[Congressional Record Volume 165, Number 81 (Wednesday, May 15, 2019)]
[Senate]
[Pages S2852-S2854]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                             Mental Health

  Ms. SMITH. Mr. President, when I first came to the Senate, I knew I 
wanted to make mental health one of my top priorities. As a Minnesotan, 
I am proud of the way our Senators have led the way on this important 
issue, from Paul Wellstone to Al Franken, to Amy Klobuchar. I am 
honored to have the chance to further our proud legacy when it comes to 
improving our mental health system, but that is not the only reason I 
have chosen to make mental health a focus.
  I am glad it has become a more prominent issue here in Washington, 
but I have noticed it usually comes to the forefront in the context of 
some unthinkable tragedy. When a high-profile celebrity takes his or 
her own life, we immediately want to reach out to other people who are 
suffering in silence. Of course, we do. That is not a bad thing.
  We can't repeat the number often enough. If you are having thoughts 
of suicide, please, please call the National Suicide Prevention 
Lifeline at 1-800-273-8255. Even if you aren't suffering from acute 
mental illness, put that number in your cell phone so you can, someday, 
help someone who is.
  On the other hand, when a profoundly disturbed person commits a 
horrible act of violence, we immediately want to intervene before the 
next time it happens. Of course, we do.
  When we bring up the need to improve our mental health system as the 
answer to the epidemic of mass shootings in America, though, we are 
making two huge mistakes. First, we are ignoring our responsibility to 
address a much more direct cause of these tragedies--guns. Second, we 
are unfairly and falsely stigmatizing mental illness.
  Here is another thing we can't say often enough: It is exceedingly 
rare that one's mental illness leads one to commit acts of violence. In 
fact, one is much more likely to be a victim of violence than to be a 
perpetrator, and we must not make it harder for people to seek help by 
falsely tagging them, as we do, as being potentially dangerous.
  Yes, these tragedies are reminders that we need to spend more time 
talking about mental health, but let's have the right conversation. For 
most people who struggle with mental illness in America, the struggle 
is not about life or death; it is about the quality of the lives we 
lead. Mental health is a continuum, and many of our fellow citizens 
fall somewhere along this continuum. These millions of Americans 
deserve our attention, and these millions of Americans deserve our 
help.
  The other reason I want to focus on mental health care while I am 
here in the Senate is that I am one of them. When it started for me, I 
thought I was just having a bad day or, really, a series of bad days. 
While growing up, I had always been a pretty cheerful kid, but at some 
point during my second year of college, I had started to find it harder 
and harder to cope with the daily challenges of life. Actually, it had 
been my roommate who had noticed that I had not been myself and hadn't 
been myself for a long time. She had suggested that I talk to someone 
over at the Student Health Services. It had been a completely foreign 
idea to me, and I had responded in the way a lot of people would have--
``I have this.'' Eventually, I had realized that maybe I had been wrong 
about that.
  It was really hard to make that phone call, walk over to the 
counselor's office, and sit in the waiting room. I didn't know what to 
expect, and to be honest, I was embarrassed. The counselor's name was 
Charlotte. She was nice, had common sense, and wasn't patronizing or 
judgmental. She just asked me some simple questions about how I was 
feeling, and I remember what a relief it was just to talk about it. 
Over the course of a few months, Charlotte gave me some ideas about how 
to cope a little bit better with the challenges I was facing, and I 
would always walk out of her office feeling a little bit more 
courageous and a little bit more hopeful.
  Did I live happily ever after? Well, not quite. That is not how 
mental illness works. There isn't a box for when you are healthy and a 
box for when you are not. Like I said, it is a continuum, and you try 
to get a little closer to the healthy end every day.
  At one point in my thirties, though, I found myself sliding back in 
the wrong direction. There was nothing unusually traumatic going on in 
my life.

[[Page S2853]]

I had a career, and Archie and I were raising our two sons. We were 
busy, and we were tired, but that is the way it is when you are a young 
parent. Still, something was wrong.
  All who have suffered from depression have their own metaphors to 
describe it, but most can identify with the sensation of the color just 
sort of draining out of your world. The things that used to give you 
joy don't give you joy anymore. The things that you used to love to do 
may just make you exhausted. Basically, you are just trying to slog 
through the day. Of course, when you feel this way, just making it 
through the day is tough. I found myself struggling to be a good mom, a 
good wife, a good friend, a good colleague. I just felt off all the 
time--clumsy and slow. I forgot things and got angry at the drop of a 
hat.
  See, the thing is, depression messes with your memory. I will never 
forget when my young son asked me quietly and cautiously: ``Mom, are 
you OK?'' It was a spiral. The worse things got, the more frustrated I 
became, but I couldn't get it together. Down and down I went until I 
could no longer see hope on the horizon. I was never suicidal, but I 
struggled to function. I definitely wasn't living my best life. I 
really wasn't living at all.
  That is the reality of mental illness for millions of Americans. I am 
one of the lucky ones. I was lucky that my college had excellent mental 
health resources and that my roommate cared enough about me to urge me 
to take advantage of those resources. I was lucky that when my 
depression came back with a vengeance, I had health insurance that 
covered treatment. There was a therapist named Susan with the skill and 
the expertise to help me.

  Susan asked me a few questions:
  How are you sleeping?
  Terrible.
  Are you forgetting things?
  All the time.
  She then suggested that I take a diagnostic test, which basically 
consisted of answering questions like those. Even then, I was 
resistant. People often say that depression lies, and the biggest lie 
depression tells is that what is wrong with you is you. So you resist 
getting help because you refuse to accept that there is anything 
happening except that you stupidly forgot it was recycling day again.
  I went ahead and I did the diagnostic test, and Susan came back and 
said: Yes, you are clinically depressed, so let's talk about what we 
can do about it.
  One thing I would say to people who are resisting going in for that 
appointment is that even after I got that diagnosis, I was still in 
control. When Susan brought up the idea of medication, it was a 
suggestion and not an order. I will admit it--it was a suggestion I had 
a hard time with. I didn't want to become a different person. I didn't 
want some pill messing with my brain. What if it didn't work and I got 
worse? On the other hand, what if it did work? Would I really be 
better, or would it just be an illusion of feeling better?
  Susan convinced me to give it a try, and I was lucky again when the 
first medication we tried worked. I didn't feel better right away. 
There was no big milestone moment where I woke up and everything was 
great again. But I remember feeling like I was slowly coming out of a 
fog. The color started to seep back into my day a little bit more every 
day. I began to reengage with my family and my friends and my work, and 
I could see hope on the horizon again. After a couple of years on 
medication, I slowly ramped down, and I haven't had to get treatment 
since.
  As I said, there is no happily ever after when it comes to mental 
illness, but happier is possible. If anyone needs proof, just talk to 
me.
  So that is my story, but really it is the story of millions of 
Americans. I chose to share mine--first in an op-ed in the Rochester 
Post-Bulletin and now here on the floor of the Senate--because I want 
to urge anyone who struggles with depression or anxiety or substance 
abuse or post-traumatic stress disorder or any other mental health 
issue to reach out and seek help.
  Destigmatizing and demystifying mental illness is just the beginning. 
Everyone can be a friend to those in need by urging them to take 
advantage of the resources that are available to them, but the 100 of 
us here in the Senate have a responsibility to make sure those 
resources are available to everyone. We can't afford to leave holes in 
the net we build to catch people when they fall, especially when one of 
the biggest holes is in our schools.
  I have spent a lot of time over the last months having conversations 
with teachers and administrators in public schools across Minnesota. 
Time and again, when I ask them ``What keeps you up at night?'' they 
come back to the mental health of their students. They talk about the 
causes--everything from increased social pressure that comes from 
social media to the trauma of losing a parent to opioids--but they also 
tell me what the crisis really looks like at ground level.
  A principal in St. Paul told me about the regular phenomenon of an 
ambulance pulling up at the school doors, rushing to the aid of a 
student who has suffered a break. It has happened more than a half a 
dozen times at his school alone this year. Meanwhile, the principal in 
Parkers Prairie--a town in Otter Tail County of just over 1,000, 
people--tells me that she sees students experiencing homelessness and 
other trauma, students dealing with PTSD, and students with eating 
disorders. Just this year, she has had three students end up in the 
hospital for self-harming. They have a heroic social worker who comes 
in but only every other day because they have to share her with another 
school in the district.
  School psychologists across Minnesota tell me they are struggling to 
keep up with the number of kids who need urgent intervention to make 
sure that, for example, their behavioral issues don't become so 
significant that they get them kicked out of school altogether.
  As for kids whose issues are very real but not so acute--like the 
ninth grader whose anxiety makes her sick to her stomach every day--
they wind up stuck on waiting lists for treatment. And that is even 
before psychologists can do any active outreach to the students who 
haven't reached out for help.
  That is why last month I reintroduced my Mental Health Services for 
Students Act. This bill would create a grant program for school 
districts looking to expand the mental health services they are able to 
offer to students by partnering with community mental health system 
organizations.

  If we are going to get our arms around this crisis, we need to train 
more teachers, administrators, and members of the school community, 
including parents, to recognize when kids are struggling and to connect 
them with help. If we here in the Senate are serious about addressing 
mental health in our schools, we should pass this bill without delay.
  A comprehensive approach to mental health means improving the system 
all along the age continuum. Over in the HELP Committee, we will have 
an opportunity this year to reauthorize the Child Abuse Prevention and 
Treatment Act, or CAPTA. And I have a bill, sponsored in the House by 
my friend Representative Dean Phillips, that would improve the delivery 
of mental health services within our child welfare system. For example, 
our bill would make sure that young, at-risk children get important 
developmental screenings when they need it.
  We are learning that childhood trauma can be a major factor in future 
mental illness. The more we do to address the underlying trauma, 
whether it is poverty, the death or incarceration of a loved one or a 
parent, or sexual abuse, the better we address those issues, the better 
chance we will have of turning the tide on this epidemic.
  The mental health crisis isn't only affecting our kids; it is 
affecting our parents too. According to a study by the Centers for 
Disease Control, one in five adults age 55 or older experiences a 
mental health issue, and a third of them never receive treatment. Men 
over the age of 75 have a higher suicide rate than any other age group. 
The social isolation that too often comes with aging or caring for a 
loved one isn't just unfortunate; it is a public health risk.
  Just as we have learned to reach out to the veterans in our lives and 
in our communities to let them know we are there for them if they are 
struggling, we should do the same for our elders. As the HELP Committee 
takes up the reauthorization of the Older Americans Act this year, I 
will be working to do my part.

[[Page S2854]]

  Our mental health system should be there for people at every age, 
from nursery to nursing home. It should be there for people everywhere 
along the mental health continuum, offering everything from preventive 
care, to ongoing therapy for chronic conditions, to crisis support for 
those in acute distress. It should also be there for people in every 
ZIP Code, and unfortunately, some of the biggest holes in our system 
can be found in rural areas.
  As a Senator, I am proud to serve on the Agriculture Committee. I 
frequently meet with farm groups, and today mental health is one of the 
first topics to come up. Farming is an inherently stressful profession, 
especially these days, when the numbers for suicide prevention hotlines 
regularly appear in farm publications. But we need to include the 
entire rural community, from bankers and pastors to grocers and 
fertilizer sellers. We need to include them in this conversation, and 
we need to make sure that when people do reach out for help, there is 
help there for them.
  Unfortunately, rural communities in general are often underserved by 
mental health professionals compared to cities and suburbs. Many still 
have inconsistent access to the internet, meaning that even online 
resources can be out of reach for someone who is struggling. That is 
why, in the last farm bill, we set up a rural health liaison in the 
Department of Agriculture--someone who understands the specific needs 
of rural communities and is charged with paying attention to a crisis 
that has too often lurked beneath the surface.
  Last year, Senator Murkowski and I worked together to pass a law that 
would provide mental health professionals in the National Health 
Service Corps with greater flexibility in where they practice and 
deliver care, increasing the resources available in underserved rural 
communities.
  I hope my colleagues will join me in continuing to take action to 
address the mental health crisis, and I hope that sharing my own story 
will make it easier for more Americans to add their voices to this 
fight.
  Still, there is no magic cure for depression. There is no magic bill 
to solve this problem. Mental health is a reality of life for millions 
of people in our country, and we can't legislate it away. If we work to 
help more Americans bring their struggles out of the shadows into the 
sunshine, if we reach out to people in need and connect them with 
people who can help, and if we understand the factors that make people 
vulnerable to these problems and focus our energies on making sure the 
net is there to catch them if they fall--if we do these things, then we 
can take steps in the right direction, one right after the other and 
one day at a time.
  I still remember what it felt like in those weeks and months after I 
began to treat my depression--the sense of empowerment that came with 
finally taking my mental health into my own hands, the renewed energy 
that came with finally feeling like today is better than yesterday and 
maybe tomorrow will be even better yet, and the joy that came with 
finally seeing hope on the horizon once again. So even in the midst of 
this public health crisis, I believe there is hope on the horizon for 
the millions of Americans who struggle with mental illness, but they 
are counting on us to make this hopeful vision a reality.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.

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