I 
118TH CONGRESS 
1ST SESSION H. R. 6415 
To increase access to mental health, substance use, and counseling services 
for first responders, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 14, 2023 
Ms. TOKUDA (for herself, Mr. FITZPATRICK, Ms. BALINT, Mr. LAMALFA, Mr. 
TONKO, Mrs. WATSON COLEMAN, Mr. NEGUSE, Ms. NORTON, Ms. SALI-
NAS, and Mrs. TORRES of California) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committee on Transportation and Infrastructure, for a period to 
be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To increase access to mental health, substance use, and 
counseling services for first responders, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Crisis Assistance and 
Resources in Emergencies for First Responders Act’’ or 
the ‘‘CARE for First Responders Act’’. 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) According to the Department of Homeland 
Security, there are an estimated 4.6 million people 
serving as career and volunteer professionals in the 
United States within 5 primary response disciplines: 
law enforcement, fire and rescue services, emergency 
management, and public works. 
(2) First responders are usually the first on the 
scene to face challenging, dangerous, and draining 
situations. 
(3) First responders are also the first to reach 
out to disaster survivors and provide emotional and 
physical support to them. These duties, although es-
sential to the entire community, are strenuous to 
first responders and with time put them at an in-
creased risk of experiencing some mental health and 
substance use issues and conditions. 
(4) The combination of exposure to trauma, de-
manding schedules, and physically challenging roles 
puts first responders at an increased risk for mental 
health issues such as depression, post-traumatic 
dress disorder, stress, and suicidal behaviors. 
(5) According to a 2018 study by the Substance 
Abuse and Mental Health Services Administration, 
30 percent of first responders develop behavioral 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
health conditions including depression and post-trau-
matic stress disorder, as compared with 20 percent 
in the general population. 
(6) The Substance Abuse and Mental Health 
Services Administration finds that an estimated be-
tween 125 and 300 police officers die by suicide an-
nually. 
(7) Data from the National Violent Death Re-
porting System indicates that first responders made 
up 1 percent of all suicides from 2015 to 2017. 
When broken down by response discipline, these first 
responder suicides occurred among law enforcement 
officers (58 percent), firefighters (21 percent), emer-
gency medical services providers (18 percent) and 
public safety telecommunicators (2 percent). 
(8) According to the Firefighter Behavioral 
Health Alliance, more firefighters died of suicide 
than in the line of duty between 2014 and 2020, and 
nearly 58 percent of firefighters were exposed to 
traumatic events like mass shootings, violence car 
crashes, or child abuse. 
(9) For many first responders, it can be dif-
ficult to transition from being a provider to client or 
patient is not an easy one so when a first responder 
finally seeks treatment, it can be devastating to en-
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
counter an ill-prepared provider and may result in 
reluctance to seek further help. 
(10) Many first responders may consider stress 
to be ‘‘part of the job’’ and feel that they cannot or 
should not talk about traumatic events and other oc-
cupational stressors. Perceived stigma around men-
tal health problems or concerns over impact on em-
ployment, including but not limited to being labeled 
as ‘‘unfit’’ for duty, may lead first responders to not 
report trauma, mental health issues, or suicidal 
thoughts. 
(11) There are limited resources available to 
specifically address the mental health needs of first 
responders. Often, first responders are directed to 
general mental health practitioners who may not un-
derstand the unique demands faced by first respond-
ers or the cultures in which they operate. While 
these services may meet the needs of many patients, 
general practitioners may not understand what first 
responders experience on the job or be able to relate 
to them in a culturally competent manner. 
(12) Providing first responders with mental 
health and substance use resources and services that 
are readily available and occupationally relevant can 
help them deal with excess stress, attain timely and 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
clinically appropriate care, and feel better prepared 
to respond to an emergency. 
(13) Public safety telecommunicators, including 
9–1–1 operators and fire dispatchers, are the back-
bone of our national emergency response system. 
They provide round-the-clock coverage in more than 
6,000 emergency communication centers around the 
country. 
(14) Public safety telecommunicators are re-
sponsible 
for 
answering 
emergency 
and 
non-
emergency calls and directing police, fire and rescue, 
and other emergency response personnel to assist 
those in need. They are required to multitask, con-
duct on-the-spot problem solving, and maintain 
composure and compassion, while coaching callers 
through often difficult and disturbing situations like 
home invasions, incidents of domestic violence, burn-
ing homes, automobile accidents and fatalities, and 
homicides. 
(15) The work of public safety telecommunica-
tors is often high-stress, fast-paced, and emotionally 
demanding. Every day, they are faced with chal-
lenges and trauma that places them at increased 
risk for developing mental health challenges. 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
(16) According to studies conducted by Na-
tional Institute for Occupational Safety and Health, 
between 17 percent and 24 percent of public safety 
telecommunicators have symptoms of post-traumatic 
stress disorder and 24 percent have symptoms of de-
pression. While telecommunicators are often the very 
first responders engaged with those on scene, re-
search on their suicide risk and mental health has 
lagged. 
(17) Despite playing a critical role in protecting 
and saving lives in emergency situations, public safe-
ty telecommunicators are classified by most States 
and by the Federal Government as office and admin-
istrative support personnel and not as first respond-
ers, leaving them without access to important mental 
health resources available to other emergency re-
sponse professionals. 
SEC. 3. CRISIS COUNSELING ASSISTANCE AND TRAINING. 
(a) IN GENERAL.—Section 416(a) of the Robert T. 
Stafford Disaster Relief and Emergency Assistance Act 
(42 U.S.C. 5183(a)) is amended by inserting ‘‘and to 
qualified emergency response providers responding to 
major disasters’’ after ‘‘victims of major disasters’’. 
(b) DEFINITIONS.—Section 102 of the Robert T. 
Stafford Disaster Relief and Emergency Assistance Act 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
(42 U.S.C. 5122) is amended by adding at the end the 
following: 
‘‘(13) PUBLIC SAFETY TELECOMMUNICATOR.— 
The term ‘public safety telecommunicator’ means a 
public safety telecommunicator as designated in de-
tailed occupation 43–5031 in the Standard Occupa-
tional Classification Manual of the Office of Man-
agement and Budget issued in 2018, or any suc-
cessor designation. 
‘‘(14) QUALIFIED EMERGENCY RESPONSE PRO-
VIDERS.—The term ‘qualified emergency response 
providers’ means— 
‘‘(A) emergency response providers (as de-
fined in section 2 of the Homeland Security Act 
of 2002 (6 U.S.C. 101)); and 
‘‘(B) public safety telecommunicators.’’. 
SEC. 4. SPECIALIZED SERVICES FOR FIRST RESPONDERS. 
Subpart 3 of part B of title V of the Public Health 
Service Act (42 U.S.C. 290bb–31) is amended by adding 
at the end the following: 
‘‘SEC. 520O. SPECIALIZED SERVICES FOR FIRST RESPOND-
ERS. 
‘‘(a) ESTABLISHMENT.—Not later than 2 years after 
the date of enactment of this Act, the Secretary of Health 
and Human Services, acting through the Assistant Sec-
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
retary of the Substance Abuse and Mental Health Admin-
istration, shall develop and carry out a comprehensive pro-
gram designed to provide mental health services specifi-
cally tailored to qualified emergency response providers. 
Such program shall— 
‘‘(1) provide for mental health care availability 
to qualified emergency response providers on a 24- 
hour basis; 
‘‘(2) provide for a qualified emergency response 
providers hotline operated through the 988 Suicide 
and Crisis Lifeline under section 520E–3 of the 
Public Health Service Act (42 U.S.C. 290bb–36c) 
that is confidential and toll-free, sufficiently staffed 
by appropriately trained mental health personnel 
and available at all times; and 
‘‘(3) provide for outreach to, and education pro-
grams for, qualified emergency response providers 
and their families, with priority given to qualified 
emergency response providers of major disasters. 
‘‘(b) BEST PRACTICES RESEARCH.— 
‘‘(1) IN GENERAL.—The Secretary shall, in con-
sultation with the heads of the agencies specified in 
paragraph (2), conduct or support research on best 
practices for providing mental health services to, and 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
prevent suicide among, qualified emergency response 
providers. 
‘‘(2) AGENCIES SPECIFIED.—The agencies spec-
ified in this paragraph are the following: 
‘‘(A) The Department of Homeland Secu-
rity. 
‘‘(B) The Federal Emergency Management 
Agency. 
‘‘(C) The United States Fire Administra-
tion. 
‘‘(D) The National Institute of Mental 
Health. 
‘‘(E) The Centers for Disease Control and 
Prevention. 
‘‘(F) The Department of Justice. 
‘‘(c) INFORMATION ADDRESSED IN EDUCATION PRO-
GRAMS.—Education provided under subsection (a)(3) shall 
include information designed to— 
‘‘(1) remove the stigma associated with mental 
illness; 
‘‘(2) encourage qualified emergency response 
providers to seek treatment and assistance for men-
tal illness; 
‘‘(3) promote skills for coping with mental ill-
ness; and 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
‘‘(4) help families of qualified emergency re-
sponse providers with— 
‘‘(A) understanding issues arising from the 
transition of qualified emergency response pro-
viders back into family life and regular work, 
following the end of a disaster assignment; 
‘‘(B) identifying signs and symptoms of 
mental illness; and 
‘‘(C) encouraging qualified emergency re-
sponse providers to seek assistance for mental 
illness. 
‘‘(d) PEER SUPPORT COUNSELING PROGRAM.— 
‘‘(1) IN
GENERAL.—The Secretary shall, as 
part of the comprehensive program under this sec-
tion, establish and carry out a peer support coun-
seling program, under which active and retired 
qualified emergency response providers may volun-
teer as peer counselors— 
‘‘(A) to assist other qualified emergency 
response providers with issues related to mental 
health, readiness, and readjustment; and 
‘‘(B) to conduct outreach to qualified 
emergency response providers and their fami-
lies. 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
‘‘(2) ADMINISTRATION.—In carrying out the 
peer support counseling program under this section, 
the Secretary shall— 
‘‘(A) provide for adequate training of indi-
viduals who volunteer to serve as peer coun-
selors, including training carried out under sec-
tion 416(a) of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act; and 
‘‘(B) coordinate with such community or-
ganizations, State and local governments, insti-
tutions of higher education, chambers of com-
merce, local business organizations, organiza-
tions that provide mental health services, and 
other organizations as the Secretary considers 
appropriate. 
‘‘(e) OTHER COMPONENTS.—The Secretary may take 
such other actions to carry out the comprehensive program 
under this section as the Secretary determines appropriate 
for purposes of reducing the incidence of mental illness 
and suicide among qualified emergency response pro-
viders. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) PUBLIC SAFETY TELECOMMUNICATORS.— 
The term ‘‘public safety telecommunicator’’ means a 
public safety telecommunicator as designated in de-
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS
tailed occupation 43–5031 in the Standard Occupa-
tional Classification Manual of the Office of Man-
agement and Budget issued in 2018, or any suc-
cessor designation. 
‘‘(2) QUALIFIED EMERGENCY RESPONSE PRO-
VIDERS.—The term ‘qualified emergency response 
providers’ means— 
‘‘(A) emergency response providers (as de-
fined in section 2 of the Homeland Security Act 
of 2002 (6 U.S.C. 101)); and 
‘‘(B) public safety telecommunicators. 
‘‘(3) MAJOR DISASTER.—The term ‘major dis-
aster’ has the meaning given such term in section 
102 of the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act (42 U.S.C. 5122). 
‘‘SEC. 520P. ON-SITE MENTAL HEALTH SERVICES GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Assistant Secretary for Mental Health and Substance 
Use, shall award competitive grants to eligible entities to 
establish a new health care delivery site that is a mobile 
unit to provide integrated, short-term crisis services to 
qualified emergency response providers of a major dis-
aster. Such services shall be— 
‘‘(1) linguistically and culturally appropriate; 
‘‘(2) trauma-informed; and 
VerDate Sep 11 2014 
01:48 Dec 05, 2023
Jkt 049200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H6415.IH
H6415
dmwilson on DSKJM0X7X2PROD with BILLS