[Congressional Record Volume 151, Number 74 (Tuesday, June 7, 2005)]
[Senate]
[Pages S6157-S6159]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA:
  S. 1177. A bill to improve mental health services at all facilities 
of the Department of Veterans Affairs; to the Committee on Veterans' 
Affairs.
  Mr. AKAKA. Mr. President, I rise proudly today to introduce 
legislation that would enhance the Department of Veterans Affairs' (VA) 
ability to provide mental health and other specialized services to its 
patients. At a time when our Nation is at war, it is imperative that we 
ensure that all veterans have access to top quality mental health care, 
whether they visit a VA hospital or clinic.
  At the time of its creation, the VA health care system was tasked 
with meeting the special needs of its veteran patients. Those veterans 
who suffered from spinal cord injuries, amputations, blindness, Post-
Traumatic Stress Disorder, substance abuse, and homelessness required 
unique forms of treatment and rehabilitation. During the past few 
decades, VA has emerged as the industry leader in providing specialized 
services to these types of patients. Much of VA's expertise in these 
areas remains unparalleled in the larger health care community--
particularly with regard to mental health care.
  However, it is with great dismay that I rise today, as VA's 
specialized programs are in jeopardy due to budget constraints. 
Increased demand and flatline budget increases over the past

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few years have literally starved the system. Sadly, this problem is not 
a new one. Back in 1996, Congress recognized the merits of these 
specialized programs and that they could be vulnerable to cuts because 
of their smaller scale. As such, we enacted legislation that required 
VA to retain its capacity to provide specialized services at the levels 
in place at the time of the bill's passage in 1996, and to annually 
report as to the status of its compliance with this requirement.
  Despite this effort by Congress and the actions of my predecessors on 
this Committee to subsequently strengthen the original legislation to 
protect VA's specialized services, VA continues to underfund and cut 
back resources for these vital programs. Additionally, VA has employed 
measures such as counting dollars according to 1996 levels to appear as 
if they are in compliance. In the area of mental health care, this has 
been especially true. My proposed legislation amends the statute to 
ensure that capacity funding levels are adjusted for inflation. We need 
to be talking about real dollars--not 1996 dollars--to get a true sense 
of VA's capacity to care for veterans with mental health needs.
  This legislation would also mandate that VA carry out a number of 
measures designed to improve mental health and substance abuse 
treatment capacity at Community-Based Outpatient Clinics and throughout 
the VA system. Currently, many clinics do not even provide mental 
health services at all. My bill would ensure that at least 90 percent 
of all clinics can provide mental health services, either onsite or 
through referrals. Furthermore, it would establish more comprehensive 
performance measures to provide incentives for clinics to maintain 
mental health capacity, for primary care doctors to screen patients for 
mental illness, and require that every primary health care facility be 
able to provide at least five days of inpatient detoxification 
services.
  Finally, the bill seeks to foster greater cooperation between VA and 
the Department of Defense (DoD) in treating servicemembers and 
subsequently veterans who suffer from some form of mental health or 
readjustment disorder. It has been estimated that anywhere from 20 to 
30 percent of the men and women who are currently serving in Iraq and 
Afghanistan will require treatment for a mental health issue. The bill 
would direct the two Departments to agree upon standardized separation 
screening procedures for sexual trauma and mental health disorders, as 
well as establish a joint VA-DoD Workgroup to examine potential ways of 
combating stigma associated with mental illness, educate 
servicemembers' families, and make VA's expertise in the field of 
mental health more readily available to DoD providers.
  We still have much work to do in the area of mental illness 
associated with service in the armed forces. But this bill is a step in 
the right direction. I ask my colleagues for their support of this 
bill, for it not only seeks to combat disorders that can be very 
debilitating, but it also would protect specialized services that are 
at the heart of VA's mission.
  I ask unanimous consent that the full text of the bill be printed in 
the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1177

       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 ``Veterans Mental Health Care 
     Capacity Enhancement Act of 2005''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Mental health treatment capacity at community-based 
     outpatient clinics remains inadequate and inconsistent, 
     despite the requirement under section 1706(c) of title 38, 
     United States Code, that every primary care health care 
     facility of the Department of Veterans Affairs develop and 
     carry out a plan to meet the mental health care needs of 
     veterans who require such services.
       (2) In 2001, the minority staff of the Committee on 
     Veterans' Affairs of the Senate conducted a survey of 
     community-based outpatient clinics and found that there was 
     no established systemwide baseline of acceptable mental 
     health service levels at such clinics.
       (3) In 2004, the Department of Veterans Affairs workgroup 
     on mental health care, which developed and submitted a 
     Comprehensive Mental Health Strategic Plan to the Secretary 
     of Veterans Affairs, found service and funding gaps within 
     the Department of Veterans Affairs health care system, and 
     made numerous recommendations for improvements. As of May 
     2005, Congress had not received a final report on the 
     workgroup's findings.
       (4) In February 2005, the Government Accountability Office 
     reported that the Department of Veterans Affairs had not 
     fully met any of the 24 clinical care and education 
     recommendations made in 2004 by the Special Committee on 
     Post-Traumatic Stress Disorder of the Under Secretary for 
     Health, Veterans Health Administration.

     SEC. 3. REQUIRED CAPACITY FOR COMMUNITY-BASED OUTPATIENT 
                   CLINICS.

       (a) Strengthening of Performance Measures for Mental Health 
     Programs.--Section 1706(b)(6) of title 38, United States 
     Code, is amended by adding at the end the following:
       ``(D) The Under Secretary shall include, as goals in the 
     performance contracts entered into with Network Directors to 
     prioritize mental health services--
       ``(i) establishing appropriate staff-patient ratio levels 
     for various programs (including mental health services at 
     community-based outpatient clinics);
       ``(ii) fostering collaborative environments for providers; 
     and
       ``(iii) encouraging clinicians to conduct mental health 
     consultations during primary care visits.''.
       (b) Inflationary Indexing of Capacity Requirements.--
     Section 1706(b) of title 38, United States Code, is amended 
     by adding at the end the following:
       ``(7) For the purposes of meeting and reporting on the 
     capacity requirements under paragraph (1), the Secretary 
     shall ensure that the funding levels allocated for 
     specialized treatment and rehabilitative services for 
     disabled veterans are adjusted for inflation each fiscal 
     year.''.
       (c) Mental Health and Substance Abuse Services.--Section 
     1706(c) of title 38, United States Code, is amended--
       (1) by inserting ``(1)'' before ``The Secretary''; and
       (2) by adding at the end the following:
       ``(2) The Secretary shall ensure that not less than 90 
     percent of community-based outpatient clinics have the 
     capacity to provide onsite, contract-referral, or tele-mental 
     health services--
       ``(A) for at least 10 percent of all clinic visits by not 
     later than September 30, 2006; and
       ``(B) for at least 15 percent of all clinic visits by not 
     later than September 30, 2007.
       ``(3) The Secretary shall ensure that not less than 2 years 
     after the date of enactment of this paragraph--
       ``(A) each primary care health care facility of the 
     Department has the capacity and resources to provide not less 
     than 5 days of inpatient, residential detoxification services 
     onsite or at a nearby contracted or Department facility; and
       ``(B) a case manager is assigned to coordinate follow up 
     outpatient services at each community-based outpatient 
     clinic.''.
       (d) Reporting Requirement.--Not later than January 31, 
     2008, the Secretary of Veterans Affairs shall submit a report 
     to Congress that--
       (1) describes the status and availability of mental health 
     services at community-based outpatient clinics;
       (2) describes the substance of services available at such 
     clinics;
       (3) includes the ratios between mental health staff and 
     patients at such clinics; and
       (4) includes the certification of the Inspector General of 
     the Department of Veterans Affairs.

     SEC. 4. COOPERATION ON MENTAL HEALTH AWARENESS AND 
                   PREVENTION.

       (a) Agreement.--The Secretary of Defense and the Secretary 
     of Veterans Affairs shall enter into a Memorandum of 
     Understanding--
       (1) to ensure that separating servicemembers receive 
     standardized individual mental health and sexual trauma 
     assessments as part of separation exams; and
       (2) includes the development of shared guidelines on how to 
     conduct the assessments.
       (b) Establishment of Joint VA-DOD Workgroup on Mental 
     Health.--
       (1) In general.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary of Defense and the 
     Secretary of Veterans Affairs shall establish a joint 
     workgroup on mental health, which shall be comprised of not 
     less than 7 leaders in the field of mental health appointed 
     from their respective departments.
       (2) Study.--Not later than 1 year after the establishment 
     of the workgroup under paragraph (1), the workgroup shall 
     analyze the feasibility, content, and scope of initiatives 
     related to--
       (A) combating stigmas and prejudices associated with 
     servicemembers who suffer from mental health disorders or 
     readjustment issues, through the use of peer counseling 
     programs or other educational initiatives;
       (B) ways in which the Department of Veterans Affairs can 
     make their expertise in treating mental health disorders more 
     readily available to Department of Defense mental health care 
     providers;
       (C) family and spousal education to assist family members 
     of veterans and servicemembers to recognize and deal with 
     signs of potential readjustment issues or other mental health 
     disorders; and

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       (D) seamless transition of servicemembers who have been 
     diagnosed with mental health disorders from active duty to 
     veteran status (in consultation with the Seamless Transition 
     Task Force and other entities assisting in this effort).
       (3) Report.--Not later than June 30, 2007, the Secretary of 
     Defense and the Secretary of Veterans Affairs shall submit a 
     report to Congress containing the findings and 
     recommendations of the workgroup established under this 
     subsection.

     SEC. 5. PRIMARY CARE CONSULTATIONS FOR MENTAL HEALTH.

       (a) Guidelines.--The Under Secretary for Health, Veterans 
     Health Administration, shall establish systemwide guidelines 
     for screening primary care patients for mental health 
     disorders and illnesses.
       (b) Training.--Based upon the guidelines established under 
     subsection (a), the Under Secretary for Health, Veterans 
     Health Administration, shall conduct appropriate training for 
     clinicians of the Department of Veterans Affairs to carry out 
     mental health consultations.
                                 ______