[Congressional Record Volume 161, Number 146 (Tuesday, October 6, 2015)]
[House]
[Pages H6826-H6832]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           MENTAL HEALTH WEEK

  The SPEAKER pro tempore (Ms. McSally). Under the Speaker's announced 
policy of January 6, 2015, the gentleman from Pennsylvania (Mr. Murphy) 
is recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY of Pennsylvania. Madam Speaker, this evening, just before 
votes, I went outside on the balcony here of this Capitol to watch the 
sun set. It was one of those beautiful evenings of crimson and gold and 
gray clouds silhouetted against the twilight glow of the evening. And 
then I glanced over to the buildings here at the Capitol and was 
suddenly brought back to reality when I saw so many flags on our 
buildings flying at half mast, flying at half mast because, once again, 
we are remembering the tragedies that have shaken our Nation time and 
time again.
  This has been a bloody summer, a bloody summer of many attacks that 
have been associated with folks with mental illness.
  I know most people with mental illness are not violent, and I know 
that there are many other tragedies that occur; but tonight, during 
this week, which is Mental Health Week in America, I want to highlight, 
Madam Speaker, what we must do as a nation, what we cannot continue to 
push aside.
  Just think of what happened this summer, just a few examples:
  June 13, attack on the Dallas Police headquarters by a man who had a 
history of family violence and mental instability;
  July 23, Lafayette, Louisiana, a shooting in a movie theater by a man 
who had had a judge's orders to send him to a mental hospital in the 
past;
  August 16, Antioch, Tennessee, a movie theater attack;
  August 26, Roanoke, Virginia, a live, on-air shooting, a tragic scene 
of a reporter being killed, and a cameraman;
  August 28, 2015, Houston, Texas, while a deputy police officer was at 
a gas station, riddled with bullets by a man who had a history of 
mental illness;
  September 22, the son of a State senator, former State senator of 
Virginia, killed a man, and also killed himself in Bowling Green;
  And this last week, October 1, in Roseburg, Oregon, nine people were 
killed, and the gunman killed himself in another tragic scene.
  There is more to it than this, of course. In this country last year, 
125 people with mental illness were killed in some sort of a police 
shooting where the police oftentimes did not even know, but the 
confrontation grew and ended in a death.
  It is estimated there were somewhere between 1,200 and 1,500 murders 
in this country this last year by people with mental illness. But more 
than that, there are 10,000 or more, maybe 20,000, maybe 100,000 people 
with mental illness who are the victims of crime. Some are killed.
  There are thousands and thousands of people who are homeless, who die 
that slow-motion death of homelessness, of their physical ailments and 
their illnesses.
  There were 41,000 suicide deaths, 1.2 million suicide attempts that 
required some medical care, 43,000 substance abuse overdose deaths. 
This list goes on and on and on.
  And what happens is, when we treat people with mental illness early 
in their life, their prognosis is improved. In many cases, they can go 
on to have fruitful lives. But when it is untreated, they likely 
develop other problems, not just with mental illness, but social, job, 
and physical health.
  Persons with serious mental illness, in treatment, are 15 times less 
likely to engage in an act of violence than those who are not in 
treatment.

                              {time}  2015

  In America, some 60 million people in any given year will have some 
diagnosable mental illness, from the very mild and transient ones, 
which we all experience, to severe mental illness, such as 
schizophrenia or bipolar or extreme depression. But of those with 
serious mental illness, about 4 million of those 11 million will not 
have any treatment for a variety of reasons: treatment may not be 
available; they may refuse treatment; or what happens so often with 
those with serious mental illness, they are characteristically unaware 
that they have an illness--it is a brain illness, a serious mental 
illness--like a person with Alzheimer's or stroke or traumatic brain 
injury, a person who may not even know that they have a problem.
  What do we do about this as a nation? Mostly we just talk. Sadly and 
tragically, what we do here in the House of Representatives, we will 
have a moment of silence, but it is not followed by action. What we 
need is not more silence. We need action.
  Madam Speaker, we need people in this country to rise up and say: 
This is the time. This is the day. This is the issue where we are, once 
and for all, going to do comprehensive reform of our mental health 
system in America.
  Our mental health system in America is fragmented at best, a system 
with regulations that are abusive and neglectful towards those with 
serious mental illness. And more so, it is worse if you are a minority 
or low-income.
  This is odd because in a field that is filled with some of the most 
compassionate and caring people I know, people I have had the pleasure 
to work side by side with in my role as a psychologist, we have Federal 
policies and State policies that leave their hands tied, their eyes 
blinded, and their mouths gagged to prevent treatment from occurring. 
Ultimately, the individuals suffer and their families suffer.
  Tonight we will review what the problem is and what can be done 
systemically, thoroughly, and definitively, what this country must do 
if we are serious about treating mental illness.
  One of my colleagues from the Toledo area, who represents northern 
Ohio, is with us now. I yield to the gentlewoman from Ohio (Ms. 
Kaptur).
  Ms. KAPTUR. I thank you, Congressman Murphy, for yielding to me. I 
want to say how fortunate the country is that the people of 
Pennsylvania have elected you here to serve the people of our Nation 
with the strong background that you have and with the obvious depths of 
knowledge that you have about those who are mentally ill and the 
compassion you have in a field that is very difficult, where the 
answers still remain incomplete.
  I want to be on the floor this evening to say to those who are 
listening in the Chamber, to those who may be listening outside, your 
efforts to draft the Helping Families in Mental Health Crisis Act, H.R. 
2646, is a watershed moment in this Congress.
  I have served in this Congress a lot longer than the others on the 
floor this evening. I was here in 1998 when, sadly, we lost two of our 
Capitol Police officers, Jacob Chestnut and John Gibson. A diagnosed 
schizophrenic receiving Federal SSI benefits but off his medicines and 
estranged from his family headed on a rampage all across the country, 
all the way from the West to here, and delusionally, he set out to 
quash, I guess, a purple force he had tracked here to the Capitol.
  He broke into the majority leader's office. All the staff went under 
the desks. I thought, well, maybe this is the moment that Congress will 
finally face up to the violent impulses that have fallen right at our 
knees. I said, but I would wager one of two things will happen: either 
we will finally cut the mustard and do what is right, or we will have 
more barricades and armed officers. Well, it was the latter option that 
actually happened.
  As we mourn the deaths of nine innocent victims at Umpqua Community

[[Page H6827]]

College, I commend Congressman Murphy of Pennsylvania for putting a 
bill forward that forces us to probe deeply the pattern of these mass 
shootings. We need to know the perpetrators.
  We understand the perpetrator in Oregon had served in the U.S. 
military for a very brief time. He was discharged. And my question to 
the U.S. military is: Why? Why was he discharged? Did you discharge him 
to care if you saw a pattern that needed treatment? Or did you close 
your eyes too? Because that has happened repeatedly in the U.S. 
military, though I must say that they are doing a little bit better, 
because some of their own members have now been killed around the 
country because of individuals who face very severe illnesses in their 
own lives and have simply never had the kind of doctor to help them 
come out of the dark shadows of the existence in which they have been 
living.
  Many of these individuals have been abandoned by their families. Many 
times they are expelled from school.
  As you look around the country and you see the people who commit 
these heinous, heinous crimes and then many times take their own life, 
they are completely alone or they are living with one member of their 
family, abandoned by their other family members and, as the gentleman 
from Pennsylvania has said, many times ending up homeless, the victims 
of attacks themselves, or many times, out of whatever is happening in a 
very ill brain, taking it out on the rest of society.
  Probing deeply into mental illness requires a discipline that 
Congressman Murphy has and an understanding that no Congress yet has 
had. That myopia is symptomatic of what is happening across our Nation: 
more security but no significant attention to those who show out-of-
control and violent tendencies, those tragically mentally ill citizens 
who are driven by their illness to harm others.
  If someone has a broken back, we have special wards. What happens to 
the mentally ill in the district that I represent and across this 
country, some of them end up in the jail. Seventy-five percent of those 
incarcerated in northern Ohio have dual diagnoses of mental illness and 
substance abuse. What does that tell us? Our jails have become the 
depositories for this Nation's mentally ill.

  I am not saying that individuals diagnosed with mental illness are 
more likely to commit crimes. I agree with Congressman Murphy that most 
of them become victims of crimes because they aren't thinking straight, 
and it doesn't have to be this way.
  The bill that Congressman Murphy has written and has vetted and has 
worked with different groups and individuals, and which I support and a 
host of other Members do on a bipartisan basis, is supported by one of 
the most important organizations in our country: the National Alliance 
on Mental Illness. I have the highest respect for them.
  H.R. 2646 fixes the Nation's broken mental health system by 
refocusing programs, reforming grants, and removing Federal barriers to 
care. It names an assistant secretary for mental illness at the 
Department of Health and Human Services, and it encourages more 
meaningful involvement from family members and caregivers who, frankly, 
at this point, many times, just give up because they have this force 
within their homes that they cannot contain.
  Rather than just paying tribute to those among us who have been lost 
and those who save them at risk to their own lives, cannot we elevate 
the solution to efforts that could help to prevent further tragedies?
  We think about the Capitol shootings. We think about Sandy Hook. We 
think about Virginia Polytechnic. The U.S. leads the world in mass 
shootings. There have been 294 mass shootings in 2015 alone, and each 
one gives us an indicator of the possible sign of untreated mental 
illness. Each one represents a failure of our society, and dispelling 
the stigma of mental illness for those who suffer remains a task 
unfinished.
  When do the elected Representatives of the American people say, 
``Enough. America can do better. America must do better''? Let's create 
a pathway, by passing H.R. 2646, to immediate treatment for those 
mentally ill citizens dangerous to others and dangerous to themselves.
  Congressman Murphy, I can't thank you enough. I don't recall a bill 
which has had such broad bipartisan support. You have worked so hard to 
go around the country. This is not a partisan issue; this is an 
American issue. I hope America can lead the world in trying to find a 
better way.
  The suffering that we see in our districts, in community after 
community after community, broken families, broken people, this doesn't 
have to be in our country.
  In the hearing that you conducted in Cleveland, I learned something 
really important that I didn't know, and that is that in the way that 
the reimbursement occurs to hospitals for people seeking care, that 
research in mental illness is at the bottom of the list because 
reimbursement doesn't flow the same way. So as we try to find answers 
to what is going on in the human brain, with the secretion of such 
chemicals like dopamine and serotonin and these different chemicals 
that those who are healthy have being secreted at a normal level, those 
who do not have that system working for them have big problems; but 
yet, if doctors try to get research dollars to solve and figure out 
what is going on in the human brain, the reimbursement system we have 
today simply doesn't work. I didn't know that.
  So I thank you for coming to Ohio because I am focused on that like a 
laser beam, and it is a part of the answer. So thank you for allowing 
me some time tonight on the floor. The people I represent thank you. We 
want to help you. I hope those listening will find cosponsors from 
their different parts of the country to help you move this bill 
forward. We couldn't do anything more important for the country. Thank 
you.
  Mr. MURPHY of Pennsylvania. Madam Speaker, I yield to the gentlewoman 
from North Carolina (Mrs. Ellmers), a member of the Energy and Commerce 
Committee and a cosponsor of this bill.
  Mrs. ELLMERS of North Carolina. Thank you to the gentleman from 
Pennsylvania.
  I, too, want to thank him for his tireless work on this effort. This 
is such an important piece of legislation in dealing with mental health 
and putting necessary reforms in place. The gentleman has truly been an 
absolute champion on this issue, and H.R. 2646 is such a meaningful 
piece of legislation that will help in so many different ways.
  Mental health in this country is a crisis and it is an epidemic, and 
there are so many families across this country that are dealing with 
this issue.
  The gentleman came to my district a little over a year ago, and we 
had a wonderful roundtable discussion. There were so many individuals 
who came to it, so many family members who came to it to speak on this 
issue. They were so appreciative of the fact that there was actually 
some legislation that was being developed to deal with this issue. 
These are families that have nowhere else to go.
  In my experience as a nurse, in health care, but then also as my 
experience has gone forward in taking care of those in my district and 
then traveling across the country and meeting with families and talking 
with individuals about how much this affects their lives, and it is 
almost amazing when you start having the conversation about this piece 
of legislation because I don't even think they think that anybody wants 
to help them anymore. I think they feel so far and left behind that it 
isn't even in their mind that someone is out there looking for an 
answer and helping in a way that will be meaningful into the future.
  The gentleman from Pennsylvania has done extensive work with so many 
groups, so many patient advocacy groups. His own personal knowledge as 
a child psychologist has played into this issue. There are certain 
barriers that are in place, and they are in place because we have put 
them there. Well-meaning, well-intended HIPAA laws, all of these things 
that have been put in place to help protect patients and their privacy 
and their issues, yet it prevents us from being able to understand the 
situation. It prevents families from being able to get care for their 
loved ones.
  Maybe an adult child of parents who are struggling to help their 
child, their son, their daughter. They may be out

[[Page H6828]]

on the streets; they may be at home; they may have issues; they may not 
be working. I mean, there are so many different things that can be 
happening, and they know that that individual needs help, and they have 
no one to go to.

                              {time}  2030

  Madam Speaker, this legislation will change much of that. It is a 
step in the right direction. There is much more that needs to be done. 
We were just talking a moment ago about our jails, our prisons, and how 
many of those who are within those walls and behind those bars 
literally are there because they have mental health issues. Yes, they 
may have committed a crime; yes, they may have found themselves in a 
terrible situation and ended up in jail, possibly even drug abuse; but 
the bottom line is the mental health issue that lies there.
  We are talking even about issues of fiscal responsibility in this 
country, and I think of how much money we will save and how much of a 
difference it will make if we deal with this issue in the way that it 
needs to be dealt with.
  So, Madam Speaker, I am a cosponsor of this legislation. This is an 
incredibly important piece of legislation. It is bipartisan, and it is 
for every American in this country, every American in this country that 
is dealing with this issue with a loved one or with a friend. We all 
have them. We all walk down the streets and see individuals who we know 
are homeless, and we know that the root cause is mental illness. We can 
change something in this country. This is one change we need to make. 
We need to come together as a whole House of Representatives to pass 
this piece of legislation.
  Again, I just want to finish by thanking the gentleman from 
Pennsylvania one more time for his tireless efforts. You have truly 
been the champion for every mental health issue, and this piece of 
legislation passed by the House of Representatives will be a monumental 
step in the direction of mental health reform.
  Mr. MURPHY of Pennsylvania. I thank the gentlewoman for her comments 
and for her continued pursuit of making sure we pass this.
  This bill was first introduced over a year ago, reworked with a lot 
of bipartisan input, Members of Congress from both sides of the aisle, 
and also from many, many organizations. The other day, some 23 
organizations delivered a letter to some Members of Congress saying 
they want to see comprehensive mental health reform.
  This is the first and the most comprehensive mental health reform our 
country has seen. The last time some efforts were made, it was the very 
last bill that President Kennedy signed before he was assassinated to 
begin to make some change in our country to move away from the asylums 
and towards community mental health. Unfortunately, that dream only 
came partially true because what happened is we closed those asylums.
  Back in the 1950s, we had 550,000 psychiatric hospital beds in this 
country. At that time the population of the country was 150 million. 
Now the population of the country is over 316 million, 320 million, and 
we only have 40,000 psych beds.
  Now, Madam Speaker, some of that is because we have come up with more 
effective treatments, better ways of identifying and diagnosing people, 
better medications, and, quite frankly, those asylums of yesteryear 
needed to close. Many times they were homes of abuse and given 
nicknames like snake pits, cuckoo's nests, and other derogatory terms 
because they were so bad. But then along came community medical health 
centers, and that was supposed to pick up the slack. As States found 
that they could close these asylums, they looked and saw that they 
could save some money, and they didn't put the money into mental health 
services, nor did the Federal Government. What happened instead was the 
people traded the hospital bed for the jail cell, for the homeless 
shelter, and for the morgue. That is where we are today.
  Now, it is not for lack of trying because, indeed, the Federal 
Government has spent a lot of money--some $100-plus billion a year--on 
this, mostly through disability payments, but some for Federal 
programs.
  Madam Speaker, what I want to do tonight is now talk about 10 things 
we can do as a nation to deal with this, 10 things we must do.
  First of all, the General Accounting Office report that we 
commissioned from the Energy and Commerce Committee, we said: Tell us 
what programs there are in the Federal Government that deal with mental 
health and, more specifically, serious mental illness.
  I was amazed to hear how many there were, 112 agencies scattered 
across eight departments. It is a dysfunctional and uncoordinated 
system. It is a system that really does not have central control. It is 
a system that has not even met among these agencies for years, even 
though one of the agencies, SAMHSA, Substance Abuse and Mental Health 
Services Administration, is supposed to be the lead agency to say get 
together and meet. They hadn't even met since 2009.
  By the way, when we had a hearing on this in the Oversight and 
Investigations Subcommittee, they said: Oh, we will start doing that 
soon. But this report that came out that excoriated the Federal 
programs said that they are not only uncoordinated, but nobody even 
checks to see if what they do works. They are programs with the 
Department of Defense; Veterans' Affairs; Education, Health and Human 
Services; HUD. The list goes on and on. I think there are 20-plus 
programs for homelessness. There was redundancy and there was overlap, 
but it is not coordinated. We make it the most difficult for those who 
have the most difficulty.
  So here is number one of what we want to do. We want to have the 
office of the assistant secretary for mental health and substance abuse 
created--a new office, but not new money. We do not need any money for 
this. We take the current office of SAMHSA and elevate that title of 
the person who runs that agency to the level of an assistant secretary. 
That person's job will be to create an annual report to Congress to 
tell us the state of the States, tell us how they spend their money 
that they get from the Federal level, tell us what are the best 
practices out there that can serve as models for other States, collect 
that data.
  Right now what we do get is data on numbers of suicides. We get some 
homicide data, but we really don't get that much on homeless data. We 
have so-so quality of data for substance abuse, what happens there. But 
for the most part, no one asks about these agencies and coordinates 
them. This person's job is to do this. More so, this person is going to 
have to be a mental health provider, someone who understands the field. 
The last Director of SAMHSA was an attorney, perhaps well-intended, but 
did not understand the field. Just like you would not appoint someone 
to head the Joint Chiefs of Staff to run the Army who is not a general 
or the Navy who is not an admiral, you need someone to run this who 
knows what they are doing.

  In addition to coordinating these agencies, what they would do is 
give a report to Congress of which ones can be eliminated because they 
are redundant, merge the money together, make more money available, and 
send more money out to communities. Let Congress then act to revamp 
these multiple organizations to do what is most effective to get 
funding back to the communities and to the people where it is needed, 
not to stay in Washington, D.C.
  I think President Reagan talked about perhaps some proof of eternity 
is a Federal program. What we don't want to have here is the 
continuation of programs that exist just for the sake of employment. 
Programs should exist for the sake of doing the right thing for people 
out there, and right now, we have a failure.
  The second item is to drive evidence-based care. Another General 
Accounting Office report which came out talked about some of the 
abysmal conditions here. They were saying that agencies had difficulty 
identifying programs supporting individuals with serious mental illness 
because they didn't always track whether or not such individuals were 
among those served by the program.
  Again, SAMHSA in the past--which is supposed to lead these 
organizations--doesn't really track to say: What are the evidence-based 
programs you are doing? When we had a hearing on these issues, SAMHSA 
told me afterwards they would change nothing.

[[Page H6829]]

They do list some evidence-based programs, but the evidence base is 
oftentimes people who do programs and say: Take my word for it, it 
works.
  If it works, why do we have millions of people with mental illness? 
Why do we have 4 million people not getting any care at all? Why do we 
continue to fill our jails, homeless shelters, and morgues with people 
with mental illness? There are some excellent programs out there, quite 
frankly, but there are also many that need to be changed.
  As part of this process, it was stated in the GAO report that many of 
the programs hadn't completed their evaluations, many had no 
evaluations, some were underway, and 17 programs had no evaluation 
completed and none planned. So the government was not even looking to 
see if what they were doing had any value. We are going to change that, 
Madam Speaker. We are going to make sure the programs that are out 
there have evidence-based care.
  The National Child Traumatic Stress Network is an excellent program 
that does a great job. Another program is called RAISE, Response After 
Initial Schizophrenia Episode. It does a great job because they work in 
terms of getting care early in someone's life when they first show 
symptoms. It is called the prodromal stage. When you get to someone 
early, you improve their prognosis. But a lot of these other programs--
and I will highlight some of the sloppy and irrational programs we have 
out here tonight--can make a difference if they are done the right way.
  Madam Speaker, it is important to note that with regard to serious 
mental illness, about 50 percent of those with serious mental illness, 
it will emerge by age 14, and about 75 percent of the cases by age 24. 
Every time a person has what the public popularly knows as a breakdown, 
or we refer to it as a psychological or psychiatric crisis, there is 
harm that occurs to the person, psychological harm and neurological 
harm, because it is a brain disease. So it is important to get to 
people early on. That is why we want evidence-based care that really 
and truly does that and not programs that are fluff. We want them to 
have outcome measures and determine them.
  By the way, Madam Speaker, just the opposite of that, some of the 
things that SAMHSA has funded in the past have also been programs 
specifically geared toward telling people to stop taking their 
medication. When people have anxiety, they have plans in telling you 
how to drink a fruit smoothie. None of those are evidence-based care, 
and none of those treat people with serious mental illness.
  Number three, go to the mental health workforce. We have a serious, 
serious shortage here of providers. Even if you wanted to get care, you 
can't get care in many counties. I think perhaps one-fourth or one-
third of counties in Oregon do not even have a psychiatrist in them. 
Many do not have a clinical psychologist or clinical social workers or 
peer support teams with the adequacy to meet the need. It is the same 
across the Nation.
  What happens here is there are about 9,000 child psychiatrists in 
this country. We need 30,000, precisely for the reason I said before, 
that these problems emerge during those adolescent and young adult 
years. If you don't have the right qualified people, you can't treat 
them. Similarly, clinical psychologists, counseling psychologists, 
clinical social workers, and peer support teams specifically trained 
and available to be out there, we have massive shortages.
  Part of the job of the assistant secretary is going to be to identify 
what do we need in communities and how do we get them. Our bill 
authorizes, for the first time, minorities to work with fellowships.
  We also authorize people to be volunteers at community health 
centers. This is one of the bizarre things that only the Federal 
Government can do. If you want to work at a community health center, 
you can work, and your medical malpractice insurance is covered. If you 
want to volunteer, it is not there.
  Now, think about this. If there are some well-intended and 
compassionate--as I know many are--mental health providers who want to 
volunteer maybe an afternoon a week, give of their time to help, they 
are not allowed to do it because the center can't afford their 
malpractice insurance because they would have to pay the regular rate 
as opposed to a Federal plan rate. Our bill also authorizes that they 
can volunteer.

  We also authorize programs with telemedicine so that when a 
pediatrician or a family member identifies someone in need of care, 
they can access them immediately if need be, especially in rural areas 
and faraway areas where there is not enough support there.
  The next one is the shortage of mental health beds. I had mentioned 
earlier this grave shortage where we had 550,000 beds in the 1950s; we 
have 40,000 today. It is a serious crisis-level shortage in every 
community.
  During one of our hearings, Senator Creigh Deeds, a State senator in 
Virginia, testified. Many are familiar with his story. He was a former 
gubernatorial candidate in Virginia, and he took his son, Gus, with him 
oftentimes campaigning around the State of Virginia.
  Gus played a musical instrument, and they enjoyed their time 
together; but sadly, Gus deteriorated. When his father, who raised him, 
fed him, and clothed him, took him to a hospital for care, the hospital 
said: We don't have any psych beds.
  As they made calls and tried to find more in Virginia, they couldn't 
find any. Young Gus was sent home with his father. They wouldn't 
provide many details, but they sent Gus home. Gus took a knife and 
attacked his father, nearly killing him. Creigh escaped, and Gus then 
killed himself, all because of a lack of beds.
  Madam Speaker, there was a story last week in The Washington Post 
about another Virginia man, a 24-year-old man who was arrested for $5 
worth of shoplifting at a 7-Eleven in Virginia. He was taken to jail 
for shoplifting. But upon recognizing that he had a serious mental 
illness, they wanted to get him to a hospital. Again, there weren't 
beds available. So he stayed in that jail, I believe, over 70 days, 
often naked, covered in his own feces, refusing to eat, and losing 40 
pounds. Ultimately, he died for lack of a bed.
  Now, that is not the only problem that is out there. Understand that 
we don't want to bring back those asylums, but when a person is in that 
crisis mode, it is not appropriate to bring them to a jail.

                              {time}  2045

  It is not appropriate to leave them in an emergency room for hours or 
days or weeks sometimes waiting for a hospital bed to open up, and it 
certainly is inappropriate to discharge someone without any wraparound 
services or care.
  But what happens is, when you have a bed shortage, you cannot get 
care for crisis by qualified persons. We don't have the providers. We 
don't have the places.
  It is important for someone to have a clean and calm and caring 
environment separate from other environmental stresses and problems so 
you can work with them and stabilize them, perhaps get them on 
medication, help them relax, help organize things for home care or 
outpatient care for them. Sometimes that takes a few days. Sometimes 
that takes a couple weeks. But the idea is you need a place for them.
  Without beds, oftentimes a staff simply cannot do a thorough 
evaluation and they sometimes then will simply make an uninformed and 
premature release of the individual, of the consumer, saying, ``Well, 
he doesn't seem that bad. We will send him home,'' not really 
understanding whether or not that person is a threat to themselves or 
someone else.
  Understand this, that even with the brain diseases of schizophrenia 
and bipolar, when questioned, someone could be in a position where, 
when asked if they are going to harm themselves or someone else, they 
would say, ``No. I am fine. Really, it is okay. It was just a 
disagreement I had.'' They can keep it together for a little bit.
  And if a staff is already saying: Look, we don't have hospital beds. 
Let's send him home,'' they will be sent home without really knowing 
the seriousness of their illness or providing full services.
  Further, if you want to evaluate if someone is a threat to harm 
themselves or someone else or in imminent

[[Page H6830]]

danger of that, many times the doctors and the courts are reluctant to 
go through that process. Many times they are looking for another out.
  And many times--like in Pennsylvania, it is called a 302 procedure--
they will bypass that or they will say to the patient, ``Can you just 
voluntarily commit yourself or promise you will be okay and you will go 
out and get care?''
  I want to add this because it is very important while the President 
and other people are talking about access to guns and talking about 
background checks. You can't do a background check if you don't have a 
background record--you can't do a background check if you don't have a 
background record--and if there is no place to help people when they 
are in crisis.
  And if doctors and judges are not going to have someone involuntarily 
committed, there is no record. There is nothing that can appear on the 
national list to prevent a person from purchasing a firearm.
  There was no time spent in a hospital where staff can truly evaluate 
are these delusions and hallucinations which can be controlled with 
medication, will the person be stabilized, are they a risk threat. You 
can't do that. We need more beds, and our bill says there will be more.
  This is one of those areas of incredible prejudices and bigotry. You 
see, Medicaid has this rule that, if you are between the ages of 21 and 
64, you cannot go into a private hospital that has more than 16 beds. 
Now, think about that.
  If you have money, you can go in a hospital. If you are low income, 
you are out of luck. You are on the street. It is a different standard 
that is grossly unfair and incredibly prejudicial. And again I go to 
this point, that those who are minorities or low income are treated the 
worst.
  A person is ten times more likely to be treated in a jail cell than 
in a hospital if they are seriously mentally ill--ten times more 
likely. And, yet, that treatment in a jail cell is not appropriate at 
all.
  It is not treatment. Oftentimes they are put in isolation. They may 
get in a fight with a guard. What started off as a small charge may end 
up as a felony assault charge.
  A person with serious mental illness oftentimes for the same crime 
will spend four times the amount in jail as a person who is not 
mentally ill. And all along, if we had the proper place to treat them, 
we could have done that.
  Our bill lifts this 16-bed cap, this ridiculously absurd 16-bed cap, 
and says, instead, we would like to have an average length of stay of 
less than 30 days. That can be achieved. In about 98 percent of cases, 
it can be achieved.
  And, by the way, it is far less expensive to have someone in a 
psychiatric hospital bed than an emergency room by about four times. 
Some studies have gone as high as saying it is about 20 times less 
expensive to have them in outpatient care than in a jail cell.
  We would save a lot more money if we fixed this crisis shortage, 
worked on other outpatient care to transition people out, and wrap them 
around with the necessary services so they could go out more stable.
  Point number five: We eliminate the same day doctor barrier, another 
one of those ridiculously prejudicial rules out there that Medicaid has 
that harms those of low income.
  I mentioned a number of times that the prodromal stages of 
adolescents and young adulthood is when serious mental illness begins 
to emerge, those first symptoms that sometimes someone may think is a 
little bit strange, there is something different about this person. 
Perhaps their grades are dropping. Perhaps they are not taking care of 
themselves the way they used to. Perhaps they are withdrawing from 
relationships and friends.
  Those could be early signs of a bigger problem. But it takes, between 
first symptoms and first professional treatment, on average, 110 weeks, 
over 2 years, of waiting time between first symptoms, in part, because 
people are not aware of what to look for in the symptoms, but, in part, 
because they are not connected with other providers here and, even when 
they are, they are not allowed to do anything.
  The same day doctor rule is a Medicaid rule which says you can't see 
two doctors in the same day at the same location.
  So here is the problem. If a pediatrician says to a mother or father, 
``We are very concerned about your teenage son''--who is in the later 
years, 17 or so--``I would like him to see a psychiatrist right away 
because I am very concerned about the behaviors you are describing to 
me'' and then, when that doctor realizes that that person is on 
Medicaid, basically, Medicaid says, ``We are not paying for it,'' how 
cruel and abusive is that, to say to someone, ``Just because you have 
low income we are not going to cover the services here'' when this is a 
critical time?
  When you have that warm hand-off in the doctor's office, there is a 
95 percent likelihood that the person will follow up, according to a 
study by Children's Hospital of Pittsburgh.
  When you wait and you say, ``Here is the number. Call it another 
day,'' that likelihood drops below 45 percent.
  And when you miss that golden opportunity to help a person in times 
of need, that person may be very reluctant to come back for care in the 
future. We fix this by saying we are going to drop that same day doctor 
rule.
  Number six: We have to empower parents and caregivers to be part of 
the solution. Twenty years ago HIPAA laws came out that said, ``In 
order to help your insurance be portable, we want to protect the 
records.'' Good idea. ``We wanted to make sure records had privacy.'' 
Good idea.
  But HIPAA moved from the place where we are supposed to assist care 
and confidentiality to the point where it impairs care. It has gone too 
far. Let me give you a couple of examples.
  Right now a doctor--and I am a psychologist. If I know a family 
member brings someone in to see me, I can listen to them in a very 
passive mode, but I can't provide them any information. That is 
helpful. They are giving me vital information for history.
  If I don't have the accurate history, a provider does not have 
accurate history, you can't accurately diagnose. You don't know if the 
person has been on medication before, does it work or not work, who has 
this person seen before, what sets them off, are they doing better, 
what are their symptoms.
  If I don't have or a provider does not have that information, they 
may miss making the accurate diagnosis and then not be able to provide 
proper treatment and follow-up. When that occurs, harm can follow.
  Now, if I get the information, great. But what happens if that family 
member is not there? The provider can't go out and seek other family 
members and friends to get that information because HIPAA laws are seen 
as barriers to that.
  Because as soon as a doctor at a hospital calls and says, ``Your 
adult son is in the hospital. I need to ask you some information about 
it,'' that doctor has already violated HIPAA laws by identifying the 
person's son is in a hospital.
  Now, think about this, though. A parent, the person who was caring 
and loving throughout a lifetime, committed to their family member, a 
brother, a sister, someone's mother or father, they are prohibited from 
being part of the care team by HIPAA laws.
  A stranger, some appointed worker, someone who may see them as they 
roll in and out of their job, even if they care and they burn out, they 
will be maybe sitting next to a family member in court and simply say, 
``I can't tell you anything about this family member. You will have to 
find out for yourself.''
  Here is another problem, though. Not only are you impaired from 
getting diagnostic information, you can't evaluate medications. But 
understand that people with serious mental illness are often at high 
risk for other medical problems, in part, because their hygiene may be 
poor, they may not take care of themselves, may not see doctors, et 
cetera.
  But they also are in a situation where they may take some medications 
that make them high risk for diabetes or heart disease. And without 
getting a family member to help them with that, they do not have the 
ability to properly treat them.
  My goal in this bill is to simply say that, in cases where someone 
has diminished capacity to take care of themselves where, in absence of 
treatment, they become gravely disabled, a provider may tell a known 
caregiver--so notice I have already set the bar pretty high--may tell a 
known caregiver a few simple facts: the diagnosis,

[[Page H6831]]

the treatment plan, the treating doctors, time and place of 
appointment, and what are the medications they are on. No therapy notes 
are allowed to be exchanged. We specifically prohibit that in this 
bill. But that is important.
  And, by the way, I might add one other thing. As I hear a lot of 
people talking about the concerns of why didn't a parent do anything, 
why didn't they know anything in some cases, like the young man at 
Virginia Tech who killed so many students or the gentlemen in Oregon or 
at Sandy Hook Elementary School in Connecticut, it is because providers 
cannot do a risk assessment.
  They cannot contact a family member and say, ``Can you tell me if 
this person has any morbid fantasy and fascination with death, with 
extremely violent video games, with dark Web sites? Do they have 
weapons that are unsecured? Do they talk about violent issues? Have 
they made threats before?'' You can't do that risk assessment. Without 
that, you end up not knowing the risk.
  Number seven: States receive money for mental health services and 
substance abuse disorders. Those dollars are about $500 million for 
mental health and about $600 to $700 million for substance abuse. The 
odd thing about this is States are not allowed to mingle that money. 
They can't braid it together.
  Even worse is that many people with a substance abuse disorder have a 
mental illness and many people with mental illness will turn toward 
other substances to self-medicate. And, yet, the person will have to go 
to two different providers, two different clinics, to get care instead 
of one. We drop that barrier and say Federal grants should go to States 
in a way that help the States work this best.

  Number eight: We want to bring accountability to the spending of 
Federal funds. Now, here is where we have seen in another GAO report 
the absolute absurdity and cruelty of how money is spent.
  A GAO report done this last summer told us that many times documents 
and applications for many who receive grants were not reviewed. They 
couldn't tell you what the application criterion was to get an award. 
They didn't have program-specific guidance. Information was missing or 
not readily available. They didn't even know where it was stored. You 
couldn't follow the paper trail to see where it was. And so what 
happens is no one knows how this money was spent.
  But let me tell you some of the absurd things we have found money is 
spent on, our tax dollars. How about this? A Web site last winter was 
posted by SAMHSA for the people of Boston to help them with their 
worries about snow. That is right. They posted a 1-800 number you could 
call if you had snow anxiety. These are people from New England, for 
goodness sake. They know how to handle snow. But our tax dollars went 
to help them understand it.
  There are Web sites that tell you to drink a fruit smoothie if you 
are anxious, programs that tell you how to make a mask, programs that 
we fund to how to make collages, a painting in SAMHSA's headquarters 
that cost $22,500 of two people sitting on a rock surrounded by other 
people--$22,000.
  When we asked the director of SAMHSA what that was for, they said it 
is more mental health awareness. The only thing I am aware of is it is 
a waste of money and that money could have gone to help pay someone's 
salary to actually treat a patient.
  Well, it gets worse. A Web site for 3-year-old children, the cost of 
$426,000, with animated characters and sing-along songs. The purpose, 
we asked the director of SAMHSA, prevention. ``Prevention of what?'', 
we said. ``Well, we think prevention is good.'' ``Well, what does this 
prevent and what does it do and does it work and does it do anything?'' 
We waited for weeks to get an answer and we still don't have it 1 month 
later. By the way, they took the Web site down when we shined a bright 
light on it, saying, ``What does this do?''
  We want accountability to this spending. There will be different 
grant programs now--demonstration grants, innovation grants--where 
people will know what these grants are. They can look at them as 
scientific studies in a blind review to make sure it is going to 
quality programs that really make sense. No more of this behavioral 
wellness stuff, but truly working at things that make a difference.
  Number nine: Develop alternatives to institutionalization and have 
real jail diversion. I said already what happens to so many people with 
mental illness. They end up in jail. Forty to sixty percent of people 
in prison have a mental illness.
  And what this does is it helps provide some extra funding for States 
that have wraparound services for those who have this history of 
violent incarcerations, arrests, mental illness.

                              {time}  2100

  New York has a program called Assisted Outpatient Treatment. Their 
program, which means a judge will say you need to stay in treatment at 
an outpatient level, has found they reduced incarcerations by 81 
percent. They reduced homelessness by over 70 percent. They reduced 
admissions to emergency rooms by over 70 percent. They had patient 
satisfaction, consumer satisfaction at over 90 percent. And they cut 
costs in half.
  States have different programs here. About 46 States have something 
on the books. But many of these States do not put these programs in 
practice because of the big cost. We know States will save a lot of 
money once they start doing this.
  But what we want to do is take people out of this cycle, this 
revolving door of jail and risk and more damage, and say that States 
need to have programs where it wraps around services for that person. 
Don't just dump them from jail onto the streets and expect a problem 
because it will erupt again. Make sure those services are there. Make 
sure the person stays in treatment.
  Now some say, well, that is unfair. Some say that might be an 
involuntary commitment, that it puts people there against their will 
and you impair their rights.
  But I say this, that a person with serious mental illness 40 percent 
of the time is not even aware they have a problem and so many times 
they refuse treatment or their past run-ins with the police and other 
hospitals because they don't want to be there, they don't want to get 
treatment.
  If we provide quality, compassionate, accessible care, they may get 
that, but not under the current system. We want to make sure they have 
that care, and we will provide the funding to do it.
  Number 10, advance early intervention and prevention programs: A lot 
of what our government spends money on is what is called primary 
prevention, the things we do for everybody, like don't smoke, wear a 
seat belt.
  But what happens is, in the area of mental illness, those wellness 
programs like I described before that are out there, the silly things 
that SAMHSA does, are not an effective use of dollars.
  Secondary and tertiary prevention is valuable. Secondary is when you 
recognize someone is at risk, but not with symptoms. Tertiary is when 
they have symptoms and you try and help them get better.
  By focusing money on the programs I mentioned before--the RAISE 
program or others, the Child and Adolescent Traumatic Stress Network--
you can move the dollars where they need to be funded and stop this 
silliness.
  Now, I should say this while I am talking about SAMHSA, that despite 
two GAO reports that criticize them--and one time afterwards I had the 
director of SAMHSA in my office and I said, ``Okay. Here is your 
opportunity. Would you change anything?'' And she said, ``No. I 
wouldn't change a thing.''
  Another time during one of our hearings one of my colleagues said, 
``On a scale of 1 to 10, how would you rate yourself on your 
programs?'' And the director said, ``I would give myself a 10,'' 
despite all these failures.
  That is the reason why we need to have an assistant secretary of 
mental health. That is the reason why we need to make these changes. 
This is the current reason why we have so many of these problems.
  Before I wrap up here, I want to yield a couple of minutes to the 
gentleman from Pennsylvania (Mr. Thompson), who has also been involved 
in the field of wellness and is also a supporter of this bill.
  Mr. THOMPSON of Pennsylvania. Madam Speaker, I thank my colleague 
from Pennsylvania for yielding and for

[[Page H6832]]

leading on this incredibly important issue that is before us.
  I rise in support of Congressman Murphy's bill, H.R. 2646, the 
Helping Families in Mental Health Crisis Act of 2015. You know this 
significant piece of legislation aims to address the fact that millions 
of Americans who suffer from a serious mental illness are going without 
treatment, as families and caregivers struggle to find support in a 
disorganized healthcare system.
  I practiced rehabilitation services for 28 years before I had the 
privilege and honor in 2009 to come to work on behalf of the citizens 
of Pennsylvania's Fifth Congressional District. Part of my career was 
working acute psychiatric services, working with people that were 
experiencing some of the most chronic and reoccurring disabling 
conditions that are out there.
  Many times the system that we are in only really responded when 
people were in crisis, but it only responded to the point that the 
person was no longer a danger to themselves or someone else.
  The system did not allow for the types of resources to be deployed 
and the care to be provided to really meet the needs of these 
individuals to stop the cycle.
  It was really a privilege and honor to work with many different 
individuals and many different family members.
  But I am so excited about this step that we are taking with this 
bill, and I really encourage leadership. This is a bill whose time is 
now. We need to elevate it to the House and to the Senate. This needs 
to be on the President's desk because we can make a difference in 
people's lives with this bill.
  It is hard to deny the staggering consequences of neglecting our 
mental health system. Suicide rates are at the highest they have been 
in more than 25 years. Our nationwide shortage of psychiatric beds is 
nearly at 100,000. The three largest mental health hospitals in the 
United States are classified as criminal incarceration facilities, 
prisons.
  I have taken the opportunity--I think it is important--to make visits 
to our prisons within the congressional district. I have done that. I 
have more of those visits coming up.
  It is very apparent to me that, as we have closed in the past 
facilities that perhaps we could have improved upon versus closing, all 
we did was shift people to the streets and from the streets to the 
prisons.
  So many people today have a dual diagnosis, some type of psychiatric 
diagnosis, but also a substance abuse diagnosis, which tends to be a 
part of that spiral. And your heart breaks to see that.

  If we want to reduce our prison population and the cost that it takes 
to maintain individuals, then this bill is a good step in that 
direction of breaking that cycle. I would argue that this bill will 
help have a cost savings over time, short term and certainly long term.
  Congressman Murphy has taken a compassionate and evidence-based 
approach to reforming the way the Federal Government addresses mental 
health.
  H.R. 2646 breaks down barriers for families. It encourages innovative 
models of care. It advances early intervention and prevention programs.
  Notably, it employs telepsychiatry to reach underserved and rural 
population areas where patients have difficulty accessing needed care. 
I know for a fact using telepsychiatry reduces the stigma of reaching 
out for help.
  I authored a bill that has become law. It is called the STEP law, the 
Servicemember Telemedicine Electronic Portability Act, which we really 
did this for our military, our Active-Duty military Reserve and Guard.
  We changed the law a few years back with a piece of legislation that 
has expanded telemedicine that is used by the Department of Defense, 
and it really has helped save lives. It has not been the only thing we 
have done, but it was a valuable part in the reduction of the suicide 
rate among our military.
  So we know the many provisions within this bill are tested. They are 
proven. There are lives to be improved and lives to be saved. It 
recognizes the important role of the family, the caregiver.
  Now, these are some of the most chronic and recurring conditions, and 
you need a strong support system. The way our system is today, it 
excludes those family members.
  So there is just a lot to support here, and I am certainly proud to 
do it.
  It is important that we make a commitment to address mental health 
with the same urgency as we do physical health.
  I will remain steadfast in my support for H.R. 2646, and I encourage 
my colleagues to do the same.
  Mr. MURPHY of Pennsylvania. In my closing minute, let me say this: As 
I opened up, this will be known as the bloody summer of 2015. Let this 
time be the autumn of our compassion in 2015.
  The time is now. We have 40 newspapers around this country that have 
published endorsements for this legislation. We have 133 bipartisan 
cosponsors.
  I plead with my colleagues to please become a cosponsor to this bill. 
I beg leadership. Let's no longer have a blind eye to this, let's no 
longer have a moment of silence, and let this be the time of our 
action.
  Let's pass H.R. 2646, the Helping Families in Mental Health Crisis 
Act, and let's bring compassion and care to the many families in 
America who are suffering from mental illness and show them that that 
twilight, as the sun sets, is indicating that there soon will be a dawn 
of great hope in America.
  I yield back the balance of my time.

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