II 

116TH CONGRESS 

2D SESSION S. 4545 

To direct the Secretary of Veterans Affairs to establish the Zero Suicide 

Initiative pilot program of the Department of Veterans Affairs. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 9, 2020 

Ms. ROSEN (for herself and Mr. CRAMER) introduced the following bill; which 

was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To direct the Secretary of Veterans Affairs to establish the 

Zero Suicide Initiative pilot program of the Department 

of Veterans Affairs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘VA Zero Suicide Dem5 onstration Project Act of 2020’’. 

6 SEC. 2. ZERO SUICIDE INITIATIVE PILOT PROGRAM. 

7 (a) ESTABLISHMENT.—Not later than 180 days after 

8 the date of the enactment of this Act, the Secretary of 

9 Veterans Affairs shall establish a pilot program called the 


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1 ‘‘Zero Suicide Initiative’’ (referred to in this section as the 

2 ‘‘program’’). 

3 (b) PURPOSE.—The program shall implement the 

4 curriculum of the Zero Suicide Institute of the Education 

5 Development Center (referred to in this section as the ‘‘In6 stitute’’) to improve safety and suicide care for veterans, 

7 thereby significantly reducing rates of suicide. 

8 (c) DEVELOPMENT.—The first year of the program 

9 shall be dedicated to program development, including 

10 planning and site selection. In developing the program, the 

11 Secretary shall consult with— 

12 (1) the Secretary of Health and Human Serv13 ices; 

14 (2) the National Institutes of Health; 

15 (3) public and private institutions of higher 

16 education; 

17 (4) educators; 

18 (5) experts in suicide assessment, treatment, 

19 and management; 

20 (6) veterans service organizations; and 

21 (7) professional associations the Secretary de22 termines relevant to the purposes of the program. 

23 (d) STAFF LEADERS; PROGRAM ELEMENTS.—The 

24 program shall consist of not less than 10 weeks of edu25 cation regarding suicide care, beginning with the selection 


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1 of five to ten staff leaders from each site selected under 

2 subsection (e) who shall carry out the following program 

3 elements: 

4 (1) Complete the organizational self-study of 

5 the Institute as a team. 

6 (2) Attend the two-day Zero Suicide Academy 

7 of the Institute. 

8 (3) Formulate a plan to collect data to support 

9 evaluation and quality improvement using the data 

10 elements worksheet of the Institute. 

11 (4) Communicate to staff at the respective site 

12 the adoption of a specific suicide care approach. 

13 (5) Administer the workforce survey of the In14 stitute to all staff at the respective site to learn 

15 more about perceived comfort with and competence 

16 in caring for patients at risk of suicide. 

17 (6) Review, develop, and implement training on 

18 processes and policies regarding patients at risk of 

19 suicide, including— 

20 (A) screening; 

21 (B) assessment; 

22 (C) use of electronic health records; 

23 (D) risk formulation; 

24 (E) treatment; and 

25 (F) care transition. 


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1 (e) SITES.— 

2 (1) NUMBER.—The Secretary shall carry out 

3 the program at five medical centers of the Depart4 ment of Veterans Affairs, one of which primarily 

5 serves veterans who live in rural and remote areas 

6 as determined by the Secretary. 

7 (2) TIMELINE.—The Secretary shall select— 

8 (A) 15 candidate sites for the program not 

9 later than 180 days after the date of the enact10 ment of this Act; and 

11 (B) the final five sites not later than 270 

12 days after the date of the enactment of this 

13 Act. 

14 (3) CONSULTATION.—In selecting sites at which 

15 to carry out the program, the Secretary shall consult 

16 with experts including officials of— 

17 (A) the National Institute of Mental 

18 Health; 

19 (B) the Substance Abuse and Mental 

20 Health Services Administration of the Depart21 ment of Health and Human Services; 

22 (C) the Office of Mental Health and Sui23 cide Prevention of the Department of Veterans 

24 Affairs; 


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1 (D) the Health Services Research Division 

2 of the Department of Veterans Affairs; 

3 (E) the Office of Health Care Trans4 formation of the Department of Veterans Af5 fairs; and 

6 (F) the Zero Suicide Institute. 

7 (4) FACTORS.—In selecting sites for the pro8 gram, the Secretary shall consider the following fac9 tors: 

10 (A) Interest in, and capacity of, the staff 

11 of the medical centers to implement the pro12 gram. 

13 (B) Geographic variation. 

14 (C) Variations in size of medical centers. 

15 (D) Regional suicide rates of veterans. 

16 (E) Demographic and health characteris17 tics of populations served by each medical cen18 ter. 

19 (f) ANNUAL PROGRESS REPORT.— 

20 (1) IN GENERAL.—Not later than two years 

21 after the date on which the Secretary establishes the 

22 program, and annually thereafter until termination 

23 of the program, the Secretary shall submit to the 

24 Committees on Veterans’ Affairs of the Senate and 


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1 the House of Representatives a report on the pro2 gram. 

3 (2) ELEMENTS.—Each report under paragraph 

4 (1) shall include the following: 

5 (A) Progress of staff leaders at each site 

6 in carrying out tasks under paragraphs (1) 

7 through (5) of subsection (d). 

8 (B) The percentage of staff at each site 

9 trained under paragraph (6) of subsection (d). 

10 (C) An assessment of whether policies and 

11 procedures implemented at each site align with 

12 standards of the Institute with regards to— 

13 (i) suicide screening; 

14 (ii) lethal means counseling; 

15 (iii) referrals for comprehensive as16 sessment of suicidality; 

17 (iv) safety planning for patients re18 ceiving referrals under clause (iii); 

19 (v) risk management during care 

20 transitions; and 

21 (vi) outreach to high-risk patients. 

22 (D) A comparison of the suicide-related 

23 outcomes at program sites and those of other 

24 medical centers of the Department of Veterans 

25 Affairs, including— 


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1 (i) the percentage of patients screened 

2 for suicide risk; 

3 (ii) the percentage of patients coun4 seled in lethal means safety; 

5 (iii) the percentage of patients 

6 screened for suicide risk referred for com7 prehensive assessment of suicidality; 

8 (iv) the percentage of patients re9 ferred for comprehensive assessment who 

10 complete safety planning; 

11 (v) emergency department utilization; 

12 (vi) inpatient psychiatric hospitaliza13 tions; 

14 (vii) the number of suicide attempts 

15 among all patients and among patients re16 ferred for comprehensive assessment of 

17 suicidality; and 

18 (viii) the number of suicide deaths 

19 among all patients and among patients re20 ferred for comprehensive assessment of 

21 suicidality. 

22 (g) FINAL REPORT.— 

23 (1) IN GENERAL.—Not later than one year 

24 after the termination of the program, the Secretary 

25 shall submit to the Committees on Veterans’ Affairs 


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1 of the Senate and House of Representatives a final 

2 report. 

3 (2) ELEMENTS.—The report under this sub4 section shall include the following: 

5 (A) A detailed analysis of information in 

6 the annual reports under subsection (f). 

7 (B) The determination of the Secretary 

8 whether it is feasible to continue the program. 

9 (C) The recommendation of the Secretary 

10 whether to extend the program or make the 

11 program permanent. 

12 (h) TERMINATION; EXTENSION.— 

13 (1) IN GENERAL.—Subject to paragraph (2), 

14 the program shall terminate on the date that is five 

15 years after the date on which the Secretary estab16 lishes the program under subsection (a). 

17 (2) AUTHORITY TO EXTEND.—The Secretary 

18 may extend the program for not more than two 

19 years if the Secretary notifies Congress in writing of 

20 such extension not less than 180 days before the ter21 mination date under paragraph (1). 

Æ 


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