II 

110TH CONGRESS 

1ST SESSION S. 1854 

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 SENATE OF THE UNITED STATES 

JULY 23, 2007 

Mr. REID (for himself, Mr. KERRY, and Mr. DODD) introduced the following 

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

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’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

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

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


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1 suicide rate for individuals 85 years of age and older 

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

3 (age 60 and older) died by suicide (Centers for Dis4 ease Control and Prevention, 2007). 

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

6 made up only 12.4 percent of the population but ac7 counted for 16 percent of all suicides. 

8 (3) According to the Centers for Disease Con9 trol and Prevention, from 1980 to 1992, the suicide 

10 rate rose 9 percent for Americans 65 years of age 

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

12 ages 80 to 84. 

13 (4) Older adults have a considerably higher rate 

14 of completed suicide than other groups. While for all 

15 age groups combined there is one suicide for every 

16 20 attempts, there is one suicide for every 4 at17 tempts among those 65 years of age and older. 

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

19 and older, it is estimated that 2,000,000 have a de20 pressive illness and another 5,000,000 suffer from 

21 depressive symptoms and syndromes that fall short 

22 of meeting full diagnostic criteria for a disorder 

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

24 1999). 


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1 (6) Seniors covered by Medicare are required to 

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

3 services while they are only required to pay a 20 

4 percent co-pay for physical health services. 

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

6 adults who complete suicide visited a physician with7 in the prior 24 hours, 41 percent within the past 

8 week, and 75 percent within the past month (Sur9 geon General’s Call to Action to Prevent Suicide, 

10 1999). 

11 (8) A substantial proportion of older patients 

12 receive no treatment or inadequate treatment for 

13 their depression in primary care settings (National 

14 Institutes of Health Consensus Development Panel 

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

16 1997). 

17 (9) Suicide in older adults is most associated 

18 with late-onset depression. Among patients 75 years 

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

20 diagnosable depression (Mental Health: A Report of 

21 the Surgeon General, 1999). 

22 (10) Research suggests that many seniors re23 ceive mental health assistance from their primary 

24 care providers or other helping professionals versus 


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1 specialty mental health professionals (Mental 

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

3 (11) Objective 4.6 of the National Strategy for 

4 Suicide Prevention calls for increasing the propor5 tion of State Aging Networks that have evidence6 based suicide prevention programs designed to iden7 tify and refer for treatment elderly people at risk for 

8 suicidal behavior. 

9 (12) Objective 1.1 of the President’s New Free10 dom Commission on Mental Health calls for advanc11 ing and implementing a national campaign to reduce 

12 the stigma of seeking care and a national strategy 

13 for suicide prevention. The report addresses tar14 geting to distinct and often hard-to-reach popu15 lations, such as ethnic and racial minorities, older 

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

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

18 White House Conference on Aging called for improv19 ing the recognition, assessment, and treatment of 

20 mental illness and depression among older Ameri21 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 06:55 Jul 24, 2007 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1854.IS S1854

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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. 


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1 SEC. 4. ELIMINATION OF DISCRIMINATORY COPAYMENT 

2 RATES FOR MEDICARE OUTPATIENT MENTAL 

3 HEALTH SERVICES. 

4 (a) IN GENERAL.—Section 1833 of the Social Secu5 rity Act (42 U.S.C. 1395l) is amended by striking sub6 section (c). 

7 (b) EFFECTIVE DATE.—The amendment made by 

8 subsection (a) shall apply to items and services furnished 

9 on or after January 1, 2008. 

10 SEC. 5. ELDERLY SUICIDE EARLY INTERVENTION AND PRE11 VENTION STRATEGIES. 

12 Title V of the Public Health Service Act is amended 

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

14 the following: 

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

16 AND PREVENTION STRATEGIES. 

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

18 grants or cooperative agreements to eligible entities to de19 velop strategies for addressing suicide among the elderly. 

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

21 or cooperative agreement under subsection (a) an entity 

22 shall— 

23 ‘‘(1) be a— 

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

25 territory, or a federally recognized Indian tribe, 

26 tribal organization (as defined in the Indian 


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1 Self-Determination and Education Assistance 

2 Act), or an urban Indian organization (as de3 fined in the Indian Health Care Improvement 

4 Act); or 

5 ‘‘(B) a public or private nonprofit organi6 zation; and 

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

8 such time, in such manner, and containing such in9 formation as the Secretary may require. 

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

11 received under a grant or cooperative agreement under 

12 this section to— 

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

14 intervention and prevention strategies in 1 or more 

15 settings that serve seniors, including senior centers, 

16 nutrition sites, primary care settings, veterans’ fa17 cilities, nursing facilities, assisted living facilities, 

18 and aging information and referral sites, such as 

19 those operated by area agencies on aging or Aging 

20 and Disability Resource Centers (as those terms are 

21 defined in section 102 of the Older Americans Act 

22 of 1965); 

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

24 early intervention and prevention services for purVerDate Aug 31 2005 06:55 Jul 24, 2007 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1854.IS S1854

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1 poses of monitoring, research and policy develop2 ment; and 

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

4 such services. 

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

6 cooperative agreement under this section shall dem7 onstrate how such applicant will— 

8 ‘‘(1) collaborate with other State and local pub9 lic and private nonprofit organizations; 

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

11 referral to seniors or their families who are at risk 

12 for suicide, and appropriate postsuicide intervention 

13 services care, and information to families and 

14 friends of seniors who recently completed suicide and 

15 other interested individuals; and 

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

17 the goals, outcomes, and effectiveness of the activi18 ties carried out under the grant or agreement, in 

19 consultation with interested families and national 

20 advocacy organizations focused on suicide preven21 tion, including senior suicide prevention. 

22 ‘‘(e) PREFERENCE.—In awarding a grant or coopera23 tive agreement under this section, the Secretary shall give 

24 preference to applicants with demonstrated expertise and 

25 capability in providing— 


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

2 including voluntary screening programs, education, 

3 and outreach to elderly who are at risk for mental 

4 or emotional disorders that may lead to a suicide at5 tempt and that are integrated with aging services 

6 support organizations; 

7 ‘‘(2) early intervention and prevention practices 

8 and strategies adapted to the community it will 

9 serve, with equal preference given to applicants that 

10 are already serving the same community, and appli11 cants that will serve a new community under a grant 

12 or agreement under this section, if the applicant has 

13 already demonstrated expertise and capability in 

14 providing early intervention and prevention practices 

15 and strategies adapted to the community or commu16 nities it currently serves; 

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

18 diverse linguistic and cultural backgrounds; and 

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

20 with rates of elder suicide that exceed the national 

21 average as determined by the Centers for Disease 

22 Control and Prevention. 

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

24 less than 85 percent of amounts received under a grant 


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1 or cooperative agreement under this section shall be used 

2 to provide direct services. 

3 ‘‘(g) COORDINATION AND COLLABORATION.— 

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

5 (including awarding grants and cooperative agree6 ments under subsection (a)), the Secretary shall col7 laborate with the Interagency Geriatric Mental 

8 Health Planning Council. 

9 ‘‘(2) CONSULTATION.— 

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

11 subparagraph (B), in developing and imple12 menting Federal policy to carry out this section, 

13 the Secretary shall consult with— 

14 ‘‘(i) State and local agencies, includ15 ing agencies comprising the aging network; 

16 ‘‘(ii) national advocacy organizations 

17 focused on suicide prevention, including 

18 senior suicide prevention; 

19 ‘‘(iii) relevant national medical and 

20 other health specialty organizations; 

21 ‘‘(iv) seniors who are at risk for sui22 cide, who have survived suicide attempts, 

23 or who are currently receiving care from 

24 early intervention and prevention services; 


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1 ‘‘(v) families and friends of seniors 

2 who are at risk for suicide, who have sur3 vived attempts, who are currently receiving 

4 care from early intervention and prevention 

5 services, or who have completed suicide; 

6 ‘‘(vi) qualified professionals who pos7 sess the specialized knowledge, skills, expe8 rience, and relevant attributes needed to 

9 serve seniors at risk for suicide and their 

10 families; and 

11 ‘‘(vii) other entities as determined by 

12 the Secretary. 

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

14 not consult with the entities described in sub15 paragraph (A) for the purpose of awarding 

16 grants and cooperative agreements under sub17 section (a). 

18 ‘‘(h) EVALUATIONS AND REPORTS.— 

19 ‘‘(1) EVALUATIONS BY GRANTEES.— 

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

21 than 1 year after receiving a grant or coopera22 tive agreement under this section, an eligible 

23 entity shall submit to the Secretary a plan on 

24 the design of an evaluation strategy to assess 


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1 the effectiveness of results of the activities car2 ried out under the grant or agreement. 

3 ‘‘(B) EVALUATION OF EFFECTIVENESS.— 

4 Not later than 2 years after receiving a grant 

5 or cooperative agreement under this section, an 

6 eligible entity shall submit to the Secretary an 

7 effectiveness evaluation on the implementation 

8 and results of the activities carried out by the 

9 eligible entity under the grant or agreement. 

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

11 date that the initial grants or cooperative agree12 ments are awarded to eligible entities under this sec13 tion, the Secretary shall submit to the appropriate 

14 committees of Congress a report describing the 

15 projects funded under this section and include an 

16 evaluation plan for future activities. The report 

17 shall— 

18 ‘‘(A) be a coordinated response by all rep19 resentatives on the Interagency Geriatric Men20 tal Health Advisory Council; and 

21 ‘‘(B) include input from consumers and 

22 family members of consumers on progress being 

23 made and actions that need to be taken. 

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


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1 ‘‘(1) AGING NETWORK.—The term ‘aging net2 work’ has the meaning given such term in section 

3 102(5) of the Older Americans Act of 1965. 

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

5 intervention’ means a strategy or approach that is 

6 intended to prevent an outcome or to alter the 

7 course of an existing condition. 

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

9 means a strategy or approach that reduces the likeli10 hood of risk or onset, or delays the onset, of adverse 

11 health problems that have been known to lead to sui12 cide. 

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

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

15 or older and being served by aging network pro16 grams; or 

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

18 or older and covered under Medicare. 

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

20 ‘‘(1) IN GENERAL.—For the purpose of car21 rying out this section there is authorized to be ap22 propriated $4,000,000 for fiscal year 2008, 

23 $6,000,000 for fiscal year 2009 and $8,000,000 for 

24 fiscal year 2010. 


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

2 appropriated for any fiscal year to carry out this 

3 section, in awarding grants and cooperative agree4 ments under this section during such fiscal year, the 

5 Secretary shall give preference to applicants in 

6 States that have rates of elderly suicide that signifi7 cantly exceed the national average as determined by 

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

9 SEC. 6. INTERAGENCY TECHNICAL ASSISTANCE CENTER. 

10 (a) INTERAGENCY RESEARCH, TRAINING, AND TECH11 NICAL ASSISTANCE CENTERS.—Section 520C(d) of the 

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

13 amended— 

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

15 early intervention and prevention strategies’’ and in16 serting ‘‘suicide early intervention and prevention 

17 strategies for all ages, particularly for groups that 

18 are at a high risk for suicide’’; 

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

20 early intervention and prevention strategies’’ and in21 serting ‘‘suicide early intervention and prevention 

22 strategies for all ages, particularly for groups that 

23 are at a high risk for suicide’’; 

24 (3) in paragraph (3)— 

25 (A) by striking ‘‘youth’’; and 


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1 (B) by inserting before the semicolon the 

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

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

4 (4) in paragraph (4), by striking ‘‘youth sui5 cide’’ and inserting ‘‘suicide for all ages, particularly 

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

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

8 early intervention techniques and technology’’ and 

9 inserting ‘‘suicide early intervention techniques and 

10 technology for all ages, particularly for groups that 

11 are at a high risk for suicide’’; 

12 (6) in paragraph (7)— 

13 (A) by striking ‘‘youth’’; and 

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

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

16 after ‘‘strategies’’; and 

17 (7) in paragraph (8)— 

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

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

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

21 ‘‘among all ages, particularly among groups 

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

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

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

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


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1 (c) AUTHORIZATION OF APPROPRIATIONS.— 

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

3 funds made available, there are authorized to be ap4 propriated for each of fiscal years 2008 through 

5 2010, such sums as may be necessary to carry out 

6 the amendments made by subsection (a). 

7 (2) SUPPLEMENT NOT SUPPLANT.—Any funds 

8 appropriated under paragraph (1) shall be used to 

9 supplement and not supplant other Federal, State, 

10 and local public funds expended to carry out other 

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

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

13 by subsection (a)). 

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

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

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

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

18 receives an increase in funding to carry out activities 

19 under subsection (d) of such section related to sui20 cide prevention and intervention among groups that 

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

22 any other provision of such section, such recipient 

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1 ceiving funding under such section or section 520E– 

2 3 of such Act (as added by section 5). 

Æ 


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