[House Report 116-517]
[From the U.S. Government Publishing Office]


116th Congress    }                                   {         Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                   {        116-517

======================================================================



 
          SUICIDE PREVENTION LIFELINE IMPROVEMENT ACT OF 2019

                                _______
                                

 September 18, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 4564]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4564) to amend the Public Health Service Act to 
ensure the provision of high-quality service through the 
Suicide Prevention Lifeline, and for other purposes, having 
considered the same, reports favorably thereon without 
amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................1
 II. Background and Need for the Legislation..........................2
III. Committee Hearings...............................................3
 IV. Committee Consideration..........................................3
  V. Committee Votes..................................................4
 VI. Oversight Findings...............................................4
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures4
VIII.Federal Mandates Statement.......................................4

 IX. Statement of General Performance Goals and Objectives............4
  X. Duplication of Federal Programs..................................4
 XI. Committee Cost Estimate..........................................4
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......5
XIII.Advisory Committee Statement.....................................5

XIV. Applicability to Legislative Branch..............................5
 XV. Section-by-Section Analysis of the Legislation...................5
XVI. Changes in Existing Law Made by the Bill, as Reported............6

                         I. Purpose and Summary

    H.R. 4564, the ``Suicide Prevention Lifeline Improvement 
Act of 2019'', was introduced by Representatives John Katko (R-
NY), Donald S. Beyer, Jr. (D-VA), and Grace F. Napolitano (D-
CA), on September 27, 2019. This bill would provide additional 
support for the Suicide Prevention Lifeline program, a national 
network of local crisis centers that provide support to 
individuals contemplating suicide, by increasing the authorized 
funding level to $50 million for each of fiscal years 2020 
through 2022. The current authorization is $7.198 million each 
fiscal year. The bill also directs the U.S. Department of 
Health and Human Services (HHS) to establish a plan for 
maintaining the program, including sharing certain data with 
the Centers for Disease Control and Prevention (CDC). In 
addition, the bill includes a pilot program to research, 
analyze, and employ various innovative technologies and 
platforms for suicide prevention and reports on the use and 
progress of the pilot. Further, H.R. 4565 requires the 
Secretary of the Department of Health and Human Services (the 
Secretary) to report on implementation of the plan within two 
years of enactment, including studying the implementation of 
the plan and options to expand data gathering from calls, as 
well as results of the study and any further recommendations. 
Finally, the Comptroller General is required to submit a study 
on the Suicide Prevention Lifeline program, the characteristics 
of the calls made to the program, implementation of the plan to 
improve service, and any legislative or administrative 
recommendations.

                II. Background and Need for Legislation

    Data shared by the CDC document a steady increase in 
suicide rates in recent years.\1\ Since 2008, suicide has 
ranked as the tenth leading cause of death in the United 
States.\2\ In 2018, suicide claimed the lives of more than 
48,000 Americans.\3\ While the causes of suicide are 
complicated, it is often preventable.
---------------------------------------------------------------------------
    \1\National Center for Health Statistics, Increase in Suicide 
Mortality in the United States, 1999-2018 (April 2020).
    \2\Id.
    \3\National Center for Health Statistics, Leading Causes of Deaths 
Reports (1981-2018) (accessed September 10, 2020).
---------------------------------------------------------------------------
    The National Suicide Prevention Lifeline (Lifeline) is a 
network of local crisis centers in the United States that 
provides free and confidential support 24 hours a day, seven 
days a week to individuals contemplating suicide or in 
emotional distress.\4\ The Lifeline is currently a network of 
170 crisis centers linked by a toll-free telephone number.\5\ 
Calls to the number are routed to the closest certified local 
crisis center, which span the Nation. Calls are answered by 
trained counselors who assess callers for suicidal risk, 
provide crisis counseling, crisis intervention, engage 
emergency services when necessary, and offer referrals to 
mental health and/or substance use services.\6\
---------------------------------------------------------------------------
    \4\National Suicide Prevention Line (https://
suicidepreventionlifeline.org/) (accessed September 10, 2020)
    \5\National Suicide Prevention Line, About (https://
suicidepreventionlifeline.org/about/) (accessed September 10, 2020).
    \6\National Suicide Prevention Lifeline, Our Crisis Centers 
(https://suicidepreventionlifeline.org/our-crisis-centers/) (accessed 
September 10, 2020).
---------------------------------------------------------------------------
    A 2019 report by the Substance Abuse and Mental Health 
Services Administration (SAMHSA) on the Lifeline stated that 
its greatest challenge to the effectiveness of the program is 
its capacity to respond rapidly to the steadily increasing call 
volume.\7\ The increased visibility of the Lifeline number 
through social media, the internet, and the media has helped 
drive its use. SAMHSA call volume shows that 545,851 calls were 
answered by the Lifeline in 2008.\8\ In 2018, the number of 
answered calls grew to 2,205,487.\9\ The Federal Communication 
Commission's recent decision to designate 988 as the 3-digit 
number for the Lifeline is projected to increase its use as 
well.
---------------------------------------------------------------------------
    \7\Federal Communications Commission, Report on the National 
Suicide Hotline Improvement Act of 2018 (August 14, 2019).
    \8\Id.
    \9\Id.
---------------------------------------------------------------------------
    The Commission's recent decision to designate 988 as the 3-
digit number for the Lifeline is projected to increase its use 
as well.\10\
---------------------------------------------------------------------------
    \10\Federal Communications Commission, FCC Designates 988 for the 
National Suicide Prevention Lifeline (July 16, 2020) (press release).
---------------------------------------------------------------------------

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 4564:
    On June 30, 2020, the Subcommittee on Health held a 
legislative hearing entitled, ``High Anxiety and Stress: 
Legislation to Improve Mental Health During Crisis.'' The 
hearing focused on H.R. 4564, the ``Suicide Prevention Lifeline 
Improvement Act of 2019'' and 21 other bills. The Subcommittee 
received testimony from the following witnesses:
           The Honorable Patrick J. Kennedy, Founder of 
        the Kennedy Forum and former Member of Congress
           Arthur C. Evans, Jr., Ph.D., Chief Executive 
        Officer, American Psychological Association
           Jeffrey L. Geller, M.D., M.P.H., President, 
        American Psychiatric Association, Professor of 
        Psychiatry and Director of Public Sector Psychiatry at 
        the University of Massachusetts Medical School 
        Worcester Recovery Center and Hospital
           Ms. Arriana Gross, National Youth Advisory 
        Board Member, Sandy Hook Promise Students Against 
        Violence Everywhere (SAVE) Promise Club IV.

                      IV. Committee Consideration

    H.R. 4564, the ``Suicide Prevention Lifeline Improvement 
Act of 2019'', was introduced by Representatives Katko (R-NY), 
Beyer (D-VA), and Napolitano (D-CA), on September 27, 2019, and 
was referred to the Committee on Energy and Commerce. The bill 
was then referred to the Subcommittee on Health on September 
30, 2019. On June 30, 2020, the Subcommittee held a legislative 
hearing on the bill.
    On July 15, 2020, the Subcommittee on Health was discharged 
from further consideration of H.R. 4564 as the bill was called 
up for markup, pursuant to notice, by the full Committee on 
Energy and Commerce. No amendments were offered to the bill 
during its consideration. The full Committee subsequently 
agreed to a motion on final passage offered by Mr. Pallone, 
Chairman of the committee, to order H.R. 4564 reported 
favorably to the House, without amendment, by a voice vote, a 
quorum being present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
4564, including the motion for final passage on the bill.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to amend 
the Public Health Service Act to improve the provision of high-
quality service through the Suicide Prevention Lifeline.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4564 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 4564 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``Suicide Prevention Lifeline Improvement Act of 2019''.

Sec. 2. Suicide prevention line

    Subsection (a) of section 2 amends the Public Health 
Service Act to require the Secretary of the Department of 
Health and Human Services (the Secretary) to develop and 
implement a plan to ensure high-quality service. Such plan 
shall include quality assurance provisions, including clearly 
defined and measurable performance indicators and objectives to 
improve responsiveness and performance of the hotline, 
quantifiable timeframes to track the progress of the hotline in 
meeting such performance indicators and objectives; standards 
crisis centers and backup centers must meet for purposes of 
participation and to ensure timely responses to outreach 
consistent with guidance established by the American 
Association of Suicidology or other guidance determined by the 
Secretary; and guidelines for crisis centers to implement 
evidence-based practices, to ensure resources are available and 
distributed to individuals using the program, to carry out 
periodic testing of the program, and to operate in consultation 
with State, local, and Indian tribal entities. The Secretary 
must complete the development of the plan and begin 
implementation not later than six months after enactment of 
this Act, and to periodically update such plan afterwards and 
make such plan available publicly.
    Subsection (b) of section 2 directs the Secretary to share 
any necessary epidemiological data with the Centers for Disease 
Control and Prevention (CDC).
    Subsection (c) of section 2 authorizes $50 million for each 
of fiscal years 2020 through 2022 and requires at least 80 
percent of funds be made available for crisis centers.

Sec. 3. Pilot program on innovative technologies

    Subsection (a) of section 3 authorizes the Secretary, 
acting through the Assistant Secretary for Mental Health and 
Substance Use, to carry out a pilot program to research, 
analyze, and employ various technologies and communication 
platforms for suicide prevention. Currently, the Suicide 
Prevention Lifeline operates via telephone and an online chat. 
This pilot is authorized at $5 million for fiscal years 2020 
and 2021.
    Subsection (b) directs the Secretary to submit a report to 
Congress on the pilot program not later than 24 months after 
the date on which the pilot program commences. Such report 
shall include: a full description of the program; the number of 
individuals served; the average wait time for response; the 
cost of the program; and any other information determined to be 
appropriate.

Sec. 4. HHS study and report

    Section 4 directs the Secretary to complete a study on the 
implementation of the plan included in section 2 not later than 
24 months after its implementation. Such plan shall also 
include options to expand data gathering from calls to the 
Lifeline program. The results of the study must be submitted to 
Congress.

Sec. 5. GAO study and report

    Subsection (a) of section 5 directs the Comptroller General 
to complete a study on the Suicide Prevention Lifeline and 
submit a report to Congress on the results of the study not 
later than 24 months after the Secretary begins implementation 
of the plan required under section 2.
    Subsection (b) of section 5 requires the study to address: 
the feasibility of geolocating callers to direct calls to the 
nearest crisis center; operation shortcomings of the Lifeline; 
geographic coverage of each crisis call center; answer rate of 
each crisis call center; the call wait time of each crisis call 
center; the hours of operation of each crisis call center; 
funding avenues of each crisis call center; implementation of 
the Secretary's plan in section 2 of this Act; and service to 
individuals requesting a foreign language speaker.
    Subsection (c) of section 5 requires the report to include 
recommendations for improving the Lifeline.

Sec. 6. Definition

    Section 6 defines the term ``Suicide Prevention Lifeline'' 
as the suicide prevention hotline maintained in section 520E 3 
of the Public Health Service Act.

       XVI. 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 (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




           *       *       *       *       *       *       *
TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

           *       *       *       *       *       *       *



Part B--Centers and Programs

           *       *       *       *       *       *       *



Subpart 3--Center for Mental Health Services

           *       *       *       *       *       *       *



SEC. 520E-3. NATIONAL SUICIDE PREVENTION LIFELINE PROGRAM.

  (a) In General.--The Secretary, acting through the Assistant 
Secretary, shall maintain the National Suicide Prevention 
Lifeline program (referred to in this section as the 
``program''), authorized under section 520A and in effect prior 
to the date of enactment of the Helping Families in Mental 
Health Crisis Reform Act of 2016.
  (b) Activities.--In maintaining the program, the activities 
of the Secretary shall include--
          (1) coordinating a network of crisis centers across 
        the United States for providing suicide prevention and 
        crisis intervention services to individuals seeking 
        help at any time, day or night;
          (2) maintaining a suicide prevention hotline to link 
        callers to local emergency, mental health, and social 
        services resources; and
          (3) consulting with the Secretary of Veterans Affairs 
        to ensure that veterans calling the suicide prevention 
        hotline have access to a specialized veterans' suicide 
        prevention hotline.
  (c) Plan.--
          (1) In general.--For purposes of maintaining the 
        suicide prevention hotline under subsection (b)(2), the 
        Secretary shall develop and implement a plan to ensure 
        the provision of high-quality service.
          (2) Contents.--The plan required by paragraph (1) 
        shall include the following:
                  (A) Quality assurance provisions, including--
                          (i) clearly defined and measurable 
                        performance indicators and objectives 
                        to improve the responsiveness and 
                        performance of the hotline, including 
                        at backup call centers; and
                          (ii) quantifiable timeframes to track 
                        the progress of the hotline in meeting 
                        such performance indicators and 
                        objectives.
                  (B) Standards that crisis centers and backup 
                centers must meet--
                          (i) to participate in the network 
                        under subsection (b)(1); and
                          (ii) to ensure that each telephone 
                        call, online chat message, and other 
                        communication received by the hotline, 
                        including at backup call centers, is 
                        answered in a timely manner by a 
                        person, consistent with the guidance 
                        established by the American Association 
                        of Suicidology or other guidance 
                        determined by the Secretary to be 
                        appropriate.
                  (C) Guidelines for crisis centers and backup 
                centers to implement evidence-based practices 
                including with respect to followup and referral 
                to other health and social services resources.
                  (D) Guidelines to ensure that resources are 
                available and distributed to individuals using 
                the hotline who are not personally in a time of 
                crisis but know of someone who is.
                  (E) Guidelines to carry out periodic testing 
                of the hotline, including at crisis centers and 
                backup centers, during each fiscal year to 
                identify and correct any problems in a timely 
                manner.
                  (F) Guidelines to operate in consultation 
                with the State department of health, local 
                governments, Indian tribes, and tribal 
                organizations.
          (3) Initial plan; updates.--The Secretary shall--
                  (A) not later than 6 months after the date of 
                enactment of the Suicide Prevention Lifeline 
                Improvement Act of 2019, complete development 
                of the initial version of the plan required by 
                paragraph (1), begin implementation of such 
                plan, and make such plan publicly available; 
                and
                  (B) periodically thereafter, update such plan 
                and make the updated plan publicly available.
  (d) Transmission of Data to CDC.--The Secretary shall 
formalize and strengthen agreements between the National 
Suicide Prevention Lifeline program and the Centers for Disease 
Control and Prevention to transmit any necessary 
epidemiological data from the program to the Centers, including 
local call center data, to assist the Centers in suicide 
prevention efforts.
  [ (c) Authorization of Appropriations.--To carry out this 
section, there are authorized to be appropriated $7,198,000 for 
each of fiscal years 2018 through 2022.]
  (e) Authorization of Appropriations.--
          (1) In general.--To carry out this section, there are 
        authorized to be appropriated $50,000,000 for each of 
        fiscal years 2020 through 2022.
          (2) Allocation.--Of the amount authorized to be 
        appropriated by paragraph (1) for each of fiscal years 
        2020 through 2022, at least 80 percent shall be made 
        available to crisis centers.

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