[Congressional Record Volume 165, Number 116 (Thursday, July 11, 2019)]
[Senate]
[Pages S4783-S4784]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                             Mental Health

  Madam President, I know the minority leader, the Democratic leader, 
just arrived, and he has heard a lot about this program from my friend 
Senator Stabenow. The excellence in mental health program--something we 
started 2 years ago. We passed legislation in 2014. We have come to the 
end of the first 2 years of that trial program. I want to talk more 
about why we need a longer term expansion of that trial, but first of 
all, we need to get a 3-month extension to get us to the end of this 
spending year.

  I am always glad to talk about this program because what it does is 
it really begins to close the gap between how we talk about physical 
health and how we talk about mental health. Somewhere between one in 
four and one in five adult Americans, according to the National 
Institutes of Health, has a mental health problem that is diagnosable 
and almost always treatable, but less than half of the people who have 
that problem actually receive the care they need. These are people who 
are our neighbors, our family members, and our colleagues.
  There is no stigma to seeking care, and society needs to do a better 
job--as I believe this program is helping us to do--talking about 
mental health like all other health.
  On the last day of October 2013, on the 50th anniversary of the 
Community Mental Health Act, which was the last bill President Kennedy 
signed into law in 1963, Senator Stabenow and I came to the floor to 
talk about that 1963 bill and how many things have been closed down 
because of that bill and how many things have not been opened to 
replace them when that happened.
  In the decades that followed, about half of the proposed community 
health centers that bill anticipated just simply were never built, and 
the facilities used for people who had substantial mental health 
challenges were closed.
  What really happened over these 50 years is that the emergency room 
and local law enforcement became the de facto mental health system for 
the country, and nobody has been well served by that, including law 
enforcement, emergency rooms, and most importantly, people with mental 
health challenges and their families.
  The Excellence in Mental Health Act was signed into law in 2014 to 
try to begin to address that problem. What the bill did was it created 
a 2-year, eight-State pilot program that would provide mental health 
care at locations that met the standards, just like any other help 
would be provided. These would be certified community behavioral health 
clinics that would have, among other things, 24/7 crisis services 
available, outpatient mental health and substance abuse treatment, 
immediate screenings, risk assessments, and diagnoses available, and 
care coordination, including partnerships with emergency rooms, the law 
enforcement community, and veterans groups. All of that would have to 
be done in order to be part of that eight-State pilot. Twenty-four 
States initially applied. Nineteen States went through the entire 
process. Eight States were chosen, including Missouri.
  Among other things, our State participated in the Emergency Room 
Enhancement Project. This is a project that is designed to identify 
people who present themselves at the emergency room as people who 
really need treatment for addiction issues and mental health issues, 
not other health issues, and then get them to a place where that 
treatment is going to be much more appropriate than it is likely to be 
at the emergency room.
  In just 6 months of working with the emergency room, law enforcement, 
and mental health services in our State, we think there has been a 
reduction in homelessness of people who came to the emergency room of 
about 72 percent and a reduction in emergency room visits of 72 
percent. Unemployment was reduced by 14 percent among the people who 
have gone to the emergency room with a mental health concern, and law 
enforcement contact was reduced by 59 percent.
  So we have 2 years of study that indicates where we have gotten in 
our State, and I think other States are seeing similar kinds of 
numbers. I have been to clinics all over our State and have talked with 
those who have dealt with this. I talked particularly to law 
enforcement people all over our State, who have seen the change in the 
people they are dealing with and the options they have available. 
Suddenly, the option is not just to go to somebody's house at a crisis 
moment in the middle of the night and be taken to the emergency room 
for one night to have that problem solved; the option is actually to go 
somewhere where your mental health challenge is being dealt with, just 
like if you had a heart attack or a kidney problem or some other 
problem.
  That is why we have introduced legislation to extend this for another 
2 years and, if money is available in the pay-for we have proposed, to 
see whether we can add more States to the program.
  When we announced this new legislation, Laura Heebner, who is with 
Compass Health systems in Missouri, was one of the people who joined 
us. She said that in the past, before this program was able to help in 
our State, roughly half of the people who sought an appointment from 
their mental

[[Page S4784]]

health facility could not get scheduled for several days, sometimes 
several weeks, and half of the people didn't come back. If a person 
shows up that one time and says ``I am here because I have a real 
problem and I need help'' and the answer is ``We are not going to help 
you today; we are not going to do an evaluation right now,'' more often 
than not or as often as not, they don't come back. So at Compass 
Health, as well as many of our other certified clinics in our State, we 
increased access. We established same day walk-ins to attempt to look 
at their problem and see if they needed help that day or could, in 
fact, come back a few days later for an extensive visit. At that 
facility and others, everybody is being seen when they come in. The 
suicide care path they established has reduced suicides by 70 percent 
since last year.
  I will make two quick points as I conclude.
  No. 1, the goal of this program is not for the Federal Government to 
take over the behavioral health costs of the country; the goal of this 
program is to look at mental health and keep track of 24 or 25 other 
healthcare markers and decide how much other healthcare is impacted in 
a positive and, in fact, a cost-saving way if you are dealing with 
mental health at the same time.
  The second point I would make is that we need to see Congress step up 
in the next few days and extend the current program through the end of 
this spending year, and then let's have a debate about why 2 more years 
of putting all that information together gives States and communities 
the information they need to find out. As a result, I believe everybody 
will understand that it is not only the right thing to do, but fiscally 
it is the smart thing to do. By dealing with mental health like all 
other health, the overall healthcare cost of that big mental health 
community goes down dramatically if you are seeing your doctor, showing 
up for your appointments, and taking your medicine. Our other problems 
are much more easily managed when adding the cost of mental healthcare 
to all our other healthcare priorities. It isn't just the right thing 
to do, it is the smart thing to do.
  Hopefully the Congress will deal with that and the Senate can take a 
leadership role in dealing with that. The House has already sent us a 
bill. We need to respond to that by doing the two things I just 
mentioned. Let's treat mental health like we treat all other health.
  I yield the floor.