[Congressional Record (Bound Edition), Volume 162 (2016), Part 3]
[House]
[Pages 4070-4077]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          A TALE OF TWO CITIES

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2015, the gentleman from Pennsylvania (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.


                             General Leave

  Mr. MURPHY of Pennsylvania. Mr. Speaker, I ask unanimous consent that 
all Members may have 5 legislative days within which to revise and 
extend their remarks and include extraneous material on the subject of 
my Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Pennsylvania?
  There was no objection.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, this is the tale of two 
cities--not the tale about the cities, but about two examples of 
America's great embarrassment and failure to treat a brain disease 
called mental illness, especially serious mental illness. It is also a 
tale of Congress' repeated failure to address this.
  Despite the cries of millions of Americans to do something about it, 
what we here in Washington tend to do when we hear of another tragedy 
that has occurred somewhere in the Nation, the

[[Page 4071]]

tragedies we know by the names of Sandy Hook Elementary School, or 
Columbine, or Aurora, Colorado, or Tucson, or Santa Barbara, what 
Washington tends to do is we have a moment of silence. But the people 
want and Members of Congress want moments of action, not moments of 
silence.
  Let me elaborate on this tale. In this building, the U.S. Capitol, 
back in the 1990s, two police officers were killed when Russell Weston 
came into the Capitol seeking a red crystal and ended up shooting these 
police officers. Under his diagnosis of paranoid schizophrenia, he was 
pushed, with his delusions and hallucinations, to take action. It ended 
up in tragedy.
  There was also recently, over the break, another man, Larry Russell 
Dawson, who has been seen around this Capitol and has once, allegedly, 
disrupted proceedings in this Chamber and, allegedly, also suffers from 
some level of mental illness. When he was entering the Capitol Visitor 
Center, a pistol was seen going through the x-ray. When he grabbed that 
pistol, police officers shot and wounded him.
  First of all, it is amazing to me that people did not die. We know 
that the entrance to the Capitol Visitor Center is a highly secure 
environment with many, many Capitol Police officers. These brave men 
and women who put themselves between danger and Members of Congress and 
the public showed tremendous restraint and judgment at that moment.
  I might add that, many times, when a mentally ill person has a 
conflict, a violent conflict with a police officer, where they may be 
reaching into their jacket or may be pointing a pistol or approaching a 
police officer with a knife, it is estimated between a quarter and a 
half of those mentally ill people involved in a police encounter end up 
dead. That is a few hundred each year.
  Though that is the tale in Washington, D.C., why are we dealing with 
mental illness as a violent threat instead of in treatment? We deal 
with it because, in this Nation, sadly, when someone with mental 
illness has reached that level or they become violent, we call the 
police.
  The rules are, which we will look at tonight: prevent people from 
getting treatment; we do not have enough providers; we don't have 
enough places to put people, so we call the police.
  Now, I should start off by saying the mentally ill are no more likely 
to be violent than the non-mentally ill; except when you look at those 
with serious mental illness such as schizophrenia, bipolar, and other 
illnesses such as that, they are 16 times more likely to engage in an 
act of violence than someone who is in treatment.
  Again, a person who is seriously mentally ill and not in treatment is 
16 times more likely to engage in an act of violence than someone who 
is in treatment.
  On the West Coast, in Seattle, another tragedy was brewing. A man 
named Cody Miller climbed a tree, a giant sequoia tree in downtown 
Seattle, and it created something of a furor.
  First, I want to read parts of an article that appeared in The New 
York Times on March 29 that describe this to show you how out of touch 
we are as a society when dealing with mental illness.
  It said: ``For more than 24 hours last week, Cody Lee Miller perched 
in a giant sequoia in downtown Seattle, pelting people and cars with 
pine cones and tearing off branches.''
  Investigators were investigating how much it would cost, using some 
``complicated formula that goes far beyond the value of natural 
beauty,'' the article said.
  ``A Seattle tree expert . . . said Mr. Miller caused $7,800 in 
damage, according to court documents released this week. Investigators 
took into account the tree's age, its potential life span and how much 
of its lush foliage was denuded.
  ``The formula, created by professional foresters, goes like this. The 
trunk is 34 inches in diameter at breast height, an investigator's 
report said. The tree has a `95 percent species rating,' a `100 percent 
condition rating' and a 100 `percent location rating' . . . The 
sequoia's pre-damage value was put at $51,700. But after Mr. Miller's 
arboreal escapade, the tree lost 15 percent of its value, the documents 
show, and is now worth only $43,900 . . .`The damage to the tree was 
extensive,' the report said.
  ``Mr. Miller was charged on Monday with first-degree malicious 
mischief and third-degree assault. He was also ordered to stay away 
from the tree by observing `no unwanted contact'''--I repeat, ``by 
observing `no unwanted contact''' with the tree.
  Now, the story goes on to describe trees and sequoias, but not until 
the very end of the article it mentions Mr. Miller's mother, Lisa 
Gossett. She said that she had not talked to her son for some 5 years. 
She saw it on the news and she barely recognized him.
  See, what was happening is Lisa Gossett and her daughter sat in their 
Alaska home watching this clip of the man perched in the tree. With 
their hearts broken, with tears streaming down their faces, Lisa and 
her daughter soon came to realize they were watching their son and 
their brother become the latest Internet mockery of a mentally ill 
person.
  You see, when Cody Lee Miller climbed this 80-foot tree and sat there 
for 25 hours, he was sporting a bushy beard and ragged clothes, and 
most Americans were amused by this and they called it #manintree. It 
was an international viral story overnight. But this was no joke; this 
was no prank. This was the culmination of untreated mental illness 
that, once again, our society turned into a joke.
  And we wonder why there is a stigma, when newspapers like The New 
York Times write a mocking story like that towards a man who has a 
disease. Would they have written an article like that if it was about 
someone with cancer or diabetes or AIDS or any other disease? My guess 
is no. But somehow, in our society, it is okay to mock a person who is 
suffering from schizophrenia.
  When he was younger, he was clean-cut and rambunctious, loving and 
happy. Those are the words his friends used to describe him. At a young 
age, he was diagnosed with attention deficit hyperactivity disorder; 
however, other than excess energy, like any child, he didn't sport any 
behavioral issues. But then, 6 years ago, his mother began to notice an 
unusual shift in her son's behavior as he grew increasingly paranoid.
  Let me note here that serious mental illness, about 50 percent of the 
time, emerges by age 14, and 75 percent of the time by age 24. It is 
very, very difficult to predict; although, we have now indicated some 
108 genetic markers of schizophrenia and bipolar illness. Still, the 
issue is many parents have a loving and caring child, then something 
changes.

                              {time}  1945

  His behavior changed when Lisa would find knives stored under her 
son's pillow. And when confronting Cody about her discovery, he would 
simply respond: It is just to keep us safe.
  As time passed on, Cody's mental instability progressed. He refused 
to enter certain stores downtown. When making an exception, Cody would 
cover his face with a hood, convinced people were constantly staring at 
him.
  Following this enhanced paranoia came the emergence of night terrors 
and constant crying and shouting for his mother during the night. Cody 
would shriek in fear of the ``evil presence'' surrounding him.
  This worrisome behavior continued to escalate as Cody spiraled out of 
control. He could be found walking down the street in high socks and 
clown glasses spreading deer bones on the road.
  He hit a man with a flat tire and began to have dreams of killing his 
grandmother, going so far as setting her wood shop on fire. At that 
point, his grandmother said she could no longer handle him and sent him 
out.
  He was caught in the revolving door of the United States' 
embarrassing and shamefully broken mental health system. He was 
constantly shuffled between homelessness and incarceration.

[[Page 4072]]

  Lisa pleaded for others to help her son and appealed to the Alaska's 
Governor's office, mental health evaluators, and probation office for 
assistance.
  But despite her efforts, Lisa's attempts to get her son proper 
treatment seemed hopeless due to the bureaucratic morass that is our 
mental health care system, which is not really a system at all.
  She was sidelined from helping her son due to the inefficient system 
and forced to sit by and watch as Cody eroded over time.
  We pretend in our own deluded state that all the seriously mentally 
ill are fully aware of their symptoms and welcome treatment. The fact 
is many don't.
  Forty percent of individuals with schizophrenia and bipolar disorder 
don't even recognize that the delusions and hallucinations are not 
real. This
is a medical condition called anosognosia.
  Anosognosia is also something you see in people with dementia or 
Alzheimer's or stroke. It is very real. The person is not aware of 
their own problem.
  But somehow we come up with this anthropomorphism which says, well, 
they can decide for themselves. They cannot decide for themselves when 
they don't even know who they are, that they exist, or what planet they 
are on.
  They see things differently. They hear things differently. They smell 
things differently. They encode information differently into their 
brain. They process it and recall it differently. So for us to say that 
they just don't want treatment is a fool's errand on our part.
  Can you imagine if we said that, again, to someone with cancer? ``You 
don't understand your disease.'' Diabetic? ``We are going to dismiss 
you.''
  What if a person clutched his chest in a heart attack and laid 
unconscious in the street? Would we tell that person ``We are not going 
to help you until you wake up and tell us to treat you''?
  Worse yet, will we say to that person ``We are not going to treat you 
until you are an imminent danger of killing yourself or killing someone 
else''? No. But that is what we do with the mentally ill.
  The Energy and Commerce Committee's Oversight and Investigations 
Subcommittee that I chair had a couple-year study paving the way for my 
bill, the Helping Families in Mental Health Crisis Act.
  With 187 cosponsors from both sides of the aisle, my bipartisan 
measure addresses the shortage of psychiatric beds, clarifies HIPAA 
privacy laws so families can be allowed to have some compassionate 
communication and be part of frontline care, and it helps patients get 
treatment well before their illness spirals into crisis.
  My legislation has been endorsed by dozens of publications and 
newspapers, including The Washington Post, The Seattle Times, The San 
Francisco Chronicle, The Wall Street Journal, and the Pittsburgh Post-
Gazette.
  Each day I hear from countless families from across the country that 
we are experiencing a mental health crisis, and they are counting on 
our efforts to bring positive changes to the mental health system. We 
cannot let these families down. Lives are depending upon it. We cannot 
wish this away, and denial is not a treatment.
  But let me tell you what Americans have to say about this because, as 
we are dealing with this issue, Americans are wondering why Congress is 
not acting. Why is Congress being so passive? Why aren't we doing what 
we need to do?
  I want to tell you about a story that I posted on my Facebook page 
and this picture that I posted as well.
  This is Cody Lee Miller in court. Look at his hair. Look at his 
beard. This is a man that obviously has not been taking care of 
himself.
  He is in shackles on his ankles and his wrists, chained at his waist, 
and led by two police officers wearing their purple gloves so they are 
not at risk of infection while a judge sits in the background. This is 
a man who was diagnosed with schizophrenia being treated like a 
criminal.
  Now, I wrote on my post this: ``Friends, you really can't make this 
stuff up.''
  A man who is diagnosed with paranoid schizophrenia, #ManInTree, ``who 
desperately needs psychiatric care is brought in shackles before a 
judge because he has been charged with first-degree malicious mischief 
and third-degree assault. What was the outcome? The judge ordered him 
to stay away from the tree, but he first needs to make his $50,000 
bail.
  ``Just look at this picture and tell me our mental health system 
isn't a mess. It is unbelievable. Recall that for 24 hours last week, 
Cody Lee Miller remained atop a giant sequoia tree in downtown Seattle. 
Since that time, there has been a greater outpouring of concern over 
the tree than the plight of this young man who is so clearly in the 
throes of a psychotic break.''
  I make reference here to that article from The New York Times being 
far more concerned about the tree than a human being.
  I wrote further: ``He is ordered to have `no unwanted contact' with a 
sequoia, yet no concern about getting him into treatment. Such a sad 
indictment against an abusive system that would order no contact with a 
tree, yet remains silent on getting the mentally ill into care.
  ``Cody's mom talks about his downward spiral and has made it her 
mission to be a voice for families who desperately want to help their 
loved ones but are blocked by Federal and State laws that make it 
impossible to help mentally ill family members. Meanwhile, Congress is 
still stalling my Helping Families in Mental Health Crisis Act, H.R. 
2646.''
  This posting must have hit a nerve. Members of Congress follow 
Facebook pages and Twitter, and we have our social media. Many times 
when we post something we may hear from a few thousand people. As of a 
few minutes ago, this posting has led to 1.8 million hits on my 
Facebook.
  What is also compelling is, as sad as this story is about this man 
treated like a prisoner, like a common criminal, instead of getting 
treatment, are the heart-wrenching comments made by the families. I 
want to read some of them to you. These are people from around the 
world, really, who have commented on what is happening here.
  Holly Huntley Perron wrote: ``I agree with Cody's mom. The real 
culprits are the State and Federal laws that prevent loved ones being 
able to help family members in trouble.''
  By that I reference laws which say that, unless you are in imminent 
danger of killing yourself or someone else, no one is going to force 
you into treatment or laws that say, if this person says that they 
don't want help, you can't make them get help, or if the person in the 
midst of a delusion says: Don't tell my mother or my father because 
they are a part of the CIA or they are a Martian and they are planting 
thoughts in my brain, the doctors cannot tell the family members when 
is the next appointment, what is the medication, what is the diagnosis, 
and how should they treat him. They may say to take him home when the 
family says: What should I do?
  We have heard of cases where the doctor says: We can't tell you 
because he doesn't want us to. But the family says: But I am taking him 
home. What should I do? We can't tell you.
  One family member has said to the doctors: Let's just have a 
supposition. Just pretend that there was a case where someone with 
schizophrenia is going to my house. What should I do? And they say: We 
are not going to tell you.
  These go on to happen where family members may be in court pleading 
in tears with the judge: Tell me where my son is. Tell me where my 
daughter is. Where is my father? My mother? My brother? My sister? Tell 
me so I can do something with them.
  A caseworker may be sitting in the courtroom knowing full well where 
the person is and knowing there are problems, but they say: I can't 
tell you.
  Because we believe their delusions are a reality, that they somehow 
have a right to be sick instead of a right to be well.
  James Sobczak wrote: ``My guess is that he will get some mental 
health

[[Page 4073]]

services in jail. Evaluate him and see if they can petition him to a 
psychiatric hospital. This is a process.''
  Here is the problem. When we take the mentally ill people into jail, 
80 percent of them get no treatment. Eighty percent of people taken to 
jail get no treatment.
  And of those in jail, 40 to 60 percent of those in jail have some 
level of mental illness and many are severely mentally ill. What 
happens instead is a person is 10 times more likely to be in jail than 
in a hospital if they are mentally ill.
  Once there, they don't get treatment. They oftentimes are subjected 
to abuse by other prisoners. They may get in fights with prison guards 
and then charged with another crime.
  Because of all these problems, a person with mental illness tends to 
serve a sentence four times longer for the same crime than a person 
without mental illness. When you discharge them, they don't get 
treatment. So they get involved in this revolving door.
  But why? Why, in heaven's name, is jail the right place to send 
someone with a brain disease? Why is it that Congress doesn't wake up?
  Instead of passing so many silly bills all the time, we are willing 
to let people continue to die, by the way, at a rate of about 10 people 
an hour.
  Last year in the United States 41,000 deaths by suicide, 45,000-plus 
deaths by drug overdose, somewhere between 200 and 500 deaths of a 
mentally ill person confronting a police officer.
  Thousands--and we don't even know accurately how many--are people who 
are homeless and die. One person in Los Angeles died every day who was 
homeless. And about 200,000 of these homeless people are severely 
mentally ill people.
  But we have gotten ourselves accustomed to stepping over them, to 
ignoring them, and to treating them as an invisible class that doesn't 
exist and somehow saying that that is what they want to be when they 
are not even aware. We think it is comfortable for them to live in 
filth and squalor.
  If you add the numbers up, the total number of mentally ill who died 
last year in this country, it is probably well over 85,000, maybe 
100,000, maybe 120,000.
  I might add that even that lowest number is far greater than the 
total United States' combat deaths in the entire Korean war and Vietnam 
war combined for the length of those wars.
  In 1 year in America, that is how many died, and what we do here is 
we throw them in jail or, quite frankly, many of them die in jail as 
well.
  Another comment. Jim Holden wrote: ``The `system' is the problem. We 
can't help these people because `personal choice' is championed over 
their health and well-being. People on the streets need to be a danger 
to themselves or others before we can offer much-needed help. As a 
social worker I have always found this frustrating.''
  Another woman, Jilly Aliska White, writes: ``My brother-in-law was 
just arrested for doing something during a psychotic break from his 
textbook schizophrenia. My husband's mom thinks he is finally going to 
get the help he needs now that he is in the system. Yeah. Right. He is 
not going to be any better off. They don't give a rat's when they can 
just shuffle him through the corrections system. It breaks my heart to 
explain this to them but look at the track record of them `helping.'''
  Deb Smith writes:

       Unfortunately, our jails and juvenile centers have become 
     mental health facilities. While a person has mental health 
     problems, they also may commit crimes for which they can be 
     arrested and held. This is a very difficult and often a very 
     dangerous situation for everyone involved. It is never as 
     simple as get them treatment, nor is it as simple as just set 
     them free if they commit a crime. The judge has to look at 
     all sides, including the safety of both sides, but for the 
     individual and the citizens in the community and what risk 
     the person may have of further harm to himself or others if 
     released.

  Cindy Irvin writes: ``There is still a shame and embarrassment about 
mental illness that totally we don't understand. And then you have the 
people who believe that mental illness is a myth. Until these attitudes 
change--probably by some respected celebrity having a psychotic break--
mental health care will stay in the shadows.''
  Beverly Di Mele wrote: ``The problem is the mentally ill have rights, 
and if they choose not to seek treatment, they have that right. The 
treatment given to them prior to 1970s was forced and inhumane. They 
were locked up for decades, medicated, isolated, and restrained. This 
doesn't happen much anymore, thank God. They had procedures done on 
them like prefrontal lobotomies and were subjected to shock therapy. It 
was cruel and unusual treatment for humans that didn't happen to see 
the world as `normal' people did. How would you like to see this 
treatment forced on your parent, child, or loved one?''
  I agree with most of that. We don't want those treatments again, 
except, when she writes ``This doesn't happen much anymore, thank 
God,'' she is wrong. We should never allow again to bring back our 
asylums with its horrendous treatment.
  But we have gone from a time of 550,000 psychiatric hospital beds in 
this country in the 1950s to less than 48,000 now. In the 1950s, the 
population of the United States was 150 million. Now it exceeds 316 
million.
  There are about 10 million people with severe mental illness, and 40 
percent of them--4 million or so--don't have any treatment. And what 
happens to them is they go to jail.
  When we closed these asylums, people didn't all of a sudden get 
better. Some got better because of medication. But we traded that 
psychiatric hospital bed for the prison cell. We traded that 
psychiatric hospital bed for the emergency room gurney when a person is 
given a five-point tie-down and sedation.
  We traded that psychiatric hospital bed for the streets and subway 
grates for the homeless, and we traded that psych bed for the county 
morgue where many of them die as paupers waiting to be claimed.
  Lori Welander writes: ``I suffer from major depression and had to do 
10 days in jail. While there, they refused to give me my antidepressant 
medications. This seems to be the norm in my county's jail. It is 
pretty sad. This man needs people who care about humanity, not to be 
treated like this.''
  Rhoda Robinson Brown writes: ``How about when our addicts beg the 
judges for treatment and get put into prison for years? Most think at 
least when they are in prison they won't be able to use drugs. Ask any 
addict that has been in county prison how easy it is to still get 
drugs. You will have people say they don't want their tax money paying 
for an addict's treatment. Don't they realize it costs more to keep 
them in prison for years? Our justice system is so broken.''

                              {time}  2000

  Indeed, a study done in Arkansas for their legislature found that it 
cost 20 times more to put a person with mental illness in jail than in 
an outpatient treatment--20 times more.
  Listen to this one. Sylvia Blanchard writes:

       As the mother of a bipolar son, my heart goes out to his 
     family because there is no hurt that hurts as much as 
     watching someone you love have this happen in their own life. 
     My son passed away 3 years ago, and I still ache. I have a 
     child who is in the same situation. He needs mental help, 
     then he needs to get treatment to deal with issues in his 
     life that he ignores and uses drugs to hide from it. In and 
     out of jail almost each week. Nothing a parent can do when 
     it's an adult child. So sad for our system. All States need 
     to look at what Ohio Governor did with his State to turn 
     mental health and drug abuse around.

  Heidi Meyer writes:

       This all stems from a bigger problem in that there are too 
     few beds in mental health facilities for children. There is 
     nowhere to get help for them when they're young and it just 
     leads to messed up adults.

  This is a problem caused by the Federal Government. I told you that 
we have too few psychiatric beds. One of the biggest culprits of that 
is Medicaid. For people who are low-income between the ages of 22 and 
64, if you have a psychiatric problem--I can't make this nonsense up, 
it is true--a person cannot go to a private psychiatric hospital with 
more than 16 beds.
  So where do they go?

[[Page 4074]]

  They put them in an emergency room, they put them in a general 
hospital psych bed, thinking they are going to save money.
  But here is what happens. If a person is in a psychiatric hospital 
bed, it costs about $500 a day. If they go to an emergency room, it 
could be $3,000 or $4,000 a day. If they go to a general hospital psych 
unit, it could be $1,000, $1,200, $1,400 a day.
  The State of Missouri actually did a study on this and found it saved 
40 percent of Medicaid dollars by allowing people to go where the care 
is to a psychiatric hospital to understand that medications can work.
  I yield to the gentleman from Georgia (Mr. Carter) on this issue of 
medications to elaborate on this. Buddy Carter from the First District 
of Georgia, from Savannah, Georgia, knows well what medications can do 
when properly prescribed and properly followed to help treat someone.
  Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for 
yielding.
  Mr. Speaker, as the gentleman has stated, this is a serious problem. 
This is a problem that I have dealt with as a professional pharmacist 
for many years. I have dealt with it in my retail setting in my 
pharmacies, as well as a consultant pharmacist in a long-term care 
facility in skilled nursing homes. I have seen the advances that we 
have made in medicine over the years. I have seen us go from only 
having the original antipsychotics, Haldol, which was always 
accompanied by a prescription for Cogentin to mask the side effects 
that the Haldol was going to have. I have seen the evolution of the 
atypical antipsychotics, which, while they do have some side effects 
themselves, are nowhere near the side effects that the original 
antipsychotics had.
  I do thank the gentleman for bringing this important issue to light, 
and I do have a few comments that I would like to make.
  First of all, medication plays a major role in the treatment for many 
mental illnesses. With the growing burden of mental disorders 
worldwide, pharmacists are ideally positioned to play a greater role in 
supporting people with a mental illness. There is a growing amount of 
evidence to show that pharmacist-delivered services in mental health 
care help address the barriers that are hurdles for the broader mental 
healthcare team.
  Pharmacists have three roles they can play in helping our country 
address the mental health crisis.
  First, pharmacists can play a major role in the multi-disciplinary 
teams addressing health care and can support early detection of mental 
illness. With more pharmacists coming out of school with greater 
clinical experience, pharmacists can work in new roles, such as in case 
conferencing or collaborative drug therapy management.
  These new roles would also benefit from increased pharmacist 
involvement, such as the early detection of mental health conditions, 
development of healthcare plans, and follow-up of people with mental 
health problems.
  Secondly, pharmacists can play a role in supporting quality use of 
medicines and medication review, strategies to improve medication 
adherence and antipsychotic polypharmacy, and shared decision making.
  Pharmacists would have a large impact regarding medication review 
services and other pharmacist-led interventions designed to reduce 
inappropriate use of psychotropic medicines and improve medication 
adherence.
  Finally, pharmacists can help address barriers surrounding the 
implementation of mental health pharmacy services with a focus on 
organizational culture and mental health stigma.
  Over the years, the relation between the pharmacist and the physician 
has become more collaborative and cooperative. With this new 
relationship, pharmacists can work with physicians to develop 
strategies to change the attitudes and stigma surrounding mental 
health.
  As my colleague from Pennsylvania, Representative Murphy, continues 
to fight for this cause, I hope he will consider me and the profession 
of pharmacy as a friend and collaborator so we can fight to end the 
mental health crisis in this country.
  Again, I want to thank the gentleman for yielding me this time and 
for bringing this most important subject to light.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman for 
his comments and his dedication to this issue.
  Mr. Speaker, I yield to the gentleman from Oregon (Mr. Blumenauer), 
who has been absolutely steadfast in his compassion and caring for 
this. Also, it shows a bipartisan nature of our legislation. He has 
been instrumental in helping me understand other aspects of this. We 
made a number of modifications to this bill and will continue to work 
on these issues together, so I thank my friend.
  Mr. BLUMENAUER. Mr. Speaker, I thank Mr. Murphy. I appreciate his 
courtesy in permitting me to speak with him this evening.
  The Sun is setting on our Nation's Capitol. Many of our colleagues 
have returned to Washington, D.C. They are at dinner, they are with 
their families, they are meeting with their constituents. I appreciate 
his being here on the floor this evening to highlight a critical area 
that he has been so committed to and has worked on so hard because it 
is something that each and every American needs to address and needs to 
focus on because we are all in this together.
  I will say that earlier in my career as a child State legislator, I 
was part of the deinstitutionalization movement. It made a lot of 
sense. As my friend has said, we have had over a half million 
institutional beds. Some of the conditions were not what they should 
have been. Some of the treatment certainly is nothing that we would 
accept today.
  The notion of allowing people to be helped in a deinstitutionalized 
setting made sense for a lot of people. It is sad to say we didn't do a 
good job of implementing it. The institutionalization worked if we were 
there supporting the people who were deinstitutionalized with 
medication, with counseling, and with housing. And sadly, when we hit 
some choppy waters economically in my community and others around the 
country who followed what was in theory a good model, we found that 
there were too many people out on their own.
  Sadly, today, we can see evidence of the failure to do 
deinstitutionalization right on the streets of virtually every 
community large and small from coast to coast.
  I appreciate his efforts to help refocus the Federal partnership. 
Certainly there is a role for State and local government, there is a 
role for the private sector, and there is a role for individuals and 
families. The Federal Government provides resources, provides a 
framework, provides a legal setting, and we need to make sure that the 
Federal framework reflects the lessons we have learned and the 
realities today.
  I have been pleased that he has been so patient with me and others 
who have carried to him some of the questions and concerns that we have 
picked up from people in our communities who care about it. He has 
tackled an area that is complex, it is controversial, and there is room 
for give and take. I feel in the hours and hours that we have talked 
about this exchanging information, I have seen that he has done just 
that. He has drilled down, he has listened, he has incorporated, he has 
asked more questions, and I appreciate that because I think he is 
establishing a framework here with a number of our colleagues on a 
bipartisan basis that will enable this Congress to be able to make real 
progress that is long overdue.
  In my community, we are going to open a facility in September. We 
call it the Unity Center. It is a collaboration between four major 
hospitals to have a place where we can take people with mental problems 
out of emergency rooms where they can't be appropriately treated and 
where it is costly. All we can do is stabilize them, and then turn them 
back out on the street until their condition deteriorates where they 
pose a problem to themselves and others.
  As he has referenced, too much of our mental health service in this 
country is to be found behind bars. That is not the appropriate 
setting. It is not cost effective and it is not humane.

[[Page 4075]]

  We are making a small step in our community where these institutions 
have come together and have established a memorandum of understanding. 
They realize they are still going to lose money, but they are not going 
to lose as much. They are going to be able to give better care to a 
population that is very much in need.
  I am hopeful, Mr. Speaker, that we will be able to, as a result of 
the work that he is doing with this legislation and others who he is 
working with, that we will be able to focus that Federal partnership 
yet this year, to be able to have more assistance to our communities to 
make sure that the Federal programs are tailored to the needs of today 
and the experience that we have acquired.
  I am hopeful that we will be able to develop more tools for one of 
the most important ingredients in this equation, and that is the 
families who are too often prevented because of the regulatory 
framework we have. Some of this is understandable, but it shouldn't be 
a barrier for families who, in some cases, are the only people who 
really know the individual, who care about them, and who are equipped 
to be a vital partner with the mental health system.
  I look forward to further progress. I look forward to bringing back 
to you more information from Portland, Oregon, where we are going to 
have another round table discussion with concerned individuals in 
government, in the medical profession, and advocacy groups to make sure 
that the input from my community is completely reflected in this.
  Let me just say how much I appreciate his time and his effort, being 
a partner with him in this. I am looking forward to seeing the result 
before the final gavel comes down on this Congress.
  Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman from 
Oregon, and truly my friend.
  I think when people look at Congress and wonder if people can work on 
issues in a bipartisan way, I am sure if someone looked at our voting 
record on other issues, we would probably be a bit different. That is 
okay. What still stands is that we are able to come together with a 
common issue.
  I have no idea if this man is Republican, Democrat, registered to 
vote, nor should that matter to us. I have never asked a patient in my 
40 years of practicing. I know he is the same way, too. We do this 
because compassion dictates. Sometimes we are our brother's keeper, and 
we need to do the right things.

                              {time}  2015

  I do value your input on this bill. We have made a number of 
modifications. I know that, in committee, Democrats have offered 
several amendments which I want to incorporate and which look at 
specific funding for a number of things. We need more psychiatrists and 
psychologists. We just have to have them. We have to put money into 
that. We need more programs in there. We need to bolster community 
mental health services. We need to make sure that there is oversight 
over what States are doing with those dollars in order to make sure 
they are putting dollars into effective programs and not into frivolous 
ones. That is one of the roles Congress has is to be the watchdog over 
that.
  I am proud to say, in front of the Nation, that you have been awesome 
in this, and I want to continue to work with you. We will solve this 
will issue.
  Mr. BLUMENAUER. If the gentleman would yield, I just want to say that 
one of the areas that is most contentious deals with when people, like 
the gentleman that you have pictured behind you, are going to be 
compelled to have treatment. You have been open to being able to refine 
the protections to make sure--and this is something that varies across 
the country--that under the auspices of your bill that we have 
appropriate safeguards to make sure that the rights of the individual 
are respected but that we acknowledge the fact that, in some cases, the 
right for people to self-destruct is illusory.
  Mr. MURPHY of Pennsylvania. Exactly.
  Mr. BLUMENAUER. It is dangerous to them; it is dangerous to society; 
and it is heartbreaking for their families.
  I have appreciated our conversations on that, going back and forth, 
and what you have tried to do to be able to make sure that the balance 
is struck. I am confident, before we are through, that we can make sure 
that the other areas that require that give-and-take can, in fact, be 
met. I would like to thank you for allowing me to speak on behalf of 
it, and I look forward to the next steps.
  Mr. MURPHY of Pennsylvania. I thank the gentleman.
  Mr. Speaker, what the gentleman is referring to is also something 
called assisted outpatient treatment. That is a program whereby 45 
States and the District of Columbia--maybe 46 States now--have this. 
When people have a history of incarcerations, of arrests, of violence 
and when they are not in treatment, a judge protects their rights and 
may review their cases in terms of saying they can be put in inpatient 
care. If the judge says they do not meet the standard of imminent 
danger of harming themselves or someone else, assisted outpatient 
treatment is what may be warranted for them, which means the judge 
simply says: You are going to stay and continue to take your 
medication. You will continue to see your therapist and work on this.
  That being the case, when New York State did this, it found a 
reduction in incarcerations and homelessness by some 70 percent. It was 
pretty dramatic. It found satisfaction by over 80 percent, and it found 
costs go down by 50 percent.
  It is something on which we in Congress need to continue to work. We 
did pass legislation, which puts the appropriations of $15 million to 
help States do that, but we have a long way to go. It is a long way to 
go based upon what I said. I think it is 1,820,000 people so far who 
have commented. They have seen this on my Facebook page and have 
commented on it. I want to read some more comments--some heartbreaking 
lessons--people are making.
  One is by the name of Kari Butler, who wrote on my Facebook page:

       They are falling through the cracks. Easier to just put 
     them in jail with high bail. They do make medication for 
     people like him, my nephews, which is to say one is in jail 
     now since November--no release until August--mostly because 
     he didn't follow up like he was supposed to. The prosecutor 
     did a mental evaluation on him to see if he could withstand 
     court, and he concluded he could; but something is not right 
     here. He has assaulted officers and has been tased three 
     times and has not been affected. Five police officers, it 
     took, to get him into the back of a car. They tased him in 
     Walmart--once in front of the whole store.

  On it goes. There are many people with mental illness out there.
  This person writes:

       I don't believe public servants have been trained properly 
     to treat mental illness. I don't know what to do to help 
     people who get the help they need to be productive.

  One might say one of the aspects of our bill is to provide training 
for police officers--what is called emergency treatment for them. When 
police officers have been trained in that, we have actually seen--and 
the police officers like this, too--that they can quickly identify, if 
this is a mentally ill person in crisis, what they can do to deescalate 
the situation and prevent it from becoming harmful or deadly.
  Here is another point that has been written by Amethyst Lees:

       First off, the health system is horrible, and I worked 
     inside a mental institution and saw firsthand what it is 
     like. Depending on where I was, the people were not getting 
     their needs met or were being ignored. I even saw an incident 
     where a man was waiting for 15 minutes for two staff members 
     to stop talking about football just to ask for some ice. He 
     never got his ice because he lashed out for being ignored, 
     and, of course, he was restrained in a chair for an hour for 
     getting angry.

  Marianne Kernan writes with regard to Cody Miller:

       Talk to him. Our mental health system is shameful. I know, 
     as I work daily with this population, many times, their 
     treatment is inhumane. Some with dementia or Alzheimer's 
     wouldn't be treated this way if they had a break with 
     reality. It is a sad commentary on our lack of knowledge of 
     dealing with serious mental illness.

  Here are some more stories.
  Angie Geyser writes:


[[Page 4076]]

       My 13-year-old daughter, Morgan, was in police custody for 
     19 months before she finally received treatment for her 
     schizophrenia. We had to pursue a civil commitment to make it 
     happen. Now she is back in juvenile detention where she has 
     no access to the outdoors and is not allowed to have physical 
     contact with her family. The treatment of the seriously 
     mentally ill by the criminal justice system is appallingly 
     inhumane.

  Frede Trenkle writes:

       Two weeks ago, a stranger that I have been married to for 
     13 years came into my home, sprayed me with pepper spray, 
     took a knife out in front of my two kids, and threatened to 
     cut his throat. The police took him away and put him in a 
     mental health hold. I chose not to press charges and just 
     requested that he get help. This was his second hospital stay 
     in a month. The hold was supposed to be for 7 days. Four days 
     later, he got out, and I am sure because he had a plane 
     ticket out of the State. He convinced someone out there that 
     I was the threat. He denied ever having a knife. He 
     manipulated the system. I received abusive texts before I 
     changed my phone number and he sent terrible emails. I only 
     wish he could get the help he desperately needs wherever he 
     is, but because of the unchecked mental illness, I now have 
     two beautiful girls, without their father, and both needing 
     their own mental health counseling. How do we help our system 
     on all ends?

  Another woman writes:

       If you want people like this young man to get help, we all 
     need to be okay with paying more taxes and closing privatized 
     prisons. The prison system has become the dumping ground for 
     the pervasive mentally ill.

  Another one writes:

       My uncle has schizophrenia. He disappears for months at a 
     time. I worry constantly about him being hurt by law 
     enforcement. He was living 50 miles away, in the woods, on 
     his father's property, in a camper, and was threatened with a 
     gun by a neighbor because he was walking in the fields, 
     talking to things only he can see. The cops were called, and 
     they showed up with weapons drawn. Then they took him away 
     and locked him up for a month. He is only 32, but the police 
     assumed he was on drugs. He was having a psychotic episode. 
     There is not enough education in the judicial system about 
     mental illness, and innocent people are being killed through 
     the ignorance.

  Another woman writes:

       My question is this: As the mom, where should we direct the 
     young people with schizophrenia? Hospital care is effective, 
     but it seems to be temporary: 6 months in and 2 years out; 
     repeat. Has anyone found or used or heard of any successful 
     treatment going on at treatment facilities?

  The answer is yes. Actually, one of the programs in H.R. 2646, the 
Helping Families in Mental Health Crisis Act, is for something called 
RAISE, Recovery After an Initial Schizophrenia Episode. We have learned 
that, since schizophrenia and bipolar illness and severe mental 
illnesses are emerging in adolescent and young adult years, if one gets 
to someone early, with a low dose of medication, with proper evidence-
based treatment, the prognosis is much, much better; but when we don't 
treat someone, every time someone has what the lay public calls a 
nervous breakdown or a psychotic break--a crisis--we have to understand 
that, over time, these lead to neurological damage. These are not 
harmless episodes. This is not just someone who gets upset. This is a 
real psychiatric disorder that comes from the brain and leads to 
problems, and that is why we see these problems grow.
  Here is someone who doesn't quite understand the problem. A woman by 
the name of Julie writes:

       I am very much against the families of mentally ill 
     patients having the power to put their loved ones away 
     against a patient's will. Let the doctors determine if the 
     patient has a problem, not the family. Often, the family just 
     doesn't want to deal with the illness, so they want the 
     person to go away.

  Someone by the name of Robin Duffey writes:

       Julie, you don't know what you're talking about. There are 
     more of us that do care, but because of the mental health 
     laws, we are unable to make decisions for very sick family 
     members. People with schizophrenia don't realize they are 
     sick. They think their hallucinations are real, along with 
     the commanding voices they hear. So how can such an ill 
     person make a logical decision to get the help they need? The 
     answer is: they can't. The doctors have to follow the laws 
     that are in place, which is they cannot recommend committing 
     a person unless they are an immediate threat or danger to 
     someone or themselves. Yes, Julie. There are some families 
     that don't want to be bothered, but I was not one of them. I 
     highly recommend you to do research on the subject before you 
     spout your ideas. Read the Federal and State laws.

  Indeed, that is what we are trying to do with H.R. 2646.
  There are a couple of thousand more comments on my Facebook page, Mr. 
Speaker, and I certainly ask people to go and read them. They are 
heartbreaking. They are horrifying. They are tragic. They are true. 
They go on and on because our Nation refuses to acknowledge this.
  Until we pass this bill and start making changes--we can predict it--
in the time that I have been speaking here, there have been several 
more suicides; there have been more homicides; there have been more 
mentally ill people whom we have abandoned; there have been people who 
have had chronic illnesses and who have died, because the people with 
serious mental illness, for multiple reasons, tend to die 10 to 25 
years sooner than the rest of the population because of the fact that 
75 percent of those with mental illness have at least one chronic 
illness, 50 percent have at least two chronic illnesses, and a third 
have at least three chronic illnesses. I mean things like heart 
disease, lung disease, infectious disease, diabetes. They get sick and 
they, oftentimes, are not treated. Many times, they don't seek 
treatment. We let them go in this slow-motion death spiral and ignore 
them.
  We have closed the hospitals. We have put them in prisons. If they 
are out of control and if the police bring them to the emergency room 
and if there are no beds available, they tie them down to the gurney, 
where they may wait for days--or weeks, in some cases--where they are, 
perhaps, given some sedative--a chemical straightjacket, if you will--
to calm them down. That is not treatment. That is abusive. That is our 
Nation that is doing it, and Congress is culpable in this because we 
refuse to act.
  Once again, there will be a tragedy somewhere. I shudder to think--
and I hope it is not anybody here who is injured--that, somewhere out 
in America today, this is going to happen. Once again, we will gather 
for a moment of silence; the gavel will come down; and we will go back 
to our regular order of business. It is sad and it disgusts me, but 
that is what we face: all of this closing of hospitals and not opening 
up community mental health; Medicaid's saying you can't see two doctors 
in the same day; Medicaid's saying you can't go to a hospital with more 
than 16 beds; HHS' saying we can't tell parents anything, so they are 
left in the dark; the Substance Abuse and Mental Health Services 
Administration, which funds programs that teach people to make 
collages, to do interpretive dances, to get off their medication, to 
make masks and other things that have nothing to do with serious mental 
illness.
  We need to change the system, and that is what H.R. 2646 does. It 
takes that office of SAMHSA and changes it so that the director of it 
is the Assistant Secretary of Mental Health and Substance Abuse. That 
person needs to be a doctor or a psychiatrist who is trained, either an 
M.D. or an osteopath or a psychologist, but someone who understands the 
field and not just someone who is saying: Well, let's just do these 
other ``feel good'' programs.
  The city of New York just did this, too, where the mayor put up 
hundreds of millions of dollars for programs that were, supposedly, for 
the mentally ill. They weren't for the mentally ill at all. They were 
programs like parks and bike trails and ``feel good'' programs to help 
people with sadness, not to deal with depression and serious mental 
illness.
  How long can we continue to fool ourselves?
  As for this whole idea that says ``leave it up to them if they want 
to choose; don't provide them the help; make it the most difficult for 
those people who have the most difficulty,'' all of this, Mr. Speaker, 
is more commentary and evidence of the grand experiment of stopping all 
treatment under the misguided, self-centered, and projected belief that 
all people who are mentally ill are fully capable of deciding their own 
fate and direction, regardless of their deficits and disease, and that 
they have the right to self-

[[Page 4077]]

decay and self-destruction, which overrides their right to be healthy. 
The most fundamental, dangerous, and destructive hidden undercurrent of 
prejudice is the low expectation that your disability is as good as it 
gets.

                              {time}  2030

  The shift to consider changes in how we treat severe mental illness 
is the pendulum that needs to swing the other way. The grand experiment 
has failed in closing down all the institutions and care and stopping 
all treatment and not allowing community mental health.
  It is a principle that operated under the misguided, self-centered 
belief that people are always fully capable of deciding their own fate, 
regardless of their deficits and disease, and the right to self-decay 
and self-destruction overrides this right to health.
  In so doing, we have come to comfortably advocate our responsibility 
to action and live under this perverse redefinition that the most 
compassionate compassion is to do nothing at all.
  It further bolstered the most evil of prejudices that the person with 
disabilities deserves no more than what they are. Under that approach, 
no dreams, no aspirations, no goals to be better can even exist.
  Indeed, to help a person heal is a head-on collision with the bigoted 
belief that the severely mentally ill have no right to be better than 
what they are and we have no obligation to help them.
  This is the corrupt evil of the hands-off approach in the 
antitreatment model, and that perversion of thought is embedded in the 
glorification that to live a life of deterioration and paranoia and 
filth and squalor and emotional torment trumps a healed brain and the 
true chance to choose a better life.
  This is the movement of hatred and stigma toward the mentally ill 
disguised as the right to let them be sick. That hatred may be embedded 
in our own anger, our own resentment, and one's own past experiences 
projected as blame or misattribution of the lives of others or maybe 
our own fear and loathing of the mentally ill. Either way, the outcome 
is tragically the same.
  So we can have more moments of silence or we can have times of 
action. I hope the Energy and Commerce Committee picks this up.
  I hope that more Members of Congress will sign on as cosponsors of 
H.R. 2646, the Helping Families of Mental Health Crisis Act. The day 
that bill signs into law, it will begin to save lives. It will begin to 
make a difference in people's lives.
  Of all the other things we do down the road here for images or to 
push polling--I can tell you this, that the polling on this bill is in 
70s and 80s. As politicians, we think, wow, if something polls at 55 
percent, vote for it.
  My concern is: Will America wake up and look toward Congress here and 
say: When we had a chance to do something to save lives, did we act, or 
are we once again just caught up in moments of silence?
  Thomas Jefferson said something along the lines of: ``Indeed I 
tremble for my country when I reflect that God is just and His justice 
cannot sleep forever.''
  We are in that same position now. We can either have the courage to 
stand up, take action, and help the mentally ill or we can sit in 
silence. I hope this Chamber soon takes up H.R. 2646, the Helping 
Families in Mental Health Crisis Act.
  Mr. Speaker, I yield back the balance of my time.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise in support of 
H.R. 2646, the Helping Families in Mental Health Crisis Act. Thank you 
to Congressman Tim Murphy for hosting this important special order to 
discuss our country's current mental health system.
  For more than two years now, I have worked with Congressman Murphy on 
H.R. 2646, a bipartisan piece of legislation that has garnered support 
from patients, caregivers, psychiatrists, psychologists, law 
enforcement, and even editorial boards. As two of the few mental health 
providers serving in Congress, our bill reflects not only what we have 
learned in our own careers, but feedback from stakeholders, families, 
organizations, other members of Congress, and addresses many of the 
policies that we can change now to help patients struggling with severe 
mental illness and substance use disorders.
  An amended version of H.R. 2646 passed the Energy and Commerce 
Subcommittee on Health in November of 2015. Since then, there has been 
no action. I have continued to talk with members of my community about 
mental health issues and they demand action.
  It is now April of 2016 and we must move forward on the issue of 
mental health. The American people expect, deserve, and demand it. H.R. 
2646 takes a strong step forward in mental health reform. As days pass 
with no action, people are denied beds, denied care, and are floating 
through the pervasive cycle of mental illness without attention. 
Everyone deserves care. I truly hope that my colleagues will work with 
me to pass this bill for the sake of those who truly matter.




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