II

106TH CONGRESS

1ST SESSION S. 1555

To provide sufficient funds for the research necessary to enable an effective

public health approach to the problems of youth suicide and violence,

and to develop ways to intervene early and effectively with children

and adolescents who suffer depression or other mental illness, so as

to avoid the tragedy of suicide, violence, and long-term illness and disability.

IN THE SENATE OF THE UNITED STATES

AUGUST 5, 1999

Mr. DOMENICI (for himself and Mr. KENNEDY) introduced the following bill;

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To provide sufficient funds for the research necessary to

enable an effective public health approach to the problems of youth suicide and violence, and to develop ways

to intervene early and effectively with children and adolescents who suffer depression or other mental illness,

so as to avoid the tragedy of suicide, violence, and longterm illness and disability.

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

2 This Act may be cited as the ‘‘Public Health Re3 sponse to Youth Suicide and Violence Act of 1999’’.

4 SEC. 2. FINDINGS.

5 Congress makes the following findings:

6 (1) Suicide is the third leading cause of death

7 among young people 15 to 24 years of age, following

8 unintentional injuries and homicide, and is the

9 fourth leading cause of death in those 10 to 14

10 years of age. Scientific research has found that there

11 are an estimated 8 to 25 attempted suicides to 1

12 completion, and the strongest risk factors for at13 tempted suicide in youth are depression and alcohol

14 or drug use.

15 (2) There is a critical need for additional re16 search into the underlying causes of youth violence17 both suicide and violence against others. 50 percent

18 of parents with a child suffering from a serious men19 tal disorder believe their child would become violent

20 without appropriate treatment and services.

21 (3) A public health model should seek to ascer22 tain ways to identify children and adolescents who

23 are depressed or suffering from other mental or

24 emotional disorders that might result in violent be25 havior against themselves or others, as well as long-
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1 term illness disability, and to intervene before that

2 occurs.

3 (4) Not enough is known about serious mental

4 disorders in adolescents and children, devastating ill5 nesses which often lead to school failure, suicide,

6 and violence. A primary reason for this is the lack

7 of trained scientific investigators in this area of re8 search. It is critical that increased efforts be made

9 to strengthen the scientific expertise and capability

10 in the area of child mental disorders.

11 (5) About 1 in 10 children and adolescents suf12 fer from mental illness severe enough to cause some

13 level of impairment, but fewer than 1 in 5 of these

14 children receives treatment. Children who go un15 treated not only suffer, cannot learn, and may not

16 form healthy relationships with peers or family, but

17 face an increased likelihood of eventual incarceration

18 as juveniles and adults.

19 (6) Prevention of youth suicide and violence re20 quires a long-term commitment to comprehensive,

21 cost effective, and sustainable interventions directed

22 at known risk factors, and to the evaluation of their

23 success in diverse community settings by targeting

24 multiple risk factors that predispose them to suicide,

25 delinquency and violence.
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1 (7) Much more information is needed con2 cerning the psychotherapeutic and service system

3 treatment of serious mental illness in children as

4 well as barriers to appropriate and effective treat5 ment and services for these children, in the health

6 care and educational systems.

7 SEC. 3. EXPANSION OF ACTIVITIES.

8 Subpart 16 of part C of title IV of the Public Health

9 Service Act (42 U.S.C. 285p et seq) is amended by adding

10 at the end the following:

11 ‘‘SEC. 464U–1. EXPANSION OF RESEARCH ACTIVITIES WITH

12 RESPECT TO CHILDREN.

13 ‘‘(a) IN GENERAL.—The Director of the National In14 stitute of Mental Health shall use amounts made available

15 under this section to carry out activities to expand and

16 intensify research aimed at better understanding the un17 derlying developmental and other causes of mental dis18 orders that lead to youth suicide and violence.

19 ‘‘(b) MANDATORY ACTIVITIES.—To carry out the

20 purpose described in subsection (a), the Director of the

21 Institute shall—

22 ‘‘(1) work to develop investigators who are

23 trained in the area of childhood mental disorders in

24 order to continue the effort to understand the devel25 oping brain and mental disorders in children and to
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1 strengthen the capacity to ascertain the factors un2 derlying suicide and other violent behavior in youth;

3 ‘‘(2) expand support for basic research that has

4 led to a better understanding of the structure, func5 tion and circuitry of the brain, and which promises

6 to yield even more understanding as neuroimaging

7 techniques become even more sophisticated;

8 ‘‘(3) carry out activities to further encourage

9 research to clarify—

10 ‘‘(A) the relationship between mental dis11 orders and youth violence and suicide;

12 ‘‘(B) the first emergence of mental ill13 nesses in children, including schizophrenia, bi14 polar disorder, and obsessive-compulsive dis15 order;

16 ‘‘(C) effective early treatments for such ill17 nesses and disorders; and

18 ‘‘(D) in collaboration with the Director of

19 the Centers for Mental Health Services, where

20 appropriate, the manner in which to effectively

21 disseminate information derived under this

22 paragraph to care-providers in the community;

23 ‘‘(4) in order to address the major problem of

24 lack of recognition of mental disorders, and to en25 sure appropriate diagnosis and treatment, continue
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1 to encourage, in collaboration with the Adminis2 trator of the Agency for Health Care Policy and Re3 search, where appropriate, services research aimed

4 at better understanding the impact of mental dis5 orders on children, on their families, on the health

6 care system, and on schools as well as services re7 search aimed at improving care-provider and educa8 tor knowledge of mental disorders in children;

9 ‘‘(5) seek to develop, conduct research on, and

10 in collaboration with the Director of the Center for

11 Mental Health Services, where appropriate, dissemi12 nate information about, mechanisms for avoiding the

13 inappropriate criminalization of children with mental

14 disorders and the appropriate treatment of any such

15 children in criminal settings;

16 ‘‘(6) in collaboration with the Director of the

17 Centers for Disease Control and Prevention, carry

18 out additional activities to better understand the

19 scope and effect of childhood mental disorders, in20 cluding epidemiological monitoring and surveillance

21 of childhood mental illness, suicide and incidence of

22 violence;

23 ‘‘(7) in collaboration with the Director of the

24 Centers for Disease Control and Prevention, families

25 dealing with mental illness in their children, and
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1 other appropriate agencies, carry out activities to de2 velop a model curriculum of education about mental

3 disorders in children for use in the training of pri4 mary care physicians, nurses, school psychologists,

5 teachers, and others individuals responsible for the

6 care of children on an ongoing basis; and

7 ‘‘(8) in collaboration with the Director of the

8 Centers for Disease Control and Prevention, estab9 lish a system to provide technical assistance to

10 schools and communities to provide public health in11 formation and best practices to enable such schools

12 and communities to handle high-risk youth.

13 ‘‘(c) PERMISSIBLE ACTIVITIES.—To carry out the

14 purpose described in subsection (a), the Director of the

15 Institute may carry out activities—

16 ‘‘(1) relating to research concerning the effects

17 of early trauma and exposure to violence on further

18 childhood development;

19 ‘‘(2) that ensure that the goals of all interven20 tion development under this section include a focus

21 on both effectiveness and sustainability;

22 ‘‘(3) for the development and evaluation of pro23 grams aimed at prevention, early recognition, and

24 intervention for depression, youth suicide and vio-
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1 lence in diverse school and community settings to

2 determine their effectiveness and sustainability;

3 ‘‘(4) to examine the feasibility of public health

4 programs combining individual, family and commu5 nity level interventions to address suicide and vio6 lence and identify related best practices; and

7 ‘‘(5) to disseminate information to families,

8 schools, and communities concerning the recognition

9 of childhood depression, suicide risk, substance

10 abuse, and Attention Deficit Hyperactivity Disorder

11 in order to decrease the stigma associated with seek12 ing help for such conditions.

13 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There

14 is authorized to be appropriated to carry out this section,

15 $200,000,000 for fiscal year 2000, and such sums as may

16 be necessary for each of fiscal years 2001 through 2004.’’.

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