[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6968 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6968

To require the Secretary of Defense to conduct a demonstration project 
  regarding access to mental health services by members of the Armed 
                                Forces.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 18, 2008

 Ms. Moore of Wisconsin (for herself, Mr. McGovern, Mr. Grijalva, Ms. 
Bordallo, Ms. Woolsey, Mr. Rush, Mr. Filner, Ms. Schakowsky, Mr. Kagen, 
  Mr. Abercrombie, Mr. Sestak, Ms. Loretta Sanchez of California, Mr. 
Kucinich, and Mrs. Napolitano) introduced the following bill; which was 
              referred to the Committee on Armed Services

_______________________________________________________________________

                                 A BILL


 
To require the Secretary of Defense to conduct a demonstration project 
  regarding access to mental health services by members of the Armed 
                                Forces.

    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 ``Helping Those Who Serve Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Increasing numbers of members of the Armed Forces 
        serving in Afghanistan and Iraq are suffering from the 
        significant injuries of the current conflict: post traumatic 
        stress disorder and traumatic brain injury (hereafter in this 
        Act referred to as ``PTSD'' and ``TBI'', respectively) .
            (2) A recent report by the RAND Corporation estimated that 
        of the 1.64 million individuals who have been deployed to 
        Afghanistan and Iraq, approximately 300,000 individuals 
        currently suffer from PTSD or major depression and that 320,000 
        report having a probable TBI during deployment.
            (3) The need for mental health services is likely to 
        increase because deployment lengths have increased in the last 
        year, the number of troops who have served in multiple 
        deployments is increasing, and the breaks between deployments 
        have been infrequent.
            (4) Several experts have noted the difficulties faced by 
        members of the Armed Forces in getting screened, diagnosed, and 
        treated for PTSD and TBI. The RAND report found that, of those 
        who met diagnostic criteria for PTSD or major depression, only 
        53 percent had seen a physician or mental health provider to 
        seek help for a mental health problem in the past 12 months.
            (5) Stigma remains a critical barrier to members of the 
        Armed Forces who may be in need of psychological care, 
        especially fears that seeking mental health care will lower the 
        confidence of others in their abilities, threaten career 
        advancement and security clearances, and possibly cause removal 
        from their unit.
            (6) Stigma may be greatest among those individuals with the 
        greatest need for mental health services.
            (7) To combat stigma, the Mental Health Task Force of the 
        Department of Defense and others have noted the need for the 
        Department to reexamine its policies, including those policies 
        related to command notification or self-disclosure of 
        psychological health issues that contribute to fears that 
        seeking mental health care will negatively affect career 
        opportunities or advancement.
            (8) The Mental Health Task Force stated that this 
        ``widespread perception that seeking psychological health 
        services is costly to an individual's career . . . must be 
        challenged through thoughtful refinements in command 
        notification policies, including redefining the balance between 
        the need to encourage those in need to seek help and the need 
        for commanders to know in order to maintain force readiness''.
            (9) Congress recognizes that much change is under way to 
        implement numerous recommendations to address concerns that 
        soldiers in need of mental health services for PTSD and other 
        conditions are not receiving, including efforts led by the 
        Department of Defense and the Department of Veterans Affairs.
            (10) However, without addressing stigma at all levels, 
        including structurally, these laudable efforts may not 
        accomplish their goals.
            (11) In its July 2007 report, the Mental Health Task Force 
        called for ending overly conservative policies that have the 
        unintentional consequence of fueling erroneous beliefs that 
        seeking psychological health care invariably results in 
        permanent damage to one's military career. For example, the 
        Task Force called for allowing, in the case of alcohol use by a 
        member of the Armed Forces, for the member to receive 
        appropriate and non-prejudicial education and preventive 
        services, without a requirement for command notification, when, 
        in a clinician's judgment, the alcohol use does not warrant a 
        diagnosis of substance abuse or dependency or does not require 
        entry into a formal treatment program.
            (12) In May, responding to some of these concerns, 
        Secretary of Defense Robert Gates reportedly approved a change 
        in the Department's security clearance process to help remove 
        the stigma associated with seeking mental health care. Under 
        the change, members of the Armed Forces and employees of the 
        Department of Defense who have received mental health care will 
        no longer have to acknowledge that when they fill out standard 
        security clearance forms, unless the treatment was court-
        ordered or involved violence.
            (13) Congress encourages the Department to explore further 
        changes to notification and other policies to further reduce 
        stigma among members of the Armed Forces, especially as it 
        relates to career opportunities.

SEC. 3. MENTAL HEALTH SERVICES ACCESS DEMONSTRATION PROJECT.

    (a) Demonstration Project Required.--The Secretary of Defense shall 
conduct a demonstration project designed to develop and test options 
for the following:
            (1) Increasing access of members of the Armed Forces 
        returning from deployment abroad, and family members of such 
        members, to accessible, safe, and confidential mental health 
        counseling.
            (2) Reducing stigma and perceived career repercussions 
        associated with such members seeking such services.
            (3) Making high quality mental health services more user 
        friendly and accessible for members of the Armed Forces and 
        their family members, including making services available 
        outside standard working hours.
    (b) Purpose.--The purpose of the demonstration project is to 
provide high-quality treatment, using (to the extent practicable) 
evidence-based treatment, for a broad range of mental health 
conditions, including post-traumatic stress disorder and depression, 
with the goal of early intervention to promote effective coping and 
resilience.
    (c) Duration of Project.--The demonstration project authorized by 
this section shall be implemented for a period of three years beginning 
not later than one year after the date of the enactment of this Act.

SEC. 4. SPECIAL WORKING GROUP ON CONFIDENTIALITY.

    (a) Establishment.--The Secretary of Defense, acting through the 
Assistant Secretary of Defense for Health Affairs, shall establish a 
Special Working Group, which shall be composed of mental health 
professionals from each of the Armed Forces, officials from the Surgeon 
General Offices at each Armed Force, members of the Armed Forces who 
have been deployed in support of Operation Enduring Freedom or 
Operation Iraqi Freedom, and other members as determined appropriated 
by the Assistant Secretary.
    (b) Appointment.--The Secretary shall make every effort to appoint 
members of the working group not later than 60 days after the date of 
the enactment of this Act.
    (c) Purpose.--The Special Working Group shall develop guidelines 
and make recommendations about regulations to ensure that 
confidentiality is protected to the maximum extent possible for members 
of the Armed Forces participating in the demonstration project.
    (d) Specific Duties.--In addition to such other duties as the 
Secretary may assign to the Working Group, the duties of the Working 
Group shall include the following:
            (1) Review of requirements for documentation of health care 
        visits.--The review of current policies, questionnaires, and 
        other relevant documents that require official documentation of 
        health care visits by a member of the Armed Forces seeking 
        mental health services, including when access to such services 
        must be documented in the personnel record of a member.
            (2) Criteria for changes to command notification.--The 
        development of guidelines and criteria for the demonstration 
        project to address any needed changes to military command 
        notification requirements to ensure that a visit to an off-base 
        treatment site by a member of the Armed Forces for mental 
        health services is not recorded on any military medical or 
        other record of the member, except in accordance with 
        guidelines developed under paragraph (3).
            (3) Guidelines for breach of confidentiality.--The 
        development of guidelines for the demonstration project to 
        address the circumstances under which the confidentiality 
        protections afforded to a member of the Armed Forces 
        participating in the demonstration project may be breached and 
        notification to military commanders and documentation in 
        personnel records may be made. Such guidelines shall provide, 
        in general, that confidentiality may be broken only if a mental 
        health professional determines that the member is a threat to 
        the member or to another person.
            (4) Criteria to limit access to treatment records.--The 
        development of criteria for the demonstration project for 
        limiting access to the treatment records of members of the 
        Armed Forces treated at the demonstration locations, including 
        when to allow, if appropriate, appropriate access and 
        notification to military commanders consistent with guidelines 
        developed under paragraph (3).
            (5) Criteria for fitness for duty.--The development of 
        criteria for determining fitness for duty and deployment for a 
        member of the Armed Forces that does not depend solely on the 
        number of visits to mental health providers by the member.
            (6) Guidelines for payment.--The development of guidelines 
        for ensuring that demonstration sites under the demonstration 
        project receive payment from the Department of Defense for 
        treating members of the Armed Forces notwithstanding any 
        requirements of the Department that prohibit such payments 
        without certain commander notification or personnel 
        documentation requirements.
            (7) Changes related to disclosure of services received 
        under project.--The provision of changes as necessary to ensure 
        that those receiving care at demonstration locations are not 
        required to reveal any services they receive at these locations 
        on any military form or questionnaire, except to comply with 
        any guidelines developed under paragraph (3).
            (8) Standards to assess effectiveness of project.--The 
        development of evaluation standards and criteria to use to 
        assess the effectiveness of the demonstration project in 
        increasing access to care, decreasing stigma, and improving 
        high quality mental health care provided to members of the 
        Armed Forces. As appropriate, the evaluation should be 
        structured to include both pre- and post-demonstration 
        assessments of changes in--
                    (A) access and utilization of care;
                    (B) costs of care;
                    (C) outcomes of care;
                    (D) member satisfaction with access to and quality 
                of care; and
                    (E) impact on the ability of military commanders to 
                determine member fitness for duty and deployability.
    (e) Submission of Plan and Deadline.--
            (1) Plan.--The Special Working Group shall submit to the 
        Secretary of Defense a plan with details on the implementation 
        and evaluation of the demonstration project. After approval of 
        the plan by the Secretary, the Special Working Group shall 
        submit to Congress the plan.
            (2) Deadline.--All duties of the Special Working group, 
        including submission of the plan under paragraph (1), shall be 
        completed before selection of any site of the demonstration 
        project under section 3 but in no case shall the date of 
        completion of such duties be later than one year after the date 
        of the enactment of this Act.
    (f) Application of Guidelines and Recommendations.--The guidelines 
and other recommendations, including changes and standards, developed 
by the Special Working Group under this section shall be applicable 
only to the demonstration project unless the Secretary of Defense 
determines otherwise.

SEC. 5. ADVISORY GROUP FOR OVERSIGHT OF DEMONSTRATION PROGRAM.

    (a) Establishment.--The Secretary of Defense shall establish an 
advisory group of qualified individuals to oversee implementation of 
the demonstration project.
    (b) Duties.--The advisory group shall--
            (1) ensure that the demonstration project adheres to the 
        guidelines developed by the Special Working Group under section 
        4;
            (2) ensure that plans for implementing the demonstration at 
        selected sites are developed and include--
                    (A) outreach strategies to ensure that participants 
                in the project are informed about the availability of 
                the programs being provided under the project; and
                    (B) a plan for training and certifying mental 
                health providers as well as the development of 
                strategies and settings, including settings that are 
                not located at military treatment facilities, where 
                care can be offered;
            (3) ensure that the demonstration project has detailed 
        evaluation plans, using the criteria and standards developed by 
        the Special Working Group; and
            (4) ensure that independent evaluations of the 
        demonstration project are conducted in accordance with the 
        guidelines developed by the Special Working Group, and that the 
        results of those evaluations are provided to the Secretary of 
        Defense.

SEC. 6. REPORTS ON DEMONSTRATION PROJECT.

    (a) Reports Required.--
            (1) In general.--The Secretary of Defense shall submit to 
        the Committees on Armed Services of the Senate and the House of 
        Representatives two reports on the demonstration project.
            (2) First report.--The first report shall examine and 
        assess the plan developed by the Special Working Group under 
        section 4(e)(1) for implementation and evaluation of the 
        demonstration project.
            (3) Second report.--The second report shall include the 
        following:
                    (A) The results of the demonstration project, 
                evaluated in accordance with the guidelines and other 
                criteria, changes, and standards developed by the 
                Special Working Group.
                    (B) Recommendations on whether any of the policy 
                changes tested in the demonstration project should be 
                adopted throughout the Department of Defense.
                    (C) A plan to ensure that each member of the Armed 
                Forces participating in the demonstration project 
                continues to have access to mental health services and 
                providers after the conclusion of the demonstration 
                project.
    (b) Deadlines.--The first report under this section shall be 
submitted not later than one year after the date the demonstration 
project begins to be implemented. The second report shall be submitted 
at the completion of the demonstration project.

SEC. 7. STUDY AND REPORT ON RETENTION OF MILITARY MENTAL HEALTH 
              PROFESSIONALS.

    (a) Study.--The Secretary of Defense, in consultation with the 
Surgeon General of each branch of the Armed Forces, shall conduct a 
study to determine the reasons for attrition among military mental 
health professionals and to make recommendations to increase 
recruitment and retention of military mental health professionals, such 
as through scholarships, loan forgiveness, or updates in current 
recruiting bonuses.
    (b) Report.--Not later than six months after the date of the 
enactment of this Act, the Secretary of Defense shall submit to 
Congress a report on the study conducted and recommendations made under 
subsection (a), including--
            (1) the estimated cost of implementing each such 
        recommendation;
            (2) with respect to each branch of the Armed Forces, an 
        estimate of the existing number of military mental health 
        professionals and the estimated number of such professionals 
        required to meet demand, including for future years, for mental 
        health services; and
            (3) any recommendations for legislative changes necessary 
        to implement the recommendations made under such study.
    (c) Military Mental Health Professional Defined.--For purposes of 
this section, the term ``military mental health professional'' means a 
mental health professional who provides mental health services to 
members of the Armed Forces, whether such professional is a member of 
the Armed Forces, an employee of the Department of Defense, or a 
contractor of the Department of Defense.
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