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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6415 Introduced in House (IH)]

<DOC>

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Crisis Assistance and Resources in 
Emergencies for First Responders Act'' or the ``CARE for First 
Responders Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to the Department of Homeland Security, there 
        are an estimated 4.6 million people serving as career and 
        volunteer professionals in the United States within 5 primary 
        response disciplines: law enforcement, fire and rescue 
        services, emergency management, and public works.
            (2) First responders are usually the first on the scene to 
        face challenging, dangerous, and draining situations.
            (3) First responders are also the first to reach out to 
        disaster survivors and provide emotional and physical support 
        to them. These duties, although essential to the entire 
        community, are strenuous to first responders and with time put 
        them at an increased risk of experiencing some mental health 
        and substance use issues and conditions.
            (4) The combination of exposure to trauma, demanding 
        schedules, and physically challenging roles puts first 
        responders at an increased risk for mental health issues such 
        as depression, post-traumatic dress disorder, stress, and 
        suicidal behaviors.
            (5) According to a 2018 study by the Substance Abuse and 
        Mental Health Services Administration, 30 percent of first 
        responders develop behavioral health conditions including 
        depression and post-traumatic stress disorder, as compared with 
        20 percent in the general population.
            (6) The Substance Abuse and Mental Health Services 
        Administration finds that an estimated between 125 and 300 
        police officers die by suicide annually.
            (7) Data from the National Violent Death Reporting System 
        indicates that first responders made up 1 percent of all 
        suicides from 2015 to 2017. When broken down by response 
        discipline, these first responder suicides occurred among law 
        enforcement officers (58 percent), firefighters (21 percent), 
        emergency medical services providers (18 percent) and public 
        safety telecommunicators (2 percent).
            (8) According to the Firefighter Behavioral Health 
        Alliance, more firefighters died of suicide than in the line of 
        duty between 2014 and 2020, and nearly 58 percent of 
        firefighters were exposed to traumatic events like mass 
        shootings, violence car crashes, or child abuse.
            (9) For many first responders, it can be difficult to 
        transition from being a provider to client or patient is not an 
        easy one so when a first responder finally seeks treatment, it 
        can be devastating to encounter an ill-prepared provider and 
        may result in reluctance to seek further help.
            (10) Many first responders may consider stress to be ``part 
        of the job'' and feel that they cannot or should not talk about 
        traumatic events and other occupational stressors. Perceived 
        stigma around mental health problems or concerns over impact on 
        employment, including but not limited to being labeled as 
        ``unfit'' for duty, may lead first responders to not report 
        trauma, mental health issues, or suicidal thoughts.
            (11) There are limited resources available to specifically 
        address the mental health needs of first responders. Often, 
        first responders are directed to general mental health 
        practitioners who may not understand the unique demands faced 
        by first responders or the cultures in which they operate. 
        While these services may meet the needs of many patients, 
        general practitioners may not understand what first responders 
        experience on the job or be able to relate to them in a 
        culturally competent manner.
            (12) Providing first responders with mental health and 
        substance use resources and services that are readily available 
        and occupationally relevant can help them deal with excess 
        stress, attain timely and clinically appropriate care, and feel 
        better prepared to respond to an emergency.
            (13) Public safety telecommunicators, including 9-1-1 
        operators and fire dispatchers, are the backbone of our 
        national emergency response system. They provide round-the-
        clock coverage in more than 6,000 emergency communication 
        centers around the country.
            (14) Public safety telecommunicators are responsible for 
        answering emergency and nonemergency calls and directing 
        police, fire and rescue, and other emergency response personnel 
        to assist those in need. They are required to multitask, 
        conduct on-the-spot problem solving, and maintain composure and 
        compassion, while coaching callers through often difficult and 
        disturbing situations like home invasions, incidents of 
        domestic violence, burning homes, automobile accidents and 
        fatalities, and homicides.
            (15) The work of public safety telecommunicators is often 
        high-stress, fast-paced, and emotionally demanding. Every day, 
        they are faced with challenges and trauma that places them at 
        increased risk for developing mental health challenges.
            (16) According to studies conducted by National Institute 
        for Occupational Safety and Health, between 17 percent and 24 
        percent of public safety telecommunicators have symptoms of 
        post-traumatic stress disorder and 24 percent have symptoms of 
        depression. While telecommunicators are often the very first 
        responders engaged with those on scene, research on their 
        suicide risk and mental health has lagged.
            (17) Despite playing a critical role in protecting and 
        saving lives in emergency situations, public safety 
        telecommunicators are classified by most States and by the 
        Federal Government as office and administrative support 
        personnel and not as first responders, leaving them without 
        access to important mental health resources available to other 
        emergency response professionals.

SEC. 3. CRISIS COUNSELING ASSISTANCE AND TRAINING.

    (a) In General.--Section 416(a) of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5183(a)) is amended by 
inserting ``and to qualified emergency response providers responding to 
major disasters'' after ``victims of major disasters''.
    (b) Definitions.--Section 102 of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5122) is amended by 
adding at the end the following:
            ``(13) Public safety telecommunicator.--The term `public 
        safety telecommunicator' means a public safety telecommunicator 
        as designated in detailed occupation 43-5031 in the Standard 
        Occupational Classification Manual of the Office of Management 
        and Budget issued in 2018, or any successor designation.
            ``(14) Qualified emergency response providers.--The term 
        `qualified emergency response providers' means--
                    ``(A) emergency response providers (as defined in 
                section 2 of the Homeland Security Act of 2002 (6 
                U.S.C. 101)); and
                    ``(B) public safety telecommunicators.''.

SEC. 4. SPECIALIZED SERVICES FOR FIRST RESPONDERS.

    Subpart 3 of part B of title V of the Public Health Service Act (42 
U.S.C. 290bb-31) is amended by adding at the end the following:

``SEC. 520O. SPECIALIZED SERVICES FOR FIRST RESPONDERS.

    ``(a) Establishment.--Not later than 2 years after the date of 
enactment of this Act, the Secretary of Health and Human Services, 
acting through the Assistant Secretary of the Substance Abuse and 
Mental Health Administration, shall develop and carry out a 
comprehensive program designed to provide mental health services 
specifically tailored to qualified emergency response providers. Such 
program shall--
            ``(1) provide for mental health care availability to 
        qualified emergency response providers on a 24-hour basis;
            ``(2) provide for a qualified emergency response providers 
        hotline operated through the 988 Suicide and Crisis Lifeline 
        under section 520E-3 of the Public Health Service Act (42 
        U.S.C. 290bb-36c) that is confidential and toll-free, 
        sufficiently staffed by appropriately trained mental health 
        personnel and available at all times; and
            ``(3) provide for outreach to, and education programs for, 
        qualified emergency response providers and their families, with 
        priority given to qualified emergency response providers of 
        major disasters.
    ``(b) Best Practices Research.--
            ``(1) In general.--The Secretary shall, in consultation 
        with the heads of the agencies specified in paragraph (2), 
        conduct or support research on best practices for providing 
        mental health services to, and prevent suicide among, qualified 
        emergency response providers.
            ``(2) Agencies specified.--The agencies specified in this 
        paragraph are the following:
                    ``(A) The Department of Homeland Security.
                    ``(B) The Federal Emergency Management Agency.
                    ``(C) The United States Fire Administration.
                    ``(D) The National Institute of Mental Health.
                    ``(E) The Centers for Disease Control and 
                Prevention.
                    ``(F) The Department of Justice.
    ``(c) Information Addressed in Education Programs.--Education 
provided under subsection (a)(3) shall include information designed 
to--
            ``(1) remove the stigma associated with mental illness;
            ``(2) encourage qualified emergency response providers to 
        seek treatment and assistance for mental illness;
            ``(3) promote skills for coping with mental illness; and
            ``(4) help families of qualified emergency response 
        providers with--
                    ``(A) understanding issues arising from the 
                transition of qualified emergency response providers 
                back into family life and regular work, following the 
                end of a disaster assignment;
                    ``(B) identifying signs and symptoms of mental 
                illness; and
                    ``(C) encouraging qualified emergency response 
                providers to seek assistance for mental illness.
    ``(d) Peer Support Counseling Program.--
            ``(1) In general.--The Secretary shall, as part of the 
        comprehensive program under this section, establish and carry 
        out a peer support counseling program, under which active and 
        retired qualified emergency response providers may volunteer as 
        peer counselors--
                    ``(A) to assist other qualified emergency response 
                providers with issues related to mental health, 
                readiness, and readjustment; and
                    ``(B) to conduct outreach to qualified emergency 
                response providers and their families.
            ``(2) Administration.--In carrying out the peer support 
        counseling program under this section, the Secretary shall--
                    ``(A) provide for adequate training of individuals 
                who volunteer to serve as peer counselors, including 
                training carried out under section 416(a) of the Robert 
                T. Stafford Disaster Relief and Emergency Assistance 
                Act; and
                    ``(B) coordinate with such community organizations, 
                State and local governments, institutions of higher 
                education, chambers of commerce, local business 
                organizations, organizations that provide mental health 
                services, and other organizations as the Secretary 
                considers appropriate.
    ``(e) Other Components.--The Secretary may take such other actions 
to carry out the comprehensive program under this section as the 
Secretary determines appropriate for purposes of reducing the incidence 
of mental illness and suicide among qualified emergency response 
providers.
    ``(f) Definitions.--In this section:
            ``(1) Public safety telecommunicators.--The term ``public 
        safety telecommunicator'' means a public safety 
        telecommunicator as designated in detailed occupation 43-5031 
        in the Standard Occupational Classification Manual of the 
        Office of Management and Budget issued in 2018, or any 
        successor designation.
            ``(2) Qualified emergency response providers.--The term 
        `qualified emergency response providers' means--
                    ``(A) emergency response providers (as defined in 
                section 2 of the Homeland Security Act of 2002 (6 
                U.S.C. 101)); and
                    ``(B) public safety telecommunicators.
            ``(3) Major disaster.--The term `major disaster' has the 
        meaning given such term in section 102 of the Robert T. 
        Stafford Disaster Relief and Emergency Assistance Act (42 
        U.S.C. 5122).

``SEC. 520P. ON-SITE MENTAL HEALTH SERVICES GRANTS.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Mental Health and Substance Use, shall award competitive 
grants to eligible entities to establish a new health care delivery 
site that is a mobile unit to provide integrated, short-term crisis 
services to qualified emergency response providers of a major disaster. 
Such services shall be--
            ``(1) linguistically and culturally appropriate;
            ``(2) trauma-informed; and
            ``(3) incorporate disaster behavioral interventions. 
    ``(b) Use of Funds.--An eligible entity that receives a grant under 
this subsection may use funds received through the grant to provide 
mobile crisis response, stabilization, and intervention services, 
including--
            ``(1) initial support and triage via mobile crisis team 
        visits;
            ``(2) on-site screening and evaluation of mental and 
        behavioral health issues;
            ``(3) assessment of current supports and resources;
            ``(4) short-term crisis management throughout a major 
        disaster;
            ``(5) referral for appropriate follow-up services, 
        including sub-acute or acute hospital care;
            ``(6) supportive, collaborative crisis planning;
            ``(7) consultation with existing supports and services; and
            ``(8) self-care techniques and resilience training.
    ``(c) Authorized Purchase or Lease.--The Secretary may purchase or 
lease equipment for purposes of carrying out this section, which may 
include data and information systems (including the costs of repaying 
the principal of, and paying the interest on, loans for equipment).
    ``(d) Grant Terms.--
            ``(1) Maximum amount.--The amount of a grant awarded under 
        subsection (a) may not exceed $150,000.
            ``(2) Duration.--The term of a grant awarded under 
        subsection (a) shall be for a period of not less than 6 months. 
        Such term is renewable for a single, additional term so that 
        the total term of the grant does not exceed 2 years.
    ``(e) Evaluations and Technical Assistance.-- The Secretary shall--
            ``(1) evaluate the activities supported by grants awarded 
        under subsection (a), and disseminate, as appropriate, the 
        findings from the evaluation;
            ``(2) provide appropriate information, training, and 
        technical assistance, as appropriate, to eligible entities that 
        receive a grant under this section, to help such entities to 
        meet the requirements of this section, including assistance 
        with selection and implementation of evidence-based 
        interventions and frameworks to protect the mental health of 
        qualified emergency response providers; and
            ``(3) identify best practices, as applicable, to improve 
        the identification, assessment, treatment, and timely 
        transition, as appropriate, to additional or follow-up care for 
        qualified emergency response providers who are at risk for 
        mental illness, suicide, and substance abuse, and enhance the 
        coordination of care for such individuals during and after a 
        major disaster, in support of activities supported by grants 
        awarded under subsection (a).
    ``(f) Definitions.--
            ``(1) Eligible entity.--The term `eligible entity' means a 
        State, local, territorial, or Tribal health department, 
        community health center, rural health clinic, or nonprofit 
        organization that--
                    ``(A) is located in or around a major disaster 
                area; and
                    ``(B) has experience working with qualified mental 
                health professionals in providing mental health, 
                substance use, or counseling services.
            ``(2) Major disaster.--The term `major disaster' has the 
        meaning given such term in section 102 of the Robert T. 
        Stafford Disaster Relief and Emergency Assistance Act (42 
        U.S.C. 5122).
            ``(3) Major disaster area.--The term `major disaster area' 
        has the meaning given such term in section 625.2 of title 20, 
        Code of Federal Regulations (or successor regulations).
            ``(4) Public safety telecommunicators.--The term ``public 
        safety telecommunicator'' means a public safety 
        telecommunicator as designated in detailed occupation 43-5031 
        in the Standard Occupational Classification Manual of the 
        Office of Management and Budget issued in 2018, or any 
        successor designation.
            ``(5) Qualified emergency response providers.--The term 
        `qualified emergency response providers' means--
                    ``(A) emergency response providers (as defined in 
                section 2 of the Homeland Security Act of 2002 (6 
                U.S.C. 101)); and
                    ``(B) public safety telecommunicators.
            ``(6) Qualified mental health professional.-- The term 
        `qualified mental health professional' means a health care 
        practitioner or social and human services provider who--
                    ``(A) is licensed or certified under State law in 
                the State involved; and
                    ``(B) offers services for the purpose of improving 
                an individual's mental health or to treat mental health 
                or substance use disorders, including--
                            ``(i) a physician, allopathic physicians, 
                        osteopathic physician, nurse practitioner, or 
                        physician assistant with a specialty in mental 
                        and psychiatry;
                            ``(ii) a health service psychologist;
                            ``(iii) a licensed clinical social worker;
                            ``(iv) a psychiatric nurse specialist;
                            ``(v) a marriage and family therapist;
                            ``(vi) a licensed professional counselor;
                            ``(vii) a substance use disorder counselor;
                            ``(viii) an occupational therapist; or
                            ``(ix) any other individual who--
                                    ``(I) has not yet been licensed or 
                                certified to serve as a professional 
                                listed in any of clauses (i) through 
                                (viii); and
                                    ``(II) will serve at a Federally 
                                qualified health center (as defined in 
                                section 1861(aa)(4) of the Social 
                                Security Act) under the supervision of 
                                a licensed individual or certified 
                                professional so listed.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2024 through 2028.''.
                                 <all>
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