[Congressional Record Volume 153, Number 51 (Friday, March 23, 2007)]
[Senate]
[Pages S3716-S3718]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. CLINTON (for herself, Ms. Collins, Mr. Bingaman, and Ms. 
        Mikulski):
  S. 982. A bill to amend the Public Health Service Act to provide for 
integration of mental health services and mental health treatment 
outreach teams, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mrs. CLINTON. Mr. President, today, Senator Collins and I are 
reintroducing the Positive Aging Act, to improve the accessibility and 
quality of mental health services for our rapidly growing population of 
older Americans. I want to thank Senator Collins for her leadership on 
aging issues, and for partnering with me on numerous pieces of 
legislation and initiatives related to these and other important health 
issues.
  We are pleased to be reintroducing this important legislation in 
anticipation of reauthorization of the Substance Abuse and Mental 
Health Services Administration (SAMHSA).
  I want to acknowledge and thank our partners from the mental health 
and aging community who have collaborated with us and have been working 
diligently on these issues for many years, including the American 
Psychological Association, the American Association for Geriatric 
Psychiatry, the National Association of Social Workers, the Alzheimer's 
Association, the New York City Chapter of the Alzheimer's Association, 
the American Association of Homes and Services for the Aging, the 
American Academy of Child and Adolescent Psychiatry, the American 
Mental Health Counselors Association, the American Society on Aging, 
the Depression and Bipolar Support Alliance, the Geriatric Mental 
Health Alliance of New York, the Gerontological Society of America, 
Mental Health America, the National Association of State Mental Health 
Program Directors, the National Council on Aging, Psychologists in Long 
Term Care, the Older Women's League, the Society of Clinical 
Geropsychology, the Suicide Prevention Action Network USA, and all the 
other groups who have lent their support.
  American society today has benefited tremendously from advances in 
medical science that are helping us to live longer than ever before. In 
New York State alone, there are an estimated two and a half million 
citizens aged 65 or older. And this population will only continue to 
grow as the first wave of Baby Boomers turns 65 in less than ten years.
  According to a December 2006 report from the U.S. Census Bureau, the 
number of older Americans aged 65 and over is expected to double over 
the next 25 years, and nearly 20 percent of citizens will be 65 years 
or older by the year 2030. Further, the fastest growing segment of the 
U.S. population is the age group of Americans who are 85 and older.
  Although it is encouraging that our Nation's citizens are living 
longer than ever before, mental and behavioral health challenges 
accompany this increased longevity. So as we look forward to leading 
longer lives, we must also acknowledge the challenges that we face 
related to the quality of life as we age.
  Although most older adults enjoy good mental health, it is estimated 
that nearly 20 percent of Americans age 55 or older experience a mental 
disorder. In New York State alone, there are an estimated 366,000 
adults aged 55 or older with mental health or substance abuse 
disorders. Nationally, it is anticipated that the number of seniors 
with mental and behavioral health problems will almost quadruple, from 
4 million in 1970 to 15 million in 2030.
  Among the most prevalent mental health concerns older adults 
encounter are anxiety, depression, cognitive impairment, and substance 
abuse. When left untreated, these problems can have severe physical and 
psychological implications. In fact, men age 85 and older have the 
highest rates of suicide in our country and depression is the foremost 
risk factor.
  The physical consequences of mental health disorders can be both 
expensive and debilitating. Depression has a powerful negative impact 
on ability to function, resulting in high rates of disability. The 
World Health Organization projects that by the year 2020, depression 
will remain a leading cause of disability, second only to 
cardiovascular disease. Even mild depression lowers immunity and may 
compromise a person's ability to fight infections and cancers. Research 
indicates that 50-70 percent of all primary care medical visits are 
related to psychological factors such as anxiety, depression, and 
stress. Further, evidence suggests that an estimated 75 percent of 
seniors who commit suicide have visited a primary care professional 
within a month of their death.
  Mental disorders do not have to be a part of the aging process 
because we have effective treatments for these conditions. But despite 
these effective treatments, too many American seniors go without the 
services they need and deserve because of poor integration of physical 
and mental health care. As of 2006, only 37 percent of New Yorkers who 
suffer from depression had obtained mental health treatment.
  The current divide in our country between health care and mental 
health care manifests itself in many ways. Too often physicians and 
other health professionals fail to recognize the signs and symptoms of 
mental health problems. Even more troubling, knowledge about treatment 
is simply not accessible to many primary care practitioners. As a 
whole, we have failed to fully integrate mental health screening and 
treatment into our health service systems.
  These missed opportunities to diagnose and treat mental health 
disorders are taking a tremendous toll on seniors and increasing the 
burden on their families and our health care system.
  It is within our power and our responsibility to bridge the gap 
between physical and mental health care and help promote the well-being 
of older Americans.
  In last year's reauthorization of the Older Americans Act, Senator 
Collins and I successfully enacted Title I of the Positive Aging Act of 
2005, which authorized grants for the delivery of mental health 
screening and treatment

[[Page S3717]]

services for older adults and grants to promote awareness and reduce 
stigma regarding mental disorders in later life.
  While this took an important step toward improving mental health 
services for older adults, significant efforts are necessary to ensure 
comprehensive geriatric mental health care.
  That is why I am reintroducing the Title II provisions of the 
Positive Aging Act of 2005 as the Positive Aging Act of 2007 with my 
cosponsor Senator Collins. This legislation would amend the Public 
Health Service Act to improve access to mental health services for our 
nation's seniors by integrating mental health services into primary 
care and community settings.
  Specifically, the Positive Aging Act of 2007 would fund demonstration 
projects to support integration of mental health services in primary 
care settings.
  It would fund grants for community-based mental health treatment 
outreach teams to improve older Americans' access to mental health 
services.
  This legislation would also ensure that these geriatric mental health 
programs have proper attention and oversight by: mandating the 
designation of a Deputy Director for Older Adult Mental Health Services 
in the Center for Mental Health Services; including representatives of 
older Americans or their families and geriatric mental health 
professionals on the Advisory Council for the Center for Mental Health 
Services; and requiring state plans under Community Mental Health 
Services Block Grants to include descriptions of the states' outreach 
to and services for older individuals.
  And because substance-related disorders require the same attention as 
mental health conditions, the Positive Aging Act of 2007 will target 
substance abuse in older adults in projects of national significance.
  Today, we are fortunate to have a variety of effective treatments to 
address the mental health needs of American seniors. I believe that we 
owe it to older adults in this country to do all that we can to ensure 
that they have access to high quality mental health care, so they can 
enjoy their golden years.
  The Positive Aging Act of 2007 takes a critical step in this 
direction, and I look forward to working with my colleagues to enact 
this legislation during the upcoming SAMHSA reauthorization.
  Mr. President, I ask unanimous consent that letters of support be 
printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                              National Association


                                            of Social Workers,

                                    Washington, DC, March 23, 2007
     Senator Hillary Rodham Clinton,
     Russell Senate Office Building
     Washington, DC.
     Senator Susan M. Collins,
     Dirkson Senate Office Building,
     Washington, DC.
       Dear Senators Clinton and Collins: The National Association 
     of Social Workers (NASW) is the largest professional social 
     work organization, with 150,000 members nationwide. NASW 
     promotes, develops, and protects the practice of social work 
     and social workers, while enhancing the well-being of 
     individuals, families, and communities through its work, 
     service, and advocacy.
       NASW fully supports the Positive Aging Act of 2007, which 
     you are introducing today, along with Representatives Patrick 
     Kennedy (D-MA) and Ileana Ros-Lehtinen (R-FL). Many older 
     adults are currently unable to obtain much-needed mental 
     health services for a variety of reasons, including lack of 
     access and the stigma attached to mental illness. The 
     Positive Aging Act of 2007 will help integrate primary care 
     with mental health care for older adults, particularly those 
     with low incomes, living in community settings.
       Social workers are aware of the problems older people 
     encounter in obtaining necessary mental health care. 
     Frequently, they are called upon to address older adults' 
     mental health needs only after crises arise, when the 
     emotional toll on clients and their families is much higher, 
     and the costs to Medicare are much more significant.
       Clinical social workers assess and treat many older 
     Americans with mental health needs. In fact, more than 39,000 
     social workers now participate in Medicare, delivering mental 
     health services and enabling many thousands of older 
     beneficiaries to lead more fulfilling and healthier lives.
       NASW is particularly supportive of the multidisciplinary 
     teams of mental health professionals envisioned in this bill 
     as an integral part of primary care services. These teams, 
     which include professional social workers, will have the 
     training and competence to meet older Americans' diverse 
     physical and behavioral health needs. The Association 
     commends the senators and representatives for raising these 
     vital health issues, and urges Congress to move quickly to 
     enact this legislation.
       Thank you for your leadership on this vital health care 
     issue.
           Sincerely,
                                                   Carolyn Polowy,
     General Counsel.
                                  ____



                           American Psychological Association,

                                                   March 23, 2007.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
     Hon. Susan M. Collins,
     U.S. Senate,
     Washington, DC.
       Dear Senators Clinton and Collins: On behalf of the 148,000 
     members and affiliates of the American Psychological 
     Association (APA), I am writing to applaud your ongoing 
     commitment to the mental and behavioral health needs of older 
     Americans and express our strong support for the Positive 
     Aging Act of 2007. This important legislation will improve 
     access to vital mental and behavioral health care for older 
     adults by supporting the integration of mental health 
     services into primary care and community settings.
       An estimated 20 percent of community-based older adults in 
     the U.S. have a mental health problem. These disorders can 
     have a significant impact on both physical and mental health, 
     often leading to increases in disease, disability, and 
     mortality. Evidence suggests that up to 75 percent of older 
     adults who commit suicide have visited a primary care 
     professional within 30 days of their death. Although 
     effective treatments exist, the mental health needs of many 
     older Americans go unrecognized and untreated because of 
     poorly integrated systems of care to address the physical and 
     mental health needs of seniors.
       The Positive Aging Act of 2007 takes an important step 
     toward improving access to quality mental and behavioral 
     health care for older adults by integrating mental health 
     services into primary care and community settings where older 
     adults reside and receive services. By supporting 
     collaboration between interdisciplinary teams of mental 
     health professionals and other providers of health and social 
     services, this legislation promotes an integrated approach to 
     addressing the health and well being of our nation's growing 
     older adult population.
       We commend you for your leadership and commitment to the 
     mental and behavioral health needs of older adults and look 
     forward to working with you to ensure enactment of the 
     Positive Aging Act. If we can be of further assistance, 
     please feel free to contact Diane Elmore, Ph.D., in our 
     Government Relations Office at (202) 336-6104 or 
     [email protected].
           Sincerely,

                                      Gwendolyn Puryear Keita,

                                               Executive Director,
     Public Interest Directorate.
                                  ____


    Positive Aging Act of 2007 Organizational Supporters--March 2007

       Alzheimer's Association; Alzheimer's Association, New York 
     City Chapter; American Academy of Child and Adolescent 
     Psychiatry; American Association for Geriatric Psychiatry; 
     American Association of Homes and Services for the Aging; 
     American Association of Pastoral Counselors; American Group 
     Psychotherapy Association; American Mental Health Counselors 
     Association; American Occupational Therapy Association; 
     American Psychological Association; American Psychotherapy 
     Association; American Society on Aging; Anxiety Disorders 
     Association of America; Association for Ambulatory Behavioral 
     Healthcare; Bazelon Center for Mental Health Law; Clinical 
     Social Work Association; Clinical Social Work Guild 49, 
     OPEIU; Depression and Bipolar Support Alliance; Geriatric 
     Mental Health Alliance of New York; Gerontological Society of 
     America.
       Kansas Mental Health and Aging Coalition; Mental Health 
     America; Mental Health and Aging Coalition of Eastern Kansas; 
     National Alliance for Caregiving; National Association for 
     Children's Behavioral Health; National Association of Mental 
     Health Planning and Advisory Councils; National Association 
     of Psychiatric Health Systems; National Association of Social 
     Workers; National Association of State Mental Health Program 
     Directors; National Council on Aging; Oklahoma Mental Health 
     and Aging Coalition; Older Adult Consumers Alliance Older 
     Women's League; Pennsylvania Behavioral Health and Aging 
     Coalition; Psychologists in Long Term Care; Society of 
     Clinical Geropsychology; Suicide Prevention Action Network 
     USA.
                                  ____

                                              American Association


                                     for Geriatric Psychiatry,

                                     Bethesda, MD, March 20, 2007.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: The American Association for 
     Geriatric Psychiatry (AAGP) is

[[Page S3718]]

     pleased to endorse the ``Positive Aging Act of 2007.''
       The ``Positive Aging Act'' will improve the accessibility 
     and quality of mental health services for the rapidly growing 
     population of older Americans. Through projects administered 
     by the Substance Abuse and Mental Health Services 
     Administration, this legislation will integrate mental health 
     services with other primary care services in community 
     settings that are easily accessible to the elderly.
       Dementia, depression, anxiety and substance abuse among 
     Americans over age 65 are growing problems that result in 
     functional dependence, longterm institutional care and 
     reduced quality of life. Missed opportunities to diagnose and 
     treat mental diseases are taking a tremendous toll on the 
     elderly and increasing the burden on families and the health 
     care system. The ``Positive Aging Act'' will increase 
     opportunities for effective diagnosis and treatment of mental 
     disorders among the elderly.
       AAGP is a professional membership organization dedicated to 
     promoting the mental health and well-being of older people 
     and improving the care of those with late-life mental 
     disorders. AAGP's membership consists of 2,000 geriatric 
     psychiatrists, as well as other health professionals who 
     focus on the mental health problems faced by senior citizens. 
     In addition, AAGP has an active Foundation which focuses on 
     reducing the stigma of mental disorders in the aging 
     population.
       AAGP appreciates your leadership in addressing the mental 
     health needs of older Americans, and we look forward to 
     working with you on this legislation.
           Sincerely,
                                                Christine deVries,
     Executive Director.

                          ____________________