[Congressional Record (Bound Edition), Volume 155 (2009), Part 7]
[House]
[Pages 9077-9080]
[From the U.S. Government Publishing Office, www.gpo.gov]




 MELANIE BLOCKER STOKES MOM'S OPPORTUNITY TO ACCESS HEALTH, EDUCATION, 
          RESEARCH, AND SUPPORT FOR POSTPARTUM DEPRESSION ACT

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 20) to provide for research on, and services for individuals 
with, postpartum depression and psychosis, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 20

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Melanie Blocker Stokes Mom's 
     Opportunity to Access Health, Education, Research, and 
     Support for Postpartum Depression Act'' or the ``Melanie 
     Blocker Stokes MOTHERS Act''.

     SEC. 2. DEFINITIONS.

       For purposes of this Act--
       (1) the term ``postpartum condition'' means postpartum 
     depression or postpartum psychosis; and
       (2) the term ``Secretary'' means the Secretary of Health 
     and Human Services.

               TITLE I--RESEARCH ON POSTPARTUM CONDITIONS

     SEC. 101. EXPANSION AND INTENSIFICATION OF ACTIVITIES.

       (a) Continuation of Activities.--The Secretary is 
     encouraged to continue activities on postpartum conditions.
       (b) Programs for Postpartum Conditions.--In carrying out 
     subsection (a), the Secretary is encouraged to continue 
     research to expand the understanding of the causes of, and 
     treatments for, postpartum conditions. Activities under such 
     subsection shall include conducting and supporting the 
     following:
       (1) Basic research concerning the etiology and causes of 
     the conditions.
       (2) Epidemiological studies to address the frequency and 
     natural history of the conditions and the differences among 
     racial and ethnic groups with respect to the conditions.
       (3) The development of improved screening and diagnostic 
     techniques.
       (4) Clinical research for the development and evaluation of 
     new treatments.
       (5) Information and education programs for health care 
     professionals and the public, which may include a coordinated 
     national campaign to increase the awareness and knowledge of 
     postpartum conditions. Activities under such a national 
     campaign may--
       (A) include public service announcements through 
     television, radio, and other means; and
       (B) focus on--
       (i) raising awareness about screening;
       (ii) educating new mothers and their families about 
     postpartum conditions to promote earlier diagnosis and 
     treatment; and
       (iii) ensuring that such education includes complete 
     information concerning postpartum conditions, including its 
     symptoms, methods of coping with the illness, and treatment 
     resources.

     SEC. 102. SENSE OF CONGRESS REGARDING LONGITUDINAL STUDY OF 
                   RELATIVE MENTAL HEALTH CONSEQUENCES FOR WOMEN 
                   OF RESOLVING A PREGNANCY.

       (a) Sense of Congress.--It is the sense of Congress that 
     the Director of the National Institute of Mental Health may 
     conduct a nationally representative longitudinal study 
     (during the period of fiscal years 2009 through 2018) of the 
     relative mental health consequences for women of resolving a 
     pregnancy (intended and unintended) in various ways, 
     including carrying the pregnancy to term and parenting the 
     child, carrying the pregnancy to term and placing the child 
     for adoption, miscarriage, and having an abortion. This study 
     may assess the incidence, timing, magnitude, and duration of 
     the immediate and long-term mental health consequences 
     (positive or negative) of these pregnancy outcomes.
       (b) Report.--Beginning not later than 3 years after the 
     date of the enactment of this Act, and periodically 
     thereafter for the duration of the study, such Director may 
     prepare and submit to the Congress reports on the findings of 
     the study.

     TITLE II--DELIVERY OF SERVICES REGARDING POSTPARTUM CONDITIONS

     SEC. 201. ESTABLISHMENT OF GRANT PROGRAM.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq.) is amended by inserting 
     after section 330G the following:

     ``SEC. 330G-1. SERVICES TO INDIVIDUALS WITH A POSTPARTUM 
                   CONDITION AND THEIR FAMILIES.

       ``(a) In General.--The Secretary may make grants to 
     eligible entities for projects for the establishment, 
     operation, and coordination of effective and cost-efficient 
     systems for the delivery of essential services to individuals 
     with a postpartum condition and their families.
       ``(b) Certain Activities.--To the extent practicable and 
     appropriate, the Secretary shall ensure that projects funded 
     under subsection (a) provide education and services with 
     respect to the diagnosis and management of postpartum 
     conditions. The Secretary may allow such projects to include 
     the following:
       ``(1) Delivering or enhancing outpatient and home-based 
     health and support services, including case management and 
     comprehensive treatment services for individuals with or at 
     risk for postpartum conditions, and delivering or enhancing 
     support services for their families.
       ``(2) Delivering or enhancing inpatient care management 
     services that ensure the well-being of the mother and family 
     and the future development of the infant.
       ``(3) Improving the quality, availability, and organization 
     of health care and support services (including transportation 
     services, attendant care, homemaker services, day or respite 
     care, and providing counseling on financial assistance and 
     insurance) for individuals with a postpartum condition and 
     support services for their families.
       ``(4) Providing education to new mothers and, as 
     appropriate, their families about postpartum

[[Page 9078]]

     conditions to promote earlier diagnosis and treatment. Such 
     education may include--
       ``(A) providing complete information on postpartum 
     conditions, symptoms, methods of coping with the illness, and 
     treatment resources; and
       ``(B) in the case of a grantee that is a State, hospital, 
     or birthing facility--
       ``(i) providing education to new mothers and fathers, and 
     other family members as appropriate, concerning postpartum 
     conditions before new mothers leave the health facility; and
       ``(ii) ensuring that training programs regarding such 
     education are carried out at the health facility.
       ``(c) Integration With Other Programs.--To the extent 
     practicable and appropriate, the Secretary may integrate the 
     grant program under this section with other grant programs 
     carried out by the Secretary, including the program under 
     section 330.
       ``(d) Certain Requirements.--A grant may be made under this 
     section only if the applicant involved makes the following 
     agreements:
       ``(1) Not more than 5 percent of the grant will be used for 
     administration, accounting, reporting, and program oversight 
     functions.
       ``(2) The grant will be used to supplement and not supplant 
     funds from other sources related to the treatment of 
     postpartum conditions.
       ``(3) The applicant will abide by any limitations deemed 
     appropriate by the Secretary on any charges to individuals 
     receiving services pursuant to the grant. As deemed 
     appropriate by the Secretary, such limitations on charges may 
     vary based on the financial circumstances of the individual 
     receiving services.
       ``(4) The grant will not be expended to make payment for 
     services authorized under subsection (a) to the extent that 
     payment has been made, or can reasonably be expected to be 
     made, with respect to such services--
       ``(A) under any State compensation program, under an 
     insurance policy, or under any Federal or State health 
     benefits program; or
       ``(B) by an entity that provides health services on a 
     prepaid basis.
       ``(5) The applicant will, at each site at which the 
     applicant provides services funded under subsection (a), post 
     a conspicuous notice informing individuals who receive the 
     services of any Federal policies that apply to the applicant 
     with respect to the imposition of charges on such 
     individuals.
       ``(6) For each grant period, the applicant will submit to 
     the Secretary a report that describes how grant funds were 
     used during such period.
       ``(e) Technical Assistance.--The Secretary may provide 
     technical assistance to entities seeking a grant under this 
     section in order to assist such entities in complying with 
     the requirements of this section.
       ``(f) Definitions.--In this section:
       ``(1) The term `eligible entity' means a public or 
     nonprofit private entity, which may include a State or local 
     government; a public or nonprofit private recipient of a 
     grant under section 330H (relating to the Healthy Start 
     Initiative), public-private partnership, hospital, community-
     based organization, hospice, ambulatory care facility, 
     community health center, migrant health center, public 
     housing primary care center, or homeless health center; or 
     any other appropriate public or nonprofit private entity.
       ``(2) The term `postpartum condition' means postpartum 
     depression or postpartum psychosis.''.

                     TITLE III--GENERAL PROVISIONS

     SEC. 301. AUTHORIZATION OF APPROPRIATIONS.

       To carry out this Act and the amendment made by section 
     201, there are authorized to be appropriated, in addition to 
     such other sums as may be available for such purpose--
       (1) $3,000,000 for fiscal year 2010; and
       (2) such sums as may be necessary for fiscal years 2011 and 
     2012.

     SEC. 302. REPORT BY THE SECRETARY.

       (a) Study.--The Secretary shall conduct a study on the 
     benefits of screening for postpartum conditions.
       (b) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Secretary shall complete the study 
     required by subsection (a) and submit a report to the 
     Congress on the results of such study.

     SEC. 303. LIMITATION.

       Notwithstanding any other provision of this Act or the 
     amendment made by section 201, the Secretary may not utilize 
     amounts made available under this Act or such amendment to 
     carry out activities or programs that are duplicative of 
     activities or programs that are already being carried out 
     through the Department of Health and Human Services.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Louisiana (Mr. Scalise) 
each will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, once again, I ask unanimous consent that 
all Members may have 5 legislative days in which to revise and extend 
their remarks on the legislation.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 20, the Melanie Blocker Stokes 
Mom's Opportunity to Access Health, Education, Research, and Support 
for Postpartum Depression Act.
  Postpartum depression occurs after 10 to 15 percent of all 
deliveries, and the majority of patients suffer from this illness for 
more than 6 months. In its most severe form, postpartum psychosis, 
women may actually suffer from hallucinations and delusions that can 
put them and their babies at risk.
  The bill before us today amends the Public Health Service Act to 
include a new section that authorizes the Secretary of Health and Human 
Services to make grants for services related to postpartum depression 
and postpartum psychosis.
  It would encourage continued research into the causes of and 
treatments for these conditions and would give the Secretary the 
authority to provide grants to deliver services to women with these 
conditions and their families.
  I want to thank my colleague, Representative Bobby Rush, for his work 
in raising this important issue. He is the sponsor of this bill and has 
worked hard on it for a long time.
  I also want to thank Mary Jo Codey, who is the wife of former 
Governor Codey from my home State of New Jersey. She came and testified 
before our subcommittee on this bill and has been outspoken on the 
issue of postpartum depression.
  I urge my colleagues to pass this bill.
  I reserve the balance of my time.
  Mr. SCALISE. Mr. Speaker, I yield myself such time as I may consume.
  I rise today in support of H.R. 20, the Melanie Blocker Stokes 
MOTHERS Act. Last Congress, the Energy and Commerce Committee held 
hearings on this issue that were deeply emotional, especially when 
testimony was presented by Melanie Blocker Stokes' mother. This bill 
highlights the need to increase awareness of postpartum depression and 
expand the knowledge of its terrible effects.
  It is important to note that as many as 80 percent of women 
experience some mood disturbances after pregnancy. For most women, the 
symptoms are mild and go away on their own. But 10 to 20 percent of 
women develop a more disabling form of mood disorder called postpartum 
depression.
  This legislation encourages the continuation of research being done 
by Federal agencies to determine the causes of postpartum depression 
and how it can better be treated. I stand in support of this 
legislation and hope that my colleagues will join me.
  I reserve the balance of my time.
  Mr. PALLONE. I yield 3 minutes to someone who has been such a leader 
on so many health care issues, including this one, the gentleman from 
Rhode Island (Mr. Kennedy.)
  Mr. KENNEDY. I thank the gentleman from New Jersey and thank him for 
his leadership on this issue and many others regarding mental health. I 
just want to concur with him and Mr. Rush from Illinois that this issue 
of mental health and postpartum depression I'm glad to see is on the 
agenda for health care. We are in the year of health care reform, and 
it's so vital that the issue of the total health of our people makes 
its way into health care reform.
  We find that so many in our country seek help in our health care 
system and yet don't receive it because our health care system does not 
respond to the total health of a person. It responds to the physical 
part of the person but it does not respond to the emotional--the 
sympathetic part of the person; the psychological, which is the mental 
health part of the person; the spiritual, which is the sense of purpose 
that a person has for their life.
  We have done such a good job in this country in training our doctors 
to take care of a person as if they were a machine, and we could fix a 
person if they had a broken bone or if they had something that we could 
show on an x-ray or we could test through a blood test, but if we can't 
show it on an x-ray or a blood test, then we really don't know what to 
do.
  My friends, the fact of the matter is we are much more than just the 
sum of

[[Page 9079]]

our parts. Really, a much bigger part of this is the mental health and 
emotional health of our people. That is why we need to do a lot more to 
address this if we are going to address people's health in this 
country.
  Frankly, mental illnesses are the second leading cause of lost days 
in our country. It's quite surprising that even given that statistic, 
our health care system doesn't respond to this challenge.
  So I'm glad to see that this legislation calls on greater research 
into this area because, frankly, there is a physical element to this. 
The body does change as a result of mental health problems. We now 
know, thanks to the new x-ray machines, that we can actually see 
biochemical changes in the brain. We can see these biochemical changes 
in the brain, thanks to these new functional magnetic resonance imaging 
exams.
  Furthermore, I think it's so important for people to know that we 
want a vibrant and a productive people, and we want them to feel active 
and alive. The best way to do that is to make sure that we give them 
all the support that they need in this country.
  So, to do that, we need to make sure that they get all of the support 
and get their checkup from their neck up, just as they get their 
checkup everywhere else. So I'm glad that this proposal is going 
forward.
  Mr. SCALISE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Georgia (Mr. Broun).
  Mr. BROUN of Georgia. I thank the gentleman for yielding. Mr. 
Speaker, I'm a physician. I've dealt with anxiety and depression in 
patients throughout my medical career. Depression is an extremely 
debilitating disease.
  What really concerns me at this point is Americans today are getting 
very, very depressed because of this steamroller of socialism that's 
being forced down their throats, this steamroller of socialism of 
bigger and bigger government that is taking money away from small 
business, it's taking money away from families. They are struggling.
  We need to do something about the economy. Americans are hurting. We 
need to do something about it now. But greater spending and bigger 
government is not the solution.
  In fact, we're going to be taking up a budget this week that is a 
budget that should cause people great angst here in America. It's a 
budget that's going to create a tremendous amount of anxiety and 
depression.
  More people are going to see their doctors and ask for 
antidepressants and nerve pills because of this budget that we're going 
to see this week that's being presented by the Democratic majority. 
We've got to stop it.
  Republicans have offered alternative after alternative, but the 
leadership of this House won't even consider them. The leadership of 
this House has said that Republicans are the ``Party of No,'' and that 
is absolutely not factual. Republicans have offered many alternatives, 
but they just won't be considered.
  The American people need to wake up and understand that they're going 
to become more depressed, they're going to become more anxious, they're 
going to have greater strife within their families, we're going to have 
more marriages break up because of the budget, in my opinion, that we 
are going to be presented in this House--and undoubtedly this House 
will pass it. But it's going to wreck our economy.
  America is bankrupt today because of the great spending that's been 
coming down through the latter part of the Bush administration and now 
in this administration. We've got to stop it.
  The American people need to wake up and demand that we have a 
responsible government so that they won't be depressed, so they won't 
be anxious, so that we can have a good economy.
  Republicans are offering solutions--commonsense, market-based 
solutions based on the private sector. It's absolutely critical that we 
find those solutions; that we work together, Democrats and Republicans 
alike, to find economic solutions to put this country back on the right 
course.
  We're spending too much, we're taxing too much, we're borrowing too 
much, and we're bankrupting America--not only the government, but 
individuals and small businesses--and it has to stop. I call on the 
American people to write their Congressman, write their Senators, and 
say ``no.''
  We've got to have a better alternative than this budget that's going 
to be presented this week.
  Mr. RUSH. Mr. Speaker, today I rise in strong support of the Melanie 
Blocker Stokes Mom's Opportunity to Access Health, Education, Research, 
and Support for Postpartum Depression Act of 2009.
  I would like to thank Chairman Waxman, Ranking Member Barton, my 
colleague Congressman Frank Pallone, and the Members of the Energy and 
Commerce Committee who unanimously supported this legislation's passage 
out of the committee.
  After eight long years, today marks an important step forward in the 
journey for Congress to fully recognize postpartum depression as a 
national women's health priority. This bill comes to the floor today 
with strong, bipartisan support. No longer will postpartum depression 
be dismissed as mere ``baby blues.''
  Mr. Speaker, today, 60 to 80 percent of new mothers experience 
symptoms of postpartum depression while the more serious condition, 
postpartum psychosis, affects up to 20 percent of women who have 
recently given birth. Experts in the field of women's health like Susan 
Stone, Chair of the President's Advisory Council of Postpartum Support 
International, says that these statistics do not include mothers whose 
babies are stillborn, who miscarry, or who are vulnerable to these 
devastating disorders which raises those at risk into the millions. The 
most extreme form, postpartum psychosis, is exhibited in about one 
percent of all new mothers.
  At what should be the happiest time in a woman's life these mood 
disorders result in feelings of despondency, tearfulness, inadequacy, 
guilt and fatigue. In the worst case scenario, if left untreated or not 
treated properly, postpartum depression and postpartum psychosis has 
resulted in suicide and infanticide. The consequences of untreated 
maternal depression in the mother range from chronic disability to 
death of the infant as well as learning and behavioral disabilities 
that can negatively impact a child's development.
  In light of all these sobering facts, sadly, I was finally compelled 
to author H.R. 20 in December 2007 after watching the news accounts of 
the missing Melanie Blocker Stokes. This bright, vibrant woman who 
loved life was a first time mother, a successful business woman and my 
constituent. Despite her family's valiant interventions, Melanie's 
psychosis was so severe that she slipped away and ended her life in 
solitary agony.
  As news of her death swept throughout Chicago, I reached out to 
Melanie's mother, Carol Blocker, who told me her daughter's diagnosis 
and suicide was the result of postpartum psychosis.
  And, sometime later, Dr. Nada Stotland of the American Psychiatric 
Association, also a constituent of mine, also reached out to me. Dr. 
Stotland detailed the value of additional research and discussed the 
under-reporting and misdiagnosis of postpartum depression and psychosis 
in our country.
  There is no denying the fact that the need for resources to combat 
postpartum depression grows more and more each and every year. Here are 
the facts: H.R. 20 will finally put significant money and attention 
into research, screening, treatment and education for mothers suffering 
from this disease. Research indicates that some form of postpartum 
depression affects approximately 1 in 1,000 new mothers, or up to 
800,000 new cases annually. This data does not include the additional 
cases of women who may be vulnerable to these illnesses even after 
they've miscarried or who deliver stillborn infants.
  Of the new postpartum cases this year, less than 15 percent of 
mothers will receive treatment and even fewer will receive adequate 
treatment; however, with treatment over 90 percent of these mothers 
could overcome their depression. Every 50 seconds a new mother will 
begin struggling with the effects of mental illness.
  Mr. Speaker, these facts are profound and, in the words of Carol 
Blocker, ``. . . hundreds of thousands of women, who have suffered from 
postpartum depression and psychosis are still waiting for Congress to 
act eight years after legislation was first introduced.'' Mr. Speaker, 
thank you for this day because, today, Mrs. Blocker and hundreds of 
thousands of mothers will not have to wait any longer for Congress to 
act! By passage of H.R. 20, today, we will put mothers first.
  When this bill becomes law, my legislation will:

[[Page 9080]]

  Encourage the Secretary of Health and Human Services to continue: (1) 
activities on postpartum depression; and (2) research to expand the 
understanding of the causes of, and treatments for, postpartum 
conditions.
  Express the sense of Congress that the Director of the National 
Institute of Mental Health may conduct a nationally representative 
longitudinal study of the relative mental health consequences for women 
of resolving a pregnancy in various ways.
  Amend the Public Health Service Act to authorize the Secretary to 
make grants for projects for the establishment, operation, and 
coordination of effective and cost-efficient systems for the delivery 
of essential services to individuals with a postpartum condition and 
their families.
  Direct the Secretary to ensure that such projects provide education 
and services with respect to the diagnosis and management of postpartum 
conditions.
  Moreover, this bill is an affordable approach to research and 
services. This is good policy, good politics and a good public health 
bill.
  Before I close, I'd like to take a moment to remember and honor the 
hundreds of thousands of women--women who have lost either their 
ability to ``mother'' or, in far too many cases, their lives to 
postpartum depression.
  Mr. Speaker, this bill, this day and this moment would not be a 
reality had it not been for a beautiful, young Chicago native, the late 
Melanie Blocker Stokes, and the valiant effort her husband and her 
family made to save her lift but to no avail. And, even though Melanie 
did not survive her battle with postpartum psychosis, Melanie's battle 
and her ultimate sacrifice will never be forgotten because of our 
efforts, here, today.
  I would like to thank Carol Blocker, my friend, constituent and 
fellow activist, who with grace and dignity found a way for her 
daughter's memory to live on.
  I would also like to thank all the groups who support this 
legislation. Groups like, Postpartum Support International, the Family 
Mental Health Foundation, the American Psychological Association, the 
American Psychiatric Association and the American College of 
Obstetricians and Gynecologists.
  I'd also like to acknowledge the tremendous work of groups like the 
Children's Defense Fund, the Melanie Blocker Stokes Foundation, Suicide 
Prevention Action Network, Planned Parenthood Federation of America, 
Depression and Bipolar Support Alliance, Mental Health America, NARAL, 
National Alliance for Mental Illness, Community Behavioral Healthcare, 
the March of Dimes, The National Association of Social Workers, 
National Organization for Women and North American Society for 
Psychosocial Obstetrics and Gynecology.
  I thank these groups and various activists for their relentless 
efforts to address this issue including calling their congressional 
representatives and mailing or faxing letters in support of H.R. 20. 
Our work will not be done until this bill is signed by the President. 
And, the good news is, this time we have a friend and fellow Chicagoan 
in the White House.
  And, finally, let me once again thank the hundreds of thousands of 
unsung women, and their families, who have battled postpartum 
depression in silence or isolation, in some form, for far too long. To 
those women and their families I say, you will never suffer in silence 
again. And, with that, I proudly urge my colleagues to vote ``yes'' on 
H.R. 20.
  Mr. SCALISE. I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I ask that the bill be passed, and I yield 
back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 20, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BROUN of Georgia. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________