[Congressional Record Volume 155, Number 50 (Tuesday, March 24, 2009)]
[Senate]
[Pages S3672-S3675]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Ms. Collins, Mr. Whitehouse, Mr.

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        Levin, Mr. Schumer, and Ms. Stabenow):
  S. 682. A bill to amend the Public Health Service Act to improve 
mental and behavioral health services on college campuses; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. DURBIN. Colleges and universities take many steps to support 
their students and ensure that they succeed. Financial aid offices find 
ways for students to afford tuition and textbooks, housing offices 
provide safe places for students to live, and tutoring centers provide 
academic supports for students who are struggling to keep up in class. 
But there is another critical service that many students require to 
succeed, and it is much less frequently discussed. I am talking about 
mental health services and outreach provided by college counseling 
centers.
  For a long time, we have overlooked the mental health needs of 
students on college campuses. We know now that many mental illnesses 
start to manifest in this period when young people leave the security 
of home and regular medical care. The responsibility for the students' 
well-being often shifts from parents to students, and the students 
aren't always completely prepared. It is easier for a young person's 
problems to go unnoticed when he or she is away at college than when 
they are at home, in the company of parents, old friends, and high 
school teachers. College also provides a new opportunity for young 
people to experiment with drugs or alcohol.
  The consequences of not detecting or addressing mental health needs 
among students are real. Forty-five percent of college students report 
having felt so depressed that it was difficult to function. Ten percent 
have contemplated suicide. We have even seen tragedies on the scale of 
shootings at Northern Illinois University in February 2008 and at 
Virginia Tech in April 2007. These heartbreaking and traumatic 
incidents demonstrated the tragic consequences of mental instability 
and helped us recognize we need to do more to support students during 
what can be very tough years.
  Fortunately, many students can succeed in college if they have 
appropriate counseling services and access to needed medications. These 
services make a real impact. Students who seek help are 6 times less 
likely to kill themselves. Colleges are welcoming students today who 10 
or 20 years ago would not have been able to attend school due to mental 
illness, but who can today because of advances in treatment.
  But while the needs for mental health services on campus are rising, 
colleges are facing financial pressures and having trouble meeting this 
demand. As I have travelled around my State, I have learned just how 
thin colleges and universities are stretched when it comes to 
providing. counseling and other support services to students.
  Take Southern Illinois University in Carbondale. SIUC has 8 full-time 
counselors for 21,000 students. That is one counselor for every 2,500 
students. The recommended ratio is one counselor for every 1,500 
students. And there is another problem. Like many rural communities, 
Carbondale only has one community mental health agency. That agency is 
overwhelmed by the mental health needs of the community and refuses to 
serve students from SIUC. The campus counseling center is the only 
mental health option for students. The eight hard-working counselors at 
SIUC do their best under impossible conditions. They triage students 
who come in seeking help so that the ones who might be a threat to 
themselves or others are seen first. The waitlist of students seeking 
services has reached 45 students.
  The story is the same across the country. Colleges are trying to fill 
in the gaps, but because of the shortage of counselors, students' needs 
are overlooked. A recent survey of college counseling centers indicates 
that the average ratio of professional-staff-to-students is 1 to 1,952, 
and at 4-year public universities it is 1 to 2,607 students. Although 
interest in mental-health services is high, the recession has put 
pressure on administrators to cut budgets wherever they can. At times, 
counseling centers are in the cross hairs. Ten percent of survey 
respondents said their budgets were cut during the 2007-8 academic 
year, half said their budgets stayed the same, and nearly a quarter 
reported that their funds increased by 3 percent or less.
  With so many students looking for help and so few counselors to see 
them, counseling centers have to cut back on outreach. Without 
outreach, the chances of finding students who need help but do not ask 
for it go down. This is a serious problem. We know that some students 
exhibit warning signs of a tortured mental state. But faculty and 
students do not always know how or where to express their concerns. 
Outreach efforts by campus counseling centers can help educate the 
community about warning signs to look for as well as how to intervene. 
Of the students who committed suicide across the country in 2007, only 
22 percent had received counseling on campus. That means that of the 
1,000 college students who took their own lives, 800 may never have 
looked for help. How many of those young lives could have been saved if 
our college counseling centers had the resources they needed to 
identify those students and help them? Our students deserve better.
  We need to help schools meet the needs of their students, and that's 
why I'm introducing the Mental Health on Campus Improvement Act today. 
This bill would create a grant program to provide funding for colleges 
and universities to improve their mental health services. Colleges 
could use the funding to hire personnel, increase outreach, and educate 
the campus community about mental health. The bill also would direct 
the Department of Health and Human Services to develop a public, 
nation-wide campaign to educate campus communities about mental health.
  Reflecting on the loss of his own son, the well-known minister Rev. 
William Sloan Coffin once said, ``When parents die, they take with them 
a portion of the past. But when children die, they take away the future 
as well.'' I hope the bill I am introducing today will help prevent the 
unnecessary loss of more young lives and bright futures.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 682

       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 ``Mental Health on Campus 
     Improvement Act''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The 2007 National Survey of Counseling Center Directors 
     found that the average ratio of counselors to students on 
     campus is nearly 1 to 2,000 and is often far higher on large 
     campuses. The International Association of Counseling 
     Services accreditation standards recommend 1 counselor per 
     1,000 to 1,500 students.
       (2) College counselors report that 8.5 percent of enrolled 
     students sought counseling in the past year, totaling an 
     estimated 1,600,000 students.
       (3) Over 90 percent of counseling directors believe there 
     is an increase in the number of students coming to campus 
     with severe psychological problems. The majority of 
     counseling directors report concerns that the demand for 
     services is growing without an increase in resources.
       (4) A 2008 American College Health Association survey 
     revealed that 43 percent of students at colleges and 
     universities report having felt so depressed it was difficult 
     to function, and one out of every 11 students seriously 
     considered suicide within the past year.
       (5) Research conducted between 1989 and 2002 found that 
     students seen for anxiety disorders doubled, for depression 
     tripled, and for serious suicidal intention tripled.
       (6) Many students who need help never receive it. 
     Counseling directors report that, of the students who 
     committed suicide on their campuses, only 22 percent were 
     current or former counseling center clients. Directors did 
     not know the previous psychiatric history of 60 percent of 
     those students.
       (7) A survey conducted by the University of Idaho Student 
     Counseling Center in 2000 found that 77 percent of students 
     who responded reported that they were more likely to stay in 
     school because of counseling and that their school 
     performance would have declined without counseling.
       (8) A 6-year longitudinal study of college students found 
     that personal and emotional adjustment was an important 
     factor in retention and predicted attrition as well as, or 
     better than, academic adjustment (Gerdes & Mallinckrodt, 
     1994).

     SEC. 3. IMPROVING MENTAL AND BEHAVIORAL HEALTH ON COLLEGE 
                   CAMPUSES.

       Title V of the Public Health Service Act is amended by 
     inserting after section 520E-2 (42 U.S.C. 290bb-36b) the 
     following:

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     ``SEC. 520E-3. GRANTS TO IMPROVE MENTAL AND BEHAVIORAL HEALTH 
                   ON COLLEGE CAMPUSES.

       ``(a) Purpose.--It is the purpose of this section, with 
     respect to college and university settings, to--
       ``(1) increase access to mental and behavioral health 
     services;
       ``(2) foster and improve the prevention of mental and 
     behavioral health disorders, and the promotion of mental 
     health;
       ``(3) improve the identification and treatment for students 
     at risk;
       ``(4) improve collaboration and the development of 
     appropriate levels of mental and behavioral health care;
       ``(5) reduce the stigma for students with mental health 
     disorders and enhance their access to mental health services; 
     and
       ``(6) improve the efficacy of outreach efforts.
       ``(b) Grants.--The Secretary, acting through the 
     Administrator and in consultation with the Secretary of 
     Education, shall award competitive grants to eligible 
     entities to improve mental and behavioral health services and 
     outreach on college and university campuses.
       ``(c) Eligibility.--To be eligible to receive a grant under 
     subsection (b), an entity shall--
       ``(1) be an institution of higher education (as defined in 
     section 101 of the Higher Education Act of 1965 (20 U.S.C. 
     1001)); and
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require, including the information required 
     under subsection (d).
       ``(d) Application.--An application for a grant under this 
     section shall include--
       ``(1) a description of the population to be targeted by the 
     program carried out under the grant, the particular mental 
     and behavioral health needs of the students involved, and the 
     Federal, State, local, private, and institutional resources 
     available for meeting the needs of such students at the time 
     the application is submitted;
       ``(2) an outline of the objectives of the program carried 
     out under the grant;
       ``(3) a description of activities, services, and training 
     to be provided under the program, including planned outreach 
     strategies to reach students not currently seeking services;
       ``(4) a plan to seek input from community mental health 
     providers, when available, community groups, and other public 
     and private entities in carrying out the program;
       ``(5) a plan, when applicable, to meet the specific mental 
     and behavioral health needs of veterans attending 
     institutions of higher education;
       ``(6) a description of the methods to be used to evaluate 
     the outcomes and effectiveness of the program; and
       ``(7) an assurance that grant funds will be used to 
     supplement, and not supplant, any other Federal, State, or 
     local funds available to carry out activities of the type 
     carried out under the grant.
       ``(e) Special Considerations.--In awarding grants under 
     this section, the Secretary shall give special consideration 
     to applications that describe programs to be carried out 
     under the grant that--
       ``(1) demonstrate the greatest need for new or additional 
     mental and behavioral health services, in part by providing 
     information on current ratios of students to mental and 
     behavioral health professionals;
       ``(2) propose effective approaches for initiating or 
     expanding campus services and supports using evidence-based 
     practices;
       ``(3) target traditionally underserved populations and 
     populations most at risk;
       ``(4) where possible, demonstrate an awareness of, and a 
     willingness to, coordinate with a community mental health 
     center or other mental health resource in the community, to 
     support screening and referral of students requiring 
     intensive services;
       ``(5) identify how the college or university will address 
     psychiatric emergencies, including how information will be 
     communicated with families or other appropriate parties; and
       ``(6) demonstrate the greatest potential for replication 
     and dissemination.
       ``(f) Use of Funds.--Amounts received under a grant under 
     this section may be used to--
       ``(1) provide mental and behavioral health services to 
     students, including prevention, promotion of mental health, 
     screening, early intervention, assessment, treatment, 
     management, and education services relating to the mental and 
     behavioral health of students;
       ``(2) provide outreach services to notify students about 
     the existence of mental and behavioral health services;
       ``(3) educate families, peers, faculty, staff, and 
     communities to increase awareness of mental health issues;
       ``(4) support student groups on campus that engage in 
     activities to educate students, reduce stigma surrounding 
     mental and behavioral disorders, and promote mental health 
     wellness;
       ``(5) employ appropriately trained staff;
       ``(6) expand mental health training through internship, 
     post-doctorate, and residency programs;
       ``(7) develop and support evidence-based and emerging best 
     practices, including a focus on culturally- and 
     linguistically-appropriate best practices; and
       ``(8) evaluate and disseminate best practices to other 
     colleges and universities.
       ``(g) Duration of Grants.--A grant under this section shall 
     be awarded for a period not to exceed 3 years.
       ``(h) Evaluation and Reporting.--
       ``(1) Evaluation.--Not later than 18 months after the date 
     on which a grant is received under this section, the eligible 
     entity involved shall submit to the Secretary the results of 
     an evaluation to be conducted by the entity concerning the 
     effectiveness of the activities carried out under the grant 
     and plans for the sustainability of such efforts.
       ``(2) Report.--Not later than 2 years after the date of 
     enactment of this section, the Secretary shall submit to the 
     appropriate committees of Congress a report concerning the 
     results of--
       ``(A) the evaluations conducted under paragraph (1); and
       ``(B) an evaluation conducted by the Secretary to analyze 
     the effectiveness and efficacy of the activities conducted 
     with grants under this section.
       ``(i) Technical Assistance.--The Secretary may provide 
     technical assistance to grantees in carrying out this 
     section.
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out this section.

     ``SEC. 520E-4. MENTAL AND BEHAVIORAL HEALTH OUTREACH AND 
                   EDUCATION ON COLLEGE CAMPUSES.

       ``(a) Purpose.--It is the purpose of this section to 
     increase access to, and reduce the stigma associated with, 
     mental health services so as to ensure that college students 
     have the support necessary to successfully complete their 
     studies.
       ``(b) National Public Education Campaign.--The Secretary, 
     acting through the Administrator and in collaboration with 
     the Director of the Centers for Disease Control and 
     Prevention, shall convene an interagency, public-private 
     sector working group to plan, establish, and begin 
     coordinating and evaluating a targeted public education 
     campaign that is designed to focus on mental and behavioral 
     health on college campuses. Such campaign shall be designed 
     to--
       ``(1) improve the general understanding of mental health 
     and mental health disorders;
       ``(2) encourage help-seeking behaviors relating to the 
     promotion of mental health, prevention of mental health 
     disorders, and treatment of such disorders;
       ``(3) make the connection between mental and behavioral 
     health and academic success; and
       ``(4) assist the general public in identifying the early 
     warning signs and reducing the stigma of mental illness.
       ``(c) Composition.--The working group under subsection (b) 
     shall include--
       ``(1) mental health consumers, including students and 
     family members;
       ``(2) representatives of colleges and universities;
       ``(3) representatives of national mental and behavioral 
     health and college associations;
       ``(4) representatives of college health promotion and 
     prevention organizations;
       ``(5) representatives of mental health providers, including 
     community mental health centers; and
       ``(6) representatives of private- and public-sector groups 
     with experience in the development of effective public health 
     education campaigns.
       ``(d) Plan.--The working group under subsection (b) shall 
     develop a plan that shall--
       ``(1) target promotional and educational efforts to the 
     college age population and individuals who are employed in 
     college and university settings, including the use of 
     roundtables;
       ``(2) develop and propose the implementation of research-
     based public health messages and activities;
       ``(3) provide support for local efforts to reduce stigma by 
     using the National Mental Health Information Center as a 
     primary point of contact for information, publications, and 
     service program referrals; and
       ``(4) develop and propose the implementation of a social 
     marketing campaign that is targeted at the college population 
     and individuals who are employed in college and university 
     settings.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out this section.''.

     SEC. 4. INTERAGENCY WORKING GROUP ON COLLEGE MENTAL HEALTH.

       (a) Purpose.--It is the purpose of this section, pursuant 
     to Executive Order 13263 (and the recommendations issued 
     under section 6(b) of such Order), to provide for the 
     establishment of a College Campus Task Force under the 
     Federal Executive Steering Committee on Mental Health, to 
     discuss mental and behavioral health concerns on college and 
     university campuses.
       (b) Establishment.--The Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     shall establish a College Campus Task Force (referred to in 
     this section as the ``Task Force''), under the Federal 
     Executive Steering Committee on Mental Health, to discuss 
     mental and behavioral health concerns on college and 
     university campuses.
       (c) Membership.--The Task Force shall be composed of a 
     representative from each Federal agency (as appointed by the 
     head of the agency) that has jurisdiction over, or is 
     affected by, mental health and education policies and 
     projects, including--
       (1) the Department of Education;
       (2) the Department of Health and Human Services;
       (3) the Department of Veterans Affairs; and

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       (4) such other Federal agencies as the Administrator of the 
     Substance Abuse and Mental Health Services Administration and 
     the Secretary jointly determine to be appropriate.
       (d) Duties.--The Task Force shall--
       (1) serve as a centralized mechanism to coordinate a 
     national effort--
       (A) to discuss and evaluate evidence and knowledge on 
     mental and behavioral health services available to, and the 
     prevalence of mental health illness among, the college age 
     population of the United States;
       (B) to determine the range of effective, feasible, and 
     comprehensive actions to improve mental and behavioral health 
     on college and university campuses;
       (C) to examine and better address the needs of the college 
     age population dealing with mental illness;
       (D) to survey Federal agencies to determine which policies 
     are effective in encouraging, and how best to facilitate 
     outreach without duplicating, efforts relating to mental and 
     behavioral health promotion;
       (E) to establish specific goals within and across Federal 
     agencies for mental health promotion, including 
     determinations of accountability for reaching those goals;
       (F) to develop a strategy for allocating responsibilities 
     and ensuring participation in mental and behavioral health 
     promotions, particularly in the case of competing agency 
     priorities;
       (G) to coordinate plans to communicate research results 
     relating to mental and behavioral health amongst the college 
     age population to enable reporting and outreach activities to 
     produce more useful and timely information;
       (H) to provide a description of evidence-based best 
     practices, model programs, effective guidelines, and other 
     strategies for promoting mental and behavioral health on 
     college and university campuses;
       (I) to make recommendations to improve Federal efforts 
     relating to mental and behavioral health promotion on college 
     campuses and to ensure Federal efforts are consistent with 
     available standards and evidence and other programs in 
     existence as of the date of enactment of this Act; and
       (J) to monitor Federal progress in meeting specific mental 
     and behavioral health promotion goals as they relate to 
     college and university settings;
       (2) consult with national organizations with expertise in 
     mental and behavioral health, especially those organizations 
     working with the college age population; and
       (3) consult with and seek input from mental health 
     professionals working on college and university campuses as 
     appropriate.
       (e) Meetings.--
       (1) In general.--The Task Force shall meet at least 3 times 
     each year.
       (2) Annual conference.--The Secretary shall sponsor an 
     annual conference on mental and behavioral health in college 
     and university settings to enhance coordination, build 
     partnerships, and share best practices in mental and 
     behavioral health promotion, data collection, analysis, and 
     services.
       (f) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.
                                 ______