This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0063a.LAV
DATE: 12/1/2021
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HM 63 Recognizing Veteran Suicide
SPONSOR(S): Willhite and others
TIED BILLS: IDEN./SIM. BILLS: SM 302
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Local Administration & Veterans Affairs
Subcommittee
16 Y, 0 N Mwakyanjala Miller
2) State Affairs Committee
SUMMARY ANALYSIS
Since 2008, the number of veteran suicides has exceeded 6,300 each year. Many risk factors may affect
veteran suicide rates including economic disparities, homelessness, and health issues such as traumatic
stress disorder and substance abuse disorder.
In 2007, the United States Department of Veterans Affairs (VA) developed a comprehensive program designed
to reduce the incidence of suicide among veterans and launched the Veterans Crisis Line, a program that
connects veterans and current servicemembers in crisis and their families and friends with information from
qualified responders through a confidential toll-free hotline, online chat, and text messaging service.
The VA partners with hundreds of organizations, both at the local and national level to raise awareness of the
VA’s suicide prevention resources and to educate people about how they can support veterans and
servicemembers in their communities. The VA also partners with community mental health providers to expand
the network of local treatment resources available to veterans.
The Veterans Health Administration (VHA) is the largest integrated health care system in the United States.
Although the VA emphasizes mental health care for veterans, many veterans do not reach out to the VA for
help. Most use local hospitals and health clinics. However, community health providers are not prepared to
address the needs of veterans. Studies have found that most are unfamiliar with deployment-related stressors
and unsure how to refer patients to the VA.
The memorial urges the United States Congress to recognize the current crisis of veteran suicide and to fully
fund suicide prevention efforts undertaken by the VA.
Legislative memorials are not subject to the Governor’s veto powers and are not presented to the Governor for
review. Memorials have no force of law, as they are mechanisms for formally petitioning the federal
government to act on a particular subject.
This memorial does not have a fiscal impact on the state or local governments.
STORAGE NAME: h0063a.LAV PAGE: 2
DATE: 12/1/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Veterans and Mental Health and Substance Abuse
There are approximately 19,100,000 veterans in the United States,
1
with more than 1.5 million veterans
in Florida.
2
Veterans face unique challenges and some struggle with mental health and substance
abuse.
Posttraumatic Stress Disorder (PTSD) is a psychiatric disorder that can occur in people who have
experienced or witnessed a traumatic event, including war or combat.
3
The National Center for PTSD,
within the United States Department of Veterans Affairs (VA), lists the percentage of veterans with
PTSD by service era:
Between 11 and 20 percent of veterans who served in Operations Enduring Freedom
4
and Iraqi
Freedom
5
were diagnosed with PTSD in a given year.
About 12 percent of veterans who served in the Persian Gulf War
6
were diagnosed with PTSD
in a given year.
About 15 percent of veterans of the Vietnam War
7
were diagnosed with PTSD at the time of the
most recent study in the late 1980s. However, the National Center for PTSD estimates that
about 30 percent of veterans of the Vietnam War have had PTSD in their lifetimes.
8
A strong association exists between PTSD and substance abuse disorders (SUD) among veterans.
Statistics show:
9
More than two in 10 veterans with PTSD also have SUD.
Almost one in three veterans seeking treatment for SUD also have PTSD.
About one in 10 veterans returning from the wars in Iraq and Afghanistan have problems with
alcohol or other drugs.
Veterans and Suicide
In 2016, the VA completed the largest analysis of veteran suicide to date and the work has continued
every year since. The 2021 report examines mortality records for the period between 2001 and 2019
(the latest data available). The report provides information regarding veteran suicide counts, averages
per day, rates, and differences in rates of suicide.
10
1
United States Department of Veterans Affairs (VA), National Center for Veterans Analysis and Statistics,
https://www.va.gov/vetdata/veteran_population.asp (last visited October 15, 2021).
2
Florida Department of Veterans’ Affairs, Our Veterans, Fast Facts, https://floridavets.org/our-veterans/profilefast-facts/ (last visited
October 15, 2021).
3
American Psychiatric Association, What is Posttraumatic Stress Disorder?, https://www.psychiatry.org/patients-families/ptsd/what-
is-ptsd (last visited October 15, 2021).
4
October 7, 2001, ending on the date prescribed by presidential proclamation or by law. See s. 1.01(14)(h), F.S.
5
March 19, 2003, ending on the date prescribed by presidential proclamation or by law. See s. 1.01(14)(i), F.S.
6
August 2, 1990, to January 2, 1992. See s. 1.01(14)(g), F.S.
7
February 28, 1961, to May 7, 1975. See s. 1.01(14)(f), F.S.
8
National Center for PTSD, VA, How Common is PTSD in Veterans?,
https://www.ptsd.va.gov/understand/common/common_veterans.asp (last visited October 15, 2021).
9
National Center for PTSD, VA, PTSD and Substance Abuse in Veterans,
https://www.ptsd.va.gov/understand/related/substance_abuse_vet.asp (last visited October 15, 2021).
10
VA, Office of Mental Health and Suicide Prevention, 2021 National Veteran Suicide Prevention Annual Report,
https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINA L-9-8-
21.pdf (last visited October 15, 2021). STORAGE NAME: h0063a.LAV PAGE: 3
DATE: 12/1/2021
From 2001 to 2018, the suicide rate among veterans rose year to year. 2018-2019 was the first period
since 2001 in which the number and rate of suicide decreased compared to the previous period.
11
In
2019, 6,261 veterans died by suicide, which represented 13.7% of suicides among U.S. adults.
12
2019
was the first year since 2008 in which the number of veteran suicide deaths was below 6,400.
13
Veterans aged 55-74 were the largest population subgroup, accounting for 38.6% of veteran suicide
deaths in 2019.
14
The average number of veteran suicide deaths per day has risen from 16.4 in 2001 to 17.2 in 2019.
15
In
2019, of the average 17.2 veteran suicides per day, an estimated 6.8 suicides per day were among
those with Veterans Health Administration (VHA)
16
encounters in 2018 or 2019, compared with 10.4
suicides per day were among veterans with no VHA encounter.
17
In 2018, Florida had 553 veteran suicide deaths.
18
Many risk factors may affect veteran suicide rates including the following:
19
Economic disparities
o Some veterans report difficulty in transitioning to civilian positions and difficulty
translating military-related skills to higher-paying civilian jobs.
o Veterans enrolled in VHA care are less likely to be employed and more likely to have
lower income levels than veterans not receiving VHA care.
o Unemployment and poverty are correlated with homelessness among veterans.
Race, ethnicity, and sexual orientation (LGBT)
o Racial and ethnic groups differ in experiences of discrimination and historical trauma
and in access to culturally appropriate mental health treatment.
o Veterans with LGBT or related identities may be at an elevated risk for suicide.
Homelessness
o In 2019, about 37,000 veterans were homeless and about 14,000 were living on the
street or unsheltered.
Service connection
o VHA patients with military service-connected disability status may have lower risk of
suicide than other VHA patients.
Social connection and isolation
o Among VHA patients, suicide rates are highest among those who are divorced,
widowed, or never married.
o Suicide rates are elevated among individuals living in rural areas.
Health and well-being
o VHA patients who died by suicide are more likely to have sleep disorders, traumatic
brain injury, or a pain diagnosis than other VHA patients.
11
Id.
12
Id.
13
Id. at 5.
14
Id. at 4.
15
Id. at 5.
16
The VHA is the largest integrated healthcare system and provides care at 1,255 healthcare facilities, including 170 medical centers
and 1,074 outpatient clinics. See VA, Veterans Health Administration, https://www.va.gov/health/ (last visited October 15, 2021).
17
Id.
18
VA, Florida Veteran Suicide Data Sheet, 2019, https://www.mentalhealth.va.gov/docs/data-sheets/2019/2019-State-Data-Sheet-
Florida-508.pdf (last visited October 15, 2021).
19
VA, Office of Mental Health and Suicide Prevention, 2020 National Veteran Suicide Prevention Annual Report,
https://www.mentalhealth.va.gov/docs/data-sheets/2020/2020-National-Veteran-Suicide-Prevention-Annual-Report-11-2020-508.pdf
(last visited October 15, 2021) at 9-11. The 2021 National Veteran Suicide Prevention Annual Report was shorter than previous
reports due to the impact of COVID-19. The Office of Mental Health and Suicide Prevention in the U.S. Department of Veterans
Affairs is still going through data from the year 2020, therefore some information has been gathered from the 2020 Annual Report. STORAGE NAME: h0063a.LAV PAGE: 4
DATE: 12/1/2021
VA Strategy for Suicide Prevention
In 2007, the Joshua Omvig Veterans Suicide Prevention Act (Act) was signed into law.
20
The Act
directed the Secretary of the VA to develop and carry out a comprehensive program designed to
reduce the incidence of suicide among veterans. The Act requires the program to include the following:
Mandatory training for appropriate staff and contractors of the VA who interact with veterans;
Mental health assessments of veterans;
Designation of a suicide prevention counselor at each VA medical facility;
Research on best practices for suicide prevention;
Mental health care for veterans who have experienced sexual trauma while in military service;
Twenty-four hour veterans’ mental health care availability;
A toll-free hotline; and
Outreach and education for veterans and their families.
21
Since the passage of the Act, the VA has worked to expand suicide prevention initiatives, including:
Bolstering mental health services for women veterans;
Broadening telehealth services;
Developing free mobile apps to help veterans and their families;
Improving access to care by providing mental health screening and treatment services through
Vet Centers and readjustment counselors; and
Using telephone coaching to assist families of veterans.
22
In 2007, the VA also launched the Veterans Crisis Line. The program connects veterans and current
servicemembers in crisis and their families and friends with information from qualified responders
through a confidential toll-free hotline, online chat, and text messaging service.
23
The program has
answered more than 5 million calls and initiated the dispatch of emergency services to callers in crisis
more than 167,000 times. In 2009, an anonymous online chat service was added. In 2011, a text-
messaging service was also added to provide another way for veterans to connect with confidential,
round-the-clock support.
24
The VA partners with hundreds of organizations, both at the local and national level to raise awareness
of the VA’s suicide prevention resources and to educate people about how they can support veterans
and servicemembers in their communities. The VA also partners with community mental health
providers to expand the network of local treatment resources available to veterans, and with Veterans
Service Organizations (VSOs) because they help veterans find employment, manage claims and
benefits, and stay socially connected.
25
While the VHA is the largest health care system and has focused on mental health care for veterans,
many veterans do not reach out to the VA for help. Most use local hospitals and health clinics.
However, community health providers are not prepared to address the needs of veterans. Studies have
found that most are unfamiliar with deployment-related stressors and unsure how to refer patients to
the VA.
26
Suicide Prevention in Florida
20
Joshua Omvig Veterans Suicide Prevention Act, Pub. L. No. 110-110, H.R. 327, 110
th
Cong. (Nov. 5, 2007).
21
Congress.gov, H.R. 327 Summary, https://www.congress.gov/bill/110th-congress/house-bill/327 (last visited October 15, 2021).
22
VA, National Strategy for Preventing Veteran Suicide, 2018-2028, p. 11, https://sprc.org/sites/default/files/resource-
program/VA_National-Strategy-for-Preventing-Veterans-Suicide2018.pdf (last visited October 15, 2021).
23
VA Veterans Crisis Line, What to Expect, https://www.veteranscrisisline.net/about/what-to-expect (last visited October 15, 2021).
24
VA Veterans Crisis Line, What It Is, https://www.veteranscrisisline.net/about/what-is-vcl (last visited October 15, 2021).
25
Supra note 22.
26
RAND Review, How Private Health Care Providers Could Better Service Veterans, Nov. 7, 2018, https://www.rand.org/blog/rand-
review/2018/11/how-private-health-care-providers-could-better-serve-veterans.html (last visited October 15, 2021). STORAGE NAME: h0063a.LAV PAGE: 5
DATE: 12/1/2021
Florida has taken numerous steps to combat veteran suicide including, but not limited to, the following:
Joining the “Governor’s Challenge to Prevent Suicide Among Service Members, Veterans and
their Families,” a national call to action asking state, military, and civil interagency teams to
embark on a process of collaborating, planning, and implementing suicide prevention best
practices and policies for servicemembers, veterans, and their families statewide;
27
Launching the Florida Veterans Support Line, a peer-based service allowing veterans to speak
to fellow veterans to receive assistance and support;
28
Establishing the Florida Veterans Foundation, a statewide organization that provides direct
services and partners with state and local governments, veteran service organizations, and
education institutions to improve a veteran’s physical, mental, and emotional well-being;
29
Establishing the Florida Veterans’ Care Coordination Program, providing behavioral care
referral and coordination services for veterans and their families.
30
Effect of the Memorial
The memorial urges the United States Congress to recognize the current crisis of veteran suicide and
to fully fund suicide prevention efforts undertaken by the VA.
Copies of the memorial will be sent to the President of the United States, the President of the United
States Senate, the Speaker of the United States House of Representatives, and to each member of the
Florida delegation to the United States Congress.
Legislative memorials are not subject to the Governor’s veto power and are not presented to the
Governor for review. Memorials have no force of law, as they are mechanisms for formally petitioning
the federal government to act on a particular subject.
B. SECTION DIRECTORY:
Not applicable.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
27
Florida Department of Veterans’ Affairs, Governor Signs Florida Veteran Suicide Prevention Month Proclamation,
https://www.floridavets.org/governor-signs-florida-veteran-suicide-prevention-month-proclamation/ (last visited October 15, 2021).
28
Florida Veterans Support Line, About, https://www.myflvet.com/about-1, (last visited October 15, 2021).
29
Florida Veterans Foundation, About FVF, https://helpflvets.org/about/ (last visited October 15, 2021).
30
Ch. 2021-198, Laws of Fla., creating s. 394.9087, F.S. STORAGE NAME: h0063a.LAV PAGE: 6
DATE: 12/1/2021
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This memorial does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The memorial neither authorizes nor requires executive branch rulemaking.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
None.