[House Report 110-55]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-55
======================================================================
JOSHUA OMVIG VETERANS SUICIDE PREVENTION ACT
_______
March 20, 2007.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
together with
ADDITIONAL VIEWS
[To accompany H.R. 327]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 327) to direct the Secretary of Veterans Affairs to
develop and implement a comprehensive program designed to
reduce the incidence of suicide among veterans, having
considered the same, report favorably thereon with amendments
and recommend that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Legislative History.............................................. 4
Section-by-Section............................................... 4
Committee Consideration.......................................... 5
Rollcall Votes................................................... 6
Application of Law to the Legislative Branch..................... 6
Statement of Oversight Findings and Recommendations of the
Committee...................................................... 6
Statement of General Performance Goals and Objectives............ 6
Constitutional Authority Statement............................... 6
Federal Advisory Committee Act................................... 6
Unfunded Mandate Statement....................................... 6
Earmark Identification........................................... 6
Committee Estimate............................................... 6
Budget Authority and Congressional Budget Office Cost Estimate... 7
Changes in Existing Law Made by the Bill as Reported............. 8
Additional Views................................................. 11
Committee Correspondence......................................... 13
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Joshua Omvig Veterans Suicide
Prevention Act''.
SEC. 2. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) suicide among veterans suffering from post-traumatic
stress disorder (in this section referred to as ``PTSD'') is a
serious problem; and
(2) the Secretary of Veterans Affairs should take into
consideration the special needs of veterans suffering from PTSD
and the special needs of elderly veterans who are at high risk
for depression and experience high rates of suicide in
developing and implementing the comprehensive program under
this Act.
SEC. 3. COMPREHENSIVE PROGRAM FOR SUICIDE PREVENTION AMONG VETERANS.
(a) In General.--
(1) Comprehensive program for suicide prevention among
veterans.--Chapter 17 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 1720F. Comprehensive program for suicide prevention among
veterans
``(a) Establishment.--The Secretary shall develop and carry out a
comprehensive program designed to reduce the incidence of suicide among
veterans incorporating the components described in this section.
``(b) Staff Education.--In carrying out the comprehensive program
under this section, the Secretary shall provide for mandatory training
for appropriate staff and contractors (including all medical personnel)
of the Department who interact with veterans. This training shall cover
information appropriate to the duties being performed by such staff and
contractors. The training shall include information on--
``(1) recognizing risk factors for suicide;
``(2) proper protocols for responding to crisis situations
involving veterans who may be at high risk for suicide; and
``(3) best practices for suicide prevention.
``(c) Screening of Veterans Receiving Medical Care.--In carrying out
the comprehensive program, the Secretary shall provide for screening of
veterans who receive medical care at a Department medical facility
(including a center established under section 1712A of this title) for
risk factors for suicide.
``(d) Tracking of Veterans.--In carrying out the comprehensive
program, the Secretary shall provide for appropriate tracking of
veterans.
``(e) Counseling and Treatment of Veterans.--In carrying out the
comprehensive program, the Secretary shall provide for referral of
veterans at risk for suicide for appropriate counseling and treatment.
``(f) Designation of Suicide Prevention Counselors.--In carrying out
the comprehensive program, the Secretary shall designate a suicide
prevention counselor at each Department medical facility other than
centers established under section 1712A of this title. Each counselor
shall work with local emergency rooms, police departments, mental
health organizations, and veterans service organizations to engage in
outreach to veterans and improve the coordination of mental health care
to veterans.
``(g) Best Practices Research.--In carrying out the comprehensive
program, the Secretary shall provide for research on best practices for
suicide prevention among veterans. Research shall be conducted under
this subsection in consultation with the heads of the following
entities:
``(1) The Department of Health and Human Services.
``(2) The National Institute of Mental Health.
``(3) The Substance Abuse and Mental Health Services
Administration.
``(4) The Centers for Disease Control and Prevention.
``(h) Sexual Trauma Research.--In carrying out the comprehensive
program, the Secretary shall provide for research on mental health care
for veterans who have experienced sexual trauma while in military
service. The research design shall include consideration of veterans of
a reserve component.
``(i) 24-Hour Mental Health Care.--In carrying out the comprehensive
program, the Secretary shall provide for mental health care
availability to veterans on a 24-hour basis.
``(j) Hotline.--In carrying out the comprehensive program, the
Secretary may provide for a toll-free hotline for veterans to be
staffed by appropriately trained mental health personnel and available
at all times.
``(k) Outreach and Education for Veterans and Families.--In carrying
out the comprehensive program, the Secretary shall provide for outreach
to and education for veterans and the families of veterans, with
special emphasis on providing information to veterans of Operation
Iraqi Freedom and Operation Enduring Freedom and the families of such
veterans. Education to promote mental health shall include information
designed to--
``(1) remove the stigma associated with mental illness;
``(2) encourage veterans to seek treatment and assistance for
mental illness;
``(3) promote skills for coping with mental illness; and
``(4) help families of veterans with--
``(A) understanding issues arising from the
readjustment of veterans to civilian life;
``(B) identifying signs and symptoms of mental
illness; and
``(C) encouraging veterans to seek assistance for
mental illness.
``(l) Peer Support Counseling Program.--(1) In carrying out the
comprehensive program, the Secretary shall establish and carry out a
peer support counseling program, under which veterans shall be
permitted to volunteer as peer counselors--
``(A) to assist other veterans with issues related to
mental health and readjustment; and
``(B) to conduct outreach to veterans and the
families of veterans.
``(2) In carrying out the peer support counseling program under this
subsection, the Secretary shall provide adequate training for peer
counselors.
``(m) Other Components.--In carrying out the comprehensive program,
the Secretary may provide for other actions to reduce the incidence of
suicide among veterans that the Secretary deems appropriate.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new item:
``1720F. Comprehensive program for suicide prevention among
veterans.''.
(b) Report to Congress.--
(1) Report required.--Not later than 90 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall submit to Congress a report on the comprehensive program
under section 1720A of title 38, United States Code, as added
by subsection (a).
(2) Contents of report.--The report shall contain the
following:
(A) Information on the status of the implementation
of such program.
(B) Information on the time line and costs for
complete implementation of the program within two
years.
(C) A plan for additional programs and activities
designed to reduce the occurrence of suicide among
veterans.
(D) Recommendations for further legislation or
administrative action that the Secretary considers
appropriate to improve suicide prevention programs
within the Department of Veterans Affairs.
Amend the title so as to read:
A bill to amend title 38, United States Code, to direct the
Secretary of Veterans Affairs to develop and implement a
comprehensive program designed to reduce the incidence of
suicide among veterans.
Purpose and Summary
H.R. 327, the Joshua Omvig Veterans Suicide Prevention Act,
was introduced on January 9, 2007, by Representative Leonard L.
Boswell. The legislation would improve the ability of the
Department of Veterans Affairs to develop and implement a
comprehensive program designed to reduce the incidence of
suicide among veterans.
Background and Need for Legislation
Over the course of combat operations in Afghanistan
(Operation Enduring Freedom--OEF) and Iraq (Operation Iraqi
Freedom--OIF), there has been a growing concern with the number
of suicides that have occurred in the OEF/OIF soldier and
veteran population. The Mental Health Advisory Team (MHAT--
III), established by the Office of the Surgeon General, United
States Army Medical Command, at the request of the Office of
the Surgeon, Multinational Force-Iraq, issued a report on May
29, 2006, that found that for calendar year 2005, the suicide
rate for the OIF area of operations was 19.9 per 100,000
soldiers. That rate is considerably higher than the national
average, and the Army's overall reported rate of 13.1 per
100,000.
The stress of combat, along with the stigma that exists for
soldiers and veterans seeking mental health care, can intensify
and trigger a complex set of behaviors that may lead to
thoughts of suicide. It is vital that suicide prevention,
education, and awareness programs be strengthened throughout
the VA health care system. Just recently, VA announced that
research concerning suicides among OEF/OIF returnees was
underway and that it was implementing a comprehensive education
and training effort within local communities, as well as at VA
facilities.
H.R. 327 addresses this need to strengthen suicide
prevention, education, and awareness programs within the VA by
mandating a comprehensive program for suicide prevention among
veterans.
Legislative History
H.R. 327, the Joshua Omvig Veterans Suicide Prevention Act,
was introduced by Representative Leonard Boswell, on January 9,
2007, and was referred to the Committee on Veterans' Affairs.
H.R. 327 resembles legislation introduced in the 109th Congress
in both the House and the Senate. Senator Harkin of Iowa has
also introduced a version of the Joshua Omvig Suicide
Prevention Act, S. 479, on February 1, 2007.
On March 13, 2007, the Subcommittee on Health reported H.R.
327 to the full Committee on Veterans' Affairs.
The Committee held a markup to consider H.R. 327 on March
15, 2007, and ordered the bill reported by a voice vote.
Section-by-Section
This bill would direct the Department of Veterans Affairs
(VA) to develop and implement a comprehensive program to reduce
the incidence of suicide among veterans.
Section 1. Short title
This section would provide the short title of H.R. 327 as
the ``Joshua Omvig Veterans Suicide Prevention Act.''
Section 2. Sense of Congress
This section would express the sense of Congress that
suicide among veterans suffering from post-traumatic stress
disorder (PTSD) is a serious problem. This section also
expresses that it is the sense of Congress that the Secretary
of Veterans Affairs should take into consideration the special
needs of veterans suffering from PTSD and the special needs of
elderly veterans who are at a high risk for depression and
experience high rates of suicide in developing and implementing
the comprehensive program under this Act
Section 3. Comprehensive program for suicide prevention among veterans
This section would provide that VA shall develop a
comprehensive program that includes the components described in
Section 4.
Section 4. Components of program
Subsection (a) would require the VA to provide education
and training for VA staff, contractors, and medical personnel
who have interaction with veterans.
Subsection (b) would direct the VA to regularly screen and
monitor all veterans who receive medical care in the VA health
care system for risk factors for suicide and to provide for
referral of veterans at risk for suicide for appropriate
counseling and treatment.
Subsection (c) would require the VA to provide for the
appropriate tracking of veterans.
Subsection (d) would direct the VA to provide for referral
of veterans at risk for suicide for appropriate counseling and
treatment.
Subsection (e) would require the VA to designate a suicide
prevention counselor at each VAMC.
Subsection (f) would mandate that VA to research the best
practices for suicide prevention among veterans, including best
practices for helping veterans who have experienced military
sexual trauma. It requires the VA to work with the Department
of Health and Human Services, the National Institutes of
Health, the Centers for Disease Control, and the Substance
Abuse and Mental Health Service Administration when conducting
research.
Subsection (g) would require the VA to conduct mental
health research on veterans who have experienced military
sexual trauma.
Subsection (h) would require the VA to provide for the
availability of 24-hour mental health care for veterans.
Subsection (i) would provide for a toll-free hotline to be
available at all times.
Subsection (j) would provide outreach and education for
veterans and their families to promote mental health.
Subsection (k) would create a peer support-counseling
program where veterans can volunteer as peer counselors to
assist other veterans with mental health and readjustment
problems.
Subsection (l) would mandate that the Secretary may
provide, as the Secretary deems appropriate, for other actions
to reduce the incidence of suicide among veterans.
Section 5. Report to Congress
This section would require the VA to report, not later than
90 days after enactment, on the status of implementation,
timeline and costs for complete implementation of the program
within two years, a plan for additional programs and activities
designed to reduce the occurrence of suicide among veterans,
and recommendations by the VA for further legislation to
improve suicide prevention programs.
Committee Consideration
On Thursday, March 15, 2007, the Committee ordered the bill
reported to the House by a voice vote.
Rollcall Votes
The Committee held no rollcall votes on this bill.
Application of Law to the Legislative Branch
Section 102(b)(3) of Public Law 104-1 requires a
description of the application of this bill to the legislative
branch where the bill relates to the terms and conditions of
employment or access to public services and accommodations.
This bill does not relate to employment or access to public
services and accommodations.
Statement of Oversight Findings and Recommendations of the Committee
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause (3)(c)(4) of rule XIII of the
Rules of the House of Representatives, the Committee's
performance goals and objectives are reflected in the
descriptive portions of this report.
Constitutional Authority Statement
Under clause 3(d)(1) of rule XIII of the Rules of the House
of Representatives, the Committee must include a statement
citing the specific powers granted to Congress to enact the law
proposed by H.R. 327. Article 1, Section 8 of the Constitution
of the United States grants Congress the power to enact this
law.
Federal Advisory Committee Act
The Committee finds that the legislation does not establish
or authorize the establishment of an advisory committee within
the definition of 5 U.S.C. App., Section 5(b).
Unfunded Mandate Statement
Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by Section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4) requires a statement whether
the provisions of the reported bill include unfunded mandates.
In compliance with this requirement the Committee has received
a letter from the Congressional Budget Office that is included
herein.
Earmark Identification
H.R. 327 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the
House of Representatives.
Committee Estimate
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
H.R. 327. However, clause 3(d)(3)(B) of that rule provides that
this requirement does not apply when the Committee has included
in its report a timely submitted cost estimate of the bill
prepared by the Director of the Congressional Budget Office
under Section 402 of the Congressional Budget Act.
Budget Authority and Congressional Budget Office Cost Estimate
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 19, 2007.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 327, the Joshua
Omvig Veterans Suicide Prevention Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Michelle S.
Patterson.
Sincerely,
Peter R. Orszag,
Director.
Enclosure.
H.R. 327--Joshua Omvig Veterans Suicide Prevention Act
H.R. 327 would require the Secretary of Veterans Affairs
(VA) to develop and implement a comprehensive program to reduce
the incidence of suicide among veterans. This bill would
require that the program have specific components, including
training for all staff who interact with veterans, annual
screenings of veterans for risk factors for suicide, a suicide
prevention counselor at each medical facility, and outreach and
education for veterans and their families.
According to VA, most of those requirements are already in
place or will be implemented before the end of the year. For
example, training seminars have recently begun for all
employees and peer-support groups are a regular facet of
veterans' rehabilitation centers. Annual screenings for suicide
risk factors such as depression and alcohol abuse are routinely
performed by primary care physicians. Two medical centers are
focused on research and education about suicide and its
prevention. In addition, VA works with other medical providers
in the community to reach veterans who may not use the VA
health care system. VA also plans to hire suicide-prevention
professionals at each of its hospitals. The bill would
authorize VA to create a toll-free hotline staffed by mental
health personnel, and the agency is currently considering the
feasibility of doing this.
CBO estimates, therefore, that implementing this bill would
have little, if any, cost because VA already has or soon will
implement all the specific requirements of the bill. Enacting
the bill would not affect direct spending or receipts.
H.R. 327 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Michelle S.
Patterson. This estimate was approved by Robert A. Sunshine,
Assistant Director for Budget Analysis.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
CHAPTER 17 OF TITLE 38, UNITED STATES CODE
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
1720F. Comprehensive program for suicide prevention among veterans.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1720F. Comprehensive program for suicide prevention among veterans
(a) Establishment.--The Secretary shall develop and carry out
a comprehensive program designed to reduce the incidence of
suicide among veterans incorporating the components described
in this section.
(b) Staff Education.--In carrying out the comprehensive
program under this section, the Secretary shall provide for
mandatory training for appropriate staff and contractors
(including all medical personnel) of the Department who
interact with veterans. This training shall cover information
appropriate to the duties being performed by such staff and
contractors. The training shall include information on--
(1) recognizing risk factors for suicide;
(2) proper protocols for responding to crisis
situations involving veterans who may be at high risk
for suicide; and
(3) best practices for suicide prevention.
(c) Screening of Veterans Receiving Medical Care.--In
carrying out the comprehensive program, the Secretary shall
provide for screening of veterans who receive medical care at a
Department medical facility (including a center established
under section 1712A of this title) for risk factors for
suicide.
(d) Tracking of Veterans.--In carrying out the comprehensive
program, the Secretary shall provide for appropriate tracking
of veterans.
(e) Counseling and Treatment of Veterans.--In carrying out
the comprehensive program, the Secretary shall provide for
referral of veterans at risk for suicide for appropriate
counseling and treatment.
(f) Designation of Suicide Prevention Counselors.--In
carrying out the comprehensive program, the Secretary shall
designate a suicide prevention counselor at each Department
medical facility other than centers established under section
1712A of this title. Each counselor shall work with local
emergency rooms, police departments, mental health
organizations, and veterans service organizations to engage in
outreach to veterans and improve the coordination of mental
health care to veterans.
(g) Best Practices Research.--In carrying out the
comprehensive program, the Secretary shall provide for research
on best practices for suicide prevention among veterans.
Research shall be conducted under this subsection in
consultation with the heads of the following entities:
(1) The Department of Health and Human Services.
(2) The National Institute of Mental Health.
(3) The Substance Abuse and Mental Health Services
Administration.
(4) The Centers for Disease Control and Prevention.
(h) Sexual Trauma Research.--In carrying out the
comprehensive program, the Secretary shall provide for research
on mental health care for veterans who have experienced sexual
trauma while in military service. The research design shall
include consideration of veterans of a reserve component.
(i) 24-Hour Mental Health Care.--In carrying out the
comprehensive program, the Secretary shall provide for mental
health care availability to veterans on a 24-hour basis.
(j) Hotline.--In carrying out the comprehensive program, the
Secretary may provide for a toll-free hotline for veterans to
be staffed by appropriately trained mental health personnel and
available at all times.
(k) Outreach and Education for Veterans and Families.--In
carrying out the comprehensive program, the Secretary shall
provide for outreach to and education for veterans and the
families of veterans, with special emphasis on providing
information to veterans of Operation Iraqi Freedom and
Operation Enduring Freedom and the families of such veterans.
Education to promote mental health shall include information
designed to--
(1) remove the stigma associated with mental illness;
(2) encourage veterans to seek treatment and
assistance for mental illness;
(3) promote skills for coping with mental illness;
and
(4) help families of veterans with--
(A) understanding issues arising from the
readjustment of veterans to civilian life;
(B) identifying signs and symptoms of mental
illness; and
(C) encouraging veterans to seek assistance
for mental illness.
(l) Peer Support Counseling Program.--(1) In carrying out the
comprehensive program, the Secretary shall establish and carry
out a peer support counseling program, under which veterans
shall be permitted to volunteer as peer counselors--
(A) to assist other veterans with issues
related to mental health and readjustment; and
(B) to conduct outreach to veterans and the
families of veterans.
(2) In carrying out the peer support counseling program under
this subsection, the Secretary shall provide adequate training
for peer counselors.
(m) Other Components.--In carrying out the comprehensive
program, the Secretary may provide for other actions to reduce
the incidence of suicide among veterans that the Secretary
deems appropriate.
* * * * * * *
ADDITIONAL VIEWS OF HON. STEVE BUYER
In my letter of March 8, 2007, objecting to the markup on
the bills, including H.R. 327, H.R. 612, H.R. 797, and H.R.
1284 (letter attached), I strongly urged legislative hearings
on these bills prior to the markup. Had the Committee followed
regular order in holding legislative hearings on H.R. 327, the
Committee could have explored what actions the Department of
Veterans Affairs (VA) has taken or is planning in the area of
suicide prevention. We could also have had the benefit of VA
recommendations for improvements or technical corrections to
the legislation, and would have had Congressional Budget Office
cost analysis for the bill prior to markup.
VA has provided at my request information about the plans
of the Veterans Health Administration to reduce the incidence
of suicide among our veterans. According to this information,
VHA has already formulated a comprehensive strategy for suicide
prevention focusing on the needs of both new veterans from
Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF)
and those from prior conflicts. The specific program for
suicide prevention is based on public health and clinical
models, and activities both within VA facilities and the
medical community.
Structural elements of the program are to include:
Designation of March 1, 2007 as the first annual VA
National Suicide Prevention Awareness Day with
educational activities for all staff, clinical and non-
clinical
Designation of two Centers of Excellence focused on
suicide prevention that will provide technical
assistance to the system as a whole
Designation of the Serious Mental Illness Treatment
Research and Evaluation Center (SMITREC) to maintain
data on suicide rates and risk factors, nationally,
regionally, and locally, to guide prevention strategies
Funding for Suicide Prevention Coordinators within
each VA medical center as of April 1, 2007
Creation of a suicide prevention hotline for
veterans by the end of this calendar year
Public health oriented components of the program,
to be accelerated during the coming year, include:
Ongoing messages and education for the community
about the availability of services and the
effectiveness of treatment
Continued outreach to returning veterans to support
awareness of VA resources and identification of mental
health concerns
Increasing training for those who are in contact
with veterans about the recognition of signs and risk
factors for suicide, and process for helping veterans
engage in treatment
Strengthening collaborations with other local,
regional, and national suicide prevention activities
Clinical components of the program are to include:
Education and training for all VA staff about signs
and risk factors of suicide, and of opportunities to
help veterans in need engage in treatment
Programs organized and directed by the Suicide
Prevention Coordinators to identify veterans at high
risk for suicide and to ensure that the intensity of
their clinical monitoring and care are enhanced
Training for all mental health providers on
evidence-based interventions shown to prevent suicide
Clearly, VA is addressing suicide prevention. I expect that
the Committee will be fully engaged in the oversight of VA's
suicide planning and implementation of those plans. H.R. 327
complements VA's approach to suicide prevention, and I support
the bill.
Steve Buyer.