[Congressional Record Volume 145, Number 114 (Thursday, August 5, 1999)]
[Senate]
[Pages S10471-S10473]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DOMENICI (for himself and Mr. Kennedy):
  S. 1555. A bill to provide sufficient funds for the research 
necessary to enable an effective public health approach to the problems 
of youth suicide and violence, and to develop ways to intervene early 
and effectively with children and adolescents who suffer depression or 
other mental illness, so as to avoid the tragedy of suicide, violence, 
and longterm illness and disability; to the Committee on Health, 
Education, Labor, and Pensions.


    public health response to youth suicide and violence act of 1999

  Mr. DOMENICI. Mr. President, I rise today with great pleasure to 
introduce the ``Public Health Response to Youth Suicide and Violence 
Act of 1999.'' I would also like to thank my colleague Senator Kennedy 
for joining me as a co-sponsor of this legislation.
  All too often we read in the paper or see on TV another tragedy 
involving our children. These stories about violence, death, and 
suicide have become all too familiar and commonplace in our nation. 
Unfortunately, the children who commit these acts often suffer from a 
mental illness.
  As I have said many times before the human brain is the organ of the 
mind and just like the other organs of our body, it is subject to 
illness. And just as illnesses to our other organs require treatment, 
so too do illnesses of the brain.
  And while we have learned so much more about mental illness and 
medical science can accurately diagnosis mental illnesses and treat 
those afflicted, the same cannot be said for children and adolescents. 
Unfortunately, we still know very little about the causes of mental 
illness in children and adolescents and moreover, the appropriate 
treatment for these illnesses.
  Before I proceed there is one thing I want to make absolutely clear: 
I am not for one minute saying we should lessen our focus on law 
enforcement or incarceration of convicted offenders. Instead, I am 
simply saying we might be able to prevent some of the tragedies I have 
mentioned if we knew more about the cause and appropriate treatment for 
mental illness in children and adolescents.
  Today, suicide is the 3rd leading cause of death among individuals 
between the age of 15 to 24 and the 4th leading cause of death in those 
10 to 14 years of age. Estimates show about 1 in 10 children and 
adolescents suffer from a mental illness that is severe enough to cause 
some level of impairment. Additionally, many parents with a child 
suffering from a serious mental disorder believe their child will 
become violent without appropriate treatment.
  Beyond the possibility of suicide and violence, children not 
receiving treatment for mental disorders not only suffer, cannot learn, 
and may not form healthy relationships with peers or family, but face 
an increased likelihood of incarceration as juveniles and adults.

  I have come to the conclusion that we must make a renewed investment 
into discovering the cause and the appropriate treatment of mental 
illness in children and adolescents. Why is it that certain children 
may be afflicted with a mental illness and others are not? What is the 
best course of treatment for a child diagnosed with a mental illness?
  Everyone acknowledges that there is a critical lack of information in 
the area of child and adolescent mental illnesses and in particular the 
causes and appropriate treatment of such illnesses.
  With this in mind, I cannot think of a better entity to take the lead 
in this endeavor to increase our research and understanding of child 
and adolescent mental illness than the National Institute of Mental 
Health. The Institute is already at the forefront of mental illness 
research and I believe it is uniquely qualified to address the 
connection between mental illness and youth suicide and violence.
  The ``Public Health Response to Youth Suicide and Violence Act of 
1999'' simply seeks to reduce incidences of youth suicide and violence 
through increased research by the National Institutes of Mental Health 
(NIMH) of children and adolescents suffering from depression or other 
mental illness.
  By providing for increased research the Bill addresses a critical 
lack of knowledge in the area of child and adolescent mental illnesses 
and in particular the causes and appropriate treatment of such 
illnesses that often lead to youth suicide and violence.
  The Bill authorizes $200 million for FY 2000 to expand and intensify 
research aimed at better understanding the underlying causes of mental 
disorders that lead to youth suicide and violence.
  The Bill contains mandatory activities to be carried out by the 
Director of NIMH that include developing researchers who are trained in 
the area of childhood mental disorders in order to better understand 
the development of brain and mental disorders in children, pursue 
research into the relationship between mental disorders and youth 
violence and suicide and to develop effective treatments for these 
disorders.
  Additionally, the Director of NIMH will work with the Director of the 
Centers for Disease Control and Prevention and other appropriate 
agencies to develop a model to train primary care physicians, nurses, 
school psychologists, teachers, and other responsible individuals about 
mental disorders in children.
  The Bill also contains permissible activities the Director of NIMH 
may carry out that include examining the potential of public health 
programs that combine individual, family, and community level 
interventions to address suicide and violence and to identify related 
best practices. Additionally, the Director may develop and evaluate 
programs aimed at prevention, early recognition, and intervention of 
depression, youth suicide, and violence in diverse school and community 
settings.

[[Page S10472]]

  In conclusion, I would simply restate that I believe expanding 
research to reduce incidences of youth suicide and violence through 
increased research of children and adolescents suffering from 
depression or other mental illness is necessary and I would urge my 
colleagues to support this important piece of legislation.
  Mr. President, I ask unanimous consent that a copy of the bill and a 
summary of the bill be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1555

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Public Health Response to 
     Youth Suicide and Violence Act of 1999''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Suicide is the third leading cause of death among young 
     people 15 to 24 years of age, following unintentional 
     injuries and homicide, and is the fourth leading cause of 
     death in those 10 to 14 years of age. Scientific research has 
     found that there are an estimated 8 to 25 attempted suicides 
     to 1 completion, and the strongest risk factors for attempted 
     suicide in youth are depression and alcohol or drug use.
       (2) There is a critical need for additional research into 
     the underlying causes of youth violence-both suicide and 
     violence against others. 50 percent of parents with a child 
     suffering from a serious mental disorder believe their child 
     would become violent without appropriate treatment and 
     services.
       (3) A public health model should seek to ascertain ways to 
     identify children and adolescents who are depressed or 
     suffering from other mental or emotional disorders that might 
     result in violent behavior against themselves or others, as 
     well as long-term illness disability, and to intervene before 
     that occurs.
       (4) Not enough is known about serious mental disorders in 
     adolescents and children, devastating illnesses which often 
     lead to school failure, suicide, and violence. A primary 
     reason for this is the lack of trained scientific 
     investigators in this area of research. It is critical that 
     increased efforts be made to strengthen the scientific 
     expertise and capability in the area of child mental 
     disorders.
       (5) About 1 in 10 children and adolescents suffer from 
     mental illness severe enough to cause some level of 
     impairment, but fewer than 1 in 5 of these children receives 
     treatment. Children who go untreated not only suffer, cannot 
     learn, and may not form healthy relationships with peers or 
     family, but face an increased likelihood of eventual 
     incarceration as juveniles and adults.
       (6) Prevention of youth suicide and violence requires a 
     long-term commitment to comprehensive, cost effective, and 
     sustainable interventions directed at known risk factors, and 
     to the evaluation of their success in diverse community 
     settings by targeting multiple risk factors that predispose 
     them to suicide, delinquency and violence.
       (7) Much more information is needed concerning the 
     psychotherapeutic and service system treatment of serious 
     mental illness in children as well as barriers to appropriate 
     and effective treatment and services for these children, in 
     the health care and educational systems.

     SEC. 3. EXPANSION OF ACTIVITIES.

       Subpart 16 of part C of title IV of the Public Health 
     Service Act (42 U.S.C. 285p et seq) is amended by adding at 
     the end the following:

     ``SEC. 464U-1. EXPANSION OF RESEARCH ACTIVITIES WITH RESPECT 
                   TO CHILDREN.

       ``(a) In General.--The Director of the National Institute 
     of Mental Health shall use amounts made available under this 
     section to carry out activities to expand and intensify 
     research aimed at better understanding the underlying 
     developmental and other causes of mental disorders that lead 
     to youth suicide and violence.
       ``(b) Mandatory Activities.--To carry out the purpose 
     described in subsection (a), the Director of the Institute 
     shall--
       ``(1) work to develop investigators who are trained in the 
     area of childhood mental disorders in order to continue the 
     effort to understand the developing brain and mental 
     disorders in children and to strengthen the capacity to 
     ascertain the factors underlying suicide and other violent 
     behavior in youth;
       ``(2) expand support for basic research that has led to a 
     better understanding of the structure, function and circuitry 
     of the brain, and which promises to yield even more 
     understanding as neuroimaging techniques become even more 
     sophisticated;
       ``(3) carry out activities to further encourage research to 
     clarify--
       ``(A) the relationship between mental disorders and youth 
     violence and suicide;
       ``(B) the first emergence of mental illnesses in children, 
     including schizophrenia, bipolar disorder, and obsessive-
     compulsive disorder;
       ``(C) effective early treatments for such illnesses and 
     disorders; and
       ``(D) in collaboration with the Director of the Centers for 
     Mental Health Services, where appropriate, the manner in 
     which to effectively disseminate information derived under 
     this paragraph to care-providers in the community;
       ``(4) in order to address the major problem of lack of 
     recognition of mental disorders, and to ensure appropriate 
     diagnosis and treatment, continue to encourage, in 
     collaboration with the Administrator of the Agency for Health 
     Care Policy and Research, where appropriate, services 
     research aimed at better understanding the impact of mental 
     disorders on children, on their families, on the health care 
     system, and on schools as well as services research aimed at 
     improving care-provider and educator knowledge of mental 
     disorders in children;
       ``(5) seek to develop, conduct research on, and in 
     collaboration with the Director of the Center for Mental 
     Health Services, where appropriate, disseminate information 
     about, mechanisms for avoiding the inappropriate 
     criminalization of children with mental disorders and the 
     appropriate treatment of any such children in criminal 
     settings;
       ``(6) in collaboration with the Director of the Centers for 
     Disease Control and Prevention, carry out additional 
     activities to better understand the scope and effect of 
     childhood mental disorders, including epidemiological 
     monitoring and surveillance of childhood mental illness, 
     suicide and incidence of violence;
       ``(7) in collaboration with the Director of the Centers for 
     Disease Control and Prevention, families dealing with mental 
     illness in their children, and other appropriate agencies, 
     carry out activities to develop a model curriculum of 
     education about mental disorders in children for use in the 
     training of primary care physicians, nurses, school 
     psychologists, teachers, and others individuals responsible 
     for the care of children on an ongoing basis; and
       ``(8) in collaboration with the Director of the Centers for 
     Disease Control and Prevention, establish a system to provide 
     technical assistance to schools and communities to provide 
     public health information and best practices to enable such 
     schools and communities to handle high-risk youth.
       ``(c) Permissible Activities.--To carry out the purpose 
     described in subsection (a), the Director of the Institute 
     may carry out activities--
       ``(1) relating to research concerning the effects of early 
     trauma and exposure to violence on further childhood 
     development;
       ``(2) that ensure that the goals of all intervention 
     development under this section include a focus on both 
     effectiveness and sustainability;
       ``(3) for the development and evaluation of programs aimed 
     at prevention, early recognition, and intervention for 
     depression, youth suicide and violence in diverse school and 
     community settings to determine their effectiveness and 
     sustainability;
       ``(4) to examine the feasibility of public health programs 
     combining individual, family and community level 
     interventions to address suicide and violence and identify 
     related best practices; and
       ``(5) to disseminate information to families, schools, and 
     communities concerning the recognition of childhood 
     depression, suicide risk, substance abuse, and Attention 
     Deficit Hyperactivity Disorder in order to decrease the 
     stigma associated with seeking help for such conditions.
       ``(d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $200,000,000 
     for fiscal year 2000, and such sums as may be necessary for 
     each of fiscal years 2001 through 2004.''.
                                  ____


    Public Health Response To Youth Suicide and Violence Act of 1999

       The Bill seeks to reduce incidences of youth suicide and 
     violence through increased research by the National 
     Institutes of Mental Health (NIMH) of children and 
     adolescents suffering from depression or other mental 
     illness.
       By providing for increased research the Bill addresses a 
     critical lack of knowledge in the area of child and 
     adolescent mental illnesses and in particular the causes and 
     appropriate treatment of such illnesses that often lead to 
     youth suicide and violence.


   the need for increased research into child and adolescent mental 
                                illness

       Tody suicide is the 3rd leading cause of death among 
     individuals between the age of 15 to 24 and about 1 in 10 
     children and adolescents suffer from a mental illness that is 
     severe enough to cause some level of impairment.
       Beyond possible suicide and violence, children not 
     receiving treatment for mental disorder not only suffer, 
     cannot learn, and may not form healthy relationships with 
     peers or family, but face an increased likelihood of 
     incarceration as juveniles and adults.


     increased research by the national institute for mental health

       The Bill authorizes $200 million for FY 2000 and such sums 
     as may be necessary thereafter to expand and intensify 
     research aimed at better understanding the underlying causes 
     of mental disorders that lead to youth suicide and violence.
       Mandatory activities by the Director of NIMH include 
     developing researchers who are trained in the area of 
     childhood mental disorders in order to better understand the 
     development of brain and mental disorders in children. Pursue 
     research into the relationship between mental disorders and 
     youth violence and suicide and to develop effective 
     treatments for these disorders.

[[Page S10473]]

       Additionally, the Director or NIMH will work with the 
     Director of the Centers for Disease Control and Prevention 
     and other appropriate agencies to develop a model to train 
     primary care physicians, nurses, school psychologists, 
     teachers, and other responsible individuals about mental 
     disorders in children.
       Permissible activities by the Director of NIMH include 
     examining the potential of public health programs that 
     combine individual, family, and community level interventions 
     to address suicide and violence to identify related best 
     practices. Additionally, the Director may carry out 
     activities that develop and evaluate programs aimed at 
     prevention, early recognition, and intervention of 
     depression, youth suicide, and violence in diverse school and 
     community settings.

  Mr. KENNEDY. Mr. President, it is a privilege to join Senator Abraham 
as a sponsor of the INS Reform and Border Security Act. This 
legislation will remedy many of the problems that currently plague the 
Immigration and Naturalization Service. It will ensure strong 
enforcement of our immigration laws, and also ensure that immigration 
and citizenship services are provided expeditiously and with greater 
respect for dignity of those who benefit from these services.
  These two missions--enforcement and services--are equally important. 
Both are suffering under the current INS structure. The services are in 
especially dire straits. Over two million would-be US citizens are now 
trapped in an INS backlog. Individuals languish for years waiting for 
their naturalization and permanent resident applications to be 
processed. Files are lost. Fingerprints go stale. Courteous behavior is 
too often the exception, rather than the rule. Application fees 
continue to increase--yet poor service and long delays continue as 
well.
  On the enforcement side, the immigration laws are being applied 
inconsistently. Detention and parole policies and procedures vary 
widely from district to district. All too frequently, national 
priorities and directives are ignored at the district level.
  Many of these problems are not new. During Commissioner Doris 
Meissner's impressive tenure, the INS has made significant progress in 
trying to address the agency's problems. She has done an excellent job 
under the current structure. But, that structure has proven to be 
unworkable.
  The goal of INS Reform and Border Security Act is to put the INS 
house in order. It will untangle the overlapping and often confusing 
organizational structure of the agency and replace it with two clear 
chains of command--one for enforcement and the other for services. 
These two equally important divisions will report, through their 
respective directors, to an Associate Attorney General who will head 
the Immigration Affairs Agency. This shared central authority over the 
two branches will ensure a uniform and harmonious immigration policy. 
Coordination of the two branches is imperative for the efficient 
functioning of the agency, and for maintaining a coherent immigration 
policy.
  There is strong bipartisan agreement that the INS must be reformed. 
But restructuring must be done right. Successful reform must separate 
the enforcement and service functions while maintaining a strong 
central authority for uniform policy-making, clear accountability, and 
fiscal responsibility. The INS Reform and Border Security Act 
accomplishes these aims. The new immigration will be a major 
improvement over the current INS. I urge my colleagues to join in 
supporting the INS Reform and Border Security Act.
                                 ______