[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. Res. 518 Introduced in Senate (IS)]

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117th CONGRESS
  2d Session
S. RES. 518

Expressing the sense of the Senate that in order to effectively address 
    the high prevalence of individuals suffering from mental health 
conditions and substance use disorders, the United States needs to make 
  historic financial investments into mental health and substance use 
disorder care and finally acknowledge such care as a priority in health 
         care equal to physical health, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 17, 2022

 Mr. Warnock (for himself, Mr. Padilla, Ms. Stabenow, and Mr. Booker) 
submitted the following resolution; which was referred to the Committee 
               on Health, Education, Labor, and Pensions

_______________________________________________________________________

                               RESOLUTION


 
Expressing the sense of the Senate that in order to effectively address 
    the high prevalence of individuals suffering from mental health 
conditions and substance use disorders, the United States needs to make 
  historic financial investments into mental health and substance use 
disorder care and finally acknowledge such care as a priority in health 
         care equal to physical health, and for other purposes.

Whereas there is an urgent need to improve our health care system to better 
        integrate treatment of mental health and substance use disorders so they 
        are no longer seen separately;
Whereas, according to the World Health Organization, mental illness is severely 
        underdiagnosed, and less than half of individuals who meet diagnostic 
        criteria are identified;
Whereas there is a pressing need to provide a comprehensive solution to fix our 
        health care system that incorporates the needs and expertise of all its 
        stakeholders, especially individuals who have expertise in mental health 
        and substance use disorders;
Whereas it is essential to remove the misguided association between mental 
        illness and violence, driven by fear and misunderstanding;
Whereas mental illness and substance use disorders have been underresearched, 
        undertreated, and overstigmatized;
Whereas stigma, vilification, and dismissal of mental illness and substance 
        use--

    (1) create a culture that--

    G    (A) discourages utilization of mental health and substance use 
disorder services; and

    G    (B) lacks acknowledgment that struggling with a mental health 
condition or substance use disorder is not something to be ashamed of; and

    (2) can vary in prominence in different cultures and communities, and 
are particularly high among communities of color and minority communities;

Whereas men, in particular, face cultural and societal barriers to seeking 
        treatment for mental health concerns and substance use disorders, which 
        can contribute to concerning outcomes including suicide and aggressive 
        behavior;
Whereas the bulk of mental health and substance use disorder services are 
        reactive instead of proactive, treating patients when they are in crisis 
        instead of incorporating services and screening earlier in an attempt to 
        prevent such crises;
Whereas there is a need to increase access to treatment, services, and social 
        supports for everyone to proactively address the root causes of mental 
        illness and substance use disorders;
Whereas it is necessary to address the root causes of mental health concerns and 
        substance use disorders;
Whereas it is necessary to address suicide in a holistic manner and recognize 
        and address suicidal ideation and not just the act of suicide in 
        isolation;
Whereas there is a need to address social determinants of health, which are 
        conditions that directly and indirectly affect the health, health care, 
        and wellness of individuals and communities, in order to effectively 
        provide care for all individuals living with mental illness and 
        substance use disorders;
Whereas mental health impacts physical health, and physical health impacts 
        mental health;
Whereas the current health care system in the United States does not adequately 
        incorporate mental health and substance use disorders into the 
        assessment or delivery of care, as evidenced by the fact that all 
        ``vital signs'' are currently for physical health alone and do not touch 
        on mental health or substance use disorders;
Whereas the lack of a united approach across the Federal Government to improve 
        the care and related services for mental health and substance use 
        disorders has left States and localities--

    (1) without adequate guidance or resources;

    (2) unable to provide the mental health and substance use disorder 
services needed to adequately meet the needs of their populations; and

    (3) unable to effectively distribute services to adequately meet the 
needs of their populations;

Whereas there is a need for greater collaboration across all Federal agencies 
        that touch various aspects of the health care system in order to fully 
        incorporate the needs and concerns of everyone involved in the treatment 
        and prevention of mental health and substance use disorders;
Whereas there is a need for greater collaboration between Federal, State, and 
        local agencies that touch on various aspects of the health care system;
Whereas there is a need for a centralized location within the Federal Government 
        for good, reliable information on mental health and substance use 
        disorders for providers, patients, and caregivers;
Whereas there is a need for standardized definitions, standards of care, and 
        metrics for mental health and substance use disorders across 
        disciplines;
Whereas there is a need to change incentives for providers to better ensure 
        everyone with mental health and substance use disorders gets access to 
        the necessary care and treatment;
Whereas 13 years after the date of enactment of the Paul Wellstone and Pete 
        Domenici Mental Health Parity and Addiction Equality Act of 2008 
        (subtitle B of title V of division C of Public Law 110-343), there is 
        still a lack of compliance among insurers and failure to adequately 
        cover mental health and substance use disorder services;
Whereas Medicaid is the single largest payer of mental health and substance use 
        disorder services, and reimbursement is far from adequate;
Whereas there is a need to incentivize payers to adequately cover mental health 
        and substance use disorder services in the same manner in which all 
        specialty services are covered;
Whereas there is a need to increase the number of mental health and substance 
        use disorder providers;
Whereas 55 percent of counties in the United States do not have a single 
        psychiatrist, psychologist, or social worker;
Whereas only 10 percent of individuals in the United States suffering from a 
        substance use disorder receive specialty treatment;
Whereas there is a need to increase access to and utilization of telemedicine 
        for mental health and substance use disorder services, both within 
        States and across State lines;
Whereas there is a need for a better way to share information among providers to 
        better serve patient needs while still protecting patient privacy;
Whereas there is a need for consistent care coordination and more effective 
        transition services for patients moving between hospitals and the 
        community;
Whereas safe housing needs to be recognized as a basic requirement for 
        successful treatment and needs to be better addressed in the transition 
        of care;
Whereas there is a need to improve social determinants of health, such as 
        increased access to stable housing and jobs, for individuals suffering 
        from mental illness and substance use disorders to have a sustained 
        recovery;
Whereas there is a need to provide care in more appropriate and integrated 
        settings for all patients, such as treating geriatric patients in their 
        homes as opposed to nursing homes, when appropriate, and in compliance 
        with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et 
        seq.) and the decision of the Supreme Court of the United States in 
        Olmstead v. L.C., 527 U.S. 581 (1999);
Whereas there is a need for greater focus on intensive outpatient, partial 
        hospitalizations, residential programs, day programs, supported housing, 
        assertive community treatment, mobile crisis services, peer support 
        services, supported employment, and community-based services for adults 
        with mental illness and substance use disorders;
Whereas there is a need to ensure that services support individuals with mental 
        health conditions and substance use disorders to participate fully in 
        their communities and live and thrive independently;
Whereas there is a need to address isolation issues geriatric patients face, 
        which can negatively impact their mental health;
Whereas 30 percent of first responders experience mental health conditions, such 
        as depression and post-traumatic stress, and have higher rates of 
        suicidal ideation and suicide attempt than the rest of the population;
Whereas depression, anxiety, post-traumatic stress, and psychosis are some of 
        the most common conditions women experience pre- and postpartum;
Whereas unmet parental mental health and substance use disorder treatment and 
        service needs contribute to increased involvement with the child welfare 
        system, which leads to preventable foster care placements, given that--

    (1) in 2018, 262,956 children entered foster care, with the leading 
reasons related to mental health and substance use disorder needs of the 
parents, with--

    G    (A) 36 percent of children entering care as a result of parental 
drug abuse;

    G    (B) 14 percent of children entering care as a result of the 
inability to cope of the caretaker; and

    G    (C) 5 percent of children entering care as a result of parental 
alcohol abuse;

    (2) even when necessary to ensure the safety of a child, foster care 
itself creates additional trauma for both the child and family; and

    (3) longstanding racial inequities in child welfare services create 
disproportionate child welfare involvement for Black, Native, and Latinx 
children and families, which exacerbates the experiences of trauma for 
those families and contributes to health disparities while not resulting in 
needed access to quality mental health and substance use disorder services;

Whereas children and adolescents have unique needs when it comes to mental 
        health and substance use disorders and the services provided, given 
        that--

    (1) 45 percent of children have experienced adverse childhood 
experiences that have the potential to significantly impact the mental 
health of the children;

    (2) in the last 5 years, 49.4 percent of children who needed mental 
health services did not receive the necessary services, and there is a need 
for improved access to appropriate treatment services, which must focus on 
community-based supports and services available near their home, in order 
to effectively prevent children from experiencing a mental health crisis;

    (3) many children suffering and struggling go undiagnosed and are not 
adequately supported, and there is a need to improve training and 
understanding of mental health and substance use disorders for educators 
since often there are barriers to mental health and substance use disorder 
treatment in a school setting;

    (4) 42 percent of school districts have reported using threat 
assessment and risk assessment teams, an approach created by the United 
States Secret Service that involves identifying, evaluating, and taking 
action on assumed current or potential threats, which--

    G    (A) can cause significant harm to the mental health and emotional 
well-being of children;

    G    (B) has compounded existent stigma for groups of students;

    G    (C) has had a disproportionate impact on students of color by 
initiating criminal justice involvement in lieu of more appropriate 
services; and

    G    (D) has had a disproportionate impact on students with 
disabilities;

    (5) families and caregivers need to be included when treating children 
suffering from mental illness and substance use disorders; and

    (6) when children turn 18 years old they are cut off from mental health 
and substance use disorder services, which impacts continuity of care;

Whereas there is a growing need for mental health and substance use disorder 
        services among young adults and college-aged adults, and between 2007 
        and 2017, for individuals aged 18 to 34, there was a--

    (1) 108 percent increase in drug-related deaths;

    (2) 69 percent increase in alcohol-induced deaths; and

    (3) 35 percent increase in suicide deaths;

Whereas, despite the rising need for mental health and substance use disorder 
        treatment by young adults, there continues to be disparities in 
        accessing care experienced by young adults of color;
Whereas 5,500,000 veterans and servicemembers rely on the Department of Veterans 
        Affairs for health services, and 1,500,000 veterans have received a 
        mental health diagnosis, and--

    (1) 1 in 4 active duty members shows signs of a mental health 
condition;

    (2) the rate of post-traumatic stress disorder (referred to in this 
preamble as PTSD) is 15 times higher in servicemembers than compared to 
civilians due to military combat and military sexual assault and trauma;

    (3) the rate of depression is 5 times higher in servicemembers as 
compared to civilians;

    (4) every day, 17 veterans die by suicide;

    (5) there is a fear of disclosing mental health conditions and 
substance use disorders and seeking treatment due to negative career 
implications; and

    (6) less than 50 percent of veterans receive the mental health 
treatment and services they need;

Whereas 11 percent of individuals entering the Department of Veterans Affairs 
        health system meet the criteria for a substance use disorder;
Whereas veterans are more likely to have an alcohol use disorder than civilians;
Whereas 2 in 10 veterans with PTSD have a comorbid substance use disorder, and 1 
        in 3 veterans seeking services for a substance use disorder also has 
        PTSD, showing the interconnectedness between these conditions;
Whereas there is a need to better educate all individuals in the criminal 
        justice system on the impact and needs of individuals with mental health 
        conditions and substance use disorders;
Whereas the United States criminal justice system is the largest provider of 
        mental health services, and it was not built, nor intended to be used, 
        for that purpose, and--

    (1) there are around 550,000 individuals incarcerated in the United 
States with serious mental illness;

    (2) 1 in 5 individuals incarcerated in the United States has a serious 
mental illness; and

    (3) of those incarcerated, 75 percent with a serious mental illness 
suffer from a co-occurring substance use disorder;

Whereas there is a need for incentives to reduce inappropriate incarceration and 
        detention for individuals with mental health and substance use disorder 
        needs;
Whereas one-third of individuals incarcerated in the United States receive 
        treatment for mental illness, and many times treatment is inconsistent 
        and inadequate, and there is a need for improved access to services and 
        treatments that are also trauma-informed;
Whereas there is a need to have mental health, substance use disorder, and 
        diversion services available at all intercepts of the Sequential 
        Intercept Model, a model developed to inform more appropriate community-
        based responses and divert individuals with mental illness and substance 
        use disorders;
Whereas there is a need to improve levels of coordination, care management, and 
        insurance coverage before, during, and after incarceration;
Whereas post-release navigation is key to keeping individuals from reentering 
        the criminal justice system;
Whereas there is insufficient understanding of the mental health effects of 
        incarceration;
Whereas there is a need to redefine the juvenile justice system to account for 
        age and development reflecting the most up-to-date scientific consensus 
        on brain development and behavior and ensuring that there are 
        developmental and age appropriate services;
Whereas the juvenile justice system must fulfill its purpose of supporting, 
        rehabilitating, and treating children in need rather than punishing 
        them, given that--

    (1) studies have shown that 70 percent of youth in detention have a 
diagnosed mental illness, and 60 percent of those youths may also meet the 
criteria for a substance use disorder;

    (2) 90 percent of individuals in the juvenile justice system have been 
exposed to trauma or violence, which may increase the likelihood of 
juvenile justice involvement;

    (3) entry into the juvenile justice system may exacerbate the existing 
mental health and substance use disorder concerns of youths, particularly 
in the absence of consistent screening and treatment for these conditions; 
and

    (4) an estimated 33 percent of children in long-term juvenile justice 
facilities have intellectual, developmental, and other disabilities and 
were receiving special education services, and therefore there is a need to 
have specific services and programs within the juvenile justice system with 
a focus on their needs;

Whereas there is a need for services in the juvenile justice system to be 
        trauma-informed and developed for high-need individuals;
Whereas studies show that 41.2 percent of individuals who are diagnosed with a 
        substance use disorder are also diagnosed with a mental illness, which 
        is likely an underestimate in light of the current barriers to 
        identifying and reporting mental health concerns;
Whereas, given the high co-occurrence with mental illness, comprehensive care 
        for substance use disorders should include access to psychopharmacology, 
        psychotherapy, contingency management, recovery support, all evidence-
        based medication-assisted treatment, a multidisciplinary staff, and 
        group therapy for adults, and--

    (1) addiction treatment centers should either offer or have available 
comprehensive care and support and have the ability to treat mental illness 
as well as substance use disorders; and

    (2) to allow for treatment flexibility to fit the needs of the patient, 
there is a need to increase access to all evidence-based medication-
assisted treatment in prisons, jails, and all addiction treatment centers;

Whereas there are inequities in access, availability, and quality for mental 
        health and substance use disorder services for minority communities, 
        and--

    (1) there is greater stigma among racial and ethnic minority 
populations;

    (2) racial and ethnic minorities are disproportionately affected by 
disabilities that result from mental health conditions; and

    (3) only 31 percent of African Americans and Hispanics and 22 percent 
of Asians receive mental health care compared to 48 percent of Caucasians;

Whereas lesbian, gay, bisexual, transgender, and queer (referred to in this 
        preamble as LGBTQ) individuals are more than twice as likely to suffer 
        from mental health conditions and substance use disorders than 
        heterosexual individuals, and--

    (1) 29 percent of LGBTQ youths attempt suicide, which is almost 5 times 
more than heterosexual youths;

    (2) approximately 31 percent of LGBTQ older adults report symptoms of 
depression, and 39 percent report seriously thinking about suicide;

    (3) 30.8 percent of transgender individuals report considering suicide 
compared to 2.3 percent of heterosexual individuals; and

    (4) of the 4,890 transgender individuals incarcerated in State prisons, 
only 15 were confirmed as being housed according to their lived gender, 
while not being housed according to lived gender poses a significant threat 
to mental health;

Whereas the COVID-19 pandemic has highlighted the gaps in our health system when 
        it comes to mental health and substance use disorder services and shown 
        how sheltering in place and isolating can impact mental health and 
        substance use, specifically showing--

    (1) that 47 percent of individuals in the United States report that the 
pandemic has negatively impacted their mental health, with 21 percent 
saying that it has had a major negative impact;

    (2) a significant increase in the number of calls to suicide prevention 
hotlines;

    (3) a 1,000 percent increase in texts to the mental health hotline of 
the Substance Abuse and Mental Health Services Administration to about 
20,000 texts in April 2020;

    (4) a 55 percent increase in alcohol sales;

    (5) a record high of more than 100,000 overdose fatalities between May 
2020 and April 2021, driven by increased feelings of anxiety, depression, 
and use of substances; and

    (6) an increase in burnout and mental health conditions among 
healthcare providers, with 49 percent experiencing burnout and 38 percent 
experiencing anxiety or depression; and

Whereas there is a need for a population health approach that examines the 
        distribution of health across populations and focuses attention on the 
        need to provide access to the best evidence-based treatment for 
        individuals with mental health conditions and substance use disorders 
        who need clinical intervention in order to effectively reduce or 
        mitigate the impact of risk factors that lead to psychological distress 
        among individuals in high-risk populations: Now, therefore, be it
    Resolved, That it is the sense of the Senate that in order to 
effectively address the high prevalence of individuals suffering from 
mental health conditions and substance use disorders, the United States 
needs to make historic financial investments into mental health and 
substance use disorder care and finally acknowledge such care as a 
priority in health care, equal to physical health, and recognize that--
            (1) mental health and physical health need to be treated 
        together to treat the whole patient;
            (2) patient care needs to be patient-focused;
            (3) mental health and substance use disorder care needs to 
        be proactive and treat individuals before they are in crisis;
            (4) any stigma associated with mental health and substance 
        use disorders is completely unwarranted and serves as a barrier 
        to care;
            (5) the Federal Government needs to create a comprehensive 
        approach to improving the health care system that incorporates 
        mental health and substance use disorders and includes system 
        reform that--
                    (A) aims to break down silos across the Federal, 
                State, local, and Tribal levels for improved 
                communication and care coordination;
                    (B) provides a Federal framework to States, 
                localities, and Indian Tribes that connects agencies 
                and services so they can have guidance when working to 
                address the mental health and substance use disorder 
                needs of their communities;
                    (C) incentivizes providers to see both more complex 
                and less complex patients and to see patients in rural 
                and underserved areas;
                    (D) expects insurers to comply with parity laws and 
                holds them accountable for not providing parity of 
                mental health and substance use disorder services and 
                treatments; and
                    (E) requires both public and private payers to have 
                higher reimbursement rates for mental health and 
                substance use disorder services that are on par with 
                medical and surgical services;
            (6) the Federal Government needs to create a comprehensive 
        approach to improving the health care system that incorporates 
        mental health and substance use disorders and that includes 
        system improvements that--
                    (A) focus on early screening, diagnosis, and 
                intervention across the care continuum to prevent 
                mental health crises;
                    (B) improve the ability of families to access 
                timely, affordable, and high-quality treatment and 
                services;
                    (C) strengthen mental health and substance use 
                disorder services in schools and ensure there is 
                engagement from all stakeholders;
                    (D) improve and expand community-based services so 
                individuals have access to services locally;
                    (E) improve care coordination across treatment 
                settings so patients have services when needed and do 
                not have to navigate the system themselves;
                    (F) promote a sustained recovery that includes 
                social determinants of health, such as housing, jobs, 
                and childcare;
                    (G) can adjust to meet the needs of each individual 
                to provide the best care for each individual;
                    (H) ensure seamless transitions in care when moving 
                through steps or processes;
                    (I) end the criminalization of mental illness and 
                substance use disorders and increase programs for 
                diversion that connect individuals to treatment, social 
                supports, and social services;
                    (J) provide access to high-quality and evidence-
                based mental health and substance use disorder care for 
                individuals who are incarcerated;
                    (K) create young adult services and programs within 
                the criminal justice system for individuals who are 
                aged 18 to 25 to successfully reduce recidivism and 
                that are informed by neuropsychological brain science;
                    (L) incorporate apprenticeship or job training 
                programs into the criminal justice system, particularly 
                for youth, to empower them and reduce recidivism;
                    (M) ensure cultural congruence so everyone in need 
                of mental health and substance use disorder care has 
                services that meet their needs;
                    (N) adopt a population health approach as a tool to 
                help address ongoing disparities in access to mental 
                health and substance use disorder care by youth and 
                adults of color;
                    (O) ensure that lesbian, gay, bisexual, 
                transgender, and queer individuals, communities of 
                color, and immigrants have access to mental health and 
                substance use disorder services that are culturally 
                appropriate, are in the necessary language, and address 
                any unique stigma from their communities;
                    (P) enable veterans to access timely mental health 
                and substance use disorder care that ensures continuity 
                and is free of any administrative burdens;
                    (Q) include training for educators, first 
                responders, and clinicians to identify indicators of 
                mental health conditions and substance use disorders 
                and to reduce stigma and bias related to these 
                conditions so they can respond in a more productive way 
                and connect individuals with more appropriate services;
                    (R) support health care providers by addressing 
                their mental health and substance use disorder needs to 
                reduce burnout;
                    (S) provide a process by which States can work with 
                other States to reconcile licensure and certification 
                for and reimbursement to mental health and substance 
                use disorder providers across State lines for the 
                purpose of telemedicine;
                    (T) leverage the current mental health and 
                substance use disorder workforce by reducing 
                administrative burdens to allow mental health and 
                substance use disorder providers to perform to their 
                highest level of licensure and certification; and
                    (U) expand training opportunities and grow the 
                workforce by partnering with schools and programs to 
                provide free education to individuals who work in rural 
                or underserved areas;
            (7) expanded access to mental health and substance use 
        disorder care is essential to improving health and well-being;
            (8) all individuals in the United States deserve access to 
        mental health and substance use disorder care without any 
        barriers, such as cost or location of services; and
            (9) the United States needs to comprehensively break down 
        all barriers to receiving access to mental health and substance 
        use disorder care, including financial burdens and location 
        hurdles.
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