No official summary available for this bill.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6415 Introduced in House (IH)]
<DOC>
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. Salinas, 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 consideration
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 Representatives 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''.
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 essential to the entire
community, are strenuous to first responders and with time put
them at an increased risk of experiencing some mental health
and substance use issues and conditions.
(4) The combination of exposure to trauma, demanding
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 health conditions including
depression and post-traumatic stress disorder, as compared with
20 percent in the general population.
(6) The Substance Abuse and Mental Health Services
Administration finds that an estimated between 125 and 300
police officers die by suicide annually.
(7) Data from the National Violent Death Reporting 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),
emergency 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 difficult 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 encounter 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 occupational stressors. Perceived
stigma around mental health problems or concerns over impact on
employment, 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 understand the unique demands faced
by first responders 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 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 backbone 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 responsible for
answering emergency and nonemergency calls and directing
police, fire and rescue, and other emergency response personnel
to assist those in need. They are required to multitask,
conduct 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, burning homes, automobile accidents and
fatalities, and homicides.
(15) The work of public safety telecommunicators is often
high-stress, fast-paced, and emotionally demanding. Every day,
they are faced with challenges and trauma that places them at
increased risk for developing mental health challenges.
(16) According to studies conducted by National 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
depression. While telecommunicators are often the very first
responders engaged with those on scene, research on their
suicide risk and mental health has lagged.
(17) Despite playing a critical role in protecting and
saving lives in emergency situations, public safety
telecommunicators are classified by most States and by the
Federal Government as office and administrative support
personnel and not as first responders, leaving them without
access to important mental health resources available to other
emergency response 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 (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 detailed occupation 43-5031 in the Standard
Occupational Classification Manual of the Office of Management
and Budget issued in 2018, or any successor designation.
``(14) Qualified emergency response providers.--The term
`qualified emergency response providers' means--
``(A) emergency response providers (as defined 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 RESPONDERS.
``(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 Secretary of the Substance Abuse and
Mental Health Administration, shall develop and carry out a
comprehensive program designed to provide mental health services
specifically 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 programs 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 consultation
with the heads of the agencies specified in paragraph (2),
conduct or support research on best practices for providing
mental health services to, and prevent suicide among, qualified
emergency response providers.
``(2) Agencies specified.--The agencies specified in this
paragraph are the following:
``(A) The Department of Homeland Security.
``(B) The Federal Emergency Management Agency.
``(C) The United States Fire Administration.
``(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 Programs.--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 mental illness;
``(3) promote skills for coping with mental illness; and
``(4) help families of qualified emergency response
providers with--
``(A) understanding issues arising from the
transition of qualified emergency response providers
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 response
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 section, establish and carry
out a peer support counseling program, under which active and
retired qualified emergency response providers may volunteer 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 families.
``(2) Administration.--In carrying out the peer support
counseling program under this section, the Secretary shall--
``(A) provide for adequate training of individuals
who volunteer to serve as peer counselors, including
training carried out under section 416(a) of the Robert
T. Stafford Disaster Relief and Emergency Assistance
Act; and
``(B) coordinate with such community organizations,
State and local governments, institutions of higher
education, chambers of commerce, local business
organizations, organizations 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
providers.
``(f) Definitions.--In this section:
``(1) Public safety telecommunicators.--The term ``public
safety telecommunicator'' means a public safety
telecommunicator as designated in detailed occupation 43-5031
in the Standard Occupational Classification Manual of the
Office of Management and Budget issued in 2018, or any
successor designation.
``(2) Qualified emergency response providers.--The term
`qualified emergency response providers' means--
``(A) emergency response providers (as defined 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 disaster' 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 disaster.
Such services shall be--
``(1) linguistically and culturally appropriate;
``(2) trauma-informed; and
``(3) incorporate disaster behavioral interventions.
``(b) Use of Funds.--An eligible entity that receives a grant under
this subsection may use funds received through the grant to provide
mobile crisis response, stabilization, and intervention services,
including--
``(1) initial support and triage via mobile crisis team
visits;
``(2) on-site screening and evaluation of mental and
behavioral health issues;
``(3) assessment of current supports and resources;
``(4) short-term crisis management throughout a major
disaster;
``(5) referral for appropriate follow-up services,
including sub-acute or acute hospital care;
``(6) supportive, collaborative crisis planning;
``(7) consultation with existing supports and services; and
``(8) self-care techniques and resilience training.
``(c) Authorized Purchase or Lease.--The Secretary may purchase or
lease equipment for purposes of carrying out this section, which may
include data and information systems (including the costs of repaying
the principal of, and paying the interest on, loans for equipment).
``(d) Grant Terms.--
``(1) Maximum amount.--The amount of a grant awarded under
subsection (a) may not exceed $150,000.
``(2) Duration.--The term of a grant awarded under
subsection (a) shall be for a period of not less than 6 months.
Such term is renewable for a single, additional term so that
the total term of the grant does not exceed 2 years.
``(e) Evaluations and Technical Assistance.-- The Secretary shall--
``(1) evaluate the activities supported by grants awarded
under subsection (a), and disseminate, as appropriate, the
findings from the evaluation;
``(2) provide appropriate information, training, and
technical assistance, as appropriate, to eligible entities that
receive a grant under this section, to help such entities to
meet the requirements of this section, including assistance
with selection and implementation of evidence-based
interventions and frameworks to protect the mental health of
qualified emergency response providers; and
``(3) identify best practices, as applicable, to improve
the identification, assessment, treatment, and timely
transition, as appropriate, to additional or follow-up care for
qualified emergency response providers who are at risk for
mental illness, suicide, and substance abuse, and enhance the
coordination of care for such individuals during and after a
major disaster, in support of activities supported by grants
awarded under subsection (a).
``(f) Definitions.--
``(1) Eligible entity.--The term `eligible entity' means a
State, local, territorial, or Tribal health department,
community health center, rural health clinic, or nonprofit
organization that--
``(A) is located in or around a major disaster
area; and
``(B) has experience working with qualified mental
health professionals in providing mental health,
substance use, or counseling services.
``(2) Major disaster.--The term `major disaster' 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).
``(3) Major disaster area.--The term `major disaster area'
has the meaning given such term in section 625.2 of title 20,
Code of Federal Regulations (or successor regulations).
``(4) Public safety telecommunicators.--The term ``public
safety telecommunicator'' means a public safety
telecommunicator as designated in detailed occupation 43-5031
in the Standard Occupational Classification Manual of the
Office of Management and Budget issued in 2018, or any
successor designation.
``(5) Qualified emergency response providers.--The term
`qualified emergency response providers' means--
``(A) emergency response providers (as defined in
section 2 of the Homeland Security Act of 2002 (6
U.S.C. 101)); and
``(B) public safety telecommunicators.
``(6) Qualified mental health professional.-- The term
`qualified mental health professional' means a health care
practitioner or social and human services provider who--
``(A) is licensed or certified under State law in
the State involved; and
``(B) offers services for the purpose of improving
an individual's mental health or to treat mental health
or substance use disorders, including--
``(i) a physician, allopathic physicians,
osteopathic physician, nurse practitioner, or
physician assistant with a specialty in mental
and psychiatry;
``(ii) a health service psychologist;
``(iii) a licensed clinical social worker;
``(iv) a psychiatric nurse specialist;
``(v) a marriage and family therapist;
``(vi) a licensed professional counselor;
``(vii) a substance use disorder counselor;
``(viii) an occupational therapist; or
``(ix) any other individual who--
``(I) has not yet been licensed or
certified to serve as a professional
listed in any of clauses (i) through
(viii); and
``(II) will serve at a Federally
qualified health center (as defined in
section 1861(aa)(4) of the Social
Security Act) under the supervision of
a licensed individual or certified
professional so listed.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $5,000,000 for each of fiscal
years 2024 through 2028.''.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR H5734)
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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Economic Development, Public Buildings, and Emergency Management.
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