[Congressional Record Volume 159, Number 154 (Thursday, October 31, 2013)]
[Senate]
[Pages S7710-S7712]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        COMMUNITY MENTAL HEALTH

  Ms. STABENOW. Madam President, I very much wish to thank a great 
friend and colleague, Senator Blunt, for joining me today on the floor 
and in leadership on some very important community mental health 
legislation.
  We have an opportunity to get something done with this issue.
  I ask unanimous consent to proceed with the colloquy.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. STABENOW. We wish to do this today because today marks the 50th 
anniversary to the day that President John F. Kennedy signed into law 
the Community Mental Health Act. The good news is he signed this act. 
The unfortunate news is it was the last act he signed in his life.
  Today we want to recognize what that has meant to so many people 
across the country. This put in place the ability to serve people in 
the community who have mental health issues, rather than only being in 
institutions, being able to serve people closer to home, at home or to 
be able to give them the opportunity to get the help they need and 
still be active and successful in the community.
  I think so many of us have been touched by mental health issues, 
which is part of physical--it is not mental and physical health. I 
think it is about time. I know my friend would agree that we start 
treating illnesses above

[[Page S7711]]

the neck differently than illnesses below the neck. It is all about 
comprehensive health care. We have all been touched in some way.
  My father went undiagnosed with a bipolar disorder for 10 years when 
I was growing up. When he finally received the help he needed, the 
medication he needed, he was able to work and be successful for the 
rest of his life. I wish to make sure every family has that 
opportunity.
  I know for President Kennedy it was his younger sister Rosemary who 
was institutionalized in the early 1940s and that brought him to this 
issue as well as to other passionate concerns that he had. President 
Kennedy saw a way to improve the lives of people such as his sister 
living with a mental illness by providing service in the community and, 
frankly, lowering the stigma on mental health. We still have a long way 
to go on reducing the stigma and understanding that it is, in most 
occasions, a physiological change in the brain, a chemical imbalance, 
something that needs to be treated appropriately, and that is certainly 
not a choice by an individual.
  President Kennedy thought we needed to make sure we were providing 
the very best for the people in this community. In his statement to 
Congress he wrote:

       We need a new type of health facility, one which will 
     return mental health care to the mainstream of American 
     medicine, and at the same time, upgrade mental health 
     services.

  We have worked together in a bipartisan way since then. The Mental 
Health Parity and Addiction Equity Act was championed by our friends 
and colleagues, Senators Pete Domenici, Paul Wellstone, Ted Kennedy, 
and Congressman Patrick Kennedy in the House, and it became law. It 
said we have to have parity in how insurance companies treat mental 
health and physical health.
  I was pleased to get those provisions into health reform, but there 
is more to do and that is why we are here.
  I wish to turn to my friend from Missouri, who has been a great 
partner and ask, as we go forward, what his thoughts are on this day 
and what we should continue to do to continue with this legacy.
  Mr. BLUNT. I wish to say it is a very important topic, and it is a 
moment when there are many reasons, as the Senator said, that we should 
keep returning to it.
  It was this day 50 years ago when President Kennedy signed the 
Community Mental Health Act. He called it a ``bold new approach.'' 
Frankly, while some things happened in the 50 years since then and now, 
there haven't been that many bold new approaches in the last 50 years.
  This is a topic that for whatever reason our society hasn't dealt 
with in ways that have been satisfactory in making great changes. In 
fact, some of what we have done in other areas has made it harder for 
communities and families to work with people who have behavioral 
challenges, to find out the information that person does not want to 
share with them.
  All of us can probably think of some family where this has happened, 
where someone still has an ongoing commitment to an adult son or 
daughter, mom or dad, and are part of what they are doing. They are 
paying some bills or whatever. The information that people would 
benefit from knowing is hard to get to or the requirement that somebody 
follow up on a court-ordered procedure is difficult to enforce and make 
that happen.
  This is one of the times when we really need to be thinking what do 
we need to do to make this challenging work better.
  First, it is a widespread problem, but it is not a problem that is 
untreatable. There is one statistic I have seen from the National 
Institutes of Mental Health: ``One in four adults suffers from a 
diagnosable mental disorder'' that is diagnosable and, in virtually 
every case, treatable--one in four.
  This is not a stigma. This is not something where you are the only 
person this has ever happened to or to your loved ones, that this is 
the only person this has ever happened to. This is something that many 
families understand. Many people have a challenge that never gets 
diagnosed, frankly.
  Creating a way for that to happen, where we make it easier, we make 
it more comfortable, and we make it affordable--whatever we are doing 
to allow that, in almost every case, the treatable problem to be 
diagnosed and treatable is important.
  One of the topics the Senator and I started talking about almost at 
the very first of this year--we have been talking about this for almost 
10 months. Of course, it was after the tragedy at Newtown. One thing we 
know is that somebody who has a mental health problem is much more 
likely to be the victim of a crime than they are to be the perpetrator 
of a crime.
  The other thing we know is that as we look at these tragedies we have 
seen happen in the last few years, the one common denominator--whether 
it was in Newtown, Aurora, Tucson, the Navy Yard or Virginia Tech, 
whether it was at a supermarket, at a theater or on a college campus--
what we saw in every case was this was somebody who had a behavioral 
problem, a mental health problem that hadn't been dealt with in the 
right way. In many ways this has turned the attention of the country 
back to a problem that, for whatever reason, we would just as soon 
apparently not talk about.
  In fact, when the Senate committee that deals with mental health had 
a hearing in January of this year on mental health, it was the first 
time since 2007 that there had been such a hearing devoted to this 
topic--a topic that the National Institutes of Health said one of four 
adults is challenged by and the Senate, in 6 years, hadn't talked about 
it in any kind of official, focused way. This is why Senator Stabenow 
and I have been working to try to take advantage of the moment.
  In the principal piece of legislation we have been working on, the 
Excellence in Mental Health Act, we also have a model that works. A 
couple of different things were done. One, of course, was to expand the 
federally qualified health center concept, if they wanted, to add 
behavioral health, and they could under the same rules and regulations. 
Frankly, people would be walking through the same door as their 
neighbors.
  We also created ways for community health centers--the very health 
centers that President Kennedy's legislation created--to add some of 
the advantages to be in a federally qualified center, to be in a 
community mental health center.
  Certainly the Senator's efforts--and I know we both have other 
stories to tell about other things we are working on as well, but we 
have had great response from the community mental health centers and 
great response from veterans.
  The Senator may wish to talk about that a little bit because I know 
she has been engaged in many discussions with veterans' groups who say 
if only our veterans had a place to go that was close and where their 
neighbors were going perhaps for some other kind of behavioral health. 
We have a wide swath of support from our veterans' groups as well as 
our health care groups.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Ms. STABENOW. I ask unanimous consent for 2 additional minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Ms. STABENOW. I wish to go back to what the Senator from Missouri has 
indicated. Our veterans are coming home. We know that at least 200,000 
of our veterans coming home will go into the community.
  I see our distinguished chair of the Senate veterans' committee on 
the floor. I thank the Senator for all of his good work.
  In addition to the VA system, where we are strengthening mental 
health services, we know that many will come home to the communities 
and be looking to an outpatient clinic or somewhere in the community 
for help. The reason we have strong support from the Iraq and 
Afghanistan veterans' organizations is because our Excellence in Mental 
Health Act legislation, which creates a behavioral health clinic model 
based on what has been done in community health that has worked so 
well, will create an opportunity for those veterans coming home to get 
support and help in the community.
  One of the most difficult statistics to talk about is that 22 of our 
veterans are committing suicide every day--22 every day. That is 
unacceptable.

[[Page S7712]]

  We need to make sure families and veterans have the support that they 
need so that when they come home they can receive the help they need. I 
am very proud of the fact we have about 50 organizations supporting the 
Excellence in Mental Health Act, such as sheriffs and police officers. 
Most likely, if somebody needs help, they are placed in a jail or in 
the emergency room. They don't go to a mental health facility.
  What we are proposing is something that would provide 24-hour 
emergency psychiatric delivery, coupled with high quality community 
mental health services. The time is now to do this.
  We have seen the need increase as states over the years have cut 
funding for in-patient mental health services and have not replaced 
them with services in the community.
  Too often, people who need mental health treatment end up not getting 
the treatment they need, and end up in the emergency room or, worse, in 
jail. The ER and jail are not the place to treat mental illness.
  It is fair to say that our need now is greater than ever.
  Too many people who need treatment don't get it, including one-third 
of all people living with mood disorders and more than half of those 
with severe mental disorders.
  Tragically, 22 American veterans commit suicide every day. At least 
25 percent of returning veterans from Iraq and Afghanistan are in need 
of some form of mental health treatment.
  We know that people suffering from mental illness are more likely to 
be the victims of violence than the perpetrators.
  However, we have seen too many examples of what happens when people 
don't get the treatment they need around the country and right here in 
Washington, DC, where we've seen two tragic examples in the past 2 
months, including the shootings at the Navy Yard and the woman who 
tried to drive her car into the White House and the Capitol.
  What can we do to improve the way we treat mental health issues in 
this country? How can we improve people's lives?
  We need to take the final step in mental health parity by 
strengthening access to quality mental health services in communities 
across America. That is why we need to pass the Excellence in Mental 
Health Act that the Senator from Missouri and I have sponsored 
together.
  This bill would expand access to community mental health care by 
making sure more providers are available to treat mental health issues 
and can offer a broad range of mental health services, such as the 24-
hour crisis psychiatric services, integrated preventive screenings, 
integrated treatment for mental illness and substance abuse, and 
expanded peer support and counseling services for patients and 
families.
  This bill can help fulfill the legacy of President Kennedy's 
Community Mental Health Act and the Mental Health Parity and Addiction 
Equity Act.
  There will be health care legislation coming to the floor before the 
end of this year to address physician payments, and that would be a 
natural place to address the Excellence in Mental Health Act.
  I hope our colleagues will join us in supporting critical efforts to 
address mental health care in this country, and I hope they will join 
us in moving this proposal forward so we can get closer to this goal.
  I wish to turn to my colleague, the distinguished Senator from 
Missouri for closing remarks. He has been a true champion for mental 
health and a wonderful partner to me and for his views on how we can 
work together to improve mental health treatment in America.
  Mr. BLUNT. I would just say that both our States have led in this 
area. Missouri has clearly been a pioneer in mental health efforts. Our 
community health centers--many of them--have added behavioral health in 
the last few years. There are other pieces of legislation out there 
that add to this mental health first aid, where people, particularly 
dealing with young people, can take a course. And they do not become 
people who can deal with your problem, but they may help you recognize 
if you have a problem and that somebody needs to deal with this.
  In 2011, Missouri pioneered a program for Medicaid beneficiaries with 
severe mental illness that is based in community mental health centers 
and provides care coordination and disease management to address the 
``whole person,'' including both mental illness and chronic medical 
conditions. This combination saves money.
  I have worked closely with the Missouri Coalition of Community Health 
Centers, which just celebrated their 35th anniversary and they are very 
excited about how this legislation could benefit the population they 
are serving.
  I also co-sponsored the Mental Health First Aid Act of 2013 to help 
people identify, understand and respond to the signs of mental 
illnesses and addiction disorders through a pilot program for mental 
health first aid training. In my State, we are already benefitting from 
this program and in August over 100 new mental health first aiders were 
certified during Missouri's first large-scale mental health first aid 
training.
  In addition, I co-sponsored the Justice and Mental Health 
Collaboration Act to improve access to mental health services for 
people in the criminal justice system. This bill would give law 
enforcement officers the tools they need to identify and respond to 
mental health issues, while continuing to support mental health courts 
and crisis intervention teams.
  These bills--all of which have garnered bipartisan support--are steps 
in the right direction.
  I hope Senate Majority Leader Harry Reid will allow stand-alone votes 
on mental health legislation, and I hope President Obama will work with 
members from both parties to improve our Nation's policies before 
another mental health crisis results in senseless loss.
  I agree with Senator Stabenow that the time is now. We are actually 
probably beyond the time we should have done this. But we would be ill-
advised to go further down this road without looking at this system and 
figuring out how we can improve it. There are many bipartisan ideas in 
the Senate, and I believe the Excellence in Community Health Act is 
right at the top of that list. But we need to look at this, do it, and 
do it now. I look forward to seeing something happen on this between 
now and the end of the year.
  Ms. STABENOW. Madam President, I again thank my friend from Missouri 
for his commitment and for working with so many colleagues across the 
aisle on a bipartisan basis. I believe we will get this done and we 
will now, on this 50th anniversary of President Kennedy's signing the 
Community Mental Health Act, complete the circle in terms of mental 
health parity in our country.
  The PRESIDING OFFICER. The Senator from Vermont.

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