I 

118TH CONGRESS 

1ST SESSION H. R. 5514 

To authorize a pilot program to expand and intensify surveillance of selfharm in partnership with State and local public health departments, 

to establish a grant program to provide self-harm and suicide prevention 

services in hospital emergency departments, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 14, 2023 

Mr. STEWART (for himself and Ms. MATSUI) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To authorize a pilot program to expand and intensify surveillance of self-harm in partnership with State and local 

public health departments, to establish a grant program 

to provide self-harm and suicide prevention services in 

hospital emergency departments, 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 ‘‘Suicide Prevention 

5 Act’’. 


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1 SEC. 2. SYNDROMIC SURVEILLANCE OF SELF-HARM BEHAV2 IORS PROGRAM. 

3 Title III of the Public Health Service Act is amended 

4 by inserting after section 317U of such Act (42 U.S.C. 

5 247b–23) the following: 

6 ‘‘SEC. 317W. SYNDROMIC SURVEILLANCE OF SELF-HARM 

7 BEHAVIORS PROGRAM. 

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

9 grants to State, local, Tribal, and territorial public health 

10 departments for the expansion of surveillance of self-harm. 

11 ‘‘(b) DATA SHARING BY GRANTEES.—As a condition 

12 of receipt of such grant under subsection (a), each grantee 

13 shall agree to share with the Centers for Disease Control 

14 and Prevention in real time, to the extent feasible and as 

15 specified in the grant agreement, data on suicides and self16 harm for purposes of— 

17 ‘‘(1) tracking and monitoring self-harm to in18 form response activities to suicide clusters; 

19 ‘‘(2) informing prevention programming for 

20 identified at-risk populations; and 

21 ‘‘(3) conducting or supporting research. 

22 ‘‘(c) DISAGGREGATION OF DATA.—The Secretary 

23 shall provide for the data collected through surveillance 

24 of self-harm under subsection (b) to be disaggregated by 

25 the following categories: 

26 ‘‘(1) Nonfatal self-harm data of any intent. 


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1 ‘‘(2) Data on suicidal ideation. 

2 ‘‘(3) Data on self-harm where there is no evi3 dence, whether implicit or explicit, of suicidal intent. 

4 ‘‘(4) Data on self-harm where there is evidence, 

5 whether implicit or explicit, of suicidal intent. 

6 ‘‘(5) Data on self-harm where suicidal intent is 

7 unclear based on the available evidence. 

8 ‘‘(d) PRIORITY.—In making awards under subsection 

9 (a), the Secretary shall give priority to eligible entities that 

10 are— 

11 ‘‘(1) located in a State with an age-adjusted 

12 rate of nonfatal suicidal behavior that is above the 

13 national rate of nonfatal suicidal behavior, as deter14 mined by the Director of the Centers for Disease 

15 Control and Prevention; 

16 ‘‘(2) serving an Indian Tribe (as defined in sec17 tion 4 of the Indian Self-Determination and Edu18 cation Assistance Act) with an age-adjusted rate of 

19 nonfatal suicidal behavior that is above the national 

20 rate of nonfatal suicidal behavior, as determined 

21 through appropriate mechanisms determined by the 

22 Secretary in consultation with Indian Tribes; or 

23 ‘‘(3) located in a State with a high rate of cov24 erage of statewide (or Tribal) emergency department 


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1 visits, as determined by the Director of the Centers 

2 for Disease Control and Prevention. 

3 ‘‘(e) GEOGRAPHIC DISTRIBUTION.—In making 

4 grants under this section, the Secretary shall make an ef5 fort to ensure geographic distribution, taking into account 

6 the unique needs of rural communities, including— 

7 ‘‘(1) communities with an incidence of individ8 uals with serious mental illness, demonstrated suici9 dal ideation or behavior, or suicide rates that are 

10 above the national average, as determined by the As11 sistant Secretary for Mental Health and Substance 

12 Use; 

13 ‘‘(2) communities with a shortage of prevention 

14 and treatment services, as determined by the Assist15 ant Secretary for Mental Health and Substance Use 

16 and the Administrator of the Health Resources and 

17 Services Administration; and 

18 ‘‘(3) other appropriate community-level factors 

19 and social determinants of health such as income, 

20 employment, and education. 

21 ‘‘(f) PERIOD OF PARTICIPATION.—To be selected as 

22 a grant recipient under this section, a State, local, Tribal, 

23 or territorial public health department shall agree to par24 ticipate in the program for a period of not less than 4 

25 years. 


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1 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

2 provide technical assistance and training to grantees for 

3 collecting and sharing the data under subsection (b). 

4 ‘‘(h) DATA SHARING BY HHS.—Subject to sub5 section (b), the Secretary shall, with respect to data on 

6 self-harm that is collected pursuant to this section, share 

7 and integrate such data through— 

8 ‘‘(1) the National Syndromic Surveillance Pro9 gram’s Early Notification of Community Epidemics 

10 (ESSENCE) platform (or any successor platform); 

11 ‘‘(2) the National Violent Death Reporting Sys12 tem, as appropriate; or 

13 ‘‘(3) another appropriate surveillance program, 

14 including such a program that collects data on sui15 cides and self-harm among special populations, such 

16 as members of the military and veterans. 

17 ‘‘(i) RULE OF CONSTRUCTION REGARDING APPLICA18 BILITY OF PRIVACY PROTECTIONS.—Nothing in this sec19 tion shall be construed to limit or alter the application 

20 of Federal or State law relating to the privacy of informa21 tion to data or information that is collected or created 

22 under this section. 

23 ‘‘(j) REPORT.— 

24 ‘‘(1) SUBMISSION.—Not later than 3 years 

25 after the date of enactment of this Act, the SecVerDate Sep 11 2014 05:08 Sep 16, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5514.IH H5514

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1 retary shall evaluate the suicide and self-harm 

2 syndromic surveillance systems at the Federal, 

3 State, and local levels and submit a report to Con4 gress on the data collected under subsections (b) and 

5 (c) in a manner that prevents the disclosure of indi6 vidually identifiable information, at a minimum, con7 sistent with all applicable privacy laws and regula8 tions. 

9 ‘‘(2) CONTENTS.—In addition to the data col10 lected under subsections (b) and (c), the report 

11 under paragraph (1) shall include— 

12 ‘‘(A) challenges and gaps in data collection 

13 and reporting; 

14 ‘‘(B) recommendations to address such 

15 gaps and challenges; and 

16 ‘‘(C) a description of any public health re17 sponses initiated at the Federal, State, or local 

18 level in response to the data collected. 

19 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—To 

20 carry out this section, there are authorized to be appro21 priated $20,000,000 for each of fiscal years 2024 through 

22 2028.’’. 


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1 SEC. 3. GRANTS TO PROVIDE SELF-HARM AND SUICIDE 

2 PREVENTION SERVICES. 

3 Part B of title V of the Public Health Service Act 

4 (42 U.S.C. 290aa et seq.) is amended by adding at the 

5 end the following: 

6 ‘‘SEC. 520O. GRANTS TO PROVIDE SELF-HARM AND SUICIDE 

7 PREVENTION SERVICES. 

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

9 Human Services shall award grants to hospital emergency 

10 departments to provide self-harm and suicide prevention 

11 services. 

12 ‘‘(b) ACTIVITIES SUPPORTED.— 

13 ‘‘(1) IN GENERAL.—A hospital emergency de14 partment awarded a grant under subsection (a) shall 

15 use amounts under the grant to implement a pro16 gram or protocol to better prevent suicide attempts 

17 among hospital patients after discharge, which may 

18 include— 

19 ‘‘(A) screening patients for self-harm and 

20 suicide in accordance with the standards of 

21 practice described in subsection (e)(1) and 

22 standards of care established by appropriate 

23 medical and advocacy organizations; 

24 ‘‘(B) providing patients short-term self25 harm and suicide prevention services in accordVerDate Sep 11 2014 05:08 Sep 16, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5514.IH H5514

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1 ance with the results of the screenings de2 scribed in subparagraph (A); and 

3 ‘‘(C) referring patients, as appropriate, to 

4 a health care facility or provider for purposes of 

5 receiving long-term self-harm and suicide pre6 vention services, and providing any additional 

7 follow up services and care identified as appro8 priate as a result of the screenings and short9 term self-harm and suicide prevention services 

10 described in subparagraphs (A) and (B). 

11 ‘‘(2) USE OF FUNDS TO HIRE AND TRAIN

12 STAFF.—Amounts awarded under subsection (a) 

13 may be used to hire clinical social workers, mental 

14 and behavioral health care professionals, and sup15 port staff as appropriate, and to train existing staff 

16 and newly hired staff to carry out the activities de17 scribed in paragraph (1). 

18 ‘‘(c) GRANT TERMS.—A grant awarded under sub19 section (a)— 

20 ‘‘(1) shall be for a period of 3 years; and 

21 ‘‘(2) may be renewed subject to the require22 ments of this section. 

23 ‘‘(d) APPLICATIONS.—A hospital emergency depart24 ment seeking a grant under subsection (a) shall submit 

25 an application to the Secretary at such time, in such manVerDate Sep 11 2014 05:08 Sep 16, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5514.IH H5514

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1 ner, and accompanied by such information as the Sec2 retary may require. 

3 ‘‘(e) STANDARDS OF PRACTICE.— 

4 ‘‘(1) IN GENERAL.—Not later than 180 days 

5 after the date of the enactment of this section, the 

6 Secretary shall develop standards of practice for 

7 screening patients for self-harm and suicide for pur8 poses of carrying out subsection (b)(1)(C). 

9 ‘‘(2) CONSULTATION.—The Secretary shall de10 velop the standards of practice described in para11 graph (1) in consultation with individuals and enti12 ties with expertise in self-harm and suicide preven13 tion, including public, private, and non-profit enti14 ties. 

15 ‘‘(f) REPORTING.— 

16 ‘‘(1) REPORTS TO THE SECRETARY.— 

17 ‘‘(A) IN GENERAL.—A hospital emergency 

18 department awarded a grant under subsection 

19 (a) shall, at least quarterly for the duration of 

20 the grant, submit to the Secretary a report 

21 evaluating the activities supported by the grant. 

22 ‘‘(B) MATTERS TO BE INCLUDED.—The 

23 report required under subparagraph (A) shall 

24 include— 


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1 ‘‘(i) the number of patients receiv2 ing— 

3 ‘‘(I) screenings carried out at the 

4 hospital emergency department; 

5 ‘‘(II) short-term self-harm and 

6 suicide prevention services at the hos7 pital emergency department; and 

8 ‘‘(III) referrals to health care fa9 cilities for the purposes of receiving 

10 long-term self-harm and suicide pre11 vention; 

12 ‘‘(ii) information on the adherence of 

13 the hospital emergency department to the 

14 standards of practice described in sub15 section (f)(1); and 

16 ‘‘(iii) other information as the Sec17 retary determines appropriate to evaluate 

18 the use of grant funds. 

19 ‘‘(2) REPORTS TO CONGRESS.—Not later than 

20 2 years after the date of the enactment of the Sui21 cide Prevention Act, and biennially thereafter, the 

22 Secretary shall submit to the Committee on Health, 

23 Education, Labor, and Pensions of the Senate and 

24 the Committee on Energy and Commerce of the 


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1 House of Representatives a report on the grant pro2 gram under this section, including— 

3 ‘‘(A) a summary of reports received by the 

4 Secretary under paragraph (1); and 

5 ‘‘(B) an evaluation of the program by the 

6 Secretary. 

7 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

8 carry out this section, there are authorized to be appro9 priated $30,000,000 for each of fiscal years 2024 through 

10 2028.’’. 

Æ 


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