[Congressional Record Volume 162, Number 172 (Thursday, December 1, 2016)]
[House]
[Pages H7101-H7105]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   IMPROVING THE HEALTH OF AMERICANS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2015, the gentleman from Oklahoma (Mr. Mullin) is recognized 
for 60 minutes as the designee of the majority leader.


                             General Leave

  Mr. MULLIN. Mr. Speaker, I ask that all Members may have 5 
legislative days to revise and extend their remarks and include any 
extraneous materials in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oklahoma?
  There was no objection.
  Mr. MULLIN. Mr. Speaker, I rise in support of the 21st Century Cures 
Act that passed yesterday. It is not too often that we get to be 
proactive in such important legislative business in this House. 
However, yesterday we saw a great victory for the families that so many 
of us have heard from. We have heard from mothers and fathers, brothers 
and sisters, and aunts and uncles about loved ones who are dealing with 
mental illness or dealing with drug addiction or dealing with a disease 
that we haven't been able to accurately address because we have had 
roadblocks because of legislation and rules that have been put in place 
by the FDA. But yesterday we got to pass a piece of legislation by 
overwhelming bipartisan support to say: Yes, we are listening; yes, we 
hear you; and yes, we are going to make changes.
  I am going to let my other colleagues speak. At this time I yield to 
the gentleman from Pennsylvania (Mr. Murphy), my chairman.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman for 
yielding and heading up this very important Special Order on a topic 
that affects every single family in America, and that is their health.
  As the gentleman said, yesterday we passed a very important bill, the 
21st Century Cures Act, with the charge led by the chairman of the 
Committee on Energy and Commerce, Fred Upton. I was pleased that they 
included in that package our mental health reform bill, which we moved 
out of the Committee on Energy and Commerce unanimously in July.
  We have spoken about this issue at great length for the last few 
years because it is worthy of that time. We have spoken because of the 
60 million Americans who suffer from some level of mental illness and 
the 10 million Americans who suffer from severe mental illness and the 
fact that 40 percent of them cannot get care; that half the counties in 
America have no psychiatrists, psychologists or social workers; that we 
do not have enough hospital beds for people in crisis, a shortage of 
100,000; that there are only 9,000 child and adolescent psychiatrists 
when we need 30,000, particularly important because severe mental 
illness in half the cases emerges by age 14 and 75 percent by age 24; 
that we have seen too many lives lost, that the body count in this 
Nation last year related primarily and secondarily to mental illness 
exceeds the total combat body counts of United States soldiers in World 
War I, Korea, Vietnam, Desert Storm, Bosnia, Afghanistan, and Iraq 
combined; because millions of families continue to suffer, because our 
prisons are filled with the mentally ill, our emergency rooms are 
backed up with people with mental illness-related disorders, and 
because our morgues are also filled.

  Yesterday, the House took a definitive bipartisan approach in 
changing that trajectory. The issues we have covered on mental health, 
along with the advances in the 21st Century Cures bill, sets a new 
direction for where we need to be going in this Nation to approaching 
health care overall. When we look at the research changes that we have 
made in advancing cures not only in small population orphan diseases, 
but also with regard to the total 10,000 diseases out there, we will be 
able to sufficiently and more effectively identify medical disorders 
and psychiatric disorders early on and get them treatment sooner.
  One of the aspects that was taken care of in the Helping Families 
With Mental Health Crisis Act is a program called RAISE, Response After 
Initial Schizophrenic Episode. As we know, research tells us that when 
you provide medication and effective targeted counseling early on, you 
can reduce the trajectory of severe mental illness and improve the 
prognosis greatly. But when that is not provided, every crisis moment 
of severe mental illness leads to other neurological damage, worsens 
the prognosis and, sadly, increases the chances that a person will have 
time in prison 10 times more likely than to be in a hospital when they 
are in crisis.
  We are changing that trajectory. New research will get us in that 
direction. Let me lay out for a few minutes today where this takes us 
as Congress is looking to change the Affordable Care Act. People have 
spoken ad nauseam about the problems with that act, how it has cost 
families a great deal, how it is supposed to be affordable but it is 
not, how premiums have gone up dramatically in double digits and triple 
digits over the last few years, how the deductibles and copays put it 
out of families' reach, and how it is not really a comprehensive 
approach because it does not stem the tide of increasing healthcare 
costs.
  There are some specific reasons for that. As long as we have a system 
that is based on a fee-for-service model and as long as we have a 
system that does not put the patient at the center of this focus, we 
are going to continue to have problems with cost overruns and, quite 
frankly, care problems.
  We have seen changes in the trajectory of improvements in reduction 
in mortality and morbidity. For example, over the last couple decades, 
we have seen a reduction in mortality rates for cancer, for heart 
disease, for stroke, for accidental deaths, for HIV/AIDS; but we have 
seen increases in mortality rates for suicide and also for drug 
overdose deaths.
  This really means we need to be looking at a different kind of model, 
and that model is the integrated care model, the model where behavioral 
medicine and physical medicine work together.
  Why is that important?
  We know that 75 percent of the people with a severe mental illness 
will have some other chronic illness like heart disease, lung disease, 
diabetes, infectious disease; and 50 percent of them have at least two 
chronic diseases; a third will have at least three. We know that a 
person with severe mental illness has triple the chance of moving into 
poverty, and we know that people in poverty have three times the rate 
of mental illness.
  Beyond that, if we look at people who enter into using the medical 
field from the area of chronic illness, that perhaps the first 
diagnosis might be anything from cancer, inflammatory bowel disease, 
diabetes, et cetera, the chances of them developing a psychological 
problem such as depression, panic disorder, anxiety, is massive, twice 
the rate of the rest of the population.
  This is where the costs begin to soar, because when a person 
recognizes they have this long-term problem with pain, with doctors' 
appointments, with disruption of their lifestyle, with immobility, with 
disability, et cetera, it is expected and it is common for them to 
develop other psychiatric disorders. But we have had a system that has 
ignored that.
  What happens when we ignore that?
  If a person has a chronic illness and depression, for example, 
untreated depression, it doubles. It doubles their healthcare costs. 
When there are models out there, however, that say let's

[[Page H7102]]

integrate behavioral medicine and physical medicine so that a 
physician, being a coordinated care model, when they have a patient 
with one of those illnesses, a chronic illness, they begin to treat the 
whole patient, the patient-centered model, the team approach between 
the doctor and patient there.

                              {time}  1830

  What can it do? Well, I want to cite a study done by a young doctor 
by the name of Jeffrey Brenner, who was out in New Jersey.
  You recognize that people with complex health and social issues have 
these high rates of going to emergency rooms. They are called super-
utilizers. Medicaid points out that 5 percent of the people on Medicaid 
account for 50 percent of Medicaid spending and, I might add, virtually 
all of those are people who have a concurrent psychiatric disorder, 
such as depression.
  But what Brenner did in his particular study is recognize that there 
were a number of people who had a huge number of visits to emergency 
rooms in a very costly way. He said, for example, nearly half of the 
city of Camden's 77,000 residents were visiting an emergency department 
annually, most often for head colds, viral infections, ear infections, 
and sore throats. Thirteen percent of the patients accounted for 80 
percent of hospital costs, and 20 percent of the patients accounted for 
90 percent of the costs.
  What he looked at were models that police use called hot spotting--
where are the areas of a city where you have a great deal of crime, 
and, instead of avoiding those areas, the police would go in and work 
to prevent crime. Well, similarly, in Brenner's model, he looked at 
managing these patients' care instead of ignoring them. If you ignore 
them, they go to emergency rooms repeatedly.
  Studies done, for example, at the University of Pittsburgh Medical 
Center with inflammatory bowel disease found when you ignore folks, 
they continue to go to emergency rooms. Over-utilizers of the system. 
And on a fee-for-service model, it is worth it for the doctor. They 
made a lot of money. Hospitals made money, as long as the people 
continued to come back.
  But what was it that was driving people repeatedly to get this care 
at an emergency room, or expensive care, instead of doing something 
else? What Brenner did and other studies have found is that people 
could not access their primary care physician or their specialist, so 
that is where they would go for care. They would panic. Worry, anxiety, 
depression. They weren't managing their medication well. There are 
neurobiological things that take place in the system of someone with 
depression which makes them more prone toward other infections and 
viruses, et cetera.
  What Brenner did was identified folks with a fairly complicated model 
here and developed a care management team where the goal is leaving 
patients with the ability to manage health care on their own. And how 
do they do that? By helping them see doctors more frequently.
  The studies done with the inflammatory bowel disease clinic at the 
University of Pittsburgh did the same thing. They developed an 
integrative care team, including psychiatric and psychological 
consulting, to help the person deal with their pain, help them change 
their behavior patterns, and make sure they had easy access to the 
doctors, so even getting the doctor's cell phone number, email address, 
and respond within 72 hours for doctor visits.
  What Brenner found, the first 36 patients had a total of 62 hospital 
emergency room visits per month before they began intervention. It 
dropped to 37 visits per month afterwards. Then they also found the 
hospital bill fell from a monthly average of $1.2 million to just over 
$500,000, savings that benefited State and Federal healthcare plans. 
Similar results have been found in other areas when this is targeted.
  Now, we know the Affordable Care Act had some models of this, but the 
results have been somewhat equivocal because they haven't looked at 
these as closely and really worked with the patients as closely. But 
the point is this: Recognizing if we are going to get hold of the cost 
overruns with health care, it needs to be that integrated care model--
behavioral and physical medicine working together--a coordinated care 
model, where a primary care physician and/or the specialists are 
working to coordinate the patient's care instead of leaving them on 
their own, and, quite frankly, a capitated care model, where it is 
worth it financially for the physician and patient to work together, 
not to just say: Go to the hospital whenever you want; go to the 
emergency room whenever you want; but get the care you need, the time 
you need it, with the quality you need.
  The Affordable Care Act started down this road, but it wasn't fully 
followed. But this bill we passed yesterday, and our hope is that the 
Senate passes next week, by moving forward on research; by making sure 
physicians get timely, quality information for what they should do; by 
making sure that it is disseminated to physicians, whether they are in 
urban downtown Manhattan or they are out in rural South Dakota, that 
through telemedicine they have access to the best decisionmaking; and 
by making sure that, through telehealth, which we funded in the Helping 
Families with Mental Health Crisis Act, no matter where physicians are 
in America, to have access to psychologists and psychiatrists and 
social workers and to integrate that care together, this is what makes 
a huge difference.
  Children's Hospital of Pittsburgh did a study of when that behavioral 
health consultation is done during the pediatrician visit, when there 
is a warm handoff, right away the family meets the mental health 
professional, there is over a 90-percent followup for that patient with 
the doctor. When they are given a card and said to call another day, it 
plummets to less than half.
  Similarly, look at the problems we face with opioid abuse in America. 
Last year, we had a death total of 47,000. We are reaching the point of 
the number of people who die from opioid substance abuse is reaching 
that of the level of our combat deaths during the entire Vietnam war. 
It is an embarrassing, shameful, and painful thing for our Nation to 
have, and that doesn't even include the many, many folks who still 
remain addicted.
  But here is what happens with care for the addicted. Out of every 
1,000 persons who has an addiction disorder, 900 will not seek care. Of 
the 100 who do seek care, 37 can't find it. It is not available in 
their community. Of the 63 who do seek care and find it, only 6 of them 
will find evidence-based care.

  But what if we change that trajectory? What if we say as part of 
moving forward in our revision of the Affordable Care Act and making it 
really effective health care we made sure we integrated behavioral and 
physical medicine together?
  A study done at the University of Michigan, I believe, or Michigan 
State--I have to make sure I get those right because I know Chairman 
Upton would not forgive me, but let's say it was done in Michigan--they 
did a fascinating study where they made sure when someone came to the 
emergency room with a drug overdose, they didn't do the typical thing 
and hand someone a card and say: you know, you have a drug problem; you 
need to go get help. In those cases, many times the vast majority of 
people don't follow up.
  Instead, what they did is they provided qualified drug counseling in 
the emergency room. From the same model, if a person had a broken arm, 
the hospital would set it before they went home. They wouldn't say: 
here is a card; call an orthopedic surgeon on Monday and get that arm 
set. If a person came in with chest pains, they wouldn't say: why don't 
you make an appointment in a week or two with a cardiologist. They 
would treat it right away. Well, the same thing goes with psychiatric 
disorders and drug abuse.
  What Michigan found in their study and replicated in other 
communities is there was a 50-percent increase of people following 
through on drug treatment.
  So look at the things that are done. The bill we passed yesterday 
also invests hundreds of millions of dollars into more effective 
treatment for people with a substance abuse problem. It isn't enough 
just to have them in methadone maintenance or buprenorphine programs. 
Those will not be as effective. You have got to get them into effective 
counseling programs.
  So what we see is this: The bipartisan efforts that have worked 
through

[[Page H7103]]

here and have made some big differences in where we are going with 
research and care will set us on a strong trajectory to making a big 
difference as this Congress and the new President work to change the 
Affordable Care Act to really being affordable and really being care-
focused.
  That being said, we will still have, tragically, too many stories 
while we are waiting to get that care out there. We will still have too 
many episodes: a homicide, or a suicide, or a drug overdose death, or 
someone has lost their job, or a marriage is broken up, or families who 
have been abandoned by someone else, or children who are lost, or those 
who are homeless. It continues on as long as we are not properly 
addressing the issues of mental illness in America.
  I tell you, even though we have those long, somber moments of 
sadness, there is some joy in what this House did yesterday in this 
strong, bipartisan, coordinated effort to say we are changing the 
direction of how we recognize mental health care, what we are going to 
do about that, and how that has to be an integral component as we move 
forward to change health overall. We can do this. We can reduce costs 
dramatically by providing better and more effective care.
  So for all those families who have been contacting us Members of 
Congress, literally the millions of Americans who are suffering from 
these diseases of mental illness and the tens of millions of families 
who recognize the suffering there, help is on its way. The actions that 
Congress took yesterday, the actions that we anticipate the Senate will 
take next week, the signature of the President will move these things 
forward. We will create a new dawn, a brighter horizon for people who, 
up to this point, had very little hope of where things are.
  We know we have a long way to go, and we know this next Congress, as 
we move into the next session next year, is going to have their hands 
full, but we can do this. And I know there are dedicated people here on 
both sides of the aisle just waiting and eager to make a big difference 
for America's families. And where there is help, there is hope.
  Mr. MULLIN. Mr. Speaker, as you can see, the gentleman from 
Pennsylvania is extremely passionate about this. He has been the leader 
and a voice for mental illness for my entire time that I have been up 
here, which hasn't been that long--only 4 years--but we appreciate his 
passion and his dedication to this.
  Unfortunately, mental illness isn't going away. It is becoming more 
of a problem. And we, as Members of Congress, are going to have to 
address this. I look forward to continuing to work with the chairman on 
this.
  Yesterday was a step in the right direction, but we have a long way 
to go. We are in this fight, and we are in this fight together. I 
couldn't imagine being with anyone better than the gentleman from 
Pennsylvania. So I thank him for his dedication.
  Mr. Speaker, I yield to the gentlewoman from Indiana (Mrs. Brooks).
  Mrs. BROOKS of Indiana. Before the chairman of our committee steps 
away, I just want to acknowledge the leadership that Congressman Murphy 
of Pennsylvania has given to this issue--an issue that so many Members 
of Congress haven't talked about enough until he began talking about 
it.
  I want to thank the gentleman from Oklahoma (Mr. Mullin), for leading 
this Special Order. We have heard from our constituents, and we know 
families where 1 in 4 adults--a total of 61.5 million Americans--will 
struggle with mental illness in any given year. While the numbers are 
staggering--and certainly, my colleague from Pennsylvania knows the 
numbers and statistics better than maybe this Chamber combined--they 
don't actually tell the deeply personal and typically painful stories 
that this disease inflicts on those it touches, their friends, 
neighbors, and families.
  Whether it was Columbine, Aurora, or Sandy Hook, time and time again, 
tragedies have left our communities devastated and reeling, wondering 
if our fellow citizens could have been spared the violence and 
bloodshed had we simply been able to see the signs of mental illness.
  Many lessons followed in the wake of all of these tragedies, but 
chief among them always came out the fact that our mental health system 
is broken: we are unable to fully recognize the signs and symptoms of 
an individual suffering from mental illness; we often don't have the 
resources to help these individuals and their families; and we have 
very limited mental health workforce, which is overwhelmed and often 
underprepared for the vast challenges they face day in and day out.
  Mental illness is sometimes referred to as an invisible illness. 
However, just because you can't see the illness, it doesn't mean it 
isn't there. It is a serious disease, and in order to make any progress 
in more effectively identifying it, we must begin to recognize it as 
such.
  Before the end of this year, we have a chance to make the first major 
mental health reforms this country has seen in over 50 years. And I am 
very proud to stand with the gentleman from Pennsylvania in support of 
his years of tireless work to bring to the forefront this health crisis 
we are facing in America--a crisis often pushed to the side because it 
may be too difficult or too uncomfortable to talk about. I applaud his 
efforts and the efforts of so many from our committee, particularly the 
staff, who have made it possible to work to include these important 
reforms to our mental health system in the critical 21st Century Cures 
bill that passed the House last night overwhelmingly.
  Right now, our medical system does not allow families of those 
suffering from mental illness to become true partners in their care. 
The language in our bill takes significant steps toward easing these 
barriers and making sure that people struggling with mental illness 
will have more access to the care and treatment that they need.
  Our prisons and emergency rooms have become de facto psychiatric 
treatment centers and are overcrowded with individuals suffering from 
mental illness; however, we have learned over the years we cannot 
simply arrest away this problem. I am pleased that there are reforms to 
the way our criminal justice system handles individuals with mental 
illness. As someone who has worked in the criminal justice system most 
of my career, I can assess that such support is long overdue and so 
very necessary.
  One of the greatest issues with our mental health system is there is 
a critical shortage, as Dr. Murphy just mentioned, in our mental health 
workforce. This effort contains significant measures to train and 
expand this critically important workforce.

                              {time}  1845

  These are simply a few of the important reforms included in 21st 
Century Cures which, above all else, sets a new and higher standard for 
mental health care and treatment in America.
  Once again, I applaud Congressman Murphy's incredible work to fix our 
broken mental health care system. I am proud to have supported this 
effort throughout the legislative process and look to the Senate to now 
take up the 21st Century Cures and bring relief to the individuals and 
families across America who need it the most.
  Mr. MULLIN. Mr. Speaker, it is always an honor to have people that 
are willing to come down and share their time and their passion with 
us, so I would like to thank my colleague from Indiana for laying it 
out in such an eloquent form like she always does.
  Also, congratulations on the committee assignment. I don't know if I 
wish the gentlewoman good luck or not.
  Mr. Speaker, at this time I yield to the gentleman from Illinois (Mr. 
Dold).
  Mr. DOLD. Mr. Speaker, I want to thank my friend from Oklahoma for 
yielding on what is an incredibly important topic.
  I also want to weigh in and thank my good friend, Dr. Tim Murphy, for 
his incredible work on a really comprehensive piece of mental health 
legislation. I want to not only congratulate him, I want to thank him 
for successfully shepherding this first real piece of mental health 
legislation, honestly, since 1962. It is now up to the Senate to move 
this forward.
  I am pleased to be here as not only an original cosponsor, but helped 
introduce the Helping Families in Mental Health Crisis Act, which was 
now attached to this recent 21st Century Cures bill, another bill that 
I am proud to not only stand up and support.

[[Page H7104]]

  As we look at cures, as we look at what we are doing, we see so much 
tension across our country today. We just got done with a national 
election, and, frankly, it seems as people are at each others' throats. 
And the one thing that we can agree on, I hope, regardless of whom you 
voted for, we should all be on the same page that we want 21st Century 
Cures to move forward; because, frankly, as we look at the number of 
people that are suffering from diabetes, Alzheimer's, Parkinson's, and 
the like, they don't care what political persuasion you are. They are 
just impacting families all across our country.
  Another huge piece of that is mental health; and as we look at mental 
health, there is no question, family after family, an enormous number 
of people, nearly 10 million Americans, suffer from a serious mental 
health issue, including schizophrenia, bipolar disorder, major 
depression, amongst others. Yet millions of these people are going 
without treatment, and their families are struggling to care for them 
each and every day.
  We need to talk about treatment. Treatment before tragedy is 
something that I know has been talked about time and again.
  The Federal Government currently dedicates about $130 billion towards 
112 programs intended to address mental health, but there is still a 
nationwide shortage of nearly 100,000 beds needed for psychiatric care 
and only one child and adolescent psychiatrist for every 2,000 children 
with a mental health disorder. Frankly, that is just unacceptable.
  My constituents have come to me time and again demanding that we do 
better. The Filler Foundation comes to mind as something that we have 
to do because, again, as we look at mental health, one of the things 
that we know is tied to that is this incredible epidemic of 
prescription drugs and opiates that are really just impacting every 
single community across our country. Ultimately, we know that this 
mental health disorder is a huge part of that, as people are trying to 
self-medicate, and so people are overdosing and dying on a regular 
basis.
  Ultimately, this bill that we are talking about today helps and now 
allows those families to give better care, be better informed, so that 
parents or caregivers can actually play a more vital role.
  In July, we passed the Helping Families in Mental Health Crisis Act, 
422-2. And just recently, this other bill that we just passed, the 21st 
Century Cures, that included this mental health legislation, passed 
with enormous bipartisan support right here in this body. It is time 
that the Senate take up this legislation and pass it.
  I am confident that the incredible providers that are in my district, 
the families who are in need that have been asking for help, will 
benefit from the many grants that we reauthorized, the updates that we 
have made to improve communication between the patients, the families, 
and the providers, and the steps that we took to ensure that insurance 
providers are complying with existing mental health parity laws.
  Over the past 2 years, Dr. Murphy's efforts have engaged Democrats 
and Republicans from every region of the country. Just a few short 
months ago, and I am sure--I don't know if he was in Oklahoma with my 
good friend, but I know he came out to my district. We had a roundtable 
talking about mental health issues. We went and visited some of the 
facilities together to talk about the real needs that are out there. 
Ultimately, we know that mental health impacts so many families across 
our country.
  I would venture to say, Mr. Speaker, that not a single Member in this 
body has not been impacted in some way, shape, or form, by a loved one, 
a friend, a family member that is suffering from some sort of mental 
illness. So I believe that we have an incredible opportunity here.
  Ultimately, when I go out and I talk to people--and I know my good 
friend, I am sure, has done the same--they say: Is Congress working? 
And the answer oftentimes is no. But I do think that we have to step 
back and take a look at what we can accomplish when we actually do come 
together.
  Something that we all should be proud of is the fact that we were 
able to move forward in this body to talk about not only 21st Century 
Cures, talking about funding for the National Institutes of Health, 
talking about trying to deal with some of the prescription drug and 
opiate epidemics, but really trying to tackle head-on the issue of 
mental health and the impacts that this has for our Nation.

  So I want to thank my good friend from Oklahoma for organizing this 
Special Order. I want to thank, obviously, my good friend, Dr. Murphy, 
for the great work that he has been doing for years on this.
  And I do want to make sure that the American people know that today 
we took a big step forward and, honestly, we are not going to rest 
until this is signed into law by the President and really enabling so 
many families to get a tremendous amount of relief.
  Mr. MULLIN. I thank the gentleman for his service. My good friend 
from Illinois is going to be missed. His service has been something we 
can all hold in great respect. I am going to miss seeing him in the 
morning at our workout, but he has influenced us in a better way. If we 
can always leave where we have been better than we found it, that is a 
legacy we can all walk with. I thank the gentleman for his service, and 
I hope our friendship will continue.
  Mr. Speaker, as my friend from Illinois was saying about the opioid 
addiction, I want to point out a sad statistic. Oklahoma is ranked 28th 
in population throughout the country, and yet we had the 10th highest--
10th highest--accidental opioid overdose deaths. We have more 
accidental drug overdose deaths caused by painkiller addictions than 
vehicle accidents in the State of Oklahoma.
  And these aren't from the young who may be going through a time of 
experimenting. This isn't from the elderly who may not understand the 
prescription which they are taking. This is coming from our mothers. 
Our number one--number one--individual that is losing their life to 
opioid overdose is our middle-aged mothers. There is a problem.
  The 21st Century Cures does address this, but just the same as mental 
health, it is a first step in the right direction.
  Mr. Speaker, at this time I yield to the gentleman from Pennsylvania 
(Mr. Perry), another good friend of mine, a true patriot to this 
country, one who has years and years of service. I have a tremendous 
amount of respect for him.
  Mr. PERRY. Mr. Speaker, I thank the gentleman, my friend from the 
great State of Oklahoma. I am privileged to have visited not only his 
State, but his district, and met the fabulous and wonderful people 
there, and they are lucky to have him representing them here.
  You talk about that statistic, and I am here to talk specifically 
about mental illness, but this opioid epidemic has touched every single 
community. You don't have to live in the city. You don't have to live 
in underprivileged areas. I know very good friends that it has wracked 
their families, and it has wracked our communities.
  Certainly, one of the great things about the 21st Century Cures Act 
is the help that is on the way. It is probably not going to be enough, 
but we need to do everything we can, at least in making these first 
steps in wrapping our minds and our hands around this problem and 
getting to a solution.
  So I am thankful that the gentleman has taken the time to hold this 
Special Order, to bring that, as well as the other issues, up, and I 
appreciate that.
  Mr. Speaker, I want to talk a little bit about the mental health 
situation in our country, and I think the gentleman has alluded to much 
of it in his conversation.
  Mr. Speaker, more than 11 million Americans suffer from severe 
schizophrenia, bipolar disorder, and major depression, yet millions--
literally millions--are going without any treatment whatsoever. And 
families, these families are struggling to care for these people.
  You have a broken arm or some physical malady, you can see that and 
you can get to a cure in many, many cases. But these mental illnesses 
vex us, where your loved one is fine one moment and the next moment is 
not, and you don't know when that is going to happen or the gravity of 
the situation, how bad it might be at any given moment. These are our 
loved ones. These are our family members and our neighbors.

[[Page H7105]]

  The Federal Government's approach to mental health has been a chaotic 
patchwork of antiquated programs and ineffective policies spread across 
numerous bureaucratic agencies that simply don't get to the issue at 
hand, and I think we can all see that.
  Sadly, many patients end up in the criminal justice system or are on 
the street because services are unavailable. I know that in the State 
that I reside in, the great State of Pennsylvania, years back, we 
closed our State hospitals where much of the care was given to these 
people, and they just ended up out on the street or back with their 
families, which often are cases that their families just don't know 
what to do. They don't know how to handle it. They can't handle it.
  Then these folks end up in the penal system, which is no place for 
people that justifiably are sick. They have an issue. They are sick. 
They are not criminals, but they are sick.
  In the worst case scenarios, some individuals commit acts of 
violence. And every one of us has heard the stories and seen the film 
footage on the news of these acts of violence that can be directly 
attributable to mental illness.
  Now, we should be able to feel safe in our homes, all of us, in our 
communities, and our hearts just break every single time a senseless 
act of violence occurs and we see that. And certainly, for parents, 
these tragedies, they hit especially close to home.
  We need to remember that the beneficiaries of mental health treatment 
aren't only those directly treated for mental illness, but also our 
broader community when we see those things, those images on TV, because 
mental health treatment is a preventive measure to reducing acts of 
violence. It is a preventive measure. It actually stops those things 
from ever occurring if we get to it.
  Now, I was an enthusiastic supporter and cosponsor of my colleague 
Congressman Tim Murphy's Helping Families in Mental Health Crisis Act. 
He literally worked on it for years, and I watched him struggle through 
that. And that bill was actually included in the 21st Century Cures 
Act, which passed this very House last night.

  This legislation coordinates programs across different agencies, 
those disparate agencies that don't seem to work with one another, 
where information is siloed. It coordinates that, those programs, and 
promotes effective evidence-based programs, evidence-based so we can 
get to solutions.
  Just like most other things with the Federal Government, by removing 
Federal barriers to care, advancing early intervention programs, adding 
alternatives to institutionalization, and improving the transition from 
one level of care to another, we directly address our Nation's broken 
mental health care system, finally. Finally, a step in the right 
direction.
  So, once again, I applaud and thank the gentleman from Oklahoma for 
allowing me this time and bringing this issue to the floor; and I urge 
my colleagues in the Senate to send this bill directly to the 
President's desk, absolutely, as soon as possible. We can't wait for 
another tragedy to occur where we are all watching on television the 
footage of something that could have been prevented and avoided.
  Mr. MULLIN. Mr. Speaker, I thank my colleague from Pennsylvania for 
also being extremely passionate about moving in the right direction 
with mental health. It is something that we continue to look over.
  As I stated when we first started tonight, we had an overwhelming 
amount of bipartisan support on passing the 21st Century Cures Act. We 
could see that the hard work that the staff over in the Energy and 
Commerce Committee, on both sides, the Republican staff and the 
Democratic staff, worked together to come up with a bipartisan bill to 
make sure that we are putting our families first, that we are putting 
our constituents first.

                              {time}  1900

  We are setting aside the partisanship that often finds its way inside 
our conversations. We set it aside and actually were very proactive on 
a very important piece of legislation.
  I would like to thank Chairman Murphy, with his passion on mental 
health, and our outgoing chairman, Mr. Fred Upton, who has dedicated 
his years of service to the betterment of our constituents and his 
passion for fighting this and seeing this through. I would like to 
thank him for his dedication. The gentleman will be missed as our 
chairman.
  Mr. Speaker, I see no other speakers at this time. I yield back the 
balance of my time.

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