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[House Report 116-77]
[From the U.S. Government Publishing Office]

 116th Congress   }                                           {  Report
                          HOUSE OF REPRESENTATIVES
 1st Session      }                                           {  116-77

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

 
FOSTERING INTERGOVERNMENTAL HEALTH TRANSPARENCY IN VETERAN SUICIDES ACT

                                _______
                                

  May 20, 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. 2340]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 2340) to direct the Secretary of Veterans 
Affairs to provide to Congress notice of any suicide or 
attempted suicide of a veteran in a Department of Veterans 
Affairs facility, and for other purposes, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
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..........................................     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     7
Advisory Committee Statement.....................................     7
Constitutional Authority Statement...............................     7
Applicability to Legislative Branch..............................     7
Statement on Duplication of Federal Programs.....................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill as Reported.............     8

    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 ``Fostering Intergovernmental Health 
Transparency in Veteran Suicides Act'' or ``FIGHT Veteran Suicides 
Act''.

SEC. 2. CONGRESSIONAL NOTICE OF SUICIDES AND ATTEMPTED SUICIDES OF 
                    VETERANS IN DEPARTMENT OF VETERANS AFFAIRS 
                    FACILITIES.

  Section 1720F of title 38, United States Code, is amended by adding 
at the end the following new subsection:
  ``(l) Congressional Notice Requirements.--(1) In the case of the 
suicide or attempted suicide of any veteran that occurs in, or on the 
grounds of, a Department facility, the Secretary shall submit to the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives and the Senators and member of Congress representing 
the district in which the facility is located and the Senators and 
member of Congress representing the district in which the veteran 
resides the following notices:
          ``(A) Not later than seven days after the date on which the 
        suicide or attempted suicide occurs, notice of--
                  ``(i) the suicide or attempted suicide; and
                  ``(ii) the name of the facility and location where 
                the suicide or attempted suicide occurred.
          ``(B) Subject to subparagraph (C), not later than 60 days 
        after such date, notice of the following information (if 
        available) regarding the veteran who committed or attempted to 
        commit suicide:
                  ``(i) The enrollment status of the veteran with 
                respect to the patient enrollment system of the 
                Department under section 1705 of this title.
                  ``(ii) The most recent encounter between the veteran 
                and any employee or facility of the Veterans Health 
                Administration before the suicide or attempted suicide 
                occurred.
                  ``(iii) Whether the veteran had other medical 
                insurance or coverage (including TRICARE, Medicare, and 
                Medicaid).
                  ``(iv) The Armed Force in which the veteran served.
                  ``(v) The time period when the veteran served in the 
                Armed Forces.
                  ``(vi) The age of the veteran.
                  ``(vii) The marital status of the veteran.
                  ``(viii) The employment status of the veteran.
                  ``(ix) The housing status of the veteran.
                  ``(x) The gender identity of the veteran.
                  ``(xi) The sexual orientation of the veteran.
                  ``(xii) The race of the veteran.
                  ``(xiii) Confirmation that the Secretary has provided 
                notice to the immediate family members of the veteran 
                regarding any Department support or assistance for 
                which such family members may be eligible.
          ``(C) In collecting and reporting information under 
        subparagraph (B), the Secretary shall take all steps the 
        Secretary determines necessary to respect the privacy and 
        dignity of the veteran and the family of the veteran.
  ``(2) Each notice submitted under subparagraph (A) or (B) of 
paragraph (1) shall include a copy of guidance developed by the 
Secretary for purposes of dissemination that is designed to--
          ``(A) deter the sensationalism of suicide;
          ``(B) provide information regarding warning signs that are 
        often exhibited by veterans at risk of suicide; and
          ``(C) provide notice of the resources the Department offers 
        to veterans who may be at risk of suicide, including the 
        Veterans Crisis Line and readjustment counseling provided 
        through Vet Centers.''.

                          Purpose and Summary

    H.R. 2340, as amended, would require the Secretary of the 
Department of Veterans Affairs (VA) to notify Congress 
following a suicide or an attempt of suicide by a veteran that 
occurs in, or on the grounds of, a Department facility. In 
addition, it requires VA to include in each notification: 
guidance to assist Congress in deterring the sensationalism of 
suicide, guidance for identifying warning signs exhibited by 
veterans at risk of suicide, and information on the resources 
offered by VA to veterans at risk of suicide.
    Representative Max Rose of New York introduced H.R. 2340 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. In April 2019, 3 
veterans died by suicide on VA campuses within 5 days. Each of 
these tragedies were shocking, but are sadly part of an 
alarming trend. According to Dr. Richard Stone, Executive-in-
Charge of the Veterans Health Administration, approximately 260 
veterans have attempted suicide on the grounds of VA facilities 
in recent history, 20 dying as a result of those attempts.
---------------------------------------------------------------------------
    \1\VA National Suicide Data Report 2005-2016, Office of Mental 
Health and Suicide Prevention, U.S. Department of Veterans Affairs, 
September, 2018.
---------------------------------------------------------------------------
    Congress should be notified of these tragic incidents so 
that VA continues to receive the support and resources 
necessary to intervene and successfully deter veterans from 
attempting suicide. VA staff have notified the House and Senate 
Committees on Veterans' Affairs in many instances, but this 
notification is not required. Therefore, Congress cannot be 
certain that the established practice of notifying Congress 
will continue with changes in personnel, leadership, or 
administration. The FIGHT Veterans Suicide Act would mandate 
that these notifications continue.
    In addition to codifying Congressional notification, the 
measure would also require VA to: provide communications 
guidance to deter the sensationalism of suicide, provide 
information on identifying warning signs often exhibited by 
veterans at risk of suicide, and identify resources offered by 
the Department for at-risk veterans including the Veterans 
Crisis Line and Vet Center readjustment counseling. 
Communications guidance for Congressional offices--especially 
for offices responding to press inquiries--is critical for 
preventing potential suicide contagion. According to the CDC:

          ``. . . [S]uicide ``contagion,'' [is] a process by 
        which exposure to the suicide or suicidal behavior of 
        one or more persons influences others to commit or 
        attempt suicide. Evidence suggests that the effect of 
        contagion is not confined to suicides occurring in 
        discrete geographic areas. In particular, nonfictional 
        newspaper and television coverage of suicide has been 
        associated with a statistically significant excess of 
        suicides.''\2\
---------------------------------------------------------------------------
    \2\Suicide Contagion and the Reporting of Suicide, Recommendations 
from a National Workshop, Morbidity and Mortality Weekly Report, 
Centers for Disease Control and Prevention, September 19, 1989.

    Thus, inclusion of Congressional communications guidance 
with required notifications, and information to assist offices 
with identifying warning signs of at-risk veterans so that 
veterans can be connected to VA resources would ensure each 
recipient is aware of the risk of improper communications 
surrounding these tragic losses.

                                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. 2340.
    On April 29, 2019, the Committee on Veterans' Affairs 
conducted an oversight hearing titled, ``Tragic Trends: Suicide 
Prevention Among Veterans'' to explore actions both VA and 
Congress 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. 2340.
    The following witnesses testified:
          The Honorable Earl Blumenauer, U.S. House of 
        Representatives; The Honorable J. Louis 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. 2340 was not considered before the Subcommittee on 
Health.

                        Committee Consideration

    On May 8, 2019, the Committee on Veterans' Affairs met in 
an open markup session, a quorum being present, and reported 
favorably H.R. 2340, as amended, 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 in the nature of a substitute offered by 
Representative Mark Takano of California that would require VA 
to notify Congress following a suicide or an attempt of suicide 
by a veteran that occurs in, or on the grounds of, a Department 
facility; and include guidance to assist Congress in deterring 
the sensationalism of suicide, identify warning signs exhibited 
by veterans at risk of suicide, and provide information on the 
resources offered by VA to veterans at risk of suicide.
    An amendment to the amendment in the nature of a substitute 
offered by Representative Daniel P. Meuser of Pennsylvania that 
would authorize the VA Secretary to take measures to protect 
the privacy and dignity of veterans and their families involved 
in the suicide or attempted suicide on VA property in the 
collection and reporting of information to Congress.

                            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. 2340, 
as amended, to the House. A motion by Ranking Member David P. 
Roe of Tennessee to report H.R. 2340, as amended, 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. 2340 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. 
2340 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. 2340 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 16, 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. 2340, the 
Fostering Intergovernmental Health Transparency in Veteran 
Suicides 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,
                                            Mark P. Hadley,
                                        (For Keith Hall, Director).
    Enclosure.

    
    

    H.R. 2340 would require the Department of Veterans Affairs 
(VA) to notify the Congress within seven days of any suicide or 
attempted suicide that takes place in or on the grounds of a VA 
facility. The bill also would require the department to submit 
within 60 days of the incident additional information to the 
Congress about the veterans' demographics and their use of VA 
health care.
    CBO estimates that implementing the bill would cost less 
than $500,000 to prepare necessary regulations; 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 Theresa Gullo, Assistant Director 
for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2340, as amended, 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. 
2340, as amended.

                   Constitutional Authority Statement

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 2340, as amended, 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. 2340, as amended, 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. 2340, as amended, 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 tile of the 
measure as the FIGHT Veteran Suicides Act.

Section 2. Congressional notice of suicides and attempted suicides of 
        veterans in Department of Veterans Affairs facilities

    Section 2 of the bill would amend section 1720F of title 
38, United States Code by requiring VA to report to Congress 
each time a suicide or attempted suicide occurs in, or on the 
grounds of, a VA facility within seven days of the occurrence 
with information regarding the location of the occurrence, and 
within 60 days with additional information regarding the social 
determinants that may have contributed to the incident.
    In addition, section 2 would require VA to include in each 
notification: communications guidance to Congress for deterring 
the sensationalism of suicide, information regarding warning 
signs exhibited by at-risk veterans, and notice of VA resources 
available to at-risk veterans.

         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 italic, existing law in which no change is 
proposed is shown in roman):

         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):

                      TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *

CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *

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) Health Assessments of Veterans.--In carrying out the 
comprehensive program, the Secretary shall direct that medical 
staff offer mental health in their overall health assessment 
when veterans seek medical care at a Department medical 
facility (including a center established under section 1712A of 
this title) and make referrals, at the request of the veteran 
concerned, to appropriate counseling and treatment programs for 
veterans who show signs or symptoms of mental health problems.
  (d) 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.
  (e) 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.
  (f) 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.
  (g) 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.
  (h) 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.
  (i) 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.
  (j) 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, 
        including training carried out under the national 
        program of training required by section 304(c) of the 
        Caregivers and Veterans Omnibus Health Services Act of 
        2010 (38 U.S.C. 1712A note).
          (3) In addition to other locations the Secretary 
        considers appropriate, the Secretary shall carry out 
        the peer support program under this subsection at each 
        Department medical center.
          (4)(A) As part of the counseling program under this 
        subsection, the Secretary shall emphasize appointing 
        peer support counselors for women veterans. To the 
        degree practicable, the Secretary shall seek to recruit 
        women peer support counselors with expertise in--
          (i) female gender-specific issues and services;
          (ii) the provision of information about services and 
        benefits provided under laws administered by the 
        Secretary; or
          (iii) employment mentoring.
  (B) To the degree practicable, the Secretary shall emphasize 
facilitating peer support counseling for women veterans who are 
eligible for counseling and services under section 1720D of 
this title, have post-traumatic stress disorder or suffer from 
another mental health condition, are homeless or at risk of 
becoming homeless, or are otherwise at increased risk of 
suicide, as determined by the Secretary.
  (C) The Secretary shall conduct outreach to inform women 
veterans about the program and the assistance available under 
this paragraph.
  (D) In carrying out this paragraph, the Secretary shall 
coordinate with such community organizations, State and local 
governments, institutions of higher education, chambers of 
commerce, local business organizations, organizations that 
provide legal assistance, and other organizations as the 
Secretary considers appropriate.
  (E) In carrying out this paragraph, the Secretary shall 
provide adequate training for peer support counselors, 
including training carried out under the national program of 
training required by section 304(c) of the Caregivers and 
Veterans Omnibus Health Services Act of 2010 (38 U.S.C. 1712A 
note).
  (k) 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 
considers appropriate.
  (l) Congressional Notice Requirements.--(1) In the case of 
the suicide or attempted suicide of any veteran that occurs in, 
or on the grounds of, a Department facility, the Secretary 
shall submit to the Committees on Veterans' Affairs of the 
Senate and the House of Representatives and the Senators and 
member of Congress representing the district in which the 
facility is located and the Senators and member of Congress 
representing the district in which the veteran resides the 
following notices:
          (A) Not later than seven days after the date on which 
        the suicide or attempted suicide occurs, notice of--
                  (i) the suicide or attempted suicide; and
                  (ii) the name of the facility and location 
                where the suicide or attempted suicide 
                occurred.
          (B) Subject to subparagraph (C), not later than 60 
        days after such date, notice of the following 
        information (if available) regarding the veteran who 
        committed or attempted to commit suicide:
                  (i) The enrollment status of the veteran with 
                respect to the patient enrollment system of the 
                Department under section 1705 of this title.
                  (ii) The most recent encounter between the 
                veteran and any employee or facility of the 
                Veterans Health Administration before the 
                suicide or attempted suicide occurred.
                  (iii) Whether the veteran had other medical 
                insurance or coverage (including TRICARE, 
                Medicare, and Medicaid).
                  (iv) The Armed Force in which the veteran 
                served.
                  (v) The time period when the veteran served 
                in the Armed Forces.
                  (vi) The age of the veteran.
                  (vii) The marital status of the veteran.
                  (viii) The employment status of the veteran.
                  (ix) The housing status of the veteran.
                  (x) The gender identity of the veteran.
                  (xi) The sexual orientation of the veteran.
                  (xii) The race of the veteran.
                  (xiii) Confirmation that the Secretary has 
                provided notice to the immediate family members 
                of the veteran regarding any Department support 
                or assistance for which such family members may 
                be eligible.
          (C) In collecting and reporting information under 
        subparagraph (B), the Secretary shall take all steps 
        the Secretary determines necessary to respect the 
        privacy and dignity of the veteran and the family of 
        the veteran.
  (2) Each notice submitted under subparagraph (A) or (B) of 
paragraph (1) shall include a copy of guidance developed by the 
Secretary for purposes of dissemination that is designed to--
          (A) deter the sensationalism of suicide;
          (B) provide information regarding warning signs that 
        are often exhibited by veterans at risk of suicide; and
          (C) provide notice of the resources the Department 
        offers to veterans who may be at risk of suicide, 
        including the Veterans Crisis Line and readjustment 
        counseling provided through Vet Centers.

           *       *       *       *       *       *       *
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