[Congressional Record Volume 145, Number 65 (Thursday, May 6, 1999)]
[Senate]
[Pages S4892-S4897]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself, Mr. Kennedy, Mr. Jeffords, Mr. Dodd, 
        Mr. DeWine, Ms. Mikulski, and Ms. Collins):
  S. 976. A bill to amend title V of the Public Health Service Act to 
focus the authority of the Substance Abuse and Mental Health Service 
Administration on community-based services children and adolescents, to 
enhance flexibility and accountability, to establish programs for youth 
treatment, and to respond to crises, especially those related to 
children and violence; to the Committee on Health, Education, Labor, 
and Pensions.


               youth drug and mental health services act

 Mr. FRIST. Mr. President, as a physician and father of three 
young boys, I am alarmed at the current level of drug use in America. 
In April of 1998, the Office of National Drug Control Policy reported 
that 74 million Americans have tried illicit drugs at least once in 
their lifetime. Of these, 22 million Americans have tried cocaine, 4.6 
million have tried crack cocaine and 2.4 million have tried heroin. 
Last year, 23 million Americans used an illicit drug, and today there 
are 13 million Americans who are current drug users which means they 
have used an illicit drug in the last month.
  The rapid decline of overall drug use in America that began in the 
mid eighties, thanks in part to the efforts of Presidents Reagan and 
Bush, has stagnated and leveled off.
  It is true that cocaine use has decreased from 5.7 million users in 
1985 to its current stagnate level of around 1.5 million in 1997 and 
marijuana use is also down from 19 million users in 1985 to around 11 
million in 1997. However, before we become too satisfied, we as a 
nation must face the very troubling fact that drug and alcohol use is 
dramatically on the rise among our youth.
  In 1992, the percentage of 10th graders that admitted to using an 
illicit drug at least once in the last 30 days according to the Office 
of National Drug Control Policy was 11 percent. By 1997 that figure had 
more than doubled to 23 percent. Most troubling is the dramatic 
increase in heroin use among our nation's teenage population.
  Let us not forget about the drug of choice for our youth and 
adolescents, alcohol. Although the legal drinking age is 21 in all 
States, the National Household Survey on Drug Abuse undertaken by 
SAMHSA reports that more than 50 percent of young adults age eighteen 
to twenty are consuming alcohol and more than 25 percent report having 
five or more drinks at one time during the past month.
  There are many factors for this increase in youth substance abuse but 
the factors that I, as a father, am most concerned with is the overall 
decline of the disapproval of drug use and the decline of the 
perception of the risk of drug use among our youth.
  Against this alarming challenge I am pleased to introduce the ``The 
Youth Drug and Mental Health Services Act of 1999.''
  This important and needed legislation will reauthorize the Substance 
Abuse and Mental Health Services Administration (SAMHSA) to improve 
this vital agency by providing greater flexibility for States and 
accountability based on performance, while at the same time placing 
critical focus on youth and adolescent substance abuse and mental 
health services. Joining me in sponsoring this effort is Senator 
Kennedy who, as ranking member of my Subcommittee on Public Health, has 
been instrumental in developing

[[Page S4893]]

this legislation. Joining Senator Kennedy and me as original cosponsors 
are Senators Jeffords, Dodd, DeWine, Mikulski and Collins.
  SAMHSA, formerly known as the Alcohol, Drug Abuse, and Mental Health 
Services Administration (ADAMHA) was created in 1992 by the Public Law 
102-321, the ADAMHA Reorganization Act. SAMHSA's purpose is to assist 
States in addressing the importance of reducing the incidence of 
substance abuse and mental illness by supporting programs for 
prevention and treatment. SAMHSA provides funds to States for alcohol 
and drug abuse prevention and treatment programs and activities, and 
mental health services through the Substance Abuse Prevention and 
Treatment (SAPT) and the Community Mental Health Services (CMHS) Block 
Grants.
  SAMHSA's block grants account for 40 percent and 15 percent 
respectively of all substance abuse and community mental health 
services funding in the States. They are a major portion of this 
nation's response to substance abuse and mental health service needs.
  In introducing the legislation, I have targeted six main goals which 
include: promote State flexibility in block grant funding; ensure 
accountability for the expenditure of Federal funds; develop and 
support youth and adolescent substance abuse prevention and treatment 
initiatives; develop and support mental health initiatives that are 
designed to prevent and respond to incidents of teen violence; insure 
the availability of Federal funding for emergencies; and support 
programs targeted for the homeless to treat mental health and substance 
abuse.
  In 1981, President Ronald Reagan revolutionized Federal support for 
mental health and substance abuse services by eliminating what were 
many discretionary programs for which States, local governments, and 
providers had to compete for funds. Instead he created the Alcohol, 
Drug Abuse and Mental Health Services (ADMS) Block Grant. This Block 
Grant awarded funds to States based on a formula. States were eligible 
to receive the funds as long as the Federal government was assured the 
State would comply with certain requirements. This shift to a block 
grant gave primary responsibility for providing mental health and 
substance abuse services to the States--where it should be to allow our 
States to respond to local needs.
  Unfortunately, over the years, the Block Grant program has become 
more prescriptive. As a result, these additional requirements place 
burdens on States and remove State flexibility, which was the main 
purpose of the Block Grant program. We need more State flexibility and 
my bill accomplishes this by implementing a number of recommendations 
from the States. It repeals a requirement in the substance abuse block 
grant that requires States to use 35 percent of their funds for alcohol 
related activities and 35 percent for drug related activities. The 
requirement that States maintain a $100,000 revolving fund to support 
recovery homes is made optional. New waivers are created for several 
other requirements in the substance abuse block grant. Application 
requirements in the mental health block grant are minimized, and States 
will be able to obligate their block grant funds over two years instead 
of one giving them more time to plan for and use the funds.
  If this bill is enacted, the Governors will be able to make a one 
time infusion of funds into the States substance abuse or mental health 
treatment system without having to commit themselves to increases in 
future years when budgets might not accommodate that funding. As a 
result of this bill, States will have more flexibility in their use of 
funds than they have had in the past ten years.

  With more flexibility, comes the need for more accountability. 
Therefore, my bill changes the way States are held accountable for 
their use of Federal funds. For example, under the current substance 
abuse block grant, States are required to spend a prescribed amount of 
money to address the needs of pregnant addicts and women with children. 
States are held accountable as to whether they spent the prescribed 
amount of funds, not on the true outcomes of whether that population is 
being successfully treated which is how they should be held 
accountable. The Federal government should be less concerned with 
whether the State spent the required amount of funds and more concerned 
on whether the State is being successful in reducing the number of 
infants born addicted or HIV positive.
  My bill sets a process in place over the next 2 years to develop a 
system based on performance measures to monitor States' progress. The 
reason why the bill does not implement such a system now is that the 
State treatment systems are not prepared to make that change. First, 
because there is no agreement on what measures to use. Second, the 
current State data systems are not adequate to collect and report on 
performance data. Very few States currently have data systems that 
could provide the necessary data.
  To respond to these concerns, this bill requires the Secretary of 
Health and Human Services to submit a plan to Congress within 2 years 
detailing the performance measures to be used in such a system that 
have been agReed to by the States and Federal government. That plan is 
to include the data elements that States will have to collect, the 
definitions of the data elements and the legislative language necessary 
to implement the recommended program.
  The bill also authorizes a grant program for the Secretary to provide 
financial support to States for developing the data infrastructure 
necessary to collect and report on the performance data.
  As I have previously discussed, the increase in youth drug and 
alcohol abuse is a problem that threatens to undermine our society. To 
increase the focus of SAMHSA on youth substance abuse, the bill places 
a new emphasis on youth in developing treatment programs.
  Although I believe that none of our children is truly safe when it 
comes to drugs and alcohol, there are children, because of their 
environment or state of mental health, that are more at risk to become 
drug or alcohol abusers. Children of substance abusers, victims of 
physical or sexual abuse, high school drop outs, the economically 
disadvantaged or those with mental health problems or who have 
attempted suicide are all at risk of drug and alcohol abuse. In order 
to develop effective techniques for prevention and treatment for these 
children, the bill also reauthorizes a grant program to develop 
effective models for the prevention and treatment of drug and alcohol 
abuse among high risk youth.
  During discussions regarding the increased incidence of youth 
substance abuse several of my colleagues on the Health, Education, 
Labor and Pensions Committee have approached me to express their 
concern and desire to develop provisions to address the problem of 
youth substance abuse: Senator DeWine has expressed an interest in 
developing provisions that would offer early intervention and 
prevention; Senator Dodd has correctly pointed out that there has been 
little focus thus far on developing techniques to provide effective 
treatment for our children; Senator Reed has pointed out that over 60% 
of youth in the juvenile justice system may have substance abuse 
disorders, compared to 22% in the general population; and Senator 
Bingaman has offered his help to address the problems with youth 
substance abuse in rural areas, Native American communities and other 
areas that are either underserved or where there is an emerging 
substance abuse problem among youth.
  We will be working over the next few weeks to incorporate the 
elements addressed above into a bipartisan proposal. In the meantime, 
the bill creates the authority for a new program on youth treatment 
which will be strengthened by the bipartisan proposal when the Health, 
Education, Labor and Pensions Committee takes action on the bill.
  The issue of children of substance abusers is also addressed in this 
bill. As I have mentioned, children of substance abusers are at high 
risk of being substance abusers themselves. The Department of Health 
and Human Services reported to Congress last month that 8.3 million, or 
11 percent, of American children live with at least one parent who is 
either an alcoholic or in need of treatment for the abuse of drugs. 
This report also sadly confirms that between 50 to 80 percent of 
children in the child abuse, neglect and

[[Page S4894]]

foster care systems have parents who need substance abuse treatment. To 
address this, the bill reauthorizes the Children of Substance Abusers 
Act (COSA) and moves its authority to SAMHSA from the Health Resources 
and Services Administration (HRSA) for better coordination. Funding 
under COSA, which was authored by Senator Dodd and enacted during the 
102nd Congress, would be used for identification and evaluation of 
families experiencing substance abuse and offer treatment and 
prevention services.
  Another area I am addressing in this bill is youth violence and 
mental health services. As we have seen by the many tragedies in our 
nation's schools, the issue of youth violence causes us much pause for 
thought. Although I believe we cannot legislate a less violent society, 
this bill has programs which we hope will begin to address the issue of 
youth violence and assist communities by helping them meet the mental 
health needs of youth to cope with violence related stress.
  The first step the bill takes is to authorize a provision that will 
assist local communities in developing ways to assist children in 
dealing with violence, building upon the actions last year of Senators 
Specter and Harkin in the Senate Appropriations Subcommittee on Labor, 
HHS and Education. This bill will authorize SAMHSA to make grants in 
consultation with the Attorney General and the Secretary of Education 
to assist local communities. These grants will support activities that 
include: financial support to enable the communities to implement 
programs designed to help violent youth; technical assistance to local 
communities; and assistance in the creation of community partnerships 
among the schools, law enforcement and mental health services. In order 
to receive funding for services under this provision an organization 
would have to ensure that they will carry out six activities which 
include: security of the school; educational reform to deal with 
violence; the review and updating of school policies to deal with 
violence; alcohol and drug abuse prevention and early intervention; 
mental health prevention and treatment services; and early childhood 
development and psychosocial services. The funds, however, may only be 
used for prevention, early intervention, and treatment services.

  In order to help youth and adolescents cope with violence and 
emergency crises, the bill establishes grants for developing knowledge 
with regard to evidence-based practices for treating mental health 
disorders resulting from violence related stress. In addition, the bill 
will establish centers of excellence to provide technical assistance to 
communities in dealing with the emotional burden of violence if and 
when it occurs.
  By law, SAMHSA discretionary grant awards must be peer reviewed which 
regularly take up to six months to approve which makes SAMHSA unable to 
act quickly in a emergency. To ensure the availability of funding for 
emergencies, the bill establishes an emergency response fund to allow 
the federal government to address emergency substance abuse or mental 
health needs in local communities. For example, this funding could be 
available to assist communities exposed to violence or terrorism or 
communities experiencing a serious substance abuse emergency such as 
increased drug traffic or inhalant abuse.
  The final theme of the bill that I would like to highlight is the 
issue of services for the homeless.
  Individuals who are homeless face major barriers to access and 
utilize mainstream addictive and mental disorder treatment and recovery 
services, including lack of income verification documentation, 
difficulties in maintaining schedules, and lack of transportation. 
Furthermore, most providers are not equipped to handle the complex 
social and health conditions which the homeless population presents. An 
insufficient number of mainstream providers offer the long-term, 
residentially-based aftercare and housing services that are essential 
for homeless individuals adherence to treatment and residential 
stability. Mainstream providers are not typically linked to the full 
range of health, housing, and human development services that homeless 
individuals with addictive and mental disorders require for recovery 
and residential stability.
  In order to help address the unique challenges of serving the 
homeless, the bill reauthorizes grants to develop and expand mental 
health and substance abuse treatment services for homeless individuals.
  In addition, it reauthorizes the successful Projects for Assistance 
in Transition from Homelessness program, know as PATH. PATH is a 
formula grant program which provides funds to States to provide mental 
health services to homeless individuals including outreach, screening 
and treatment, habilitation and rehabilitation.
  Mr. President, thus far I have laid out the major legislative changes 
my colleagues and I are undertaking to improve SAMHSA programs. 
However, I would like to talk about the great work that is accomplished 
locally by discussing recent efforts in my home State of Tennessee.
  SAMHSA provides over 70 percent of overall funding for the Tennessee 
Department of Health's Bureau of Alcohol and Drug Abuse Services, which 
is headed by Dr. Stephanie Perry.
  Last year Tennessee received over $25 million from the Substance 
Abuse Prevention and Treatment Block Grant to spend on treatment and 
prevention activities. With this funding the Tennessee Bureau of 
Alcohol and Drug Abuse Services provides funding to community-based 
programs that offer a wide range of services throughout the State.
  In the area of prevention services, the funding allows for the 
Intensive Focus Group program which provides structured, short term 
educational and counseling programs for youth and their families. In 
addition, the State is also able to fund Regional Prevention 
Coordinators who are assigned to each region of the State to assist 
communities in the development, implementation and coordination of 
alcohol and drug prevention activities. One additional program, I would 
like to highlight is the Faith Initiative which is a voluntary 
involvement of faith leaders to establish the role of interfaith 
communities in substance abuse and violence prevention.
  In the area of treatment, where Tennessee spends 65 percent of its 
total substance abuse dollars, there are several different treatment 
programs that focus on youth residential and day treatment, family 
intervention and referral services. Other offered services include 
medical detoxification which is a 24 hour a day, 7 days a week program 
that provides residential service for alcohol and drug abusers. 
Overall, the block grant funds permit nearly 6,500 Tennesseans to 
receive the substance abuse treatment they desperately need.
  I am pleased that Tennessee has focused on serving individuals with 
co-occurring disorders. There are an estimated 25,000 Tennesseans 
identified as having co-occurring disorders, meaning they require both 
mental health and substance abuse services. The Co-Occurring Disorders 
Project is a partnership between Tennessee's Division of Mental Heath 
Services and Bureau of Alcohol and Drug Services, allowing the patient 
to overcome the difficult circumstances that make their recovery 
complex by allowing them to receive both substance abuse treatment and 
mental health treatment in an integrated system of care.
  Another project that SAMHSA makes possible is the Central Intake 
Process which Tennessee developed to establish a uniformed system for 
anyone who requires alcohol and/or drug use treatment. Here is how this 
program works as demonstrated by the true case of a man named John.
  John, is a 35 year-old, black male who was referred to Central Intake 
by his probation officer. John's past legal history includes 12 assault 
charges, 3 contempt of court charges, 15 public drunk charges and one 
DUI. John is a high school graduate, and has 24 months of technical 
training in operating heavy equipment. In the 30 days prior to his 
assessment, John had used 2 pints of alcohol a day, smoked crack 
cocaine on 22 days and marijuana on 4 days. John has been abusing 
alcohol for 27 years, marijuana for 21 years and cocaine for 4 years. 
He also has reported heroin use.
  He was diagnosed as alcohol, cocaine and marijuana dependent and 
referred to a residential program with a step-

[[Page S4895]]

down transitional living facility outside his geographic region. Upon 
completion of the program, the Central Intake case manager arranged a 
placement with a halfway house in another part of the State. The case 
manager for John reports that he has been clean and sober for 10 
months, continues to live in the halfway house, is employed, involved 
in Alcoholics Anonymous and is a member of a church. By establishing 
Central Intake, Tennessee, thanks to Federal block grant dollars is 
able to evaluate and offer appropriate treatment for individuals like 
John to help put their lives back together.
  With the $4.4 million that the Tennessee Department of Mental Health 
received in 1998, Tennessee was able to utilize and enhance an array of 
services dedicated to mental health. Overall the block grant money was 
distributed to 16 private not-for-profit community health centers and 
nine community health agencies throughout the State. SAMHSA block grant 
funds were used for consumer and family support groups. In addition the 
major allocation of funding is spent on drop-in/socialization services 
across the State. In all there are 35 consumer-operated centers which 
provide a place for consumers to meet and socialize with other 
consumers of mental health services. In addition funding is used for 
co-occurring disorder projects which train clinicians, establish 
resource centers, and establish a statewide network for dual diagnosis 
advocacy.
  To address the youth population, the Tennessee Department of Mental 
Health uses SAMHSA block grant dollars to fund a program called BASIC. 
BASIC which stands for Better Attitudes and Skills in Children is a 
public school based early intervention and prevention program that 
identifies and works with children with serious emotional disturbance 
with a goal of reducing the incidence of adolescent and adult mental 
health problems. This project also focuses on enhancing awareness and 
capacity for response of school personnel to the mental health needs of 
children.
  SAMHSA funds also pay for the early children intervention project 
which targets preschool children with behavior problems that are in a 
day care setting. The purpose of this program is to intervene at the 
point which behavior problems become obtrusive and problematic for the 
parents, teaching staff and other children in the day care center.
  Finally, I would like to mention the Respite Services program for 
families of children identified as seriously emotionally disturbed, or 
dually diagnosed as emotionally disturbed and mentally retarded. 
Respite consultants assist in identifying and developing community-
based respite resources, and work with families to utilize these 
resources in the most effective manner.
  Mr. President, the bill I introduce today will ensure that Tennessee 
and other states will continue to receive critically needed Federal 
funds for community based programs to help individuals with substance 
abuse and mental health disorders. The changes that I have outlined 
will dramatically increase State flexibility in the use of Federal 
funds and ensure that each State is able to address its unique needs. 
The bill also provides a much needed focus on the troubling issue of 
the recent increase in drug use by our youth and addresses how we can 
be helpful to local communities in regard to the issue of children and 
violence. I am pleased to offer this bill today and I look forward to 
working on theses issues with my colleagues as the bill is considered 
by the Senate.
 Mr. KENNEDY. Mr. President, today, we are introducing a bill 
to bring mental health and substance abuse treatment services into the 
next century. I commend Senator Frist for his effective leadership on 
this issue. We have worked closely together on this important 
legislation to define the types of mental health and substance abuse 
treatment and services research that deserve to be funded, and to 
improve the process of accountability for clinical outcomes.
  The bill also contains a number of provisions to address the alarming 
increase in violence in our schools and communities and the traumatic 
consequences of such violence. The legislation emphasizes a number of 
programs to prevent and reduce the impact of mental disorders and 
substance abuse in children and adolescents.
  The tragic events in Colorado earlier this month are a reminder of 
how much more we need to help families, to protect children, and to 
make our schools and communities safer.
  This legislation provides new support for children who are witnesses 
and survivors of domestic and community violence. Too often, these 
children are at great risk for long term psychological problems, 
including developmental delays, psychiatric symptoms such as anxiety or 
depression, and even the risk that these traumatized individuals will 
grow up to become perpetrators of violence themselves.
  Another major feature of this bill is the attempt to address a number 
of concerns that were not apparent when we established the Substance 
Abuse and Mental Health Services Administration in 1992. We need to do 
more to help states identify the kinds of assistance that are most 
relevant to the persons they are currently serving and to do so in the 
most efficient and effective ways. Our bill accomplishes this by 
streamlining the services, and helps assure that the right services are 
going to those who most need them.
  We also intend to address the needs of persons with both mental 
disorders and substance abuse. We must give greater priority to 
programs that support the mental health and substance abuse treatment 
needs of patients in primary care clinics.
  I look forward to working closely with my colleagues to enact this 
legislation. We know that we can deal more effectively with the serious 
problems of substance abuse and mental illness, and enable far more of 
our fellow citizens to lead fulfilling and productive lives.
Mr. JEFFORDS. Mr. President, I rise today to join my colleague 
from Tennessee, Senator Frist, in introducing the ``Youth Drug and 
Community-Based Substance Abuse and Mental Health Services Act.'' I am 
proud to be a cosponsor of this legislation that will reauthorize the 
very important work conducted by the Substance Abuse and Mental Health 
Services Administration (SAMHSA). I want to commend Senator Frist for 
his valuable leadership in this effort.
  Substance abuse affects us all. Many of us have a close friend or 
family member who is a substance abuser or living in recovery, and 
persons with mental illness continue to needlessly face obstacles to 
their successful treatment that can, and should be eliminated.
  SAMHSA's role is to improve access to quality mental health and 
substance abuse services in the nation. It carries out this 
responsibility to the tremendous advantage of States, local 
governments, and communities across the nation. This reauthorization 
bill will improve access and reduce barriers to high quality, effective 
programs and services for individuals who suffer from, or are at risk 
for, substance abuse or mental illness, as well as for their families 
and communities. It strengthens SAMHSA's national leadership in 
ensuring that knowledge, based on science and state-of-the-art 
practice, is effectively used for the prevention and treatment of 
addictive and mental disorders.
  SAMHSA fosters Federal-State partnerships by supporting State and 
local community mental health and substance abuse programs. SAMHSA's 
budget of $2.3 billion is distributed through grants to states, local 
communities, private organizations, and schools. This reauthorization 
will increase flexibility for the States and for the Secretary in the 
provision of these services. This bill will repeal and/or make optional 
several existing requirements, and instead allows the States to use the 
grant funds to better serve their particular mental health and 
substance abuse populations. It dramatically reduces the administrative 
burden of federal mandates and allows the States greater flexibility to 
coordinate programs to develop a seamless system of care.
  This flexibility necessitates a need for increased accountability. 
This bill improves the way States are held accountable for their use of 
Federal funds. Under the current system, States are required to spend 
certain amounts on certain populations and their success is determined 
on whether they have spent the required amount of

[[Page S4896]]

funds. Not on whether they are accomplishing program goals. We will 
change these programs to focus on performance and results as Congress 
has done with other programs.
  I would now like to speak about what I see as the most important 
provisions of this bill. The first is the Title I provisions relating 
to services for children and adolescents. It is critical that we focus 
on treatment for youth. The substance abuse treatment system in this 
country is focused primarily on adult addicts. A system of care for 
adolescents is not routinely available. And yet the statistics show 
that adolescents are more frequently using drugs than they did five 
years ago. This reauthorization facilitates a system of care that 
addresses their needs.
  The events of Littleton, Colorado have made us all keenly aware of 
the mental health of children in dealing with violence. The provision 
on Children and Violence in this bill pulls together the abilities of 
the Departments of Health and Human Resources, Education and Justice to 
support programs to address children and violence issues at the 
community levels. Mental health professionals, educators, and law 
enforcement officials can collaborate so that at-risk youths with 
disorders can be diagnosed early and moved into the proper treatment 
setting.
  School districts will implement the wide range of early childhood 
development, early intervention and prevention, and mental health 
treatment services that appear to have the greatest likelihood of 
preventing violence among children. To ensure the availability of 
funding for emergencies, the bill establishes an emergency response 
fund to allow the federal government to support communities which have 
experienced trauma due to teen violence. To help youth and adolescents 
cope with violence and emergency crises, the bill establishes grants 
for developing knowledge with regard to best practices for treating 
psychiatric disorders resulting from emergency crisis. This is an 
approach that I understand is supported by both the research and 
service communities. It makes sense to me and I know that such programs 
will be helpful in every community in America.
  I must also point out that this bill includes the formula compromise 
included in last years's omnibus appropriations bill for the Substance 
Abuse Prevention and Treatment Block Grant funds. This is an issue of 
paramount importance to small and rural states, and I am pleased that 
this legislation ratifies last year's agreement.
  Mr. President, this is an important bill that will greatly improve 
the quality of substance abuse and mental health treatment in this 
nation. I look forward to considering this bill in the near future in 
committee, and then I hope it will receive the full attention of the 
Senate. I would like to once again thank Senator Frist for putting so 
much time and effort into crafting legislation that will benefit so 
many American families.
 Mr. DODD. Mr. President, I rise to express my support for the 
Substance Abuse and Mental Health Services Administration (SAMHSA) 
Reauthorization Act and to commend Senator Frist for his leadership on 
this issue. I am pleased to join him as a co-sponsor of this 
legislation.
  This reauthorization will support SAMHSA in achieving its mission to 
improve the quality and availability of mental health and substance 
abuse prevention, early intervention, and treatment services. The 
SAMHSA Act allows States to develop comprehensive systems to provide 
better quality mental health care so that children and adults with 
serious emotional disturbances may remain in the comfort of their home 
and within a familiar environment as they receive treatment. The 
flexibility provided by this piece of legislation will also allow 
States to build partnerships with schools and neighborhoods so that we 
can better confront the causes and impact of violence on our schools 
and communities. I am pleased that this legislation will also continue 
to support homeless individuals who need mental health services and 
will allow States to be innovative in addressing the needs of special 
populations such as pregnant, addicted women and those with HIV.
  I am particularly pleased that this legislation incorporates a bill 
introduced by Senator Jeffords and myself, the ``Children of Substance 
Abusers Act'' (COSA). Children with substance abusing parents face 
serious health risks, including congenital birth defects, 
psychological, emotional and developmental problems, and the increased 
likelihood of becoming substance abusers themselves. Additionally, they 
are three times more likely to be abused and four times more likely to 
be neglected than children whose parents are not substance abusers. 
COSA addresses the devastation generated in the wake of parental 
substance abuse by promoting aggressive outreach to families in need 
and providing early intervention, prevention, and treatment services, 
and education and training for health and social services providers on 
recognizing and serving these families.
  Although this legislation is an excellent beginning, I am concerned 
about the omission of two critical issues which have not been 
adequately addressed by federal efforts to date-- the need to provide 
treatment to teens who are abusing alcohol and drugs and the use of 
restraints and seclusion on children in mental health facilities.
  Statistics reveal that in senior high schools across the country, 
twenty-five percent of students use an illicit drug on a monthly basis, 
and seven percent on a daily basis. In 1997, fifty-two percent of 
senior high school students reported monthly alcohol use, meaning more 
than four million teens consumed alcohol in any given month. Yet, only 
twenty percent of the 648,000 adolescents with severe substance abuse 
problems receive treatment. The legislation that I have introduced 
today, the ``Teen Substance Abuse Treatment Act of 1999'' would fill an 
important gap in our national strategy for combating substance abuse in 
our communities by dedicating funding for treating youth with alcohol 
and drug problems. This legislation would authorize grants to develop 
innovative services aimed at the specific needs of teenagers, including 
services that coordinate mental health and substance abuse services. In 
addition this legislation would address the interaction between 
substance abuse and violent and antisocial behavior.
  While I am disappointed that this bill is not currently included in 
the SAMHSA Reauthorization legislation that will be introduced today, I 
am encouraged that Senator Frist has agreed to work with me, Senator 
Reed, and Senator Bingaman prior to a markup of the bill to craft 
legislation to comprehensively address the substance abuse needs of 
adolescents.
  Secondly, Mr. President, I also today want to briefly mention an 
issue that I hope will eventually be addressed within SAMHSA's 
reauthorization. This issue, the misapplication of restraints and 
seclusion within facilities providing mental health care services, 
signals a national tragedy that must be addressed. As evidenced last 
year by the Hartford Courant in a ground breaking investigative series 
that confirmed 142 deaths that occurred during or shortly after 
restraints were applied, the federal government must do better to 
protect individuals with mental illnesses from the punitive and deadly 
misuse of restraints and seclusion. Additionally, because many of these 
deaths go unreported, the actual number of restraint-related deaths may 
be many times higher. More than 26 percent of restraint-related deaths 
were children--nearly twice the proportion they constitute in mental 
health institutions.
  The alarming number of deaths reported in the series illustrates the 
need for national, uniform standards for the use of restraints in the 
mental health care field. Low pay for mental health care workers, 
little-to-no training, and a lack of accountability and oversight, all 
contribute to the deplorable conditions found in many of the nation's 
mental health care treatment centers. The initiative that I hope to 
include within SAMHSA will establish uniform standards for restraint 
use, ensure adequate training and appropriate staffing levels, and 
allow protection and advocacy organizations to review deaths that occur 
at mental health care facilities. Legislation concerning the use of 
restraint and seclusion use is badly needed. As the Hartford Courant 
series mentioned, the federal government monitors the size of eggs but 
does not record the number of deaths caused by

[[Page S4897]]

the use of restraints and seclusion in mental health care facilities. I 
look forward to working with Senator Frist toward the inclusion of this 
important initiative within SAMHSA's reauthorization.
  Mr. President, this bill demonstrates our continuing support for 
SAMHSA and for sustaining programs which improve the quality and 
availability of substance abuse and mental health services. I am 
pleased that Senator Frist has moved this legislation forward and look 
forward to working with him to include provisions to address the 
substance abuse treatment needs of adolescents and to enact standards 
regarding the use of restraint and seclusion. I again offer my support 
and co-sponsorship of this bill.
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