7-8-04
Bill Passed Senate by unanimous Consent,
Received in House
108th CONGRESS
2d Session
S. 2634
IN THE HOUSE OF REPRESENTATIVES
July 9, 2004
Referred to the Committee on Energy and Commerce
AN ACT
To amend the Public Health Service Act to support the planning, implementation,
and evaluation of organized activities involving statewide youth suicide early
intervention and prevention strategies, to provide funds for campus mental
and behavioral health service centers, and for other purposes.
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 `Garrett Lee Smith Memorial Act'.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) More children and young adults die from suicide each year than from
cancer, heart disease, AIDS, birth defects, stroke, and chronic lung disease
combined.
(2) Over 4,000 children and young adults tragically take their lives every
year, making suicide the third overall cause of death between the ages of
10 and 24. According to the Centers for Disease Control and Prevention suicide
is the third overall cause of death among college-age students.
(3) According to the National Center for Injury Prevention and Control of
the Centers for Disease Control and Prevention, children and young adults
accounted for 15 percent of all suicides completed in 2000.
(4) From 1952 to 1995, the rate of suicide in children and young adults
has tripled.
(5) From 1980 to 1997, the rate of suicide among young adults ages 15 to
19 increased 11 percent.
(6) From 1980 to 1997, the rate of suicide among children ages 10 to 14
increased 109 percent.
(7) According to the National Center of Health Statistics, suicide rates
among Native Americans range from 1.5 to 3 times the national average for
other groups, with young people ages 15 to 34 making up 64 percent of all
suicides.
(8) Congress has recognized that youth suicide is a public health tragedy
linked to underlying mental health problems and that youth suicide early
intervention and prevention activities are national priorities.
(9) Youth suicide early intervention and prevention have been listed as
urgent public health priorities by the President's New Freedom Commission
in Mental Health (2002), the Institute of Medicine's Reducing Suicide: A
National Imperative (2002), the National Strategy for Suicide Prevention:
Goals and Objectives for Action (2001), and the Surgeon General's Call to
Action To Prevent Suicide (1999).
(10) Many States have already developed comprehensive Statewide youth suicide
early intervention and prevention strategies that seek to provide effective
early intervention and prevention services.
(11) In a recent report, a startling 85 percent of college counseling centers
revealed an increase in the number of students they see with psychological
problems. Furthermore, the American College Health Association found that
61 percent of college students reported feeling hopeless, 45 percent said
they felt so depressed they could barely function, and 9 percent felt suicidal.
(12) There is clear evidence of an increased incidence of depression among
college students. According to a survey described in the Chronicle of Higher
Education (February 1, 2002), depression among freshmen has nearly doubled
(from 8.2 percent to 16.3 percent). Without treatment, researchers recently
noted that `depressed adolescents are at risk for school failure, social
isolation, promiscuity, self medication with drugs and alcohol, and suicide--now
the third leading cause of death among 10-24 year olds.'.
(13) Researchers who conducted the study `Changes in Counseling Center Client
Problems Across 13 Years' (1989-2001) at Kansas State University stated
that `students are experiencing more stress, more anxiety, more depression
than they were a decade ago.' (The Chronicle of Higher Education, February
14, 2003).
(14) According to the 2001 National Household Survey on Drug Abuse, 20 percent
of full-time undergraduate college students use illicit drugs.
(15) The 2001 National Household Survey on Drug Abuse also reported that
18.4 percent of adults aged 18 to 24 are dependent on or abusing illicit
drugs or alcohol. In addition, the study found that `serious mental illness
is highly correlated with substance dependence or abuse. Among adults with
serious mental illness in 2001, 20.3 percent were dependent on or abused
alcohol or illicit drugs, while the rate among adults without serious mental
illness was only 6.3 percent.'.
(16) A 2003 Gallagher's Survey of Counseling Center Directors found that
81 percent were concerned about the increasing number of students with more
serious psychological problems, 67 percent reported a need for more psychiatric
services, and 63 percent reported problems with growing demand for services
without an appropriate increase in resources.
(17) The International Association of Counseling Services accreditation
standards recommend 1 counselor per 1,000 to 1,500 students. According to
the 2003 Gallagher's Survey of Counseling Center Directors, the ratio of
counselors to students is as high as 1 counselor per 2,400 students at institutions
of higher education with more than 15,000 students.
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICES ACT.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq) is amended--
(1) in section 520E (42 U.S.C. 290bb-36)--
(A) in the section heading by striking `CHILDREN AND ADOLESCENTS' and
inserting `YOUTH';
(B) by striking subsection (a) and inserting the following:
`(a) IN GENERAL- The Secretary shall award grants or cooperative agreements
to public organizations, private nonprofit organizations, political subdivisions,
and Federally recognized Indian tribes or tribal organizations to implement
the State-sponsored statewide or tribal youth suicide early intervention and
prevention strategy as developed under section 596A.';
(C) in subsection (b), by striking all after `coordinated' and inserting
`with the Strategy for Suicide Prevention Federal Steering Group and the
suicide prevention resource center provided for under section 596B.';
(i) in the matter preceding paragraph (1), by striking `A State' and
all that follows through `desiring' and inserting `A public organization,
private nonprofit organization, political subdivision, and Federally
recognized Indian tribes or tribal organization desiring';
(ii) by redesignating paragraphs (1) through (9) as paragraphs (2) through
(10), respectively;
(iii) by inserting before paragraph (2) (as so redesignated), the following:
`(1) comply with the State-sponsored statewide early intervention and prevention
strategy as developed under section 596A;';
(iv) in paragraph (2) (as so redesignated), by striking `children and
adolescents' and inserting `youth';
(v) in paragraph (3) (as so redesignated), by striking `best evidence-based,';
(vi) in paragraph (4) (as so redesignated), by striking `primary' and
all that follows and inserting `general, mental, and behavioral health
services, and substance abuse services;';
(vii) in paragraph (5) (as so redesignated), by striking `children and'
and all that follows and inserting `youth including the school systems,
educational institutions, juvenile justice system, substance abuse programs,
mental health programs, foster care systems, and community child and
youth support organizations;';
(viii) by striking paragraph (8) (as so redesignated), and inserting
the following:
`(8) offer access to services and care to youth with diverse linguistic
and cultural backgrounds;'; and
(ix) by striking paragraph (9) (as so redesignated), and inserting the
following:
`(9) conduct annual self-evaluations of outcomes and activities, including
consulting with interested families and advocacy organizations;';
(E) by striking subsection (d) and inserting the following:
`(d) USE OF FUNDS- Amounts provided under a grant or cooperative agreement
under this section shall be used to supplement, and not supplant, Federal
and non-Federal funds available for carrying out the activities described
in this section. Applicants shall provide financial information to demonstrate
compliance with this section.';
(i) by striking `contract,'; and
(ii) by inserting after `Secretary that the' the following: `application
complies with the State-sponsored statewide early intervention and prevention
strategy as developed under section 596A and';
(G) in subsection (f), by striking `contracts,';
(i) by striking `A State' and all that follows through `organization
receiving' and inserting `A public organization, private nonprofit organization,
political subdivision, and Federally recognized Indian tribes or tribal
organization receiving'; and
(ii) by striking `contract,' each place that such appears;
(I) in subsection (h), by striking `contracts,';
(i) by striking `A State' and all that follows through `organization
receiving' and inserting `A public organization, private nonprofit organization,
political subdivision, and Federally recognized Indian tribes or tribal
organization receiving'; and
(ii) by striking `contract,';
(K) in subsection (k), by striking `5 years' and inserting `3 years';
(L) in subsection (l)(2), by striking `21' and inserting `24'; and
(i) by striking `APPROPRIATION- ' and all that follows through `For'
in paragraph (1) and inserting `APPROPRIATION- For'; and
(ii) by striking paragraph (2);
(2) by inserting after part I (42 U.S.C. 290jj et seq), the following:
`PART J--SUICIDE EARLY INTERVENTION AND PREVENTION';
(3) by redesignating section 520E (42 U.S.C. 290bb-36), as amended by paragraph
(1), as section 596 and transferring such section to part J (as added by
paragraph (2)); and
(4) by adding at the end of part J (as added by paragraph (2) and amended
by paragraph (3)), the following:
`SEC. 596A. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES,
TRAINING, AND TECHNICAL ASSISTANCE.
`(a) YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES-
`(1) IN GENERAL- The Secretary acting through the Administrator of the Substance
Abuse and Mental Health Services Administration, shall award grants or cooperative
agreements to eligible entities to--
`(A) develop and implement State-sponsored statewide or tribal youth suicide
early intervention and prevention strategies in schools, educational institutions,
juvenile justice systems, substance abuse programs, mental health programs,
foster care systems, and other child and youth support organizations;
`(B) support public organizations and private nonprofit organizations
actively involved in State-sponsored statewide or tribal youth suicide
early intervention and prevention strategies and in the development and
continuation of State-sponsored statewide youth suicide early intervention
and prevention strategies;
`(C) collect and analyze data on State-sponsored statewide or tribal youth
suicide early intervention and prevention services that can be used to
monitor the effectiveness of such services and for research, technical
assistance, and policy development; and
`(D) assist eligible entities, through State-sponsored statewide or tribal
youth suicide early intervention and prevention strategies, in achieving
targets for youth suicide reductions under title V of the Social Security
Act (42 U.S.C. 701 et seq.).
`(A) DEFINITION- In this subsection, the term `eligible entity' means--
`(ii) a public organization or private nonprofit organization designated
by a State to develop or direct the State-sponsored statewide youth
suicide early intervention and prevention strategy; and
`(iii) a Federally-recognized Indian tribe or tribal organization (as
defined in the Indian Self-Determination and Education Assistance Act)
or an urban Indian organization (as defined in the Indian Health Care
Improvement Act) that is actively involved in the development and continuation
of a tribal youth suicide early intervention and prevention strategy.
`(B) PREFERENCE- In awarding grants and cooperative agreements under this
section, the Secretary shall give preference to States that have rates
of youth suicide that significantly exceed the national average as determined
by the Centers for Disease Control and Prevention.
`(C) LIMITATION- In carrying out this section, the Secretary shall ensure
that each State is awarded only one grant or cooperative agreement under
this section. For purposes of the preceding sentence, a State shall be
considered to have been awarded a grant or cooperative agreement if the
eligible entity involved is the State or an entity designated by the State
under subparagraph (A)(ii). Nothing in this subparagraph shall be construed
to apply to entities described in subparagraph (A)(iii).
`(3) PREFERENCE- In providing assistance under a grant or cooperative agreement
under this subsection, an eligible entity shall give preference to public
organizations, private nonprofit organizations, political subdivisions,
and tribal organizations actively involved with the State-sponsored statewide
or tribal youth suicide early intervention and prevention strategy that--
`(A) provide early intervention and assessment services, including screening
programs, to youth who are at risk for mental or emotional disorders that
may lead to a suicide attempt, and that are integrated with, school systems,
educational institutions, juvenile justice systems, substance abuse programs,
mental health programs, foster care systems, and other child and youth
support organizations;
`(B) demonstrate collaboration among early intervention and prevention
services or certify that entities will engage in future collaboration;
`(C) employ or include in their applications a commitment to evaluate
youth suicide early intervention and prevention practices and strategies
adapted to the local community;
`(D) provide timely referrals for appropriate community-based mental health
care and treatment of youth who are at risk for suicide in child-serving
settings and agencies;
`(E) provide immediate support and information resources to families of
youth who are at risk for suicide;
`(F) offer access to services and care to youth with diverse linguistic
and cultural backgrounds;
`(G) offer appropriate post-suicide intervention services, care, and information
to families, friends, schools, educational institutions, juvenile justice
systems, substance abuse programs, mental health programs, foster care
systems, and other child and youth support organizations of youth who
recently completed suicide;
`(H) offer continuous and up-to-date information and awareness campaigns
that target parents, family members, child care professionals, community
care providers, and the general public and highlight the risk factors
associated with youth suicide and the life-saving help and care available
from early intervention and prevention services;
`(I) ensure that information and awareness campaigns on youth suicide
risk factors, and early intervention and prevention services, use effective
communication mechanisms that are targeted to and reach youth, families,
schools, educational institutions, and youth organizations;
`(J) provide a timely response system to ensure that child-serving professionals
and providers are properly trained in youth suicide early intervention
and prevention strategies and that child-serving professionals and providers
involved in early intervention and prevention services are properly trained
in effectively identifying youth who are at risk for suicide;
`(K) provide continuous training activities for child care professionals
and community care providers on the latest youth suicide early intervention
and prevention services practices and strategies;
`(L) conduct annual self-evaluations of outcomes and activities, including
consulting with interested families and advocacy organizations; and
`(M) provide services in areas or regions with rates of youth suicide
that exceed the national average as determined by the Centers for Disease
Control and Prevention.
`(4) REQUIREMENT FOR DIRECT SERVICES- Not less than 85 percent of grant
funds received under this subsection shall be used to provide direct services.
`(b) SUICIDE PREVENTION RESOURCE CENTER; TRAINING AND TECHNICAL ASSISTANCE-
`(1) OPERATION OF CENTER- The Secretary, acting through the Administrator
of the Substance Abuse and Mental Health Services Administration and in
consultation with the National Strategy for Suicide Prevention Federal Steering
Group, shall award a competitive grant or contract to a public or private
nonprofit entity for the establishment of a Suicide Prevention Resource
Center to carry out the activities described in paragraph (3).
`(2) APPLICATION- To be eligible for a grant or contract under paragraph
(1), an entity shall prepare and submit to the Secretary an application
at such time, in such manner, and containing such information as the Secretary
may require.
`(3) AUTHORIZED ACTIVITIES- The Suicide Prevention Resource Center shall
provide appropriate information, training, and technical assistance to States,
political subdivisions of a State, Federally recognized Indian tribes, tribal
organizations, public organizations, or private nonprofit organizations
for--
`(A) the development or continuation of statewide or tribal youth suicide
early intervention and prevention strategies;
`(B) ensuring the surveillance of youth suicide early intervention and
prevention strategies;
`(C) studying the costs and effectiveness of statewide youth suicide early
intervention and prevention strategies in order to provide information
concerning relevant issues of importance to State, tribal, and national
policymakers;
`(D) further identifying and understanding causes and associated risk
factors for youth suicide;
`(E) analyzing the efficacy of new and existing youth suicide early intervention
techniques and technology;
`(F) ensuring the surveillance of suicidal behaviors and nonfatal suicidal
attempts;
`(G) studying the effectiveness of State-sponsored statewide and tribal
youth suicide early intervention and prevention strategies on the overall
wellness and health promotion strategies related to suicide attempts;
`(H) promoting the sharing of data regarding youth suicide with Federal
agencies involved with youth suicide early intervention and prevention,
and State-sponsored statewide or tribal youth suicide early intervention
and prevention strategies for the purpose of identifying previously unknown
mental health causes and associated risk-factors for suicide in youth;
and
`(I) other activities determined appropriate by the Secretary.
`(5) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated
to carry out this subsection, $3,000,000 for fiscal year 2005, $4,000,000
for fiscal year 2006, and $5,000,000 for fiscal year 2007.
`(c) COORDINATION AND COLLABORATION-
`(1) IN GENERAL- In carrying out this section, the Secretary shall collaborate
with the National Strategy for Suicide Prevention Federal Steering Group
and other Federal agencies responsible for early intervention and prevention
services relating to youth suicide.
`(2) CONSULTATION- In carrying out this section, the Secretary shall consult
with--
`(A) State and local agencies, including agencies responsible for early
intervention and prevention services under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.), the State Children's Health Insurance Program
under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.),
programs funded by grants under title V of the Social Security Act (42
U.S.C. 701 et seq.), and programs under part C of the Individuals with
Disabilities Education Act (20 U.S.C. 1431 et seq.);
`(B) local and national organizations that serve youth at risk for suicide
and their families;
`(C) relevant national medical and other health and education specialty
organizations;
`(D) youth who are at risk for suicide, who have survived suicide attempts,
or who are currently receiving care from early intervention services;
`(E) families and friends of youth who are at risk for suicide, who have
survived suicide attempts, who are currently receiving care from early
intervention and prevention services, or who have completed suicide;
`(F) qualified professionals who possess the specialized knowledge, skills,
experience, and relevant attributes needed to serve youth at risk for
suicide and their families; and
`(G) third-party payers, managed care organizations, and related commercial
industries.
`(3) POLICY DEVELOPMENT- The Secretary shall--
`(A) coordinate and collaborate on policy development at the Federal level
with the National Strategy for Suicide Prevention Federal Steering Group;
and
`(B) consult on policy development at the Federal level with the private
sector, including consumer, medical, suicide prevention advocacy groups,
and other health and education professional-based organizations, with
respect to State-sponsored statewide or tribal youth suicide early intervention
and prevention strategies.
`(d) RULE OF CONSTRUCTION; RELIGIOUS ACCOMMODATION- Nothing in this section
shall be construed to preempt any State law, including any State law that
does not require the suicide early intervention for youth whose parents or
legal guardians object to such early intervention based on the parents' or
legal guardians' religious beliefs.
`(e) EVALUATIONS AND REPORT-
`(1) EVALUATIONS BY ELIGIBLE ENTITIES- Not later than 18 months after receiving
a grant or cooperative agreement under subsection (a), an eligible entity
shall submit to the Secretary the results of an evaluation to be conducted
by the entity concerning the effectiveness of the activities carried out
under the grant or agreement.
`(2) REPORT- Not later than 2 years after the date of enactment of this
section, the Secretary shall submit to the appropriate committees of Congress
a report concerning the results of--
`(A) the evaluations conducted under paragraph (1); and
`(B) an evaluation conducted by the Secretary to analyze the effectiveness
and efficacy of the activities conducted with grants, collaborations,
and consultations under this section.
`(f) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out subsection
(a), there are authorized to be appropriated $7,000,000 for fiscal year 2005,
$16,000,000 for fiscal year 2006, $25,000,000 for fiscal year 2007, and such
sums as may be necessary for each of fiscal years 2008 and 2009.
`SEC. 596B. MENTAL AND BEHAVIORAL HEALTH SERVICES ON CAMPUS.
`(a) PURPOSE- It is the purpose of this section to increase access to, and
enhance the range of, services for students with mental and behavioral health
problems that can lead to school failure, such as depression, substance abuse,
and suicide attempts, so as to ensure that college students have the support
necessary to successfully complete their studies.
`(b) PROGRAM AUTHORIZED- From funds appropriated under subsection (j), the
Secretary shall award competitive grants to institutions of higher education
to create or expand mental and behavioral health services to students at such
institutions, to provide such services, and to develop best practices for
the delivery of such services. Such grants shall, subject to the availability
of such appropriations, be for a period of 3 years.
`(c) ELIGIBLE GRANT RECIPIENTS- Any institution of higher education that seeks
to provide, or provides, mental and behavioral health services to students
is eligible to apply for a grant under this section. Services may be provided
at--
`(1) college counseling centers;
`(2) college and university psychological service centers;
`(3) mental health centers;
`(4) psychology training clinics; and
`(5) institution of higher education supported, evidence-based, mental health
and substance abuse screening programs.
`(d) APPLICATIONS- Each institution of higher education seeking to obtain
a grant under this section shall submit an application to the Secretary. Each
such application shall include--
`(1) a description of identified mental and behavioral health needs of students
at the institution of higher education;
`(2) a description of currently available Federal, State, local, private,
and institutional resources to address the needs described in paragraph
(1) at the institution of higher education;
`(3) an outline of program objectives and anticipated program outcomes,
including an explanation of how the treatment provider at the institution
of higher education will coordinate activities under this section with existing
programs and services;
`(4) the anticipated impact of funds provided under this section in improving
the mental and behavioral health of students attending the institution of
higher education;
`(5) outreach strategies, including ways in which the treatment provider
at the institution of higher education proposes to reach students, promote
access to services, and address the range of needs of students;
`(6) a proposed plan for reaching those students most in need of services;
`(7) a plan to evaluate program outcomes and assess the services provided
with funds under this section;
`(8) financial information concerning the applicant to demonstrate compliance
with subsection (h); and
`(9) such additional information as is required by the Secretary.
`(e) PEER REVIEW OF APPLICATIONS- The Secretary, in consultation with the
Secretary of Education, shall provide the applications submitted under this
section to a peer review panel for evaluation. With respect to each application,
the peer review panel shall recommend the application for funding or for disapproval.
`(f) USE OF FUNDS- Funds provided by a grant under this section may be used
for 1 or more of the following activities:
`(1) Prevention, screening, early intervention, assessment, treatment, management,
and education of mental and behavioral health problems that can lead to
school failure, such as depression, substance abuse, and suicide attempts
by students enrolled at the institution of higher education.
`(2) Education of families to increase awareness of potential mental and
behavioral health issues of students enrolled at the institution of higher
education.
`(3) Hiring staff trained to identify and treat mental and behavioral health
problems, including residents and interns such as those in psychological
doctoral and post doctoral programs.
`(4) Evaluating and disseminating outcomes and best practices of mental
and behavioral health services.
`(g) ADDITIONAL REQUIRED ELEMENTS- Each institution of higher education that
receives a grant under this section shall--
`(1) provide annual reports to the Secretary describing the use of funds,
the program's objectives, and how the objectives were met, including a description
of program outcomes;
`(2) perform such additional evaluations as the Secretary may require, which
may include--
`(A) increases in range of services provided;
`(B) increases in the quality of services provided;
`(C) increases in access to services;
`(D) college continuation rates;
`(E) decreases in college dropout rates;
`(F) increases in college graduation rates; and
`(G) accepted and valid measurements and assessments of improved mental
health functionality; and
`(3) coordinate such institution's program under this section with other
related efforts on campus by entities concerned with the general mental
and behavioral health needs of students.
`(h) SUPPLEMENT NOT SUPPLANT- Grant funds provided under this section shall
be used to supplement, and not supplant, Federal and non-Federal funds available
for carrying out the activities described in this section. Grantees shall
provide financial information to demonstrate compliance with this subsection.
`(i) REQUIREMENT FOR DIRECT SERVICES AND LIMITATIONS-
`(1) DIRECT SERVICES- Not less than 75 percent of grant funds received under
this section shall be used to provide direct services.
`(2) ADMINISTRATIVE COSTS- Not more than 5 percent of grant funds received
under this section shall be used for administrative costs.
`(3) PROHIBITION ON USE FOR CONSTRUCTION OR RENOVATION- Grant funds received
under this section shall not be used for construction or renovation of facilities
or buildings.
`(j) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
for grants under this section, $5,000,000 for fiscal year 2005, $7,000,000
for fiscal year 2006, $10,000,000 for fiscal year 2007, and such sums as may
be necessary for each fiscal years 2008 and 2009.
`SEC. 596C. DEFINITIONS.
`(1) EARLY INTERVENTION- The term `early intervention' means a strategy
or approach that is intended to prevent an outcome or to alter the course
of an existing condition.
`(2) EDUCATIONAL INSTITUTION; INSTITUTION OF HIGHER EDUCATION; SCHOOL- The
term--
`(A) `educational institution' means a school or institution of higher
education;
`(B) `institution of higher education' has the meaning given such term
in section 101 of the Higher Education Act of 1965; and
`(C) `school' means an elementary or secondary school (as such terms are
defined in section 901 of the Elementary and Secondary Education Act of
1965).
`(3) PREVENTION- The term `prevention' means a strategy or approach that
reduces the likelihood or risk of onset, or delays the onset, of adverse
health problems.
`(4) YOUTH- The term `youth' means individuals who are between 6 and 24
years of age.'.
Passed the Senate July 8, 2004.
Attest:
EMILY J. REYNOLDS,
Secretary.
END
