[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2162 Introduced in Senate (IS)]
110th CONGRESS
1st Session
S. 2162
To improve the treatment and services provided by the Department of
Veterans Affairs to veterans with post-traumatic stress disorder and
substance use disorders, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 15, 2007
Mr. Akaka introduced the following bill; which was read twice and
referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To improve the treatment and services provided by the Department of
Veterans Affairs to veterans with post-traumatic stress disorder and
substance use disorders, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Mental Health
Improvements Act of 2007''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--SUBSTANCE USE DISORDERS AND MENTAL HEALTH CARE
Sec. 101. Findings on substance use disorders and mental health.
Sec. 102. Expansion of substance use disorder treatment services at
Department of Veterans Affairs Medical
Centers.
Sec. 103. Care for veterans with mental health and substance use
disorders by clinician teams.
Sec. 104. Program for enhanced treatment of substance use disorders and
post-traumatic stress disorder in veterans.
Sec. 105. National centers of excellence on post-traumatic stress
disorder and substance use disorders.
Sec. 106. Report on residential mental health care facilities of the
Veterans Health Administration.
Sec. 107. Tribute to Justin Bailey.
TITLE II--MENTAL HEALTH ACCESSIBILITY ENHANCEMENTS
Sec. 201. Pilot program on peer outreach and support for veterans and
use of community mental health centers and
Indian Health Service facilities.
TITLE III--RESEARCH
Sec. 301. Research program on comorbid post-traumatic stress disorder
and substance use disorders.
Sec. 302. Extension of authorization for Special Committee on Post-
Traumatic Stress Disorder.
TITLE IV--ASSISTANCE FOR FAMILIES OF VETERANS
Sec. 401. Clarification of authority of Secretary of Veterans Affairs
to provide mental health services to
families of veterans.
Sec. 402. Pilot program on provision of readjustment and transition
assistance to veterans and their families
in cooperation with Vet Centers.
TITLE I--SUBSTANCE USE DISORDERS AND MENTAL HEALTH CARE
SEC. 101. FINDINGS ON SUBSTANCE USE DISORDERS AND MENTAL HEALTH.
Congress makes the following findings:
(1) More than 1,500,000 members of the Armed Forces have
been deployed in Operation Iraqi Freedom and Operation Enduring
Freedom. The 2005 Department of Defense Survey of Health
Related Behaviors Among Active Duty Personnel reports that 23
percent of members of the Armed Forces on active duty
acknowledge a significant problem with alcohol use, with
similar rates of acknowledged problems with alcohol use among
members of the National Guard.
(2) The effects of substance abuse are wide ranging,
including significantly increased risk of suicide, exacerbation
of mental and physical health disorders, breakdown of family
support, and increased risk of unemployment and homelessness.
(3) While veterans suffering from mental health conditions,
chronic physical illness, and polytrauma may be at increased
risk for development of a substance use disorder, treatment for
these veterans is complicated by the need to address adequately
the physical and mental symptoms associated with these
conditions through appropriate medical intervention.
(4) While the Veterans Health Administration has
dramatically increased health services for veterans from 1996
through 2006, the number of veterans receiving specialized
substance abuse treatment services decreased 18 percent during
that time. No comparable decrease in the national rate of
substance abuse has been observed during that time.
(5) While some facilities of the Veterans Health
Administration provide exemplary substance use disorder
treatment services, the availability of such treatment services
throughout the health care system of the Veterans Health
Administration is inconsistent.
(6) According to the Government Accountability Office, the
Department of Veterans Affairs significantly reduced its
substance use disorder treatment and rehabilitation services
between 1996 and 2006, and has made little progress since in
restoring these services to their pre-1996 levels.
SEC. 102. EXPANSION OF SUBSTANCE USE DISORDER TREATMENT SERVICES AT
DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTERS.
(a) Provision of Substance Use Disorder Treatment Services.--The
Secretary of Veterans Affairs shall ensure the provision, at each
Department of Veterans Affairs medical center and community based
outpatient clinic, of the following services and treatments with
respect to substance use disorder for veterans:
(1) Short term motivational counseling services.
(2) Intensive outpatient care services.
(3) Relapse prevention services.
(4) Ongoing aftercare and outpatient counseling services.
(5) Opiate substitution therapy services.
(6) Pharmacological treatments aimed at reducing craving
for drugs and alcohol.
(7) Detoxification and stabilization services.
(8) Such other services as the Secretary considers
appropriate.
(b) Exemptions.--
(1) In general.--The Secretary may exempt an individual
medical center or community based outpatient clinic from
providing all of the services otherwise required by subsection
(a).
(2) Annual report.--Each year, the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a report setting forth the exemptions made under paragraph (1)
as of the date of the report and the reasons therefor.
SEC. 103. CARE FOR VETERANS WITH MENTAL HEALTH AND SUBSTANCE USE
DISORDERS BY CLINICIAN TEAMS.
(a) In General.--In the event the Secretary of Veterans Affairs
provides a veteran inpatient or outpatient care for a substance use
disorder and a comorbid mental health disorder, the Secretary shall
ensure that treatment for such disorders is provided concurrently by a
team of clinicians with appropriate expertise.
(b) Team of Clinicians With Appropriate Expertise Defined.--In this
section, the term ``team of clinicians with appropriate expertise''
means a team consisting of the following:
(1) Clinicians and health professionals with expertise in
treatment of substance use disorders and mental health
disorders.
(2) Such other professionals as the Secretary considers
appropriate for the provision of treatment to veterans for
substance use and mental health disorders.
SEC. 104. PROGRAM FOR ENHANCED TREATMENT OF SUBSTANCE USE DISORDERS AND
POST-TRAUMATIC STRESS DISORDER IN VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall carry out
a program for the purpose of enhancing the care and treatment for
veterans with substance use disorders and post-traumatic stress
disorder (PTSD).
(b) Allocation of Funds.--The Secretary of Veterans Affairs shall
carry out the program through a competitive allocation of funds to
facilities of the Department of Veterans Affairs for the provision of
care and treatment to veterans described in subsection (a).
(c) Application.--A facility of the Department, including a medical
center, a community based outpatient clinic, or a readjustment
counseling center, seeking an allocation of funds under this section
shall submit to the Secretary an application therefor in such form and
in such manner as the Secretary considers appropriate.
(d) Use of Allocated Funds.--Each Department facility receiving an
allocation of funds under this section shall use such funds for the
purpose described in subsection (a), including the establishment or
improvement of the following:
(1) Programs that treat veterans with post-traumatic stress
disorder and a substance use disorder through a systematic
integration of treatment for such disorders.
(2) Programs that treat veterans with substance use
disorders through the development of substance use disorder
intervention strategies, including strategies developed in
collaboration with the families of veterans.
(3) Peer outreach programs that--
(A) re-engage veterans of Operation Iraqi Freedom
and Operation Enduring Freedom who miss multiple
appointments for treatment of post-traumatic stress
disorder or a substance use disorder; and
(B) are conducted--
(i) through readjustment counseling
centers;
(ii) in tandem with efforts of community-
based outpatient clinics and post-traumatic
stress disorder and substance use disorder
treatment teams based in Department of Veterans
Affairs medical centers; and
(iii) with appropriate regard for patient
privacy.
(4) Collaboration between urgent care clinicians at
Department of Veterans Affairs medical centers and substance
use disorder and post-traumatic stress disorder treatment
professionals to ensure expedited referral of veterans who are
diagnosed with post-traumatic stress disorder or a substance
use disorder.
(5) Programs of treatment or services for veterans with
substance use disorders and post-traumatic stress disorder that
utilize innovative and flexible scheduling of treatment and
services by emphasizing scheduling of group meetings or
appointments in the evening and on weekends.
(6) Evidence-based treatment of post-traumatic stress
disorder and substance use disorders.
(e) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report setting forth the programs and
facilities for which funds have been allocated under this section as of
the date of the report.
(f) Funding.--
(1) In general.--In carrying out the program described in
this section, the Secretary shall allocate for each of fiscal
years 2008, 2009, and 2010, from funds available to the
Department for medical care in such fiscal year, an amount
equal to not less than $50,000,000 to carry out the program.
(2) Minimum funding.--In allocating amounts under paragraph
(1), the Secretary shall ensure that, after funds are allocated
under this section for a fiscal year, the total expenditure for
programs of the Department relating to the treatment of post-
traumatic stress disorder and substance use disorders is not
less than $50,000,000 in excess of the baseline amount in that
fiscal year.
(3) Baseline.--For purposes of paragraph (2), the baseline
amount is the amount of the total expenditures on programs of
the Department relating to the treatment of post-traumatic
stress disorder and substance use disorders for the most recent
fiscal year for which final expenditure amounts are known
(except for amounts made available to carry out this section),
adjusted to reflect any subsequent increase in applicable costs
to deliver such programs.
SEC. 105. NATIONAL CENTERS OF EXCELLENCE ON POST-TRAUMATIC STRESS
DISORDER AND SUBSTANCE USE DISORDERS.
(a) In General.--Subchapter II of chapter 73 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7330A. National centers of excellence on post-traumatic stress
disorder and substance use disorders
``(a) Establishment of Centers.--(1) The Secretary shall establish
not less than six national centers of excellence on post-traumatic
stress disorder and substance use disorders.
``(2) The purpose of the centers established under this section is
to serve as Department facilities that provide comprehensive inpatient
treatment and recovery services for veterans newly diagnosed with both
post-traumatic stress disorder and a substance use disorder.
``(b) Location.--Each center established in accordance with
subsection (a) shall be located at a medical center of the Department
that--
``(1) provides inpatient care;
``(2) is geographically situated in an area with a high
number of veterans that have been diagnosed with both post-
traumatic stress disorder and substance use disorder; and
``(3) is capable of treating post-traumatic stress disorder
and substance use disorders.
``(c) Process of Referral and Transition to Step Down Diagnosis
Rehabilitation Treatment Programs.--The Secretary shall establish a
process to refer and aid the transition of veterans from the national
centers of excellence on post-traumatic stress disorder and substance
use disorders established pursuant to subsection (a) to programs that
provide step down rehabilitation treatment for individuals with post-
traumatic stress disorder and substance use disorders.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 of such title is amended by inserting after the item
relating to section 7330 the following new item:
``7330A. National centers of excellence on post-traumatic stress
disorder and substance use disorders.''.
SEC. 106. REPORT ON RESIDENTIAL MENTAL HEALTH CARE FACILITIES OF THE
VETERANS HEALTH ADMINISTRATION.
(a) In General.--Not later than six months after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall, acting
through the Office of the Medical Inspector of the Department of
Veterans Affairs--
(1) conduct a review of all residential mental health care
facilities, including domiciliary facilities, of the Veterans
Health Administration; and
(2) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the review.
(b) Elements.--The report required by subsection (a)(2) shall
include the following:
(1) A description of the availability of care in
residential mental health care facilities in each Veterans
Integrated Service Network (VISN).
(2) An assessment of the supervision and support provided
in the residential mental health care facilities of the
Veterans Health Administration.
(3) The ratio of staff members at each residential mental
health care facility to patients at such facility.
(4) An assessment of the appropriateness of rules and
procedures for the prescription and administration of
medications to patients in such residential mental health care
facilities.
(5) A description of the protocols at each residential
mental health care facility for handling missed appointments.
(6) Any recommendations the Secretary considers appropriate
for improvements to such residential mental health care
facilities and the care provided in such facilities.
SEC. 107. TRIBUTE TO JUSTIN BAILEY.
This title is enacted in tribute to Justin Bailey, who, after
returning to the United States from service as a member of the Armed
Forces in Operation Iraqi Freedom, died in a domiciliary facility of
the Department of Veterans Affairs while receiving care for post-
traumatic stress disorder and a substance use disorder.
TITLE II--MENTAL HEALTH ACCESSIBILITY ENHANCEMENTS
SEC. 201. PILOT PROGRAM ON PEER OUTREACH AND SUPPORT FOR VETERANS AND
USE OF COMMUNITY MENTAL HEALTH CENTERS AND INDIAN HEALTH
SERVICE FACILITIES.
(a) Pilot Program Required.--Commencing not later than 180 days
after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall carry out a pilot program to assess the feasability and
advisability of providing to veterans of Operation Iraqi Freedom and
Operation Enduring Freedom, and, in particular, veterans who served in
such operations as a member of the National Guard or Reserve, the
following:
(1) Peer outreach services.
(2) Peer support services.
(3) Readjustment counseling services described in section
1712A of title 38, United States Code.
(4) Other Mental health services.
(b) Provision of Certain Services.--In providing services described
in paragraphs (3) and (4) of subsection (a) under the pilot program to
veterans who reside in rural areas and do not have adequate access
through the Department of Veterans Affairs to the services described in
such paragraphs, the Secretary shall, acting through the Office of
Rural Health, provide such services as follows:
(1) Through community health centers under contracts or
other agreements for the provision of such services that are
entered into for purposes of the pilot program.
(2) Through the Indian Health Service pursuant to a
memorandum of understanding entered into by the Secretary of
Veterans Affairs and the Secretary of Health and Human Services
for purposes of the pilot program.
(c) Duration.--The pilot program shall be carried out during the
three-year period beginning on the date of the commencement of the
pilot program.
(d) Program Locations.--
(1) In general.--The pilot program shall be carried out in
at least two Veterans Integrated Service Networks (VISN)
selected by the Secretary for purposes of the pilot program.
(2) Rural geographic locations.--At least two of the
locations selected shall be in rural geographic locations that
lack access to comprehensive mental health services through the
Department of Veterans Affairs.
(e) Participation in Program.--Each community mental health center
or facility of the Indian Health Service participating in the pilot
program under subsection (b) shall--
(1) provide the services described in paragraphs (3) and
(4) of subsection (a) to eligible veterans, including, to the
extent practicable, through the utilization of telehealth
services for the provision of such services;
(2) utilize best practices and technologies; and
(3) meet such other requirements as the Secretary shall
require.
(f) Compliance With Department Protocols.--Each community mental
health center or facility of the Indian Health Service participating in
the pilot program under subsection (b) shall comply with applicable
protocols of the Department before incurring any liability on behalf of
the Department for the provision of services as part of the pilot
program.
(g) Provision of Clinical Information.--Each community mental
health center or facility of the Indian Health Service participating in
the pilot program under subsection (b) shall provide the Secretary with
such clinical information on each veteran for whom such health center
or facility provides mental health services under the pilot program as
the Secretary shall require.
(h) Training.--
(1) Training of veterans.--As part of the pilot program,
the Secretary shall carry out a national program of training
for veterans described in subsection (a) to provide the
services described in paragraphs (1) and (2) of such
subsection.
(2) Training of clinicians.--
(A) In general.--The Secretary shall conduct a
training program for clinicians of community mental
health centers or Indian Health Service facilities
participating in the pilot program under subsection (b)
to ensure that such clinicians can provide the services
described in paragraphs (3) and (4) of subsection (a)
in a manner that accounts for factors that are unique
to the experiences of veterans who served on active
duty in Operation Iraqi Freedom or Operation Enduring
Freedom (including their combat and military training
experiences).
(B) Participation in training.--Each community
mental health center or facility of the Indian Health
Service participating in the pilot program under
subsection (b) shall participate in the training
program conducted pursuant to subparagraph (A).
(i) Annual Reports.--Each community mental health center or
facility of the Indian Health Service participating in the pilot
program under subsection (b) shall submit to the Secretary on an annual
basis a report containing, with respect to the provision of services
under subsection (b) and for the last full calendar year ending before
the submission of such report--
(1) the number of--
(A) veterans served; and
(B) courses of treatment provided; and
(2) demographic information for such services, diagnoses,
and courses of treatment.
(j) Definitions.--In this section:
(1) The term ``community mental health center'' has the
meaning given such term in section 410.2 of title 42, Code of
Federal Regulations (as in effect on the day before the date of
the enactment of this Act).
(2) The term ``eligible veteran'' means a veteran in need
of mental health services who--
(A) is enrolled in the Department of Veterans
Affairs health care system; and
(B) has received a referral from a health
professional of the Veterans Health Administration to a
community mental health center or to a facility of the
Indian Health Service for purposes of the pilot
program.
(3) The term ``Indian Health Service'' means the
organization established by section 601(a) of the Indian Health
Care Improvement Act (25 U.S.C. 1661(a)).
(k) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out the provisions
of this section.
TITLE III--RESEARCH
SEC. 301. RESEARCH PROGRAM ON COMORBID POST-TRAUMATIC STRESS DISORDER
AND SUBSTANCE USE DISORDERS.
(a) Program Required.--The Secretary of Veterans Affairs shall
carry out a program of research into comorbid post-traumatic stress
disorder (PTSD) and substance use disorder.
(b) Discharge Through National Center for Posttraumatic Stress
Disorder.--The research program required by subsection (a) shall be
carried out and overseen by the National Center for Posttraumatic
Stress Disorder. In carrying out the program, the Center shall--
(1) develop protocols and goals with respect to research
under the program; and
(2) coordinate research, data collection, and data
dissemination under the program.
(c) Research.--The program of research required by subsection (a)
shall address the following:
(1) Comorbid post-traumatic stress disorder and substance
use disorder.
(2) The systematic integration of treatment for post-
traumatic stress disorder with treatment for substance use
disorder.
(3) The development of protocols to evaluate care of
veterans with comorbid post-traumatic stress disorder and
substance use disorder and to facilitate cumulative clinical
progress of such veterans over time.
(d) Funding.--
(1) Authorization of appropriations.--There is authorized
to be appropriated for the Department of Veterans Affairs for
each of fiscal years 2008 through 2011, $2,000,000 to carry out
this section.
(2) Availability.--Amounts authorized to be appropriated by
paragraph (1) shall be made available to the National Center on
Posttraumatic Stress Disorder for the purpose specified in that
paragraph.
(3) Supplement not supplant.--Any amount made available to
the National Center on Posttraumatic Stress Disorder for a
fiscal year under paragraph (2) is in addition to any other
amounts made available to the National Center on Posttraumatic
Stress Disorder for such year under any other provision of law.
SEC. 302. EXTENSION OF AUTHORIZATION FOR SPECIAL COMMITTEE ON POST-
TRAUMATIC STRESS DISORDER.
Section 110(e)(2) of the Veterans' Health Care Act of 1984 (38
U.S.C. 1712A note) is amended by striking ``through 2008'' and
inserting ``through 2012''.
TITLE IV--ASSISTANCE FOR FAMILIES OF VETERANS
SEC. 401. CLARIFICATION OF AUTHORITY OF SECRETARY OF VETERANS AFFAIRS
TO PROVIDE MENTAL HEALTH SERVICES TO FAMILIES OF
VETERANS.
(a) In General.--Section 1701(5)(B) of title 38, United States
Code, is amended--
(1) by inserting ``marriage and family counseling,'' after
``professional counseling,''; and
(2) by striking ``as may be essential to'' and inserting
``as the Secretary considers appropriate for''.
(b) Location.--Paragraph (5) of section 1701 of title 38, United
States Code, shall not be construed to prevent the Secretary of
Veterans Affairs from providing services described in subparagraph (B)
of such paragraph to individuals described in such subparagraph in
Readjustment Counseling Centers, Department of Veterans Affairs medical
centers, community-based outpatient clinics, or in such other
facilities of the Department of Veterans Affairs as the Secretary
considers necessary.
SEC. 402. PILOT PROGRAM ON PROVISION OF READJUSTMENT AND TRANSITION
ASSISTANCE TO VETERANS AND THEIR FAMILIES IN COOPERATION
WITH VET CENTERS.
(a) Pilot Program.--The Secretary of Veterans Affairs shall carry
out, through a non-Department of Veterans Affairs entity, a pilot
program to assess the feasability and advisability of providing
readjustment and transition assistance described in subsection (b) to
veterans and their families in cooperation with centers under section
1712A of title 38, United States Code (commonly referred to as ``Vet
Centers'').
(b) Readjustment and Transition Assistance.--Readjustment and
transition assistance described in this subsection is assistance as
follows:
(1) Readjustment and transition assistance that is
preemptive, proactive, and principle-centered.
(2) Assistance and training for veterans and their families
in coping with the challenges associated with making the
transition from military to civilian life.
(c) Non-Department of Veterans Affairs Entity.--
(1) In general.--The Secretary shall carry out the pilot
program through any for-profit or non-profit organization
selected by the Secretary for purposes of the pilot program
that has demonstrated expertise and experience in the provision
of assistance and training described in subsection (b).
(2) Contract or agreement.--The Secretary shall carry out
the pilot program through a non-Department entity described in
paragraph (1) pursuant to a contract or other agreement entered
into by the Secretary and the entity for purposes of the pilot
program.
(d) Duration of Pilot Program.--The pilot program shall be carried
out during the three-year period beginning on the date of the enactment
of this Act, and may be carried out for additional one-year periods
thereafter.
(e) Location of Pilot Program.--
(1) In general.--The Secretary of Veterans Affairs shall
provide assistance under the pilot program in cooperation with
10 centers described in subsection (a) designated by the
Secretary for purposes of the pilot program.
(2) Designations.--In designating centers described in
subsection (a) for purposes of the pilot program, the Secretary
shall designate centers so as to provide a balanced
geographical representation of such centers throughout the
United States, including the District of Columbia, the
Commonwealth of Puerto Rico, tribal lands, and other
territories and possessions of the United States.
(f) Participation of Centers.--A center described in subsection (a)
that is designated under subsection (e) for participation in the pilot
program shall participate in the pilot program by promoting awareness
of the assistance and training available to veterans and their families
through--
(1) the facilities and other resources of such center;
(2) the non-Department of Veterans Affairs entity selected
pursuant to subsection (c); and
(3) other appropriate mechanisms.
(g) Additional Support.--In carrying out the pilot program, the
Secretary of Veterans Affairs may enter into contracts or other
agreements, in addition to the contract or agreement described in
subsection (c), with such other non-Department of Veterans Affairs
entities meeting the requirements of subsection (c) as the Secretary
considers appropriate for purposes of the pilot program.
(h) Report on Pilot Program.--
(1) Report required.--Not later than six months after the
date of the conclusion of the pilot program, the Secretary
shall submit to the congressional veterans affairs committees a
report on the pilot program.
(2) Elements.--Each report under paragraph (1) shall
include the following:
(A) A description of the activities under the pilot
program as of the date of such report, including the
number of veterans and families provided assistance
under the pilot program and the scope and nature of the
assistance so provided.
(B) A current assessment of the effectiveness of
the pilot program.
(C) Any recommendations that the Secretary
considers appropriate for the extension or expansion of
the pilot program.
(3) Congressional veterans affairs committees defined.--In
this subsection, the term ``congressional veterans affairs
committees'' means--
(A) the Committees on Veterans' Affairs and
Appropriations of the Senate; and
(B) the Committees on Veterans' Affairs and
Appropriations of the House of Representatives.
(i) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated for
the Department of Veterans Affairs for each of fiscal years
2008 through 2010 $1,000,000 to carry out this section.
(2) Availability.--Amounts authorized to be appropriated by
paragraph (1) shall remain available until expended.
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