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What it does 

Veterans, both deployed and non-deployed, have a significantly higher suicide risk compared to the U.S. general population. Many veterans suffer from severe psychological trauma or traumatic brain injury, which may lead to a higher percentage of veteran suicide. This bill seeks to increase attention on veteran suicide and its underlying causes by requiring the creation of a veteran suicide report.

H.R. 4640 requires the Department of Veteran Affairs (VA) to complete a review of all veteran suicide deaths who received VA hospital care or services during the preceding five years; the report must include:

  • The total number of veterans who died by suicide, including a summary that presents their age, gender, and race;
  • A list of medications prescribed to or found in the system of the veteran at the time of their death (specifically listing drugs that carry a warning regarding suicidal ideation, were off-label, or psychotropic), along with:
    • the VA’s policies governing such prescriptions; and
    • a medical diagnoses summary by the VA physicians that led to the prescription of such medication;
  • The percentage of veterans who were not taking any medication prescribed by a VA physician as well as the number of instances in which the veteran was concurrently on multiple medications prescribed by a VA physician;
  • The percentage of veterans with combat experience or trauma, including traumatic brain injury and post-traumatic stress;
  • Veteran Health Administration facilities with “markedly” high prescription and suicide rates of patients being treated at those facilities; and
  • Any revealed patterns discerned across this information and recommendations to improve the safety and well-being of veterans.

The report must be submitted to Congress and be publicly available within 18 months of the law’s enactment.

Relevant Science 

Traumatic brain injury (TBI) occurs when an external mechanical force causes brain dysfunction. It usually results from a violent blow or jolt to the head or body. An object penetrating the skull, such as a bullet or shattered piece of skull, also can cause traumatic brain injury. TBI is usually classified into two levels. Mild traumatic brain injury may cause temporary dysfunction of brain cells. More serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain that can result in long-term complications or even death.

A report issued by the National Institutes of Health shows that Major Depressive Disorder (MDD) may be the most common and challenging mental health condition that patients encounter following a TBI, which is also an early sign of future suicidal attempts. Some believe that a TBI might cause rupture of neural circuits involving the prefrontal cortex, amygdala, hippocampus, basal ganglia and thalamus. These regions in the human brain are important for cognitive ability and damage to such areas would lead to cognitive failure. It is hypothesized that such damage would relate to the development of MDD. Another hypothesis is that TBI would disturb the neurotransmission system and hinder the transmission of neurotransmitters such as serotonin, glutamate and dopamine. Neurotransmitters play essential roles in proper transmission of electrical signals through neurons and have a substantial effect on mood management. A low level of serotonin, for example, is associated with emotional changes and aggression, which are common symptoms of a mood disorder. 

Relevant Experts 

Timothy J. Strauman is a professor of Psychology and Neuroscience at Duke. He specializes in self-regulatory processes in vulnerability to depression and other psychological disorders.


The Clay Hunt Suicide Prevention for American Veterans (SAV) Act was signed by the President and became Public Law No: 114-2 on February 12, 2015. The Act seeks to prevent veteran suicide by establishing guidelines for VA mental health care and suicide prevention programs. It requires the VA to conduct an independent third party evaluation of the program and submit an annual report to Congress. It also directs the VA to establish the Veterans Integrated Service Networks (VISNs) to assist veterans transitioning from active duty and to improve the access of veterans to mental health services. The VA is also authorized to collaborate with nonprofit mental health organizations to exchange training sessions and best practices in the prevention of veteran suicides. This Act was inspired by the suicide of Marine veteran Clay Hunt, who suffered from severe mental diseases, including Post-Traumatic Stress Disorder, after separating from the military.

Endorsements & Opposition 


  • As of June 14, 2016, there are no publicly reported endorsements for H.R. 4640.
  • More generally, the public typically supports improving mental healthcare systems for veterans. The Clay Hunt SAV Act, for example, is widely supported. According to a media report, Dr. Sandra Bond Chapman from the Center of Brain Health University of Texas at Dallas stated that “the SAV Act will address obstacles in veterans’ access to timely and appropriate services. Under the bill, special care and attention will be given to service personnel transitioning from active duty to veteran status through community outreach and peer support groups.”


  • As of June 14, 2016, there is no publicly reported opposition for H.R. 4640.
  • From a general perspective, any opposition to veteran programs is typically rooted in an aversion to additional governmental costs. Former Senator Tom Coburn (R-OK) said that legislation such as the SAV Act “carries too hefty a price tag for authority that the VA could, in most cases, already exercise … In almost every case, [the] VA already has the tools and authorities it needs to address these problems. The department needs leadership, not another piece of ineffective legislation. Congress should be holding the VA accountable rather than adding to its list of poorly managed programs,” according to a media report

H.R. 4640 was introduced and referred to the House Committee on Veterans’ Affairs on February 26, 2016. It was referred to the Subcommittee on Health for consideration on March 7, 2016. 


The bill is sponsored by Rep. David Jolly (R-FL-13). The three co-sponsors are Rep. Dina Titus (D-NV-1), Ralph Lee Abraham (R-LA-5), and Tulsi Gabbard (D-HI-2).

Primary Author 
Nancy Zhang
Elise Demeter, PhD & Aubrey Incorvaia, MPP
Recommended Citation 

Duke SciPol, “Veteran Suicide Prevention Act (HR 4640, 114th Congress)” available at (6/19/2016).