[Congressional Record Volume 155, Number 154 (Thursday, October 22, 2009)]
[Senate]
[Pages S10704-S10705]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. STABENOW (for herself, Mr. Voinovich, Mrs. Hutchison, Mr. 
        Brown, and Mr. Kerry):
  S. 1857. A bill to establish national centers of excellence for the 
treatment of depressive and bipolar disorders; to the Committee on 
Health, Education, Labor, and Pensions.
  Ms. STABENOW. Mr. President, today I introduced legislation to create 
a national strategy for treating two diseases that affect millions of 
Americans: depression and bipolar disorders. This bill, the 
Establishing a Network of Health-Advancing National Centers of 
Excellence for Depression, or the ENHANCED Act, will establish a 
network of national centers of excellence for the treatment of these 
disabling conditions. My bill would increase the number of people with 
depressive disorders who receive appropriate and evidence-based 
treatment; it would create a national resource to develop and 
disseminate evidence-based interventions, and provide public and 
professional education aimed at eradicating the stigma associated with 
depressive and bipolar disorders.
  Depression and bipolar disorders affect one of every five people in 
the United States and are the leading cause of disability among 
individuals between the ages of 15 and 44. In fact, more Americans 
suffer from depression, bipolar illness and other mood disorders than 
from coronary heart disease and cancer combined.
  Depression can affect anyone, at any age, at any time. It affects 
children, adolescents, and adults. It affects people of all racial, 
ethnic, religious, and socioeconomic levels as well as both sexes. 
Young adults, women of childbearing age, people with chronic medical 
conditions such as diabetes and heart disease, and adults over the age 
of 55 are at especially high risk of depression.
  With medication, psychotherapy, or combined treatment, most people 
with depression and mood disorders can be effectively treated and 
resume productive lives. Yet one-third of those suffering from 
depression--nearly 5 million Americans--do not receive treatment 
because they cannot afford it, do not believe it is needed, are afraid 
of societal judgment, or do not know where to go.
  My bill is based on work done informally by 16 academic research 
institutions across the nation. Led by my own State's University of 
Michigan Depression Center, these comprehensive research and treatment 
centers have joined together to create a network of depression centers 
positioned to take academic research and translate it into practice, 
standardize diagnoses, treat early and more effectively, and prevent 
recurrences of depression and bipolar disorders.
  Currently, there is no direct federal support or coordination of this 
work. Clinicians lack universally accepted multi-disciplinary 
approaches and real-time clinical and care management guidelines. 
Nearly half of all diagnoses of depression and bipolar are missed. And 
tragically, one of the preventable costs of undiagnosed, untreated and 
undertreated depression is suicide. The World Health Organization 
recently reported that suicide causes more deaths around the world 
every year than homicide or war. Across all age groups nationwide, more 
than 90 percent of those who commit suicide have a diagnosable 
psychiatric illness at the time of death: usually depression, alcohol 
abuse or both. Clearly, we need better diagnostic approaches to 
depression in primary care, other medical settings, and mental health 
programs.
  Finally, depression has a significant economic impact on society. The 
estimated total annual cost of depression in the U.S. is $83.1 billion, 
with the majority of costs in the form of reduced productivity, 
absenteeism, and mortality.
  The ENHANCED Act offers us a viable response to a devastating and 
often debilitating disease: it would create a national network with a 
pathway for developing and expanding up to 30 depression centers of 
excellence with a goal of increasing access to the most appropriate and 
evidence-based depression care; it would develop and disseminate 
evidence-based treatment standards, clinical guidelines, and protocols 
to improve accurate and timely diagnosis of depression and bipolar 
disorders; it would expand multidisciplinary, translational, and 
patient-oriented research by fostering the collaboration of academic 
and community-based organizations; and, it would establish a 
sustainable national resource for public and professional education and 
training.
  We need to act now to make effective and evidence-based treatment of 
depressive and bipolar disorders available to the millions of Americans 
suffering from depression.
  I urge my colleagues to join me today to support the ENHANCED Act.
  Mr. President, I ask unanimous consent that letters of support be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                        Mental Health America,

                                 Alexandria, VA, October 13, 2009.
     Hon. Debbie Stabenow,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Stabenow: On behalf of Mental Health America 
     (MHA) and our national network of more than 300 affiliates 
     across the United States, I wanted to express our strong 
     support for your legislative proposal to establish national 
     centers of excellence for the treatment of depressive and 
     bipolar disorders.
       Your proposal to create the national network of centers of 
     excellence for depressive and bipolar disorders would enhance 
     the coordination and integration of physical, mental and 
     social care that are so critical to the identification and 
     treatment of depression and other mental disorders across the 
     lifespan. The work of these centers will be an essential 
     component in the dissemination and implementation of 
     evidence-based practices in clinical settings throughout the 
     country.
       The goals of this initiative would be to create improved 
     clinical care guidelines, chronic care coordination, multi-
     disciplinary translational research, and public-private 
     partnerships. Publicly available national databases would be 
     developed and community resources would be leveraged. This 
     initiative would also encourage the use of electronic health 
     records and telehealth technologies to better coordinate, 
     manage, and improve access to care.
       These centers are especially critical at this time given 
     the strong evidence that economic uncertainty and recession 
     increase the rates of psychiatric symptoms and demand for 
     services. Depression is associated with poorer health 
     outcomes and higher health care costs. Rates of depression 
     and suicide--already at a staggering level of nearly 33,000 
     persons a year (roughly twice the number of homicides)--tend 
     to climb during times of economic tumult. Our nation must 
     prioritize the integration and coordination of mental health 
     with general health care.
       As you know, the lack of adequate care coordination for 
     individuals with mental illness makes this population 
     particularly vulnerable. For example, persons with serious 
     mental illness die, on average, 25 years earlier than the 
     general population, mainly due to other co-occurring chronic 
     conditions. This proposal is an important step in an effort 
     to decrease these distressing mortality rates and improve the 
     quality of life for individuals experiencing mental health 
     conditions.
       MHA applauds your work on this important legislative 
     initiative and looks forward to working with you to achieve 
     its enactment at the earliest possible date.
           Sincerely,
                                             David L. Shern, Ph.D,
     President and CEO.
                                  ____

                                          American Association for


                                         Geriatric Psychiatry,

                                    Bethesda, MD, October 6, 2009.
     Hon. Debbie Stabenow,
     U.S. Senate, Hart Senate Office Building,
     Washington, DC.
       Dear Senator Stabenow: On behalf of the American 
     Association for Geriatric Psychiatry (AAGP), I wanted to take 
     this opportunity to express our strong support for your

[[Page S10705]]

     legislative proposal to establish national centers of 
     excellence for the treatment of depressive and bipolar 
     disorders.
       AAGP is a professional membership organization dedicated to 
     promoting the mental health and well being of older Americans 
     and improving the care of those with late-life mental 
     disorders. AAGP's membership consists of approximately 2,000 
     geriatric psychiatrists as well as other health professionals 
     who focus on the mental health problems faced by older 
     adults.
       Of the approximately 32 million Americans who have attained 
     age 65, about five million suffer from depression, yet an 
     astounding number go without treatment. Depression is 
     associated with poorer health outcomes and higher health care 
     costs. Those with depression are more likely to be 
     hospitalized and experience almost twice the number of 
     medical visits than those without depression. Older adults 
     also have the highest rate of suicide in the country, 
     accounting for approximately 20 percent of all suicide 
     deaths; and the suicide rate for those 85 and older is nearly 
     twice the national average.
       The national network of centers of excellence for 
     depressive disorders that would be created by your proposal 
     would enhance the coordination and integration of physical, 
     mental and social care that is so critical to the 
     identification and treatment of depression and other mental 
     disorders across the lifespan. The work of these centers will 
     be an essential component in the dissemination and 
     implementation of evidence-based practices in clinical 
     settings throughout the country.
       We applaud your work on this important legislative 
     initiative and look forward to working with you to achieve 
     its enactment at the earliest possible date.
           Sincerely,
                                     Charles F. Reynolds, III, MD,
     President.
                                  ____

                                               American Academy of


                              Child and Adolescent Psychiatry,

                                                   Washington, DC.
     Hon. Sherrod Brown,
     Russell Senate Office Building,
     Washington, DC.
     Hon. John Kerry,
     Russell Senate Office Building,
     Washington, DC.
     Hon. Kay Bailey Hutchison,
     Russell Senate Office Building,
     Washington, DC.
     Hon. Debbie Stabenow,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senators Brown, Kerry, Hutchison, and Stabenow: On 
     behalf of the American Academy of Child and Adolescent 
     Psychiatry (AACAP), I write to support the ENHANCED Act of 
     2009. The establishment of national centers of excellence for 
     the treatment of depression and bipolar disorder is essential 
     as we move forward with real healthcare reform.
       As child and adolescent psychiatrists, our members are 
     deeply invested in early identification of children with 
     depressive disorders, as well as prevention strategies 
     targeting children at risk. As many as 1 in 33 children and 1 
     in 8 teenagers in the United States have clinical depression. 
     Suicide is the leading cause of death among those between the 
     ages of 15 and 24.
       While many adolescents are diagnosed with a depressive 
     disorder, most go undetected and untreated. Lack of detection 
     leads to social and academic decline, may foster treatment 
     resistance in children, and result in many future problems.
       The AACAP is a medical membership association established 
     by child and adolescent psychiatrists in 1954. Now over 8,000 
     members strong, the AACAP is the leading national medical 
     association dedicated to treating and improving the quality 
     of life for the estimated 14 million American youth under 18 
     years of age who are affected by emotional, behavioral, 
     developmental and mental disorders.
       On behalf of AACAP's members, I commend you for your 
     continued leadership on this issue. We are pleased to support 
     this bill and we look forward to working with you and your 
     staff to ensure its passage. Please contact Kristin Kroeger, 
     Director of Government Affairs, if you have any questions 
     concerning children's mental health issues.
           Sincerely,
                                                Robert L. Hendren,
     President.
                                  ____

                                               American Foundation


                                       for Suicide Prevention,

                                   New York, NY, October 21, 2009.
     Hon. Debbie Stabenow,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Stabenow: It is with great enthusiasm that we 
     write to support the ENHANCED Act which would establish a 
     national network of Centers of Excellence for the treatment 
     of a full range of depressive disorders that afflict our 
     population.
       Although depressive disorders are the most common illnesses 
     that lead to disability in our country, there has been little 
     concerted national effort to acknowledge the problem and 
     enhance the treatment. Besides disability, they cause 
     enormous suffering, loss of productivity, difficulty with 
     family, friends and colleagues and can be fatal. As you are 
     aware, suicide is the 11th leading cause of death in this 
     country. Ninety percent of those who die by suicide have a 
     mental disorder and the most common mental disorder is 
     depression. Most people have known someone who has died by 
     suicide. While survivors often recognize that the person was 
     in a great deal of pain and agony, they often do not 
     understand that the person was suffering from a treatable 
     disease. We believe that this legislation can lead to 
     partnerships between organizations like ours and the Centers 
     of Excellence with the goal of reducing suicide. This has 
     been an unrealized national imperative since the National 
     Strategy for Suicide Prevention was issued in 2001.
       Given that there is evidence that depression is under-
     recognized and often inadequately treated, we believe that 
     these Centers of Excellence would provide appropriate and 
     evidence-based treatment. In so doing, they would provide 
     families, the public and professionals with knowledge about 
     theses disorders and help to erase the stigma that exists 
     about them.
       Treating depression requires a great deal of skill in order 
     to provide the best care to each individual. These Centers of 
     Excellence will promote best practices and therefore become 
     national resources for the 35,000,000 people affected with 
     depressive illnesses.
       Given the recent well-documented increase in suicides in 
     the military and returning veterans, it is clear that the 
     country needs an all-out commitment to the education and 
     treatment of these disorders. Thank you again for your work 
     on this bill and please let us know how we can ensure that it 
     becomes law, so that millions of Americans suffering from 
     depressive disorders can recover and live healthy and 
     productive lives.
           Sincerely,
     Robert Gebbia,
       Executive Director.
     Paula J. Clayton,
       Medical Director.
                                 ______