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Government News
Suicide-Prevention Bill Would End Discriminatory MH Copay
Psychiatric News
Volume 42 Number 16 page 8-22

Proposed legislation that aims to prevent suicide among older Americans and establish a suicide-prevention program for veterans are among several suicide-reduction measures making their way through Congress.

Senate Majority Leader Harry Reid (D-Nev.) introduced the Stop Senior Suicide Act (S 1854) in July. The bill is targeted at older adults, an age group with the highest suicide rate in the United States. Nearly 7,000 older adults died by suicide in 2004, the most recent statistics available from the Centers for Disease Control and Prevention.

The bill would authorize formation of the Interagency Geriatric Mental Health Planning Council to make recommendations on the integration of services for mental health, suicide prevention, physical health, and aging. Funding would be through government grants and go to public or private organizations that plan and implement elderly suicide intervention and prevention strategies.

The bill also would improve Medicare's mental health benefits by lowering patients' copayment rate for outpatient mental health services to equal the rate for other outpatient services.

Jerry Reed, executive director of the Suicide Prevention Action Network (SPAN USA), said the bill is an important step forward in addressing some of the challenges facing older adults, which include depression, mental illness, loneliness, and isolation. A critical part of any suicide-prevention effort is expanded access to mental health care, he told Psychiatric News. The bill's critical feature would correct the discriminatory copayments the government requires for outpatient mental health services in Medicare.

Reid, who lost his father to suicide in 1972, said the vulnerability of older adults to suicide is not well known and that the unacceptably high suicide rates among the elderly must be addressed.

"These findings do not just constitute a serious public health problem," Reid said in a Senate floor speech. "They also conflict with America's belief in living our golden years in dignity."

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Another new initiative is legislation to establish the first comprehensive suicide-prevention program for veterans. The Senate Veterans Affairs Committee approved a bill (S 479) in late June that would direct the secretary of Veterans Affairs (VA) to develop a comprehensive program to reduce the number of suicides among veterans.

The legislation, passed by the House in March (HR 327), would create a program that provides mandatory training for "appropriate" VA staff and contractors, including medical personnel, who interact with veterans; screen veterans for suicide risk when they receive medical care; refer at-risk veterans for counseling and treatment; require suicide-prevention counselors at medical facilities; require veterans' mental health care to be available 24 hours a day; and provide outreach and education for veterans and their families.

The House bill, called the Joshua Omvig Veterans Suicide Prevention Act, was named for a 22-year-old combat veteran from Iowa who committed suicide after an 11-month tour in Iraq.

The Senate bill's sponsor, Sen. Tom Harkin (D-Iowa), told suicide-prevention advocates at a Capitol Hill luncheon in July that the Omvig family told him that Joshua avoided mental health care when he needed it because he was concerned its presence on his medical record would hurt his job prospects.

"That's the kind of stigma we are up against," Harkin said.

He urged supporters of the measure to keep up pressure on members of Congress to get the bill enacted to benefit the one-third of returning veterans who seek mental health care and the many others who also need it but don't seek it.

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Among the other legislative priorities for suicide-prevention advocates are mental health insurance parity bills (S 558, HR 1424), which are progressing separately in the House and Senate. The Senate reached a broad compromise agreement among mental health advocates and insurance industry and business representatives on language for the bill, while the House bill received its first committee approval in July (Psychiatric News, July 20).

The parity measures would provide similar expanded coverage to the majority of privately insured Americans as advocated for Medicare beneficiaries in Reid's bill.

"Without mental health, you don't have total health," Reid said, about SPAN USA's support of parity insurance coverage.

Sen. Gordon Smith (R-Ore.) urged support for renewal of the Garrett Lee Smith Memorial Act, which was the first federal law to provide funding for programs to prevent youth suicide. It will expire in 2007 without renewal (Psychiatric News, November 19, 2004). The law was named for Smith's son, who was diagnosed with bipolar disorder and eventually committed suicide.

"Hardly a week goes by that I don't get a letter from a parent who says the funding in that bill helped save the lives of their children," Smith told prevention advocates in July.

SPAN USA also is urging a $1.5 million expansion of the National Violent Death Reporting System (NVDRS), which collects data from medical examiners, coroners, police, crime labs, and death certificates to understand the circumstances around violent deaths, including suicides.

Although the NVDRS operates in only 17 states, suicide-prevention advocates have found its data crucial to developing and evaluating suicide-prevention programs. Six states have used NVDRS data to develop statewide suicide-prevention plans.

The suicide-prevention and other mental health bills can be accessed by searching on their respective bill number at<http://thomas.loc.gov>.

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