79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–400 

VETERANS CRISIS LINE STUDY ACT OF 2017 

NOVEMBER 7, 2017.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. ROE of Tennessee, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 4173] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 4173) to direct the Secretary of Veterans Affairs to conduct a study on the Veterans Crisis Line, having considered the 

same, report favorably thereon with an amendment and recommend that the bill as amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 3 

Background and Need for Legislation .................................................................... 3 

Hearings ................................................................................................................... 3 

Subcommittee Consideration .................................................................................. 4 

Committee Consideration ........................................................................................ 4 

Committee Votes ...................................................................................................... 4 

Committee Oversight Findings ............................................................................... 4 

Statement of General Performance Goals and Objectives .................................... 5 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 5 

Earmarks and Tax and Tariff Benefits .................................................................. 5 

Committee Cost Estimate ....................................................................................... 5 

Congressional Budget Office Estimate ................................................................... 5 

Federal Mandates Statement ................................................................................. 5 

Advisory Committee Statement .............................................................................. 6 

Constitutional Authority Statement ...................................................................... 6 

Applicability to Legislative Branch ........................................................................ 6 

Statement on Duplication of Federal Programs .................................................... 6 

Disclosure of Directed Rulemaking ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill as Reported ...................................... 7 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Veterans Crisis Line Study Act of 2017’’. 

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SEC. 2. STUDY ON EFFICACY OF VETERANS CRISIS LINE. 

(a) STUDY.—The Secretary of Veterans Affairs shall conduct a study on the outcomes and the efficacy of the Veterans Crisis Line during the five-year period beginning January 1, 2014, based on an analysis of national suicide data and data collected from the Veterans Crisis Line. 

(b) MATTERS INCLUDED.—The study under subsection (a) shall address the following: 

(1) The efficacy of the Veterans Crisis Line in leading veterans to sustained 

mental health regimens, by determining— 

(A) the number of veterans who, after contacting the Veterans Crisis Line 

and being referred to a suicide prevention specialist, begin and continue 

mental health care furnished by the Secretary of Veterans Affairs; and 

(B) the number of veterans who, after contacting the Veterans Crisis Line 

and being referred to a suicide prevention specialist, either— 

(i) begin mental health care furnished by the Secretary but do not 

continue such care; or 

(ii) do not begin such care. 

(2) The visibility of the Veterans Crisis Line, by determining— 

(A) the number of veterans who contact the Veterans Crisis Line and 

have not previously received hospital care or medical services furnished by 

the Secretary; and 

(B) the number of veterans who contact the Veterans Crisis Line and 

have previously received hospital care or medical services furnished by the 

Secretary. 

(3) The role of the Veterans Crisis Line as part of the mental health care 

services of the Department, by determining, of the veterans who are enrolled 

in the health care system established under section 1705(a) of title 38, United 

States Code, who contact the Veterans Crisis Line, the number who are under 

the care of a mental health care provider of the Department at the time of such 

contact. 

(4) Whether receiving sustained mental health care affects suicidality and 

whether veterans previously receiving mental health care furnished by the Secretary use the Veterans Crisis Line in times of crisis, with respect to the veterans described in paragraph (3), by determining the time frame between receiving such care and the time of such contact. 

(5) The effectiveness of the Veterans Crisis Line in assisting veterans at risk 

for suicide when the Veterans Crisis Line is contacted by a non-veteran, by determining, of the number of non-veterans who contact the Veterans Crisis Line 

looking for support in assisting a veteran, how many of such individuals receive 

support in having a veteran begin to receive mental health care furnished by 

the Secretary. 

(6) The overall efficacy of the Veterans Crisis Line in preventing suicides and 

whether the number of contacts affects the efficacy, by determining— 

(A) the number of veterans who contact the Veterans Crisis Line who ultimately commit or attempt suicide; and 

(B) of such veterans, how many times did a veteran contact the Veterans 

Crisis Line prior to committing or attempting suicide. 

(7) The long-term efficacy of the Veterans Crisis Line in preventing repeated 

suicide attempts and whether the efficacy is temporary, by determining, of the 

number of veterans who contacted the Veterans Crisis Line and did not commit 

or attempt suicide during the following six-month period, the number who contacted the Veterans Crisis Line in crisis at a later time and thereafter did commit or attempt suicide. 

(8) Whether referral to mental health care affects the risk of suicide, by determining— 

(A) the number of veterans who contact the Veterans Crisis Line who are 

not referred to, or do not continue receiving, mental health care who commit suicide; and 

(B) the number of veterans described in paragraph (1)(A) who commit or 

attempt suicide. 

(9) The efficacy of the Veterans Crisis Line to promote continued mental 

health care in those veterans who are at high risk for suicide whose suicide was 

prevented, by determining, of the number of veterans who contacted the Veterans Crisis Line and did not commit or attempt suicide soon thereafter, the 

number that begin and continue to receive mental health care furnished by the 

Secretary. 

(10) Such other matters as the Secretary determines appropriate. 

(c) RULE OF CONSTRUCTION REGARDING DATA COLLECTION.—Nothing in this section may be construed to modify or affect the manner in which data is collected, 

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or the kind or content of data collected, by the Secretary under the Veterans Crisis 

Line. 

(d) SUBMISSION.—Not later than March 1, 2020, the Secretary shall submit to the 

Committees on Veterans’ Affairs of the House of Representatives and the Senate the 

study under subsection (a). 

(e) VETERANS CRISIS LINE DEFINED.—In this section, the term ‘‘Veterans Crisis 

Line’’ means the toll-free hotline for veterans established under section 1720F(h) of 

title 38, United States Code. 

PURPOSE AND SUMMARY

H.R. 4173, the ‘‘Veterans Crisis Line Study Act of 2017,’’ would 

require the Secretary of the Department of Veterans Affairs (VA) 

conduct a study on the outcomes and the efficacy of the Veterans 

Crisis Line during the five-year period beginning January 1, 2014, 

based on an analysis of national suicide data and data collected 

from the Veterans Crisis Line. 

BACKGROUND AND NEED FOR LEGISLATION

In 2007, the Veterans Crisis Line (VCL) was established as a 

partnership between the Department of Veterans Affairs (VA), the 

Substance Abuse and Mental Health Services Administration 

(SAMHSA), and the National Suicide Prevention Lifeline. As of 

May 2016, the VCL has answered over 2.3 million calls, over 

55,000 texts and dispatched emergency services over 61,000 times.1

While VA does collect valuable, anonymous data points from VCL 

callers, it does not currently process them through any meaningful 

form of data analytics as it relates to the efficacy of the program. 

Instead, VCL statistics are currently evaluated for quality and access metrics. 

The Veterans Crisis Line Study Act of 2017 would direct the Secretary to evaluate the efficacy of the Veterans Crisis Line, with respect to continuity of VA mental health services. Research and data 

analysis would utilize the growing national availability of statistics 

regarding suicides to better evaluate the impact of the VCL and potentially highlight opportunities for outcome improvements. The 

Committee believes evaluating the VCL effectively requires a focus 

on the full continuum of mental health care provided by VA once 

a veteran first contacts the VCL or establishes a need for mental 

health services. 

It is important to note that the data collected under this bill is 

not to be collected differently than they currently are. 

HEARINGS

There were no Subcommittee hearings held on H.R. 4173. 

On October 24, 2017, the full Committee conducted a legislative 

hearing on a number of bills including H.R. 4173. 

The following witnesses testified: 

The Honorable Jim Banks, U.S. House of Representatives, 

3rd District, Indiana; The Honorable Mike Gallagher, U.S. 

House of Representatives, 8th District, Wisconsin; The Honorable John R. Carter, U.S. House of Representatives, 31st District, Texas; The Honorable Glenn Thompson, U.S. House of 

Representatives, 5th District, Pennsylvania; The Honorable 

Neal P. Dunn, U.S. House of Representatives, 2nd District, 

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Florida; The Honorable Andy Barr, U.S. House of Representatives, 6th District, Kentucky; The Honorable David J. Shulkin, 

M.D., Secretary, U.S. Department of Veterans Affairs, who was 

accompanied by Carolyn Clancy M.D, the Executive in Charge 

of the Veterans Health Administration, and Laurie Zephyrin 

M.D., MPH, MBA, the Acting Deputy Under Secretary for 

Health for Community Care for the Veterans Health Administration; Adrian M. Atizado, Deputy National Legislative Director, Disabled American Veterans; Roscoe G. Butler, Deputy Director for Health Care, Veterans Affairs and Rehabilitation Division, The American Legion; and, Kayda Keleher, Associate 

Director, National Legislative Service, Veterans of Foreign 

Wars of the United States. 

Statements for the record were submitted by: 

American Federation of Government Employees, AFL–CIO; 

American Health Care Association; American Medical Association; AMVETS; Concerned Veterans of America; Fleet Reserve 

Association; Got Your 6; Health IT Now; Iraq and Afghanistan 

Veterans of America; Military Officers Association of America; 

Military Order of the Purple Heart; National Alliance on Mental Illness; National Guard Association of the United States; 

Nurses Organization of Veterans Affairs/Association of VA Psychologist Leaders/Association of VA Social Workers/Veterans 

Healthcare Action Campaign; Paralyzed Veterans of America; 

Reserve Officers Association; University of Pittsburgh; Vietnam Veterans of America; and the Wounded Warrior Project. 

SUBCOMMITTEE CONSIDERATION

There was no Subcommittee consideration of H.R. 4173. 

COMMITTEE CONSIDERATION

On November 2, 2017, the full Committee met in open markup 

session, a quorum being present, and ordered H.R. 4173 to be reported favorably to the House of Representatives by voice vote. 

During consideration of the bill, the following amendments were 

considered and agreed to by voice vote: 

An Amendment to H.R. 4173 was offered by Representative Jim 

Banks of Indiana. 

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 ordering H.R. 4173 reported to 

the House. A motion by Representative Tim Walz of Minnesota, 

Ranking Member of the Committee on Veterans’ Affairs, to report 

H.R. 4173 favorably to the House of Representatives was agreed to 

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. 

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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 evaluate the efficacy of the Veterans Crisis Line, 

with respect to the full continuum of VA mental health care services. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

With respect to the requirement with respect to clause 3(c)(2) of 

rule XIII of the Rules of the House of Representatives, the Committee has requested but not received from the Director of the Congressional Budget Office an estimate of new budget authority, entitlement authority, or tax expenditures or revenues. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 4173 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

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 this bill. 

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 of 1974. The Committee has requested 

but not received a cost estimate for this bill from the Director of 

the Congressional Budget Office. Assuming the appropriation of authorized amounts, the Committee estimates, and according to a 

preliminary score from the Congressional Budget Office, that the 

legislation would also have a discretionary cost of $1 million over 

the 2018–2022 period. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

With respect to the requirements of clause 3(c)(2) of rule XIII of 

the Rules of the House of Representatives and section 308(a) of the 

Congressional Budget Act of 1974 and with respect to requirements 

of clause (3)(c)(3) of rule XIII of the Rules of the House of Representatives and section 402 of the Congressional Budget Act of 

1974, the Committee has requested but not received a cost estimate 

for this bill from the Director of Congressional Budget Office. 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. 

FEDERAL MANDATES STATEMENT

With respect to the requirements of 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), 

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the Committee has requested but not received from the Director of 

the Congressional Budget Office a statement as to whether the provisions of the reported bill include unfunded mandates. 

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. 4173. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 4173 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. 4173 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 section 3(g) of H. Res. 5, 115th Cong. (2017), the 

Committee finds that no provision of H.R. 4173 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. 

DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), the 

Committee estimates that H.R. 4173 contains no directed rulemaking that would require the Secretary to prescribe regulations. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would provide the short title for H.R. 4173 

as the ‘‘Veterans Crisis Line Study Act of 2017’’. 

Section 2. Study on efficacy of Veterans Crisis Line 

Section 2(a) of the bill would direct the Secretary of the Department of Veterans Affairs to conduct a study on the outcomes and 

efficacy of the VCL for the five-year period starting January 1, 

2014. 

Section 2(b) of the bill outlines the metrics to be targeted for 

analysis for the study, to include: 2(b)(1)—the efficacy of the VCL, 

2(b)(2)—the visibility of the VCL; 2(b)(3)—the role of the VCL as 

part of the continuum of care provided by VA; 2(b)(4)—whether VAprovided mental health care affects suicidality; 2(b)(5)—the effectiveness of a non-veteran calling to seek assistance for a veteran; 

2(b)(6)—the overall efficacy of the VCL in preventing suicides and 

whether repeated VCL contacts affect the efficacy; 2(b)(7)—the 

long-term efficacy of the VCL in preventing repeated suicide atVerDate Sep 11 2014 00:26 Nov 09, 2017 Jkt 079006 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR400.XXX HR400
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tempts; 2(b)(8)—effectiveness of referral patterns; 2(b)(9)—the efficacy of the VCL to promote continued mental healthcare for highrisk veterans. 

Section 2(c) of the bill stipulates that all data collected under this 

bill shall be collected in the same manner as prior to the enactment 

of this legislation, beginning January 1, 2014. 

Section 2(d) of the bill requires the Secretary to report the findings of the study to the Congressional Committees on Veterans’ Affairs by March 1, 2020. 

Section 2(e) of the bill defines the term ‘‘Veterans Crisis Line.’’ 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

If enacted, this bill would make no changes in existing law. 

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