I 

110TH CONGRESS 

1ST SESSION H. R. 4897 

To amend the Social Security Act and the Public Health Service Act to 

improve elderly suicide early intervention and prevention strategies, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 19, 2007 

Ms. HOOLEY (for herself, Mr. TIM MURPHY of Pennsylvania, Ms. DELAURO, 

Mrs. JONES of Ohio, Mr. KENNEDY, Mr. KLEIN of Florida, Mrs. MCCARTHY of New York, Ms. MATSUI, Mr. RAMSTAD, and Mr. WYNN) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committee on Ways and Means, 

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 amend the Social Security Act and the Public Health 

Service Act to improve elderly suicide early intervention 

and prevention strategies, 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 ‘‘Stop Senior Suicide 

5 Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The rate of suicide among older adults is 

4 higher than that for any other age group, and the 

5 suicide rate for individuals 85 years of age and older 

6 is the highest of all. In 2004, 6,860 older Americans 

7 (age 60 and older) died by suicide (Centers for Dis8 ease Control and Prevention, 2007). 

9 (2) In 2004, the elderly (age 65 and older) 

10 made up only 12.4 percent of the population but ac11 counted for 16 percent of all suicides. 

12 (3) According to the Centers for Disease Con13 trol and Prevention, from 1980 to 1992, the suicide 

14 rate rose 9 percent for Americans 65 years of age 

15 and above, and rose 35 percent for men and women 

16 ages 80 to 84. 

17 (4) Older adults have a considerably higher rate 

18 of completed suicide than other groups. While for all 

19 age groups combined there is one suicide for every 

20 20 attempts, there is one suicide for every 4 at21 tempts among those 65 years of age and older. 

22 (5) Of the nearly 35,000,000 Americans age 65 

23 and older, it is estimated that 2,000,000 have a de24 pressive illness and another 5,000,000 suffer from 

25 depressive symptoms and syndromes that fall short 

26 of meeting full diagnostic criteria for a disorder 


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1 (Mental Health: A Report of the Surgeon General, 

2 1999). 

3 (6) Seniors covered by Medicare are required to 

4 pay a 50 percent co-pay for outpatient mental health 

5 services while they are only required to pay a 20 

6 percent co-pay for physical health services. 

7 (7) It is estimated that 20 percent of older 

8 adults who complete suicide visited a physician with9 in the prior 24 hours, 41 percent within the past 

10 week, and 75 percent within the past month (Sur11 geon General’s Call to Action to Prevent Suicide, 

12 1999). 

13 (8) A substantial proportion of older patients 

14 receive no treatment or inadequate treatment for 

15 their depression in primary care settings (National 

16 Institutes of Health Consensus Development Panel 

17 on Depression in Late Life, 1992; Lebowitz et al., 

18 1997). 

19 (9) Suicide in older adults is most associated 

20 with late-onset depression. Among patients 75 years 

21 of age and older, 60 to 75 percent of suicides have 

22 diagnosable depression (Mental Health: A Report of 

23 the Surgeon General, 1999). 

24 (10) Research suggests that many seniors re25 ceive mental health assistance from their primary 


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1 care providers or other helping professionals versus 

2 specialty mental health professionals (Mental 

3 Health: A Report of the Surgeon General, 1999). 

4 (11) Objective 4.6 of the National Strategy for 

5 Suicide Prevention calls for increasing the propor6 tion of State Aging Networks that have evidence7 based suicide prevention programs designed to iden8 tify and refer for treatment elderly people at risk for 

9 suicidal behavior. 

10 (12) Objective 1.1 of the President’s New Free11 dom Commission on Mental Health calls for advanc12 ing and implementing a national campaign to reduce 

13 the stigma of seeking care and a national strategy 

14 for suicide prevention. The report addresses tar15 geting to distinct and often hard-to-reach popu16 lations, such as ethnic and racial minorities, older 

17 men, and adolescents (NFC Report, 2003). 

18 (13) One of the top 10 resolutions at the 2005 

19 White House Conference on Aging called for improv20 ing the recognition, assessment, and treatment of 

21 mental illness and depression among older Ameri22 cans. 


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1 SEC. 3. ESTABLISHMENT OF A FEDERAL INTERAGENCY 

2 GERIATRIC MENTAL HEALTH PLANNING 

3 COUNCIL. 

4 (a) IN GENERAL.—The Secretary of Health and 

5 Human Services shall establish an Interagency Geriatric 

6 Mental Health Planning Council (referred to in this sec7 tion as the ‘‘Council’’) to coordinate and collaborate on 

8 the planning for the delivery of mental health services, to 

9 include suicide prevention, to older adults. 

10 (b) MEMBERS.—The members of the Council shall in11 clude representatives of— 

12 (1) the Substance Abuse and Mental Health 

13 Services Administration; 

14 (2) the Indian Health Service; 

15 (3) the Health Resources and Services Adminis16 tration; 

17 (4) the Centers for Medicare & Medicaid Serv18 ices; 

19 (5) the National Institute of Mental Health; 

20 (6) the National Institute on Aging; 

21 (7) the Centers for Disease Control and Preven22 tion; 

23 (8) the Department of Veterans Affairs; and 

24 (9) older adults, family members of older adults 

25 with mental illness, and geriatric mental health ex26 perts or advocates for elderly mental health conVerDate Aug 31 2005 05:08 Dec 27, 2007 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4897.IH H4897

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1 cerns, to be appointed by the Secretary of Health 

2 and Human Services in consultation with a national 

3 advocacy organization focused on suicide prevention, 

4 including senior suicide prevention. 

5 (c) CO-CHAIRS.—The Assistant Secretary for Health 

6 and the Assistant Secretary for Aging of the Department 

7 of Health and Human Services shall serve as the co-chairs 

8 of the Council. 

9 (d) ACTIVITIES.—The Council shall— 

10 (1) carry out an interagency planning process 

11 to foster the integration of mental health, suicide 

12 prevention, health, and aging services, which is crit13 ical for effective service delivery for older adults; 

14 (2) make recommendations to the heads of rel15 evant Federal agencies to improve the delivery of 

16 mental health and suicide prevention services for 

17 older adults; and 

18 (3) submit an annual report to the President 

19 and Congress concerning the activities of the Coun20 cil. 

21 SEC. 4. ELIMINATION OF DISCRIMINATORY COPAYMENT 

22 RATES FOR MEDICARE OUTPATIENT PSY23 CHIATRIC SERVICES. 

24 Section 1833(c) of the Social Security Act (42 U.S.C. 

25 1395l(c)) is amended to read as follows: 


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1 ‘‘(c)(1) Notwithstanding any other provision of this 

2 part, with respect to expenses incurred in a calendar year 

3 in connection with the treatment of mental, psycho4 neurotic, and personality disorders of an individual who 

5 is not an inpatient of a hospital at the time such expenses 

6 are incurred, there shall be considered as incurred ex7 penses for purposes of subsections (a) and (b)— 

8 ‘‘(A) for expenses incurred in any year before 

2009, only 621 9 ⁄2 percent of such expenses; 

‘‘(B) for expenses incurred in 2009, only 683 10 ⁄4

11 percent of such expenses; 

12 ‘‘(C) for expenses incurred in 2010, only 75 

13 percent of such expenses; 

‘‘(D) for expenses incurred in 2011, only 811 14 ⁄4

15 percent of such expenses; 

‘‘(E) for expenses incurred in 2012, only 871 16 ⁄2

17 percent of such expenses; 

‘‘(F) for expenses incurred in 2013, only 933 18 ⁄4

19 percent of such expenses; and 

20 ‘‘(G) for expenses incurred in 2014 or any sub21 sequent year, 100 percent of such expenses. 

22 ‘‘(2) For purposes of subparagraphs (A) through (G) 

23 of paragraph (1), the term ‘treatment’ does not include 

24 brief office visits (as defined by the Secretary) for the sole 

25 purpose of monitoring or changing drug prescriptions used 


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1 in the treatment of such disorders or partial hospitaliza2 tion services that are not directly provided by a physi3 cian.’’. 

4 SEC. 5. ELDERLY SUICIDE EARLY INTERVENTION AND PRE5 VENTION STRATEGIES. 

6 Title V of the Public Health Service Act is amended 

7 by inserting after section 520E–2 (42 U.S.C. 290bb–36b) 

8 the following: 

9 ‘‘SEC. 520E–3. ELDERLY SUICIDE EARLY INTERVENTION 

10 AND PREVENTION STRATEGIES. 

11 ‘‘(a) IN GENERAL.—The Secretary shall award 

12 grants or cooperative agreements to eligible entities to de13 velop strategies for addressing suicide among the elderly. 

14 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible for a grant 

15 or cooperative agreement under subsection (a) an entity 

16 shall— 

17 ‘‘(1) be a— 

18 ‘‘(A) State or local government agency, a 

19 territory, or a federally recognized Indian tribe, 

20 tribal organization (as defined in the Indian 

21 Self-Determination and Education Assistance 

22 Act), or an urban Indian organization (as de23 fined in the Indian Health Care Improvement 

24 Act); or 


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1 ‘‘(B) a public or private nonprofit organi2 zation; and 

3 ‘‘(2) submit to the Secretary an application at 

4 such time, in such manner, and containing such in5 formation as the Secretary may require. 

6 ‘‘(c) USE OF FUNDS.—An entity shall use amounts 

7 received under a grant or cooperative agreement under 

8 this section to— 

9 ‘‘(1) develop and implement elderly suicide early 

10 intervention and prevention strategies in 1 or more 

11 settings that serve seniors, including senior centers, 

12 nutrition sites, primary care settings, veterans’ fa13 cilities, nursing facilities, assisted living facilities, 

14 and aging information and referral sites, such as 

15 those operated by area agencies on aging or Aging 

16 and Disability Resource Centers (as those terms are 

17 defined in section 102 of the Older Americans Act 

18 of 1965); 

19 ‘‘(2) collect and analyze data on elderly suicide 

20 early intervention and prevention services for pur21 poses of monitoring, research and policy develop22 ment; and 

23 ‘‘(3) assess the outcomes and effectiveness of 

24 such services. 


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1 ‘‘(d) REQUIREMENTS.—An applicant for a grant or 

2 cooperative agreement under this section shall dem3 onstrate how such applicant will— 

4 ‘‘(1) collaborate with other State and local pub5 lic and private nonprofit organizations; 

6 ‘‘(2) offer immediate support, information, and 

7 referral to seniors or their families who are at risk 

8 for suicide, and appropriate postsuicide intervention 

9 services care, and information to families and 

10 friends of seniors who recently completed suicide and 

11 other interested individuals; and 

12 ‘‘(3) conduct annual self-evaluations concerning 

13 the goals, outcomes, and effectiveness of the activi14 ties carried out under the grant or agreement, in 

15 consultation with interested families and national 

16 advocacy organizations focused on suicide preven17 tion, including senior suicide prevention. 

18 ‘‘(e) PREFERENCE.—In awarding a grant or coopera19 tive agreement under this section, the Secretary shall give 

20 preference to applicants with demonstrated expertise and 

21 capability in providing— 

22 ‘‘(1) early intervention and assessment services, 

23 including voluntary screening programs, education, 

24 and outreach to elderly who are at risk for mental 

25 or emotional disorders that may lead to a suicide atVerDate Aug 31 2005 05:08 Dec 27, 2007 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4897.IH H4897

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1 tempt and that are integrated with aging services 

2 support organizations; 

3 ‘‘(2) early intervention and prevention practices 

4 and strategies adapted to the community it will 

5 serve, with equal preference given to applicants that 

6 are already serving the same community, and appli7 cants that will serve a new community under a grant 

8 or agreement under this section, if the applicant has 

9 already demonstrated expertise and capability in 

10 providing early intervention and prevention practices 

11 and strategies adapted to the community or commu12 nities it currently serves; 

13 ‘‘(3) access to services and care for seniors with 

14 diverse linguistic and cultural backgrounds; and 

15 ‘‘(4) services in States or geographic regions 

16 with rates of elder suicide that exceed the national 

17 average as determined by the Centers for Disease 

18 Control and Prevention. 

19 ‘‘(f) REQUIREMENT FOR DIRECT SERVICES.—Not 

20 less than 85 percent of amounts received under a grant 

21 or cooperative agreement under this section shall be used 

22 to provide direct services. 

23 ‘‘(g) COORDINATION AND COLLABORATION.— 

24 ‘‘(1) IN GENERAL.—In carrying out this section 

25 (including awarding grants and cooperative agreeVerDate Aug 31 2005 05:08 Dec 27, 2007 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4897.IH H4897

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1 ments under subsection (a)), the Secretary shall col2 laborate with the Interagency Geriatric Mental 

3 Health Planning Council. 

4 ‘‘(2) CONSULTATION.— 

5 ‘‘(A) IN GENERAL.—Except as provided in 

6 subparagraph (B), in developing and imple7 menting Federal policy to carry out this section, 

8 the Secretary shall consult with— 

9 ‘‘(i) State and local agencies, includ10 ing agencies comprising the aging network; 

11 ‘‘(ii) national advocacy organizations 

12 focused on suicide prevention, including 

13 senior suicide prevention; 

14 ‘‘(iii) relevant national medical and 

15 other health specialty organizations; 

16 ‘‘(iv) seniors who are at risk for sui17 cide, who have survived suicide attempts, 

18 or who are currently receiving care from 

19 early intervention and prevention services; 

20 ‘‘(v) families and friends of seniors 

21 who are at risk for suicide, who have sur22 vived attempts, who are currently receiving 

23 care from early intervention and prevention 

24 services, or who have completed suicide; 


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1 ‘‘(vi) qualified professionals who pos2 sess the specialized knowledge, skills, expe3 rience, and relevant attributes needed to 

4 serve seniors at risk for suicide and their 

5 families; and 

6 ‘‘(vii) other entities as determined by 

7 the Secretary. 

8 ‘‘(B) LIMITATION.—The Secretary shall 

9 not consult with the entities described in sub10 paragraph (A) for the purpose of awarding 

11 grants and cooperative agreements under sub12 section (a). 

13 ‘‘(h) EVALUATIONS AND REPORTS.— 

14 ‘‘(1) EVALUATIONS BY GRANTEES.— 

15 ‘‘(A) EVALUATION DESIGN.—Not later 

16 than 1 year after receiving a grant or coopera17 tive agreement under this section, an eligible 

18 entity shall submit to the Secretary a plan on 

19 the design of an evaluation strategy to assess 

20 the effectiveness of results of the activities car21 ried out under the grant or agreement. 

22 ‘‘(B) EVALUATION OF EFFECTIVENESS.— 

23 Not later than 2 years after receiving a grant 

24 or cooperative agreement under this section, an 

25 eligible entity shall submit to the Secretary an 


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1 effectiveness evaluation on the implementation 

2 and results of the activities carried out by the 

3 eligible entity under the grant or agreement. 

4 ‘‘(2) REPORT.—Not later than 3 years after the 

5 date that the initial grants or cooperative agree6 ments are awarded to eligible entities under this sec7 tion, the Secretary shall submit to the appropriate 

8 committees of Congress a report describing the 

9 projects funded under this section and include an 

10 evaluation plan for future activities. The report 

11 shall— 

12 ‘‘(A) be a coordinated response by all rep13 resentatives on the Interagency Geriatric Men14 tal Health Advisory Council; and 

15 ‘‘(B) include input from consumers and 

16 family members of consumers on progress being 

17 made and actions that need to be taken. 

18 ‘‘(i) DEFINITION.—In this section: 

19 ‘‘(1) AGING NETWORK.—The term ‘aging net20 work’ has the meaning given such term in section 

21 102(5) of the Older Americans Act of 1965. 

22 ‘‘(2) EARLY INTERVENTION.—The term ‘early 

23 intervention’ means a strategy or approach that is 

24 intended to prevent an outcome or to alter the 

25 course of an existing condition. 


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1 ‘‘(3) PREVENTION.—The term ‘prevention’ 

2 means a strategy or approach that reduces the likeli3 hood of risk or onset, or delays the onset, of adverse 

4 health problems that have been known to lead to sui5 cide. 

6 ‘‘(4) SENIOR.—The term ‘senior’ means— 

7 ‘‘(A) an individual who is 60 years of age 

8 or older and being served by aging network pro9 grams; or 

10 ‘‘(B) an individual who is 65 years of age 

11 or older and covered under Medicare. 

12 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—– 

13 ‘‘(1) IN GENERAL.—For the purpose of car14 rying out this section there is authorized to be ap15 propriated $4,000,000 for fiscal year 2008, 

16 $6,000,000 for fiscal year 2009 and $8,000,000 for 

17 fiscal year 2010. 

18 ‘‘(2) PREFERENCE.—If less than $3,500,000 is 

19 appropriated for any fiscal year to carry out this 

20 section, in awarding grants and cooperative agree21 ments under this section during such fiscal year, the 

22 Secretary shall give preference to applicants in 

23 States that have rates of elderly suicide that signifi24 cantly exceed the national average as determined by 

25 the Centers for Disease Control and Prevention.’’. 


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1 SEC. 6. INTERAGENCY TECHNICAL ASSISTANCE CENTER. 

2 (a) INTERAGENCY RESEARCH, TRAINING, AND TECH3 NICAL ASSISTANCE CENTERS.—Section 520C(d) of the 

4 Public Health Service Act (42 U.S.C. 290bb–34(d)) is 

5 amended— 

6 (1) in paragraph (1), by striking ‘‘youth suicide 

7 early intervention and prevention strategies’’ and in8 serting ‘‘suicide early intervention and prevention 

9 strategies for all ages, particularly for groups that 

10 are at a high risk for suicide’’; 

11 (2) in paragraph (2), by striking ‘‘youth suicide 

12 early intervention and prevention strategies’’ and in13 serting ‘‘suicide early intervention and prevention 

14 strategies for all ages, particularly for groups that 

15 are at a high risk for suicide’’; 

16 (3) in paragraph (3)— 

17 (A) by striking ‘‘youth’’; and 

18 (B) by inserting before the semicolon the 

19 following: ‘‘for all ages, particularly for groups 

20 that are at a high risk for suicide’’; 

21 (4) in paragraph (4), by striking ‘‘youth sui22 cide’’ and inserting ‘‘suicide for all ages, particularly 

23 among groups that are at a high risk for suicide’’; 

24 (5) in paragraph (5), by striking ‘‘youth suicide 

25 early intervention techniques and technology’’ and 

26 inserting ‘‘suicide early intervention techniques and 


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1 technology for all ages, particularly for groups that 

2 are at a high risk for suicide’’; 

3 (6) in paragraph (7)— 

4 (A) by striking ‘‘youth’’; and 

5 (B) by inserting ‘‘for all ages, particularly 

6 for groups that are at a high risk for suicide,’’ 

7 after ‘‘strategies’’; and 

8 (7) in paragraph (8)— 

9 (A) by striking ‘‘youth suicide’’ each place 

10 that such appears and inserting ‘‘suicide’’; and 

11 (B) by striking ‘‘in youth’’ and inserting 

12 ‘‘among all ages, particularly among groups 

13 that are at a high risk for suicide’’. 

14 (b) CONFORMING AMENDMENT.—Section 520C of 

15 the Public Health Service Act (42 U.S.C. 290bb–34) is 

16 amended in the heading by striking ‘‘YOUTH’’. 

17 (c) AUTHORIZATION OF APPROPRIATIONS.— 

18 (1) IN GENERAL.—In addition to any other 

19 funds made available, there are authorized to be ap20 propriated for each of fiscal years 2008 through 

21 2010, such sums as may be necessary to carry out 

22 the amendments made by subsection (a). 

23 (2) SUPPLEMENT NOT SUPPLANT.—Any funds 

24 appropriated under paragraph (1) shall be used to 

25 supplement and not supplant other Federal, State, 


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1 and local public funds expended to carry out other 

2 activities under section 520C(d) of the Public Health 

3 Service Act (42 U.S.C. 290bb–34(d)) (as amended 

4 by subsection (a)). 

5 (3) RESULT OF INCREASE IN FUNDING.—If, as 

6 a result of the enactment of this Act, a recipient of 

7 a grant under subsection (a)(2) of section 520C of 

8 the Public Health Service Act (42 U.S.C. 290bb–34) 

9 receives an increase in funding to carry out activities 

10 under subsection (d) of such section related to sui11 cide prevention and intervention among groups that 

12 are at a high risk for suicide, then, notwithstanding 

13 any other provision of such section, such recipient 

14 shall provide technical assistance to all grantees re15 ceiving funding under such section or section 520E– 

16 3 of such Act (as added by section 5). 

Æ 


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