[Congressional Record Volume 168, Number 32 (Thursday, February 17, 2022)]
[Senate]
[Pages S789-S791]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





                         SUBMITTED RESOLUTIONS

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SENATE RESOLUTION 518--EXPRESSING THE SENSE OF THE SENATE THAT IN ORDER 
  TO EFFECTIVELY ADDRESS THE HIGH PREVALENCE OF INDIVIDUALS SUFFERING 
 FROM MENTAL HEALTH CONDITIONS AND SUBSTANCE USE DISORDERS, THE UNITED 
STATES NEEDS TO MAKE HISTORIC FINANCIAL INVESTMENTS INTO MENTAL HEALTH 
AND SUBSTANCE USE DISORDER CARE AND FINALLY ACKNOWLEDGE SUCH CARE AS A 
    PRIORITY IN HEALTH CARE EQUAL TO PHYSICAL HEALTH, AND FOR OTHER 
                                PURPOSES

  Mr. WARNOCK (for himself, Mr. Padilla, Ms. Stabenow, and Mr. Booker) 
submitted the following resolution; which was referred to the Committee 
on Health, Education, Labor, and Pensions:

                              S. Res. 518

       Whereas there is an urgent need to improve our health care 
     system to better integrate treatment of mental health and 
     substance use disorders so they are no longer seen 
     separately;
       Whereas, according to the World Health Organization, mental 
     illness is severely underdiagnosed, and less than half of 
     individuals who meet diagnostic criteria are identified;
       Whereas there is a pressing need to provide a comprehensive 
     solution to fix our health care system that incorporates the 
     needs and expertise of all its stakeholders, especially 
     individuals who have expertise in mental health and substance 
     use disorders;
       Whereas it is essential to remove the misguided association 
     between mental illness and violence, driven by fear and 
     misunderstanding;
       Whereas mental illness and substance use disorders have 
     been underresearched, undertreated, and overstigmatized;
       Whereas stigma, vilification, and dismissal of mental 
     illness and substance use--
       (1) create a culture that--
          (A) discourages utilization of mental health and 
     substance use disorder services; and
          (B) lacks acknowledgment that struggling with a mental 
     health condition or substance use disorder is not something 
     to be ashamed of; and
       (2) can vary in prominence in different cultures and 
     communities, and are particularly high among communities of 
     color and minority communities;
       Whereas men, in particular, face cultural and societal 
     barriers to seeking treatment for mental health concerns and 
     substance use disorders, which can contribute to concerning 
     outcomes including suicide and aggressive behavior;
       Whereas the bulk of mental health and substance use 
     disorder services are reactive instead of proactive, treating 
     patients when they are in crisis instead of incorporating 
     services and screening earlier in an attempt to prevent such 
     crises;
       Whereas there is a need to increase access to treatment, 
     services, and social supports for everyone to proactively 
     address the root causes of mental illness and substance use 
     disorders;
       Whereas it is necessary to address the root causes of 
     mental health concerns and substance use disorders;
       Whereas it is necessary to address suicide in a holistic 
     manner and recognize and address suicidal ideation and not 
     just the act of suicide in isolation;
       Whereas there is a need to address social determinants of 
     health, which are conditions that directly and indirectly 
     affect the health, health care, and wellness of individuals 
     and communities, in order to effectively provide care for all 
     individuals living with mental illness and substance use 
     disorders;
       Whereas mental health impacts physical health, and physical 
     health impacts mental health;
       Whereas the current health care system in the United States 
     does not adequately incorporate mental health and substance 
     use disorders into the assessment or delivery of care, as 
     evidenced by the fact that all ``vital signs'' are currently 
     for physical health alone and do not touch on mental health 
     or substance use disorders;
       Whereas the lack of a united approach across the Federal 
     Government to improve the care and related services for 
     mental health and substance use disorders has left States and 
     localities--
       (1) without adequate guidance or resources;
       (2) unable to provide the mental health and substance use 
     disorder services needed to adequately meet the needs of 
     their populations; and
       (3) unable to effectively distribute services to adequately 
     meet the needs of their populations;
       Whereas there is a need for greater collaboration across 
     all Federal agencies that touch various aspects of the health 
     care system in order to fully incorporate the needs and 
     concerns of everyone involved in the treatment and prevention 
     of mental health and substance use disorders;
       Whereas there is a need for greater collaboration between 
     Federal, State, and local agencies that touch on various 
     aspects of the health care system;
       Whereas there is a need for a centralized location within 
     the Federal Government for good, reliable information on 
     mental health and substance use disorders for providers, 
     patients, and caregivers;
       Whereas there is a need for standardized definitions, 
     standards of care, and metrics for mental health and 
     substance use disorders across disciplines;
       Whereas there is a need to change incentives for providers 
     to better ensure everyone with mental health and substance 
     use disorders gets access to the necessary care and 
     treatment;
       Whereas 13 years after the date of enactment of the Paul 
     Wellstone and Pete Domenici Mental Health Parity and 
     Addiction Equality Act of 2008 (subtitle B of title V of 
     division C of Public Law 110-343), there is still a lack of 
     compliance among insurers and failure to adequately cover 
     mental health and substance use disorder services;
       Whereas Medicaid is the single largest payer of mental 
     health and substance use disorder services, and reimbursement 
     is far from adequate;
       Whereas there is a need to incentivize payers to adequately 
     cover mental health and substance use disorder services in 
     the same manner in which all specialty services are covered;
       Whereas there is a need to increase the number of mental 
     health and substance use disorder providers;
       Whereas 55 percent of counties in the United States do not 
     have a single psychiatrist, psychologist, or social worker;
       Whereas only 10 percent of individuals in the United States 
     suffering from a substance use disorder receive specialty 
     treatment;
       Whereas there is a need to increase access to and 
     utilization of telemedicine for mental health and substance 
     use disorder services, both within States and across State 
     lines;
       Whereas there is a need for a better way to share 
     information among providers to better serve patient needs 
     while still protecting patient privacy;
       Whereas there is a need for consistent care coordination 
     and more effective transition services for patients moving 
     between hospitals and the community;
       Whereas safe housing needs to be recognized as a basic 
     requirement for successful treatment and needs to be better 
     addressed in the transition of care;
       Whereas there is a need to improve social determinants of 
     health, such as increased access to stable housing and jobs, 
     for individuals suffering from mental illness and substance 
     use disorders to have a sustained recovery;
       Whereas there is a need to provide care in more appropriate 
     and integrated settings for all patients, such as treating 
     geriatric patients in their homes as opposed to nursing 
     homes, when appropriate, and in compliance with the Americans 
     with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) and 
     the decision of the Supreme Court of the United States in 
     Olmstead v. L.C., 527 U.S. 581 (1999);
       Whereas there is a need for greater focus on intensive 
     outpatient, partial hospitalizations, residential programs, 
     day programs, supported housing, assertive community 
     treatment, mobile crisis services, peer support services, 
     supported employment, and community-based services for adults 
     with mental illness and substance use disorders;
       Whereas there is a need to ensure that services support 
     individuals with mental health conditions and substance use 
     disorders to participate fully in their communities and live 
     and thrive independently;
       Whereas there is a need to address isolation issues 
     geriatric patients face, which can negatively impact their 
     mental health;
       Whereas 30 percent of first responders experience mental 
     health conditions, such as depression and post-traumatic 
     stress, and have higher rates of suicidal ideation and 
     suicide attempt than the rest of the population;
       Whereas depression, anxiety, post-traumatic stress, and 
     psychosis are some of the most common conditions women 
     experience pre- and postpartum;
       Whereas unmet parental mental health and substance use 
     disorder treatment and service needs contribute to increased 
     involvement with the child welfare system, which leads to 
     preventable foster care placements, given that--
       (1) in 2018, 262,956 children entered foster care, with the 
     leading reasons related to mental health and substance use 
     disorder needs of the parents, with--
          (A) 36 percent of children entering care as a result of 
     parental drug abuse;
          (B) 14 percent of children entering care as a result of 
     the inability to cope of the caretaker; and
          (C) 5 percent of children entering care as a result of 
     parental alcohol abuse;
       (2) even when necessary to ensure the safety of a child, 
     foster care itself creates additional trauma for both the 
     child and family; and
       (3) longstanding racial inequities in child welfare 
     services create disproportionate child welfare involvement 
     for Black, Native, and Latinx children and families, which 
     exacerbates the experiences of trauma for those families and 
     contributes to health disparities while not resulting in 
     needed access to quality mental health and substance use 
     disorder services;

       Whereas children and adolescents have unique needs when it 
     comes to mental health

[[Page S790]]

     and substance use disorders and the services provided, given 
     that--
       (1) 45 percent of children have experienced adverse 
     childhood experiences that have the potential to 
     significantly impact the mental health of the children;
       (2) in the last 5 years, 49.4 percent of children who 
     needed mental health services did not receive the necessary 
     services, and there is a need for improved access to 
     appropriate treatment services, which must focus on 
     community-based supports and services available near their 
     home, in order to effectively prevent children from 
     experiencing a mental health crisis;
       (3) many children suffering and struggling go undiagnosed 
     and are not adequately supported, and there is a need to 
     improve training and understanding of mental health and 
     substance use disorders for educators since often there are 
     barriers to mental health and substance use disorder 
     treatment in a school setting;
       (4) 42 percent of school districts have reported using 
     threat assessment and risk assessment teams, an approach 
     created by the United States Secret Service that involves 
     identifying, evaluating, and taking action on assumed current 
     or potential threats, which--
          (A) can cause significant harm to the mental health and 
     emotional well-being of children;
          (B) has compounded existent stigma for groups of 
     students;
          (C) has had a disproportionate impact on students of 
     color by initiating criminal justice involvement in lieu of 
     more appropriate services; and
          (D) has had a disproportionate impact on students with 
     disabilities;
       (5) families and caregivers need to be included when 
     treating children suffering from mental illness and substance 
     use disorders; and
       (6) when children turn 18 years old they are cut off from 
     mental health and substance use disorder services, which 
     impacts continuity of care;
       Whereas there is a growing need for mental health and 
     substance use disorder services among young adults and 
     college-aged adults, and between 2007 and 2017, for 
     individuals aged 18 to 34, there was a--
       (1) 108 percent increase in drug-related deaths;
       (2) 69 percent increase in alcohol-induced deaths; and
       (3) 35 percent increase in suicide deaths;
       Whereas, despite the rising need for mental health and 
     substance use disorder treatment by young adults, there 
     continues to be disparities in accessing care experienced by 
     young adults of color;
       Whereas 5,500,000 veterans and servicemembers rely on the 
     Department of Veterans Affairs for health services, and 
     1,500,000 veterans have received a mental health diagnosis, 
     and--
       (1) 1 in 4 active duty members shows signs of a mental 
     health condition;
       (2) the rate of post-traumatic stress disorder (referred to 
     in this preamble as PTSD) is 15 times higher in 
     servicemembers than compared to civilians due to military 
     combat and military sexual assault and trauma;
       (3) the rate of depression is 5 times higher in 
     servicemembers as compared to civilians;
       (4) every day, 17 veterans die by suicide;
       (5) there is a fear of disclosing mental health conditions 
     and substance use disorders and seeking treatment due to 
     negative career implications; and
       (6) less than 50 percent of veterans receive the mental 
     health treatment and services they need;
       Whereas 11 percent of individuals entering the Department 
     of Veterans Affairs health system meet the criteria for a 
     substance use disorder;
       Whereas veterans are more likely to have an alcohol use 
     disorder than civilians;
       Whereas 2 in 10 veterans with PTSD have a comorbid 
     substance use disorder, and 1 in 3 veterans seeking services 
     for a substance use disorder also has PTSD, showing the 
     interconnectedness between these conditions;
       Whereas there is a need to better educate all individuals 
     in the criminal justice system on the impact and needs of 
     individuals with mental health conditions and substance use 
     disorders;
       Whereas the United States criminal justice system is the 
     largest provider of mental health services, and it was not 
     built, nor intended to be used, for that purpose, and--
       (1) there are around 550,000 individuals incarcerated in 
     the United States with serious mental illness;
       (2) 1 in 5 individuals incarcerated in the United States 
     has a serious mental illness; and
       (3) of those incarcerated, 75 percent with a serious mental 
     illness suffer from a co-occurring substance use disorder;
       Whereas there is a need for incentives to reduce 
     inappropriate incarceration and detention for individuals 
     with mental health and substance use disorder needs;
       Whereas one-third of individuals incarcerated in the United 
     States receive treatment for mental illness, and many times 
     treatment is inconsistent and inadequate, and there is a need 
     for improved access to services and treatments that are also 
     trauma-informed;
       Whereas there is a need to have mental health, substance 
     use disorder, and diversion services available at all 
     intercepts of the Sequential Intercept Model, a model 
     developed to inform more appropriate community-based 
     responses and divert individuals with mental illness and 
     substance use disorders;
       Whereas there is a need to improve levels of coordination, 
     care management, and insurance coverage before, during, and 
     after incarceration;
       Whereas post-release navigation is key to keeping 
     individuals from reentering the criminal justice system;
       Whereas there is insufficient understanding of the mental 
     health effects of incarceration;
       Whereas there is a need to redefine the juvenile justice 
     system to account for age and development reflecting the most 
     up-to-date scientific consensus on brain development and 
     behavior and ensuring that there are developmental and age 
     appropriate services;
       Whereas the juvenile justice system must fulfill its 
     purpose of supporting, rehabilitating, and treating children 
     in need rather than punishing them, given that--
       (1) studies have shown that 70 percent of youth in 
     detention have a diagnosed mental illness, and 60 percent of 
     those youths may also meet the criteria for a substance use 
     disorder;
       (2) 90 percent of individuals in the juvenile justice 
     system have been exposed to trauma or violence, which may 
     increase the likelihood of juvenile justice involvement;
       (3) entry into the juvenile justice system may exacerbate 
     the existing mental health and substance use disorder 
     concerns of youths, particularly in the absence of consistent 
     screening and treatment for these conditions; and
       (4) an estimated 33 percent of children in long-term 
     juvenile justice facilities have intellectual, developmental, 
     and other disabilities and were receiving special education 
     services, and therefore there is a need to have specific 
     services and programs within the juvenile justice system with 
     a focus on their needs;
       Whereas there is a need for services in the juvenile 
     justice system to be trauma-informed and developed for high-
     need individuals;
       Whereas studies show that 41.2 percent of individuals who 
     are diagnosed with a substance use disorder are also 
     diagnosed with a mental illness, which is likely an 
     underestimate in light of the current barriers to identifying 
     and reporting mental health concerns;
       Whereas, given the high co-occurrence with mental illness, 
     comprehensive care for substance use disorders should include 
     access to psychopharmacology, psychotherapy, contingency 
     management, recovery support, all evidence-based medication-
     assisted treatment, a multidisciplinary staff, and group 
     therapy for adults, and--
       (1) addiction treatment centers should either offer or have 
     available comprehensive care and support and have the ability 
     to treat mental illness as well as substance use disorders; 
     and
       (2) to allow for treatment flexibility to fit the needs of 
     the patient, there is a need to increase access to all 
     evidence-based medication-assisted treatment in prisons, 
     jails, and all addiction treatment centers;
       Whereas there are inequities in access, availability, and 
     quality for mental health and substance use disorder services 
     for minority communities, and--
       (1) there is greater stigma among racial and ethnic 
     minority populations;
       (2) racial and ethnic minorities are disproportionately 
     affected by disabilities that result from mental health 
     conditions; and
       (3) only 31 percent of African Americans and Hispanics and 
     22 percent of Asians receive mental health care compared to 
     48 percent of Caucasians;
       Whereas lesbian, gay, bisexual, transgender, and queer 
     (referred to in this preamble as LGBTQ) individuals are more 
     than twice as likely to suffer from mental health conditions 
     and substance use disorders than heterosexual individuals, 
     and--
       (1) 29 percent of LGBTQ youths attempt suicide, which is 
     almost 5 times more than heterosexual youths;
       (2) approximately 31 percent of LGBTQ older adults report 
     symptoms of depression, and 39 percent report seriously 
     thinking about suicide;
       (3) 30.8 percent of transgender individuals report 
     considering suicide compared to 2.3 percent of heterosexual 
     individuals; and
       (4) of the 4,890 transgender individuals incarcerated in 
     State prisons, only 15 were confirmed as being housed 
     according to their lived gender, while not being housed 
     according to lived gender poses a significant threat to 
     mental health;
       Whereas the COVID-19 pandemic has highlighted the gaps in 
     our health system when it comes to mental health and 
     substance use disorder services and shown how sheltering in 
     place and isolating can impact mental health and substance 
     use, specifically showing--
       (1) that 47 percent of individuals in the United States 
     report that the pandemic has negatively impacted their mental 
     health, with 21 percent saying that it has had a major 
     negative impact;
       (2) a significant increase in the number of calls to 
     suicide prevention hotlines;
       (3) a 1,000 percent increase in texts to the mental health 
     hotline of the Substance Abuse and Mental Health Services 
     Administration to about 20,000 texts in April 2020;
       (4) a 55 percent increase in alcohol sales; and
       (5) a record high of more than 100,000 overdose fatalities 
     between May 2020 and April 2021, driven by increased feelings 
     of anxiety, depression, and use of substances; and

[[Page S791]]

       (6) an increase in burnout and mental health conditions 
     among healthcare providers, with 49 percent experiencing 
     burnout and 38 percent experiencing anxiety or depression; 
     and
       Whereas there is a need for a population health approach 
     that examines the distribution of health across populations 
     and focuses attention on the need to provide access to the 
     best evidence-based treatment for individuals with mental 
     health conditions and substance use disorders who need 
     clinical intervention in order to effectively reduce or 
     mitigate the impact of risk factors that lead to 
     psychological distress among individuals in high-risk 
     populations: Now, therefore, be it
       Resolved, That it is the sense of the Senate that in order 
     to effectively address the high prevalence of individuals 
     suffering from mental health conditions and substance use 
     disorders, the United States needs to make historic financial 
     investments into mental health and substance use disorder 
     care and finally acknowledge such care as a priority in 
     health care, equal to physical health, and recognize that--
       (1) mental health and physical health need to be treated 
     together to treat the whole patient;
       (2) patient care needs to be patient-focused;
       (3) mental health and substance use disorder care needs to 
     be proactive and treat individuals before they are in crisis;
       (4) any stigma associated with mental health and substance 
     use disorders is completely unwarranted and serves as a 
     barrier to care;
       (5) the Federal Government needs to create a comprehensive 
     approach to improving the health care system that 
     incorporates mental health and substance use disorders and 
     includes system reform that--
       (A) aims to break down silos across the Federal, State, 
     local, and Tribal levels for improved communication and care 
     coordination;
       (B) provides a Federal framework to States, localities, and 
     Indian Tribes that connects agencies and services so they can 
     have guidance when working to address the mental health and 
     substance use disorder needs of their communities;
       (C) incentivizes providers to see both more complex and 
     less complex patients and to see patients in rural and 
     underserved areas;
       (D) expects insurers to comply with parity laws and holds 
     them accountable for not providing parity of mental health 
     and substance use disorder services and treatments; and
       (E) requires both public and private payers to have higher 
     reimbursement rates for mental health and substance use 
     disorder services that are on par with medical and surgical 
     services;
       (6) the Federal Government needs to create a comprehensive 
     approach to improving the health care system that 
     incorporates mental health and substance use disorders and 
     that includes system improvements that--
       (A) focus on early screening, diagnosis, and intervention 
     across the care continuum to prevent mental health crises;
       (B) improve the ability of families to access timely, 
     affordable, and high-quality treatment and services;
       (C) strengthen mental health and substance use disorder 
     services in schools and ensure there is engagement from all 
     stakeholders;
       (D) improve and expand community-based services so 
     individuals have access to services locally;
       (E) improve care coordination across treatment settings so 
     patients have services when needed and do not have to 
     navigate the system themselves;
       (F) promote a sustained recovery that includes social 
     determinants of health, such as housing, jobs, and childcare;
       (G) can adjust to meet the needs of each individual to 
     provide the best care for each individual;
       (H) ensure seamless transitions in care when moving through 
     steps or processes;
       (I) end the criminalization of mental illness and substance 
     use disorders and increase programs for diversion that 
     connect individuals to treatment, social supports, and social 
     services;
       (J) provide access to high-quality and evidence-based 
     mental health and substance use disorder care for individuals 
     who are incarcerated;
       (K) create young adult services and programs within the 
     criminal justice system for individuals who are aged 18 to 25 
     to successfully reduce recidivism and that are informed by 
     neuropsychological brain science;
       (L) incorporate apprenticeship or job training programs 
     into the criminal justice system, particularly for youth, to 
     empower them and reduce recidivism;
       (M) ensure cultural congruence so everyone in need of 
     mental health and substance use disorder care has services 
     that meet their needs;
       (N) adopt a population health approach as a tool to help 
     address ongoing disparities in access to mental health and 
     substance use disorder care by youth and adults of color;
       (O) ensure that lesbian, gay, bisexual, transgender, and 
     queer individuals, communities of color, and immigrants have 
     access to mental health and substance use disorder services 
     that are culturally appropriate, are in the necessary 
     language, and address any unique stigma from their 
     communities;
       (P) enable veterans to access timely mental health and 
     substance use disorder care that ensures continuity and is 
     free of any administrative burdens;
       (Q) include training for educators, first responders, and 
     clinicians to identify indicators of mental health conditions 
     and substance use disorders and to reduce stigma and bias 
     related to these conditions so they can respond in a more 
     productive way and connect individuals with more appropriate 
     services;
       (R) support health care providers by addressing their 
     mental health and substance use disorder needs to reduce 
     burnout;
       (S) provide a process by which States can work with other 
     States to reconcile licensure and certification for and 
     reimbursement to mental health and substance use disorder 
     providers across State lines for the purpose of telemedicine;
       (T) leverage the current mental health and substance use 
     disorder workforce by reducing administrative burdens to 
     allow mental health and substance use disorder providers to 
     perform to their highest level of licensure and 
     certification; and
       (U) expand training opportunities and grow the workforce by 
     partnering with schools and programs to provide free 
     education to individuals who work in rural or underserved 
     areas;
       (7) expanded access to mental health and substance use 
     disorder care is essential to improving health and well-
     being;
       (8) all individuals in the United States deserve access to 
     mental health and substance use disorder care without any 
     barriers, such as cost or location of services; and
       (9) the United States needs to comprehensively break down 
     all barriers to receiving access to mental health and 
     substance use disorder care, including financial burdens and 
     location hurdles.

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