[Congressional Record Volume 147, Number 65 (Monday, May 14, 2001)]
[Senate]
[Pages S4852-S4853]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             RURAL MENTAL HEALTH ACCESSIBILITY ACT OF 2001

  Mr. THOMAS. Mr. President, last week we had the opportunity to 
introduce a bill called the ``Rural Mental Health Accessibility Act of 
2001.''
  I am pleased to be joined by Senators Conrad, Domenici, Johnson, 
Roberts, and Nelson from Nebraska to bring forward the opportunity for 
us to strengthen medical provisions for mental health in rural States 
in particular.
  As you might imagine, rural States have many unique problems. We have 
small towns and small cities where not all medical specialties are 
present. We

[[Page S4853]]

have to build sort of a network of health care for small towns. One of 
the things that has been most difficult to provide in those rural areas 
is mental health in small towns where kids need some counseling, and 
where there are real problems with no one there who is a specialist in 
mental health.
  This Rural Mental Health Accessibility Act reflects on those unique 
needs and provides States and local communities flexibility.
  The Federal programs that assist in health care needs in Wyoming are 
different than they are in Pennsylvania, or in Rhode Island. We need to 
have flexibility in all cases, particularly in the case of mental 
health which is more of a speciality.
  This act provides for creative and collaborative provider education 
to help provide education for the mental health provider so they can 
come to those rural areas and give some assistance in education.
  It increases access to mental services to vulnerable children and 
seniors in unserved rural areas throughout these States.
  Certainly the circumstances are unique. With the stigma associated 
with mental illness, people do not seek the services. They are not 
handled there, and it cannot be done easily.

  Seventy-five percent of the 518 nationally designated mental health 
professional shortage areas are located in rural areas, which, I guess, 
is not hard to understand.
  One-fifth of all rural communities have no mental health services of 
any kind.
  Frontier communities have even more drastic numbers. Ninety-five 
percent have no psychiatrists. Sixty-eight percent have no 
psychologists. Seventy-eight percent have no social workers.
  You can see that it is really necessary to have a network where 
people can move around to provide the services that the communities do 
not have.
  Suicide rates among rural children and adolescents are higher in 
urban areas. That is a very surprising statistic. We don't think of it 
that way. In fact, it is true.
  Twenty percent of the Nation's elderly population lives in rural 
areas. Only 9 percent of our Nation's physicians practice in rural 
areas.
  Often the primary care physicians are the only ones who are the 
source of treatment in these particular areas.
  Primary care physicians do not necessarily have the specialized 
training in terms of mental health.
  To address these issues, this bill does the following: Create the 
Mental Health Community Education Grant Program; States and communities 
to conduct targeted public education campaigns focused on mental 
illness, focused on suicide, and focused on substance abuse. These are 
things that all communities to some extent are trying to keep out of 
the public eye, kind of acting as if it really isn't true. But, indeed, 
we know that it is, and especially in rural communities.
  I must tell you, frankly, that I am surprised at the suicide rate in 
a rural State such as Wyoming, which is higher than most places. It 
really points out the need for the kind of health services that we are 
hoping to provide.
  It creates an Interdisciplinary Grant Program; permits universities 
and other entities to establish interdisciplinary training programs so 
they can provide, hopefully, training for these kinds of health 
providers.
  Mental health and primary care providers are taught side by side in 
the classroom, so that with clinical training in rural areas we can 
help provide for all of these kinds of needs that exist. We encourage 
more collaboration, certainly, amongst providers, so we can have this 
network we talk about.
  It actually authorizes $30 million for 20 mental telehealth 
demonstration projects. And it is equally divided. I think as we get 
more and more into high-tech telemedicine, it will be even more 
important. Of course, to do that you have to have equipment, you have 
to have people on both ends who have some training to provide these 
kinds of services.
  It provides mental health services to children and elderly residents 
at long-term care facilities located in mental health shortage areas.
  Projects also provide mental illness education and targeted 
instruction on coping and dealing with the stressful experiences of 
childhood, adolescence and aging. One might even think it is 
appropriate where we have some of the kinds of problems we have in 
public schools. There is often the necessity to have help in these 
stressful experiences.
  It requires a study. The Director of the National Institute of Mental 
Health of the Office of Rural Health Policy will report to Congress on 
the efficacy and effectiveness of mental telemedicine.
  So I think it is something that is very much needed, something we can 
help provide in communities where it does not now exist. Frankly, 
without some special assistance, it probably will not exist in the 
foreseeable future.
  There are a number of supporting organizations. The Rural Mental 
Health Accessibility Act 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.
  So I believe it is critically important that we consider this 
legislation as we talk about health care. Again, I cannot overemphasize 
the need for flexibility and taking a look at all the areas to be 
served. It is one thing to serve in a downtown metropolitan center--and 
they have their difficulties, of course--but it is also difficult to 
serve in Medicine Bow, WY, where you have to reach out from somewhere 
else to bring in people to provide these kinds of services.
  So, first of all, I thank the Presiding Officer for being a sponsor, 
but also I thank him for the time and the support he has given to 
helping those in need of health care and mental health care.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The senior assistant bill clerk proceeded to call the roll.
  Mr. THOMAS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Nelson of Nebraska). Without objection, it 
is so ordered.
  Mr. THOMAS. Mr. President, I believe we are in an hour of time 
allocated to the Senator from Wyoming.
  The PRESIDING OFFICER. Under the previous order, the time until 2 
p.m. is under the control of the Senator from Wyoming, Mr. Thomas, or 
his designee.

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