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July 29, 2021
Veteran Suicide Prevention
Background
for those services is not typically provided in the statutory
Suicide is the 10th leading cause of death in the United
text of these acts. Rather, report language accompanying
States. Although suicide rates have increased among the
the MILCON-VA appropriations act generally provides
U.S. general population over the past two decades, veterans
specified amounts for mental health care and suicide
are disproportionately affected by suicide. According to the
prevention. For example, in FY2021, Congress provided
U.S. Department of Veterans Affairs (VA), in the period of
$10.3 billion for mental health care. Of that amount, $1.9
2005-2018, suicide rates increased more quickly among
billion was for suicide prevention treatment and $312.6
veterans compared to nonveteran adults, adjusting for age
million was for suicide prevention outreach (H.Rept. 116-
and sex. In 2018—the most recent year in which national
445, p. 46). Report language accompanying appropriations
data are available—the suicide rate for veterans was 1.5
measures is not considered binding in the same manner as
times greater than among nonveteran adults (see Figure 1),
language in statute, but rather explains provisions of a
and an average of 17.6 veterans died by suicide per day.
measure and/or communicates legislative intent.
Figure 1. Veteran and Nonveteran Suicide Rate per
In congressional budget submissions, VA provides more
100,000 Population, 2005–2018
granular information about mental health care obligations.
Rates Adjusted for Age and Sex
Suicide prevention treatment and outreach, respectively, are
a subset of mental health care obligations. Table 1 provides
obligations—the total sum of funding available—for such
activities for FY2019 through FY2022.
Table 1. VA Mental Health Care and Suicide
Prevention Obligations, FY2019-FY2022
(in millions of dol ars)
FY21
FY22
FY19
FY20
(est.)
(req.)
Mental Health
$8,949.0 $10,285.5 $11,998.9 $13,541.4
Care
Source: Prepared by CRS using VA 2005-2018 National Suicide Data
Suicide
Appendix accompanying the 2020 National Veteran Suicide
Prevention
$1,422.2 $1,418.3
$1,553.0
$1,741.3
Prevention Annual Report.
Treatment
VA data suggest that use of Veterans Health Administration
Suicide
(VHA) services by specific veteran populations can reduce
Prevention
$206.5
$240.8
$311.4
$598.0
suicide. VA has named suicide as its top clinical priority for
Outreach
FY2018 to FY2024. As a result, the department has funded
Veterans Crisis
$107.3
$111.8
$113.9
$256.0
and implemented numerous suicide prevention programs
Line
largely administered through VHA. Congress has also
National
expressed interest in reducing veteran suicide through
Suicide
appropriations and authorizing legislation.
Prevention
$35.2
$35.8
$41.3
$42.1
Strategy
VA Suicide Prevention Appropriations
Implementation
and Obligations
Centers of
$5.5
$3.9
$5.6
$5.3
Generally, VA is funded through annual Military
Excellence
Construction, Veterans Affairs, and Related Agencies
Demonstration
$5.2
$6.1
$5.8
$4.7
(MILCON-VA) appropriations acts. The VA budget is
Projects
comprised of mandatory and discretionary funding. The
Local Facility
medical services account, which includes suicide
and Community
$1.6
$0.7
$0.8
$0.8
prevention, is funded solely with discretionary funds.
Outreach
Within the medical services account, mental health care and
Activities
suicide prevention treatment and outreach are funded
Suicide
through medical services appropriations. Such medical
Prevention
$51.7
$57.0
$59.3
$62.3
services appropriations are specified in MILCON-VA
Coordinators
appropriations acts, but a more specific allocation of funds
and Teams
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Veteran Suicide Prevention
FY21
FY22
at highest risk for suicide or other related adverse outcomes.
FY19
FY20
(est.)
(req.)
Using a statistical algorithm, REACH VET analyzes
existing data (e.g., use of VHA services) to identify
Suicide
veterans at the highest suicide risk in the next month.
Prevention 2.0
$0
$4.2
$31.4
$66.6
Initiative
Congressional Activity and Legislation
PREVENTS
$0
$21.3
$53.4
$104.5
Previous Congresses have passed several bills to address
Staff Sergeant
veteran suicide. Significant pieces of legislation enacted
Parker Gordon
into law during the 110th-116th Congresses are highlighted
Fox Suicide
$0
$0
$1.6
$55.7
below, focusing on key provisions of those acts. In general,
Prevention
these laws have increased VHA’s offering of suicide
Grant Program
prevention services, as well as oversight of such services.
Source: Prepared by CRS based on FY21-FY22 VA Congressional
Veterans Comprehensive Prevention, Access to Care,
Budget Submissions, Volume II.
and Treatment (COMPACT) Act of 2020 (P.L. 116-214)
Notes: PREVENTS = The President’s Roadmap to Empower
– A significant provision in this bill is the authorization of
Veterans and End a National Tragedy of Suicide. Actual obligations
VA to provide emergent suicide care to eligible veterans
are provided for FY19-FY20. Estimated obligations based on
without requiring payment. This new requirement expands
appropriated funding are provided for FY21 and obligations based on
requested funding are provided for FY22. Suicide prevention
upon existing VHA policy that allowed for emergent mental
treatment and outreach are not intended to add to the mental health
health care; such care was limited to certain individuals and
care total, as mental health care encompasses other activities not
may have required payment under some circumstances.
listed in the table. Suicide prevention outreach activities may not add
to the suicide prevention outreach total due to rounding.
Commander John Scott Hannon Veterans Mental
Health Care Improvement Act of 2019 (Hannon Act;
Selected VA Suicide Prevention
P.L. 116-171) – A significant provision in this bill is the
Outreach Programs
authorization of the Staff Sergeant Parker Gordon Fox
Suicide prevention outreach focuses on all at-risk veterans,
Suicide Prevention Grant Program that requires VA to
including those who are not eligible, enrolled, or currently
award grants to certain community-based organizations to
receiving VHA services. Selected VA suicide prevention
provide veteran suicide prevention services.
outreach programs are described in further detail below.
Clay Hunt Suicide Prevention for American Veterans
National Strategy for Preventing Veteran Suicide
(SAV) Act (P.L. 114-2) – Among other things, this bill
(National Strategy)
required VA to arrange for independent, annual evaluations
The National Strategy is VA’s 10-year strategic plan (2018-
of VHA mental health care and suicide prevention
2028) for reducing veteran suicide and guides VA’s suicide
programs and to undertake a pilot program to repay the
prevention efforts. The plan identifies 14 goals within 4
education loans of eligible psychiatrists (or certain
strategic directions. To address these goals, the plan
psychiatric residents) in exchange for additional obligated
discusses, among other things, implementation of different
service.
interventions to reach all veterans.
Joshua Omvig Veterans Suicide Prevention Act (P.L.
Veterans Crisis Line (VCL)
110-110) – This bill amended Title 38 of the U.S. code by
The VCL is a confidential toll-free hotline, online chat, and
adding a new section 1720F, a comprehensive program for
text messaging service that provides 24/7 crisis intervention
suicide prevention among veterans. Among other things,
services. Launched in 2007, it is free and available to all
the program must include an SPC at each VAMC and a toll-
veterans, including those not enrolled in VHA services. As
free hotline (“Veterans Crisis Line”).
of April 2021, the VCL responded to more than 5.4 million
calls, 630,000 chats, 204,000 texts, and has referred more
Despite these efforts, Congress, VA, and stakeholders
than 975,000 veterans to suicide prevention coordinators.
continue to express concern over seemingly limited
progress made to date to reduce veteran suicide. During the
Suicide Prevention Coordinators (SPCs)
117th Congress, implementation and congressional
SPCs are VHA employees that coordinate care for veterans
oversight of the Veterans COMPACT Act and the Hannon
at high risk for suicide who are receiving care within VHA.
Act may inform future legislative efforts (for more
SPCs can be assigned referrals from the VCL to ensure care
information, see CRS Report R46848, Commander John
continuity with a veteran’s local VHA provider. As of April
Scott Hannon Veterans Mental Health Care Improvement
2019, VA has employed approximately 444 SPCs, with at
Act of 2019 (P.L. 116-171) and Veterans COMPACT Act of
least one SPC at each VA Medical Center (VAMC) and
2020 (P.L. 116-214)).
very large Community-Based Outpatient Clinic (CBOC).
Victoria R. Green, Analyst in Health Policy
Recovery Engagement and Coordination for
Michele L. Malloy, Research Librarian
Health—Veterans Enhanced Treatment (REACH
VET)
IF11886
REACH VET was launched across VAMCs in April 2017
and is used within VHA to predict which veterans may be
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Veteran Suicide Prevention
Disclaimer
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