[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.
____________________