II 

117TH CONGRESS 

1ST SESSION S. 3397 

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 

DECEMBER 15, 2021 

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 2021’’. 

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) CURRICULUM.—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.— 

9 (1) IN GENERAL.—The first year of the pro10 gram shall be dedicated to program development, in11 cluding planning and site selection. 

12 (2) CONSULTATION.—In developing the pro13 gram, the Secretary shall consult with— 

14 (A) the Secretary of Health and Human 

15 Services; 

16 (B) the National Institutes of Health; 

17 (C) public and private institutions of high18 er education; 

19 (D) educators; 

20 (E) experts in suicide assessment, treat21 ment, and management; 

22 (F) veterans service organizations; and 

23 (G) professional associations the Secretary 

24 of Veterans Affairs determines relevant to the 

25 purposes of the program. 


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

2 program shall consist of not less than ten weeks of edu3 cation regarding suicide care, beginning with the selection 

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

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

6 elements: 

7 (1) Complete the organizational self-study of 

8 the Institute as a team. 

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

10 of the Institute. 

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

12 evaluation and quality improvement using the data 

13 elements worksheet of the Institute. 

14 (4) Communicate to staff at the respective site 

15 the adoption of a specific suicide care approach. 

16 (5) Administer the workforce survey of the In17 stitute to all staff at the respective site to learn 

18 more about perceived comfort with and competence 

19 in caring for patients at risk of suicide. 

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

21 processes and policies regarding patients at risk of 

22 suicide, including— 

23 (A) screening; 

24 (B) assessment; 

25 (C) use of electronic health records; 


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1 (D) risk formulation; 

2 (E) treatment; and 

3 (F) care transition. 

4 (e) SITES.— 

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

6 the program at five medical centers of the Depart7 ment of Veterans Affairs, one of which primarily 

8 serves veterans who live in rural and remote areas 

9 as determined by the Secretary. 

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

11 (A) 15 candidate sites for the program not 

12 later than 180 days after the date of the enact13 ment of this Act; and 

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

15 days after the date of the enactment of this 

16 Act. 

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

18 to carry out the program, the Secretary shall consult 

19 with experts including officials of— 

20 (A) the National Institute of Mental 

21 Health; 

22 (B) the Substance Abuse and Mental 

23 Health Services Administration of the Depart24 ment of Health and Human Services; 


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1 (C) the Office of Mental Health and Sui2 cide Prevention of the Department of Veterans 

3 Affairs; 

4 (D) the Health Services Research Division 

5 of the Department of Veterans Affairs; 

6 (E) the Office of Health Care Trans7 formation of the Department of Veterans Af8 fairs; and 

9 (F) the Zero Suicide Institute. 

10 (4) FACTORS.—In selecting sites for the pro11 gram, the Secretary shall consider the following fac12 tors: 

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

14 of the medical centers to implement the pro15 gram. 

16 (B) Geographic variation. 

17 (C) Variations in size of medical centers. 

18 (D) Regional suicide rates of veterans. 

19 (E) Demographic and health characteris20 tics of populations served by each medical cen21 ter. 

22 (f) ANNUAL PROGRESS REPORT.— 

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

24 after the date on which the Secretary establishes the 

25 program, and annually thereafter until termination 


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1 of the program, the Secretary shall submit to the 

2 Committee on Veterans’ Affairs of the Senate and 

3 the Committee on Veterans’ Affairs of the House of 

4 Representatives a report on the program. 

5 (2) ELEMENTS.—Each report under paragraph 

6 (1) shall include the following: 

7 (A) Progress of staff leaders at each site 

8 in carrying out tasks under paragraphs (1) 

9 through (5) of subsection (d). 

10 (B) The percentage of staff at each site 

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

12 (C) An assessment of whether policies and 

13 procedures implemented at each site align with 

14 standards of the Institute with regards to— 

15 (i) suicide screening; 

16 (ii) lethal means counseling; 

17 (iii) referrals for comprehensive as18 sessment of suicidality; 

19 (iv) safety planning for patients re20 ceiving referrals under clause (iii); 

21 (v) risk management during care 

22 transitions; and 

23 (vi) outreach to high-risk patients. 

24 (D) A comparison of the suicide-related 

25 outcomes at program sites and those of other 


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1 medical centers of the Department of Veterans 

2 Affairs, including— 

3 (i) the percentage of patients screened 

4 for suicide risk; 

5 (ii) the percentage of patients coun6 seled in lethal means safety; 

7 (iii) the percentage of patients 

8 screened for suicide risk referred for com9 prehensive assessment of suicidality; 

10 (iv) the percentage of patients re11 ferred for comprehensive assessment who 

12 complete safety planning; 

13 (v) emergency department utilization; 

14 (vi) inpatient psychiatric hospitaliza15 tions; 

16 (vii) the number of suicide attempts 

17 among all patients and among patients re18 ferred for comprehensive assessment of 

19 suicidality; and 

20 (viii) the number of suicide deaths 

21 among all patients and among patients re22 ferred for comprehensive assessment of 

23 suicidality. 

24 (g) FINAL REPORT.— 


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

2 after the termination of the program, the Secretary 

3 shall submit to the Committee on Veterans’ Affairs 

4 of the Senate and the Committee on Veterans’ Af5 fairs of the House of Representatives a final report. 

6 (2) ELEMENTS.—The report under paragraph 

7 (1) shall include the following: 

8 (A) A detailed analysis of information in 

9 the annual reports under subsection (f). 

10 (B) An evaluation of the effectiveness and 

11 outcomes of the program, including an evalua12 tion of all data collected during the program. 

13 (C) The determination of the Secretary 

14 whether it is feasible to continue the program. 

15 (D) The recommendations of the Secretary 

16 whether to expand the program to additional 

17 sites, extend the program, or make the program 

18 permanent. 

19 (h) TERMINATION; EXTENSION.— 

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

21 the program shall terminate on the date that is five 

22 years after the date on which the Secretary estab23 lishes the program under subsection (a). 

24 (2) AUTHORITY TO EXTEND.—The Secretary 

25 may extend the program for not more than two 


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1 years if the Secretary notifies Congress in writing of 

2 such extension not less than 180 days before the ter3 mination date under paragraph (1). 

Æ 


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