[Congressional Record Volume 154, Number 83 (Tuesday, May 20, 2008)]
[House]
[Pages H4193-H4196]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
JUSTIN BAILEY VETERANS SUBSTANCE USE DISORDERS PREVENTION AND TREATMENT
ACT OF 2008
Mr. FILNER. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 5554) to amend title 38, United States Code, to expand and
improve health care services available to veterans from the Department
of Veterans Affairs for substance use disorders, and for other
purposes, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5554
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 ``Justin Bailey Veterans
Substance Use Disorders Prevention and Treatment Act of
2008''.
SEC. 2. EXPANSION OF VETERANS SUBSTANCE USE DISORDER
PROGRAMS.
Subsection (d) of section 1720A of title 38, United States
Code, is amended by adding at the end the following new
paragraph:
``(3)(A) Each plan under paragraph (1) shall ensure that
the medical center provides ready access to a full continuum
of care for substance use disorders for veterans in need of
such care.
``(B) In this paragraph, the term `full continuum of care'
includes all of the following care, treatment, and services:
``(i) Screening for substance use disorder in all settings,
including primary care settings.
``(ii) Detoxification and stabilization services.
``(iii) Intensive outpatient care services.
``(iv) Relapse prevention services.
``(v) Outpatient counseling services.
``(vi) Residential substance use disorder treatment.
``(vii) Pharmacological treatment to reduce cravings, and
opioid substitution therapy referred to in paragraph (2).
``(viii) Coordination with groups providing peer to peer
counseling.
``(ix) Short-term, early interventions for substance use
disorders, such as motivational counseling, that are readily
available and provided in a manner to overcome stigma
associated with the provision of such interventions and
related care.
``(x) Marital and family counseling.
``(C) The Secretary shall provide for outreach to veterans
who served in Operation Enduring Freedom or Operation Iraqi
Freedom to increase awareness of the availability of care,
treatment, and services from the Department for substance use
disorders.''.
SEC. 3. REQUIREMENT FOR ALLOCATION OF DEPARTMENT RESOURCES TO
ENSURE AVAILABILITY FOR ALL VETERANS REQUIRING
TREATMENT FOR SUBSTANCE USE DISORDERS.
(a) Equitable Allocation of Funding; Annual Report.--
Section 1720A of title 38, United States Code, as amended by
section 2, is further amended by adding at the end the
following new subsection:
``(e)(1) The Secretary shall ensure that amounts made
available for care, treatment, and services provided under
this section are allocated in such a manner that a full
continuum of care (as defined in subsection (d)(3)(B)) is
available to veterans seeking such care, treatment, or
services, without regard to the location of the residence of
any such veterans.
``(2)(A) In addition to the report required under section
1703(c)(1) of this title (relating to furnishing of contract
care and services under this section), the Secretary shall
include in the budget documents which the Secretary submits
to Congress for any fiscal year a detailed report on the
care, treatment, and services furnished by the Department
under this section during the most recently completed fiscal
year.
``(B) Each report under subparagraph (A) shall include data
on the following for each medical facility of the Department:
``(i) The number of veterans who have been provided care,
treatment, or services under this section at the facility for
each 1,000 veterans who have received hospital care (if
applicable) or medical services at the facility.
``(ii) The number of veterans for whom substance use
disorder screening was carried out under subsection
(d)(3)(B)(i) at the facility.
``(iii) The number of veterans for whom a substance use
disorder was identified after a screening was carried out
under subsection (d)(3)(B)(i) at the facility.
``(iv) The number of veterans who were referred by the
facility for care, treatment, or services for substance use
disorders under this section.
``(v) The number of veterans who received care, treatment
or services at the facility for substance use disorders under
this section.
``(vi) Availability of the full continuum of care (as
defined in subsection (d)(3)(B)) at the facility.
``(C) Each report prepared under subparagraph (A) shall be
reviewed by the Committee on Care of Severely Chronically
Mentally Ill Veterans authorized by section 7321 of this
title. The Committee shall provide an independent assessment
of the care, treatment, and services furnished directly by
the Department under this section to veterans. Such
assessment shall include a detailed analysis of the
availability, the barriers to access (if any), and the
quality of such care, treatment, and services.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to fiscal years beginning on or after October 1,
2009.
SEC. 4. PILOT PROGRAM FOR INTERNET-BASED SUBSTANCE USE
DISORDER TREATMENT FOR VETERANS OF OPERATION
IRAQI FREEDOM AND OPERATION ENDURING FREEDOM.
(a) Findings.--Congress makes the following findings:
(1) Stigma associated with seeking treatment for mental
health disorders has been demonstrated to prevent some
veterans from seeking such treatment at a medical facility
operated by the Department of Defense or the Department of
Veterans Affairs.
(2) There is a significant incidence among veterans of
post-deployment mental health problems, especially among
members of a reserve component who return as veterans to
civilian life.
(3) Computer-based self-guided training has been
demonstrated to be an effective strategy for supplementing
the care of psychological conditions.
(4) Younger veterans, especially those who served in
Operation Enduring Freedom or Operation Iraqi Freedom, are
comfortable with and proficient at computer-based technology.
(5) Veterans living in rural areas find access to treatment
for substance use disorder limited.
(6) Self-assessment and treatment options for substance use
disorders through an Internet website may reduce stigma and
provides additional access for individuals seeking care and
treatment for such disorders.
(b) In General.--Not later than October 1, 2009, the
Secretary of Veterans Affairs shall initiate a pilot program
to test the feasibility and advisability of providing
veterans who seek treatment for substance use disorders
access to a computer-based self-assessment, education, and
specified treatment program through a secure Internet website
operated by the Secretary. Participation in the pilot program
is available on a voluntary basis for those veterans who have
served in Operation Enduring Freedom or Operation Iraqi
Freedom.
(c) Elements of Pilot Program.--
(1) In general.--In designing and carrying out the pilot
program under this section, the Secretary of Veterans Affairs
shall ensure that--
(A) access to the Internet website and the programs
available on the website by a veteran (or family member) does
not involuntarily generate an identifiable medical record of
that access by that veteran in any medical database
maintained by the Department;
(B) the Internet website is accessible from remote
locations, especially rural areas; and
(C) the Internet website includes a self-assessment tool
for substance use disorders, self-guided treatment and
educational materials for such disorders, and appropriate
information and materials for family members of veterans.
(2) Consideration of similar projects.--In designing the
pilot program under this section, the Secretary of Veterans
Affairs shall consider similar pilot projects of the
Department of Defense for the early diagnosis and treatment
of post-traumatic stress disorder and other mental health
conditions established under section 741 of the John Warner
National Defense Authorization Act of Fiscal Year 2007
(Public Law 109-364; 120 Stat. 2304).
(3) Location of pilot program.--The Secretary shall carry
out the pilot program through those medical centers of the
Department of Veterans Affairs that have established Centers
for Excellence for Substance Abuse Treatment and Education or
that have established a Substance Abuse Program Evaluation
and Research Center.
(4) Contract authority.--The Secretary of Veterans Affairs
may enter into contracts with qualified entities or
organizations to carry out the pilot program required under
this section.
(d) Duration of Pilot Program.--The pilot program required
by subsection (a) shall be carried out during the two-year
period beginning on the date of the commencement of the pilot
program.
(e) Authorization of Appropriations.--There are authorized
to be appropriated to the Secretary of Veterans Affairs
$1,500,000 for each of fiscal years 2010 and 2011 to carry
out the pilot program under this section.
[[Page H4194]]
(f) Report.--Not later than six months after the completion
of the pilot program, the Secretary shall submit to Congress
a report on the pilot program, and shall include in that
report an assessment of the feasibility and advisability of
the pilot program, of any cost savings or other benefits
associated with the pilot program, and recommendations for
the continuation or expansion of the pilot program.
SEC. 5. REPORT ON RESIDENTIAL MENTAL HEALTH CARE FACILITIES
OF THE VETERANS HEALTH ADMINISTRATION.
(a) Review and Report.--Not later than six months after the
date of the enactment of this Act, the Secretary of Veterans
Affairs, acting through the Office of the Medical Inspector
of the Department of Veterans Affairs, shall--
(1) conduct a review of all residential mental health care
facilities, including domiciliary facilities, of the Veterans
Health Administration; and
(2) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the review conducted under
paragraph (1).
(b) Elements of Report.--The report required by subsection
(a)(2) shall include the following:
(1) A description of the availability of care in
residential mental health care facilities in each Veterans
Integrated Service Network (VISN).
(2) An assessment of the supervision and support provided
in the residential mental health care facilities of the
Veterans Health Administration.
(3) The ratio of staff members at each residential mental
health care facility to patients at such facility.
(4) An assessment of the appropriateness of rules and
procedures for the prescription and administration of
medications to patients in such residential mental health
care facilities.
(5) A description of the protocols at each residential
mental health care facility for handling missed appointments.
(6) Any recommendations the Secretary considers appropriate
for improvements to such residential mental health care
facilities and the care provided in such facilities.
SEC. 6. TRIBUTE TO JUSTIN BAILEY.
This Act is enacted in tribute to Justin Bailey, who, after
returning to the United States from service as a member of
the Armed Forces in Operation Iraqi Freedom, died in a
domiciliary facility of the Department of Veterans Affairs
while receiving care for post-traumatic stress disorder and a
substance use disorder.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California (Mr. Filner) and the gentleman from Indiana (Mr. Buyer) each
will control 20 minutes.
The Chair recognizes the gentleman from California.
Mr. FILNER. Mr. Speaker, this bill is named after Justin Bailey, who
was a veteran of the Iraq War who died in a domiciliary facility of the
Department of Veterans Affairs while receiving care for PTSD and a
substance use disorder, a very tragic story but one that seems to be
becoming all too familiar.
We have seen in recent weeks internal communications between members
of the VA staff who we rely on to treat soldiers like Justin Bailey who
seem to not take the symptoms of PTSD or suicide very seriously. They
try to manipulate the data so we don't know all the facts. They try to
get cheaper treatment if a diagnosis other than PTSD is made, and we
are not serving our veterans when this occurs. We must not take lightly
the commitment of servicemembers like Justin Bailey who choose to
defend the country and freedoms that we enjoy.
We know the problems that veterans who have served in past wars face.
We know about post-traumatic stress disorder. We know about the high
reported incidence of substance abuse, and that it is what we call a
common co-morbidity to mental health issues. And we, of course,
unfortunately know about the high rate of homelessness. We know about
these issues because we have seen entire generations of veterans tackle
these problems, many without proper support from the VA and many who
find themselves on the streets homeless or we see in statistics on
suicide.
We must commit ourselves that whatever is necessary to prevent the
newest generation of veterans from Afghanistan and Iraq will be done so
they do not experience these same devastating issues.
There is growing concern about the reported effects of combat
deployments on Operation Enduring Freedom and Operation Iraqi Freedom
servicemembers. The suicide rates are on the rise back to where they
were in our Vietnam era.
We know the rate of post-traumatic stress disorder among these
veterans has been estimated at about a third. I think if you include
hidden symptoms of traumatic brain injury we're up to probably double
that or more.
We know that the rate of homelessness amongst this group is growing.
The same cycles that we saw with Vietnam are repeating themselves.
We cannot as a Congress, as a Nation allow this to happen again. We
must reinforce our commitment to take care of those who have served.
This is a cost of war. We're spending $1 billion, Madam Speaker, on the
Iraq and Afghanistan Wars every two days, $1 billion every 2 days.
Shouldn't our servicemembers get all the treatment they need? We have
the money. It's a question of our will and our priorities.
{time} 1400
So I urge you to support H.R. 5554. We would improve and expand the
VA health care services available for veterans for substance use
disorders, and require that all VA medical centers provide access to
the full continuum of care for these disorders.
We also want to make sure that the Secretary reaches out to our OIF/
OEF veterans with substance abuse disorders, and make sure that the
funding is in place for the full continuum of care no matter where a
veteran lives.
We also ask for a complete report on the services furnished by the
Department in the last fiscal year, and have a 2-year pilot program on
providing assessment, education and treatment via the Internet to
veterans with substance use disorders. And finally, we would require
the VA to conduct a review and report on the residential mental health
facilities within the system.
I urge my colleagues to support H.R. 5554. We will hear from
Congressman Michaud from Maine, the chairman of our Health
Subcommittee, who wrote this bill. And he will have a chance to really
explain it better after we hear from our ranking member.
Madam Speaker, I reserve the balance of my time.
Mr. BUYER. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, H.R. 5554, as amended, the Justin Bailey Veterans
Substance Use Disorders Prevention and Treatment Act of 2008, would
amend title 38, United States Code, to expand and improve health care
services available to veterans from the Department of Veterans Affairs
for substance abuse disorders.
Unfortunately, many veterans who have experienced combat trauma have
difficulty dealing with the demands of military service and/or
readjusting to home life often turn to alcohol and drugs to ease the
pain that has become part of their lives. VA has dedicated more than
$458 million to improve access and quality of care for veterans who
require substance use treatment since it began implementing the Mental
Health Strategic Plan in 2005.
H.R. 5455, however, would be much more comprehensive and require that
VA provides a ``full continuum of care'' to veterans suffering from
substance use disorders at all VA medical centers or through contracts
with local providers. This full continuum of care would include
comprehensive screening for substance use disorders in all settings,
detoxification and stabilization services, intensive outpatient and
residential care, pharmacological treatments, and peer-to-peer and
family and marital counseling.
This legislation would also direct VA to conduct a pilot program for
Internet-based substance use disorder treatment for veterans of
Operations Iraqi Freedom and Enduring Freedom.
Some of our veterans are confronted with a new form of challenge in
their life, which for some is greater than the warfare which they had
faced, where it has no clear front and has no clear refuge. And in the
case of our OIF/OEF veterans in the wars in Iraq and Afghanistan, over
30 percent of those veterans who have received VA care have been
diagnosed with a possible mental health problem and 12 percent of these
with a possible substance use disorder.
Outreach to every veteran is critical, and I'm pleased that under the
leadership of Secretary Peake, VA has started contacting nearly 570,000
recent combat veterans to talk to them about available VA medical care
and benefits.
Providing a full continuum of care in all settings will go a long way
to enhance access to care and help at-risk veterans recognize the
signs, treat the symptoms, and overcome the stigma that prevents many
veterans from seeking care.
[[Page H4195]]
Problems associated with substance use disorder can have lasting
effects on the mental and physical health of our veterans, and I
commend the Subcommittee on Health Chairman Michaud and Ranking Member
Miller for their leadership on the bill.
We can make significant progress in ensuring that the mental health
wellness care that veterans seek and deserve is available with the
passage of this bill.
Madam Speaker, I reserve the balance of my time.
Mr. FILNER. Madam Speaker, I yield 2 minutes to the author of the
bill and the Chair of our Health Subcommittee of the Veterans'
Committee in the Congress, the gentleman from Maine (Mr. Michaud).
Mr. MICHAUD. Thank you, Mr. Chairman.
I rise today in support of H.R. 5554, the Justin Bailey Veterans
Substance Use Disorders Prevention and Treatment Act of 2008. This
legislation does amend title 38, United States Code, to expand and
improve health care services available to veterans for substance use
disorders.
It requires that all VA medical centers provide ready access to a
full continuum of care for substance use disorders. And it explicitly
defines that ``full continuum of care'' as ranging from initial
screening through outpatient care and family therapy. We have an
obligation to take care of the men and women who chose to fight for our
freedom and the freedom of all oppressed people.
This legislation had strong bipartisan support during its
development. I want to thank members of the Health Care Subcommittee,
especially Mr. Miller, for their support and contributions to this
legislation, as well as the committee staff on both sides of the aisle.
I also would like to thank Congresswoman Berkley, who has been a true
advocate for our veterans, and who has been strongly involved in the
development of this legislation as well.
I also want to thank you, Mr. Chairman, for your leadership, as well
as Ranking Member Buyer for your leadership in this legislation. I
encourage my colleagues to support it.
Mr. BUYER. I urge my colleagues to adopt this legislation, and I
yield back the balance of my time.
Mr. FILNER. Madam Speaker, I yield 5 minutes to a very active,
aggressive member of our committee, who is always there when we need
her, the gentlelady from Nevada (Ms. Berkley).
Ms. BERKLEY. Madam Speaker, I also would like to thank the chairman
of our full committee, Mr. Filner, for being so supportive, and the
chairman of our subcommittee, Mr. Michaud, for helping to make this
legislation a reality today. I'm very grateful for the opportunity to
be part of this important piece of legislation.
Nationally, one in five veterans returning from Iraq and Afghanistan
suffer from PTSD. Twenty-three percent of members of the Armed Forces
on active duty acknowledge that they have a significant problem with
alcohol. Veterans must receive the help they need to deal with these
conditions.
The effects of substance abuse are devastating, including
significantly increased risk of suicide, exacerbation of mental and
physical health disorders, breakdown of family support, and increased
risk of unemployment and homelessness. Veterans suffering from mental
health problems are at increased risk for developing a substance abuse
disorder.
A constituent of mine, Lance Corporal Justin Bailey, was a 1998
graduate of Las Vegas High School. Upon returning from a tour of duty
in Iraq, he was diagnosed with PTSD and was discharged from the Marines
in 2004. He developed a substance abuse disorder, and with the
encouragement of his parents, checked himself into a VA facility in
west Los Angeles to get the treatment that he needed and recognized
that he needed.
He sought treatment for a drug abuse problem, and yet he was given
five additional medications on a self-medication program. With those
five additional medications in his system, Justin overdosed and died on
January 26, 2007.
The loss of a child is devastating enough, but what made matters
worse is the way that Justin's parents were treated by the VA. They
were treated with indifference and apathy at the West L.A. facility
that their son died at. They were handed Justin's belongings in a trash
bag.
Last August, 8 months after Justin's death, the Baileys returned to
Los Angeles to meet with the Chief of Staff at the West L.A. facility.
They came away from the meeting feeling that the Chief of Staff had
been completely unprepared and seemed out of touch with the needs of
the veterans. The Chief of Staff went so far as to state that his staff
didn't know how to treat veterans of the Iraq and Afghan war because
they were young, and the staff was not tough enough on these younger
veterans, they tended to give them anything they asked for.
I'm very pleased that the committee included my amendment to require
the VA to conduct a review of all residential mental health care
facilities, including domiciliary facilities, and agree to rename the
bill in Justin's honor. I know this means a great deal to Justin's
family.
Passage of the Justin Bailey Substance Use Disorder Treatment and
Prevention Act will help to ensure that we have the mental health
resources and substance abuse treatment programs needed to care for our
veterans. The assessments of residential mental health facilities
required will help us to learn how well the VA is performing and what
we can do to improve these services, including expanded availability at
VA hospitals.
The availability of treatment for PTSD, including substance abuse
disorder counseling, will save many lives. This must remain a top
priority.
A review of the services provided to our veterans is needed to ensure
that what happened to Justin does not happen to anyone else ever again.
It's imperative that we provide adequate mental health services for
those who have sacrificed for our great Nation and those who continue
to serve.
I wholeheartedly support H.R. 5554 and urge my colleagues to do the
same.
Mr. FILNER. I want to thank the gentlelady from Nevada for putting a
real face to this problem. I know it means a lot to the family, but it
means a lot to all of us. So thank you.
Another great member of our committee, Mr. Rodriguez from Texas,
dealt with mental health issues in his previous life, and I will yield
to him as much time as he might consume.
Mr. RODRIGUEZ. Thank you, Mr. Chairman. And I want to personally
thank you for this piece of legislation.
I had the pleasure and the opportunity to serve 7 years in the area
of mental health and work with heroin addicts, substance abusers and
community mental health.
One of the things that I've realized is that a lot of people that do
substance abuse as the result of having mental health problems as well
as post-traumatic stress. During the Vietnam War, we left our soldiers
and we abandoned them. A large number of them now find themselves as
part of those statistics of being homeless. Part of the statistics are
a large number of veterans that are committing suicide. This program
that will allow the continuum of care is going to allow an opportunity
for them to be able to get access to service. I want to thank both
sides and the chairman for their leadership in this area.
In addition, let me just say that this area is one of the areas where
we really need to make an emphasis. I am really pleased to see that,
because when you do abuse drugs, when people do abuse alcohol, one of
the difficulties is the fact that the family gets impacted. This allows
an opportunity for that intervention to occur.
Thank you very much, and congratulations on this legislation.
Mr. FILNER. Thank you, Mr. Rodriguez, for your expertise.
General Leave
Mr. FILNER. Madam Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and include extraneous material on H.R. 5554, as amended.
The SPEAKER pro tempore (Mrs. Tauscher). Is there objection to the
request of the gentleman from California?
There was no objection.
Mr. CONYERS. Madam Speaker, I rise to voice my strong support for
H.R. 5554, the ``Justin Bailey Veterans Substance Use Disorders
Prevention and Treatment Act of
[[Page H4196]]
2008.'' This legislation grants to our veterans access to a
comprehensive continuum of substance abuse treatment services provided
by Department of Veterans Affairs medical centers. The bill also
requires the Secretary of Veterans Affairs to inform veterans of
Operations Enduring Freedom or Iraqi Freedom about the availability of
such care.
Madam Speaker, we have sent thousands of otherwise healthy young men
and women to Iraq and Afghanistan to fight. Many of those who were
lucky enough to escape unscathed physically, are suffering agonizing
symptoms emotionally. Depression, anxiety, and symptoms of post-
traumatic stress disorder plague countless veterans returning from the
battlefield. Without proper treatment, our veterans turn to self-
medicating these psychiatric symptoms by abusing alcohol and other
substances.
It would be negligent, if not hypocritical, of us not to offer
comprehensive substance abuse treatment for all returning veterans.
This legislation ensures that a ``continuum'' of services, including
screening for substance use disorders, detoxification and stabilization
services, intensive outpatient services, relapse prevention services,
counseling services, and other necessary services, are offered to our
returning veterans.
Of course, these services require funding. H.R. 5554 ensures that
funding for a full continuum of substance abuse treatment is made
available to veterans seeking such care. Although H.R. 5554 authorizes
a pilot program for Internet-based substance use disorder treatment,
let us not sell our veterans short by cutting corners on care. More
funding is needed to ensure that enough psychiatrists, nurses,
psychologists, and social workers are available to care for our
returning veterans. As well, more research funding is required in order
to better understand and treat disorders of substance abuse and
dependence which plague our veterans.
Madam Speaker, I find it appalling that we ask our young men and
women in the Armed Forces to sacrifice life and limb overseas in Iraq
and Afghanistan, yet when those very soldiers return home, we deny them
vital mental health and substance abuse treatment services. Let us
begin to right this wrong by supporting H.R. 5554, and improve
substance abuse treatment services available to our veterans.
Mr. FILNER. Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from California (Mr. Filner) that the House suspend the rules
and pass the bill, H.R. 5554, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
____________________