I 

118TH CONGRESS 

1ST SESSION H. R. 6415 

To increase access to mental health, substance use, and counseling services 

for first responders, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 14, 2023 

Ms. TOKUDA (for herself, Mr. FITZPATRICK, Ms. BALINT, Mr. LAMALFA, Mr. 

TONKO, Mrs. WATSON COLEMAN, Mr. NEGUSE, Ms. NORTON, Ms. SALINAS, and Mrs. TORRES of California) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committee on Transportation and Infrastructure, for a period to 

be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL 

To increase access to mental health, substance use, and 

counseling services for first responders, and for other 

purposes. 

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 ‘‘Crisis Assistance and 

5 Resources in Emergencies for First Responders Act’’ or 

6 the ‘‘CARE for First Responders Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) According to the Department of Homeland 

4 Security, there are an estimated 4.6 million people 

5 serving as career and volunteer professionals in the 

6 United States within 5 primary response disciplines: 

7 law enforcement, fire and rescue services, emergency 

8 management, and public works. 

9 (2) First responders are usually the first on the 

10 scene to face challenging, dangerous, and draining 

11 situations. 

12 (3) First responders are also the first to reach 

13 out to disaster survivors and provide emotional and 

14 physical support to them. These duties, although es15 sential to the entire community, are strenuous to 

16 first responders and with time put them at an in17 creased risk of experiencing some mental health and 

18 substance use issues and conditions. 

19 (4) The combination of exposure to trauma, de20 manding schedules, and physically challenging roles 

21 puts first responders at an increased risk for mental 

22 health issues such as depression, post-traumatic 

23 dress disorder, stress, and suicidal behaviors. 

24 (5) According to a 2018 study by the Substance 

25 Abuse and Mental Health Services Administration, 

26 30 percent of first responders develop behavioral 


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1 health conditions including depression and post-trau2 matic stress disorder, as compared with 20 percent 

3 in the general population. 

4 (6) The Substance Abuse and Mental Health 

5 Services Administration finds that an estimated be6 tween 125 and 300 police officers die by suicide an7 nually. 

8 (7) Data from the National Violent Death Re9 porting System indicates that first responders made 

10 up 1 percent of all suicides from 2015 to 2017. 

11 When broken down by response discipline, these first 

12 responder suicides occurred among law enforcement 

13 officers (58 percent), firefighters (21 percent), emer14 gency medical services providers (18 percent) and 

15 public safety telecommunicators (2 percent). 

16 (8) According to the Firefighter Behavioral 

17 Health Alliance, more firefighters died of suicide 

18 than in the line of duty between 2014 and 2020, and 

19 nearly 58 percent of firefighters were exposed to 

20 traumatic events like mass shootings, violence car 

21 crashes, or child abuse. 

22 (9) For many first responders, it can be dif23 ficult to transition from being a provider to client or 

24 patient is not an easy one so when a first responder 

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1 counter an ill-prepared provider and may result in 

2 reluctance to seek further help. 

3 (10) Many first responders may consider stress 

4 to be ‘‘part of the job’’ and feel that they cannot or 

5 should not talk about traumatic events and other oc6 cupational stressors. Perceived stigma around men7 tal health problems or concerns over impact on em8 ployment, including but not limited to being labeled 

9 as ‘‘unfit’’ for duty, may lead first responders to not 

10 report trauma, mental health issues, or suicidal 

11 thoughts. 

12 (11) There are limited resources available to 

13 specifically address the mental health needs of first 

14 responders. Often, first responders are directed to 

15 general mental health practitioners who may not un16 derstand the unique demands faced by first respond17 ers or the cultures in which they operate. While 

18 these services may meet the needs of many patients, 

19 general practitioners may not understand what first 

20 responders experience on the job or be able to relate 

21 to them in a culturally competent manner. 

22 (12) Providing first responders with mental 

23 health and substance use resources and services that 

24 are readily available and occupationally relevant can 

25 help them deal with excess stress, attain timely and 


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1 clinically appropriate care, and feel better prepared 

2 to respond to an emergency. 

3 (13) Public safety telecommunicators, including 

4 9–1–1 operators and fire dispatchers, are the back5 bone of our national emergency response system. 

6 They provide round-the-clock coverage in more than 

7 6,000 emergency communication centers around the 

8 country. 

9 (14) Public safety telecommunicators are re10 sponsible for answering emergency and non11 emergency calls and directing police, fire and rescue, 

12 and other emergency response personnel to assist 

13 those in need. They are required to multitask, con14 duct on-the-spot problem solving, and maintain 

15 composure and compassion, while coaching callers 

16 through often difficult and disturbing situations like 

17 home invasions, incidents of domestic violence, burn18 ing homes, automobile accidents and fatalities, and 

19 homicides. 

20 (15) The work of public safety telecommunica21 tors is often high-stress, fast-paced, and emotionally 

22 demanding. Every day, they are faced with chal23 lenges and trauma that places them at increased 

24 risk for developing mental health challenges. 


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1 (16) According to studies conducted by Na2 tional Institute for Occupational Safety and Health, 

3 between 17 percent and 24 percent of public safety 

4 telecommunicators have symptoms of post-traumatic 

5 stress disorder and 24 percent have symptoms of de6 pression. While telecommunicators are often the very 

7 first responders engaged with those on scene, re8 search on their suicide risk and mental health has 

9 lagged. 

10 (17) Despite playing a critical role in protecting 

11 and saving lives in emergency situations, public safe12 ty telecommunicators are classified by most States 

13 and by the Federal Government as office and admin14 istrative support personnel and not as first respond15 ers, leaving them without access to important mental 

16 health resources available to other emergency re17 sponse professionals. 

18 SEC. 3. CRISIS COUNSELING ASSISTANCE AND TRAINING. 

19 (a) IN GENERAL.—Section 416(a) of the Robert T. 

20 Stafford Disaster Relief and Emergency Assistance Act 

21 (42 U.S.C. 5183(a)) is amended by inserting ‘‘and to 

22 qualified emergency response providers responding to 

23 major disasters’’ after ‘‘victims of major disasters’’. 

24 (b) DEFINITIONS.—Section 102 of the Robert T. 

25 Stafford Disaster Relief and Emergency Assistance Act 


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1 (42 U.S.C. 5122) is amended by adding at the end the 

2 following: 

3 ‘‘(13) PUBLIC SAFETY TELECOMMUNICATOR.— 

4 The term ‘public safety telecommunicator’ means a 

5 public safety telecommunicator as designated in de6 tailed occupation 43–5031 in the Standard Occupa7 tional Classification Manual of the Office of Man8 agement and Budget issued in 2018, or any suc9 cessor designation. 

10 ‘‘(14) QUALIFIED EMERGENCY RESPONSE PRO11 VIDERS.—The term ‘qualified emergency response 

12 providers’ means— 

13 ‘‘(A) emergency response providers (as de14 fined in section 2 of the Homeland Security Act 

15 of 2002 (6 U.S.C. 101)); and 

16 ‘‘(B) public safety telecommunicators.’’. 

17 SEC. 4. SPECIALIZED SERVICES FOR FIRST RESPONDERS. 

18 Subpart 3 of part B of title V of the Public Health 

19 Service Act (42 U.S.C. 290bb–31) is amended by adding 

20 at the end the following: 

21 ‘‘SEC. 520O. SPECIALIZED SERVICES FOR FIRST RESPOND22 ERS. 

23 ‘‘(a) ESTABLISHMENT.—Not later than 2 years after 

24 the date of enactment of this Act, the Secretary of Health 

25 and Human Services, acting through the Assistant SecVerDate Sep 11 2014 01:48 Dec 05, 2023 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6415.IH H6415

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1 retary of the Substance Abuse and Mental Health Admin2 istration, shall develop and carry out a comprehensive pro3 gram designed to provide mental health services specifi4 cally tailored to qualified emergency response providers. 

5 Such program shall— 

6 ‘‘(1) provide for mental health care availability 

7 to qualified emergency response providers on a 24- 

8 hour basis; 

9 ‘‘(2) provide for a qualified emergency response 

10 providers hotline operated through the 988 Suicide 

11 and Crisis Lifeline under section 520E–3 of the 

12 Public Health Service Act (42 U.S.C. 290bb–36c) 

13 that is confidential and toll-free, sufficiently staffed 

14 by appropriately trained mental health personnel 

15 and available at all times; and 

16 ‘‘(3) provide for outreach to, and education pro17 grams for, qualified emergency response providers 

18 and their families, with priority given to qualified 

19 emergency response providers of major disasters. 

20 ‘‘(b) BEST PRACTICES RESEARCH.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall, in con22 sultation with the heads of the agencies specified in 

23 paragraph (2), conduct or support research on best 

24 practices for providing mental health services to, and 


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1 prevent suicide among, qualified emergency response 

2 providers. 

3 ‘‘(2) AGENCIES SPECIFIED.—The agencies spec4 ified in this paragraph are the following: 

5 ‘‘(A) The Department of Homeland Secu6 rity. 

7 ‘‘(B) The Federal Emergency Management 

8 Agency. 

9 ‘‘(C) The United States Fire Administra10 tion. 

11 ‘‘(D) The National Institute of Mental 

12 Health. 

13 ‘‘(E) The Centers for Disease Control and 

14 Prevention. 

15 ‘‘(F) The Department of Justice. 

16 ‘‘(c) INFORMATION ADDRESSED IN EDUCATION PRO17 GRAMS.—Education provided under subsection (a)(3) shall 

18 include information designed to— 

19 ‘‘(1) remove the stigma associated with mental 

20 illness; 

21 ‘‘(2) encourage qualified emergency response 

22 providers to seek treatment and assistance for men23 tal illness; 

24 ‘‘(3) promote skills for coping with mental ill25 ness; and 


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1 ‘‘(4) help families of qualified emergency re2 sponse providers with— 

3 ‘‘(A) understanding issues arising from the 

4 transition of qualified emergency response pro5 viders back into family life and regular work, 

6 following the end of a disaster assignment; 

7 ‘‘(B) identifying signs and symptoms of 

8 mental illness; and 

9 ‘‘(C) encouraging qualified emergency re10 sponse providers to seek assistance for mental 

11 illness. 

12 ‘‘(d) PEER SUPPORT COUNSELING PROGRAM.— 

13 ‘‘(1) IN GENERAL.—The Secretary shall, as 

14 part of the comprehensive program under this sec15 tion, establish and carry out a peer support coun16 seling program, under which active and retired 

17 qualified emergency response providers may volun18 teer as peer counselors— 

19 ‘‘(A) to assist other qualified emergency 

20 response providers with issues related to mental 

21 health, readiness, and readjustment; and 

22 ‘‘(B) to conduct outreach to qualified 

23 emergency response providers and their fami24 lies. 


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1 ‘‘(2) ADMINISTRATION.—In carrying out the 

2 peer support counseling program under this section, 

3 the Secretary shall— 

4 ‘‘(A) provide for adequate training of indi5 viduals who volunteer to serve as peer coun6 selors, including training carried out under sec7 tion 416(a) of the Robert T. Stafford Disaster 

8 Relief and Emergency Assistance Act; and 

9 ‘‘(B) coordinate with such community or10 ganizations, State and local governments, insti11 tutions of higher education, chambers of com12 merce, local business organizations, organiza13 tions that provide mental health services, and 

14 other organizations as the Secretary considers 

15 appropriate. 

16 ‘‘(e) OTHER COMPONENTS.—The Secretary may take 

17 such other actions to carry out the comprehensive program 

18 under this section as the Secretary determines appropriate 

19 for purposes of reducing the incidence of mental illness 

20 and suicide among qualified emergency response pro21 viders. 

22 ‘‘(f) DEFINITIONS.—In this section: 

23 ‘‘(1) PUBLIC SAFETY TELECOMMUNICATORS.— 

24 The term ‘‘public safety telecommunicator’’ means a 

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1 tailed occupation 43–5031 in the Standard Occupa2 tional Classification Manual of the Office of Man3 agement and Budget issued in 2018, or any suc4 cessor designation. 

5 ‘‘(2) QUALIFIED EMERGENCY RESPONSE PRO6 VIDERS.—The term ‘qualified emergency response 

7 providers’ means— 

8 ‘‘(A) emergency response providers (as de9 fined in section 2 of the Homeland Security Act 

10 of 2002 (6 U.S.C. 101)); and 

11 ‘‘(B) public safety telecommunicators. 

12 ‘‘(3) MAJOR DISASTER.—The term ‘major dis13 aster’ has the meaning given such term in section 

14 102 of the Robert T. Stafford Disaster Relief and 

15 Emergency Assistance Act (42 U.S.C. 5122). 

16 ‘‘SEC. 520P. ON-SITE MENTAL HEALTH SERVICES GRANTS. 

17 ‘‘(a) IN GENERAL.—The Secretary, acting through 

18 the Assistant Secretary for Mental Health and Substance 

19 Use, shall award competitive grants to eligible entities to 

20 establish a new health care delivery site that is a mobile 

21 unit to provide integrated, short-term crisis services to 

22 qualified emergency response providers of a major dis23 aster. Such services shall be— 

24 ‘‘(1) linguistically and culturally appropriate; 

25 ‘‘(2) trauma-informed; and 


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1 ‘‘(3) incorporate disaster behavioral interven2 tions. 

3 ‘‘(b) USE OF FUNDS.—An eligible entity that receives 

4 a grant under this subsection may use funds received 

5 through the grant to provide mobile crisis response, sta6 bilization, and intervention services, including— 

7 ‘‘(1) initial support and triage via mobile crisis 

8 team visits; 

9 ‘‘(2) on-site screening and evaluation of mental 

10 and behavioral health issues; 

11 ‘‘(3) assessment of current supports and re12 sources; 

13 ‘‘(4) short-term crisis management throughout 

14 a major disaster; 

15 ‘‘(5) referral for appropriate follow-up services, 

16 including sub-acute or acute hospital care; 

17 ‘‘(6) supportive, collaborative crisis planning; 

18 ‘‘(7) consultation with existing supports and 

19 services; and 

20 ‘‘(8) self-care techniques and resilience training. 

21 ‘‘(c) AUTHORIZED PURCHASE OR LEASE.—The Sec22 retary may purchase or lease equipment for purposes of 

23 carrying out this section, which may include data and in24 formation systems (including the costs of repaying the 


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1 principal of, and paying the interest on, loans for equip2 ment). 

3 ‘‘(d) GRANT TERMS.— 

4 ‘‘(1) MAXIMUM AMOUNT.—The amount of a 

5 grant awarded under subsection (a) may not exceed 

6 $150,000. 

7 ‘‘(2) DURATION.—The term of a grant awarded 

8 under subsection (a) shall be for a period of not less 

9 than 6 months. Such term is renewable for a single, 

10 additional term so that the total term of the grant 

11 does not exceed 2 years. 

12 ‘‘(e) EVALUATIONS AND TECHNICAL ASSISTANCE.— 

13 The Secretary shall— 

14 ‘‘(1) evaluate the activities supported by grants 

15 awarded under subsection (a), and disseminate, as 

16 appropriate, the findings from the evaluation; 

17 ‘‘(2) provide appropriate information, training, 

18 and technical assistance, as appropriate, to eligible 

19 entities that receive a grant under this section, to 

20 help such entities to meet the requirements of this 

21 section, including assistance with selection and im22 plementation of evidence-based interventions and 

23 frameworks to protect the mental health of qualified 

24 emergency response providers; and 


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1 ‘‘(3) identify best practices, as applicable, to 

2 improve the identification, assessment, treatment, 

3 and timely transition, as appropriate, to additional 

4 or follow-up care for qualified emergency response 

5 providers who are at risk for mental illness, suicide, 

6 and substance abuse, and enhance the coordination 

7 of care for such individuals during and after a major 

8 disaster, in support of activities supported by grants 

9 awarded under subsection (a). 

10 ‘‘(f) DEFINITIONS.— 

11 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en12 tity’ means a State, local, territorial, or Tribal 

13 health department, community health center, rural 

14 health clinic, or nonprofit organization that— 

15 ‘‘(A) is located in or around a major dis16 aster area; and 

17 ‘‘(B) has experience working with qualified 

18 mental health professionals in providing mental 

19 health, substance use, or counseling services. 

20 ‘‘(2) MAJOR DISASTER.—The term ‘major dis21 aster’ has the meaning given such term in section 

22 102 of the Robert T. Stafford Disaster Relief and 

23 Emergency Assistance Act (42 U.S.C. 5122). 

24 ‘‘(3) MAJOR DISASTER AREA.—The term ‘major 

25 disaster area’ has the meaning given such term in 


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1 section 625.2 of title 20, Code of Federal Regula2 tions (or successor regulations). 

3 ‘‘(4) PUBLIC SAFETY TELECOMMUNICATORS.— 

4 The term ‘‘public safety telecommunicator’’ means a 

5 public safety telecommunicator as designated in de6 tailed occupation 43–5031 in the Standard Occupa7 tional Classification Manual of the Office of Man8 agement and Budget issued in 2018, or any suc9 cessor designation. 

10 ‘‘(5) QUALIFIED EMERGENCY RESPONSE PRO11 VIDERS.—The term ‘qualified emergency response 

12 providers’ means— 

13 ‘‘(A) emergency response providers (as de14 fined in section 2 of the Homeland Security Act 

15 of 2002 (6 U.S.C. 101)); and 

16 ‘‘(B) public safety telecommunicators. 

17 ‘‘(6) QUALIFIED MENTAL HEALTH PROFES18 SIONAL.— The term ‘qualified mental health profes19 sional’ means a health care practitioner or social and 

20 human services provider who— 

21 ‘‘(A) is licensed or certified under State 

22 law in the State involved; and 

23 ‘‘(B) offers services for the purpose of im24 proving an individual’s mental health or to treat 


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1 mental health or substance use disorders, in2 cluding— 

3 ‘‘(i) a physician, allopathic physicians, 

4 osteopathic physician, nurse practitioner, 

5 or physician assistant with a specialty in 

6 mental and psychiatry; 

7 ‘‘(ii) a health service psychologist; 

8 ‘‘(iii) a licensed clinical social worker; 

9 ‘‘(iv) a psychiatric nurse specialist; 

10 ‘‘(v) a marriage and family therapist; 

11 ‘‘(vi) a licensed professional counselor; 

12 ‘‘(vii) a substance use disorder coun13 selor; 

14 ‘‘(viii) an occupational therapist; or 

15 ‘‘(ix) any other individual who— 

16 ‘‘(I) has not yet been licensed or 

17 certified to serve as a professional list18 ed in any of clauses (i) through (viii); 

19 and 

20 ‘‘(II) will serve at a Federally 

21 qualified health center (as defined in 

22 section 1861(aa)(4) of the Social Se23 curity Act) under the supervision of a 

24 licensed individual or certified profes25 sional so listed. 


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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section 

3 $5,000,000 for each of fiscal years 2024 through 2028.’’. 

Æ 


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