[Congressional Record Volume 161, Number 158 (Tuesday, October 27, 2015)]
[Senate]
[Pages S7547-S7549]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BLUMENTHAL (for himself, Ms. Baldwin, and Mr. Markey):
  S. 2210. A bill to require the Secretary of Veterans Affairs to carry 
out a program to establish peer specialists in patient aligned care 
teams at medical centers of the Department of Veterans Affairs, and for 
other purposes; to the Committee on Veterans' Affairs.
  Mr. BLUMENTHAL. Mr. President, in 2013, the VA estimated that about 
1.5 million veterans required mental health services, which VA provides 
in a variety of settings. In addition to the traditional VA medical 
centers, veterans may access mental health services and support through 
Vet Centers--which often appeal to veterans because of their welcoming, 
home-like environment; Community Based Outpatient Clinics, which play 
an important role in telehealth delivery by connecting rural veterans 
to psychiatry services from the medical center home-base, a Veterans 
Crisis Line, VA staff on college and university campuses, and other 
outreach efforts. Another important means of delivering mental health 
services has been the inclusion of mental health professionals within 
primary care delivery through VA's Patient Aligned Care Teams, which 
improves the screening process and allows providers to recognize and 
treat mental health issues occurring among those veterans who present 
in their primary care locations.
  In addition to providing ongoing care to veterans with mental health 
needs, VA plays a role in suicide risk assessment and prevention among 
veterans. According to VA, about one-quarter of the 18 to 22 veterans 
who die by suicide each day were receiving care through VA. Suicide 
rates are even higher among those veterans who do not use VA for the 
health care services. Given the stigma and reluctance of some veterans 
to seek mental health treatment, veterans using VA for primary care may 
be missing a key entry point to the peer support model of care. 
Expanding this effective model into the primary care setting could 
provide another opportunity for veterans to access mental health 
services through VA. That is why, today, I am introducing--with my 
cosponsors Senators Baldwin and Markey--the Veteran Partners' Efforts 
to Enhance Reintegration, Veteran PEER Act, a bill that would expand 
the peer support model of care for mental health services within the VA 
system to help ensure that veterans receive the effective and timely 
care they deserve.
  VA has begun a program to co-locate mental health care providers 
within primary care settings in an effort to promote effective 
treatment of common mental health conditions in the primary care 
environment. This is a positive step; however, the peer support model 
of care for mental health services has not been similarly integrated. 
Research on the use of the peer support model of care for mental health 
services within the VA has shown that Peer Specialists helped patients 
become more active in treatment, which can promote recovery. Peer 
support was recognized by the Centers for Medicare and Medicaid 
Services as an evidence-based practice in 2007; and over 20 states have 
Medicaid reimbursement for peer support services. In response to the 
President's August 2014 Executive Orders to improve mental health 
services for veterans, VA committed to integrating and expanding the 
peer support model of care beyond traditional mental health settings 
into primary care clinics in order to better connect with veterans 
wherever they seek care. However, progress toward placing Peer 
Specialists in primary care teams has been slow.
  The Veteran PEER bill would require VA to expand its use of Peer 
Specialists--VA employees who promote veterans' recovery by sharing 
their own recovery stories, providing encouragement, and teaching 
skills needed for successful recovery. These professionals may also 
provide case management assistance, help with accessing the right 
mental health care, and teach coping and self-advocacy skills. In 
general, peer support programs aim to develop veterans' self-management 
skills and restore participation in work and other social roles. 
Recognizing this effective model of care, this bill would require VA to 
establish Peer Specialists in Patient Aligned Care Teams within VA 
medical centers to promote the use and integration of mental health 
services into the primary care setting. Over a two year period, the 
program would be carried out in 25 locations.

[[Page S7548]]

  The bill directs VA to take into consideration the needs of female 
veterans when establishing peer support programs, ensure that female 
Peer Specialists are made available to veterans through the program, 
and consider rural and underserved areas when selecting program 
locations. VA would be required to regularly report to Congress on the 
progress of the program including on its benefits to veterans and their 
family members and data on the gender of clients served by the program. 
Given that VA is one of the largest employers of Peer Specialists, VA's 
regular reporting on the program would not only allow Congress to 
conduct appropriate oversite of the activities, but could also provide 
important insights for the wider peer support community.
  Given the pressing need for mental health services, it is imperative 
that we equip VA with the resources and organizational structure it 
needs to care for veterans who access these services and to find ways 
to reach more veterans with effective mental health services when they 
need them. Expanding the peer support model into the primary care 
setting could provide another opportunity for veterans to access mental 
health services through VA. As a nation we have asked more of these 
individuals than most of us can comprehend. We must now honor the 
promise we made as a nation--to take care of those who have taken care 
of us.
  Mr. President, I ask unanimous consent that the text of the bill and 
letters of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2210

       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 ``Veteran Partners' Efforts to 
     Enhance Reintegration Act'' or the ``Veteran PEER Act''.

     SEC. 2. PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN 
                   PATIENT ALIGNED CARE TEAM SETTINGS WITHIN 
                   MEDICAL CENTERS OF DEPARTMENT OF VETERANS 
                   AFFAIRS.

       (a) Program Required.--The Secretary of Veterans Affairs 
     shall carry out a program to establish peer specialists in 
     patient aligned care teams at medical centers of the 
     Department of Veterans Affairs to promote the use and 
     integration of mental health services in a primary care 
     setting.
       (b) Timeframe for Establishment of Program.--The Secretary 
     shall carry out the program at medical centers of the 
     Department as follows:
       (1) Not later than 180 days after the date of the enactment 
     of this Act, at not fewer than ten medical centers of the 
     Department.
       (2) Not later than two years after the date of the 
     enactment of this Act, at not fewer than 25 medical centers 
     of the Department.
       (c) Selection of Locations.--
       (1) In general.--The Secretary shall select medical centers 
     for the program as follows:
       (A) Not fewer than five shall be medical centers of the 
     Department that are designated by the Secretary as polytrauma 
     centers.
       (B) Not fewer than ten shall be medical centers of the 
     Department that are not designated by the Secretary as 
     polytrauma centers.
       (2) Considerations.--In selecting medical centers for the 
     program under paragraph (1), the Secretary shall consider the 
     feasibility and advisability of selecting medical centers in 
     the following areas:
       (A) Rural areas and other areas that are underserved by the 
     Department.
       (B) Areas that are not in close proximity to an active duty 
     military installation.
       (C) Areas representing different geographic locations, such 
     as census tracts established by the Bureau of the Census.
       (d) Gender-specific Services.--In carrying out the program 
     at each location selected under subsection (c), the Secretary 
     shall ensure that--
       (1) the needs of female veterans are specifically 
     considered and addressed; and
       (2) female peer specialists are included in the program.
       (e) Reports.--
       (1) Periodic reports.--
       (A) In general.--Not later than 180 days after the date of 
     the enactment of this Act, and not less frequently than once 
     every 180 days thereafter until the Secretary determines that 
     the program is being carried out at the last location to be 
     selected under subsection (c), the Secretary shall submit to 
     Congress a report on the program.
       (B) Elements.--Each report required by subparagraph (A) 
     shall include the following:
       (i) The findings and conclusions of the Secretary with 
     respect to the program during the 180-day period preceding 
     the submittal of the report.
       (ii) An assessment of the benefits of the program to 
     veterans and family members of veterans during the 180-day 
     period preceding the submittal of the report.
       (2) Final report.--Not later than 180 days after the 
     Secretary determines that the program is being carried out at 
     the last location to be selected under subsection (c), the 
     Secretary shall submit to Congress a report detailing the 
     recommendations of the Secretary as to the feasibility and 
     advisability of expanding the program to additional 
     locations.
                                  ____

                                    Chicago, IL, October 14, 2015.
     Hon. Richard Blumenthal,
     U.S. Senate,
     Washington, DC.
       Dear Senator Blumenthal: On behalf of the Depression and 
     Bipolar Support Alliance (DBSA), it is with great pleasure 
     that I endorse the Veteran Partners' Efforts to Enhance Re-
     integration (PEER) Act. This bill addresses a critically 
     important gap within the U.S. Department of Veterans Affairs 
     (VA) that inhibits access to behavioral health services. We 
     look forward to working with you to improve veterans' access 
     to care.
       Since 2013, the VA has effectively used peer support 
     specialists to enhance behavioral health care delivered to 
     veterans in behavioral health settings. Yet, a majority of 
     veterans in need of behavioral health care will enter the VA 
     system through a primary care center. To help create the 
     necessary connection from primary care to behavioral health 
     services, the PEER Act will utilize behavioral health peer 
     support specialists to assist veterans in various primary 
     care settings.
       Specifically, the bill will require the VA to establish a 
     pilot program to assess the feasibility and advisability of 
     establishing peer support specialists in Patient Aligned Care 
     Teams within VA medical centers to promote the use and 
     integration of mental health services into the primary care 
     setting. DBSA strongly supports the requirement that VA 
     medical centers give special consideration to the needs of 
     female veterans when designing the pilot programs and ensure 
     that female peer support specialists are available in each of 
     the pilot locations. We also welcome the collection and 
     reporting of data that will provided to Congress every six 
     months from the pilot. The VA utilizes the largest number of 
     peer support specialists in the nation. As such, this data 
     will help improve the role of the peer support specialists 
     within the VA and throughout America's entire health care 
     system.
       As the leading peer-led organization supporting individuals 
     with mood disorders and their families, DBSA understands the 
     importance of peer support for individuals with a behavioral 
     health condition. We feel strongly that expanded use of peer 
     specialists within the VA will increase veteran engagement in 
     their care, and lead to better outcomes and sustained 
     wellness. We applaud you for leading this new effort and 
     stand ready to support the VA as it implements this pilot 
     program.
           Sincerely,

                                             Allen Doederlein,

                                                        President,
     Depression and Bipolar Support Alliance.
                                  ____

                                              National Alliance on


                                               Mental Illness,

                                  Arlington, VA, October 26, 2015.
     Hon. Richard Blumenthal,
     U.S. Senate,
     Washington, DC.
       Dear Senator Blumenthal: On behalf of the National Alliance 
     on Mental Illness (NAMI), I am writing to offer our strong 
     support for your proposed legislation, the Veteran Partners' 
     Efforts to Enhance Re-Integration (PEER) Act. As the nation's 
     largest organization representing people living with serious 
     mental illness and their families, NAMI is pleased to support 
     this important legislation.
       As you know, the Department of Veterans Affairs (VA) 
     currently uses Peer Specialists to assist veterans living 
     with mental illness. These Peer Specialists do a tremendous 
     job in helping veterans' access mental health services and 
     navigate the complicated VA health care system. Every day 
     they promote recovery through development of self-management 
     skills and assistance in moving toward employment and 
     community integration.
       Your PEER bill would direct the VA to establish a pilot 
     program to assess the feasibility of ``going to scale'' in 
     the VA with a peer support program built on Patient Aligned 
     Care Teams within VA medical centers across the nation. This 
     would be a major step forward in promoting integration of 
     mental health services into primary care settings. Your bill 
     would also direct the VA to specifically take into 
     consideration the needs of female veterans when designing 
     pilot programs and to ensure that female peer support 
     specialists are available in each of the pilot locations.
       NAMI strongly supports this effort to expand access to peer 
     specialists in the VA. Thank you for bringing this important 
     legislation forward. NAMI looks forward to working with you 
     to ensure its swift passage.
           Sincerely,
     Mary Giliberti.
                                  ____

                                     Military Officers Association


                                                    of America

                                 Alexandria, VA, October 26, 2015.
     Hon. Richard Blumenthal,
     Ranking Member, Committee on Veterans Affairs, U.S. Senate, 
         Washington, DC.
       Dear Senator Blumenthal: On behalf of the more than 390,000 
     members of the Military Officers Association of America

[[Page S7549]]

     (MOAA), I'm writing to thank you for sponsoring the ``Veteran 
     Partners Efforts to Enhance Reintegration (PEER) Act,'' a 
     bill that would establish a two-year pilot program that 
     requires the Department of Veterans Affairs to establish peer 
     specialists in patient aligned care teams at 25 medical 
     center locations.
       MOAA has long supported peer support programs as a means to 
     enhance delivery of health care services. By extending VA's 
     existing mental health peer support model into the primary 
     care setting helps to further reduce barriers in accessing 
     mental health services while also supporting the Department's 
     current efforts at integrating mental-physical health care 
     concurrently to increase system capacity.
       All veterans deserve access to mental health care when they 
     need it and wherever they may live. As such, we are 
     particularly grateful for special consideration in this 
     legislation for female veterans and those living in rural or 
     underserved areas.
       I greatly appreciate your leadership and look forward to 
     the passage of this timely legislation.
           Sincerely,
                                                Norbert Ryan, Jr.,
     President.
                                  ____



                           American Public Health Association,

                                                 October 23, 2015.
     Hon. Richard Blumenthal,
     Ranking Member, Senate Committee on Veterans' Affairs, 
         Washington, DC.
       Dear Ranking Member Blumenthal: On behalf of the American 
     Public Health Association, a diverse community of public 
     health professionals who champion the health of all people 
     and communities, I write in support of the Veteran Partners' 
     Efforts to Enhance Reintegration Act, which would require the 
     inclusion of peer support specialists in Patient Aligned Care 
     Teams within medical centers at the Department of Veterans 
     Affairs.
       Rates of mental illness are disproportionately high among 
     U.S. veterans, particularly posttraumatic stress disorder, 
     substance abuse disorders, depression, anxiety and military 
     sexual trauma. Nearly 50 percent of combat veterans from Iraq 
     report that they have suffered from PTSD, and close to 40 
     percent of these same veterans report problem alcohol use. In 
     2010, about 22 veterans died each day as a result of suicide. 
     Military culture promotes inner strength, self-reliance and 
     the ability to shake off injury, which may contribute to 
     stigma surrounding mental health issues. Stigma may create a 
     reluctance to seek help and a fear of negative social 
     consequences, and is the most often cited reason for why 
     people to do not seek counseling or other mental health 
     services.
       Through a peer support model of care, Peer Specialists--
     veterans who have recovered or are recovering from a mental 
     health condition--provide veterans with assistance in 
     accessing mental health services, navigating the health care 
     system and skills needed for a successful recovery. Expanding 
     the peer support model to the primary care setting may offer 
     a key entry point for those reluctant to access mental health 
     services. The bill would also direct the VA to take into 
     consideration the needs of female veterans and locations that 
     are underserved.
       Thank you for your commitment to the health and wellbeing 
     of U.S. veterans and to improving access to mental health 
     services within the VA.
           Sincerely,
                                          Georges C. Benjamin, MD,
     Executive Director.

                          ____________________