[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.
____________________