[Congressional Record Volume 149, Number 68 (Thursday, May 8, 2003)]
[House]
[Pages H3850-H3854]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MENTAL HEALTH CAUCUS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 2003, the gentlewoman from California (Mrs. Napolitano) is 
recognized for 60 minutes as the designee of the minority leader.
  Mrs. NAPOLITANO. Mr. Speaker, as the Democratic Chair of the 
bipartisan Congressional Mental Health Caucus, which we recently began, 
I am pleased to anchor at this time along with my Republican cochair, 
the gentleman from Pennsylvania (Mr. Murphy), who spoke a few minutes. 
He was granted some time by my good friend to make his remarks, and I 
hope that he will be able to return.
  Mr. Speaker, this week is National Suicide Awareness Week, and we 
want to highlight that fact. Approximately 30,000 people, 30,000 
people, commit suicide in the United States every year, making suicide 
the 11th leading cause of death nationwide. Suicide is particularly a 
problem among young people, communities of color, and seniors. The 
States with the five highest suicide rates are Nevada, Wyoming, 
Montana, New Mexico, and Arizona.
  Everyone should be screened by the health care providers in our 
schools for mental health and/or risk of suicide. Because of the 
associated stigma of the crazies, we cannot count on people to seek out 
help on their own. Another key point is our need for more mental health 
professionals to break down financial and language barriers to mental 
health.
  Mr. Speaker, I will right now take the time to introduce the 
gentleman from Texas (Mr. Rodriguez) to address this same issue.
  Mr. RODRIGUEZ. Mr. Speaker, I would like to thank the gentlewoman 
from California (Mrs. Napolitano) for taking this opportunity to talk 
about suicide and the mentally ill. I think one of the difficulties 
that we encounter is the fact that when it comes to the mentally ill, 
it is usually one of the last that we talk about, and in fact it is 
usually an afterthought in terms of providing resources that are 
drastically needed for not only for the mentally ill but for the issue 
in terms of preventing suicides.
  Mental disorders are common in the United States, and we sometimes do 
not realize how common they are. There is an estimated 22 percent of 
Americans age 18 and older and one out of five adults who suffer from 
diagnosed mental disorders throughout a year. Tragically, mental 
disorder is often linked with suicide. Of the 29,350 people who died by 
suicide in the year 2000, more than 90 percent of the people who killed 
themselves have diagnosable mental disorders, commonly depressive 
disorders as well as substantive abuse disorders and other dual 
diagnoses.
  At this time I would also like to focus my remarks on critical 
segments of our population, and that is our veterans. Today while we 
continue to deploy troops in Iraq, it is important to remember that the 
wounds of combat that would disable and harm our troops are not merely 
just physical. Many combat wounds will affect the minds, the brain, and 
the spirit of our Armed Forces and their loved ones. So often we forget 
that long after the visible battle wounds are healed, many veterans 
continue to suffer not only physically but also mentally. For our 
heroes of today as well as yesterday's

[[Page H3851]]

stress-related conditions like post-traumatic stress disorders, PTSD, 
and depression can be among the most chronic and disabling of the 
illnesses. For example, more than 30 percent of veterans, Vietnam 
veterans, have experienced PTSD at some point after the war experience. 
I have heard alarming statistics just the other day in some testimony 
on the House Committee on Veterans' Affairs, a witness testified that a 
great number of Vietnam veterans that did not die during Vietnam, of 
which we lost over 59,000 lives, committed suicide after they came back 
than soldiers lost in the battle in that conflict.

  Given these alarming statistics, it is shameful that we have not 
appropriated sufficient funds to provide our heroes with the care that 
they need. From 1996 to 2000, programs for PTSD, or the homeless 
substantive abuse programs, and serious mental illness grew 
approximately 5.5 percent overall in the number of patients that they 
served, but the resources shrank approximately 13.5 percent for the 
budgets for the mentally ill that are veterans.
  In addition to the painful experience of dealing with their mental 
disorders and especially PTSD and others, many of these veterans find 
themselves on the street. Homelessness is prevalent in this segment of 
veterans. A large number of displaced and at-risk veterans live with 
lingering effects of posttraumatic stress disorders and substance 
abuse, compounded by the lack of family and social support networks. 
Although accurate numbers are challenging to identify since no one 
really keeps the national records on homeless veterans, but the VA 
estimates that on any given night we will find 300,000 veterans that 
are homeless, and more than half a million experience homelessness 
throughout the course of any given year. This is important to note: Of 
the homeless that are out there, 40 percent report mental health 
problems.
  In order to properly serve these veterans we must be committed to a 
comprehensive approach to the treatment and we must appropriate 
sufficient resources in dollars. Veterans need a coordinated effort 
that provides secure housing and nutritional meals; essential physical 
health care, substance abuse aftercare, and the mental health 
counseling; and personal development. And one of the things about 
substance abuse is a lot of the times the mentally ill, as they try to 
cope with their depression, as they try to meet and cope with the 
problems that they are encountering, they self-medicate, and that is 
why a lot of them go into substance abuse.
  As a Member of the House Committee on Veterans' Affairs, I am proud 
of the work that we put forth and passed in Public Law 107-95, which is 
the Homeless Veterans Comprehensive Assistance Act, a year and a half 
ago, to properly address this shameful issue.
  This truly comprehensive legislation sought to end homelessness among 
veterans within a decade, but we have got to continue to move forward. 
However, just this week we held an oversight hearing where we invited 
Deputy Secretary McKay to provide us a status report on the 
implementation of the Homeless Veterans Comprehensive Assistance Act.
  The news is not that good. If we continue at this pace, we will not 
reach our goal in 10 years. Rather, it will take 25 years. This is not 
acceptable. Especially now after we have seen also the veterans from 
the Gulf war and now we have the veterans from Iraq, and we encounter 
to have veterans who are fighting the war on terrorism, we have to make 
sure that as they leave the Armed Forces that we are there for them, 
and I am disappointed that the VA has not moved on the critical 
programs such as the creation of special needs grants for women, 
veterans especially, and the chronically mentally ill, the ones who 
real seriously ill and need that service, as well as the fragile 
elderly and the terminal ill. We must move on the creation of 
specialized treatment programs for these veterans that are in need. 
These critical programs have not yet been designed, and it is difficult 
and it is hard, but we need to continue to move.
  In closing, let me just say that I want to thank my colleagues once 
again for raising this issue and mentioning the importance of zeroing 
in on the issue of suicide and the issue of the mentally ill. As a 
social worker personally with clinical experience and training, I am 
proud to echo the concerns of my colleagues and to urge this body to 
devote adequate resources and to implement programs which speak to the 
needs that are before us and of those that are forgotten, yet critical 
segment of our society, and that is the mentally ill and those who 
commit suicide.
  And I want to add one additional thing. As we talk about suicide, I 
know the gentlewoman from California (Mrs. Napolitano) has done 
significant work for the Latino young ladies, Latinas, who are prone to 
commit suicide, in the need to reach out to our young. We have 
forgotten Columbine. We have forgotten the fact that we still have 
young people throughout this country that need assistance, and when it 
comes to our young, we have not done what we should do, and that is to 
make sure we have the programs to reach out to them. Most of the time 
throughout this country, the only resources they have is after they get 
into the criminal justice system. And that is too late. We need to make 
sure we have programs that reach out to our young.
  I want to congratulate the gentlewoman from California (Mrs. 
Napolitano) for her legislation and her efforts in providing that 
assistance in the area of Latina suicide and health care.

  One of the other areas that I would like to mention that sometimes 
goes unnoticed, and that is the issue of depression. As people suffer 
from depression, women and young, men, young people and the elderly, it 
is an issue that we do not see as a mental health issue, but it is an 
issue that hits us without us realizing it. Just like the work burnout. 
By the time one realizes it, they have gotten into trouble, and a lot 
of times people lose their jobs because they get burned out and do not 
have the energy. But people suffer from depression, and it is important 
for us to work on those areas.
  And I just want to mention one other item because I think it is 
important. As we look at the issue of terrorism and as we look at the 
problems and the things that we have been confronted with, what has 
occurred here not only at the Pentagon but what has occurred in New 
York, those in individuals in New York, those individuals at the 
Pentagon, as well as others, we need to make sure we reach out to them 
because they have experienced what a lot of us have not, and in so 
doing, they are also going to be suffering from nightmares. They are 
also going to be suffering from coping with a situation that they 
themselves went through, and so they are going to be having what we 
might consider post-traumatic stress disorders of which they need to be 
able to deal with. So as a society and as a community in these United 
States, we need to put the resources in those areas. And once again I 
want to thank the gentlewoman from California (Mrs. Napolitano) for 
having taken the time for us to be here tonight and I want to 
congratulate her in bringing up this issue that is usually left in the 
back burner.
  Mr. Speaker, when we talk about health care a lot of times as an 
afterthought we talk about mental health, and that is unfortunate. We 
really need to put that on the front burner. We need to make sure we 
bring it forth and provide the resources. I thank the gentlewoman for 
having me here tonight.
  Mrs. NAPOLITANO. I thank the gentleman from Texas (Mr. Rodriguez). 
Mr. Speaker, I think he has made some very valid points, and I want to 
elaborate a little more on that, in that more than one third of our 
veterans need psychiatric care, most, as the gentleman has stressed, 
for the PTSD, posttraumatic stress disorder, and unfortunately the 
Veterans Administration's spending for mental health care has decreased 
since 1996 by a whopping 23 percent, almost a quarter. Veterans in need 
of mental health services often have to wait weeks, even months in some 
parts of country, for appointments, never mind having assistance by a 
psychologist, psychiatrist. One reason is because only 40 percent of 
the Veterans Administration clinics, Mr. Speaker, have mental health 
professionals.

                              {time}  2115

  Many veterans are forced to travel over an hour for care. Veterans 
who need weekly or biweekly follow-up appointments for therapy or 
medication

[[Page H3852]]

regulation can only be seen every 6 weeks. The Veterans Administration 
desperately needs more psychiatric staff. Sadly, less than 9 percent of 
the Veterans Administration funds are available for residency training 
or designated for psychiatric residency in the year 2002.
  Our heroes, our active duty soldiers, just recently on television 
there was a young soldier who when asked what he was thinking when he 
came home, he said, I wake up with dreams where I was in the tank 
seeing the Iraqis use women and children as shields. Somebody needs to 
help those young men and women who have witnessed the atrocities and do 
not have the ability to download or be able to have professional 
assistance to deal with this traumatic scene that they are going to 
live with for the rest of their lives.
  Not only are they in immediate danger in combat service, they need 
our help to be able to function properly in our society. Many of them 
experience extreme flashbacks and nightmares of war situations, but 
they may not openly talk about them. I can tell you, Mr. Speaker, from 
experience, from my brother-in-law who was in World War II, he refused 
to talk about his experiences because they were so painful.
  Soldiers must be screened for these mental health problems and given 
assistance before they progress to suicidal proportions. Families of 
soldiers who have served in war also need mental health services to 
cope with their loved ones' fears, their anxiety, and their issues.
  Very sadly, unfortunately, lack of appropriate mental health services 
for soldiers has led not only to suicide, but to homicide. Last year, 
the four soldiers at Fort Bragg allegedly killed their wives or 
partners. Family members noticed the soldiers were experiencing rage 
and other mental wounds of service and needed mental health treatment. 
None was provided; none was available.
  We talk about our homeless, our street people. As my colleague just 
mentioned, there are over 300,000 people without shelter on any given 
night. Approximately 25 percent of these homeless have serious mental 
illness, such as schizophrenia, bipolar disorder and PTSD. 
Unfortunately, many minorities, particularly African Americans, are 
overrepresented among the mentally ill homeless population.
  Only a handful of the homeless shelters currently provide 
comprehensive mental health services; and yet without these services, 
we will never break the cycle of homelessness and help people get back 
on their feet and function in our society. We do not even have accurate 
figures on the number of homeless people who commit suicide; but given 
their likelihood of mental health illness, their desperate situation, 
this number is expected to be high.
  Now I go on to our youngsters, Mr. Speaker. Suicide is the third 
leading cause of death among young people ages 10 to 24, followed by 
unintentional injuries and homicide. Our U.S. Surgeon General estimates 
that one in five children, one in five children, will experience a 
serious mental health problem during their school years. Can you 
imagine, one in five? That means three of my grandchildren, because I 
have fourteen. A sad statistic.
  A variety of causes lead youth to serious mental health problems and 
suicide, including academic problems, peer pressure, fear of school 
violence, severe change in family situation, rape during college years, 
and the double stigma of the mental stress and the rape.
  Children are considered by many psychologists to be the most 
resilient age group with regard to mental illness, meaning that, if 
given appropriate treatment, children are likely to fully recover, if 
they are given treatment. Children also need a good deal of 
preventative mental health care to ensure that they do not reach the 
critical suicide stage. They need help in adapting to dramatic life 
changes, such as moving from one city to another, switching schools, 
parental divorce or a loss of a family member, a loved one.
  Latino adolescents are the most likely of any racial or ethnic group 
to attempt suicide in the United States. The Native American and 
Alaskan Native youth are the most likely of any racial or ethnic group 
to commit suicide.
  I first learned of this problem in a 1990 report by a representative 
group of health care providers of Hispanic origin that brought to us 
here in Washington a report presented to the Congressional Hispanic 
Caucus. It stated that a shocking one in three Latino adolescents ages 
9 to 11 had seriously considered suicide, and that 15 percent of those 
adolescents actually attempted suicide. That is horrible. That is 
unacceptable.
  So we responded by spearheading and securing funding from Health and 
Human Services, SAMHSA, substance abuse, for a pilot program in my 
district to provide school-based mental health services through a 
nonprofit mental health care provider. This program has served over 300 
students in three middle schools and one high school, many of whom have 
no health insurance and could not have received these services 
elsewhere. They were either unable to provide services to them or their 
provider would not cover them.
  Children exposed to violence and poverty are at a heightened risk for 
mental illness and for suicide, as are students who have experienced, 
as I said, parental death or divorce. Children in schools need to be 
screened for mental illness and suicide risk factors so they can be 
given appropriate care. Schools should have trained personnel who can 
spot the first signs and prevent at-risk children from attempting 
suicide.
  Seventy percent of school children and adolescents nationwide who 
need mental health services are not getting them. Untreated mental 
illness has led to violence in schools; and as we have seen in the 
newspaper, there continues to be almost on a daily basis an instance 
where something has happened in a school, there is violence, there is a 
suicide attempt or suicide has been committed.
  In 1996 a Health and Human Service study found that almost 20 percent 
of students feared being violently attacked by their peers at school. 
Students have attacked their teachers and their administrators at a 
time that is crucial for children in middle schools and high schools 
that have tremendous pressures.
  Then we look at the shortage of mental health services. Many schools 
do not have mental health professionals. In fact, I do not know of many 
that can even afford nurses, let alone mental health care providers. 
Nearly all people who commit suicide have a diagnosable mental illness 
or substance abuse problem, something that has been found in about 70 
percent of the students that have been treated for mental health 
illness, or they have more than one.
  Most people who need mental health services do not have access to 
them because of the stigma associated with mental health care, because 
of financial barriers, because of language barriers, or simply a lack 
of available services. This is a particular problem in minority 
communities, where individuals are less likely to have health insurance 
and more likely to have a language barrier to receive care. Only 32 
percent of Hispanic female youth at risk for suicide during the year of 
2000 received mental health treatment. That is only 32 percent.
  The shortage of mental health professionals is a vital, vital 
necessity, especially amongst minorities. We are facing a severe 
shortage of mental health professionals, particularly in the areas in 
high populations of minorities, who can render services bilingually, in 
the native language, or a language that they can understand.
  Research in other areas of health care indicates that minority health 
care workers are more likely to practice in areas with high minority 
populations; but unfortunately, we have shockingly few minority health 
care professionals. Only 1 percent of licensed psychologists are 
Hispanic, 1 percent. Moreover, there are only 29 mental health 
professionals for every 100,000 Hispanics in the United States. There 
are only 70 Asian American/Pacific Islander mental health providers for 
every 100,000 Asian American/Pacific Islanders in the United States. 
Further, half of the Asian American/Pacific Islanders who need mental 
health services report that they do not access them because of language 
barriers. Interesting.
  But do not think that mental illness and suicide only plague minority 
communities or young people. Let us look at our elderly. Our Nation's 
seniors are at an enormously high risk of suicide. In fact, the highest 
suicide rate in the

[[Page H3853]]

United States of any age group occurs among people ages 65 years and 
older. There is an average of one suicide among elderly every 90 
minutes.
  Seniors are at a high risk for depression. Fifteen out of every 100 
people in the U.S. over 65 are depressed. Unfortunately, it goes 
unnoticed, because families and health care providers are focused only 
on their health, more often than not. But depression among seniors, 
when left untreated, can worsen conditions, lead to disability and, 
ultimately, result in suicide.
  Now, Substance Abuse Mental Health Services estimates that 20 percent 
of the elderly over 65 years old who commit suicide visited a physician 
within 24 hours of their act; 41 percent visited within a week of their 
suicide; and 75 percent have been seen by a physician within 1 month of 
their suicide. Clearly, our physicians are not screening their elderly 
patients for depression or suicide risk, nor are they providing 
adequate treatment for mental illness. This has to change. It must 
change. It cannot continue.
  Depression and suicide are not a normal part of aging; and they must 
not, they cannot be ignored. The most common causes of senior 
depression and suicide include terminal illness, physical pain, loss of 
a spouse, and/or social isolation.
  Then we go into Medicare. Unfortunately, current Medicare rules make 
it very difficult for seniors to access mental health services. 
Currently, Medicare requires beneficiaries to pay 50 percent copay for 
mental health services, compared to 20 percent copay for other health 
services. We must make mental health equal to health care delivery.
  Further, Medicare imposes a lifetime limit of in-patient care in 
psychiatric hospitals of 190 days, a lifetime limit, 190 days. Later 
this year, hopefully Congress will debate this Medicare modernization; 
and when we do, we must make it clear that we must address these 
insufficient mental health provisions, and we must ensure that Medicare 
provides access to mental health services that our seniors desperately 
need.
  Medicare is not the only Federal program falling short on mental 
health services. While men are more likely to commit suicide, women 
attempt suicide twice as often as men, often using less lethal means 
such as pills or slicing their wrists. Suicide is more common among 
single, divorced, or widowed women than among married women.
  The two most common mental illnesses among women who attempt suicide 
are postpartum depression and bipolar disorder. Suicide rates for women 
peak between the ages of 45 and 54, often due, guess what, to hormonal 
changes during menopause that affect their mental health. 
Unfortunately, gynecologists and obstetricians do not screen enough 
patients for postpartum depression or mental health illnesses related 
to menopause.
  Then we look at our college students. They are at a heightened risk 
for mental illness and suicide because they are away from home for the 
first time, away from traditional support systems, and face intensive 
peer pressure and academic pressure, and, as has happened in many of 
our colleges, unfortunately and sadly, rape on our campuses.

                              {time}  2130

  This brings shame, shock, and denial and causes them to take the 
ultimate step of suicide. It is the second leading cause of death among 
college students. The rate among these students has tripled since 1970.
  Well, Mr. Speaker, we are coming to the end of the hour and I want to 
make sure that we stress that we need to make mental health a higher 
national priority, to expand access to health care, mental health care 
for all Americans. I thank the gentleman from Pennsylvania (Mr. 
Murphy). He has consented to be a cochair in our bipartisan Mental 
Health Caucus which now numbers over 17 Members from both sides. We 
invite more Members to join and work with us and bring this up into the 
light and be able to talk about it, discuss it, and do something about 
it.
  Mr. Speaker, this is a large and daunting issue. The mentally ill 
need all the support and supporters they can get. We must eradicate the 
stigma and work openly and honestly to help those many that need our 
help.
  I want to thank all of the Members who are working with us to improve 
mental health issues in our Nation. I want to thank my distinguished 
colleague and cochair, once again, the gentleman from Pennsylvania (Mr. 
Murphy), and I would then say to my colleagues that I am very pleased 
that even at this late hour, I have an opportunity to bring before my 
colleagues one of the things that has bothered a lot of us for a long 
time.
  Ms. BORDALLO. Mr. Speaker, I am pleased to join my colleagues this 
evening on this most important issue and I thank my colleague, Mrs. 
Napolitano, for bringing attention to National Suicide Awareness Week. 
This is a very personal issue for me as I have experienced first hand 
the impact of suicide on family and friends.
  Tonight I want to bring special attention to the issue of suicide in 
youth and young adults.
  In the year 2000, persons under age 25 accounted for 15 percent of 
all suicides. In 1999, more teenagers and young adults died from 
suicide than from cancer, heart disease, AIDS, birth defects, stroke, 
and chronic lung disease combined.
  Nationally, suicide is the 9th leading cause of death. Among 10-24 
year-olds, suicide ranks 3rd and in Guam, where the suicide rate is six 
times higher than the national average, it ranks 2nd as the leading 
cause of death in youth and young adults.
  Mr. Speaker, we cannot stand by and allow this tragedy to continue. 
We must focus our efforts on what causes the youth in our communities 
to choose to end their lives.
  The report of the Surgeon General's Conference on Children's Mental 
Health: Developing a National Action Agenda indicates that children 
with mental health needs are usually identified by the schools only 
after their emotional or behavioral problems cannot be managed by their 
regular classroom teacher.
  We must educate and train parents, teachers and others who work with 
our children to recognize the warning signs of suicidal young adults.
  We must provide funding for the programs and services that will treat 
our children and provide guidance and support to their family and 
friends, including expanding Medicaid eligibility to allow lower income 
and poor families to access programs and services.
  We must also recognize the racial, cultural and ethnic influence on 
behaviors and its effect on properly identifying at-risk youth and 
address its impact on intervention and access to the programs and 
services.
  Most importantly, we must help our children understand that suicide 
is never the answer to their problems.
  Ms. WATSON. Mr. Speaker, there are approximately 30,000 suicide 
deaths every year in the U.S. Suicide is the 11th leading cause of 
death nationwide, and is the 3rd leading cause of death among people 
ages 10-24, following unintentional injuries and homicide.
  Statistics of completed suicide only tell part of the story. National 
Institute of Mental Health (NIMH) estimates that research indicates 
that there are an estimated 8-25 attempted suicides to one completion; 
the ratio is higher in women and youth. Adolescent males are 4 times 
more likely to actually commit suicide than females. Adolescent females 
are twice as likely as adolescent males to attempt suicide.
  Since peaking in the early 1990's, overall adolescent suicide rates 
have dropped. However, most of this is attributed to a drop in male 
adolescent suicide. Rates for females have remained constant. Fifty-
three percent of young people who commit suicide abuse substances.
  Most people who commit suicide have a diagnosable mental illness, but 
are not receiving treatment.
  Children who are exposed to violence, experience a loss in the 
family, experience parental divorce, or have academic problems are at a 
heightened risk for mental health problems and suicide.
  The U.S. Surgeon General estimates that 1 in 5 children will 
experience a serious mental health problem during their school years. 
Seventy percent of these children will not receive mental health 
services, putting them at an even higher risk of suicide.
  Native American/Alaskan Native youth are more than twice as likely to 
commit suicide as any other adolescent racial group to commit suicide, 
with approximately 20 deaths per 100,000 Native Americans/Alaskan 
Natives ages 15-19.
  Hispanic adolescents are most likely to exhibit non-lethal suicide 
behavior. A 1999 report found that a shocking 1 in 3 Latina adolescents 
seriously considered suicide. Fifteen percent of Hispanic high school-
age females actually attempt suicide each year.
  People who are homeless, incarcerated, in the foster care system, or 
exposed to serious violence are all at a higher risk for mental illness 
and suicide. African-Americans and Hispanics are overrepresented in 
these groups.
  Minorities are less likely to access mental health care, due to lack 
of insurance and other

[[Page H3854]]

financial barriers and cultural stigma. For instance, only one third of 
African-Americans in need of mental health services actually receive 
them.
  Among Hispanic Americans with a mental disorder, fewer than 1 in 11 
contact mental health specialists, while fewer than 1 in 5 contact 
general health care providers. Among Hispanic immigrants with mental 
disorders, fewer than 1 in 20 use services from mental health 
specialists, while fewer than 1 in 10 use services from general health 
care providers.
  Of Asian-Americans who report needing mental health services, half of 
them do not receive them because they cannot find a provider who speaks 
their language.
  There is a serious lack of mental healthcare providers, and an even 
greater lack of minority providers, who are more likely to practice in 
communities with high minority populations.
  We must invest more in our mental healthcare system in order to 
prevent suicide. We need more psychiatrists and psychologists. We need 
to screen all of our children for mental health problems and suicide 
risk factors. And when our children exhibit symptoms of mental 
illness--such as withdrawal from family and friends, academic trouble, 
sadness or behavioral problems--we must make sure they get the 
appropriate treatment immediately.
  Mrs. NAPOLITANO. Mr. Speaker, I yield back the balance of my time.

                          ____________________