[Congressional Record Volume 154, Number 90 (Tuesday, June 3, 2008)]
[Senate]
[Pages S4983-S4986]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
VETERANS MENTAL HEALTH AND OTHER CARE IMPROVEMENTS ACT OF 2008
Mrs. BOXER. Mr. President, I ask unanimous consent that the Senate
proceed to the immediate consideration of Calendar No. 632, S. 2162.
The PRESIDING OFFICER. The clerk will report the bill by title.
The legislative clerk read as follows:
A bill (S. 2162) to improve the treatment and services
provided by the Department of Veterans Affairs to veterans
with post-traumatic stress disorder and substance use
disorders, and for other purposes.
There being no objection, the Senate proceeded to consider the bill,
which had been reported from the Committee on Veterans' Affairs, with
an amendment, as follows:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans
Mental Health Improvements Act of 2008''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--SUBSTANCE USE DISORDERS AND MENTAL HEALTH CARE
Sec. 101. Findings on substance use disorders and mental health.
Sec. 102. Expansion of substance use disorder treatment services
provided by Department of Veterans Affairs.
Sec. 103. Care for veterans with mental health and substance use
disorders.
Sec. 104. National centers of excellence on post-traumatic stress
disorder and substance use disorders.
Sec. 105. Report on residential mental health care facilities of the
Veterans Health Administration.
Sec. 106. Tribute to Justin Bailey.
TITLE II--MENTAL HEALTH ACCESSIBILITY ENHANCEMENTS
Sec. 201. Pilot program on peer outreach and support for veterans and
use of community mental health centers and Indian Health
Service facilities.
TITLE III--RESEARCH
Sec. 301. Research program on comorbid post-traumatic stress disorder
and substance use disorders.
Sec. 302. Extension of authorization for Special Committee on Post-
Traumatic Stress Disorder.
TITLE IV--ASSISTANCE FOR FAMILIES OF VETERANS
Sec. 401. Clarification of authority of Secretary of Veterans Affairs
to provide mental health services to families of
veterans.
Sec. 402. Pilot program on provision of readjustment and transition
assistance to veterans and their families in cooperation
with Vet Centers.
TITLE I--SUBSTANCE USE DISORDERS AND MENTAL HEALTH CARE
SEC. 101. FINDINGS ON SUBSTANCE USE DISORDERS AND MENTAL
HEALTH.
Congress makes the following findings:
(1) More than 1,500,000 members of the Armed Forces have
been deployed in Operation Iraqi Freedom and Operation
Enduring Freedom. The 2005 Department of Defense Survey of
Health Related Behaviors Among Active Duty Personnel reports
that 23 percent of members of the Armed Forces on active duty
acknowledge a significant problem with alcohol use, with
similar rates of acknowledged problems with alcohol use among
members of the National Guard.
(2) The effects of substance abuse are wide ranging,
including significantly increased risk of suicide,
exacerbation of mental and physical health disorders,
breakdown of family support, and increased risk of
unemployment and homelessness.
(3) While veterans suffering from mental health conditions,
chronic physical illness, and polytrauma may be at increased
risk for development of a substance use disorder, treatment
for these veterans is complicated by the need to address
adequately the physical and mental symptoms associated with
these conditions through appropriate medical intervention.
(4) While the Veterans Health Administration has
dramatically increased health services for veterans from 1996
through 2006, the number of veterans receiving specialized
substance abuse treatment services decreased 18 percent
during that time. No comparable decrease in the national rate
of substance abuse has been observed during that time.
(5) While some facilities of the Veterans Health
Administration provide exemplary substance use disorder
treatment services, the availability of such treatment
services throughout the health care system of the Veterans
Health Administration is inconsistent.
(6) According to the Government Accountability Office, the
Department of Veterans Affairs significantly reduced its
substance use disorder treatment and rehabilitation services
between 1996 and 2006, and has made little progress since in
restoring these services to their pre-1996 levels.
SEC. 102. EXPANSION OF SUBSTANCE USE DISORDER TREATMENT
SERVICES PROVIDED BY DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall
ensure the provision of such services and treatment to each
veteran enrolled in the health care system of the Department
of Veterans Affairs who is in need of services and treatments
for a substance use disorder as follows:
(1) Short term motivational counseling services.
(2) Intensive outpatient or residential care services.
(3) Relapse prevention services.
(4) Ongoing aftercare and outpatient counseling services.
(5) Opiate substitution therapy services.
(6) Pharmacological treatments aimed at reducing craving
for drugs and alcohol.
(7) Detoxification and stabilization services.
(8) Such other services as the Secretary considers
appropriate.
(b) Provision of Services.--The services and treatments
described in subsection (a) may be provided to a veteran
described in such subsection--
(1) at Department of Veterans Affairs medical centers or
clinics;
(2) by referral to other facilities of the Department that
are accessible to such veteran; or
(3) by contract or fee-form service payments with
community-based organizations for the provision of such
services and treatments.
(c) Alternatives in Case of Services Denied Due to Clinical
Necessity.--If the Secretary denies the provision to a
veteran of services or treatment for a substance use disorder
due to clinical necessity, the Secretary shall provide the
veteran such other services or treatments as are medically
appropriate.
(d) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report setting forth, for each medical
facility of the Department, the availability of the
following:
(1) Medically supervised withdrawal management.
(2) Programs for treatment of alcohol and other substance
use disorders that are--
(A) integrated with primary health care services; or
(B) available as specialty substance use disorder services.
(3) Specialty programs for the treatment of post-traumatic
stress disorder.
(4) Programs to treat veterans who are diagnosed with both
a substance use disorder and a mental health disorder.
SEC. 103. CARE FOR VETERANS WITH MENTAL HEALTH AND SUBSTANCE
USE DISORDERS.
(a) In General.--If the Secretary of Veterans Affairs
provides a veteran inpatient or outpatient care for a
substance use disorder and a comorbid mental health disorder,
the Secretary shall ensure that treatment for such disorders
is provided concurrently--
(1) through a service provided by a clinician or health
professional who has training and expertise in treatment of
substance use disorders and mental health disorders;
(2) by separate substance use disorder and mental health
disorder treatment services when there is appropriate
coordination, collaboration, and care management between such
treatment services; or
(3) by a team of clinicians with appropriate expertise.
(b) Team of Clinicians With Appropriate Expertise
Defined.--In this section, the term ``team of clinicians with
appropriate expertise'' means a team consisting of the
following:
(1) Clinicians and health professionals with expertise in
treatment of substance use disorders
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and mental health disorders who act in coordination and
collaboration with each other.
(2) Such other professionals as the Secretary considers
appropriate for the provision of treatment to veterans for
substance use and mental health disorders.
SEC. 104. NATIONAL CENTERS OF EXCELLENCE ON POST-TRAUMATIC
STRESS DISORDER AND SUBSTANCE USE DISORDERS.
(a) In General.--Subchapter II of chapter 73 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 7330A. National centers of excellence on post-
traumatic stress disorder and substance use disorders
``(a) Establishment of Centers.--(1) The Secretary shall
establish not less than six national centers of excellence on
post-traumatic stress disorder and substance use disorders.
``(2) The purpose of the centers established under this
section is to serve as Department facilities that provide
comprehensive inpatient or residential treatment and recovery
services for veterans diagnosed with both post-traumatic
stress disorder and a substance use disorder.
``(b) Location.--Each center established in accordance with
subsection (a) shall be located at a medical center of the
Department that--
``(1) provides specialized care for veterans with post-
traumatic stress disorder and a substance use disorder; and
``(2) is geographically situated in an area with a high
number of veterans that have been diagnosed with both post-
traumatic stress disorder and substance use disorder.
``(c) Process of Referral and Transition to Step Down
Diagnosis Rehabilitation Treatment Programs.--The Secretary
shall establish a process to refer and aid the transition of
veterans from the national centers of excellence on post-
traumatic stress disorder and substance use disorders
established pursuant to subsection (a) to programs that
provide step down rehabilitation treatment for individuals
with post-traumatic stress disorder and substance use
disorders.
``(d) Collaboration With the National Center for Post-
Traumatic Stress Disorder.--The centers established under
this section shall collaborate in the research of the
National Center for Post-Traumatic Stress Disorder.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 73 of such title is amended by inserting
after the item relating to section 7330 the following new
item:
``7330A. National centers of excellence on post-traumatic stress
disorder and substance use disorders.''.
SEC. 105. REPORT ON RESIDENTIAL MENTAL HEALTH CARE FACILITIES
OF THE VETERANS HEALTH ADMINISTRATION.
(a) Reviews.--The Secretary of Veterans Affairs shall,
acting through the Office of Mental Health Services of the
Department of Veterans Affairs--
(1) not later than six months after the date of the
enactment of this Act, conduct a review of all residential
mental health care facilities, including domiciliary
facilities, of the Veterans Health Administration; and
(2) not later than two years after the date of the
completion of the review required by paragraph (1), conduct a
follow-up review of such facilities to evaluate any
improvements made or problems remaining since the review
under paragraph (1) was completed.
(b) Report.--Not later than 90 days after the completion of
the review required by subsection (a)(1), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report on such review. The report 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. 106. TRIBUTE TO JUSTIN BAILEY.
This title 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.
TITLE II--MENTAL HEALTH ACCESSIBILITY ENHANCEMENTS
SEC. 201. PILOT PROGRAM ON PEER OUTREACH AND SUPPORT FOR
VETERANS AND USE OF COMMUNITY MENTAL HEALTH
CENTERS AND INDIAN HEALTH SERVICE FACILITIES.
(a) Pilot Program Required.--Commencing not later than 180
days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall carry out a pilot program
to assess the feasability and advisability of providing to
veterans of Operation Iraqi Freedom and Operation Enduring
Freedom, and, in particular, veterans who served in such
operations as a member of the National Guard or Reserve, the
following:
(1) Peer outreach services.
(2) Peer support services provided by licensed providers of
peer support services or veterans who have personal
experience with mental illness.
(3) Readjustment counseling services described in section
1712A of title 38, United States Code.
(4) Other mental health services.
(b) Provision of Certain Services.--In providing services
described in paragraphs (3) and (4) of subsection (a) under
the pilot program to veterans who reside in rural areas and
do not have adequate access through the Department of
Veterans Affairs to the services described in such
paragraphs, the Secretary shall, acting through the Office of
Mental Health Services and the Office of Rural Health,
provide such services as follows:
(1) Through community mental health centers or other
entities under contracts or other agreements for the
provision of such services that are entered into for purposes
of the pilot program.
(2) Through the Indian Health Service pursuant to a
memorandum of understanding entered into by the Secretary of
Veterans Affairs and the Secretary of Health and Human
Services for purposes of the pilot program.
(c) Duration.--The pilot program shall be carried out
during the three-year period beginning on the date of the
commencement of the pilot program.
(d) Program Locations.--
(1) In general.--The pilot program shall be carried out
within areas selected by the Secretary for the purpose of the
pilot program in at least two Veterans Integrated Service
Networks (VISN).
(2) Rural geographic locations.--The locations selected
shall be in rural geographic locations that, as determined by
the Secretary, lack access to comprehensive mental health
services through the Department of Veterans Affairs.
(3) Qualified providers.--In selecting locations for the
pilot program, the Secretary shall select locations in which
an adequate number of licensed mental health care providers
with credentials equivalent to those of Department mental
health care providers are available in Indian Health Service
facilities, community mental health centers, and other
entities are available for participation in the pilot
program.
(e) Participation in Program.--Each community mental health
center, facility of the Indian Health Service, or other
entity participating in the pilot program under subsection
(b) shall--
(1) provide the services described in paragraphs (3) and
(4) of subsection (a) to eligible veterans, including, to the
extent practicable, telehealth services that link the center
or facility with Department of Veterans Affairs clinicians;
(2) use the clinical practice guidelines of the Veterans
Health Administration or the Department of Defense in the
provision of such services; and
(3) meet such other requirements as the Secretary shall
require.
(f) Compliance With Department Protocols.--Each community
mental health center, facility of the Indian Health Service,
or other entity participating in the pilot program under
subsection (b) shall comply with--
(1) applicable protocols of the Department before incurring
any liability on behalf of the Department for the provision
of services as part of the pilot program; and
(2) access and quality standards of the Department relevant
to the provision of services as part of the pilot program.
(g) Provision of Clinical Information.--Each community
mental health center, facility of the Indian Health Service,
or other entity participating in the pilot program under
subsection (b) shall, in a timely fashion, provide the
Secretary with such clinical information on each veteran for
whom such health center or facility provides mental health
services under the pilot program as the Secretary shall
require.
(h) Training.--
(1) Training of veterans.--As part of the pilot program,
the Secretary shall carry out a program of training for
veterans described in subsection (a) to provide the services
described in paragraphs (1) and (2) of such subsection.
(2) Training of clinicians.--
(A) In general.--The Secretary shall conduct a training
program for clinicians of community mental health centers,
Indian Health Service facilities, or other entities
participating in the pilot program under subsection (b) to
ensure that such clinicians can provide the services
described in paragraphs (3) and (4) of subsection (a) in a
manner that accounts for factors that are unique to the
experiences of veterans who served on active duty in
Operation Iraqi Freedom or Operation Enduring Freedom
(including their combat and military training experiences).
(B) Participation in training.--Personnel of each community
mental health center, facility of the Indian Health Service,
or other entity participating in the pilot program under
subsection (b) shall participate in the training program
conducted pursuant to subparagraph (A).
(i) Annual Reports.--Each community mental health center,
facility of the Indian Health Service, or other entity
participating in the pilot program under subsection (b) shall
submit to the Secretary on an annual basis a report
containing, with respect to the provision of services under
subsection (b) and for the last full calendar year ending
before the submission of such report--
(1) the number of--
(A) veterans served; and
(B) courses of treatment provided; and
(2) demographic information for such services, diagnoses,
and courses of treatment.
(j) Program Evaluation.--
(1) In general.--The Secretary shall, through Department of
Veterans Affairs Mental Health Services investigators and in
collaboration with
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relevant program offices of the Department, design and
implement a strategy for evaluating the pilot program.
(2) Elements.--The strategy implemented under paragraph (1)
shall assess the impact that contracting with community
mental health centers, the Indian Health Service, and other
entities participating in the pilot program under subsection
(b) has on the following:
(A) Access to mental health care by veterans in need of
such care.
(B) The use of telehealth services by veterans for mental
health care needs.
(C) The quality of mental health care and substance use
disorder treatment services provided to veterans in need of
such care and services.
(D) The coordination of mental health care and other
medical services provided to veterans.
(k) Definitions.--In this section:
(1) The term ``community mental health center'' has the
meaning given such term in section 410.2 of title 42, Code of
Federal Regulations (as in effect on the day before the date
of the enactment of this Act).
(2) The term ``eligible veteran'' means a veteran in need
of mental health services who--
(A) is enrolled in the Department of Veterans Affairs
health care system; and
(B) has received a referral from a health professional of
the Veterans Health Administration to a community mental
health center, a facility of the Indian Health Service, or
other entity for purposes of the pilot program.
(3) The term ``Indian Health Service'' means the
organization established by section 601(a) of the Indian
Health Care Improvement Act (25 U.S.C. 1661(a)).
(l) Authorization of Appropriations.--There is authorized
to be appropriated such sums as may be necessary to carry out
the provisions of this section.
TITLE III--RESEARCH
SEC. 301. RESEARCH PROGRAM ON COMORBID POST-TRAUMATIC STRESS
DISORDER AND SUBSTANCE USE DISORDERS.
(a) Program Required.--The Secretary of Veterans Affairs
shall carry out a program of research into comorbid post-
traumatic stress disorder (PTSD) and substance use disorder.
(b) Discharge Through National Center for Posttraumatic
Stress Disorder.--The research program required by subsection
(a) shall be carried out by the National Center for
Posttraumatic Stress Disorder. In carrying out the program,
the Center shall--
(1) develop protocols and goals with respect to research
under the program; and
(2) coordinate research, data collection, and data
dissemination under the program.
(c) Research.--The program of research required by
subsection (a) shall address the following:
(1) Comorbid post-traumatic stress disorder and substance
use disorder.
(2) The systematic integration of treatment for post-
traumatic stress disorder with treatment for substance use
disorder.
(3) The development of protocols to evaluate care of
veterans with comorbid post-traumatic stress disorder and
substance use disorder and to facilitate cumulative clinical
progress of such veterans over time.
(d) Funding.--
(1) Authorization of appropriations.--There is authorized
to be appropriated for the Department of Veterans Affairs for
each of fiscal years 2008 through 2011, $2,000,000 to carry
out this section.
(2) Availability.--Amounts authorized to be appropriated by
paragraph (1) shall be made available to the National Center
on Posttraumatic Stress Disorder for the purpose specified in
that paragraph.
(3) Supplement not supplant.--Any amount made available to
the National Center on Posttraumatic Stress Disorder for a
fiscal year under paragraph (2) is in addition to any other
amounts made available to the National Center on
Posttraumatic Stress Disorder for such year under any other
provision of law.
SEC. 302. EXTENSION OF AUTHORIZATION FOR SPECIAL COMMITTEE ON
POST-TRAUMATIC STRESS DISORDER.
Section 110(e)(2) of the Veterans' Health Care Act of 1984
(38 U.S.C. 1712A note; Public Law 98-528) is amended by
striking ``through 2008'' and inserting ``through 2012''.
TITLE IV--ASSISTANCE FOR FAMILIES OF VETERANS
SEC. 401. CLARIFICATION OF AUTHORITY OF SECRETARY OF VETERANS
AFFAIRS TO PROVIDE MENTAL HEALTH SERVICES TO
FAMILIES OF VETERANS.
(a) In General.--Chapter 17 of title 38, United States
Code, is amended--
(1) in section 1701(5)(B)--
(A) by inserting ``marriage and family counseling,'' after
``professional counseling,''; and
(B) by striking ``as may be essential to'' and inserting
``as the Secretary considers appropriate for''; and
(2) in subsections (a) and (b) of section 1782, by
inserting ``marriage and family counseling,'' after
``professional counseling,''.
(b) Location.--Paragraph (5) of section 1701 of title 38,
United States Code, shall not be construed to prevent the
Secretary of Veterans Affairs from providing services
described in subparagraph (B) of such paragraph to
individuals described in such subparagraph in centers under
section 1712A of such title (commonly referred to as ``Vet
Centers''), Department of Veterans Affairs medical centers,
community-based outpatient clinics, or in such other
facilities of the Department of Veterans Affairs as the
Secretary considers necessary.
SEC. 402. PILOT PROGRAM ON PROVISION OF READJUSTMENT AND
TRANSITION ASSISTANCE TO VETERANS AND THEIR
FAMILIES IN COOPERATION WITH VET CENTERS.
(a) Pilot Program.--The Secretary of Veterans Affairs shall
carry out, through a non-Department of Veterans Affairs
entity, a pilot program to assess the feasability and
advisability of providing readjustment and transition
assistance described in subsection (b) to veterans and their
families in cooperation with centers under section 1712A of
title 38, United States Code (commonly referred to as ``Vet
Centers'').
(b) Readjustment and Transition Assistance.--Readjustment
and transition assistance described in this subsection is
assistance as follows:
(1) Readjustment and transition assistance that is
preemptive, proactive, and principle-centered.
(2) Assistance and training for veterans and their families
in coping with the challenges associated with making the
transition from military to civilian life.
(c) Non-Department of Veterans Affairs Entity.--
(1) In general.--The Secretary shall carry out the pilot
program through any for-profit or non-profit organization
selected by the Secretary for purposes of the pilot program
that has demonstrated expertise and experience in the
provision of assistance and training described in subsection
(b).
(2) Contract or agreement.--The Secretary shall carry out
the pilot program through a non-Department entity described
in paragraph (1) pursuant to a contract or other agreement
entered into by the Secretary and the entity for purposes of
the pilot program.
(d) Duration of Pilot Program.--The pilot program shall be
carried out during the three-year period beginning on the
date of the enactment of this Act, and may be carried out for
additional one-year periods thereafter.
(e) Location of Pilot Program.--
(1) In general.--The Secretary of Veterans Affairs shall
provide assistance under the pilot program in cooperation
with 10 centers described in subsection (a) designated by the
Secretary for purposes of the pilot program.
(2) Designations.--In designating centers described in
subsection (a) for purposes of the pilot program, the
Secretary shall designate centers so as to provide a balanced
geographical representation of such centers throughout the
United States, including the District of Columbia, the
Commonwealth of Puerto Rico, tribal lands, and other
territories and possessions of the United States.
(f) Participation of Centers.--A center described in
subsection (a) that is designated under subsection (e) for
participation in the pilot program shall participate in the
pilot program by promoting awareness of the assistance and
training available to veterans and their families through--
(1) the facilities and other resources of such center;
(2) the non-Department of Veterans Affairs entity selected
pursuant to subsection (c); and
(3) other appropriate mechanisms.
(g) Additional Support.--In carrying out the pilot program,
the Secretary of Veterans Affairs may enter into contracts or
other agreements, in addition to the contract or agreement
described in subsection (c), with such other non-Department
of Veterans Affairs entities meeting the requirements of
subsection (c) as the Secretary considers appropriate for
purposes of the pilot program.
(h) Report on Pilot Program.--
(1) Report required.--Not later than six months after the
date of the conclusion of the pilot program, the Secretary
shall submit to the congressional veterans affairs committees
a report on the pilot program.
(2) Elements.--Each report under paragraph (1) shall
include the following:
(A) A description of the activities under the pilot program
as of the date of such report, including the number of
veterans and families provided assistance under the pilot
program and the scope and nature of the assistance so
provided.
(B) A current assessment of the effectiveness of the pilot
program.
(C) Any recommendations that the Secretary considers
appropriate for the extension or expansion of the pilot
program.
(3) Congressional veterans affairs committees defined.--In
this subsection, the term ``congressional veterans affairs
committees'' means--
(A) the Committees on Veterans' Affairs and Appropriations
of the Senate; and
(B) the Committees on Veterans' Affairs and Appropriations
of the House of Representatives.
(i) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated for
the Department of Veterans Affairs for each of fiscal years
2008 through 2010 $1,000,000 to carry out this section.
(2) Availability.--Amounts authorized to be appropriated by
paragraph (1) shall remain available until expended.
Mr. AKAKA. Mr. President, I am pleased to express my strong support
for S. 2162, the Veterans' Mental Health and Other Care Improvements
Act of 2008, as amended. This bill includes provisions on mental health
care, suicide prevention, care for substance use disorders, prevention
of homelessness, pain and epilepsy care, and other health care matters.
This comprehensive legislation addresses many critical issues facing
our Nation's veterans.
Returning home from battle does not necessarily bring an end to
conflict. Servicemembers return home, but the war often follows them in
their hearts and minds. Their invisible wounds are
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complicated and wide-ranging, and we must provide all possible
assistance. I am working with VA Secretary James Peake to ensure that
VA is forthright about the numbers of suicides and attempted suicides
among veterans. Solid and reliable information is critical to our
understanding of the issues. Prevention of suicide is a vitally
important mission.
A growing number of veterans are in need of mental health care. VA's
Special Committee on Post-Traumatic Stress Disorder advised in its 2006
formal report that virtually all returning servicemembers face
readjustment issues. An assessment of mental health problems among
returning soldiers, recently published in the Journal of the American
Medical Association in November, 2007, found that 42.4 percent of
National Guard and reservists screened by the Department of Defense
required mental health treatment.
Additionally, a March 2007 study published in the Archives of
Internal Medicine reported that more than one-third of war veterans who
have served in either Iraq or Afghanistan suffer from various mental
ailments, including post-traumatic stress disorder, anxiety,
depression, substance use disorder and other problems. A RAND study
released in April 2008, emphasized the high risks of PTSD and
depression, especially among servicemembers sent on multiple
deployments, and among National Guard and reservists.
Further, the RAND study found that the stigma associated with mental
health care continues to prevent servicemembers and veterans from
accessing care. VA and the Department of Defense must redouble their
efforts to ensure that receiving mental health care does not harm one's
career. No individual is immune to the risk of mental health problems,
and all must have the opportunity to receive care.
On April 25, 2007, the Committee on Veterans' Affairs held a hearing
on veterans' mental health concerns, and on VA's response. We heard
heart-wrenching testimony from the witnesses.
The provisions of this bill are a direct outgrowth of that hearing
and the testimony given by those who have suffered with mental health
issues, and by their family members. Earlier versions of the provisions
included in this bill were also discussed at a legislative hearing on
October 24, 2007.
This bill represents a bi-partisan approach, and is cosponsored by
Senators Burr, Rockefeller, Mikulski, Bingaman, Ensign, Smith, Collins,
Clinton, Dole, and Sessions. It is a tribute to Justin Bailey, a
veteran of Operation Iraqi Freedom, who died in a VA domiciliary
facility while receiving care for PTSD and a substance use disorder.
This was a tragedy that will live on with Justin's parents, who have so
courageously advocated for improvements to VA mental health care.
Provisions included in this legislative package stem from bills which
have all been reported favorably by the Senate Committee on Veterans'
Affairs, including: S. 1233 as reported on August 29, 2007; and S.
2004, S. 2142, S. 2160, and S. 2162, as ordered reported on November
14, 2007.
I will briefly outline other provisions in S. 2162, as amended.
As I mentioned, the legislation would make sweeping changes to VA
mental health treatment and research. Most notably, it would ensure a
minimum level of substance use disorder care for veterans in need. It
would also require VA to improve treatment of veterans with multiple
disorders, such as PTSD and substance use disorder. To ascertain if
VA's residential mental health facilities are appropriately staffed,
this bill would mandate a review of such facilities. It would also
create a vital research program on PTSD and Substance Use Disorders, in
cooperation with, and building on the work of, the National Center for
PTSD.
Veterans with physical and mental wounds often turn to drugs and
alcohol to ease their pain. Experts believe that stress is the primary
cause of drug abuse, and of relapse to drug abuse. Research by Sinha,
Fuse, Aubin and O'Malley in Psychopharmacology, 2000, and by Brewer et
al. in Addiction, 1998, has found that patients with psychological
trauma, including PTSD, are often susceptible to alcohol and drug
abuse. Similarly, according to the National Institute on Drug Abuse,
patients subjected to chronic stress, as experienced by those with
PTSD, are prone to drug use. VA has long dealt with substance abuse
issues, but there is much more than can be done. This legislation would
provide a number of solutions to enhance substance use disorder
treatment.
The inclusion of families in mental health treatment is vital. To
this end, the bill would fully authorize VA to provide mental health
services to families of veterans and would set up a program to help
veterans and families transition to civilian life.
Beneficiary travel reimbursements are essential to improving access
to VA health care for veterans in rural areas. This legislation would
increase the beneficiary travel mileage reimbursement rate from 11
cents per mile to 28.5 cents per mile, and permanently set the
deductible to the 2007 amount of $3 each way.
It is important that veterans who rely on VA for their health care
have access to emergency care. This bill would make corrections to the
procedure used by VA to reimburse community hospitals for emergency
care provided to eligible veterans so as to ensure that both veterans
and community hospitals are not inappropriately burdened by emergency
care costs.
Too often, veterans suffer from lack of care merely because they are
unaware of the services available to them. This legislation would
enhance outreach and accessibility by creating a pilot program on the
use of peers to help reach out to veterans. It would also encourage
improved accessibility for mental health care in rural areas.
The legislation also addresses homelessness, which is far too
prevalent in the veteran population. The bill would create targeted
programs to provide assistance for low-income veteran families. It
would also allow homeless service providers to receive VA funds without
offsetting other sources of income and require that facilities which
furnish services to homeless veterans are able to meet the needs of
women veterans.
The committee heard testimony that epilepsy is often associated with
traumatic brain injury, the injury that many are calling the signature
wound of the current conflicts. This suggests a strong need to improve
VA's effectiveness in dealing with epilepsy. The pending legislation
would establish six VA epilepsy centers of excellence, which will focus
on research, education, and clinical care activities in the diagnosis
and treatment of epilepsy. These centers would restore VA to the
position of leadership it once held in epilepsy research and treatment.
The medical community has made impressive advances in pain care and
management, but VA has lagged behind in implementing a standardized
policy for dealing with pain. The bill includes a provision that would
establish a pain care program at all inpatient facilities, to prevent
long-term chronic pain disability. It also provides for education for
VA's health care workers on pain assessment and treatment, and would
require VA to expand research on pain care.
I urge all of my colleagues to support S. 2162, as amended. It has
the potential to bring relief and support to tens of thousands of
veterans and their families across the country.
Mrs. BOXER. Mr. President, I ask unanimous consent that the committee
substitute amendment be withdrawn, the Akaka-Burr substitute amendment
which is at the desk be agreed to; the bill, as amended, be read a
third time and passed; the motions to reconsider be laid upon the
table, with no intervening action or debate, and any statements related
to the bill be printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 4824) was agreed to.
(The amendment is printed in today's Record under ``Text of
Amendments.'')
The bill (S. 2162), as amended, was ordered to be engrossed for a
third reading, was read the third time, and passed.
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