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116th Congress    }                                   {         Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                   {         116-70

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



 
            SUPPORT FOR SUICIDE PREVENTION COORDINATORS ACT

                                _______
                                

  May 17, 2019.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

         Mr. Takano, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2333]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 2333) to direct the Comptroller General of the 
United States to conduct an assessment of the responsibilities, 
workload, and vacancy rates of Department of Veterans Affairs 
suicide prevention coordinators, and for other purposes, having 
considered the same, report favorably thereon without amendment 
and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Section-by-Section Analysis of the Legislation...................     6

                          PURPOSE AND SUMMARY

    H.R. 2333 would require the Comptroller General of the 
United States (GAO) to conduct an assessment of the 
responsibilities, workload, training, and vacancy rates of the 
Department of Veterans Affairs' (VA) Suicide Prevention 
Coordinators (SPCs) and to report its findings to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives, not later than one year after the date of the 
enactment of this act.
    Representative Anthony Brindisi of New York introduced H.R. 
2333 on April 18, 2019.

                  BACKGROUND AND NEED FOR LEGISLATION

    According to the National Suicide Data Report for 2005-
2016,\1\ approximately 20 veterans, members of the National 
Guard, and reservists die by suicide each day. A 
disproportionately higher rate of suicide exists in the veteran 
population compared to that of the civilian population. In 
2018, VA identified suicide prevention as its highest clinical 
priority.\2\
---------------------------------------------------------------------------
    \1\VA National Suicide Data Report 2005-2016, Office of Mental 
Health and Suicide Prevention, U.S. Department of Veterans Affairs, 
September 2018.
    \2\Department of Veterans Affairs, Department of Veterans Affairs 
Fiscal Years 2018-2024 Strategic Plan (Washington, D.C.: Feb. 12, 
2018).
---------------------------------------------------------------------------
    SPCs are the face of VA's efforts to combat veteran 
suicide. The Veterans Health Administration (VHA) is the only 
healthcare system that has full-time employees dedicated to the 
issue of suicide prevention. SPCs identify high-risk veterans 
and ensure they receive appropriate care, conduct outreach, and 
promote awareness and suicide prevention best practices within 
VA, among other responsibilities. As of April 2019, VA has 
approximately 444 SPCs stationed at every medical center, who 
are managing care for almost 30,000 veterans who are at high 
risk for suicide, in addition to managing several other duties. 
In Fiscal Year 2018, SPCs conducted more than 20,000 outreach 
events, reaching almost 2 million people. During oversight 
trips to VA facilities, many Committee staff have heard from 
SPCs that they are overworked and unable to keep up with their 
many responsibilities. After an internal analysis in 2018, VHA 
determined the need for an additional 246 SPCs.\3\ The REACH 
VET program, a predictive algorithm that produces a red flag in 
a patient's health record, alerts the SPCs to do outreach to 
those veterans presenting as high risk in VA. The need for this 
tool is indicative of the heavy workload of SPCs as they try to 
meet and coordinate the needs of thousands of veterans.
---------------------------------------------------------------------------
    \3\Testimony of Dr. Richard Stone, Executive in Charge, Veterans 
Health Administration during House Committee on Veterans' Affairs 
oversight hearing ``Tragic Trends: Suicide Prevention Among Veterans,'' 
April 29, 2019.
---------------------------------------------------------------------------
    The current rate of vacancies in VHA mental health, among 
psychologists, psychiatrists, and social workers, remains 
steady at 10%. Given the prevalence of the epidemic among 
veterans, and VA's recent shift to a public health approach, 
SPCs are attempting groundbreaking work with a patient load, on 
average, of 90 veterans per SPC. As VA works to improve its 
mental health services, and as more veterans turn to VHA for 
care, the capacity of suicide prevention coordinators will 
continue to be a necessary and crucial function of addressing 
societal forces that cause suicidality in the veteran 
population. This measure will help to fully illustrate the 
limitations and structure that SPCs currently operate in and 
identify what can be done to better enable them in their 
efforts.

                                HEARINGS

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress--(1) the following hearings were used to develop 
or consider H.R. 2333.
    On April 29, 2019, the Committee on Veterans' Affairs 
conducted an oversight hearing titled, ``Tragic Trends: Suicide 
Prevention Among Veterans'' to explore actions the Department 
of Veterans Affairs and the House Committee on Veterans' 
Affairs could take to combat the epidemic of suicide within the 
veteran population.
    The following witnesses testified:
          Shelli Avenevoli PhD, the Deputy Director of the 
        National Institute of Mental Health within the National 
        Institute of Health; Richard McKeon PhD, MPH, the Chief 
        of the Suicide Prevention Branch within the Substance 
        Abuse and Mental Health Services Administration; and 
        Richard Stone M.D., the Executive-in-Charge of the 
        Veterans Health Administration within the U.S. 
        Department of Veterans Affairs, who was accompanied by 
        Keita Franklin LCSW, PhD, the National Director of 
        Suicide Prevention of the Office of Mental Health and 
        Suicide Prevention within the U.S. Department of 
        Veterans Affairs.
    Statements for the record were received by American 
Veterans, Disabled American Veterans, Iraq and Afghanistan 
Veterans of America, The American Legion, Vietnam Veterans of 
America, Wounded Warrior Project, Center for Disease Control, 
Veterans of Foreign Wars, and The Independence Fund.
    On April 30, 2019, the Subcommittee on Health conducted a 
legislative hearing on several bills including H.R. 2333.
    The following witnesses testified:
          The Honorable Earl Blumenauer, U.S. House of 
        Representatives; The Honorable J. Luis Correa, U.S. 
        House of Representatives; The Honorable Conor Lamb, 
        U.S. House of Representatives; The Honorable Max Rose, 
        U.S. House of Representatives; Keita Franklin LCSW, 
        PhD, the National Director of Suicide Prevention of the 
        Office of Mental Health and Suicide Prevention within 
        the U.S. Department of Veterans Affairs, who was 
        accompanied by Tracy Gaudet M.D., the Director of the 
        Office of Patient Centered Care within the U.S. 
        Department of Veterans Affairs and Larry Mole PharmD, 
        the Chief Consultant on Population Health of the U.S. 
        Department of Veterans Affairs; Stephanie Mullen, 
        Research Director for Iraq and Afghanistan Veterans of 
        America; Carlos Fuentes, the Director of the National 
        Legislative Service within Veterans of Foreign Wars; 
        and Joy Ilem, the National Legislative Director for 
        Disabled American Veterans.
    No statements for the record were received.

                       SUBCOMMITTEE CONSIDERATION

    H.R. 2333 was not considered before the Subcommittee.

                        COMMITTEE CONSIDERATION

    On May 8, 2019, the Committee on Veterans' Affairs met in 
an open markup session, a quorum being present, and favorably 
reported H.R. 2333 to the House of Representatives by voice 
vote.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with reporting H.R. 2333 
to the House. A motion by Ranking Member David P. Roe of 
Tennessee to report H.R. 2333 favorably to the House of 
Representatives was adopted by voice vote.

                      COMMITTEE OVERSIGHT FINDINGS

    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 to expand access to high quality 
mental healthcare and related resources to curb the prevalence 
of suicide among veterans, servicemembers, Reservists, and 
members of the Coast Guard and National Guard.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 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.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 2333 does not contain any Congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
2333 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 2333 provided by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 15, 2019.
Hon. Mark Takano,
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. 2333, the Support 
for Suicide Prevention Coordinators Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    

    H.R. 2333 would require the Government Accountability 
Office (GAO) to conduct an assessment of the responsibilities, 
workload, training, and vacancy rates of suicide prevention 
coordinators at the Department of Veterans Affairs.
    On the basis of information from GAO, CBO estimates that 
preparing the report would take about one year and require four 
full-time employees at an average compensation of $130,000. As 
a result, CBO estimates that implementing the bill would cost 
$1 million over the 2020-2024 period; such spending would be 
subject to the availability of appropriated funds.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Leo Lex, Deputy Assistant Director 
for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2333 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2333.

                   CONSTITUTIONAL AUTHORITY STATEMENT

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 2333 is authorized by Congress' power to 
``provide for the common Defense and general Welfare of the 
United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 2333 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.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 2333 establishes or reauthorizes a program of the 
Federal Government known to be duplicative of another Federal 
program, a program that was included in any report from the 
Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill establishes the short title of the 
measure as the ``Support for Suicide Prevention Coordinators 
Act of 2019.''

Section 2. Comptroller General assessment of responsibilities, 
        workload, and vacancy rates of Department of Veterans Affairs 
        suicide prevention coordinators

    Section 2(a) of the bill would require the GAO to conduct 
an assessment of the responsibilities, workload, training, and 
vacancy rates of the Department of Veterans Affairs suicide 
prevention coordinators.
    Section 2(b) would require the GAO to submit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a report containing the findings of the 
assessment required by subsection (a) not later than one year 
after the date of the enactment.

                                  [all]