(a)
(b)
(1) recognizing risk factors for suicide;
(2) proper protocols for responding to crisis situations involving veterans who may be at high risk for suicide; and
(3) best practices for suicide prevention.
(c)
(d)
(e)
(1) The Department of Health and Human Services.
(2) The National Institute of Mental Health.
(3) The Substance Abuse and Mental Health Services Administration.
(4) The Centers for Disease Control and Prevention.
(f)
(g) 24-
(h)
(i)
(1) remove the stigma associated with mental illness;
(2) encourage veterans to seek treatment and assistance for mental illness;
(3) promote skills for coping with mental illness; and
(4) help families of veterans with-
(A) understanding issues arising from the readjustment of veterans to civilian life;
(B) identifying signs and symptoms of mental illness; and
(C) encouraging veterans to seek assistance for mental illness.
(j)
(A) to assist other veterans with issues related to mental health and readjustment; and
(B) to conduct outreach to veterans and the families of veterans.
(2) In carrying out the peer support counseling program under this subsection, the Secretary shall provide adequate training for peer counselors, including training carried out under the national program of training required by section 304(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (38 U.S.C. 1712A note).
(3) In addition to other locations the Secretary considers appropriate, the Secretary shall carry out the peer support program under this subsection at each Department medical center.
(4)(A) As part of the counseling program under this subsection, the Secretary shall emphasize appointing peer support counselors for women veterans. To the degree practicable, the Secretary shall seek to recruit women peer support counselors with expertise in-
(i) female gender-specific issues and services;
(ii) the provision of information about services and benefits provided under laws administered by the Secretary; or
(iii) employment mentoring.
(B) To the degree practicable, the Secretary shall emphasize facilitating peer support counseling for women veterans who are eligible for counseling and services under section 1720D of this title, have post-traumatic stress disorder or suffer from another mental health condition, are homeless or at risk of becoming homeless, or are otherwise at increased risk of suicide, as determined by the Secretary.
(C) The Secretary shall conduct outreach to inform women veterans about the program and the assistance available under this paragraph.
(D) In carrying out this paragraph, the Secretary shall coordinate with such community organizations, State and local governments, institutions of higher education, chambers of commerce, local business organizations, organizations that provide legal assistance, and other organizations as the Secretary considers appropriate.
(E) In carrying out this paragraph, the Secretary shall provide adequate training for peer support counselors, including training carried out under the national program of training required by section 304(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (38 U.S.C. 1712A note).
(k)
(Added
Section 304(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010, referred to in subsec. (j)(2), (4)(E), is section 304(c) of
Section 3(a)(1) of
2018-Subsec. (j)(4).
2013-Subsec. (j)(1).
Subsec. (j)(2).
Subsec. (j)(3).
"(a)
"(1)
"(2)
"(b)
"(c)
"(1)
"(2)
"(A) a maximum amount to be awarded under the grant of not more than $750,000 per grantee per fiscal year; and
"(B) intervals of payment for the administration of the grant.
"(d)
"(1)
"(A)
"(i) rural communities;
"(ii) Tribal lands;
"(iii) territories of the United States;
"(iv) medically underserved areas;
"(v) areas with a high number or percentage of minority veterans or women veterans; and
"(vi) areas with a high number or percentage of calls to the Veterans Crisis Line.
"(B)
"(i) to provide services in areas of the United States that have experienced high rates of suicide by eligible individuals, including suicide attempts; and
"(ii) to eligible entities that can assist eligible individuals at risk of suicide who are not currently receiving health care furnished by the Department.
"(C)
"(2)
"(e)
"(1)
"(2)
"(3)
"(A) coordinate with the Secretary with respect to the provision of clinical services to eligible individuals in accordance with subsection (n) or any other provisions of the law regarding the delivery of health care by the Secretary;
"(B) inform every veteran who receives assistance under this section from the entity of the ability of the veteran to apply for enrollment in the patient enrollment system of the Department under section 1705(a) of title 38, United States Code; and
"(C) if such a veteran wishes to so enroll, inform the veteran of a point of contact at the Department who can assist the veteran in such enrollment.
"(4)
"(A) the effect of the services furnished by the entity on the financial stability of the eligible individual;
"(B) the effect of the services furnished by the entity on the mental health status, wellbeing, and suicide risk of the eligible individual; and
"(C) the effect of the services furnished by the entity on the social support of the eligible individuals receiving those services.
"(5)
"(A) shall require each entity receiving a grant under this section to submit to the Secretary an annual report that describes the projects carried out with such grant during the year covered by the report;
"(B) shall specify to each such entity the evaluation criteria and data and information to be submitted in such report; and
"(C) may require each such entity to submit to the Secretary such additional reports as the Secretary considers appropriate.
"(f)
"(1)
"(2)
"(A) A description of the suicide prevention services proposed to be provided by the eligible entity and the identified need for those services.
"(B) A detailed plan describing how the eligible entity proposes to coordinate or deliver suicide prevention services to eligible individuals, including-
"(i) an identification of the community partners, if any, with which the eligible entity proposes to work in delivering such services;
"(ii) a description of the arrangements currently in place between the eligible entity and such partners with regard to the provision or coordination of suicide prevention services;
"(iii) an identification of how long such arrangements have been in place;
"(iv) a description of the suicide prevention services provided by such partners that the eligible entity shall coordinate, if any; and
"(v) an identification of local suicide prevention coordinators of the Department and a description of how the eligible entity will communicate with local suicide prevention coordinators.
"(C) A description of the population of eligible individuals and their families proposed to be provided suicide prevention services.
"(D) Based on information and methods developed by the Secretary for purposes of this subsection, an estimate of the number of eligible individuals at risk of suicide and their families proposed to be provided suicide prevention services, including the percentage of those eligible individuals who are not currently receiving care furnished by the Department.
"(E) Evidence of measurable outcomes related to reductions in suicide risk and mood-related symptoms utilizing validated instruments by the eligible entity (and the proposed partners of the entity, if any) in providing suicide prevention services to individuals at risk of suicide, particularly to eligible individuals and their families.
"(F) A description of the managerial and technological capacity of the eligible entity-
"(i) to coordinate the provision of suicide prevention services with the provision of other services;
"(ii) to assess on an ongoing basis the needs of eligible individuals and their families for suicide prevention services;
"(iii) to coordinate the provision of suicide prevention services with the services of the Department for which eligible individuals are also eligible;
"(iv) to tailor suicide prevention services to the needs of eligible individuals and their families;
"(v) to seek continuously new sources of assistance to ensure the continuity of suicide prevention services for eligible individuals and their families as long as they are determined to be at risk of suicide; and
"(vi) to measure the effects of suicide prevention services provided by the eligible entity or partner organization, in accordance with subsection (h)(2), on the lives of eligible individuals and their families who receive such services provided by the organization using pre- and post-evaluations on validated measures of suicide risk and mood-related symptoms.
"(G) Clearly defined objectives for the provision of suicide prevention services.
"(H) A description and physical address of the primary location of the eligible entity.
"(I) A description of the geographic area the eligible entity plans to serve during the grant award period for which the application applies.
"(J) If the eligible entity is a State or local government or an Indian tribe, the amount of grant funds proposed to be made available to community partners, if any, through agreements.
"(K) A description of how the eligible entity will assess the effectiveness of the provision of grants under this section.
"(L) An agreement to use the measures and metrics provided by the Department for the purposes of measuring the effectiveness of the programming as described in subsection (h)(2).
"(M) Such additional application criteria as the Secretary considers appropriate.
"(g)
"(1)
"(A) suicide risk identification and management;
"(B) the data required to be collected and shared with the Department;
"(C) the means of data collection and sharing;
"(D) familiarization with and appropriate use of any tool to be used to measure the effectiveness of the use of the grants provided; and
"(E) the requirements for reporting under subsection (e)(5) on services provided via such grants.
"(2)
"(h)
"(1)
"(2)
"(A) A framework for collecting and sharing information about entities in receipt of grants under this section for purposes of improving the services available for eligible individuals and their families, set forth by service type, locality, and eligibility criteria.
"(B) The measures and metrics to be used by each entity in receipt of grants under this section to determine the effectiveness of the programming being provided by such entity in improving mental health status, wellbeing, and reducing suicide risk and completed suicides of eligible individuals and their families, which shall include an existing measurement tool or protocol for the grant recipient to utilize when determining programmatic effectiveness.
"(3)
"(A) Veterans service organizations.
"(B) National organizations representing potential community partners of eligible entities in providing supportive services to address the needs of eligible individuals and their families, including national organizations that-
"(i) advocate for the needs of individuals with or at risk of behavioral health conditions;
"(ii) represent mayors;
"(iii) represent unions;
"(iv) represent first responders;
"(v) represent chiefs of police and sheriffs;
"(vi) represent governors;
"(vii) represent a territory of the United States; or
"(viii) represent a Tribal alliance.
"(C) National organizations representing members of the Armed Forces.
"(D) National organizations that represent counties.
"(E) Organizations with which the Department has a current memorandum of agreement or understanding related to mental health or suicide prevention.
"(F) State departments of veterans affairs.
"(G) National organizations representing members of the reserve components of the Armed Forces.
"(H) National organizations representing members of the Coast Guard.
"(I) Organizations, including institutions of higher education, with experience in creating measurement tools for purposes of advising the Secretary on the most appropriate existing measurement tool or protocol for the Department to utilize.
"(J) The National Alliance on Mental Illness.
"(K) A labor organization (as such term is defined in section 7103(a)(4) of title 5, United States Code).
"(L) The Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide Task Force, and such other organizations as the Secretary considers appropriate.
"(4)
"(A) criteria for the award of a grant under this section;
"(B) the already developed measures and metrics to be used by the Department to measure the effectiveness of the use of grants provided under this section as described in subsection (h)(2); and
"(C) a framework for the sharing of information about entities in receipt of grants under this section.
"(i)
"(1)
"(2)
"(A) Confirmation of the status of a potential eligible individual as a veteran.
"(B) Confirmation of whether the potential eligible individual is enrolled in the patient enrollment system of the Department under section 1705(a) of title 38, United States Code.
"(C) Confirmation of whether a potential eligible individual is currently receiving care furnished by the Department or has recently received such care.
"(3)
"(j)
"(k)
"(1)
"(A)
"(B)
"(i) An assessment of the effectiveness of the grant program under this section, including-
"(I) the effectiveness of grant recipients and their community partners, if any, in conducting outreach to eligible individuals;
"(II) the effectiveness of increasing eligible individuals engagement in suicide prevention services; and
"(III) such other validated instruments and additional measures as determined by the Secretary and as described in subsection (h)(2).
"(ii) A list of grant recipients and their partner organizations, if any, that delivered services funded by the grant and the amount of such grant received by each recipient and partner organization.
"(iii) The number of eligible individuals supported by each grant recipient, including through services provided to family members, disaggregated by-
"(I) all demographic characteristics as determined necessary and appropriate by the Secretary in coordination with the Centers for Disease Control and Prevention;
"(II) whether each such eligible individual is enrolled in the patient enrollment system of the Department under section 1705(a) of title 38, United States Code;
"(III) branch of service in the Armed Forces;
"(IV) era of service in the Armed Forces;
"(V) type of service received by the eligible individual; and
"(VI) whether each such eligible individual was referred to the Department for care.
"(iv) The number of eligible individuals supported by grants under this section, including through services provided to family members.
"(v) The number of eligible individuals described in clause (iv) who were not previously receiving care furnished by the Department, with specific numbers for the population of eligible individuals described in subsection (q)(4)(B).
"(vi) The number of eligible individuals whose mental health status, wellbeing, and suicide risk received a baseline measurement assessment under this section and the number of such eligible individuals whose mental health status, wellbeing, and suicide risk will be measured by the Department or a community partner over a period of time for any improvements.
"(vii) The types of data the Department was able to collect and share with partners, including a characterization of the benefits of that data.
"(viii) The number and percentage of eligible individuals referred to the point of contact at the Department under subsection (e)(3)(C).
"(ix) The number of eligible individuals newly enrolled in the patient enrollment system of the Department under section 1705(a) of title 38, United States Code[,] based on a referral to the Department from a grant recipient under subsection (e)(3)(C), disaggregated by grant recipient.
"(x) A detailed account of how the grant funds were used, including executive compensation, overhead costs, and other indirect costs.
"(xi) A description of any outreach activities conducted by the eligible entity in receipt of a grant with respect to services provided using the grant.
"(xii) The number of individuals who seek services from the grant recipient who are not eligible individuals.
"(C)
"(2)
"(A) a follow-up on the interim report submitted under paragraph (1) containing the elements set forth in subparagraph (B) of such paragraph; and
"(B) a report on-
"(i) the effectiveness of the provision of grants under this section, including the effectiveness of community partners in conducting outreach to eligible individuals and their families and reducing the rate of suicide among eligible individuals;
"(ii) an assessment of the increased capacity of the Department to provide services to eligible individuals and their families, set forth by State, as a result of the provision of grants under this section;
"(iii) the feasibility and advisability of extending or expanding the provision of grants consistent with this section; and
"(iv) such other elements as considered appropriate by the Secretary.
"(l)
"(1)
"(A)
"(B)
"(i) evaluate the effectiveness of the grant program under this section in-
"(I) addressing the factors that contribute to suicides;
"(II) increasing the use of suicide prevention services;
"(III) reducing mood-related symptoms that increase suicide and suicide risk; and
"(IV) where such information is available due to the time frame of the grant program, reducing suicidal ideation, suicide attempts, self-harm, and deaths by suicide; and
"(V) reducing suicidal ideation, suicide attempts, self-harm, and deaths by suicide among eligible individuals through eligible entities located in communities; and
"(ii) compare the results of the grant program with other national programs in delivering resources to eligible individuals in the communities where they live that address the factors that contribute to suicide.
"(2)
"(A)
"(B)
"(3)
"(m)
"(1)
"(2)
"(3)
"(n)
"(o)
"(1)
"(2)
"(p)
"(q)
"(1)
"(A) the Committee on Veterans' Affairs and the Subcommittee on Military Construction, Veterans Affairs, and Related Agencies of the Committee on Appropriations of the Senate; and
"(B) the Committee on Veterans' Affairs and the Subcommittee on Military Construction, Veterans Affairs, and Related Agencies of the Committee on Appropriations of the House of Representatives.
"(2)
"(3)
"(A) an incorporated private institution or foundation-
"(i) no part of the net earnings of which incurs to the benefit of any member, founder, contributor, or individual; and
"(ii) that has a governing board that would be responsible for the operation of the suicide prevention services provided under this section;
"(B) a corporation wholly owned and controlled by an organization meeting the requirements of clauses (i) and (ii) of subparagraph (A);
"(C) an Indian tribe;
"(D) a community-based organization that can effectively network with local civic organizations, regional health systems, and other settings where eligible individuals and their families are likely to have contact; or
"(E) A State or local government.
"(4)
"(A) a veteran as defined in section 101 of title 38, United States Code;
"(B) an individual described in section 1720I(b) of such title; or
"(C) an individual described in any of clauses (i) through (iv) of section 1712A(a)(1)(C) of such title.
"(5)
"(6)
"(A) A parent.
"(B) A spouse.
"(C) A child.
"(D) A sibling.
"(E) A step-family member.
"(F) An extended family member.
"(G) Any other individual who lives with the eligible individual.
"(7)
"(8)
"(A)
"(i) Health risk factors, including the following:
"(I) Mental health challenges.
"(II) Substance abuse.
"(III) Serious or chronic health conditions or pain.
"(IV) Traumatic brain injury.
"(ii) Environmental risk factors, including the following:
"(I) Prolonged stress.
"(II) Stressful life events.
"(III) Unemployment.
"(IV) Homelessness.
"(V) Recent loss.
"(VI) Legal or financial challenges.
"(iii) Historical risk factors, including the following:
"(I) Previous suicide attempts.
"(II) Family history of suicide.
"(III) History of abuse, neglect, or trauma.
"(B)
"(9)
"(10)
"(11)
"(A)
"(i) Outreach to identify those at risk of suicide with an emphasis on eligible individuals who are at highest risk or who are not receiving health care or other services furnished by the Department.
"(ii) A baseline mental health screening for risk.
"(iii) Education on suicide risk and prevention to families and communities.
"(iv) Provision of clinical services for emergency treatment.
"(v) Case management services.
"(vi) Peer support services.
"(vii) Assistance in obtaining any benefits from the Department that the eligible individual and their family may be eligible to receive, including-
"(I) vocational and rehabilitation counseling;
"(II) supportive services for homeless veterans;
"(III) employment and training services;
"(IV) educational assistance; and
"(V) health care services.
"(viii) Assistance in obtaining and coordinating the provision of other benefits provided by the Federal Government, a State or local government, or an eligible entity.
"(ix) Assistance with emergent needs relating to-
"(I) health care services;
"(II) daily living services;
"(III) personal financial planning and counseling;
"(IV) transportation services;
"(V) temporary income support services;
"(VI) fiduciary and representative payee services;
"(VII) legal services to assist the eligible individual with issues that may contribute to the risk of suicide; and
"(VIII) child care (not to exceed $5,000 per family of an eligible individual per fiscal year).
"(x) Nontraditional and innovative approaches and treatment practices, as determined appropriate by the Secretary, in consultation with appropriate entities.
"(xi) Such other services necessary for improving the mental health status and wellbeing and reducing the suicide risk of eligible individuals and their families as the Secretary considers appropriate, which may include-
"(I) adaptive sports, equine assisted therapy, or in-place or outdoor recreational therapy;
"(II) substance use reduction programming;
"(III) individual, group, or family counseling; and
"(IV) relationship coaching.
"(B)
"(12)
"(13)
"(a)
"(1) Enhanced guidance with respect to gender-specific-
"(A) risk factors for suicide and suicidal ideation;
"(B) treatment efficacy for depression and suicide prevention;
"(C) pharmacotherapy efficacy; and
"(D) psychotherapy efficacy.
"(2) Guidance with respect to the efficacy of alternative therapies, other than psychotherapy and pharmacotherapy, including the following:
"(A) Yoga therapy.
"(B) Meditation therapy.
"(C) Equine therapy.
"(D) Other animal therapy.
"(E) Training and caring for service dogs.
"(F) Agritherapy.
"(G) Art therapy.
"(H) Outdoor sports therapy.
"(I) Music therapy.
"(J) Any other alternative therapy that the Work Group considers appropriate.
"(3) Guidance with respect to the findings of the Creating Options for Veterans' Expedited Recovery Commission (commonly referred to as the 'COVER Commission') established under section 931 of the Jason Simcakoski Memorial and Promise Act (title IX of
"(b)
"(e)
"(1)
"(A)
"(B)
"(i) veterans of all eras, as determined by the Secretary;
"(ii) women veterans;
"(iii) minority veterans;
"(iv) Native American veterans, as defined in section 3765 of title 38, United States Code;
"(v) veterans who identify as lesbian, gay, bisexual, transgender, or queer (commonly referred to as 'LGBTQ');
"(vi) veterans who live in rural or highly rural areas;
"(vii) individuals transitioning from active duty in the Armed Forces to civilian life; and
"(viii) other high-risk groups of veterans, as determined by the Secretary.
"(2)
"(A)
"(B)
"(f)
"(g)
"(a)
"(1)
"(2)
"(A)
"(B)
"(i) Metrics relating to social media, which may include the following:
"(I) Impressions.
"(II) Reach.
"(III) Engagement rate.
"(IV) Such other metrics as the Secretary considers necessary.
"(ii) Metrics relating to television, which may include the following:
"(I) Nielsen ratings.
"(II) Such other metrics as the Secretary considers necessary.
"(iii) Metrics relating to email, which may include the following:
"(I) Open rate.
"(II) Response rate.
"(III) Click rate.
"(IV) Such other metrics as the Secretary considers necessary.
"(C)
"(3)
"(4)
"(A) Relevant stakeholders, such as organizations that represent veterans, as determined by the Secretary.
"(B) Mental health and suicide prevention experts.
"(C) Such other persons as the Secretary considers appropriate.
"(5)
"(6)
"(A) the progress of the Department in meeting the goals established under paragraph (1) and the targets established under paragraph (3); and
"(B) a description of action to be taken by the Department to modify mental health and suicide prevention media outreach campaigns if those goals and targets are not being met.
"(b)
"(a)
"(1) To improve the efficiency and effectiveness of suicide prevention efforts carried out by the Secretary and non-profit mental health organizations.
"(2) To assist non-profit mental health organizations with the suicide prevention efforts of such organizations through the use of the expertise of employees of the Department of Veterans Affairs.
"(3) To jointly carry out suicide prevention efforts.
"(b)
"(c)
"(1) suicide among veterans suffering from post-traumatic stress disorder (in this section referred to as 'PTSD') is a serious problem; and
"(2) the Secretary of Veterans Affairs should take into consideration the special needs of veterans suffering from PTSD and the special needs of elderly veterans who are at high risk for depression and experience high rates of suicide in developing and implementing the comprehensive program under this Act [enacting this section and provisions set out as a note under section 101 of this title]."