide; and
       ``(D) a compilation of policies, procedures, and best 
     practices established, developed, or implemented by grantees 
     under this section.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $20,000,000 for 
     the period of fiscal years 2021 through 2025.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Oregon (Mr. Walden) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on H.R. 4861.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield myself such time as I may 
consume.
  I rise today in support of H.R. 4861, the Effective Suicide Screening 
and Assessment in the Emergency Department Act.
  Madam Speaker, suicide is the 10th leading cause of death, now 
claiming more than 47,000 American lives each

[[Page H5018]]

year. Despite national efforts to lower the suicide rate, a number of 
reports show a steady increase in suicides in recent years. In fact, 
over the last two decades, the suicide rate in the U.S. increased 35 
percent. These are clearly alarming trends.
  Like other health crises, the emergency room is often a place where 
people at risk for suicide go for help. Data shows us that the risk of 
a suicide attempt or a death is highest within 30 days of discharge 
from an emergency department or inpatient psychiatric unit.
  Further, over a third of individuals without a diagnosis who died by 
suicide made an emergency room visit within a year of their death. That 
is why we have to act to equip our emergency rooms with better training 
and tools to screen and assess patients at risk for suicide.
  This bill would create a grant program to help emergency departments 
develop policies and procedures for identifying and assessing people 
who are at risk of suicide and enhancing the coordination of care for 
them after discharge. These improvements would be made possible by 
better training, sharing of best practices, and hiring of behavioral 
health professionals in the emergency room who specialize in suicidal 
ideation.
  This bill has support from the American Foundation for Suicide 
Prevention, the American Association of Suicidology, and the American 
College of Emergency Physicians, groups that know these issues up 
close.
  I thank my colleagues, Representative Eliot Engel, who is here, and 
also Representative Gus Bilirakis. They led this important legislation 
to the floor.
  I also thank Ranking Member Walden and all members and staff of our 
committee for their efforts to move the bill.
  Madam Speaker, I urge my colleagues to support the bill, and I 
reserve the balance of my time.
  Mr. WALDEN. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise today in strong support of H.R. 4861. This is 
the Effective Suicide Screening and Assessment in the Emergency 
Department Act that was introduced by Representative Bilirakis, whom we 
will hear from in a minute, and our friend Congressman Engel.
  Before I talk about the legislation, I would say what a joy and 
privilege it has been to serve on the Energy and Commerce Committee 
with Mr. Engel. He is an incredible individual, cares deeply about his 
constituents, and works hard on their behalf.
  Moreover, Congressman Engel has been one of those people who is 
always kind and thoughtful to all of us on both sides of the aisle and 
works to put the interests of Americans first, both on the Energy and 
Commerce Committee and in his incredibly important and powerful role as 
chairman of the Foreign Affairs Committee.
  Congressman Engel has served America and New York well, and while we 
haven't always agreed on every issue, we have never been disagreeable, 
and I wish him and his wife Godspeed in whatever is next in his career.
  This legislation would authorize a grant program to improve the 
identification, screening, assessment, and treatment of patients in 
emergency departments who are at risk for suicide.
  Consideration of this bill could not come at a more pressing and 
important time. As we have said before on these matters, the COVID-19 
pandemic and the resulting economic downturn have impacted the mental 
health and well-being of all Americans. In fact, a recently released 
report by the Well Being Trust and the American Academy of Family 
Physicians predicts that, because of the pandemic, an additional 
150,000 Americans could die of ``deaths from despair,'' meaning deaths 
from suicide or drug or alcohol misuse.
  Emergency departments are key locations to intervene and assist those 
who may be contemplating taking their own lives. As past research 
identified, one in every eight emergency department visits in the U.S. 
was related to a mental health or substance use disorder.
  By creating grants for emergency departments to develop policies for 
screening those at risk of suicide and enhancing their post-discharge 
care coordination, this bill would improve our frontline healthcare 
providers' ability to intervene when someone is in crisis, ultimately 
reducing deaths from despair, especially during this difficult time.
  I would urge my colleagues to join the chairman of the committee and 
myself and our colleagues who put so much time and effort and work into 
crafting this legislation to support it, pass it, and let's get it into 
law.
  Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield such time as he may consume to 
the gentleman from New York (Mr. Engel).
  I do want to say I appreciate, again, Mr. Walden's comments about the 
excellent career of Mr. Engel, but I am also not ready to say good-bye 
to either Mr. Engel or Mr. Walden at this time because we are going to 
be here for a while the next few months.
  Mr. ENGEL. Madam Speaker, I rise in support of H.R. 4861, the 
Effective Suicide Screening and Assessment in the Emergency Department 
Act.
  Before I tell why, I want to thank my good friend Mr. Pallone from 
New Jersey. We came to Congress together a long while ago, and we have 
worked very closely together.
  And I want to thank Mr. Walden. He said I am thoughtful. He is one of 
the most thoughtful Members in Congress. He reaches across the aisle, 
and we have made a lot of great progress, and the country is so much 
better having people with that kind of temperament to reach across the 
aisle. I thank the gentleman for all the kind words. They really mean a 
lot.
  I authored this legislation with my colleague, Gus Bilirakis, to help 
reduce rates of suicide in the United States.
  Suicide is the 10th leading cause of death in the U.S. It claimed 
more than 47,000 lives in 2017, alone.

                              {time}  1600

  According to the National Institute of Mental Health, the suicide 
rate in the U.S. increased by an alarming 31 percent from 2001 to 2017.
  In this time of COVID, where the pandemic has taken an untold 
physical and emotional toll on Americans' health, officials are 
reporting surges in mental and behavioral health problems.
  Studies show that as many as 11 percent of all patients visiting a 
hospital emergency department are at risk for suicide, but only a 
fraction of these at-risk patients are ever identified.
  Our bill aims to improve the identification, assessment, and 
treatment of patients in emergency departments who are at high risk of 
suicide.
  It provides $100 million over a 5-year period to support emergency 
department programs to prevent suicides specifically by:
  Training emergency department clinicians to identify patients with an 
elevated risk of suicide;
  Developing programs to coordinate care and follow-up of those with an 
elevated risk of suicide;
  Supporting the recruitment and retainment of behavioral health 
professionals who specialize in treating individuals with suicidal 
tendencies; and
  Incentivizing the development of new approaches, such as telehealth, 
to help those at high risk of suicide.
  Our legislation has been endorsed by over 40 mental health advocacy 
groups, including: the Emergency Nurses Association, the American 
Nurses Association, the American Psychological Association, the 
American Psychiatric Association, The Kennedy Forum, the National 
Alliance on Mental Illness, and Mental Health America.
  Madam Speaker, I urge my colleagues to support the legislation.
  Mr. WALDEN. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Florida (Mr. Bilirakis), a real leader in the area of 
healthcare and especially mental health services improvement.
  Mr. BILIRAKIS. Mr. Speaker, I appreciate the gentleman yielding.
  I rise today in support of H.R. 4861, the Effective Suicide Screening 
and Assessment in the Emergency Department Act.
  Our Nation remains in the midst of a suicide crisis, Mr. Speaker. 
Over the past several decades, the suicide rate has risen sharply, 
increasing by 31 percent since 2001--this is unacceptable--

[[Page H5019]]

making suicide the 10th leading cause of death and claiming an 
estimated 47,000 lives annually.
  A 2016 study found that 11 percent of all emergency department 
patients exhibited suicidal ideation. However, only 3 percent of those 
patients were diagnosed by current screening tools. Furthermore, about 
70 percent of patients who leave the emergency department after a 
suicide attempt never attend their first outpatient follow-up 
appointment.
  At the same time, emergency departments, which are often the place 
within our healthcare system that provides care for people who are at 
risk for suicide, have inconsistent protocols for screening and 
treating high-risk patients.
  For this reason, I introduced with my friend and colleague, a true 
statesman, Congressman Engel, the Effective Suicide Screening and 
Assessment in the Emergency Department Act.
  The bill creates a voluntary HHS program to assist emergency 
departments in developing protocols for identifying, assessing, and 
treating individuals at risk for suicide, with preference given to 
either critical access hospitals or hospitals located in a geographic 
area with a suicide risk that is higher than the national rate.
  Grants last for 2 years, and grantees must submit a report annually 
on their efforts to improve the identification, assessment, and 
discharge policies for individuals who are at risk for suicide.
  This proactive approach is very vital, because emergency departments 
are often, again, the first and, sadly, too often, the only point of 
contact within the healthcare system for those most at risk for 
suicide, like individuals living with severe mental health conditions 
or substance use disorders.
  With the added physical, mental, emotional, and economic stress this 
pandemic has inflicted on American lives, there is growing data and a 
consensus of concern from public health experts and stakeholders that 
these stressors could lead to even more lives lost to suicide.
  Mr. Speaker, I urge my colleagues to pass the Effective Suicide 
Screening and Assessment in the Emergency Department Act to further 
equip our health providers to recognize and assist these patients in 
crisis.
  Mr. WALDEN. Mr. Speaker, I have no other speakers on our side of the 
aisle, and I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I urge support for the bill, and I yield 
back the balance of my time.
  The SPEAKER pro tempore (Mr. Cuellar). The question is on the motion 
offered by the gentleman from New Jersey (Mr. Pallone) that the House 
suspend the rules and pass the bill, H.R. 4861, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________