[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 1057 Introduced in House (IH)]
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116th CONGRESS
2d Session
H. RES. 1057
Expressing the sense of the House of Representatives that in order to
effectively address the high prevalence of those suffering from mental
health conditions and substance use disorders, the United States needs
to make historic financial investments into mental health and substance
use disorder care and finally acknowledge such care as a priority in
health care equal to physical health, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 21, 2020
Mr. Kennedy (for himself, Ms. Matsui, Mr. Tonko, Mr. Cardenas, and Mr.
Trone) submitted the following resolution; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
RESOLUTION
Expressing the sense of the House of Representatives that in order to
effectively address the high prevalence of those suffering from mental
health conditions and substance use disorders, the United States needs
to make historic financial investments into mental health and substance
use disorder care and finally acknowledge such care as a priority in
health care equal to physical health, and for other purposes.
Whereas there is an urgent need to improve our health care system to better
integrate mental health and substance use disorders so they are no
longer seen separately;
Whereas according to the World Health Organization, mental illness is severely
underdiagnosed, and less than half of those who meet diagnostic criteria
are identified;
Whereas there is a pressing need to provide a comprehensive solution to fix our
health system that incorporates the needs and expertise of all its
stakeholders, especially those who have expertise in mental health and
substance use disorders;
Whereas it is essential to remove the misguided association between mental
illness and violence driven by fear and misunderstanding;
Whereas mental illness and substance use disorders have been underresearched,
undertreated, and overstigmatized;
Whereas stigma, vilification, and dismissal of mental illness and substance
use--
(1) create a culture that--
G (A) discourages utilization of mental health and substance use
disorder services; and
G (B) lacks acknowledgment that struggling with mental health
conditions or substance use disorder is not something to be ashamed of; and
(2) can vary in prominence in different cultures and communities, and
are particularly high among communities of color and minority communities;
Whereas men in particular face cultural and societal barriers to seeking
treatment for mental health concerns and substance use disorders, which
can contribute to concerning outcomes including suicide and aggressive
behaviors;
Whereas the bulk of our mental health and substance use disorder services are
reactive instead of proactive, treating patients when they are in crisis
instead of incorporating services and screenings earlier in an attempt
to prevent such crisis from occurring;
Whereas there is a need to increase access to treatment, services, and social
supports for everyone to proactively address root causes of mental
illness and substance use disorders;
Whereas it is necessary to address the root causes of mental health concerns and
substance use disorders;
Whereas it is necessary to address suicide in a holistic manner and recognize
and address suicide ideation and not just the action in isolation;
Whereas there is a need to address social determinants of health, which are
conditions that directly and indirectly affect the health, health care,
and wellness of individuals and communities, in order to effectively
provide care for all individuals living with mental illness and
substance use disorders;
Whereas mental health impacts physical health, and physical health impacts
mental health;
Whereas the current health care system does not adequately incorporate mental
health and substance use disorders into the assessment or delivery of
care, as evidenced by the fact that all vital signs are currently for
physical health alone and do not touch on mental health or substance use
disorders;
Whereas the lack of a united approach across the Federal Government to improve
mental health and substance use disorders has left States and
localities--
(1) without adequate guidance or resources;
(2) without resources unable to provide the mental health and substance
use disorder services needed to adequately meet the needs of their
populations; and
(3) with resources unable to effectively distribute services to
adequately meet the needs of their populations;
Whereas there is a need for greater collaboration across all Federal departments
that touches various aspects of the health care system in order to fully
incorporate the needs and concerns of everyone involved in the mental
health and substance use disorder system;
Whereas there is a need for greater collaboration between Federal, State, and
local departments that touches on various aspects of the health care
system;
Whereas there is a need for one centralized location within the Federal
Government for good, reliable information on mental health and substance
use disorders for providers, patients, and caregivers;
Whereas there is a need for standardized definitions, standards of care, and
metrics for mental health and substance use disorders across
disciplines;
Whereas there is a need to change incentives for providers to better ensure
everyone with mental health and substance use disorders needs gets
access to the necessary care and treatment;
Whereas the Mental Health Parity and Addiction Equality Act has been in effect
since 2008, and 12 years later there is still a lack of compliance among
insurers not adequately covering mental health and substance use
disorder services;
Whereas Medicaid is the single largest payer of mental health and substance use
disorder services, and reimbursement is far from adequate;
Whereas there is a need to incentivize payers to adequately cover mental health
and substance use disorder services in the same manner that all
specialty services are covered;
Whereas there is a need to increase the number of mental health and substance
use disorder providers;
Whereas 55 percent of counties in the United States do not have a single
psychiatrist, psychologist, or social worker;
Whereas only 10 percent of people suffering from a substance use disorder
receive specialty treatment;
Whereas there is a need to increase access and utilization to telemedicine for
mental health and substance use disorder services both within States and
across State lines;
Whereas patient privacy needs to be protected, but there needs to be a better
way to share information among providers to better serve the patient's
needs;
Whereas safe housing needs to be recognized as a basic requirement for treatment
to be successful and needs to be better addressed as people transition
care;
Whereas there is a need to improve social determinants of health, such as
increased access to stable housing and jobs, for those suffering from
mental illness and substance use disorders to have a sustained recovery;
Whereas there is a need to provide care in more appropriate and integrated
settings for all patients, such as treating geriatric patients in their
homes as opposed to nursing homes, when appropriate and in compliance
with the Americans with Disabilities Act of 1990 (Public Law 101-336)
and the Supreme Court's Olmstead v. L.C. decision;
Whereas there is a need for greater focus on intensive outpatient, partial
hospitalizations, residential programs, day programs, supported housing,
assertive community treatment, mobile crisis services, peer support
services, supported employment, and community-based services for adults
with mental illness and substance use disorders;
Whereas there is a need to ensure that services support individuals with mental
health conditions and substance use disorders to participate fully in
their communities and live and thrive independently
Whereas there needs to be consistent care coordination and more effective
transition services for those moving between hospitals and the
community;
Whereas there is a need to address isolation issues geriatric patients face
which can negatively impact their mental health;
Whereas depression, anxiety, post-traumatic stress, and psychosis are some of
the most common conditions women experience pre- and postpartum;
Whereas unmet parental mental health and substance use disorder treatment and
service needs contribute to increased involvement with the child welfare
system, which leads to preventable foster care placements, given that--
(1) in 2018, 262,956 children entered foster care, with the leading
reasons related to mental health and substance use disorder needs of the
parents, with--
G (A) 36 percent of children entering care as a result of parental
drug abuse;
G (B) 14 percent of children entering care as a result of the
caretaker's inability to cope; and
G (C) 5 percent of children entering care as a result of parental
alcohol abuse;
(2) even when necessary to ensure a child's safety, foster care itself
creates additional trauma for both the child and family; and
(3) longstanding racial inequities in child welfare services create
disproportionate child welfare involvement for Black, Native, and Latinx
children and families, which exacerbates those families' experiences of
trauma and contribute to health disparities while not resulting in needed
access to quality mental health and substance use disorder services;
Whereas children and adolescents have unique needs when it comes to mental
health and substance use disorders and the services provided, given
that--
(1) 45 percent of children have experienced adverse childhood
experiences which have the potential to significantly impact the mental
health of children;
(2) in the last 12 months, 49.4 percent of children who needed mental
health services did not receive the necessary services, and there needs to
be improved access to more appropriate treatment services, which must focus
on community-based supports and services available near their home, in
order to effectively prevent children from experiencing a mental health
crisis;
(3) many children suffering and struggling go undiagnosed and are not
adequately supported, and there is a need to improve training and
understanding of mental health and substance use disorder concerns for
educators since often there are barriers to mental health and substance use
disorder treatment in a school setting;
(4) 42 percent of school districts have reported using threat
assessment and risk assessment teams, an approach created by the United
States Secret Service that involves identifying, evaluating, and taking
action on current or potential threats which--
G (A) can cause significant harm to the mental health and emotional
well-being of children;
G (B) has compounded already existent stigma for groups of students;
G (C) has had a disproportionate impact on students of color by
initiating justice involvement in lieu of more appropriate services; and
G (D) has had a disproportionate impact on students with
disabilities;
(5) families and caregivers need to be included when treating children
suffering from mental illness and substance use disorders; and
(6) when children turn 18 they are cut off from mental health and
substance use disorder services which impacts continuity of care;
Whereas there is a growing need for mental health and substance use disorder
services amongst young adults and college-aged adults, and between 2007
and 2017, for those aged 18-34 there was a--
(1) 108-percent increase in drug-related deaths;
(2) 69-percent increase in alcohol-induced deaths; and
(3) 35-percent increase in suicide deaths;
Whereas despite the rising need for mental health and substance use disorder
treatment by young adults, there continues to be disparities in
accessing care experienced by young adults of color;
Whereas 5.5 million veterans and servicemembers rely on the Department of
Veterans Affairs for health services, and 1.5 million veterans have
received a mental health diagnosis, and--
(1) 1 in 4 active duty members shows signs of mental health conditions;
(2) the rate of post-traumatic stress disorder (PTSD) is 15 times
higher in servicemembers than compared to civilians due to military combat
and military sexual assault and trauma;
(3) the rate of depression is 5 times higher in servicemembers than
compared to civilians;
(4) every day, 22 veterans die by suicide;
(5) there is a fear of disclosing mental health conditions and
substance use disorders and seeking treatment due to negative career
implications; and
(6) less than 50 percent of veterans receive the mental health
treatment and services they need;
Whereas 11 percent of those entering the Veterans Affairs health system meet the
criteria for a substance use disorder;
Whereas veterans are more likely to have an alcohol use disorder than civilians;
Whereas 2 in 10 veterans with PTSD have a comorbid substance use disorder, and 1
in 3 veterans seeking services for a substance use disorder also have
PTSD, showing the interconnectedness between these conditions;
Whereas there is a need to better educate all those in the criminal justice
system on the impact and needs of those with mental health conditions
and substance use disorders;
Whereas the United States justice system is the largest provider of mental
health services, and it was not built, or intended to be used, for that
purpose, and--
(1) there are 550,000 people currently incarcerated with mental
illness;
(2) 1 in 5 people incarcerated has a serious mental illness; and
(3) of those incarcerated, 75 percent with a serious mental illness
suffer from a co-occurring substance use disorder;
Whereas there is a need for incentives to reduce inappropriate incarceration and
detention for those with mental health and substance use disorder needs;
Whereas one-third of people incarcerated receive treatment for mental illness,
and many times it is inconsistent and inadequate, and there is a need
for improved access to services and treatments that are also trauma
informed;
Whereas there is a need to have mental health, substance use disorder, and
diversion services available at all intercepts of the Sequential
Intercept Model, a model developed to inform more appropriate community-
based responses and divert those with mental illness and substance use
disorder;
Whereas there is a need to improve levels of coordination, care management, and
insurance coverage before, during, and after incarceration;
Whereas postrelease navigation is key to keeping people from reentering the
justice system;
Whereas there is insufficient understanding of the mental health effects of
incarceration;
Whereas there is a need to redefine the juvenile justice system to include those
who are 25 years of age or younger in order to reflect the most up-to-
date scientific consensus on brain development and behavior;
Whereas the juvenile justice system must fulfill its purpose of supporting,
rehabilitating, and treating children in need rather than punishing them
given that--
(1) studies have shown that 70 percent of youth in detention have a
diagnosed mental illness, and 60 percent of those may also meet the
criteria for a substance use disorder;
(2) 90 percent of those in the juvenile justice system have been
exposed to trauma or violence which may increase the likelihood of juvenile
justice involvement;
(3) entry into the juvenile justice system may exacerbate the existing
mental health and substance use disorder concerns of youths, particularly
in the absence of consistent screening and treatment for these conditions;
and
(4) an estimated 33 percent of children in long-term juvenile justice
facilities have intellectual, developmental, and other disabilities and
were receiving special education services; therefore there is a need to
have specific services and programs within the juvenile justice system with
a focus on their needs;
Whereas studies show that 41.2 percent of those who are diagnosed with a
substance use disorder are also diagnosed with a mental illness, which
is likely an underestimate in light of the current barriers to
identifying and reporting mental health concerns;
Whereas given the high co-occurrence with mental illness, comprehensive care for
substance use should include access to psychopharmacology,
psychotherapy, contingency management, recovery support, all evidence-
based medication-assisted treatment, a multidisciplinary staff, and
group therapy for adults, and--
(1) addiction treatment centers should either offer or have available
comprehensive care and support and have the ability to treat mental illness
as well as substance use disorders; and
(2) to allow for treatment flexibility to fit the needs of the patient,
there is a need to increase access to all evidence-based medication-
assisted treatment, in prisons, jails, and all addiction treatment centers;
Whereas there are inequities in access, availability, and quality for mental
health and substance use disorder services for minority communities,
and--
(1) there is greater stigma among racial and ethnic minority
populations;
(2) racial and ethnic minorities are disproportionately affected by
disabilities that result from mental health conditions; and
(3) only 31 percent of African Americans and Hispanics and 22 percent
of Asians receive mental health care compared to 48 percent of Caucasians;
Whereas LGBTQ individuals are more than twice as likely to suffer from mental
health conditions and substance use disorders than heterosexual
individuals, and--
(1) 29 percent of LGBTQ youths attempt suicide, which is almost 5 times
more likely than heterosexual youths;
(2) approximately 31 percent of LGBTQ older adults report symptoms of
depression, and 39 percent report seriously thinking about suicide;
(3) 30.8 percent of transgender individuals report considering suicide
compared to 2.3 percent of heterosexual individuals; and
(4) of the 4,890 transgender individuals incarcerated in State prisons,
only 15 were confirmed of being housed according to their lived gender,
which poses a significant threat to their mental health;
Whereas the COVID-19 pandemic has highlighted the gaps in our health system when
it comes to mental health and substance use disorder services and shown
how sheltering in place and isolating can impact one's mental health and
substance use, specifically showing--
(1) that 47 percent of people report that the pandemic has negatively
impacted their mental health, with 21 percent saying that it has had a
major negative impact;
(2) a significant increase in number of calls to suicide prevention
hotlines;
(3) a 1,000-percent increase in texts to SAMHSA's mental health hotline
to about 20,000 texts in April 2020;
(4) a 55-percent increase in number of alcohol sales; and
(5) an 11.4-percent increase in overdose fatalities in the first
quarter of 2020 driven by increased feelings of anxiety, depression, and
use of substances; and
Whereas there is a need for a population health approach that examines the
distribution of health across populations and focuses attention on the
need to provide access to the best evidence-based treatment for those
with mental health conditions and substance use disorders who need
clinical intervention in order to effectively reduce or mitigate the
impact of risk factors that lead to psychological distress among those
in high-risk populations: Now, therefore, be it
Resolved, That it is the sense of the House of Representatives that
in order to effectively address the high prevalence of those suffering
from mental health conditions and substance use disorders, the United
States needs to make historic financial investments into mental health
and substance use disorder care and finally acknowledge such care as a
priority in health care, equal to physical health, and recognize that--
(1) mental health and physical health need to be treated
together to treat the whole patient;
(2) patient care needs to be patient-focused;
(3) mental health and substance use disorder care needs to
be proactive and treat people before they are in crisis;
(4) any stigma associated with mental health and substance
use disorders is completely unwarranted and serves as a barrier
to care;
(5) the Federal Government needs to create a comprehensive
approach to improving the health care system that incorporates
mental health and substance use disorders that includes system
reform that--
(A) aims to break down silos across the Federal,
State, local, and Tribal levels for improved
communication and care coordination;
(B) provides a Federal framework to States,
localities, and Tribes that connects agencies and
services so they can have guidance when working to
address the mental health and substance use disorder
needs of their communities;
(C) incentivizes providers to see both more complex
and less complex patients and to see patients in rural
and underserved areas;
(D) expects insurers to comply with parity laws and
holds them accountable for not providing parity of
mental health and substance use disorder services and
treatments; and
(E) requires both public and private payers to have
higher reimbursement rates for mental health and
substance use disorder services that are on par with
medical and surgical services;
(6) the Federal Government needs to create a comprehensive
approach to improving the health care system that incorporates
mental health and substance use disorders that includes system
improvements that--
(A) focuses on early screenings, diagnosis, and
intervention across the care continuum to prevent those
from experiencing a mental health crisis;
(B) improves families' ability to access timely,
affordable, and high-quality treatment and services;
(C) strengthens mental health and substance use
disorder services in schools and ensures there is
engagement from all stakeholders;
(D) improves and expands community-based services
so people have access to services locally;
(E) improves care coordination across treatment
settings so patients have the services they need when
they need it and do not need to navigate the system
themselves;
(F) promotes a sustained recovery that includes
social determinants of health, such as housing, jobs,
and childcare;
(G) can adjust to meet the needs of each individual
to provide the best care for each person;
(H) ensures seamless transitions in care when
moving through steps or processes;
(I) ends the criminalization of mental illness and
substance use disorders and increases programs for
diversion that connects individuals to treatment,
social supports, and social services;
(J) provides access to high-quality and evidence-
based mental health and substance use disorder care for
those who are incarcerated;
(K) creates young adult services and programs
within the justice system for those who are ages 18 to
25 to successfully reduce recidivism and that are
informed by neuropsychological brain science;
(L) incorporates apprenticeship or job training
programs into the justice system, particularly for
youth, to empower them and reduce recidivism;
(M) ensures cultural congruence so everyone in need
of mental health and substance use disorder care has
services that meet their needs;
(N) adopts a population health approach as a tool
to help address ongoing disparities in access to mental
health and substance use disorder care by youth and
adults of color;
(O) ensures that LGBTQ individuals, communities of
color, and immigrants have access to mental health and
substance use disorder services that are culturally
appropriate, are in the necessary language, and address
any unique stigma from their communities;
(P) enables veterans to access timely mental health
and substance use disorder care that ensures continuity
and is free of any administrative burdens;
(Q) includes training for educators, first
responders, and clinicians to identify indicators of
mental health conditions and substance use disorders
and to reduce stigma and bias related to these
conditions so they can respond in a more productive way
and connect people with more appropriate services;
(R) supports health care providers by addressing
their mental health and substance use disorder needs to
reduce burnout;
(S) provides a process in which States can work
with other States to reconcile licensure and
certification for and reimbursement to mental health
and substance use disorder providers across State lines
for the purpose of telemedicine;
(T) leverages the current mental health and
substance use disorder workforce by reducing
administrative burdens to allow mental health and
substance use disorder providers to perform to their
highest level of licensure and certification; and
(U) expands training opportunities and grows the
workforce by partnering with schools and programs to
provide free education to those who work in rural or
underserved areas;
(7) expanded access to mental health and substance use
disorder care is essential to improving health and well-being;
(8) all Americans deserve access to mental health and
substance use disorder care without any barriers, such as cost
or location of services; and
(9) the United States needs to comprehensively break down
all barriers to receiving access to mental health and substance
use disorder care including financial burdens and location
hurdles.
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