II 117th CONGRESS 1st Session S. 1543 IN THE SENATE OF THE UNITED STATES May 10, 2021 Ms. Hassan (for herself, Ms. Ernst , Mr. Blumenthal , Mrs. Capito , Mr. Coons , Mr. Cornyn , Mr. Markey , Mrs. Shaheen , Mr. Tillis , Mr. Murphy , and Mr. Braun ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act to provide best practices on student suicide awareness and prevention training and condition State educational agencies, local educational agencies, and tribal educational agencies receiving funds under section 520A of such Act to establish and implement a school-based student suicide awareness and prevention training policy.

1. Short title This Act may be cited as the Suicide Training and Awareness Nationally Delivered for Universal Prevention Act of 2021 or the STANDUP Act of 2021 . 2. Findings The Congress finds as follows: (1) Since 2010, suicide has been the second-leading cause of death for young people ages 10 through 24. In 2019, 6,488 young people ages 10–24 died by suicide. (2) Based on the 2019 Youth Risk Behavior Survey of the Centers for Disease Control and Prevention (in this section referred to as CDC ), 8.9 percent of youth in grades 9–12 reported that they made at least one suicide attempt during the 12 months before the survey. (3) While there is no complete count of suicide attempts in the United States, CDC data suggests that for every reported death by suicide among people ages 10 through 24, approximately 33.5 young people visit a hospital for self-harm related injuries. (4) In 2019, suicide was the tenth-leading cause of death overall in the United States, with over 47,500 people dying by suicide, and there were more than twice as many suicides in the United States as there were homicides. (5) Youth often display warning signs and signals before harming themselves or others. Research shows that 70 percent of those who die by suicide tell someone of their plans or give another warning sign. (6) According to the CDC, the rates of suicide among non-Hispanic American Indians and Alaska Natives were 60 percent greater than the general population in 2019 and are the highest of any racial or ethnic group in the United States. In addition, a study of CDC data from 2001 through 2015 shows that suicide rates for Black children ages 5 through 12 were roughly 2 times higher than those of similarly aged White children. 3. Student suicide awareness and prevention training (a) In general Title V of the Public Health Service Act is amended by inserting after section 520A of such Act ( 42 U.S.C. 290bb–32 ) the following: 520B. Student suicide awareness and prevention training policies (a) In general As a condition on receipt of funds under section 520A, each State educational agency, local educational agency, and tribal educational agency that receives such funds, directly or through a State or Indian Tribe, for activities to be performed in schools with respect to grades 6 through 12, including the Project AWARE State Education Agency Grant Program, shall— (1) establish and implement a school-based student suicide awareness and prevention training policy; (2) consult with stakeholders (including principals, teachers, parents, local tribal officials, and other school leaders) in the development of the policy under subsection (a)(1); and (3) collect and report information in accordance with subsection (c). (b) School-Based student suicide awareness and prevention training policy A school-based student suicide awareness and prevention training policy implemented pursuant to subsection (a)— (1) shall be evidence-based; (2) shall be culturally and linguistically appropriate; (3) shall provide evidence-based training to students in grades 6 through 12, using school-based mental health service providers, if such providers are reasonably available, regarding— (A) suicide education and awareness, including warning signs for suicide and self-harm; (B) methods that students can use to seek help for themselves and others; and (C) student resources for suicide awareness and prevention; (4) shall provide for retraining of such students every school year; (5) may last for such period as the State educational agency, local educational agency, or tribal educational agency involved determines to be appropriate; (6) may be implemented through any delivery method, including in-person trainings, digital trainings, or train-the-trainer models; and (7) may include discussion of comorbidities and risk factors for suicidal ideation or self-harm, including substance misuse, sexual, or physical abuse, mental illness, and other evidence-based comorbidities or risk factors. (c) Collection of information and reporting Each State educational agency, local educational agency, and tribal educational agency that receives funds under section 520A shall, with respect to each school served by the agency, collect and report to the Secretary the following information: (1) The number of student trainings conducted. (2) The number of students trained, disaggregated by age and grade level. (3) The number of help-seeking reports made by students after implementation of such policy. (d) Evidence-Based program listing The Secretary, in consultation with the Secretary of Education, shall make publicly available the policies established by State educational agencies, local educational agencies, and tribal educational agencies pursuant to this section and the training that is available to students and teams pursuant to such policies, including identification of whether such training is available to trainees at no cost. (e) Implementation timeline A State educational agency, local educational agency, or tribal educational agency shall establish and begin implementation of the policies required by subsection (a)(1) not later than the beginning of the third fiscal year following the date of enactment of this section for which the agency receives funds under section 520A. (f) Definitions In this section: (1) The term evidence-based has the meaning given to such term in section 8101 of the Elementary and Secondary Education Act of 1965. (2) The term local education agency has the meaning given to such term in section 8101 of the Elementary and Secondary Education Act of 1965. (3) The term school-based mental health service provider has the meaning given to such term in section 4102(6) of the Elementary and Secondary Education Act of 1965. (4) The term State educational agency has the meaning given to such term in section 8101 of the Elementary and Secondary Education Act of 1965. (5) The term tribal educational agency has the meaning given to such term in section 6132 of the Elementary and Secondary Education Act of 1965. 520B–1. Best practices for student suicide awareness and prevention training The Secretary, acting through the Assistant Secretary, in consultation with the Secretary of Education and the Bureau of Indian Education, shall— (1) publish best practices for school-based student suicide awareness and prevention training, pursuant to section 520B, that are based on— (A) evidence-based practices; and (B) input from relevant Federal agencies, national organizations, Indian tribes and tribal organizations, and related stakeholders; (2) publish guidance, based on the best practices under paragraph (1), to provide State educational agencies, local educational agencies, and tribal educational agencies with information on student suicide awareness and prevention best practices; (3) disseminate such best practices to State educational agencies, local educational agencies, and tribal educational agencies; and (4) provide technical assistance to State educational agencies, local educational agencies, and tribal educational agencies. . 4. Effective date The amendments made by this Act shall only apply with respect to applications for assistance under section 520A of the Public Health Service Act ( 42 U.S.C. 290bb–32 ) that are submitted after the date of enactment of this Act.