[Congressional Record Volume 162, Number 30 (Thursday, February 25, 2016)]
[House]
[Pages H930-H938]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1730
                       CARE FOR THE MENTALLY ILL

  The SPEAKER pro tempore (Mr. Walker). 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.


                             General Leave

  Mr. MURPHY of Pennsylvania. Mr. Speaker, I ask unanimous consent that 
all Members may have 5 legislative days within which to revise and 
extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Pennsylvania?
  There was no objection.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, let me start off with some 
sobering news. I call it the body count.
  Last year, 2015, in the United States, there were 41,000 suicide 
deaths in this country. There were 45,000 deaths from drug overdoses. 
Many of those folks suffered from depression. There were an estimated 
1,200 homicides by people who are seriously mentally ill. About half of 
all deadly police encounters occurred with someone who is mentally ill.
  There is an unknown number of mentally ill who died 25 years sooner 
because they tend to die of chronic illnesses. There is about one 
homeless person per day in Los Angeles who dies. We know about 200,000 
homeless people in this country are mentally ill.
  It is a sad case in any numbers. But if you add those numbers up, 
even the most conservative version is that there were some 85,000 
deaths last year related to mental illness--and it is probably much 
higher--and more have died from mental illness-related problems than 
the total United States combat

[[Page H931]]

deaths of the entire Korean War and Vietnam Wars combined.
  That is sobering, but it is worse. It is worse because we could 
prevent a large number of these mental illness problems. We could save 
many of those with mental illness from their early demise. We could 
save their families from suffering. But, unfortunately, the Federal 
Government is the problem.
  Let me lay out this evening in this Special Order some of the 
particular problems that we have.
  In particular, for those who are low income, Medicaid itself is one 
of the biggest discriminators against people with mental illness 
getting treatment.
  First, consider this. Fifteen percent of Medicaid recipients have 
serious mental illness. That is far more than the general population. 
Serious mental illness is things like schizophrenia, bipolar illness, 
schizoaffective disorder, and severe depression.
  Thirty-one percent of those on SSI have serious mental illness. 
Twenty-six percent of those with Social Security disability have 
serious mental illness.
  In the general population, by the way, there is only about 1 percent 
with schizophrenia. About 2.6 of the general population have been 
diagnosed as bipolar.
  So look at how much higher those numbers are among the poor. That 
makes sense. Because mentally ill people are three times more likely to 
have low income as a result of their mental illness. Low-income 
individuals are three times more likely to have mental illness, many as 
a result of being poor.
  Poverty and homelessness are both associated with serious mental 
illness. Both are associated with inadequate primary care and 
preventative care. But here are some ways that Medicaid makes it harder 
for people with mental illness to get care.
  First of all, there is a rule called the same-day doctor rule. If you 
take someone to the doctor and the internist or family physician is 
very concerned that person has a mental illness, they are told they 
have to come back another day before they can see the psychiatrist.
  That is a serious problem. Because when you have the warm handoff in 
the doctor's office, you have 95 percent that will return versus less 
than half if they have to come back another day. And treatment is the 
key to getting better.
  There is a 16-bed rule from the Institute of Mental Diseases which 
says that, if the hospital has more than 16 beds and you are between 
ages 22 and 64, we are not paying for it.
  The problem with that is that serious mental illness tends to emerge 
in 50 percent of the cases by age 14 and in 75 percent of the cases by 
age 24.
  So at the very time when problems are emerging, the very time when 
someone may have their first serious crisis that may require some 
inpatient care, they are told there will be no room.
  Only 45 percent of Medicaid recipients with schizophrenia actually 
get evidence-based care. Only 35 percent of those with a bipolar 
diagnosis who are on Medicaid get evidence-based care.
  Listen to this statistic. Ninety-two percent of low-income children 
and foster children are prescribed drugs off label--those are drugs 
that are not approved by FDA--according to an HHS Inspector General's 
report, and many of those prescriptions, according to the report, are 
done without clinical justification.
  The homeless with schizophrenia have a rate of hospitalization for 
complications of hypertension almost twice as high as others. Fifty 
percent of individuals with schizophrenia are noncompliant with 
treatment regimens during their illness and don't adhere to 
medications. They need assistance in doing so.
  Also, half of those with serious mental illness have at least two 
chronic physical health conditions, such as chronic pulmonary disease, 
infectious disease, cardiovascular disease, gastrointestinal problems, 
and these people are generally in poorer health.
  So what happens is that those with serious mental illness and a 
number of other clinical aspects have compromised physical symptoms and 
we don't have a place to treat them.
  We used to have 550,000 psychiatric hospital beds in the 1950s. Now 
we have less than 40,000. During that same time, the population of the 
United States climbed from 150 million to over 300 million today.
  So where do people who have an acute mental health crisis go? Sadly, 
whether it is acute or chronic, about 200,000 of our homeless are 
mentally ill. Twenty-eight percent of them get some of their food out 
of a garbage can.
  We also have a large portion of those with mental illness filling our 
prisons. When we closed down those psychiatric hospitals, some got 
better. But, basically, we traded the hospital bed for the prison cot, 
a blanket over a subway grate, an emergency room or a gurney or a slab 
in some morgue.
  The incarceration rate among the seriously mentally ill is 16 percent 
of the population. Some 60 percent of the incarcerated may have some 
level of mental illness.
  And then what happens in the area of violence? Well, in general, 
people with mental illness are no more violent than the rest of the 
population. But when untreated serious mental illness occurs, they are 
16 times more likely to be perpetrators of violence.
  As I said before, there are over 1,000 homicides a year, and we have 
no idea how many are victims of crime. Estimates are it is 6 to 10 
times greater.
  What happens if a person with mental illness is not treated? The 
longer a person waits for treatment for a psychotic episode, the longer 
it takes a person's illness to come into remission. That means it costs 
more.

  For bipolar illness, the sooner a person starts lithium, the greater 
their improvement. It means it would cost less if we treated them. 
Delusions, hallucinations, and other severe symptoms increase the 
longer treatment is withheld.
  As far as the costs go, the cost of schizophrenia alone far exceeds 
that of coronary artery disease. The mortality rates of schizophrenia 
are far more than breast cancer.
  The costs of serious mental illness in this country are about $55 
billion in direct costs and $70 billion in indirect costs, but there is 
also the added cost of emergency room care, added cost of primary care, 
and the cost of treating their other medical problems.
  The deinstitutionalization move in this country is associated with 
much higher suicide rates, such that, while our country has made great 
strides in reducing mortality rates over the last couple of decades in 
heart disease, auto accidents, HIV/AIDS, stroke, and cancer, we have 
seen huge increases in suicide rates and drug overdose deaths.
  As a Nation, we should be ashamed of that. As a Congress, we should 
be ashamed if we do nothing about this. That requires a great deal of 
change on our part. That means we are going to have to do something to 
help people with mental illness get treatment.
  Half are simply not compliant and don't adhere to their medication. 
They get worse. Their medical problems get worse. The Medicaid bills 
get higher. Half of those with serious mental illness, as I said, have 
two or more chronic physical health conditions, and it gets worse for 
them.
  There are several things we must do to treat this. Tonight we are 
going to hear from a number of Members of Congress. First, my friend 
Jim McDermott of the State of Washington will speak. We will talk about 
a number of the issues before us and what we must do in Congress.
  I yield to the gentleman from Washington (Mr. McDermott).
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. I want to first begin by acknowledging Congressman 
Murphy. He has taken on an extremely difficult issue. It takes courage 
to bring that kind of issue to the floor of the House.
  More than half a million Americans with serious mental illness 
continue to fall through the cracks of a broken and outdated system.
  As Congress begins the consideration of how to address this national 
crisis, it is important that we take some stock of history.
  Prior to the 1960s, commitment was based on a medical model where two 
physicians made a determination that a patient needed treatment. I did 
that when I came out of the military in 1970 in Seattle.
  When the first attempt at comprehensive mental health reform began in 
the 1960s in California, it signaled a shift from the medical model to 
the legal model.

[[Page H932]]

  Ronald Reagan had been elected Governor and was interested in 
reducing the population in the mental hospitals in California. The 
result was the Lanterman-Petris-Short Act in the California State 
Assembly.
  This act set a new standard, making it increasingly difficult to 
obtain commitment to a hospital. That standard was that a patient must 
be suicidal, homicidal, or gravely disabled. Gravely disabled means 
that they can't take care of their basic needs.
  I moved to California in 1968 shortly after that bill was passed to 
serve as the chief psychiatrist at the Long Beach Naval Station, where 
I saw servicemen and -women and their families. For the 2 years I was 
in California, I had almost no success in getting civil commitment for 
people that I felt were suicidal.
  I was overruled by State employees charged with the duty of 
evaluating the need for civil commitment. The real pressure was so 
great on them and the court system that it was nearly impossible to get 
anyone into treatment in a secure facility. The hospitals in the State 
were quickly emptied, and literally thousands of mentally disabled 
people went out on the streets.
  At the same time, in Congress, the mental health center movement was 
taking hold. The Community Mental Health Act was signed into law in 
1963. The bill promised adequate funding would go to mental health 
centers to effectively treat most of these patients on an outpatient 
basis.
  But things didn't go as planned. The political reality resulted in 
insufficient money going to the mental health system. This had a 
devastating effect and led to more patients wandering the streets in 
need of treatment.
  When I finished my time in the military and went back to Washington 
State, I went to the legislature and saw a similar movement was 
occurring in my State. Remembering what had happened in California, I 
argued against changing that commitment standard, but the majority 
ruled and a similar law was passed.
  As a result, we closed one of the three mental hospitals in the State 
of Washington--Northern State Hospital--with the assurance that the 
money we saved from closing that hospital would go to the mental health 
centers. We saved $11 million. $3 million went to the mental health 
centers, and $7 million or $8 million went elsewhere.
  As a result, the streets of the State of Washington began to see all 
kinds of homeless people laying on the street and so forth. As a 
result, some of the most vulnerable patients were left without a 
support structure.
  Many became homeless or were imprisoned. In the end, we simply 
replaced hospital beds with prison beds, as Congressman Murphy has 
already pointed out. Right now there are 10 times more mentally ill 
patients in jails and prison than in State hospitals.
  Turn the clock forward to 1979. I was a jail psychiatrist in King 
County, which, in effect, was the second largest mental hospital in the 
State. I had over 200 patients who belonged in treatment, not in jail.
  This had a tremendous cost on our society. All across this country--
and Washington is no different than anywhere else you go in this 
country--it has a human cost as well as a financial cost.
  The average cost per year for a prisoner without mental illness in a 
jail is $22,000 a year. For a mentally ill patient who is a prisoner, 
the cost is more than double that, at $50,000 a year. It costs 20 times 
more to imprison a mentally ill patient than to provide that same 
patient with treatment.
  These statistics are deplorable, and the process continues to remain 
in place across this country. There are some places that have done 
things on their own and made efforts to improve how they care for 
behavioral health patients.
  In Dixon, Illinois, recently two young people died. It is a town of 
20,000 people. The sheriff said: I am going to do what they are doing 
in Gloucester, Massachusetts, in the ANGEL program.
  He made the statement to the community: Anybody who is addicted to 
heroin or opioids, come in. We won't arrest you. We won't prosecute. We 
will treat you. Twenty seven people showed up in that jail.
  He said, amazingly, another thing happened. The jail was empty 
because crime went down dramatically. Most of those people were out 
committing crimes to buy drugs.

                              {time}  1745

  Now, this program encouraged those suffering from addiction to go to 
the police, where they would be directed to drug rehabilitation and not 
prosecuted. Since then, many individuals have had effective treatment.
  We need to treat addiction as a disease state and not as a criminal 
offense or some moral failure. And the same is true with mental 
illness. A comprehensive mental health reform bill would go a long way 
to that effort.
  Now, out on the floor here, again and again, we pause for a moment of 
silence. Some awful thing has happened someplace in this country, in my 
city, in 25 cities across this country, and we stand here for 1 minute 
and commemorate the tragedy with a moment of silence. After that pause, 
we do nothing.
  Virtually all mentally ill patients are more likely to be victims of 
violent crimes rather than perpetrators, and we must recognize there 
are tragic situations that can be prevented with treatment and early 
intervention.
  I understand--I have been involved in this my whole professional 
life--that the most contentious issue is whether or not the society has 
a right to detain a citizen and treat them in the most medically 
effective way.
  Many fear a return to the indeterminate confinement of people like in 
the 1960s. I saw that in Chicago when I was in medical school. None of 
us want to see that happen--not me, most of all. But certainly no one 
on this floor wants that to happen in this society.
  The balance between personal liberty and the needs of a society is a 
challenging one to strike; but difficult as it may be, we have to rise 
to that challenge. That is why I commend Congressman Murphy for 
bringing it out here and beginning the debate that ought to go on in 
this society.
  If a mentally ill person is a danger to themselves or others, there 
needs to be an ability to commit that person long enough for the 
treatment to take effect. We need to listen to those who know the 
patient best. In many cases, it is not their doctor.
  We often hear stories from families who have tried desperately to get 
treatment for their loved ones, or from police officers who have tried 
desperately to get treatment for people. We, as doctors, can't possible 
make the best assessment without hearing from family, friends, and 
those who live with patients and play an integral role in their lives.
  Giving patients and families the help they need will dramatically 
improve and even save lives. That is why we need to work together, on a 
bipartisan basis, on a bill that Mr. Murphy has brought out.
  Is it a perfect bill? No, but it is a bill from which we can work and 
reach an agreement to try and help the needs of our society. We have 
had enough moments of silence on this floor. It is time to act.
  Mr. MURPHY of Pennsylvania. I thank Dr. McDermott. He has been, 
really, a champion of mental health issues in his career and on this 
bill as well.
  I want to point out, the bill he is referring to is our Helping 
Families in Mental Health Crisis Act, H.R. 2646. It is bipartisan. It 
has 183 cosponsors today--50 Democrats, the rest Republicans--because 
we all recognize that when you are dealing with someone with mental 
illness, in the 40 years that I have practiced as a psychologist, I 
have never once asked any of my patients what party they are.
  We know that mental illness affects people regardless of gender or 
race or age, certainly not by party.
  We also know, however, that getting care is tougher. Studies have 
said that if you are Black, your chances of getting treatment for your 
mental illness are even tougher. In fact, in Los Angeles County, 9.6 
percent of the population is Black, and yet they constitute 31 percent 
of the L.A. County jail prisoners, and they have a lower likelihood of 
getting psychiatric medication.
  Although most crimes committed by people with mental illness tend to 
be nonviolent, after they have repetitive incarcerations, they tend to 
serve four times longer sentences when they are

[[Page H933]]

mentally ill than someone who is not. So that is what we mean when we 
say we have filled our prisons and we have increased our costs with 
this.
  I yield to my friend, the gentleman from Arkansas (Mr. Hill), to also 
talk about the things we need to do and our problems with mental 
illness.
  Mr. HILL. Mr. Speaker, I thank Congressman Murphy for this time and 
for bringing this issue to the floor of the House. I thank my friend, 
Mr. McDermott, from Washington, for his views.
  Congressman Murphy's bill opens a bipartisan conversation on how best 
to address the challenges that have been facing mental health services 
and our citizens in this country for decades.
  President John Kennedy implemented a groundbreaking, community-based 
treatment model for individuals with mental health illnesses. However, 
in the decades following his service, the Federal Government has missed 
opportunity after opportunity to effectively address the needs of 
Americans with mental illness. Over the years, we have seen our 
prisons, our hospitals, and our homeless shelters bear the brunt of 
providing services for our Nation's mentally ill.
  One-third of the homeless are mentally ill, some 200,000. Sixteen 
percent of incarcerated Americans, some 300,000, have mental illness. 
And mental disorders are some of the most costly health conditions we 
face in our country.
  As noted, many of our incidents of mass violence have mental illness 
as a factor. Now most States still rely on the standard of imminent 
danger for commitment of mentally ill individuals. This is, in part, a 
result of past Supreme Court decisions, most importantly, in 1975, 
O'Connor v. Donaldson, which has been used consciously many times to 
oppose involuntary commitment and argue that committing individuals who 
are not imminently dangerous to themselves or others is 
unconstitutional.
  Congressman Murphy's bill, the Helping Families in Mental Health 
Crisis Act, holds our Federal agencies accountable and requires that 
our States follow evidence-based practices that have proven to reduce 
hospitalization, homelessness, and violence.
  This bill also provides alternatives to institutionalization for 
Americans with severe mental illness; and for those that need to be 
institutionalized, it requires States to include need-for-treatment 
commitment standards in their civil commitment laws in order to remain 
eligible for certain Federal block grant programs. This will help 
clarify commitment standards for our States and will ensure that we no 
longer wait until it is too late to potentially commit dangerous 
individuals and those who need help.
  It is important that we seize this opportunity for future generations 
of Americans, and I commend my colleague for his leadership on this 
important issue.
  Mr. MURPHY of Pennsylvania. I thank the gentleman so much for his 
kindness and his support for this legislation.
  As has been said, whenever one of these tragic killings occur or when 
some tragedy occurs, we have our moment of silence, and then we do 
nothing.
  We have a chance to do something. America demands it. I know that the 
overwhelming majority of Americans expect us to do something more than 
talk about it, particularly when so many family members are struggling.

  As we closed many of these institutions, what we ended up with is 
families themselves being the ones that are being told, here's your 
son, your daughter, your brother, your sister, your mother or father; 
go take care of them. By the way, we are not going to give you much 
information on them. We are not going to provide you much support, 
unless that person, indeed, is a danger to themselves or others.
  I have heard from many family members that they have called the 
police when they have had troubles at home, struggling.
  By the way, with mental illness, when someone's out of control, we 
call the police. With other illnesses, you call paramedics because we 
recognize that that is a disease that needs help, like when someone is 
having a heart attack or something else. But with mental illness, out 
of our fear, out of our stigma, or other things, we call the police, 
and the police are oftentimes not fully trained to do this. Then we 
tell the parents, well, good luck, and take care of them. We are not 
going to give you much information.
  That whole grand experiment of closing down the hospitals, which 
those asylums needed to be closed down, but the stopping institutional 
care and stopping all treatment, that whole process has actually shown 
more failures than successes, especially when we have not provided 
community-based treatment.
  We provide treatment for so many other diseases, but when it comes to 
mental illness, we fall far short. And we somehow have this idea, this 
misguided and self-centered and projected belief of our own, that 
people are at all times fully capable of deciding their own fate and 
direction, regardless of their deficits and diseases, and that the 
right to self-decay and self-destruction overrides the right to be 
healthy.
  But remember what I said earlier about people with severe mental 
illness and having so many other chronic illnesses and somehow going 
into the slow-motion death spiral, we walk right by and pretend that 
that is okay. It is not, and it shouldn't be. Somehow, in so doing, we 
comfortably abdicate our responsibility to action and live under this 
perverse redefinition that the most compassionate compassion is to do 
nothing at all.
  It further bolsters those most evil of prejudices we have that the 
person with disabilities deserves no more than what they are. We will 
leave it up to them. Under that approach, there are no dreams; there 
are no aspirations; there is no goal to be better that can even exist. 
Indeed, to help a person heal is some head-on collision with this 
bigoted belief we have that the severely mentally ill have no right to 
be better than they are, and we have no obligation to help them.
  This is the corrupt evil of this hands-off approach and, in some 
cases, the antitreatment model and the things that we have lulled 
ourselves into, this somnolence where we become comfortable with 
crossing the street or stepping over a homeless person, when we fear 
those, when we hear the title, the term, ``mental illness.'' It is this 
perversion of thought embedded in the glorification that to live a life 
of deterioration and paranoia and filth and squalor and emotional 
torment trumps a healed brain and the true chance to choose a better 
life.
  What a sad state of affairs our Nation has to become easy with that, 
and what a sad statement it is about this Congress for taking so long 
to take action on this. I don't know how we look ourselves in the 
mirror and continue to delay this.
  A number of my colleagues also feel very strongly about this issue of 
mental health. I yield now to the gentleman from Louisiana (Mr. 
Abraham) to take a few minutes to talk about his perspectives of what 
we need to do with mental health.
  Mr. ABRAHAM. Mr. Speaker, I want to first say thank you for Dr. 
Murphy's persistence and determination for bringing this legislation to 
this point. It has been an act of love on his part, and I greatly 
appreciate it.
  Dr. Murphy, also, great thanks for your continued work with our men 
and women in uniform in the mental health field as you continue to do 
today. It is much appreciated.
  As a family doctor in rural Louisiana, I have witnessed firsthand the 
hardships mental illness can put on families, individuals, and friends. 
I am sure every American has a story of how someone that they know and 
love has been affected by mental illness. It is not a partisan issue, 
as has been said here just recently.
  Thankfully, the study and treatment of mental health has improved 
dramatically in the last 50 years, leading to better outcomes and 
better lives. But, as our knowledge of mental health improves, we must 
routinely ensure that our government is keeping up.
  It has been over 15 years since Congress last passed comprehensive 
mental health reform. During that time, the size and authority of our 
Federal mental health bureaucracy has grown to the point where the 
amount of coordination required to function effectively is too immense.
  How much has it grown?
  A recent report from the independent Government Accountability Office

[[Page H934]]

found that there are now a total of 112 Federal programs intended to 
address mental illness--112. As you can imagine, the report also found 
that there is serious fragmentation and lack of coordination among 
these programs.
  As history continues to prove time and time again, when the size of 
bureaucracy increases, the effectiveness decreases; but when mental 
health bureaucracy fails, it fails individuals, it fails families, and 
it fails communities.
  Unfortunately, the President's solution this year is to throw more 
money at the problem and increase the bureaucracy. His 2017 budget 
proposes to add $500 million in mandatory spending to the same Federal 
programs that have been proven to be inefficient, uncoordinated, and 
inadequate. This is a shortsighted response to a long-term challenge. 
We must do more than throw money at a problem and hope for a solution.
  Congressman Murphy's Helping Families in Mental Health Crisis Act has 
taken inventory of these Federal programs. It refocuses the programs 
that work and removes the ones that don't, greatly increasing program 
coordination across the Federal Government. This is only one of the 
many reasons why I have cosponsored this comprehensive bill, and I 
welcome rigorous debate on this floor on the rest of the bill's merits.

                              {time}  1800

  Finally, I thank again Dr. Murphy for his dedication and leadership 
on this mental health issue. The time, effort, and attention to detail 
that he has put into this comprehensive reform bill is what the 
American public should expect from elected officials. I strongly 
encourage and support his efforts.
  Mr. MURPHY of Pennsylvania. Thank you, Doctor. I appreciate your 
comments and your support for this bill and, of course, your practice 
in the field and understanding our needs.
  A couple of points you made there I want to elaborate on. You said 
that there are 112 Federal programs identified scattered across 8 
departments that deal with mental health. There are 26 programs for the 
homeless.
  But many of these programs have not met since 2009, and according to 
the General Accounting Office report, it is uncoordinated. A patchwork 
quilt would be a compliment because a patchwork quilt is at least 
stitched together and our mental health approach is not.
  Part of this bill is to create an office for the Assistant Secretary 
of Mental Health and Substance Abuse Disorders. That doctor would then 
be charged with meeting regularly with these programs and agencies to 
get them to work together.
  Where there is unnecessary redundancy, get them to merge. Where there 
is exemplary programs, let's expand it. But, above all, get treatment 
back to the States and back to the communities where they can do the 
most good with evidence-based programs that work.
  I will elaborate more on these in a minute, but first I want to call 
upon my friend, Chris Gibson, from New York for a few minutes.
  Mr. GIBSON. Mr. Speaker, I want to thank my friend and colleague, Dr. 
Murphy, for organizing this Special Order, but also for his strong 
leadership in an area that is so important to all Americans. I also 
want to thank him for his service to our Nation.
  Indeed, I rise to give a voice for so many of my constituents who are 
calling on this House to strengthen Federal mental health policies.
  I think this is important not only in terms of these policy changes 
that we are talking about this evening, but, quite candidly, also about 
the mindset. I think we need to think about this issue area 
differently.
  Misconceptions out there, I hear this often from my constituents, how 
we need to change the way that we think. Too often we think of mental 
health as a permanent state, that individuals are either well or not 
well, when, in fact, what we have learned is that, over the course of 
our life, mental health is really a spectra. Sometimes we are 
flourishing, and sometimes we are challenged.
  For me, this is certainly a personal issue. My closest adviser is my 
beautiful wife, Mary Jo, who is a licensed clinical social worker. I 
get the benefit of her counsel on a regular basis.
  I also look to Dr. Murphy as somebody who has spent over 40 years in 
this field. I also want to thank Grace Napolitano, who is also a leader 
of the Mental Health Caucus. I have worked together with her as we push 
forward these very important initiatives.
  I want to say that I do think we have made some progress. In a moment 
here, I will talk about some of the details of that. I think that we 
are making some progress particularly with neuroses, anxiety, and to 
some degree, depression.
  But, candidly, we are not making progress at all with regard to 
policy when it comes to very severe mental health issues. In part, Dr. 
McDermott addressed this earlier.
  We know that, in the 1960s and the 1970s, there were a series of 
exposes, very severe issues that were going on in our psychiatric 
hospitals. Consequent to that we went through a process of 
deinstitutionalization.
  But we have learned that, when we did this and put nothing in behind 
it--and I certainly can understand a lot of abuses that were going on 
and understood the need to take action to roll back and to really make 
sure that we don't have those abuses.
  But what we have learned is that it was a mistake not to put policy 
in behind that. We see this all the time. It has been mentioned already 
this evening, the issues with homelessness, the issues with mass 
violence.
  Inasmuch as we know most with very severe mental illness are not 
violent, we also know that, when we have these very tragic events, 
that, at times, these are correlated with severe mental illness without 
Federal support, without any support. So that is part of the calling 
for this evening.
  The American people want to know: Is our Congress listening? We are 
listening. That is part of the reason why Doc has organized this 
tonight to express this to the American people, that we know this is a 
very important priority.
  I want to provide some overview of some of the actions we have taken. 
First of all, last year I was at the White House when the President of 
the United States signed into law the Clay Hunt suicide awareness and 
prevention bill.
  Corporal Clay Hunt was a great American hero. He served our country 
very honorably and courageously in Iraq and Afghanistan and lost his 
life to mental health disease. His family has taken up the standard and 
are working really hard to move us forward on that.
  This bill that the President signed into law last year--a very 
bipartisan bill--is going to help strengthen mental health support for 
our servicemen and -women and our veterans.
  Likewise, the James Zadroga 9/11 healthcare bill for our first 
responders also includes a provision in there that strengthens mental 
health. So we are supporting our veterans, and we are supporting our 
first responders. These are important bills that have been enacted into 
law.
  We have also passed in this House an important bill called the Female 
Veteran Suicide Prevention Act, and we are calling on the Senate to 
pick this up so that we can also send that to the President.
  While we have made progress in some of these areas, we have much more 
to do in so many other areas. I want to talk about the Mental Health in 
Schools Act.
  I think this is a very important and certainly a challenging period 
in the lives of Americans in the teenage years and so many emotions all 
going through. We need to provide support.
  What we have found in some pilot programs in New York is, when we 
have social workers in schools, this absolutely stems incidences of 
drug abuse and crime because we are dealing with this in the area where 
we really need that support: mental health.
  We have a bill that will address this that will scale that, and I 
hope that we can get more support here in the House.
  In addition to our teenagers, I also have a bill that helps with our 
senior citizens. It is a very simple bill. It basically just adjusts 
Medicare so that, for seniors looking for counseling, they will get 
that support.
  Finally, of course, the bill that we are all rallying around tonight, 
H.R. 2646, the Helping Families in Mental Health Crisis Act--I think we 
have

[[Page H935]]

heard about some of the important dimensions of this bill.
  I just want to highlight the fact that I think that this bill is 
going to help us with the very severely mentally ill, particularly 
those suffering from psychosis.
  We have heard tonight how we have a shortage of inpatient care. We 
have got to address this because, if we don't address it, we end up 
seeing it in the penal system. That is absolutely the wrong approach to 
this, and it is costing the taxpayers as well.
  So, in addition to that, we see more coordination among agencies and 
suicide awareness and prevention programs strengthened.
  So, Mr. Speaker, I will close with this. This is a very important 
issue, and the American people are counting on us to take action. I 
think we have got a series of bills that we can rally around--
bipartisan bills--that will truly make a positive difference.
  So let me end where I began and just thank Dr. Murphy for his great 
leadership and call upon my colleagues to support his bill and these 
other bills as we move forward.
  Mr. MURPHY of Pennsylvania. I thank my friend from New York in his 
ongoing support for these issues dealing with mental illness.
  Now I would like to call upon my friend from the State of Oregon, 
Earl Blumenauer, who has been a great champion on these issues as well. 
Many times we have conversed about this. I appreciate my friend's 
guidance and support on this issue.
  I know your heart is in this and you are dedicated to it.
  Mr. Speaker, I yield to Mr. Blumenauer.
  Mr. BLUMENAUER. I appreciate your courtesy in permitting me to join 
you this evening, and I appreciate the conversation that we have had.
  Dr. McDermott's experience in the 1960s and 1970s really touched me. 
I started in my political career when I was much smarter than I am now 
and was part of the deinstitutionalization movement in my State of 
Oregon, where it was quite clear that we could provide better quality 
services that were less intrusive and more cost-effective through a 
program of deinstitutionalization. It made perfect sense on paper.
  What happened--and, luckily, karma intervened. I was a local official 
when it hit full force. The commitments that had been made to help with 
medication, to help with housing, to help with counseling, and to be 
able to provide the support services weren't ironclad guarantees.
  It was easy for subsequent legislators to erode them, and people were 
out on their own. This was a process that took place across the 
country, and we have seen the impact, as Dr. McDermott mentioned.
  I really appreciate you sinking your teeth in here to bring this 
forward. There are some elements that are clearly controversial. I have 
found over the course of 2 years that we have been talking about this a 
willingness to engage in conversation and to be open to refinement 
because we are all seeking the same objectives.
  One of the things that has just become clearer and clearer to me is 
that there needs to be stronger provisions to deal with assisted 
outpatient treatment programs. We used to call it involuntary 
commitment.
  It strikes me that we would not have a cancer patient just sort of 
cast loose on their own to sort of fend for themselves.
  But we have some of the most vulnerable members of society, in many 
cases, who are not capable of fully comprehending the situation they 
are in.
  In fact, in some cases, part of the illness they suffer from is that 
they don't think that they are sick, that we make it much more 
difficult than it should be, in some cases, impossible, for people who 
care about them most to be able to participate in treatment.
  I appreciate your willingness to work with us to strike the balance.
  I see this as part of a much larger movement. In my community, we are 
finally opening a facility this fall to get people with mental problems 
out of emergency rooms, where they actually can't be treated. They can 
just be warehoused at, actually, great expense and risk to the 
employees in the emergency room.
  I am convinced that, if we are able to work together to tease out the 
expenses--Dr. McDermott talked about how incarcerating people and 
treating them behind bars, where so many people with mental illness end 
up, is 20 times more expensive than treatment.
  Being able to hit that sweet spot, to be able to balance treatment, 
to be able to have intervention with appropriate safeguards, to empower 
the families, and to be able to help people on a path to treatment like 
we would do with any other illness is very, very important.
  I would hope that we would be able to continue this conversation. I 
hope that there will be other Special Orders where we have a chance to 
involve people who want to explore and maybe refine some of these 
elements, to be able to answer questions about the necessary 
protections and have the give-and-take that sometimes is hard to do 
when we are in sort of a formalized setting.
  I have appreciated your willingness to tackle tough issues, to be 
open to suggestions, to be willing to engage others, but, most 
importantly, that this Congress not go home without having legislation 
to meet our responsibilities to refine and focus our mental health 
programs to get more out of the resources that we have, to provide new 
tools for families, and I think build on a foundation.
  I think the bill that you have introduced is a great start. I am 
encouraged that you have sparked a very robust conversation and that 
there are other bills that are moving forward. But I hope we can build 
on this to be able to get across the finish line.
  I look forward to continuing our conversation, whether it is here 
tonight, in another evening, or with our colleagues, to make sure that 
we are doing what we should do to correct a situation that is a 
national tragedy, that is unnecessary, that is wasteful and inhumane.
  Mr. MURPHY of Pennsylvania. I thank the gentleman for his comments.
  I will add to that in the sense that about 10 people per hour die 
related to mental illness, and it is probably much more than we know 
of.
  I thank you for your good counsel, too. I may have been doing this 40 
years, but I have a lot to learn in the field of mental health.
  I have learned a great deal from colleagues and from people like Paul 
Gionfriddo of Mental Health America or the leaders of the American 
Psychological Association, the American Psychiatric Association, and 
from Fuller Torrey. There is a whole host of names in this country who 
continue to write about and talk about this and show us research on 
this.
  Osteopaths, physical therapists--you name the field--and social 
workers are out there talking about the problems that we have with 
this. You are right. It is the most compassionate thing to make some 
changes on this.
  I know one of my colleagues who is also in the Energy and Commerce 
Committee with me, Susan Brooks, would like to comment on this as well 
and talk about our needs now, what we need to do in mental health.
  Mrs. BROOKS of Indiana. I want to thank the gentleman from 
Pennsylvania, Dr. Murphy, for introducing this important legislation 
and arranging for this Special Order today.
  As I am sure it has already been stated, one in five Americans 
struggle with mental illness. One in five. This is a critical situation 
in the country, as we have just heard, a national tragedy.
  That is why we must address it with a comprehensive, community-based, 
mental health care proposal like the one we are talking about here 
today, and we must do it in a bipartisan way.
  So I am very pleased that we have colleagues from the other side of 
the aisle here as well this evening talking about it.
  We have all seen the tragic headlines about people who lose their 
battle with mental illness and their families who are often powerless 
to help them or prevent them from harming themselves or others.
  According to researchers, about half of the people with schizophrenia 
and 40 percent of people with bipolar disorder don't believe they are 
mentally ill. These individuals have the right to refuse therapy and 
medication, and under current law, their families are only able to 
intervene when their condition becomes suicidal or extremely dangerous.

[[Page H936]]

  So in practical reality, my young adult children in their 20s, if 
they struggle with serious mental illness, I could be completely shut 
out from their diagnosis and treatment, unable to help them before 
their condition became completely debilitating.

                              {time}  1815

  As a mother, as a parent, this is heartbreaking. It is further 
evidence that something has to change. We have all talked to too many 
families, whether it is at ceremonies remembering their lives when they 
have taken their lives or when they have overdosed. That is too late. 
This bill is important for all parents in America, the loved ones, the 
family members who desperately want to help but are unable to do so.
  But it is also important to every American regardless of whether or 
not they have a personal connection to mental illness. It is critically 
important when we look at our criminal justice system.
  Sixty years ago--and I think we talked about this a little bit 
earlier--there was one psychiatric bed for every 300 Americans. Fast-
forward 50 years later, that number has shrunk to one psychiatric bed 
for every 3,000 Americans. Today, it is even less. The people, as you 
have mentioned, who work in our emergency rooms and in our criminal 
justice system are paying the price. Those people who work there are 
paying the price.
  The National Alliance on Mental Illness estimates that between 25 and 
40 percent of people with mental illness will be jailed or incarcerated 
at some time in their lives. I am a former criminal defense attorney 
and a prosecutor. I can tell you not with respect to treatment, but 
dealing with them, either if they had been arrested or if we needed to 
prosecute them, I have seen the statistics--and these are real people.
  Our courts, jails, and prisons are full of people with mental 
illness. Most of them are not getting the treatment they need. In our 
State prisons and local jails, more than half of the women and three-
quarters of the men have at least one mental health diagnosis. In 
Federal prisons, about half of all inmates, regardless of gender, 
struggle with some form of mental illness.
  We must reform the way we care for and treat people with mental 
illness. We can't rely on the prisons and jails to serve as the de 
facto mental health institutions that they have become, and we must 
make families the partner to ensure that patients with serious and 
debilitating illness can maintain a comprehensive regimen of care.
  I applaud the work of my colleague, Dr. Murphy, the only psychologist 
serving in Congress, for his leadership and for crafting the Helping 
Families in Mental Health Crisis Act, H.R. 2646. I am not going to go 
through all of the proposals because you have so many people. I am so 
pleased that you have people. I am sure that you have talked about all 
that is in the bill.
  But I must say, I urge my colleagues to join us in supporting this 
proposal. It does focus on the programs that will help families and 
patients. It will improve that connectivity between primary care 
doctors, mental health professionals, and the patients and families. It 
will help with the existing shortage of in-patient psychiatric beds. It 
will bring accountability to programs like SAMHSA, to make sure that 
their resources are being used in the most effective and consistent way 
for patients.
  I just want to applaud Dr. Murphy and all of those who care deeply 
about mental illness, because I don't want to go to more of these 
ceremonies of family members who are remembering their family members 
who have died from suicide or who have died from an overdose. Thank you 
for your work.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank my friend, Mrs. 
Brooks.
  I might say that we have all heard those stories from families. I am 
sure there are families watching tonight, Mr. Speaker, who will 
consider contacting a Member of Congress and share that story as well. 
Nothing is more painful than to hear the story of a parent like you 
described, a nightmare of a parent to be told that their child has a 
problem and there is nothing the government will let them do about it. 
How difficult that must be.
  While waiting for my other colleague, Doug LaMalfa, of California, to 
come forward, I want to mention a couple of things on the bill that 
have been referenced.
  As I said before, the bill has an assistant secretary for substance 
abuse and mental health disorders that would organize the programs. It 
would drive evidence-based care for programs such as response after an 
initial schizophrenic episode, assisted outpatient treatment, and 
assertive community treatment, or programs like the National Child 
Traumatic Stress Network, which is an exceptional program. It is a 
government-funded program that does exceptionally good, high-quality 
work.
  We know that we have to build a mental health workforce to take care 
of our extreme doctor shortage. There simply aren't enough 
psychiatrists, psychologists, or clinical social workers. When we have 
9,000 child and adolescent psychiatrists, we need 30,000. We have too 
few clinical psychologists and others who want to work with those with 
serious mental illness.
  As I said earlier, we have to fix the shortage of mental health beds, 
places that treat people who are in crisis, instead of putting them in 
jail, sending them back on the street, or strapping them to a gurney in 
an emergency room, giving them a five-point tie-down and some chemical 
sedative. We have to eliminate that same-day doctor barrier which says 
you can't see two doctors in the same day. We have to empower parents 
to be part of the treatment plan, because right now they are still 
harnessed and kept away from them.
  I yield to the gentleman from California (Mr. LaMalfa) for some of 
his comments.
  Mr. LaMALFA. Mr. Speaker, I thank Dr. Murphy. I really appreciate him 
holding this Special Order, his dedication, and his persistence in 
moving this issue along. It is very important because mental health is 
an issue that is getting more and more rampant in our communities.
  We really have some challenges in northern California with it and the 
lack of available treatment. I just had a doctor visit my office 
yesterday from Siskiyou County who, had she had this ability, had that 
county had these resources available in the way that your bill 
prescribes, tragedy would have been prevented with an attempted suicide 
and a suicide that actually happened in that same family. It is really 
inexcusable after a point that we are not able to channel the resources 
and have the effectiveness of the program that you are seeking.
  Previously, in Nevada County, California, we witnessed a devastating 
shooting at a nearby health clinic that took the lives of three 
individuals back in 2001. The shooter, who suffered from mental 
illness, had repeatedly refused treatment, despite his family's best 
efforts to get him help. This is where the system, again, is broken.
  Outdated laws leave individuals suffering with severe mental illness 
to fend for themselves, only to have intervention step in when it is 
too late. Does it really take an attempted suicide, does it really take 
a drug overdose, to get attention, instead, when people that have this 
and know about these triggers would be able to get them the help they 
need with the right implementation? We need to break down those 
barriers and provide that pathway.
  The Assisted Outreach Treatment program, for example, helps patients 
and families experiencing severe mental health issues to get the 
treatment they need before a crisis occurs. Patients are able to live 
at home and meet their therapist on a regular basis while having access 
to lifesaving medications. Success rates are testimony to the 
effectiveness of the program in terms of compassion and effectiveness. 
Again, in one of my counties, Nevada County, where this program is in 
effect, hospitalization was reduced 46 percent, incarceration reduced 
65 percent, homelessness reduced 61 percent, and emergency contacts and 
emergency needs reduced 44 percent.

  Of the patients who entered the program overall, 90 percent said it 
made them more likely to keep their appointments and take their 
medication, and 81 percent said it helped them get well and stay well. 
This is what it is all

[[Page H937]]

about: to give them hope and to put them in the mainstream of society 
where they can function well and be successful. Forty-nine percent 
fewer abused alcohol, 48 percent fewer abused drugs.
  Yet, instead of investing in programs such as this, we continue to 
spend billions on duplicative behavioral wellness programs that allow 
far too many Americans to fall through the cracks.
  We have got to do more to care for our neighbors in this country. I 
rise today in support, and I am proud to be a cosponsor of the 
gentleman's legislation. We cannot stand by anymore and allow the 
status quo because, as we know too well, the cost of inaction is too 
high for those who suffer from it and for the families and the 
communities. This is going to be very effective in helping to channel 
that and having a success we can all be proud of.
  Thank you for the time and for your persistence.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman for 
his support.
  While waiting for my friend John Katko of New York to come forward, I 
want to reflect on how long it has taken us to do this.
  What we used to do up through the 1800s is just throw people in jail. 
Then along came an activist by the name of Dorothea Dix, who saw the 
abysmal conditions in our prisons for the mentally ill, saw them 
chained to walls in squalor and filth, beaten and abused. She spoke up 
to have institutions built that would be better respites for them. 
Indeed, that took place for awhile, but then they became overcrowded, 
and that was part of what we shut down.
  As my other colleague talked about, Mr. Blumenauer mentioned that 
then we thought, well, we have other outpatient care for them. That 
promise never came through.
  This legislation would, as I mentioned before, allow us to have more 
providers in psychology, psychiatry, social work. It would also merge 
the mental health and substance abuse dollars to allow States to use 
both. We have got to be treating mental health and substance abuse 
dollars, not to cut either one, but to make sure that a person with 
substance abuse disorder and mental illness can be treated.
  It would bring accountability of spending Federal funds for grants. 
Our bill would establish a national mental health policy lab within 
SAMHSA, Substance Abuse and Mental Health Services Administration, and 
set scientific objective outcome measures.
  It would also have an interagency serious mental illness coordinating 
committee, which could coordinate the Federal spending in mental health 
and make suggestions to the Assistant Secretary's office and to 
Congress and bring together government offices with experts in the 
field to develop reforms in the mental health system.
  We want to have alternatives to institutionalization and jail 
diversion. Assisted outpatient treatment is one version; assertive 
community treatment is another one. We are making sure that we provide 
the wraparound services for the mentally ill person instead of dumping 
them into jails and leaving them there only to get worse. And we want 
to advance early intervention and prevention programs, where this bill 
establishes most of its funding there to make sure we have those 
programs.
  I yield to the gentleman from New York (Mr. Katko), someone whom I 
have also gotten to know pretty well over this bill, with his own 
passion for this issue as well.
  Mr. KATKO. Mr. Speaker, I thank Dr. Murphy.
  I rise today to talk about one of the most serious challenges facing 
our country, and that is the mental health issue. It is a problem that 
affects the rich and the poor, old and young, employed and unemployed. 
It can strike anyone.
  For far too long, the issue of mental health has stayed in the 
shadows in our country. If we want to directly face the challenges that 
the American people face in their everyday lives, we cannot allow the 
silence to continue. That is why I so enthusiastically support your 
bill, Doctor.
  A short time ago, I met with some of my constituents in upstate New 
York that were part of a drug treatment, education training, and 
rehabilitation program. One of the individuals told me of his personal 
battle with mental health.
  About 10 years ago, his sister died of cancer, and his marriage broke 
down soon thereafter. He couldn't sleep because of the trauma and 
stress, which led to anxiety and depression, and he didn't know what to 
do. As he was doing yard work one day, someone he knew walked past and 
said he could provide something to help him sleep. It was heroin. He 
tried it. Pretty soon he was hooked, and his life was ravaged for years 
and years. In fact, it took 7 years of him being pushed to the brink by 
drugs for him to seek help--7 years, 7 lost years.
  Six years later, he has found paid work, probably for the first time 
since his addiction. He told me that if we lived in a culture where the 
trauma of grief and the need to get help for mental health problems 
were more clearly recognized, things could have been much different for 
him. Just think how much better it would have been for him and think 
how much better it would have been for others in the country.
  The reality is that, for many people today, mental health is a huge 
issue. With the awareness of the mental health issue increasing, I 
fervently hope that the acceptance and understanding of the individual 
suffering from it will as well.
  We cannot prevent all mental health issues. There are no cures for 
all conditions. But we can help the culture change in our country. This 
bill goes a long way towards doing that, and I commend you for that, 
Doctor.
  We can insist that everyone counts and that everyone matters and that 
no one dealing with any form of illness should ever feel ashamed. That 
is how you bring real change to America.
  Before I close, I want to note that the second leading cause of death 
among individuals 24 years or younger in this country, as the doctor 
well knows, is suicide. The 10th leading cause of death in this country 
for all adults is suicide. It is an epidemic. It is not treated as such 
in this country, and it is high time that we do so.
  For every suicide in this country, there are 12 suicide attempts. 
Think of the costs to our society. Think of the costs and the burdens 
on families, the burdens on the health industry who have to deal with 
this. We must do a better job, and we have to do a better job.
  That is why I am proud in my district that soon after I was elected 
last year, we formed a mental health task force. We are enthusiastic 
about a lot of things and a lot of changes it is going to bring about, 
but there is nothing we are more enthused about than this bill.
  Doctor, I commend you for this. I hope that we get this passed in the 
House, and I hope we get this bill moving once and for all.
  Again, I commend you, Congressman Murphy, for your steadfastness on 
this issue.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, how much time do I have 
remaining?
  The SPEAKER pro tempore. The gentleman from Pennsylvania has 2 
minutes remaining.
  Mr. MURPHY of Pennsylvania. I yield to the gentleman from Indiana 
(Mr. Bucshon).
  Mr. BUCSHON. Mr. Speaker, I am here to support Dr. Murphy's 
tremendous work in the area of mental illness. It shows that one person 
really can make a difference. Dr. Murphy is leading the charge for our 
country to change the way that we deal with our mental health programs.
  I have got direct experience with this. I have a high school friend 
who suffered from schizophrenia and eventually lost her family as it is 
related to that. I have had two high school friends who suffered from 
severe depression and ended up suicidal and subsequently did take their 
own lives.
  This is critical legislation. With people like Dr. Murphy working 
hard to get this done, we really can make a difference on behalf of 
people with severe mental illness in our country.
  I commend you, Dr. Murphy, for the strong work. Continue to push. I 
am hopeful we can get this through the House of Representatives this 
year.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, let me close with these 
statements.
  With 60 million Americans out there with some form of mental illness 
this

[[Page H938]]

year and 10 million or so with severe mental illness, they all have 
families. I hope those families wake up and speak up. I hope they 
contact their Member of Congress.
  I know that mental illness can be treated, but it cannot be treated 
if we ignore it and it gets worse. I don't want more tragedies here. I 
hate to wish any of these tragedies on my colleagues in Congress, but I 
know it will happen. We will be here again for moments of silence. We 
will have more Members that face this suffering in their own families 
and in their communities, and we should not allow that.
  I hope that soon we can call forth H.R. 2646, the Helping Families in 
Mental Health Crisis Act, because to delay it is to cause more harm, to 
deny it is to cause more death. Let's finally do something to help turn 
this problem around with mental health in America.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________