[Congressional Record Volume 147, Number 64 (Thursday, May 10, 2001)]
[Senate]
[Pages S4824-S4827]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. THOMAS (for himself, Mr. Conrad, Mr. Domenici, Mr. 
        Johnson, Mr. Roberts, and Mr. Nelson of Nebraska):
  S. 859. A bill to amend the Public Health Service Act to establish a 
mental health community education program, and for other purposes; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. THOMAS. Mr. President, I rise today to introduce the Rural Mental 
Health Accessibility Act of 2001 with Senators Conrad, Domenici, 
Johnson, Roberts, and Nelson from Nebraska. Like all of the rural 
health bills I've worked on with my colleagues in the Senate Rural 
Health Caucus, I am proud of the bipartisan effort behind this 
important legislation.
  I believe, the Rural Mental Health Accessibility Act of 2001 is 
crucial because it reflects the unique needs of rural communities to 
improve access to mental health services.
  Many people do not seek mental health services because of the stigma 
associated with mental illnesses. This is especially true in rural 
areas where anonymity is more difficult to obtain. This legislation 
creates the Mental Health Community Education Grant program, which 
permits states and communities to conduct targeted public education 
campaigns with particular emphasis on mental illnesses, mental 
retardation, suicide, and substance abuse disorders. This new program 
will go a long way in reducing the stigmatization and misinformation 
surrounding mental health issues.
  More than 75 percent of the 518 nationally designated Mental Health 
Professional Shortage Areas are located in rural areas and one-fifth of 
all rural counties in the nation have no mental health services of any 
kind. Frontier counties have even more drastic numbers as 95 percent of 
these remote areas do not have psychiatrists, 68 percent do not have 
psychologists and 78 percent do not have social workers. While I'm 
proud that every county in my home state of Wyoming now has a 
psychologist, there are still several counties that are severely 
underserved and are designated as a Mental Health Shortage Area.
  Due to the scarcity of mental health specialists in rural 
communities, primary care providers are often the only source of 
treatment. However, primary care providers do not receive the 
specialized training necessary to recognize the signs of depression and 
other mental illnesses in their patients. The Rural Mental Health 
Accessibility Act of 2001 authorizes an Interdisciplinary Grant program 
that will permit universities and other entities to establish 
interdisciplinary training programs where mental health providers and 
primary care providers are taught side-by-side in the classroom, with 
clinical training conducted in rural underserved communities. This will 
encourage greater collaboration amongst providers and increase the 
quality of care for rural patients.

  I am particularly concerned that suicide rates among rural children 
and adolescents are higher than in urban areas, especially in western 
and frontier states. Additionally, 20 percent of the nation's elderly 
population live in rural areas, but only 9 percent of our nation's 
physicians practice in rural areas. This bill authorizes $30 million 
for 20 demonstration projects, equally divided, to provide mental 
health services to children and elderly residents of long term care 
facilities located in mental health shortage areas. These projects will 
also provide mental illness education and targeted instruction on 
coping and dealing with the

[[Page S4825]]

stressful experiences of childhood and adolescence or aging.
  To prepare for further expansion of mental telehealth, this bill 
requires the Director of the National Institute of Mental Health in 
consultation with the Director of the Office of Rural Health Policy to 
report to Congress on the efficacy and effectiveness of mental health 
services delivered through the utilization of telehealth technologies.
  In crafting this legislation I and my colleagues worked with numerous 
outside organizations with an interest in mental health issues. As a 
result of this collaboration, the Rural Mental Health Accessibility Act 
of 2001 is strongly supported by the National Rural Health Association, 
the National Alliance for the Mentally Ill, the American Psychiatric 
Association and the American Psychological Association.
  I believe this legislation is critically important to the health and 
well-being of our rural communities. I strongly urge all my colleagues 
to support the rural areas in their states by becoming cosponsors of 
the Rural Mental Health Accessibility Act of 2001.
  I ask unanimous consent that the text of the bill and letters of 
endorsement from supporting organizations be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 S. 859

       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 ``Rural Mental Health 
     Accessibility Act of 2001''.

     SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq.) is amended by adding at 
     the end the following:

     ``SEC. 330I. MENTAL HEALTH COMMUNITY EDUCATION PROGRAM.

       ``(a) Program Authorized.--The Director of the Office of 
     Rural Health Policy (of the Health Resources and Services 
     Administration) shall award grants to eligible entities to 
     conduct mental health community education programs.
       ``(b) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' includes 
     a State entity, public or private school, mental health 
     clinic, rural health clinic, local public health department, 
     nonprofit private entity, federally qualified health center, 
     rural Area Health Education Center, Indian tribe and tribal 
     organization, and any other entity deemed eligible by the 
     Secretary.
       ``(2) Mental health community education program.--The term 
     `mental health community education program' means a program 
     regarding mental illness, mental retardation, suicide 
     prevention and co-occurring mental illness and substance 
     abuse disorder.
       ``(c) Preference.--In awarding grants under subsection (a), 
     the Director shall give a preference to eligible entities 
     that are or propose to be in a network, or work in 
     collaboration, with other eligible entities to carry out the 
     programs under this section, such as a rural public or 
     nonprofit private entity that represents a network of local 
     health care providers or other entities that provide or 
     support delivery of health care services, and a State office 
     of rural health or other appropriate State entity.
       ``(d) Duration.--The Director shall award grants under 
     subsection (a) for a period of 3 years.
       ``(e) Amount.--Each grant awarded under this section shall 
     not be greater than $200,000 each fiscal year.
       ``(f) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds received through 
     such grant to administer a mental health community education 
     program to rural populations that provides information to 
     dispel myths regarding mental illness and to reduce any 
     stigma associated with mental illness.
       ``(g) Application.--An eligible entity desiring a grant 
     under subsection (a) shall submit an application to the 
     Director at such time, in such manner, and containing such 
     information as the Director may reasonably require, 
     including--
       ``(1) a description of the activities which the eligible 
     entity intends to carry out using amounts provided under the 
     grant;
       ``(2) a plan for continuing the project after Federal 
     support is ended;
       ``(3) a description of the manner in which the educational 
     activities funded under the grant will meet the mental health 
     care needs of underserved rural populations within the State; 
     and
       ``(4) a description of how the local community or region to 
     be served by the network or proposed network, if the eligible 
     entity is in such a network, will be involved in the 
     development and ongoing operations of the network.
       ``(h) Evaluations; Report.--Each eligible entity that 
     receives a grant under this section shall submit to the 
     Director of the Office of Rural Health Policy (of the Health 
     Resources and Services Administration) an evaluation 
     describing the programs authorized under this section and any 
     other information that the Director deems appropriate. After 
     receiving such evaluations, the Director shall submit to the 
     appropriate committees of Congress a report describing such 
     evaluations.
       ``(i) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $50,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 through 2006.

     ``SEC. 330J. INTERDISCIPLINARY GRANT PROGRAM.

       ``(a) Program Authorized.--The Director of the Office of 
     Rural Health Policy (of the Health Resources and Services 
     Administration) shall award grants to eligible entities to 
     establish interdisciplinary training programs that include 
     significant mental health training in rural areas for certain 
     health care providers.
       ``(b) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     public university or other educational institution that 
     provides training for mental health care providers or primary 
     health care providers.
       ``(2) Mental health care provider.--The term `mental health 
     care provider' means--
       ``(A) a physician with postgraduate training in a residency 
     program of psychiatry;
       ``(B) a licensed psychologist (as defined by the Secretary 
     for purposes of section 1861(ii) of such Act (42 U.S.C. 
     1395x(ii)));
       ``(C) a clinical social worker (as defined in section 
     1861(hh)(1) of such Act (42 U.S.C. 1395x(hh)(1)); or
       ``(D) a clinical nurse specialist (as defined in section 
     1861(aa)(5)(B) of such Act (42 U.S.C. 1395x(aa)(5)(B))).
       ``(3) Primary health care provider.--The term `primary 
     health care provider' includes family practice, internal 
     medicine, pediatrics, obstetrics and gynecology, geriatrics, 
     and emergency medicine physicians as well as physician 
     assistants and nurse practitioners.
       ``(4) Rural area.--The term `rural area' means a rural area 
     as defined in section 1886(d)(2)(D) of the Social Security 
     Act, or such an area in a rural census tract of a 
     metropolitan statistical area (as determined under the most 
     recent modification of the Goldsmith Modification, originally 
     published in the Federal Register on February 27, 1992 (57 
     Fed. Reg. 6725)), or any other geographical area that the 
     Director designates as a rural area.
       ``(c) Duration.--Grants awarded under subsection (a) shall 
     be awarded for a period of 5 years.
       ``(d) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds received through 
     such grant to administer an interdisciplinary, side-by-side 
     training program for mental health care providers and primary 
     health care providers, that includes providing, under 
     appropriate supervision, health care services to patients in 
     underserved, rural areas without regard to patients' ability 
     to pay for such services.
       ``(e) Application.--An eligible entity desiring a grant 
     under subsection (a) shall submit an application to the 
     Director at such time, in such manner, and containing such 
     information as the Director may reasonably require, 
     including--
       ``(1) a description of the activities which the eligible 
     entity intends to carry out using amounts provided under the 
     grant;
       ``(2) a description of the manner in which the activities 
     funded under the grant will meet the mental health care needs 
     of underserved rural populations within the State; and
       ``(3) a description of the network agreement with 
     partnering facilities.
       ``(f) Evaluations; Report.--Each eligible entity that 
     receives a grant under this section shall submit to the 
     Director of the Office of Rural Health Policy (of the Health 
     Resources and Services Administration) an evaluation 
     describing the programs authorized under this section and any 
     other information that the Director deems appropriate. After 
     receiving such evaluations, the Director shall submit to the 
     appropriate committees of Congress a report describing such 
     evaluations.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $100,000,000 
     for fiscal year 2002 and such sums as may be necessary for 
     each of the fiscal years 2003 through 2006.

     ``SEC. 330K. STUDY OF MENTAL HEALTH SERVICES DELIVERED WITH 
                   TELEHEALTH TECHNOLOGIES.

       ``(a) In General.--The Director of the National Institute 
     of Mental Health, in consultation with the Director of the 
     Office of Rural Health Policy, shall carry out activities to 
     research the efficacy and effectiveness of mental health 
     services delivered remotely by a qualified mental health 
     professional (psychiatrist or doctoral level psychologist) 
     using telehealth technologies.
       ``(b) Mandatory Activities.--Research described in 
     subsection (a) shall include--
       ``(1) objective measurement of treatment outcomes for 
     individuals with mental illness treated remotely using 
     telehealth technologies as compared to individuals with 
     mental illness treated face-to-face;
       ``(2) objective measurement of treatment compliance by 
     individuals with mental illness treated remotely using 
     telehealth technologies as compared to individuals with 
     mental illness treated face-to-face; and
       ``(3) any other variables as determined by the Director.
       ``(c) Authorization of Appropriations.--There are 
     authorized to be appropriated to

[[Page S4826]]

     carry out this section such sums as may be necessary.

     ``SEC. 330L. MENTAL HEALTH SERVICES DELIVERED VIA TELEHEALTH.

       ``(a) Program Authorized.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Office for the Advancement of Telehealth of 
     the Health Resources and Services Administration, shall award 
     grants to eligible entities to establish demonstration 
     projects for the provision of mental health services to 
     special populations as delivered remotely by qualified mental 
     health professionals using telehealth and for the provision 
     of education regarding mental illness as delivered remotely 
     by qualified mental health professionals and qualified mental 
     health education professionals using telehealth.
       ``(2) Number of demonstration projects.--Ten grants shall 
     be awarded under paragraph (1) to provide services for the 
     children and adolescents described in subsection (d)(1)(A) 
     and not less than 6 of such grants shall be for services 
     rendered to individuals in rural areas. Ten grants shall also 
     be awarded under paragraph (1) to provide services for the 
     elderly described in subsection (d)(1)(B) in rural areas. If 
     the maximum number of grants to be awarded under paragraph 
     (1) is not awarded, the Secretary shall award the remaining 
     grants in a manner that is equitably distributed between the 
     populations described in subparagraphs (A) and (B) of 
     subsection (d)(1).
       ``(b) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     public or nonprofit private telehealth provider network which 
     has as part of its services mental health services provided 
     by qualified mental health providers.
       ``(2) Qualified mental health education professionals.--The 
     term `qualified mental health education professionals' refers 
     to teachers, community mental health professionals, nurses, 
     and other entities as determined by the Secretary who have 
     additional training in the delivery of information on mental 
     illness to children and adolescents or who have additional 
     training in the delivery of information on mental illness to 
     the elderly.
       ``(3) Qualified mental health professionals.--The term 
     `qualified mental health professionals' refers to providers 
     of mental health services currently reimbursed under medicare 
     who have additional training in the treatment of mental 
     illness in children and adolescents or who have additional 
     training in the treatment of mental illness in the elderly.
       ``(4) Special populations.--The term `special populations' 
     refers to the following 2 distinct groups:
       ``(A) Children and adolescents located in primary and 
     secondary public schools in mental health underserved rural 
     areas or in mental health underserved urban areas.
       ``(B) Elderly individuals located in long-term care 
     facilities in mental health underserved rural areas.
       ``(5) Telehealth.--The term `telehealth' means the use of 
     electronic information and telecommunications technologies to 
     support long-distance clinical health care, patient and 
     professional health-related education, public health, and 
     health administration.
       ``(c) Amount.--Each entity that receives a grant under 
     subsection (a) shall receive not less than $1,500,000 with no 
     more than 40 percent of the total budget outlined for 
     equipment.
       ``(d) Use of Funds.--
       ``(1) In general.--An eligible entity that receives a grant 
     under this section shall use such funds--
       ``(A) for the populations described in subsection 
     (b)(3)(A)--
       ``(i) to provide mental health services, including 
     diagnosis and treatment of mental illness, in primary and 
     secondary public schools as delivered remotely by qualified 
     mental health professionals using telehealth;
       ``(ii) to provide education regarding mental illness 
     (including suicide and violence) in primary and secondary 
     public schools as delivered remotely by qualified mental 
     health professionals and qualified mental health education 
     professionals using telehealth, including early recognition 
     of the signs and symptoms of mental illness, and instruction 
     on coping and dealing with stressful experiences of childhood 
     and adolescence (such as violence, social isolation, and 
     depression); and
       ``(iii) to collaborate with local public health entities 
     and the eligible entity to provide the mental health 
     services; and
       ``(B) for the populations described in subsection 
     (b)(3)(B)--
       ``(i) to provide mental health services, including 
     diagnosis and treatment of mental illness, in long-term care 
     facilities as delivered remotely by qualified mental health 
     professionals using telehealth;
       ``(ii) to provide education regarding mental illness to 
     primary staff (including physicians, nurses, and nursing 
     aides) as delivered remotely by qualified mental health 
     professionals and qualified mental health education 
     professionals using telehealth, including early recognition 
     of the signs and symptoms of mental illness, and instruction 
     on coping and dealing with stressful experiences of old age 
     (such as loss of physical and cognitive capabilities, death 
     of loved ones and friends, social isolation, and depression); 
     and
       ``(iii) to collaborate with local public health entities 
     and the eligible entity to provide mental health services.
       ``(2) Other uses.--An eligible entity receiving a grant 
     under this section may also use funds to--
       ``(A) acquire telehealth equipment to use in primary and 
     secondary public schools and long-term care facilities for 
     the purposes of this section;
       ``(B) develop curriculum to support activities described in 
     subsections (d)(1)(A)(ii) and (d)(1)(B)(ii);
       ``(C) pay telecommunications costs; and
       ``(D) pay qualified mental health professionals and 
     qualified mental health education professionals on a 
     reasonable cost basis as determined by the Secretary for 
     services rendered.
       ``(3) Prohibited uses.--An eligible entity that receives a 
     grant under this section shall not use funds received through 
     such grant to--
       ``(A) purchase or install transmission equipment (other 
     than such equipment used by qualified mental health 
     professionals to deliver mental health services using 
     telehealth under the project); or
       ``(B) build upon or acquire real property (except for minor 
     renovations related to the installation of reimbursable 
     equipment).
       ``(e) Equitable Distribution.--In awarding grants under 
     this section, the Secretary shall ensure, to the greatest 
     extent possible, that such grants are equitably distributed 
     among geographical regions of the United States.
       ``(f) Application.--An entity that desires a grant under 
     this section shall submit an application to the Secretary at 
     such time, in such manner, and containing such information as 
     the Secretary determines to be reasonable.
       ``(g) Report.--Not later than 5 years after the date of 
     enactment of this section, the Secretary shall prepare and 
     submit a report to the appropriate committees of Congress 
     that shall evaluate activities funded with grants under this 
     section.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $30,000,000 for fiscal year 2002 and such sums that are 
     required to carry out this program for fiscal years 2003 
     through 2009.
       ``(i) Sunset Provision.--This section shall be effective 
     for 7 years from the date of enactment of this section.''.
                                  ____

                                       NAMI, National Alliance for


                                             the Mentally Ill,

                                       Arlington, VA, May 7, 2001.
     Hon. Craig Thomas,
     U.S. Senate, Hart Office Building,
     Washington, DC.
       Dear Senator Thomas: on behalf of the 220,000 members and 
     1,200 affiliates of the National Alliance for the Mentally 
     Ill (NAMI), I am pleased to offer our support for the Rural 
     Mental Health Accessibility Act of 2001. As the nation's 
     largest organization representing children and adults with 
     severe mental illnesses and their families, NAMI is pleased 
     to support this important legislation. Thank you for your 
     leadership in bringing this bipartisan measure forward.
       Accessing mental illness treatment and services is a 
     particular challenge for individuals living in isolated rural 
     communities. The challenges related to geographic isolation 
     are too often further compounded by the stigma associated 
     with severe mental illnesses such as schizophrenia, bipolar 
     disorder, major depression and severe anxiety disorders. 
     Advances in scientific research and medical treatment for 
     these serious brain disorders have been tremendous in recent 
     years. Your legislation will bring these advances in research 
     and treatment to underserved rural areas. The initiatives 
     contained in the rural Mental Health Accessibility Act--
     community education to address stigma, training for 
     providers, funding for a telehealth services program--are an 
     important step forward for expanding access to treatment in 
     sparsely populated regions of our country. NAMI looks forward 
     to working with you to ensure passage of this legislation in 
     2001.
       Thank you for your leadership on this important issue for 
     individuals with severe mental illnesses and their families.
           Sincerely,
                                                Jacqueline Shannon
     President.
                                  ____



                            National Rural Health Association,

                                      Washington, DC, May 4, 2001.
     Hon. Craig Thomas,
     U.S. Senate,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Thomas: on behalf of the National Rural Health 
     Association, I would like to convey our strong support for 
     the Rural Mental Health Accessibility Act of 2001.
       While a lack of primary care services in rural and frontier 
     areas has long been acknowledged, the scarcity of rural 
     mental health services has only recently received increased 
     attention. At the end of 1997, 76% of designated mental 
     health professional shortage areas were located in 
     nonmetropolitan areas with a total population of over 30 
     million Americans.
       The Rural Mental Health Accessibility Act of 2001 would 
     provide important first steps toward increased access to 
     mental health care services in rural and frontier areas. The 
     stigma associated with having a mental disorder and the lack 
     of anonymity in small rural communities leads to under-
     diagnosis and under-treatment of mental disorders among rural 
     residents. Your legislation

[[Page S4827]]

     would address this problem by creating a Mental Health 
     Community Education Program aimed at reducing the stigma and 
     misinformation surrounding mental health care.
       In many rural and frontier communities, primary care 
     providers by necessity are responsible for the delivery of 
     mental health services. Because primary care providers often 
     lack specific mental health training, interdisciplinary 
     collaboration and training would increase access for rural 
     residents to appropriate mental health care treatment. The 
     interdisciplinary training grant program created by your 
     legislation would increase collaboration and sharing of 
     information between mental health providers and primary care 
     providers and improve care for rural residents.
       The NRHA appreciates your ongoing leadership on rural 
     health issues, and stands ready to work with you on enactment 
     of the Rural Mental Health Accessibility Act of 2001, which 
     would increase the availability of mental health care in 
     rural and frontier areas.
           Sincerely,
                                                  Charlotte Hardt,
                                                        President.

  Mr. CONRAD. Mr. President, today I am pleased to join my colleagues 
as a cosponsor of the Rural Mental Health Accessibility Act of 2001. 
This bipartisan effort would take important steps toward improving 
access to mental health care in rural America.
  This issue is particularly important to me and my constituents in 
North Dakota. Sadly, as compared to the rest of the United States, 
North Dakota has the second-highest suicide rate among children ages 10 
through 14, and the sixth-highest suicide rate among teenagers 15 
through 19 years of age. As a result, over the 10 year period from 1987 
to 1996, the percentage of deaths due to suicide among North Dakota's 
children and teens was double the national average. Clearly, suicide 
makes a much greater impact on child mortality in North Dakota than it 
does in the rest of the United States, and it is a leading cause of 
death in this age group.
  In the vast majority of cases, suicide is directly related to mental 
illness, particularly mood disorders such as depression. Depressive 
symptoms are remarkably common in North Dakota's school-age children, 
with one screening finding that 21 percent of students had mild 
depression and 5 percent had moderate-to-severe depression. This level 
of depression is likely a contributing factor to the 2,600 suicide 
attempts by North Dakota's teens reported in 1999.
  North Dakota is not alone in this crisis. Rather, it is one of a 
group of western and Plains states that have elevated youth suicide 
rates. As agricultural difficulties continue to plague rural areas, the 
stress on families and individuals grows greater with each passing 
season. Farm financial stress has been related to individual 
psychological problems and an increased risk of mental disorders, 
including depression, substance abuse, and suicide.
  It is important to keep in mind that rural areas have a prevalence of 
mental illness similar to urban areas. The difference is that people in 
rural areas have less access to health care, especially mental health 
care. Availability of mental health treatment is scarce in remote rural 
areas. Additionally, there remains a strong stigma surrounding mental 
illness and its treatment. The bill we introduce today would address 
both of these problems: reducing the stigma and increasing access to 
mental health services in rural areas.
  Our bill addresses the problem of stigma through $50 million in 
grants designed to support community mental health education programs. 
Existing state and community efforts could be sustained and expanded 
through these grants, and new efforts could obtain early support. In 
addition, our bill establishes $30 million in demonstration projects 
for the provision of mental health education in rural public schools 
and nursing homes using televideoconferencing technology. Rural schools 
and nursing homes would have access to information regarding mental 
illness, information that would reduce stigma, enhance understanding, 
and increase recognition of mental disorders. Importantly, suicide 
education and prevention are to be key parts of these programs.
  Other provisions of our bill address the access problem to mental 
health services found in the majority of rural communities. Since 
mental health care in rural communities is often provided solely by 
primary care clinics, our bill establishes a $150 million grant program 
to foster close interaction between mental health professionals and 
primary care physicians. The grants would be available to public 
universities or educational institutions to develop side-by-side 
training programs for mental health care professionals and primary care 
providers. These provider teams would give care to patients in 
underserved, rural areas without regard to the patient's ability to pay 
for such services. It is expected that primary care providers 
participating in such a training program would develop greater comfort 
and improved coordination with colleagues in treating mental illness in 
rural settings.

  Finally, our bill would increase access to mental health care 
professionals by taking advantage of the latest telehealth 
technologies. Our bill would fund telehealth demonstration projects 
that would be focused on providing mental health services to hard-to-
reach populations, such as children, adolescents, and the elderly. 
These individuals would be able to receive mental health services in 
convenient sites, such as rural public schools and nursing homes.
  It is my hope that the Rural Mental health Accessibility Act will 
strengthen existing community efforts to fight mental illness while 
encouraging the formation of new and innovative programs. I am pleased 
to join Senator Thomas and others in this effort. I urge my colleagues 
to support this important legislation.
                                 ______