[House Report 115-400]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-400
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VETERANS CRISIS LINE STUDY ACT OF 2017
_______
November 7, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 4173]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 4173) to direct the Secretary of Veterans
Affairs to conduct a study on the Veterans Crisis Line, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 5
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 7
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Crisis Line Study Act of
2017''.
SEC. 2. STUDY ON EFFICACY OF VETERANS CRISIS LINE.
(a) Study.--The Secretary of Veterans Affairs shall conduct a study
on the outcomes and the efficacy of the Veterans Crisis Line during the
five-year period beginning January 1, 2014, based on an analysis of
national suicide data and data collected from the Veterans Crisis Line.
(b) Matters Included.--The study under subsection (a) shall address
the following:
(1) The efficacy of the Veterans Crisis Line in leading
veterans to sustained mental health regimens, by determining--
(A) the number of veterans who, after contacting the
Veterans Crisis Line and being referred to a suicide
prevention specialist, begin and continue mental health
care furnished by the Secretary of Veterans Affairs;
and
(B) the number of veterans who, after contacting the
Veterans Crisis Line and being referred to a suicide
prevention specialist, either--
(i) begin mental health care furnished by the
Secretary but do not continue such care; or
(ii) do not begin such care.
(2) The visibility of the Veterans Crisis Line, by
determining--
(A) the number of veterans who contact the Veterans
Crisis Line and have not previously received hospital
care or medical services furnished by the Secretary;
and
(B) the number of veterans who contact the Veterans
Crisis Line and have previously received hospital care
or medical services furnished by the Secretary.
(3) The role of the Veterans Crisis Line as part of the
mental health care services of the Department, by determining,
of the veterans who are enrolled in the health care system
established under section 1705(a) of title 38, United States
Code, who contact the Veterans Crisis Line, the number who are
under the care of a mental health care provider of the
Department at the time of such contact.
(4) Whether receiving sustained mental health care affects
suicidality and whether veterans previously receiving mental
health care furnished by the Secretary use the Veterans Crisis
Line in times of crisis, with respect to the veterans described
in paragraph (3), by determining the time frame between
receiving such care and the time of such contact.
(5) The effectiveness of the Veterans Crisis Line in
assisting veterans at risk for suicide when the Veterans Crisis
Line is contacted by a non-veteran, by determining, of the
number of non-veterans who contact the Veterans Crisis Line
looking for support in assisting a veteran, how many of such
individuals receive support in having a veteran begin to
receive mental health care furnished by the Secretary.
(6) The overall efficacy of the Veterans Crisis Line in
preventing suicides and whether the number of contacts affects
the efficacy, by determining--
(A) the number of veterans who contact the Veterans
Crisis Line who ultimately commit or attempt suicide;
and
(B) of such veterans, how many times did a veteran
contact the Veterans Crisis Line prior to committing or
attempting suicide.
(7) The long-term efficacy of the Veterans Crisis Line in
preventing repeated suicide attempts and whether the efficacy
is temporary, by determining, of the number of veterans who
contacted the Veterans Crisis Line and did not commit or
attempt suicide during the following six-month period, the
number who contacted the Veterans Crisis Line in crisis at a
later time and thereafter did commit or attempt suicide.
(8) Whether referral to mental health care affects the risk
of suicide, by determining--
(A) the number of veterans who contact the Veterans
Crisis Line who are not referred to, or do not continue
receiving, mental health care who commit suicide; and
(B) the number of veterans described in paragraph
(1)(A) who commit or attempt suicide.
(9) The efficacy of the Veterans Crisis Line to promote
continued mental health care in those veterans who are at high
risk for suicide whose suicide was prevented, by determining,
of the number of veterans who contacted the Veterans Crisis
Line and did not commit or attempt suicide soon thereafter, the
number that begin and continue to receive mental health care
furnished by the Secretary.
(10) Such other matters as the Secretary determines
appropriate.
(c) Rule of Construction Regarding Data Collection.--Nothing in this
section may be construed to modify or affect the manner in which data
is collected, or the kind or content of data collected, by the
Secretary under the Veterans Crisis Line.
(d) Submission.--Not later than March 1, 2020, the Secretary shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate the study under subsection (a).
(e) Veterans Crisis Line Defined.--In this section, the term
``Veterans Crisis Line'' means the toll-free hotline for veterans
established under section 1720F(h) of title 38, United States Code.
PURPOSE AND SUMMARY
H.R. 4173, the ``Veterans Crisis Line Study Act of 2017,''
would require the Secretary of the Department of Veterans
Affairs (VA) conduct a study on the outcomes and the efficacy
of the Veterans Crisis Line during the five-year period
beginning January 1, 2014, based on an analysis of national
suicide data and data collected from the Veterans Crisis Line.
BACKGROUND AND NEED FOR LEGISLATION
In 2007, the Veterans Crisis Line (VCL) was established as
a partnership between the Department of Veterans Affairs (VA),
the Substance Abuse and Mental Health Services Administration
(SAMHSA), and the National Suicide Prevention Lifeline. As of
May 2016, the VCL has answered over 2.3 million calls, over
55,000 texts and dispatched emergency services over 61,000
times.\1\
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\1\https://www.gao.gov/assets/690/683918.pdf
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While VA does collect valuable, anonymous data points from
VCL callers, it does not currently process them through any
meaningful form of data analytics as it relates to the efficacy
of the program. Instead, VCL statistics are currently evaluated
for quality and access metrics.
The Veterans Crisis Line Study Act of 2017 would direct the
Secretary to evaluate the efficacy of the Veterans Crisis Line,
with respect to continuity of VA mental health services.
Research and data analysis would utilize the growing national
availability of statistics regarding suicides to better
evaluate the impact of the VCL and potentially highlight
opportunities for outcome improvements. The Committee believes
evaluating the VCL effectively requires a focus on the full
continuum of mental health care provided by VA once a veteran
first contacts the VCL or establishes a need for mental health
services.
It is important to note that the data collected under this
bill is not to be collected differently than they currently
are.
HEARINGS
There were no Subcommittee hearings held on H.R. 4173.
On October 24, 2017, the full Committee conducted a
legislative hearing on a number of bills including H.R. 4173.
The following witnesses testified:
The Honorable Jim Banks, U.S. House of
Representatives, 3rd District, Indiana; The Honorable
Mike Gallagher, U.S. House of Representatives, 8th
District, Wisconsin; The Honorable John R. Carter, U.S.
House of Representatives, 31st District, Texas; The
Honorable Glenn Thompson, U.S. House of
Representatives, 5th District, Pennsylvania; The
Honorable Neal P. Dunn, U.S. House of Representatives,
2nd District, Florida; The Honorable Andy Barr, U.S.
House of Representatives, 6th District, Kentucky; The
Honorable David J. Shulkin, M.D., Secretary, U.S.
Department of Veterans Affairs, who was accompanied by
Carolyn Clancy M.D, the Executive in Charge of the
Veterans Health Administration, and Laurie Zephyrin
M.D., MPH, MBA, the Acting Deputy Under Secretary for
Health for Community Care for the Veterans Health
Administration; Adrian M. Atizado, Deputy National
Legislative Director, Disabled American Veterans;
Roscoe G. Butler, Deputy Director for Health Care,
Veterans Affairs and Rehabilitation Division, The
American Legion; and, Kayda Keleher, Associate
Director, National Legislative Service, Veterans of
Foreign Wars of the United States.
Statements for the record were submitted by:
American Federation of Government Employees, AFL-CIO;
American Health Care Association; American Medical
Association; AMVETS; Concerned Veterans of America;
Fleet Reserve Association; Got Your 6; Health IT Now;
Iraq and Afghanistan Veterans of America; Military
Officers Association of America; Military Order of the
Purple Heart; National Alliance on Mental Illness;
National Guard Association of the United States; Nurses
Organization of Veterans Affairs/Association of VA
Psychologist Leaders/Association of VA Social Workers/
Veterans Healthcare Action Campaign; Paralyzed Veterans
of America; Reserve Officers Association; University of
Pittsburgh; Vietnam Veterans of America; and the
Wounded Warrior Project.
SUBCOMMITTEE CONSIDERATION
There was no Subcommittee consideration of H.R. 4173.
COMMITTEE CONSIDERATION
On November 2, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 4173 to be
reported favorably to the House of Representatives by voice
vote. During consideration of the bill, the following
amendments were considered and agreed to by voice vote:
An Amendment to H.R. 4173 was offered by Representative Jim
Banks of Indiana.
COMMITTEE VOTES
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 4173
reported to the House. A motion by Representative Tim Walz of
Minnesota, Ranking Member of the Committee on Veterans'
Affairs, to report H.R. 4173 favorably to the House of
Representatives was agreed to by voice vote.
COMMITTEE OVERSIGHT FINDINGS
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to evaluate the efficacy of the
Veterans Crisis Line, with respect to the full continuum of VA
mental health care services.
NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES
With respect to the requirement with respect to clause
3(c)(2) of rule XIII of the Rules of the House of
Representatives, the Committee has requested but not received
from the Director of the Congressional Budget Office an
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues.
EARMARKS AND TAX AND TARIFF BENEFITS
H.R. 4173 does not contain any Congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
COMMITTEE COST ESTIMATE
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
this bill. However, clause 3(d)(3)(B) of that Rule provides
that this requirement does not apply when the Committee has
included in its report a timely submitted cost estimate of the
bill prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act of
1974. The Committee has requested but not received a cost
estimate for this bill from the Director of the Congressional
Budget Office. Assuming the appropriation of authorized
amounts, the Committee estimates, and according to a
preliminary score from the Congressional Budget Office, that
the legislation would also have a discretionary cost of $1
million over the 2018-2022 period.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
With respect to the requirements of clause 3(c)(2) of rule
XIII of the Rules of the House of Representatives and section
308(a) of the Congressional Budget Act of 1974 and with respect
to requirements of clause (3)(c)(3) of rule XIII of the Rules
of the House of Representatives and section 402 of the
Congressional Budget Act of 1974, the Committee has requested
but not received a cost estimate for this bill from the
Director of Congressional Budget Office. The Committee has
requested but not received from the Director of the
Congressional Budget Office a statement as to whether this bill
contains any new budget authority, spending authority, credit
authority, or an increase or decrease in revenues or tax
expenditures.
FEDERAL MANDATES STATEMENT
With respect to the requirements of Section 423 of the
Congressional Budget and Impoundment Control Act (as amended by
Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104-
4), the Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether the provisions of the reported bill include unfunded
mandates.
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
4173.
STATEMENT OF CONSTITUTIONAL AUTHORITY
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 4173 is authorized by Congress' power to
``provide for the common Defense and general Welfare of the
United States.''
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that H.R. 4173 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act.
STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS
Pursuant to section 3(g) of H. Res. 5, 115th Cong. (2017),
the Committee finds that no provision of H.R. 4173 establishes
or reauthorizes a program of the Federal Government known to be
duplicative of another Federal program, a program that was
included in any report from the Government Accountability
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most
recent Catalog of Federal Domestic Assistance.
DISCLOSURE OF DIRECTED RULEMAKING
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 4173 contains no directed
rulemaking that would require the Secretary to prescribe
regulations.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Short title
Section 1 of the bill would provide the short title for
H.R. 4173 as the ``Veterans Crisis Line Study Act of 2017''.
Section 2. Study on efficacy of Veterans Crisis Line
Section 2(a) of the bill would direct the Secretary of the
Department of Veterans Affairs to conduct a study on the
outcomes and efficacy of the VCL for the five-year period
starting January 1, 2014.
Section 2(b) of the bill outlines the metrics to be
targeted for analysis for the study, to include: 2(b)(1)--the
efficacy of the VCL, 2(b)(2)--the visibility of the VCL;
2(b)(3)--the role of the VCL as part of the continuum of care
provided by VA; 2(b)(4)--whether VA-provided mental health care
affects suicidality; 2(b)(5)--the effectiveness of a non-
veteran calling to seek assistance for a veteran; 2(b)(6)--the
overall efficacy of the VCL in preventing suicides and whether
repeated VCL contacts affect the efficacy; 2(b)(7)--the long-
term efficacy of the VCL in preventing repeated suicide
attempts; 2(b)(8)--effectiveness of referral patterns;
2(b)(9)--the efficacy of the VCL to promote continued mental
healthcare for high-risk veterans.
Section 2(c) of the bill stipulates that all data collected
under this bill shall be collected in the same manner as prior
to the enactment of this legislation, beginning January 1,
2014.
Section 2(d) of the bill requires the Secretary to report
the findings of the study to the Congressional Committees on
Veterans' Affairs by March 1, 2020.
Section 2(e) of the bill defines the term ``Veterans Crisis
Line.''
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
If enacted, this bill would make no changes in existing
law.
[all]