[Congressional Record (Bound Edition), Volume 146 (2000), Part 11]
[House]
[Pages 15360-15368]
[From the U.S. Government Publishing Office, www.gpo.gov]



                    MEDICARE PRESCRIPTION DRUG PLAN

  The SPEAKER pro tempore (Mr. Sherwood). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, tonight, I would like to start our 1 hour 
Special Order on the Democratic side by talking about the need for a 
Medicare prescription drug plan. This is an issue that I have taken to 
the floor many times to discuss. It is the highest priority for the 
Democratic Party and those Democrats in the Congress both in the House 
and the Senate.
  I noticed that my colleagues on the other side who spoke before me 
mentioned the issue of drug prices and how drug prices have increased 
significantly and the disparity between drug prices here in the United 
States versus Canada or Mexico or other countries.
  But I have to be somewhat critical of the Republican leadership 
because the fact of the matter is that, on many occasions over the last 
few weeks, Democrats have tried to bring a Medicare prescription drug 
bill to the floor to adopt and have the Congress adopt a comprehensive 
package that would include prescription drugs under Medicare for 
seniors and the disabled.
  On every occasion when we have tried to do that, and there have been 
at least two so far in the last few weeks, the Republicans have stopped 
the effort, and, instead, put forward a plan that seeks to basically 
give some money to seniors to go out and try and see if they can get an 
insurance company to sell them a policy that would cover prescription 
drugs, not under the rubric of Medicare, in a fashion that the 
insurance companies have already indicated that they would not sell 
such policies, such drug-only policies.
  As a result, I have been very critical of the fact that the 
Republican leadership really does not want a Medicare prescription drug 
plan; they do not want seniors seriously to see enacted into law by the 
President a plan that will actually provide seniors with prescription 
drugs.
  Instead of just talking about this sham insurance policy where one 
goes out and sees if one can buy an insurance policy, which people can 
try to do that anyway today and find that they will be largely 
unsuccessful because the private market is not interested in offering 
drug only insurance policies.
  So I want to talk a little bit about the prescription drug issue 
tonight. I want to also point out that, even though my Republican 
colleagues talked about prices and the rising prices of prescription 
drugs, that their legislation, their prescription drug legislation does 
not address the issue of price, whereas the Democrats have tried to do 
that.
  They have tried to point out that, in the same way that there is a 
huge disparity between the price of prescription drugs here in the 
United States versus Canada, for example, there is also a huge 
disparity between the cost of the price that seniors who are in HMOs or 
employer pension plans, seniors that are part of an existing 
prescription drug plan through their HMO or in some other way where 
they are collectively able to negotiate for a cheaper price tend to be 
paying significantly less than seniors who do not have a prescription 
drug plan because they are not in an HMO or they are not covered in 
some way and have to go to the drug store on their own and just buy the 
prescription.
  There is a huge price disparity here in the United States between 
what seniors pay who do not have coverage as opposed to seniors who 
happen to be part of a larger group through their HMO or in some other 
way where they can bargain for a better price.
  The Democrats in our Medicare prescription drug plan, which we have 
tried to bring up, which the Republicans will not let us bring up, we 
address the issue of price discrimination by basically allowing 
Medicare and the Medicare program, HCFA, which is the agency that 
administers the Medicare program, to actually be a bargaining agent 
through regional benefit providers to go out and get a cheaper price 
for seniors so that the disparity, the price discrimination would no 
longer exist in this country, and we would not have this problem where 
many seniors pay a lot higher prices than a few select seniors.
  I also wanted to mention that this evening I am going to be joined by 
the gentlewoman from Texas (Ms. Jackson-Lee) and the gentleman from 
Texas (Mr. Rodriguez), both who have been leaders on health care issues 
in general, and who are going to talk about mental health issues and 
children's mental health in the context of the special order that we 
are going to have for the next hour or so.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Rodriguez) 
briefly. I know he was very concerned about this price discrimination 
issue.
  Mr. RODRIGUEZ. Mr. Speaker, let me, first of all, thank the gentleman 
from New Jersey for allowing me to say a few words.
  I was very pleased to see that, at least from the Republican 
perspective, our fellow colleagues before were talking about the price 
disparities that exist between this country and other countries on the 
same prescriptions.
  That same disparity exists in this country when it comes to the price 
that that senior citizen pays here in the United States and what that 
HMO individual pays on that same prescription. So that disparity not 
only exists

[[Page 15361]]

in this country to other countries, but within our own country itself.
  So the real problem is that the pharmaceutical companies have chosen 
to play a game with us. We have taken them on, and we have said we are 
not going to deal with it anymore. They have actually come back, 
contributed to a lot of the politicians up here, and are contributing 
heavily and expending a lot of money, as my colleagues well know, on 
advertisement that brings out the senior citizen by the name of Flo 
that talks about that she does not want government involved.
  Well, the reason she does not want government involved is because she 
wants to make sure that the pharmaceutical companies continue to do 
what they have been doing, and that is price fixing as far as I am 
concerned.
  One of the things that we have in this country is, as my colleagues 
well know, is that senior citizens on Medicare who might be receiving 
the only pension, might be Social Security, having to pay higher prices 
than someone that is under an insurance HMO. We should not tolerate 
that.
  The other thing that I think we recognize as Americans is that health 
care and prescription coverage go hand in hand. When we established 
Medicare, the prescription coverage aspect of it was not considered at 
that point in time. Yet, for Medicaid, for indigent individuals, we 
provide prescription coverage. It is only fair that we take into 
consideration our senior citizens and that we provide for them, 
especially those that are on a fixed income.
  I think they recognize the disparity, but they lost track of who we 
need to go after, and that is our pharmaceutical companies that we need 
to make sure that they are fair about the prices.
  One of the proposals that they had, I was looking at it, and it 
sounds great, but one of the main fights that we have in this country 
is the war on drugs. I represent the border. We have packages that come 
in that Customs has to check. Can my colleagues imagine having to check 
foreign prescriptions and foreign drugs that come in and to determine 
whether they are legal or not legal? As it is, we have heroin that is 
mailed into this country. We have pot that is mailed in. We have other 
types of pharmaceutical, illegal pharmaceutical things that are mailed 
in under the black market. How are we going to distinguish that?
  So I think the best thing to do is to look in terms of that cost now 
in this country and make sure that they provide an affordable cost and 
do everything we can to help our senior citizens have access to 
prescription coverage. I think that is the only thing that makes sense. 
It is something that they have been unwilling to do in the last two 
Congresses here; I am hoping that we can make it happen.
  Again, I just want to thank the gentleman from New Jersey (Mr. 
Pallone) for his efforts in this area because I think it is a key area 
that needs to be dealt with.
  Mr. PALLONE. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Rodriguez) for pointing out the two problems that we have right now 
with prescription drugs for seniors. One is there is no benefit; there 
is no guaranteed benefit under Medicare right now. The second is the 
price discrimination. If I could, I just will very quickly talk about 
both of those points.
  We are not really trying to reinvent the wheel as Democrats, but we 
are saying, and I know the gentleman from Texas said, that Medicare is 
a good program. It has been on the books now for over 30 years.
  One has part A to get one one's hospitalization. One has part B where 
one pays a certain amount per month, 40- something dollars a month on 
average, and one gets one's doctors care paid for. One has a certain 
co-payment, one gets one's doctors bill paid for.
  So what we are saying is we have this existing program which is a 
good program, very low administrative cost. We know that when Medicare 
started 30 years ago, prescription drugs really were not much of an 
issue because people did not buy many of them, but now it is.
  From a preventive point of view, we want to make sure that people 
have prescription drug coverage. So we are going to establish another 
part C or part D, if you will, under Medicare. Just like part B for 
one's doctor bills, one will pay $40 a month, whatever it is a month; 
and one will get a significant portion of one's prescription drugs paid 
for, starting with the first prescription, in the same way that one's 
doctor bills are paid for.
  It is a guaranteed benefit. In other words, if one decides to 
participate and pay the money per month, if one cannot afford it, just 
like part B, the Government will pay for it; but if one can afford it, 
one has to pay a certain premium, and then one is guaranteed all 
medically necessary drugs.
  In other words, the doctor decides that, if one needs a particular 
prescription, it is covered. It is not like where the HMO is going to 
say, well, maybe one cannot have this or one cannot have that. So 
whatever is medically necessary.
  Now, the Republicans instead, because of the drug companies, the drug 
companies lobbied them and said no, no, no, we do not want that because 
they are concerned, once this comes under the rubric of Medicare, there 
is going to be some government control over it.
  So what they do is they tell the Republicans, why do you not forget 
about the Medicare example that has been so successful, and you just 
give some money to seniors, I do not know how much, whatever you think 
you can afford with this surplus that we have; and you see if the 
seniors can go out and see if an insurance company will sell them a 
policy.
  Well, that is not Medicare. That is not building on the existing 
program. Every one of the insurance company representatives that came 
before the House committee, my Committee on Commerce, Committee on Ways 
and Means, said they will not sell those Republican drug-only policies 
because it is a benefit. It is not a risk.
  When one is selling insurance, one wants to make sure some people do 
not use the benefit and others do, and that is how one makes money. 
Well, insurance companies are not going to sell a policy where 
everybody needs a drug benefit, which 90 percent-plus seniors do.
  Now, the other thing the Democrats are saying is that, once this 
Medicare prescription drug program is established under Medicare, now 
HCFA can basically, in each region of the country, establish what we 
call a benefit provider.
  I do not want to be too bureaucratic, but this is some agency that 
will go out and negotiate a price because now there are going to be 40 
million people, seniors who are Medicare beneficiaries that the 
Government can bargain for the best price, just like the HMOs do. That 
drives the cost down. That eliminates the price discrimination that one 
is talking about.
  The Republicans do not have anything like that. They do not even 
address the issue. So our colleagues over there, and I am not trying to 
say they are badly intentioned here, but they are talking about the 
price of prescription drugs; but they are not addressing it in their 
bill.
  They will not even let us bring our bill up. We tried to do it in 
Committee on Rules when they brought up their prescription drug plan. 
They said, no, we cannot do that. Then last week, when we had the 
marriage penalty, the President came out and said, look, I will even 
agree to the Republican marriage penalty provision, even though it is 
not really helping the average person the way they have set it up; but 
you have got to add our prescription drug benefit to it. They said no, 
we are not going to do that.
  Mr. RODRIGUEZ. Mr. Speaker, I know. One of the things I think that 
the gentleman from New Jersey (Mr. Pallone) mentioned, because the 
insurance companies are unwilling to come in and take care of our 
senior citizens, and they do it for good reasons, is because they know 
that, when one becomes a senior, that is when one is going to need the 
service.
  If I can be as cynical to say that, during the time of LBJ and when 
we established both Medicaid and went forth

[[Page 15362]]

with Medicare, there was an understanding with the insurance companies 
that, number one, it was okay to have Medicare because that is when one 
becomes a senior citizen, and that is when one was not cost effective 
for the insurance companies to take one on.
  So that was okay for government to get involved with that. It was 
okay for us to have Medicaid because, after all, with Medicaid, one had 
no money to buy insurance so then it is okay. They wanted to take care 
of those that were healthy and young during that period.
  So that is one of the reasons why they would be unwilling to go and 
get involved in providing prescription coverage when we know full well 
that the average citizen is expending over $1,000, more than the 
majority are spending, over $1,000 a year on just prescription 
coverage. So it is not to their advantage. They are not going to make 
the profits that they would like to.
  The ones that are making the huge profits are our pharmaceutical 
companies, which they ought to be embarrassed; and they ought to be 
embarrassed in terms of the amount of millions of dollars they are out 
there expending on the waivers and coming out on TV talking about the 
fact that we should not want government involved. The ones who are 
doing a number on us are the pharmaceutical companies, the private 
sector. I think it is time we put a stop to that.
  Mr. PALLONE. Mr. Speaker, I agree.
  Mr. Speaker, just briefly, I am not an ideological type. I want to do 
what is practical and what works. The bottom line is one can call 
Medicare a government program. Sure it is, but I do not think it is bad 
because it is a government program. It works. The administrative costs 
of Medicare are, like, 3 percent. I would defy anybody on the 
Republican side to tell me that their typical constituent does not like 
Medicare.
  Plus it is voluntary. We are not saying that one has to participate 
in this. It is just like part B. If one does not want it, one does not 
participate.
  So if one looks at this practically speaking, the Republicans are 
talking about this drug-only insurance policy that is not going to 
work. Nobody is going to sell it. We are talking about expanding the 
existing Medicare program to cover prescription drugs which has worked 
for the last 35 years.
  I have to say that I was amazed, because I mentioned this before, 
too, that in Nevada a few months ago, they passed a plan very similar 
to the Republican plan where they are going to basically give people 
money to go out and see if they can buy these insurance-only policies. 
Not one insurance company stepped up to the plate and said they wanted 
to buy the policy.

                              {time}  2045

  So even though the legislature passed the bill and the governor 
signed the bill, just like the Republican bill here in the House of 
Representatives, there is nobody benefiting from the program because no 
insurance company will sell the policy. So what good is it? It does not 
make any sense.
  Mr. Speaker, I yield to the gentlewoman from Texas, and again I want 
to thank her for all her work on these health care issues. I know 
tonight she wants to highlight the mental health issue.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentleman for 
yielding to me, and before I turn to that I certainly cannot not 
acknowledge the crisis that we are in as it relates to our senior 
citizens and their desperate need for a benefit.
  And if I can draw from the gentleman from Texas and the fine 
leadership of the gentleman from New Jersey on these issues dealing 
with prescription drugs, let me just tell my colleagues how I define 
it. I define the effort that we are undergoing here as a Democratic 
caucus to provide a benefit as contrasted to a promise; an opportunity 
to dial the telephone. Some of our seniors, of course, as the gentleman 
well knows, still have those dial phones and not push-button phones 
because they have lived frugally all their life, and they have now the 
right to dial the telephone to an insurance company and hear them 
either get a dial tone or a hang-up sound, which means they do not have 
the money to pay for the opportunity for an insurance company to 
consider whether or not they would cover them.
  In my own county alone we have had at least two HMOs pull up stakes. 
And this is why we are talking about mental health this evening, 
because in some of those instances the HMOs do not even cover mental 
health services. But we find that they are pulling up stakes. Senior 
citizens are left holding the bag.
  I can remember when I was first elected and we were talking about 
saving Medicare and I would go around to my seniors, guess who would 
beat me to the punch? HMOs, who were signing up senior citizens on the 
Medicare program. I would have senior citizens coming to me and asking 
which one they should choose. Of course, I could not advise them on 
personal decisions, but I could advise them on our determination to 
save Medicare.
  But those same HMOs now have flown the coop and left senior citizens 
with the opportunity simply to dial a telephone number. I believe it 
will be a tragedy if we allow this to occur, the same way it will be a 
tragedy to allow the fact that people who are suffering with mental 
illness, as we will be talking about in just a moment, will not be able 
to have coverage.
  I want to show this little chart, which indicates that in the 
Republican bill that they are trying to push through the beneficiary 
pays $1744, minimally speaking. Now, we know today that there are some 
senior citizens who cannot buy food or pay rent. They do not have the 
money to take care of themselves and the high cost of prescription 
drugs, along with providing for their other needs to provide for a 
quality of life that we want them to have.
  I understand there was some jolly celebrations pooh-poohing the fact 
that we have a surplus. All right, we have a surplus. Now then is the 
time to respond to those whose hard work have helped us gain this 
prosperity, our senior citizens and many that are coming after them, to 
give them this prescription benefit through the Medicare structure and 
make it a real benefit.
  Mr. PALLONE. I want to thank the gentlewoman, and just before we turn 
to the mental health issue, I just wanted to say that she was right on 
point when she talked about these HMOs.
  I do not have a problem with HMOs. Let us face it, in our Democratic 
bill, in our Democratic Medicare prescription drug bill, we actually 
provide the HMOs with the majority of the cost of the prescription 
drugs. So sometimes Republicans say, well, they want choice; and if 
they go out and try to buy this insurance policy, they are going to 
have choice.
  Well, seniors are going to have more choice with us because we 
guarantee the benefit under Medicare. If they want to stay in the HMO, 
they can. We give the HMO more than 50 percent of the cost of providing 
the prescription drugs, so they can stay in their HMO. And the HMOs 
actually will be encouraged to offer more benefits because we will give 
them the majority of the money to pay for the prescription drug 
benefit.
  But as the gentlewoman from Texas said, the problem is now that so 
many of these HMOs are strictly just canceling coverage. As of July 3, 
when they had the latest round where they had to announce if they were 
going to pull out of the Medicare market, over 700,000 people are 
likely to lose their HMO benefits, and most likely their prescription 
drug benefits, because the HMOs are pulling out. They had to announce 
by July 3 if they want to pull out by January 2001.
  So, again, the HMOs are not the answer to prescription drugs, because 
they are not providing it or they are getting out of the market. The 
answer is to provide the guaranteed benefit under Medicare.
  What I would like to do now, Mr. Speaker, if I could, is to yield the 
balance of the hour to the gentlewoman from Texas to address the mental 
health issues and the children's mental health issues that she has been 
such a champion for.
  The SPEAKER pro tempore (Mr. Sherwood). Under the designation of

[[Page 15363]]

the minority leader, the balance of the hour is allocated to the 
gentlewoman from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. I thank the gentleman very much, and as I 
indicated, I thank the gentleman from New Jersey (Mr. Pallone) for 
being persistent in his commitment to ensuring that we as a Nation face 
the question of viable health care and viable health benefits, which 
include prescription drugs.
  And now this evening, Mr. Speaker, I believe that we will also see 
where Americans are crying out, sometimes in complete silence, in 
complete isolation for America to address the question of mental health 
needs. Notice, Mr. Speaker, that I do not define it as mental illness. 
I define it as mental health needs. And I am going to try to speak 
about the children that need these services as special needs children.
  It is important that we highlight the fact that it is so very 
important that we eliminate what is such a devastating impact of mental 
health issues, and that is the stigma attached to it. I am not reading 
from Webster's dictionary as to the definition of stigma, so my 
colleagues will have to forgive me, but even the sound of the word 
sounds negative. And in my own attempt to define it, it seems to me to 
be allowing or encouraging or suggesting that we must live in silence 
about the mental health needs of our family.
  I remember growing up and there were certain illnesses that people 
would not talk about. And as I was in a meeting with mental health 
providers, they related that we have now overcome the stigma of cancer. 
People get up and proudly say that they are cancer survivors; that they 
have survived and are fighting and their family is working with them. 
As I am told, years ago that was not something people talked about. We 
did not know. It was an unknown.
  Today, I believe that mental health needs are equated to that era. 
And as we are now in the 21st century, people are living lonely lives. 
I work a lot with the veterans hospital. I work a lot with veterans, 
and with homeless veterans. It is well documented that large numbers of 
veterans from the Vietnam War, who I give great homage and great 
respect to, who many times they are sensitive to these statistics, are 
amongst our homeless veterans. They suffer from a number of conditions, 
some of them of substance abuse, but a lot deal with mental health 
needs. They are homeless because there is a disturbance that has not 
been treated. Their families did not know how to handle it.
  When we look at the numbers dealing with children, some 13.7 million 
children suffer from diagnostical mental health disorders and only 20 
percent receive the mental health services they need.
  It is interesting that when we were funding Labor HHS, and I know we 
are about to address that issue again, I attempted to offer an 
amendment to the national mental health community, mental health 
clinics and services, that we got a mere $86 million. I was trying to 
push it up to the President's request. In actuality, the children's 
mental health services serves approximately 34,000 children, Mr. 
Speaker, and we are a Nation of 200 million plus, an increasingly 
younger nation with children who suffer from depression.
  I would imagine if we passed a playground and saw one or two children 
fall off the monkey bars or the slide or the seesaw, maybe they do not 
call them those names anymore, but we saw that they could not move 
their arm, we would rush to their aid, call the teachers' aide or the 
teacher and say two or three children have fallen and it looks as if 
they have broken their arm or broken their leg. We would rush them to 
the hospital, and before long they would come back with their badge of 
honor, their arm in a sling or a cast, and soon they would be well. But 
what would we do if there was a little child on the playground that 
seemed isolated, that seemed distraught and frustrated, that seemed 
disturbed? Maybe we would send them to the principal's office because 
they were misbehaving, but many times we would not help them.
  So this evening I am going to share with a number of my colleagues, 
and I am delighted to see the gentleman from Texas (Mr. Rodriguez), the 
gentlewoman from Indiana (Ms. Carson), and the gentlewoman from 
California (Ms. Lee). I want them to join me. I am so honored that they 
have come to talk about this stigma.
  I would be happy to yield to the gentleman from Texas, who as a State 
legislator was not afraid of tackling those issues that others would 
not speak about. I believe mental health is an issue that people do not 
speak about. They are our neighbors. We need more funding. And the 
people who are fighting this alone, whose relatives are hospitalized 
because they cannot get home care, need our help.
  I yield to the distinguished gentleman from Texas (Mr. Rodriguez).
  Mr. RODRIGUEZ. First I want to thank the gentlewoman for yielding to 
me, and I want to congratulate her because I know she has had 
legislation to address this problem.
  The gentlewoman mentioned some startling statistics, about 13.7 
million youngsters in this country that suffer from mental health 
problems. One of the other statistics that she mentioned that was also 
very interesting was that only 20 percent of those receive service. 
That means two out of every ten that get diagnosed actually get 
service.
  I want to share with my colleagues that by profession I am a social 
worker. I worked 3 years with adult heroin addicts, I worked about 4 
years with adolescent substance abusers, and approximately a couple of 
years in community mental health. While I was working with adolescents 
in the entire Bexar County area, back then it was called the mental 
health and mental retardation center, we had two people that worked 
with adolescent substance abuse, two people for a county over a 
million. And one of the things I recall is that they used to call us 
asking for help and the first thing we had to ask is, has your son or 
your daughter been incarcerated? And when they said no, they have not 
gotten into trouble, but we need help. I would have to say, well, I am 
sorry, we cannot help you until you get into the judicial system.
  So it is unfortunate that we could not reach out to these families 
and provide assistance when those individuals were in school having 
difficulties and having problems. And I want to congratulate the 
gentlewoman for pushing forward in this area.
  When we talk about mental health, I want to share with my colleagues, 
and I know the gentlewoman from Texas is aware of this, that suicide is 
the eighth leading cause of death in the United States, accounting for 
more than 1 percent of all deaths. In addition to that, when we look at 
persons under the age of 25, it accounts for 15 percent of suicides in 
1997. Between 1980 and 1997, suicide rates for 15- to 19-year-olds 
increased 11 percent. So we have had this real problem in terms of 
increases in suicide.

                              {time}  2100

  It is unfortunate that it has gotten to the point that we have very 
little service. The other reality that we really need to be very 
conscious about is the suicides. Let me just give you one more figure. 
Twelve young people between the ages of 15 to 24 die every day. Today, 
12 young people on the average committed suicide. African Americans is 
growing, in terms of the young African Americans who are committing 
suicide. Latino women are also suffering from depression. So it is an 
issue that we need to come to and revisit.
  I know that your piece of legislation helps to begin to address this 
problem and sometimes we do not realize the connection between what is 
happening out there, the consequences in terms of our schools and the 
danger that is occurring there.
  Ms. JACKSON-LEE of Texas. I think the gentleman made an important 
point. Many people believe that for some reason or another, Members of 
the United States Congress, and I hope the gentlewoman from Indiana 
will maybe mention her background a little bit, sort of drop out of the 
sky and come into the United States Congress.

[[Page 15364]]

As a lawyer, I practiced what we call probate law in Texas, the mental 
health commitments under the probate courts. So I got a chance to go 
into all kind of halfway houses and facilities to see people. Some of 
them were not as I would have wanted. They were tragic circumstances in 
terms of anyone getting any good treatment. But we had to in essence 
put someone somewhere. I felt the pain of families. I think you should 
repeat again, you were a social worker. You wanted to help people, but 
you could not help a young person unless they were put in the detention 
or the juvenile crime system.
  Mr. RODRIGUEZ. Unless they had already broken the law, we could not 
help them. That was the way it was structured in terms of how it was 
funded. So individuals out there that are having difficulties, parents, 
a multitude of parents with adolescents, we could not reach out to them 
at all. Those services are lacking throughout this country. There is a 
real need for us to revisit that. There are a lot of issues in mental 
health. I think that this is one of the areas that we are looking 
forward to. I was real pleased to see Tipper Gore reach out and do the 
conference here in Washington on mental health and the importance and 
the testimony that she provided on her firsthand experiences with 
depression and how difficult that is and the need for us to have a 
better understanding of what that can cause and the problems that that 
can bring.
  As a country, we need to recognize that a lot of people are falling 
through the cracks. If you look at the incident, the shooting that 
occurred here with that individual that had a mental health problem, 
that individual had been under treatment and had dropped out of that 
treatment. One of the few ways that we can prevent those kinds of 
atrocities is by providing mental health services. I think it is 
important that we take and work with those youngsters.
  If I can add one other thing that I am real concerned about, not 
enough studies and research have been done with the use of Ritalin and 
prescription coverage with youngsters. Ritalin and some of those 
prescriptions were made for adults. All of a sudden we started to 
provide those prescriptions for our youngsters. We do not know what the 
long-term effects are going to be. And I think we have gone overboard 
on the use of some of those prescription items with our youngsters. So 
we really need to be very cautious. There is a need for research to 
occur in this area. I am hoping that your piece of legislation will be 
funded and that we can reach out to those youngsters throughout this 
country that are suffering from depression and a variety of different 
other disorders.
  Ms. JACKSON-LEE of Texas. I thank the gentleman for his expertise and 
his leadership on this issue. We are going to work together.
  As I introduce the gentlewoman from Indiana, let me cite for you a 
statement of needs of mentally ill children in the juvenile justice 
system in a position paper done by the Mental Health and Mental 
Retardation Authority of Harris County, Joy Cunningham, executive 
director. She used the term mental illness or mentally ill children. I 
said that I was going to focus it on special needs children, but 
mentally ill children, as this paper cites, are more vulnerable to drug 
and alcohol problems and are at high risk for suicide and for 
committing nonrational violent acts. While we cannot completely divert 
these children from the juvenile justice system because their condition 
is manifested in serious behavioral problems, for the majority of these 
children an improvement in their condition equals an improvement in 
their behavior.
  This is a fait accompli. This is what is going on now. Would it not 
be great if we could get these children before it resulted in violent 
behavior? The gentlewoman has worked to try and curb the use of 
handguns or guns getting in the hands of children. Part of that, of 
course, is accidental. But part of it is guns mixing with children who 
are disturbed. She has been working on the antiviolence, and I believe 
they are all interwoven. We thank her for her leadership and sharing 
this time with us to talk about the needs of people who are suffering 
from mental needs or mental health needs and as well our children.
  I yield to the distinguished gentlewoman from Indiana (Ms. Carson).
  Ms. CARSON. Mr. Speaker, I would like first and foremost to give 
honor to whom honor is due, and that is to the distinguished 
gentlewoman and my friend from Texas (Ms. Jackson-Lee) and certainly to 
the honorable gentleman from Texas (Mr. Rodriguez).
  Mental health is an issue that has historically been kept quiet. It 
was sort of like a quiet storm within various households across this 
country and across this world. People were not inclined to talk about 
mental illness. They would pretend when they had a family member with 
mental health challenges to have been gone away on a visit or be in 
some place other than hospitalized because of their mental health 
challenges. That is not something that I have learned by reading a 
book; it is something that I have learned firsthand through my 
neighbors and through my churches. Prior to coming to the United States 
Congress, I was elected to township trustee. The reason I wanted to do 
that is because I wanted to buy a building which has since been named 
the Julia Carson Government Center in Indianapolis because it is set in 
a very nice neighborhood. But it had the highest number of homeless 
children in the whole of Marion County. It was the Mapleton-Fall Creek 
area as it is known. The kids were laying on the steps all night and 
all day. These were young children. They were 7 and 8 years of age. 
They were classified as delinquent sometimes or homeless sometimes; and 
their basic underlying needs were left ignored or unmet, the kind of 
mental health challenges that are often referred to in terms of a 
description of what really faced those very vulnerable children.
  I am pleased that the honorable gentlewoman from Texas (Ms. Jackson-
Lee) allowed me to become a cosponsor of the bill that she inspired and 
authored, H.R. 3455. I commend her for her outstanding foresight and 
insight and activism on behalf of our children who are diagnosed with 
mental health disorders. The gentlewoman's bill provides mental health 
services to children, adolescents, their families, schools and 
communities. This issue reminds me in the academic sense of the 
mathematical axiom that the whole equals the sum of its parts. While we 
talk about mental health challenges and mental health disorders among 
young people and trying to access them to proper medical services and 
coverage, we have to further recognize that there are other axioms out 
here that perpetuate that whole challenge of mental illness, and that 
is the kind of environment in which kids grow up.
  Kids live in old neighborhoods, in old houses. They still have lead-
based paint in the houses which has been known to perpetuate violence, 
delinquency and mental health disorders. We have a food stamp program 
that covers food for children, but it does not allow good nutritional 
kinds of support for children. For example, food stamps do not cover 
vitamins. It specifically denies purchase of vitamins with food stamps, 
which to me is a very vital component of anybody's well-being, 
nutrition, et cetera. I think those are areas that we need to further 
expand upon as we try to deal with the mental health disorders that 
this bill addresses.
  The gentlewoman's bill authorizes the Substance Abuse and Mental 
Health Services Administration to work with the Department of Education 
to increase the level of available resources for localities, to 
identify emotional and behavioral problems in children and adolescents 
and provide service through school and community-based clinics.
  I do not want to get into another kind of discussion here, but while 
we deny the majority of America's children who are in public education 
access to quality education and all of the tools that are attendant to 
quality education such as mental health services, counselors, nurses, 
professional people within a school setting who are

[[Page 15365]]

adept in identifying potential problems, I think we do this country a 
disservice while we wade off into areas that really do not benefit the 
majority of America's children.
  Her bill provides mental health services to children and adolescents, 
their families and their schools and communities. That is so vital if 
we are really going to get a grip on this issue. Everybody may not know 
that an estimated 20 percent of American children and adolescents, 11 
million in all, have serious diagnosable emotional or behavioral health 
disorders which range from attention deficit disorder and depression to 
bipolar disorder and schizophrenia. That is a lot of people, 11 million 
in all, of our children.
  Ms. JACKSON-LEE of Texas. That is a very good point. That is a large 
number. That is documented. We do not know what are the other numbers. 
The reason why I wanted to have this discussion on the floor of the 
House is because I have encountered a number of custodians of children, 
those who have custodial care, whether they are grandparents or aunts 
and uncles, single parents and families who are suffering alone with 
children who need mental health care.
  But one of the major problems is as we all know, the work of children 
is going to school. We get up every morning and we head out for our 
work as an adult. I am told that that work for children is when they go 
to school. The issue is, this is where they live a good portion of 
their life. And knowing children, working with children, having, I 
know, some wonderful grandchildren, are children apt to just pop up one 
day and say, my emotions don't feel well?
  This is the problem that we are facing. How do you get help for 
children who are children and do not know how to express that they are 
depressed or something is wrong other than when they act it out? And 
then that parent is left just aghast as to what happened.
  Have you seen that, particularly with those homeless children, you do 
not know, you are able to house them maybe, but were there resources 
there to help them with their state of mind?
  Ms. CARSON. There were not resources available. As the gentleman from 
Texas (Mr. Rodriguez) pointed out his experience, unless a child gets 
into the juvenile justice system, they are sort of just out there with 
no kind of support, no emotional support, nobody to talk to, nobody who 
understands. Their home conditions are such that they really cannot get 
the kind of help they need through the home. We have an inordinate 
number of children who are born with substance abuses because their 
parents were substance abusers and so we have all these little babies 
being born now who are addicted from the time that they are flushed 
into the world, if you will. There are not enough services, not enough 
identification, not enough early prevention and care for those children 
before they become problems, if you will, for society. That is indeed a 
problem, and that is why it is imperative for this Congress to 
recognize the importance of passing the measure that you have 
introduced.
  Between 9 percent and 13 percent of children ages 9 to 17 have 
serious mental and emotional disturbances that substantially interfere 
with or limit their ability to function in a family, school and 
community. Evidence 
that was compiled by the World Health Organization indicates by the 
year 2020, internationally, childhood neuropsychiatric disorders will 
rise proportionately by over 50 percent to increase one of the five 
most common causes of morbidity, mortality and disability among 
children. And, of course, the Mental Health Association reports that 
most people who commit suicide have a mental or emotional disorder. 
Within every 1 hour and 57 minutes, a person under the age of 25 years 
of age commits suicide.

                              {time}  2115

  I think this Congress has an obligation if we stand here day and 
night and talk about family values, then we need to move forward not 
just in word but in deed in terms of providing some help for all of 
these people out here who are dependent on the Sheila Jackson-Lees and 
the Barbara Lees of the country to step forward and provide meaningful 
opportunities to redress this very serious problem in our communities, 
in our individual communities and in our country.
  I would say to the gentlewoman from Texas (Ms. Jackson-Lee) that I 
have a great deal of gratitude, and I want to thank her for the 
opportunity to stand here and speak on a problem that was not a popular 
subject matter; but she certainly has done a yeoman's job in bringing 
it to the fore of the American people.
  Mr. Speaker, I am a cosponsor in support of Congresswoman Jackson-
Lee's bill H.R. 3455 and commend my colleague for her outstanding 
activism on behalf of children diagnosed with mental health disorders.
  This bill would provide mental health services to children, 
adolescents and their families, schools and communities.
  This legislation would authorize the Substance Abuse and Mental 
Health Services Administration to work with the Department of Education 
to increase the level of available resources for localities to identify 
emotional and behavioral problems in children and adolescents and would 
provide service through school and community based health clinics.
  Mental health care needs among our children are on the rise.
  An estimated 20% of American children and adolescents, 11 million in 
all, have serious diagnosable emotional or behavioral health disorders, 
which range from attention deficit disorder and depression to bipolar 
disorder and schizophrenia.
  Between 9% and 13% of children ages 9 to 17 have serious mental or 
emotional disturbances that substantially interfere with or limit their 
ability to function in the family, school, and community.
  Recent evidence compiled by the World Health Organization indicates 
by the year 2020, internationally, childhood neuropsychiatric disorders 
will rise proportionally by over 50% to become one of the five most 
common causes of morbidity, mortality, and disability among children.
  The National Mental Health Association reports that most people who 
commit suicide have a mental or emotional disorder. Within every 1 hour 
and 57 minutes, a person under the age of 25 commits suicide.
  Furthermore, the U.S. Surgeon General reports that suicide among 
African-American youth has increased 100% in the last decade.
  Too many children suffering from a mental or emotional disorder go 
unserved. An estimated two-thirds of all young people are not getting 
the mental health treatment they need.
  Effective treatments for children's psychiatric disorders typically 
require not only direct interventions such as psychotherapy or 
medication, but also a range of other actions, including interventions 
with parents and school personnel.
  The Children's Defense Fund reports that when children's mental 
health services are unavailable, affordable, or inappropriate, young 
people often end up caught in the child protection or juvenile justice 
systems. Furthermore, parents may even be forced to give up custody of 
the children to secure appropriate treatment.
  The rise in youth violence across this nation has created a climate 
of fear in our schools and communities and has therefore, contributed 
to the increase in children having mental or emotional disorders.
  The serious consequences of untreated mental health problems among 
children result in school drop-out, rise in juvenile delinquency, 
alcohol and drug abuse, and even suicide.
  We need to advocate for initiatives that promote healthy mental and 
physical growth among our youth by providing prevention efforts, 
community-based mental health services, and ensuring quality mental 
health care services.
  Implementing early-intervention services will ultimately decrease the 
likelihood of more severe emotional or behavioral problems.
  Representative Jackson-Lee's bill would not only expand resources for 
communities but would also allow communities to expand existing school-
based anti-violence prevention programs that provide crisis 
intervention, emergency services, school safety, and behavior 
management.
  Therefore, I ask my other colleagues to support this important and 
needed legislation and help our children receive the quality mental 
health services that they deserve.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
gentlewoman from Indiana (Ms. Carson). I can assure her that she has 
done a great service to those who are suffering in isolation by coming 
to the floor tonight and saying to those who are suffering with mental 
health needs that they are not alone.

[[Page 15366]]

  It is interesting, as the gentlewoman from California (Ms. Lee) 
worked so hard on the floor last week to challenge this Congress and 
ask the very simple question, can we not provide for the poor of the 
world. And I thank the gentlewoman from Indiana (Ms. Carson) very much 
for her commitment and support of the legislation that we are trying to 
pass to provide $100 million in funding for mental health needs.
  The gentlewoman from California (Ms. Lee) fought just last week when 
unfortunately we were told we had no money; we come just a few days 
later and we are hearing of the booming surplus that is coming about. 
Of course, there is a lot of debate about tax cuts to people and people 
wonder why, many of us, particularly Democrats, have a different 
perspective. Because I realize that out of information that we have 
gotten from the National Mental Health Association, and we applaud 
their work, and the White House conference with Tipper Gore, that 
people in the United States, what a tragedy, we can only serve 34,000 
children, when I have pages of gun violence incidents that suggest that 
we have troubled children in our midst and we cannot find a way to 
provide an extra $100 million for school nurses, for counselors, for 
training teachers to be able to detect whether a child is troubled. I 
believe the fight of the gentlewoman was a very important fight, 
dealing with debt relief, but dealing with HIV/AIDS around the world.
  I believe this is an important fight for the children of America, and 
I am delighted with the leadership of the gentlewoman from California 
(Ms. Lee) and would like to yield to the distinguished gentlewoman from 
California (Ms. Lee), who is aware that human needs must be paramount.
  Ms. LEE. Mr. Speaker, I would like to thank my esteemed colleague, 
the gentlewoman from Texas (Ms. Jackson-Lee), for really organizing the 
opportunity to discuss a crucial national issue, the mental health of 
our children. Let me just say I am a proud social worker. I actually 
studied psychology during my undergraduate term at Mills College in 
California and then I went on to receive my masters in social work, a 
degree at the University of California.
  Ms. JACKSON-LEE of Texas. If the gentlewoman would yield, it is 
wonderful that as we debate this that the American people understand 
that we did not just come here; that we bring experiences.
  Ms. LEE. I studied Maslow and Freud and Jung and all of the great 
psychiatrists and behavioral scientists of our time, and I studied 
psychology because I wanted to try to understand human behavior more. I 
went into community mental health, psychiatric social work, because I 
learned very quickly that the environment and the social context in 
which a child or a human being lives really that context impacts their 
life, their behavior and their mental health.
  So mental health is a question of just that; it is a question of 
health. For too long it has been stigmatized, and it has been 
neglected.
  In the early 1970s, when I was in graduate school, I actually founded 
a community mental health center; and it was called Change, 
Incorporated, and it was in Berkeley, California. I founded that center 
so that we could destigmatize and remove the artificial barriers about 
mental health for primarily low-income African American residents of 
that community.
  That mental health center survived for 10 years, but this was in the 
early 1970s, and we had a hard time raising money then for resources to 
provide the intervention and the counseling. What we saw, though, 
during those 10 years was the psychologists, social workers, 
counselors, made an enormous difference in the lives of children and 
families through intervention, through quality mental health services.
  Now, as I said, this was in the early 1970s. Here we are now in the 
year 2000 and we are still talking about the fact that mental health is 
not a critical component of our national health policy, and we are 
struggling to raise resources and to provide new resources for mental 
health counselors. We can help our children and we can offer 
alternatives to desperate young people, averting some of the terrible 
schoolyard tragedies which we have seen that really dominate our 
nightly news.
  Substance abuse, violence, school dropouts, suicide all of these are 
manifestations of a young child's acting out, yearning to be heard, 
wanting us as adults to do something to help. They are calling out for 
help. Suicide rates among African American youth have increased 100 
percent in the last 10 years, 100 percent. This is really a silent 
epidemic that is taking our young people one by one, and I know that 
with some form of intervention most of these lives would have been 
saved.
  So we do need community programs, and we do need to offer mental 
health services in our schools. We need school counselors. In my own 
State of California we have one counselor to 1,100 children. Can one 
imagine? Teachers need to be freed up to teach.
  Some children come to school hungry. They cannot concentrate. 
Consequently they act out. A teacher has to deal with that. If there 
were a counselor available, the teacher could refer that child to a 
counselor; and the counselor could develop a case management plan to 
help that child rather than allowing that child to be suspended or to 
fall out or to drop out of school.
  So I am very proud to be with the gentlewoman tonight. I thank her 
for this. I am in full support of her bill, which is such an important 
bill, The Give a Kid a Chance Omnibus Mental Health Services Act for 
Children. I think that is a great title for the bill.
  It will really forge a critical link in our health network. It also 
will boost badly needed resources for communities to develop community 
mental health programs for children and adults, the same thing that we 
tried to do in Berkeley, California, in the early 1970s.
  So here we are again. We need mental health professionals in every 
school. We need our families and children to know that it is okay to 
seek a counselor and to seek a mental health professional, and we need 
to give our kids a chance.
  Ms. JACKSON-LEE of Texas. The gentlewoman has highlighted so many 
important points I do not know where to start, but having just finished 
the fight to assist the world in its fight for HIV/AIDS, does the 
gentlewoman not think that if we discover that we have a surplus that 
was unexpected that it would not be fiscally irresponsible to be able 
to look at mental health parity in our HMO coverage? The gentlewoman 
being a psychiatric social worker has seen the pain of people suffering 
from mental illness and mental health needs, as I have called it. What 
I have seen is people who are isolated and do not know where to go.
  Let me cite these numbers for a moment. It is estimated between 
118,700 and 186,600 youth were involved in the juvenile justice system, 
I call it the juvenile crime justice system, have at least one mental 
disorder. So they really needed other kinds of help.
  According to a 1994 OJJDP study of juveniles' response to health 
screening conducted at the Mission of Juvenile Facilities, 73 percent 
of juveniles reported having mental health problems and 57 percent 
reported having prior mental health treatment. Of the 100,000 teenagers 
in juvenile detention, estimates indicate that 60 percent have 
behavioral, mental, or emotional problems.
  Is it important that we try to find the funding to be able to help 
not only these children but these families? And I know social workers 
are not paid what they should be paid.
  Ms. LEE. Or psychiatrists or psychologists.
  Ms. JACKSON-LEE of Texas. Or child psychiatrists.
  Ms. LEE. Mental health professionals need to be paid what they 
deserve to be paid, and based on their workload they need to be paid 
twice as much.
  Let me just say that one has to believe that the mind and the body 
are equally important. I think all of us believe that, but we have not 
put our money where our mouth is.
  Mental health parity is critical if one believes that one's spirit, 
one's mind is

[[Page 15367]]

just as important as the physical body. Psychosis, schizophrenia, 
depression, all of these mental issues, and I will not call it mental 
illness either because we still do not have a clear definition of 
mental illness, but all of these behavioral difficulties can be cured 
in many instances.
  So why do we not elevate the mind and the body on an equal basis, 
because certainly one cannot be treated without treating the other? So 
additional resources making mental health policy as part of our 
national health policy should really be a national priority, and we 
should use some of our surplus to do just that.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentlewoman from 
California (Ms. Lee) very much. I thank her for her work before coming 
to Congress, her work now. Let us commit ourselves, first of all, to 
the reality that this Nation is suffering from inadequate mental health 
services.
  Yes, they are there in spotty places throughout the Nation, but even 
the community mental health services or the community mental health 
centers are only in about 37 of our States. The funding does not allow 
for complete use in all 50 States.
  More teenagers die from suicide, Mr. Speaker, than from cancer, heart 
disease, AIDS, birth defects, strokes, influenza and chronic lung 
disease combined.
  The U.S. Surgeon General stresses that mental health needs should be 
a central part of this Nation's health policy debate because mental 
health is indispensable to personal well-being, family interpersonal 
relationships, and contribution to community and society. I think when 
we talk about our children, families know about anorexia nervosa, we 
know about that. We have heard about anxiety disorders, but are we 
aware that our children suffer greatly from depression?
  If I might share as I close this evening, depression is one of the 
most treatable mental illnesses as it is said here on the National 
Mental Health Association fact sheet, but early diagnosis and treatment 
are essential to depressed children and can help them lead to better 
long-term good health.
  Mr. Speaker, the real question is, how many of us would run to aid a 
fallen child with that broken arm or that bruised knee or bruised 
finger, and the tears coming to their eyes? But how many of us have 
come to this floor to demand parity for mental health treatment for all 
Americans in their HMOs and health plans?
  I want to applaud some of the great works of some Members of our 
Congress, both Republicans and Democrats, but we need to finish the 
job. The job means that we have to find good resources for children so 
that they can grow up to be healthy adults.
  Let me acknowledge Dr. James Comer, who is here with the Yale 
University Child Study Center, been a leading force on children's 
mental health; Dr. Koplewicz, from the New York University Child Study 
Center who has also been working, but they need us in the United States 
Congress to fund legislation. I hope that H.R. 3455, give a kid a 
chance legislation, that asks for just $100 million to be able to put 
school counselors and nurses in schools, to be able to help our 
children find their way and to help their parents, would be considered 
in this Congress.
  I do hope that those who feel isolated with the impact of mental 
illness in their families will find a way to believe in the United 
States Congress that we are moving toward addressing this question and 
not leaving them to suffer alone, Mr. Speaker.

NEEDS OF MENTALLY ILL CHILDREN IN THE JUVENILE JUSTICE SYSTEM POSITION 
                                 PAPER


      mental health mental retardation authority of harris county

                       Joy Cunningham Exec. Dir.

       Over the years, the MHMRA Child and Adolescent Services 
     Division, operating with limited resources, has been able to 
     serve the needs of a variety of juvenile offenders through 
     their outpatient clinics, school-based programs and day 
     treatment services. However, it is apparent that there is a 
     growing number of juveniles who are dually diagnosed whose 
     needs cannot be met in our current county institutions.
       Data collected by the Forensic unit on juvenile offenders 
     indicate 17% of these youth (one of every five) suffer from a 
     severe mental condition characterized by disturbed thinking, 
     mood disorder, or impulse control disorder. When we include 
     children who are diagnosed with Conduct Disorder, this 
     percentage increases to 33% (two out of every five). Yet, the 
     juvenile justice system does not have a single facility for 
     mentally ill offenders. At present time, the Juvenile 
     Probation Department sends children with severe mental health 
     problems to private placement. This has resulted in the 
     unprecedented amount of money spent in private placement. 
     Within the last year, the collaboration between MHMRA and the 
     juvenile probation department has resulted in the provision 
     of some psychiatric services at juvenile probation 
     facilities. However, this does not begin to address the needs 
     of mentally ill children.
       Mentally ill children are more vulnerable to drug and 
     alcohol problems, and are at high risk for suicide and for 
     committing non-rational violent acts. While we can not 
     completely divert these children from the juvenile justice 
     system because their condition is manifested in serious 
     behavioral problems, for the majority of these children, an 
     improvement in their condition equals an improvement in their 
     behavior.
       In order to address the needs of these mentally ill 
     children, we need specialized programs that emphasize 
     psychological/psychiatric intervention and that are manned by 
     professionals with training in dealing with these children. 
     These specialized services should be available in a continuum 
     of care that addresses all levels of severity, and can either 
     be contracted out or provided through MHMRA and Juvenile 
     Probation with additional funding. Some of these specialized 
     services/needs are described below.
       Because of the severity of behavior problems, many of the 
     most seriously mentally ill children are held in the 
     detention center either awaiting court or awaiting placement. 
     This is particularly detrimental for these children because 
     of their limited cognitive and emotional resources. 
     Consequently, their behavior is prone to deterioration often 
     resulting in them becoming a danger to themselves or others. 
     The needs of these children can be best addressed in a short-
     term inpatient setting where they can have access to 
     medication, and where monitoring for self-injurious behavior 
     is an integral part of the program.
       Chronically mentally ill children who are adjudicated 
     delinquent and who, as a result of their condition, are prone 
     to aggressive outbursts and whose behavior is so impaired 
     that they represent a substantial risk to themselves or 
     others, will necessitate a long term Residential Treatment 
     Placement. The focus of this placement will be to provide 
     regular psychiatric/psychological interventions in the form 
     of individual, group, and family counseling, as well as 
     medication interventions. It will also be important to 
     incorporate an aftercare program that includes a transition 
     to a less restricted facility prior to return to home 
     placement.
       No one agency should be responsible for providing services 
     for these children. The needs of these children are complex 
     and, as a result, need the efforts of all local agencies 
     including Juvenile Probation Department, MHMRA, Child 
     Protective Services, and the local school district.
       Recommendations: It is imperative that Harris County have a 
     centralized data bank, so that all the different agencies 
     have immediate access to information regarding performance 
     and participation in school program, history of mental 
     illness/condition, history of referrals to the Juvenile 
     Probation Department, and information regarding physical or 
     sexual abuse or foster placement. The lack of this 
     information makes it difficult to recognize the needs of 
     children and offer appropriate alternatives.
       Need for Research: It is imperative to have research driven 
     treatment alternatives. To this end a centralized data source 
     would be helpful. In Harris county, this would involve having 
     a data system that includes the HCJS, MHMRA, CPS, and HISD, 
     so that children can be easily identified, and to allow for 
     continuation of services.
       Training of Practitioners: Government should sponsor 
     internship/resident programs with local universities or 
     institutions of higher learning to allow for a rotation with 
     these mentally ill children. This would serve the purpose of 
     educating professionals who will be going into positions of 
     responsibility with regards to these children, and/or to 
     provide a larger pool of professionals with training with 
     this specialized population.
       Training of Juvenile Court Staff: It is imperative that all 
     levels of court personnel (judges, district attorney, 
     juvenile attorneys) and Juvenile Probation staff have an 
     understanding of how mental illness or level of functioning 
     can be a factor in criminal activity. Training in the complex 
     issues of competency should be mandatory.
       Legal System: Courts must continue to be involved because 
     these children do have severe behavioral problems that put 
     the public at risk, but also because in many instances it is 
     the threat of legal action that motivates families and youth 
     to participate in many of these programs. Therefore, they 
     should have ultimate authority to remove these children from 
     participation in these specialized programs should there be 
     no indication that they are making an impact on

[[Page 15368]]

     the youth and/or the family. In making these decisions it 
     will be important that those more closely involved with the 
     implementation of these programs should receive education 
     regarding mental illness so that they can make better 
     decisions regarding the alternatives for these children.
       Federal Funding: There is no doubt that implementation of 
     the above recommendations is a costly endeavor. Support at 
     the federal level in the way of legislation that provides 
     line item funding for these services is recommended.

  Mr. Speaker, children's mental health needs to be a national priority 
in this country today!
  In this nation, we have taken great strides to address spend 10 times 
the amount on research into childhood cancer, than on children's mental 
health, yet one of five children is affected by some sort of mental 
illness.
  Even more devastating is the fact that although one in five children 
and adolescents has a diagnosable mental, emotional, or behavioral 
problem that can lead to school failure, substance abuse, violence or 
suicide, 75 to 80 percent of these children do not receive any services 
in the form of specialty treatment or some form of mental health 
intervention.
  This heartbreaking story of Kip Kinkle, the fifteen year-old student 
of Springfield, Oregon, who shot his parents and went to school to kill 
several other students is tragic, yet illuminating.
  For three years before this horrendous event, Kip suffered from 
psychosis and heard voices, yet no one did anything to address this 
situation. No teacher sent him to the nurse and no one asked his 
parents to take him to a doctor to find out what was wrong.
  This is why I stand before you today to encourage my Colleagues to 
address the inadequate funding for comprehensive children's mental 
health services. We need to reach these 75 to 80 percent of children 
suffering from mental illness and not allow any more days to go by, 
otherwise we are waiting for another school tragedy like Kip Kinkle to 
occur.
  The recent Surgeon General's Report on Children's Mental Health 
specifically states that ``most children in need of mental health 
services do not get them . . . '' Hence, when children's mental health 
needs are not met, young people often get caught in child protective 
services or the juvenile justice system. As a result, we see that 
almost 60 percent of teenagers in juvenile detention have behavioral, 
mental or emotional disorders.
  Although children's mental health services were funded at the 
President's request under H.R. 4577, this funding was still below the 
requested funding by National Mental health Association and the 
Federation of Families for Children's Mental Health Services. In order 
to adequately fund children's mental health services, we would need to 
fund this program with at least $93 million and not the $86 million 
allocated in the poorly funded bill H.R. 4577.
  Currently, the Children's Mental Health Services Program only serves 
approximately 34,000 children. Additional funding would enable more 
states to provide more mental health services on the community level.
  This is why I attempted to offer an amendment to H.R. 4577 to 
increase the funding for the Substance Abuse and Mental Health Services 
Administration by $10 million dollars. The intent of this Amendment was 
to increase the funding for the Children's Mental Health Services 
Program under SAMSHA.
  Both the National Mental Health Association and the Federation of 
Families for Children's Mental Health Services support increased 
funding for children's mental health and agree that we need to focus 
this nation's attention on intervention measures so that we can prevent 
tragedies like Columbine in Littleton, Colorado, Heath High School in 
Paducah, Kentucky, and Westside Middle School in Jonesboro, Arkansas.
  The grant programs funded under the comprehensive community mental 
health services program are critical to insure that children with 
mental health problems and their families have access to a full array 
of quality and appropriate care in their communities. To date, there 
have not been sufficient funds to award grants to communities in all 
the states.
  It is also crucial that we emphasize the fact that mental health 
disorders often lead to teen suicide with a person under the age of 25 
committing suicide every 1 hour and 57 minutes! The fact that 8 out of 
10 suicidal persons give some sign of their intentions also begs the 
question, why do we not make children's mental health a national 
priority.
  We know that more teenagers died from suicide than from cancer, heart 
disease, AIDS, birth defects, strokes, influenza and chronic lung 
disease combined.
  Because childhood depression is so very prevalent, we must recognize 
the dire need for increased services to treat our youth.
  One of the unfortunate realities of the lack of mental health 
services is the fact that many juveniles convicted in the criminal 
justice system are in the system because they need mental health 
services. Recently, the Human Rights Watch released its year 2000 
report entitled, ``Punishment and Prejudice: Racial Disparities in the 
War on Drugs.'' This report detailing the discrepancies between 
criminal sentencing of African-American and Hispanic drug offenders 
versus White drug offenders in the juvenile justice system. This report 
also makes reference to the failure of minority youth to be provided 
adequate mental health services or appropriately sentenced according to 
their mental health needs.
  Additionally, the New York Times released a study this past March 
that was conducted on 100 rampage killings. This Report indicated that 
mental health services could help prevent future outbreaks of violence 
among our youth and save students and their parents from the torture of 
another school shooting.
  This is further support for the belief that all children need access 
to mental health services. Whether these services are provided in a 
private therapy session or in a group setting in community health 
clinics, private sessions or through the schools, we need to make these 
services available. That is why this Congress should support 
legislation that will help remedy the lack of mental health services in 
the school system.
  The National Mental Health Association recommends initiatives to 
promote the ``healthy physical and mental development for America's 
youth.'' They support initiatives like increased mental health services 
in the school system and the surrounding community so that children 
have access to help when they need it. Recommended also are community 
based programs that promote good emotional development in children and 
adolescents.
  Furthermore, the Substance Abuse and Mental Health Services 
Administration (SAMHSA) states that it advocates ``legislation that 
would provide support to communities to integrate mental health 
principles, services and supports into existing early childhood 
programs . . .''
  This is why I introduced my bill, H.R. 3455, ``Give a Kid a Chance, 
Omnibus Mental Health Services Act for Children of 1999,'' which would 
provide mental health services to children, adolescents and their 
families in the schools and in our communities. Already, this bill is 
supported by 58 members of Congress and numerous organizations 
including the National Mental Health Association, the National 
Association of School Psychologists and the Federation of Families for 
Children's Mental Health.
  By making mental health services more readily available, we can spot 
mental health issues in children early before we have escalated 
incidents of violence. My bill, H.R. 3455, would authorize the 
Substance Abuse and Mental Health Services Administration (SAMHSA) to 
work with the Department of Education (DOE) to increase the level of 
available resources for localities to identify emotional and behavioral 
problems in children and adolescents and to provide service through the 
schools and community based health clinics.
  Unlike other limited legislative remedies, my bill would require 
local entities to implement ``comprehensive community-based programs 
that provide public health interventions and promote good emotional 
development in children and adolescents. These programs would provide 
early intervention services when mental health problems occur and would 
reach children who may be at-risk for a serious emotional or behavioral 
disorder (SED) and/or substance abuse.
  One of the significant points of my legislation is that in order for 
a student to access the services of any of the mental health 
professionals, he/she would not have to have a ``medically diagnosed'' 
mental health disorder. Thus, any student in need of someone to talk to 
about their emotional problems or simply in need of a ``friend'' would 
have access.

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