[Congressional Record (Bound Edition), Volume 154 (2008), Part 8]
[Senate]
[Pages 11166-11170]
[From the U.S. Government Publishing Office, www.gpo.gov]




     VETERANS MENTAL HEALTH AND OTHER CARE IMPROVEMENTS ACT OF 2008

  Mrs. BOXER. Mr. President, I ask unanimous consent that the Senate

[[Page 11167]]

proceed to the immediate consideration of Calendar No. 632, S. 2162.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 2162) to improve the treatment and services 
     provided by the Department of Veterans Affairs to veterans 
     with post-traumatic stress disorder and substance use 
     disorders, and for other purposes.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Veterans' Affairs, with 
an amendment, as follows:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Veterans 
     Mental Health Improvements Act of 2008''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

        TITLE I--SUBSTANCE USE DISORDERS AND MENTAL HEALTH CARE

Sec. 101. Findings on substance use disorders and mental health.
Sec. 102. Expansion of substance use disorder treatment services 
              provided by Department of Veterans Affairs.
Sec. 103. Care for veterans with mental health and substance use 
              disorders.
Sec. 104. National centers of excellence on post-traumatic stress 
              disorder and substance use disorders.
Sec. 105. Report on residential mental health care facilities of the 
              Veterans Health Administration.
Sec. 106. Tribute to Justin Bailey.

           TITLE II--MENTAL HEALTH ACCESSIBILITY ENHANCEMENTS

Sec. 201. Pilot program on peer outreach and support for veterans and 
              use of community mental health centers and Indian Health 
              Service facilities.

                          TITLE III--RESEARCH

Sec. 301. Research program on comorbid post-traumatic stress disorder 
              and substance use disorders.
Sec. 302. Extension of authorization for Special Committee on Post-
              Traumatic Stress Disorder.

             TITLE IV--ASSISTANCE FOR FAMILIES OF VETERANS

Sec. 401. Clarification of authority of Secretary of Veterans Affairs 
              to provide mental health services to families of 
              veterans.
Sec. 402. Pilot program on provision of readjustment and transition 
              assistance to veterans and their families in cooperation 
              with Vet Centers.

        TITLE I--SUBSTANCE USE DISORDERS AND MENTAL HEALTH CARE

     SEC. 101. FINDINGS ON SUBSTANCE USE DISORDERS AND MENTAL 
                   HEALTH.

       Congress makes the following findings:
       (1) More than 1,500,000 members of the Armed Forces have 
     been deployed in Operation Iraqi Freedom and Operation 
     Enduring Freedom. The 2005 Department of Defense Survey of 
     Health Related Behaviors Among Active Duty Personnel reports 
     that 23 percent of members of the Armed Forces on active duty 
     acknowledge a significant problem with alcohol use, with 
     similar rates of acknowledged problems with alcohol use among 
     members of the National Guard.
       (2) The effects of substance abuse are wide ranging, 
     including significantly increased risk of suicide, 
     exacerbation of mental and physical health disorders, 
     breakdown of family support, and increased risk of 
     unemployment and homelessness.
       (3) While veterans suffering from mental health conditions, 
     chronic physical illness, and polytrauma may be at increased 
     risk for development of a substance use disorder, treatment 
     for these veterans is complicated by the need to address 
     adequately the physical and mental symptoms associated with 
     these conditions through appropriate medical intervention.
       (4) While the Veterans Health Administration has 
     dramatically increased health services for veterans from 1996 
     through 2006, the number of veterans receiving specialized 
     substance abuse treatment services decreased 18 percent 
     during that time. No comparable decrease in the national rate 
     of substance abuse has been observed during that time.
       (5) While some facilities of the Veterans Health 
     Administration provide exemplary substance use disorder 
     treatment services, the availability of such treatment 
     services throughout the health care system of the Veterans 
     Health Administration is inconsistent.
       (6) According to the Government Accountability Office, the 
     Department of Veterans Affairs significantly reduced its 
     substance use disorder treatment and rehabilitation services 
     between 1996 and 2006, and has made little progress since in 
     restoring these services to their pre-1996 levels.

     SEC. 102. EXPANSION OF SUBSTANCE USE DISORDER TREATMENT 
                   SERVICES PROVIDED BY DEPARTMENT OF VETERANS 
                   AFFAIRS.

       (a) In General.--The Secretary of Veterans Affairs shall 
     ensure the provision of such services and treatment to each 
     veteran enrolled in the health care system of the Department 
     of Veterans Affairs who is in need of services and treatments 
     for a substance use disorder as follows:
       (1) Short term motivational counseling services.
       (2) Intensive outpatient or residential care services.
       (3) Relapse prevention services.
       (4) Ongoing aftercare and outpatient counseling services.
       (5) Opiate substitution therapy services.
       (6) Pharmacological treatments aimed at reducing craving 
     for drugs and alcohol.
       (7) Detoxification and stabilization services.
       (8) Such other services as the Secretary considers 
     appropriate.
       (b) Provision of Services.--The services and treatments 
     described in subsection (a) may be provided to a veteran 
     described in such subsection--
       (1) at Department of Veterans Affairs medical centers or 
     clinics;
       (2) by referral to other facilities of the Department that 
     are accessible to such veteran; or
       (3) by contract or fee-form service payments with 
     community-based organizations for the provision of such 
     services and treatments.
       (c) Alternatives in Case of Services Denied Due to Clinical 
     Necessity.--If the Secretary denies the provision to a 
     veteran of services or treatment for a substance use disorder 
     due to clinical necessity, the Secretary shall provide the 
     veteran such other services or treatments as are medically 
     appropriate.
       (d) Report.--Not later than one year after the date of the 
     enactment of this Act, the Secretary shall submit to the 
     Committee on Veterans' Affairs of the Senate and the 
     Committee on Veterans' Affairs of the House of 
     Representatives a report setting forth, for each medical 
     facility of the Department, the availability of the 
     following:
       (1) Medically supervised withdrawal management.
       (2) Programs for treatment of alcohol and other substance 
     use disorders that are--
       (A) integrated with primary health care services; or
       (B) available as specialty substance use disorder services.
       (3) Specialty programs for the treatment of post-traumatic 
     stress disorder.
       (4) Programs to treat veterans who are diagnosed with both 
     a substance use disorder and a mental health disorder.

     SEC. 103. CARE FOR VETERANS WITH MENTAL HEALTH AND SUBSTANCE 
                   USE DISORDERS.

       (a) In General.--If the Secretary of Veterans Affairs 
     provides a veteran inpatient or outpatient care for a 
     substance use disorder and a comorbid mental health disorder, 
     the Secretary shall ensure that treatment for such disorders 
     is provided concurrently--
       (1) through a service provided by a clinician or health 
     professional who has training and expertise in treatment of 
     substance use disorders and mental health disorders;
       (2) by separate substance use disorder and mental health 
     disorder treatment services when there is appropriate 
     coordination, collaboration, and care management between such 
     treatment services; or
       (3) by a team of clinicians with appropriate expertise.
       (b) Team of Clinicians With Appropriate Expertise 
     Defined.--In this section, the term ``team of clinicians with 
     appropriate expertise'' means a team consisting of the 
     following:
       (1) Clinicians and health professionals with expertise in 
     treatment of substance use disorders and mental health 
     disorders who act in coordination and collaboration with each 
     other.
       (2) Such other professionals as the Secretary considers 
     appropriate for the provision of treatment to veterans for 
     substance use and mental health disorders.

     SEC. 104. NATIONAL CENTERS OF EXCELLENCE ON POST-TRAUMATIC 
                   STRESS DISORDER AND SUBSTANCE USE DISORDERS.

       (a) In General.--Subchapter II of chapter 73 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 7330A. National centers of excellence on post-
       traumatic stress disorder and substance use disorders

       ``(a) Establishment of Centers.--(1) The Secretary shall 
     establish not less than six national centers of excellence on 
     post-traumatic stress disorder and substance use disorders.
       ``(2) The purpose of the centers established under this 
     section is to serve as Department facilities that provide 
     comprehensive inpatient or residential treatment and recovery 
     services for veterans diagnosed with both post-traumatic 
     stress disorder and a substance use disorder.
       ``(b) Location.--Each center established in accordance with 
     subsection (a) shall be located at a medical center of the 
     Department that--
       ``(1) provides specialized care for veterans with post-
     traumatic stress disorder and a substance use disorder; and
       ``(2) is geographically situated in an area with a high 
     number of veterans that have been diagnosed with both post-
     traumatic stress disorder and substance use disorder.
       ``(c) Process of Referral and Transition to Step Down 
     Diagnosis Rehabilitation Treatment Programs.--The Secretary 
     shall establish a process to refer and aid the transition of 
     veterans from the national centers of excellence on post-
     traumatic stress disorder and substance use disorders 
     established pursuant to subsection (a) to programs that 
     provide step down rehabilitation treatment for individuals 
     with post-traumatic stress disorder and substance use 
     disorders.

[[Page 11168]]

       ``(d) Collaboration With the National Center for Post-
     Traumatic Stress Disorder.--The centers established under 
     this section shall collaborate in the research of the 
     National Center for Post-Traumatic Stress Disorder.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 73 of such title is amended by inserting 
     after the item relating to section 7330 the following new 
     item:

``7330A. National centers of excellence on post-traumatic stress 
              disorder and substance use disorders.''.

     SEC. 105. REPORT ON RESIDENTIAL MENTAL HEALTH CARE FACILITIES 
                   OF THE VETERANS HEALTH ADMINISTRATION.

       (a) Reviews.--The Secretary of Veterans Affairs shall, 
     acting through the Office of Mental Health Services of the 
     Department of Veterans Affairs--
       (1) not later than six months after the date of the 
     enactment of this Act, conduct a review of all residential 
     mental health care facilities, including domiciliary 
     facilities, of the Veterans Health Administration; and
       (2) not later than two years after the date of the 
     completion of the review required by paragraph (1), conduct a 
     follow-up review of such facilities to evaluate any 
     improvements made or problems remaining since the review 
     under paragraph (1) was completed.
       (b) Report.--Not later than 90 days after the completion of 
     the review required by subsection (a)(1), the Secretary shall 
     submit to the Committee on Veterans' Affairs of the Senate 
     and the Committee on Veterans' Affairs of the House of 
     Representatives a report on such review. The report shall 
     include the following:
       (1) A description of the availability of care in 
     residential mental health care facilities in each Veterans 
     Integrated Service Network (VISN).
       (2) An assessment of the supervision and support provided 
     in the residential mental health care facilities of the 
     Veterans Health Administration.
       (3) The ratio of staff members at each residential mental 
     health care facility to patients at such facility.
       (4) An assessment of the appropriateness of rules and 
     procedures for the prescription and administration of 
     medications to patients in such residential mental health 
     care facilities.
       (5) A description of the protocols at each residential 
     mental health care facility for handling missed appointments.
       (6) Any recommendations the Secretary considers appropriate 
     for improvements to such residential mental health care 
     facilities and the care provided in such facilities.

     SEC. 106. TRIBUTE TO JUSTIN BAILEY.

       This title is enacted in tribute to Justin Bailey, who, 
     after returning to the United States from service as a member 
     of the Armed Forces in Operation Iraqi Freedom, died in a 
     domiciliary facility of the Department of Veterans Affairs 
     while receiving care for post-traumatic stress disorder and a 
     substance use disorder.

           TITLE II--MENTAL HEALTH ACCESSIBILITY ENHANCEMENTS

     SEC. 201. PILOT PROGRAM ON PEER OUTREACH AND SUPPORT FOR 
                   VETERANS AND USE OF COMMUNITY MENTAL HEALTH 
                   CENTERS AND INDIAN HEALTH SERVICE FACILITIES.

       (a) Pilot Program Required.--Commencing not later than 180 
     days after the date of the enactment of this Act, the 
     Secretary of Veterans Affairs shall carry out a pilot program 
     to assess the feasability and advisability of providing to 
     veterans of Operation Iraqi Freedom and Operation Enduring 
     Freedom, and, in particular, veterans who served in such 
     operations as a member of the National Guard or Reserve, the 
     following:
       (1) Peer outreach services.
       (2) Peer support services provided by licensed providers of 
     peer support services or veterans who have personal 
     experience with mental illness.
       (3) Readjustment counseling services described in section 
     1712A of title 38, United States Code.
       (4) Other mental health services.
       (b) Provision of Certain Services.--In providing services 
     described in paragraphs (3) and (4) of subsection (a) under 
     the pilot program to veterans who reside in rural areas and 
     do not have adequate access through the Department of 
     Veterans Affairs to the services described in such 
     paragraphs, the Secretary shall, acting through the Office of 
     Mental Health Services and the Office of Rural Health, 
     provide such services as follows:
       (1) Through community mental health centers or other 
     entities under contracts or other agreements for the 
     provision of such services that are entered into for purposes 
     of the pilot program.
       (2) Through the Indian Health Service pursuant to a 
     memorandum of understanding entered into by the Secretary of 
     Veterans Affairs and the Secretary of Health and Human 
     Services for purposes of the pilot program.
       (c) Duration.--The pilot program shall be carried out 
     during the three-year period beginning on the date of the 
     commencement of the pilot program.
       (d) Program Locations.--
       (1) In general.--The pilot program shall be carried out 
     within areas selected by the Secretary for the purpose of the 
     pilot program in at least two Veterans Integrated Service 
     Networks (VISN).
       (2) Rural geographic locations.--The locations selected 
     shall be in rural geographic locations that, as determined by 
     the Secretary, lack access to comprehensive mental health 
     services through the Department of Veterans Affairs.
       (3) Qualified providers.--In selecting locations for the 
     pilot program, the Secretary shall select locations in which 
     an adequate number of licensed mental health care providers 
     with credentials equivalent to those of Department mental 
     health care providers are available in Indian Health Service 
     facilities, community mental health centers, and other 
     entities are available for participation in the pilot 
     program.
       (e) Participation in Program.--Each community mental health 
     center, facility of the Indian Health Service, or other 
     entity participating in the pilot program under subsection 
     (b) shall--
       (1) provide the services described in paragraphs (3) and 
     (4) of subsection (a) to eligible veterans, including, to the 
     extent practicable, telehealth services that link the center 
     or facility with Department of Veterans Affairs clinicians;
       (2) use the clinical practice guidelines of the Veterans 
     Health Administration or the Department of Defense in the 
     provision of such services; and
       (3) meet such other requirements as the Secretary shall 
     require.
       (f) Compliance With Department Protocols.--Each community 
     mental health center, facility of the Indian Health Service, 
     or other entity participating in the pilot program under 
     subsection (b) shall comply with--
       (1) applicable protocols of the Department before incurring 
     any liability on behalf of the Department for the provision 
     of services as part of the pilot program; and
       (2) access and quality standards of the Department relevant 
     to the provision of services as part of the pilot program.
       (g) Provision of Clinical Information.--Each community 
     mental health center, facility of the Indian Health Service, 
     or other entity participating in the pilot program under 
     subsection (b) shall, in a timely fashion, provide the 
     Secretary with such clinical information on each veteran for 
     whom such health center or facility provides mental health 
     services under the pilot program as the Secretary shall 
     require.
       (h) Training.--
       (1) Training of veterans.--As part of the pilot program, 
     the Secretary shall carry out a program of training for 
     veterans described in subsection (a) to provide the services 
     described in paragraphs (1) and (2) of such subsection.
       (2) Training of clinicians.--
       (A) In general.--The Secretary shall conduct a training 
     program for clinicians of community mental health centers, 
     Indian Health Service facilities, or other entities 
     participating in the pilot program under subsection (b) to 
     ensure that such clinicians can provide the services 
     described in paragraphs (3) and (4) of subsection (a) in a 
     manner that accounts for factors that are unique to the 
     experiences of veterans who served on active duty in 
     Operation Iraqi Freedom or Operation Enduring Freedom 
     (including their combat and military training experiences).
       (B) Participation in training.--Personnel of each community 
     mental health center, facility of the Indian Health Service, 
     or other entity participating in the pilot program under 
     subsection (b) shall participate in the training program 
     conducted pursuant to subparagraph (A).
       (i) Annual Reports.--Each community mental health center, 
     facility of the Indian Health Service, or other entity 
     participating in the pilot program under subsection (b) shall 
     submit to the Secretary on an annual basis a report 
     containing, with respect to the provision of services under 
     subsection (b) and for the last full calendar year ending 
     before the submission of such report--
       (1) the number of--
       (A) veterans served; and
       (B) courses of treatment provided; and
       (2) demographic information for such services, diagnoses, 
     and courses of treatment.
       (j) Program Evaluation.--
       (1) In general.--The Secretary shall, through Department of 
     Veterans Affairs Mental Health Services investigators and in 
     collaboration with relevant program offices of the 
     Department, design and implement a strategy for evaluating 
     the pilot program.
       (2) Elements.--The strategy implemented under paragraph (1) 
     shall assess the impact that contracting with community 
     mental health centers, the Indian Health Service, and other 
     entities participating in the pilot program under subsection 
     (b) has on the following:
       (A) Access to mental health care by veterans in need of 
     such care.
       (B) The use of telehealth services by veterans for mental 
     health care needs.
       (C) The quality of mental health care and substance use 
     disorder treatment services provided to veterans in need of 
     such care and services.
       (D) The coordination of mental health care and other 
     medical services provided to veterans.
       (k) Definitions.--In this section:
       (1) The term ``community mental health center'' has the 
     meaning given such term in section 410.2 of title 42, Code of 
     Federal Regulations (as in effect on the day before the date 
     of the enactment of this Act).
       (2) The term ``eligible veteran'' means a veteran in need 
     of mental health services who--
       (A) is enrolled in the Department of Veterans Affairs 
     health care system; and
       (B) has received a referral from a health professional of 
     the Veterans Health Administration to a community mental 
     health center, a facility of the Indian Health Service, or 
     other entity for purposes of the pilot program.
       (3) The term ``Indian Health Service'' means the 
     organization established by section 601(a) of

[[Page 11169]]

     the Indian Health Care Improvement Act (25 U.S.C. 1661(a)).
       (l) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     the provisions of this section.

                          TITLE III--RESEARCH

     SEC. 301. RESEARCH PROGRAM ON COMORBID POST-TRAUMATIC STRESS 
                   DISORDER AND SUBSTANCE USE DISORDERS.

       (a) Program Required.--The Secretary of Veterans Affairs 
     shall carry out a program of research into comorbid post-
     traumatic stress disorder (PTSD) and substance use disorder.
       (b) Discharge Through National Center for Posttraumatic 
     Stress Disorder.--The research program required by subsection 
     (a) shall be carried out by the National Center for 
     Posttraumatic Stress Disorder. In carrying out the program, 
     the Center shall--
       (1) develop protocols and goals with respect to research 
     under the program; and
       (2) coordinate research, data collection, and data 
     dissemination under the program.
       (c) Research.--The program of research required by 
     subsection (a) shall address the following:
       (1) Comorbid post-traumatic stress disorder and substance 
     use disorder.
       (2) The systematic integration of treatment for post-
     traumatic stress disorder with treatment for substance use 
     disorder.
       (3) The development of protocols to evaluate care of 
     veterans with comorbid post-traumatic stress disorder and 
     substance use disorder and to facilitate cumulative clinical 
     progress of such veterans over time.
       (d) Funding.--
       (1) Authorization of appropriations.--There is authorized 
     to be appropriated for the Department of Veterans Affairs for 
     each of fiscal years 2008 through 2011, $2,000,000 to carry 
     out this section.
       (2) Availability.--Amounts authorized to be appropriated by 
     paragraph (1) shall be made available to the National Center 
     on Posttraumatic Stress Disorder for the purpose specified in 
     that paragraph.
       (3) Supplement not supplant.--Any amount made available to 
     the National Center on Posttraumatic Stress Disorder for a 
     fiscal year under paragraph (2) is in addition to any other 
     amounts made available to the National Center on 
     Posttraumatic Stress Disorder for such year under any other 
     provision of law.

     SEC. 302. EXTENSION OF AUTHORIZATION FOR SPECIAL COMMITTEE ON 
                   POST-TRAUMATIC STRESS DISORDER.

       Section 110(e)(2) of the Veterans' Health Care Act of 1984 
     (38 U.S.C. 1712A note; Public Law 98-528) is amended by 
     striking ``through 2008'' and inserting ``through 2012''.

             TITLE IV--ASSISTANCE FOR FAMILIES OF VETERANS

     SEC. 401. CLARIFICATION OF AUTHORITY OF SECRETARY OF VETERANS 
                   AFFAIRS TO PROVIDE MENTAL HEALTH SERVICES TO 
                   FAMILIES OF VETERANS.

       (a) In General.--Chapter 17 of title 38, United States 
     Code, is amended--
       (1) in section 1701(5)(B)--
       (A) by inserting ``marriage and family counseling,'' after 
     ``professional counseling,''; and
       (B) by striking ``as may be essential to'' and inserting 
     ``as the Secretary considers appropriate for''; and
       (2) in subsections (a) and (b) of section 1782, by 
     inserting ``marriage and family counseling,'' after 
     ``professional counseling,''.
       (b) Location.--Paragraph (5) of section 1701 of title 38, 
     United States Code, shall not be construed to prevent the 
     Secretary of Veterans Affairs from providing services 
     described in subparagraph (B) of such paragraph to 
     individuals described in such subparagraph in centers under 
     section 1712A of such title (commonly referred to as ``Vet 
     Centers''), Department of Veterans Affairs medical centers, 
     community-based outpatient clinics, or in such other 
     facilities of the Department of Veterans Affairs as the 
     Secretary considers necessary.

     SEC. 402. PILOT PROGRAM ON PROVISION OF READJUSTMENT AND 
                   TRANSITION ASSISTANCE TO VETERANS AND THEIR 
                   FAMILIES IN COOPERATION WITH VET CENTERS.

       (a) Pilot Program.--The Secretary of Veterans Affairs shall 
     carry out, through a non-Department of Veterans Affairs 
     entity, a pilot program to assess the feasability and 
     advisability of providing readjustment and transition 
     assistance described in subsection (b) to veterans and their 
     families in cooperation with centers under section 1712A of 
     title 38, United States Code (commonly referred to as ``Vet 
     Centers'').
       (b) Readjustment and Transition Assistance.--Readjustment 
     and transition assistance described in this subsection is 
     assistance as follows:
       (1) Readjustment and transition assistance that is 
     preemptive, proactive, and principle-centered.
       (2) Assistance and training for veterans and their families 
     in coping with the challenges associated with making the 
     transition from military to civilian life.
       (c) Non-Department of Veterans Affairs Entity.--
       (1) In general.--The Secretary shall carry out the pilot 
     program through any for-profit or non-profit organization 
     selected by the Secretary for purposes of the pilot program 
     that has demonstrated expertise and experience in the 
     provision of assistance and training described in subsection 
     (b).
       (2) Contract or agreement.--The Secretary shall carry out 
     the pilot program through a non-Department entity described 
     in paragraph (1) pursuant to a contract or other agreement 
     entered into by the Secretary and the entity for purposes of 
     the pilot program.
       (d) Duration of Pilot Program.--The pilot program shall be 
     carried out during the three-year period beginning on the 
     date of the enactment of this Act, and may be carried out for 
     additional one-year periods thereafter.
       (e) Location of Pilot Program.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     provide assistance under the pilot program in cooperation 
     with 10 centers described in subsection (a) designated by the 
     Secretary for purposes of the pilot program.
       (2) Designations.--In designating centers described in 
     subsection (a) for purposes of the pilot program, the 
     Secretary shall designate centers so as to provide a balanced 
     geographical representation of such centers throughout the 
     United States, including the District of Columbia, the 
     Commonwealth of Puerto Rico, tribal lands, and other 
     territories and possessions of the United States.
       (f) Participation of Centers.--A center described in 
     subsection (a) that is designated under subsection (e) for 
     participation in the pilot program shall participate in the 
     pilot program by promoting awareness of the assistance and 
     training available to veterans and their families through--
       (1) the facilities and other resources of such center;
       (2) the non-Department of Veterans Affairs entity selected 
     pursuant to subsection (c); and
       (3) other appropriate mechanisms.
       (g) Additional Support.--In carrying out the pilot program, 
     the Secretary of Veterans Affairs may enter into contracts or 
     other agreements, in addition to the contract or agreement 
     described in subsection (c), with such other non-Department 
     of Veterans Affairs entities meeting the requirements of 
     subsection (c) as the Secretary considers appropriate for 
     purposes of the pilot program.
       (h) Report on Pilot Program.--
       (1) Report required.--Not later than six months after the 
     date of the conclusion of the pilot program, the Secretary 
     shall submit to the congressional veterans affairs committees 
     a report on the pilot program.
       (2) Elements.--Each report under paragraph (1) shall 
     include the following:
       (A) A description of the activities under the pilot program 
     as of the date of such report, including the number of 
     veterans and families provided assistance under the pilot 
     program and the scope and nature of the assistance so 
     provided.
       (B) A current assessment of the effectiveness of the pilot 
     program.
       (C) Any recommendations that the Secretary considers 
     appropriate for the extension or expansion of the pilot 
     program.
       (3) Congressional veterans affairs committees defined.--In 
     this subsection, the term ``congressional veterans affairs 
     committees'' means--
       (A) the Committees on Veterans' Affairs and Appropriations 
     of the Senate; and
       (B) the Committees on Veterans' Affairs and Appropriations 
     of the House of Representatives.
       (i) Authorization of Appropriations.--
       (1) In general.--There is authorized to be appropriated for 
     the Department of Veterans Affairs for each of fiscal years 
     2008 through 2010 $1,000,000 to carry out this section.
       (2) Availability.--Amounts authorized to be appropriated by 
     paragraph (1) shall remain available until expended.

  Mr. AKAKA. Mr. President, I am pleased to express my strong support 
for S. 2162, the Veterans' Mental Health and Other Care Improvements 
Act of 2008, as amended. This bill includes provisions on mental health 
care, suicide prevention, care for substance use disorders, prevention 
of homelessness, pain and epilepsy care, and other health care matters. 
This comprehensive legislation addresses many critical issues facing 
our Nation's veterans.
  Returning home from battle does not necessarily bring an end to 
conflict. Servicemembers return home, but the war often follows them in 
their hearts and minds. Their invisible wounds are complicated and 
wide-ranging, and we must provide all possible assistance. I am working 
with VA Secretary James Peake to ensure that VA is forthright about the 
numbers of suicides and attempted suicides among veterans. Solid and 
reliable information is critical to our understanding of the issues. 
Prevention of suicide is a vitally important mission.
  A growing number of veterans are in need of mental health care. VA's 
Special Committee on Post-Traumatic Stress Disorder advised in its 2006 
formal report that virtually all returning servicemembers face 
readjustment issues. An assessment of mental health problems among 
returning soldiers, recently published in the Journal of the American 
Medical Association in November, 2007, found that 42.4 percent of 
National Guard and reservists screened by the Department of Defense 
required mental health treatment.

[[Page 11170]]

  Additionally, a March 2007 study published in the Archives of 
Internal Medicine reported that more than one-third of war veterans who 
have served in either Iraq or Afghanistan suffer from various mental 
ailments, including post-traumatic stress disorder, anxiety, 
depression, substance use disorder and other problems. A RAND study 
released in April 2008, emphasized the high risks of PTSD and 
depression, especially among servicemembers sent on multiple 
deployments, and among National Guard and reservists.
  Further, the RAND study found that the stigma associated with mental 
health care continues to prevent servicemembers and veterans from 
accessing care. VA and the Department of Defense must redouble their 
efforts to ensure that receiving mental health care does not harm one's 
career. No individual is immune to the risk of mental health problems, 
and all must have the opportunity to receive care.
  On April 25, 2007, the Committee on Veterans' Affairs held a hearing 
on veterans' mental health concerns, and on VA's response. We heard 
heart-wrenching testimony from the witnesses.
  The provisions of this bill are a direct outgrowth of that hearing 
and the testimony given by those who have suffered with mental health 
issues, and by their family members. Earlier versions of the provisions 
included in this bill were also discussed at a legislative hearing on 
October 24, 2007.
  This bill represents a bi-partisan approach, and is cosponsored by 
Senators Burr, Rockefeller, Mikulski, Bingaman, Ensign, Smith, Collins, 
Clinton, Dole, and Sessions. It is a tribute to Justin Bailey, a 
veteran of Operation Iraqi Freedom, who died in a VA domiciliary 
facility while receiving care for PTSD and a substance use disorder. 
This was a tragedy that will live on with Justin's parents, who have so 
courageously advocated for improvements to VA mental health care.
  Provisions included in this legislative package stem from bills which 
have all been reported favorably by the Senate Committee on Veterans' 
Affairs, including: S. 1233 as reported on August 29, 2007; and S. 
2004, S. 2142, S. 2160, and S. 2162, as ordered reported on November 
14, 2007.
  I will briefly outline other provisions in S. 2162, as amended.
  As I mentioned, the legislation would make sweeping changes to VA 
mental health treatment and research. Most notably, it would ensure a 
minimum level of substance use disorder care for veterans in need. It 
would also require VA to improve treatment of veterans with multiple 
disorders, such as PTSD and substance use disorder. To ascertain if 
VA's residential mental health facilities are appropriately staffed, 
this bill would mandate a review of such facilities. It would also 
create a vital research program on PTSD and Substance Use Disorders, in 
cooperation with, and building on the work of, the National Center for 
PTSD.
  Veterans with physical and mental wounds often turn to drugs and 
alcohol to ease their pain. Experts believe that stress is the primary 
cause of drug abuse, and of relapse to drug abuse. Research by Sinha, 
Fuse, Aubin and O'Malley in Psychopharmacology, 2000, and by Brewer et 
al. in Addiction, 1998, has found that patients with psychological 
trauma, including PTSD, are often susceptible to alcohol and drug 
abuse. Similarly, according to the National Institute on Drug Abuse, 
patients subjected to chronic stress, as experienced by those with 
PTSD, are prone to drug use. VA has long dealt with substance abuse 
issues, but there is much more than can be done. This legislation would 
provide a number of solutions to enhance substance use disorder 
treatment.
  The inclusion of families in mental health treatment is vital. To 
this end, the bill would fully authorize VA to provide mental health 
services to families of veterans and would set up a program to help 
veterans and families transition to civilian life.
  Beneficiary travel reimbursements are essential to improving access 
to VA health care for veterans in rural areas. This legislation would 
increase the beneficiary travel mileage reimbursement rate from 11 
cents per mile to 28.5 cents per mile, and permanently set the 
deductible to the 2007 amount of $3 each way.
  It is important that veterans who rely on VA for their health care 
have access to emergency care. This bill would make corrections to the 
procedure used by VA to reimburse community hospitals for emergency 
care provided to eligible veterans so as to ensure that both veterans 
and community hospitals are not inappropriately burdened by emergency 
care costs.
  Too often, veterans suffer from lack of care merely because they are 
unaware of the services available to them. This legislation would 
enhance outreach and accessibility by creating a pilot program on the 
use of peers to help reach out to veterans. It would also encourage 
improved accessibility for mental health care in rural areas.
  The legislation also addresses homelessness, which is far too 
prevalent in the veteran population. The bill would create targeted 
programs to provide assistance for low-income veteran families. It 
would also allow homeless service providers to receive VA funds without 
offsetting other sources of income and require that facilities which 
furnish services to homeless veterans are able to meet the needs of 
women veterans.
  The committee heard testimony that epilepsy is often associated with 
traumatic brain injury, the injury that many are calling the signature 
wound of the current conflicts. This suggests a strong need to improve 
VA's effectiveness in dealing with epilepsy. The pending legislation 
would establish six VA epilepsy centers of excellence, which will focus 
on research, education, and clinical care activities in the diagnosis 
and treatment of epilepsy. These centers would restore VA to the 
position of leadership it once held in epilepsy research and treatment.
  The medical community has made impressive advances in pain care and 
management, but VA has lagged behind in implementing a standardized 
policy for dealing with pain. The bill includes a provision that would 
establish a pain care program at all inpatient facilities, to prevent 
long-term chronic pain disability. It also provides for education for 
VA's health care workers on pain assessment and treatment, and would 
require VA to expand research on pain care.
  I urge all of my colleagues to support S. 2162, as amended. It has 
the potential to bring relief and support to tens of thousands of 
veterans and their families across the country.
  Mrs. BOXER. Mr. President, I ask unanimous consent that the committee 
substitute amendment be withdrawn, the Akaka-Burr substitute amendment 
which is at the desk be agreed to; the bill, as amended, be read a 
third time and passed; the motions to reconsider be laid upon the 
table, with no intervening action or debate, and any statements related 
to the bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 4824) was agreed to.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The bill (S. 2162), as amended, was ordered to be engrossed for a 
third reading, was read the third time, and passed.

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