MENTAL HEALTH IN THE BLACK COMMUNITY; Congressional Record Vol. 165, No. 184
(House of Representatives - November 18, 2019)

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  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2019, the gentlewoman from the Virgin Islands (Ms. Plaskett) 
is recognized for 60 minutes as the designee of the majority leader.

                             General Leave

  Ms. PLASKETT. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and include 
any extraneous material on the subject of this Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from the Virgin Islands?
  There was no objection.
  Ms. PLASKETT. Mr. Speaker, tonight we will address mental health 
within the Black community, the lack of access to treatment, and the 
stigma of mental health within our community.
  The stigma of mental health and lack of access to treatment within 
the Black community frequently leads to Black people ignoring or 
dismissing those signs of illness.
  Mr. Speaker, I yield to the gentlewoman from Ohio (Mrs. Beatty) to 
give remarks on this and other matters of health in our community as 
well as in America.

                              {time}  2030

  Mrs. BEATTY. Mr. Speaker, first, I thank my colleague and friend, 
Congresswoman Plaskett, for leading tonight's Congressional Black 
Caucus Special Order hour.
  First, and certainly fitting, to tonight's topic on mental health, I 
salute the life and legacy of a giant in the healthcare industry who 
passed on November 10, Bernard Tyson, president and CEO of Kaiser 
Permanente and friend.
  Just this year, Mr. Speaker, he was talking to the editor-in-chief of 
Fortune magazine about lessons learned and lessons that were worth 
remembering, and now he has left them behind, and those lessons were 
about mental health.
  He was talking about, in this healthcare system, we have a system of 
healthcare for the body and for the mind, and he had integrated both 
into his system, and he had done it in a seamless way and in a way that 
did not have stigma.
  So, tonight, I say to my friend: Rest in peace. Rest in positive 
power in healthcare.
  But also, Mr. Speaker, the Congressional Black Caucus is coming 
together tonight, as the Congresswoman has said and as she powerfully 
leads us, to elevate the conversation about mental health in the 
African American community.
  Millions of adults and children are impacted by mental health 
conditions each year, including depression, schizophrenia, bipolar 
disorder, post-traumatic stress, and anxiety.
  For too long in our country, there was a stigma associated with 
mental health, especially in our community, the African American 
community. According to the United States Department of Health and 
Human Services, Offices of Minority Health, just in 2017, suicide was 
the second leading cause of death for African Americans between the 
ages of 15 and 24. Additionally, the death rate from suicide for Black 
men was four times greater than for African American women in 2017.
  We are encouraged, encouraged to see more influencers, such as Jay-Z 
and the ``Breakfast Club'' host, Charlamagne, speak out about mental 
health disparities in the Black community. But as the gentlewoman is 
leading us tonight in saying more must be done, the Federal Government 
has a moral obligation to invest more resources into mental health 
  Mr. Speaker, I thank the gentlewoman for her leadership, and I thank 
her for being a voice for us on this topic.
  Ms. PLASKETT. Mr. Speaker, I thank the gentlewoman so much for her 
admonishment to us to continue working, to continue doing what is 
necessary for those of us who live in the Black community, for those 
who are affected by what is a lack of treatment in the Black community, 
particularly in the area of mental health.
  This may explain why Black adults are 20 percent more likely to be 
reported having serious psychological distress than White adults. They 
are also more likely to have feelings of sadness, helplessness, and 
worthlessness compared to their White counterparts. And while less 
likely than their White counterparts to die from suicide, Black 
teenagers are more likely to attempt suicide than our White teenagers.
  Socioeconomic determinants have been found to have significant 
effects on mental health. In the Black community, class and poverty are 
two powerful, impactful factors.
  Black adults living in poverty are two to three times more likely to 
report serious psychological distress than those living above the 
poverty line.
  Black people of all ages are more likely to be victims of serious 
violent crime than non-Hispanic Whites, making them more likely to meet 
the diagnostic criteria for post-traumatic stress disorder.
  Mental health conditions do not discriminate based on race, color, 
gender, or identity. Anyone can experience the challenges of mental 
illness, regardless of their background. However, cultural differences, 
life experiences, socioeconomic conditions, and how well-informed one 
is can affect how an individual copes with these conditions.
  In the Virgin Islands, after the devastating storms of 2017, studies 
organized by the Community Foundation of

[[Page H8950]]

the Virgin Islands found that the trauma and lack of community caused a 
significant percentage of the population, both children and adults 
alike, to develop various mental health problems.
  Younger children are reverting to behaviors they had once advanced 
beyond, and older children are displaying cognitive impairment and 
aggressive tendencies.
  Also, about 60 percent of adults in the Virgin Islands are exhibiting 
symptoms of depression; the same percentage showed signs of PTSD.
  More than a year after the storms, 40 percent of surveyed students 
had symptoms of PTSD, with some admitting to having suicidal thoughts.
  Although anyone can develop a mental health problem, African 
Americans sometimes experience more severe forms of mental health 
conditions due to unmet needs and other barriers.
  According to the Health and Human Services Offices of Minority 
Health, African Americans are 20 percent more likely to experience 
serious psychological distress. Black Americans are also more likely to 
experience socioeconomic disparities, such as exclusion from health, 
educational, social, and economic resources, and are often not believed 
by medical professionals when reporting symptoms--often not believed. 
These disparities contribute to unfavorable mental health outcomes.
  Historical adversity, including slavery, sharecropping, segregation, 
along with other means of race-based exclusions from health, 
educational, and socioeconomic resources, have led us to the 
disparities experienced by Black Americans today. Despite progressive 
gains and reform in our society, racism lingers and continues to impact 
the Black community, including the state of mental health.
  One of the individuals who is fighting this--not just mental health, 
but all health issues, and particularly among African Americans, the 
Black community--is my colleague from Chicago, Congresswoman Robin 
Kelly. She leads the Congressional Black Caucus in health areas by 
leading our Braintrust on Health and has spent a significant amount of 
time in her district and throughout this country highlighting the 
issues that affect African Americans, disparities in health issues, as 
well as mental health.

  I ask her to speak to you, Mr. Speaker, about those issues that 
affect Black Americans, about those issues that impact our community 
and, therefore, impacts America, that does not let us be our best.
  Mr. Speaker, I yield to the gentlewoman from Illinois (Ms. Kelly).
  Ms. KELLY of Illinois. Mr. Speaker, I thank Congresswoman Plaskett 
for yielding and for her continued leadership in advancing equity and 
access for all Americans.
  Mr. Speaker, I rise tonight to speak about something that is far too 
often ignored in our communities, especially the African American 
community: mental health.
  Before starting my career in public office, I obtained a master's in 
counseling and worked as a mental health professional. As someone with 
real-life experiences, I can tell you that mental health challenges are 
more common than anyone thinks and that the only path forward is to be 
open and honest about it so more people can get the help and support 
they need to be healthy and thriving.
  According to recent surveys, African Americans are 20 percent more 
likely to experience psychological distress than White Americans, but 
just 25 percent will seek care compared to 40 percent of White 
Americans. Clearly, stigma around mental health and therapy remain a 
significant barrier to connecting those in need with care.
  We can all agree that Americans, no matter where they live or what 
they look like, should have access to affordable and accessible mental 
health services. However, this was not the case until 2010, with the 
passage of the Affordable Care Act, which moved mental healthcare from 
a nice-to-have to essential care--what it always should have been 
  Defining mental healthcare as essential healthcare was a major step 
forward. But as I noted before, stigma still prevents too many from 
seeking and assessing the care they need. That is why I am proud of the 
efforts undertaken by the Congressional Black Caucus Health Braintrust 
and the Congressional Caucus of Black Women and Girls, which I chair 
and co-chair, respectively, to destigmatize seeking mental healthcare.
  Last year, we were joined by the first lady of New York City, 
Chirlane Irene McCray, for a briefing on how we can destigmatize mental 
healthcare and better share our personal experiences to help and 
empower others. The video of that conversation is still on my Facebook 
page, and it warms my heart to see women sharing their stories on the 
thread months after the Facebook Live ended.
  We need more events like this. We need more conversations where we 
put it all on the table and accept the simple fact that, yes, it is 
hard sometimes, but there are people and organizations who can help.
  In addition to reducing stigma, which is something every Member of 
this House can do in their own districts and communities, we need to 
continue working to connect the most vulnerable with care, in 
particular, those who are regularly impacted by gun violence. In parts 
of Chicagoland, our young people have levels of PTSD on par with 
veterans returning from Iraq and Afghanistan.
  While we absolutely must address easy access to guns--as a reminder, 
H.R. 8, the Bipartisan Background Checks Act, has been sitting on 
Senate Majority Leader Mitch McConnell's desk for more than 200 days--
we cannot forget that communities have been experiencing this violence 
for decades because of congressional inaction.
  We talk about PTSD as post-traumatic. Many in my communities have 
present-traumatic; it is not ``post.'' It goes on day after day after 
  To break the cycle of violence, these communities need programs that 
empower our young people and create hope. I always say nothing stops a 
bullet like an opportunity.
  We need to work together, Republicans and Democrats, House and 
Senate, to ensure an end to gun violence and ensure robust programs 
that address the long-term psychological impacts created by years of 
unchecked violence. This is going to affect us for generations unless 
we do something about it.
  And, finally, I want to talk about a tragic reality in our Nation. 
Suicide rates are rising. Suicide is the leading cause of death for 
Generation Z, our Nation's young people. I believe our host, 
Congresswoman Plaskett, talked about the effects on African American 
young people. Our Nation's veterans are still struggling to access the 
care they need and deserve.
  In Chicagoland, we, tragically, experienced a marked rise in first 
responder suicides. Likewise, we are seeing rising rates in rural 
America, especially among our farmers because of severe weather, low 
commodity prices, and the failed Trump trade war.
  It is past time to make suicide prevention a priority. We are losing 
too many fathers, sisters, sons, and neighbors to this epidemic. We are 
losing too many African American fathers, sisters, sons, and neighbors 
to this epidemic.
  In conclusion, I want to challenge my colleagues to take up the 
mantle of mental health. In 2010, this House declared mental health 
essential, just like care for our heart, kidneys, and lungs. We now 
recognize that our minds and mental well-being are a key part of our 
overall health and should be covered as such.
  However, that declaration was nearly a decade ago. We know it is 
important, so we need to get to work on it now.
  Let's pass Congresswoman Grace Napolitano's bipartisan Mental Health 
Services for Students Act and help put more counselors and mental 
health professionals back in our schools to serve our students.
  Let's pass Congressman Cleaver's bipartisan Cady Housh and Gemesha 
Thomas Student Suicide Prevention Act to address the shocking and 
growing rate of suicide among our Nation's students and young people.
  And let's pass Congresswoman Plaskett's bipartisan Territories Health 
Equity Act to ensure that Americans living in territories have the same 
access to quality mental healthcare as Americans living in the 
continental United States.
  In summary, Mr. Speaker, 2010 marked a significant and bold step 
forward. We need to be bold today.

[[Page H8951]]


  Ms. PLASKETT. Mr. Speaker, I thank the gentlewoman from Illinois for 
what she has said, and, Mr. Speaker, I would engage the Congresswoman, 
through the Chair, in a discussion. I know that she has been going 
around the country to so many districts and talked with so many people 
about healthcare, about the disparities of health.
  Is there a connection between the lack of access to physical 
healthcare and how it affects communities in terms of mental care as 
  I yield to the gentlewoman.
  Ms. KELLY of Illinois. Well, in some communities there is a lack of 
both physical and mental healthcare, but I think we still have to deal 
with the stigma that people don't see mental health as a part of 
  I know, in the Chicagoland area, right when I became a Congresswoman, 
actually, there were six mental health facilities shut down, so if 
someone wanted help, they may have to take two buses, a taxi, on and on 
and on. There is such a barrier of not only a facility not being there, 
but also the ones that are around, it is so hard for people to get to 
  And some of the neighborhoods, like I said, people don't even want to 
come outside because of the violence and some of the particular--not 
all over, but in some of the neighborhoods.
  People are traumatized by the block they live on. They don't want to 
send their kids to play in the park. They don't want to go to the 
store. To deal with this every day, to hear gunshots every day, to have 
to deal with violence every day, that affects you on that day, but it 
affects you years later, also.
  Ms. PLASKETT. I think so much about when the gentlewoman said people 
talk about post-traumatic stress disorder, and there are so many people 
in our country who are having present-day traumatic stress disorder.
  In the Black community, there is this stigma to just live through it, 
not discuss it, and begin normalizing the kind of life that we lead, 
the kind of fear that many people in Black communities have, whether it 
is fear of being shot or fear of the police.
  Mr. Speaker, I think, as a Black mother having four sons, I begin to 
think that it is normal to be concerned for my sons out at night. That 
is not normal, and that is going to affect your mental state after a 
  So I think of all these people and the things that they are going 

                              {time}  2045

  Right. It should not be normal. We are, unfortunately, normalizing 
some things. But no, that should not be normal.
  Every mother worries about their child, but it shouldn't be, ``If my 
child is not home by a certain time, I am so worried,'' and all of 
these things that are going through your mind. That should not be 
normal for us.
  The other thing is, when you are stressing out about certain things, 
that not only affects your mental health, but it affects your physical 
health also. It affects your body head to toe, which is not good 
either. Then it gets into the high blood pressure that we face and 
heart disease and those kinds of things.
  It really does have a huge effect all over, not just on one thing or 
the other.
  Ms. PLASKETT. I think about how, if a family has individuals with 
diabetes, hypertension, the other issues, and they are taking money and 
time to deal with that--if, in fact, they are--they are not considering 
going to counseling or going to some other things about depression or 
other things that they may be feeling and things that may be happening 
within their home.
  It is a matter of taking care of what is the immediacy.
  Still, the stigma is there that your mental health is not as 
important as your physical health.
  I yield to the gentlewoman.
  Ms. KELLY of Illinois. I think mental health gets put on the back 
burner, that people will talk about, ``Oh, my arm hurts,'' or this 
hurts, or that hurts, but they don't want to say, ``I am depressed,'' 
or ``I am down,'' or ``I need counseling.''
  I sometimes think in our community--maybe in others, but we know in 
our community, ``You need to man up,'' or be strong, or give it to God 
even. You know, God will take care of this, that, and the other, so 
have faith, and those kinds of things.
  I think that God also put doctors and counselors on this Earth--and 
therapists--for us to use them and use their services. I think not 
enough of us do that, or we don't feel comfortable. If no one else in 
the family ever talks about it, then you don't grow up even thinking 
that is a possibility.
  Ms. PLASKETT. Then there is the issue of having culturally sensitive 
doctors as well.
  Ms. KELLY of Illinois. Definitely.
  Ms. PLASKETT. Because so many individuals in the African American 
community, if they are going to speak with a psychiatrist, a mental 
health professional, if that individual does not--never mind that they 
don't look like them, but if they are not culturally sensitive to the 
issues, they may not come back the second time. They may not even make 
the appointment if they realize that this person is not going to be 
able to understand the life that they lead here as a Black person in 
  I yield to the gentlewoman.
  Ms. KELLY of Illinois. Congresswoman, you hit the nail on the head. 
That is so true.
  There have been so many studies that show you do better when the 
person who is helping you looks like you or is sensitive to your 
realities, your community, what you are really about. That is so true.
  Also, that is the other thing. With the Congressional Black Caucus 
Health Braintrust, the other thing that we really push to do is to 
diversify the healthcare pipeline because that is the only way that is 
going to change, too.
  The other thing is letting our young people know that that is a good 
thing, to be a counselor or a social worker or a psychiatrist or a 
psychologist, that we should be looking into those fields also.
  You hit the nail on the head. It is hard enough for people to go to 
counseling or to admit they are depressed, so when they do seek out 
care, it has to be someone who can be empathetic and sensitive to their 
needs. Because if they are not, then the person definitely is not going 
to go back, and then, we are back to square one.
  Ms. PLASKETT. I was looking at a statistic here that, according to 
the Health Resources and Services Administration, 89.3 million 
Americans live in federally designated mental health professional 
shortage areas, in contrast to only 55.3 million Americans living in 
similarly designated primary care shortage areas and 44.6 million 
living in dental health shortage areas.
  There is, within the greater American society, a shortage of those 
professionals in the mental health area. For African Americans, that 
number is exacerbated with African Americans that look like themselves.
  We are just thinking about the Speaker earlier today issuing a 
statement saying that the Senate is considering cutting all funding--
not supporting funding for HBCUs, historically Black colleges and 
universities, where we know that a preponderance of the African 
Americans in the mental health area have been going to school.
  I yield to the gentlewoman.
  Ms. KELLY of Illinois. Right. That would be devastating for our 
community for that to happen. When I think about my district, which is 
urban, suburban, and rural--
  Ms. PLASKETT. You have rural in your area as well.
  Ms. KELLY of Illinois. Yes, I do. I have 1,200 farms. The other thing 
is, I have people in those areas who don't have cars. There are not 
buses and things like that, so again, they don't have the 
transportation or the means even to get out to go to, let's say, a 
bigger town in my district to go seek mental health help.
  We have to do more to have more professionals. This is not the time 
to cut back. When you think about just the stresses of living today, we 
need to have resources available for our students and even our 
veterans, our farmers, people who we named that are suffering from 
various things that are going on right now.
  Ms. PLASKETT. The other area is that those even who receive 
treatment, one of the things that we have noted is that African 
Americans are negatively affected by prejudice and discrimination when 
they are in the healthcare system.
  Missed diagnoses, inadequate treatment, improper bedside manner, and

[[Page H8952]]

lack of cultural competence all lead to an exacerbation of health 
issues that cause distrust and prevent many African Americans from 
seeking help in the healthcare area.
  I yield to the gentlewoman.
  Ms. KELLY of Illinois. Right. I think it is hard enough for us to go, 
and then, if we go and don't feel comfortable or feel like we are 
getting the respect or getting the care, the likelihood of us returning 
is not there.
  I mean, you would think that with anybody, of course, that you want 
to be treated with a good bedside manner, with respect. You want to 
feel that the person is listening to you, not blowing you off.
  Even when it comes to physical healthcare, the idea that we can take 
more or we don't need this or don't need that, that has been found to 
be true in how we have been treated.
  The same thing in mental health. We don't want that either. We don't 
want to be looked at as the angry Black man or the angry Black woman as 
we are expressing ourselves.
  Ms. PLASKETT. I know that there have been studies, which you were 
just discussing, where Black women are historically mistreated by 
doctors because they do not believe African American women when they 
say that they are not feeling well or when they are complaining about 
an ache or a pain, that a diagnosis on a larger scale is not done on 
them once they say that.
  Ms. KELLY of Illinois. That is why we have the issue that you know I 
am very passionate about: maternal mortality and morbidity.
  Interestingly enough, yes, some happen before the full term, but some 
happen when the mom has the baby, and it also happens after the mom has 
the baby. There could be incidents more than 2 months after the mom has 
the baby. There is postpartum depression.
  But if we are not taken seriously, then one thing can lead to 
  Ms. PLASKETT. This cuts across all economics of African Americans. 
This is not just about poor Black women.
  Ms. KELLY of Illinois. Right.
  Ms. PLASKETT. This happens at the highest economic levels of Black 
women dying in great numbers after giving birth to children.
  Ms. KELLY of Illinois. Economic, educational, you could be in the 
best physical health. Black women die at three to four times the rate 
of White women. But depending on which State you go to, the rates are 
  In my State of Illinois, it is six to one times. I just met with 
someone out there, and they said it looks like it might be even a 
little higher. In New York, it is eight to one times. In the State of 
Washington, it is not Black women but Native women at eight to one 
times the rate of White women. Yes, it cuts across every socioeconomic 
characteristic that you can find.
  Ms. PLASKETT. I thank Ms. Kelly for her leadership and continued 
support on this subject.
  For those who need a voice here in Washington, I know she is at the 
forefront, not just on mental health issues but all health issues, 
including the fact that she has considered gun violence a health issue. 
She is fighting for additional funding at NIH in this area.
  The totality of the health of the American people, I think, is so 
important, and I am grateful for Ms. Kelly's leadership in that and her 
continuing to bring up these topics.
  Ms. KELLY of Illinois. I thank the gentlewoman for her leadership. 
Anything I can do to help, of course, I am always here.
  Ms. PLASKETT. One of the things, Mr. Speaker, that we wanted to talk 
about was Blacks being overrepresented in prison: 1 million of the 
total 2.3 million people incarcerated in the United States. One million 
of those 2.3 million are, in fact, African American. That is another 
area for mental health that Black Americans face.
  A current major national concern: People of color account for 60 
percent of the prison population. While only 14 percent of Black people 
are drug users, we account for 37 percent of drug arrests.
  This incarceration could contribute to mental health issues of Black 
people and raises questions surrounding the delivery of mental health 
services in prison.
  The reverse is also true. The lack of access to mental health testing 
and treatment may, in fact, lead to incarceration. This reality leads 
to real issues in healthcare regarding access, mental health, and 
quality care treatment.
  Treatment issues that must be addressed include the fact that the 
Black community is overrepresented in inpatient treatment and 
underrepresented in outpatient treatment, highlighting the need for 
more early education and intervention.
  Regarding misdiagnosis and access to care, access is a central point 
of contention when thinking about the care of Black psychiatric 
patients. Often, communities such as my district are not equipped with 
adequate facilities and services. In the Virgin Islands, there is not 
just a lack of inpatient care for mental health but outpatient as well.
  At this point, we have almost no separate mental health facility. 
Either individuals have to be sent off-island or, unfortunately, many 
people are sent to correctional facilities for nonviolent crimes who 
are experiencing, in fact, a mental health issue.
  Unfortunately, over a year ago, we lost a young man who obviously had 
very severe mental health issues that his family had been treating him 
for. He had been sent to prison because we don't have that mental 
health facility. He, in fact, lost his life in the correctional 
facility, knowing that this poor young man had mental health services 
that he needed and that our island does not have the resources, the 
funding, to be able to provide.
  Research has shown that a lack of cultural competency in mental 
healthcare, as I discussed earlier and as you heard from Congresswoman 
Kelly, results in misdiagnosis and inadequate treatment.
  While Black patients may prefer Black physicians, only about 2 to 4 
percent of mental health providers identify as Black--2 to 4 percent--
in this country, meaning that Black patients are likely to be seen by a 
provider from a different cultural and ethnic background than their 
  Similarly, in research, there is a paucity of Black researchers and 
Black patients participating in research, which is problematic as 
research is the basis for evidence-based clinical care.
  These are all issues that are affecting the Black community.
  Some may think that we also have the stigma of what do we as African 
Americans think. African Americans are reluctant to discuss mental 
health issues and seek treatment because of the shame and the stigma 
associated with such conditions.
  Many African Americans also have trouble recognizing the signs and 
symptoms of mental health conditions, leading to underestimating the 
effects and the impacts of mental health conditions. That affects all 
of us, at all levels.
  I know, as a parent, as an African American parent, I have been one 
individual who has done this also, not recognizing when a son is 
feeling depressed and just thinking that he needs to suck it up and go 
on with his work and do what he needs to do and thinking that, ``You 
already know that you are a Black man in America. You don't have time 
to feel sorry for yourself. You have to push through,'' and realizing 
that that son was really depressed and needed to get some mental health 
  These are things that are affecting our community, and we need to be 
upfront about what we are facing. Some may think of depression as the 
blues or something that needs to be snapped out of.
  ADHD in a child is often regarded as a child being bad. Too often, 
young Black men are put in suspension or, even at the age of 
kindergarten, separated from school, taken out of the classroom because 
of bad behavior that a teacher recognized. That same behavior in a 
White student is not seen that way.

                              {time}  2100

  Those signs, that lack of sensitivity begins at the youngest age in 
Black America, and those are the things that we must be careful about.
  Oftentimes, people assume that their emotional mental state is 
normal, not realizing that they are suffering from disordered thinking 
or a clinical symptom.
  Approximately 30 percent of African American adults with mental 
illness receive treatment each year, compared

[[Page H8953]]

to the U.S. average of 43 percent. Here are some the reasons why.
  Socioeconomic factors play a part, too, and can make treatment 
options less available. In 2017, 11 percent of African Americans had no 
form of health insurance.
  For the Virgin Islands, we have this issue as well. We have only one 
full-time and one part-time psychiatrist for our islands. Today, the 
traumas of the storms that rocked the territory have become apparent, 
and, as a result, mental health is being talked about more frequently.
  I am grateful that our Governor, Governor Bryan, is declaring a 
mental health state of emergency for our islands, being clear-eyed and 
noticing that this is such an issue that we must face.
  However, access to mental health treatment is still in dire need of 
improvement. For many years, the lack of a facility and mental health 
providers have led to the Virgin Islands' government spending millions 
of dollars to send mental health patients off-island due to an 
inability to treat them within the territory. The cost of sending 
children off-island for mental health treatment totals $13 million a 
year, a significant amount for a jurisdiction with a small annual 
  The territory currently has no inpatient facilities. Outpatient 
facilities are unsuited to meet the needs of the Virgin Islands.
  A 2019 study conducted by the Caribbean Exploratory Research Center 
found that 6 out of 10 Virgin Islanders showed depressive symptoms. The 
same study revealed the symptoms of PTSD in 57 percent of adults. These 
extraordinary numbers display a mental health crisis within the Virgin 
Islands that does not have the fiscal, occupational, or infrastructural 
capacity to handle.
  The lack of mental health professionals and mental health education 
and awareness creates a barrier for many obtaining care. But I know 
that the Virgin Islands is not the only place that faces this. Places 
like inner cities within the United States, Detroit and elsewhere, also 
experience these mental health issues.
  Mr. Speaker, I would like to acknowledge my colleague, one of my 
close friends here, a classmate of mine coming into Congress in the 
same class, Congresswoman Brenda Lawrence, who has made extraordinary 
strides in supporting not just the people of her district, but also 
being one of the co-chairs of the Women's Caucus here in Washington, 
continually bringing to light the issues that face women.
  Just earlier this evening, she had a dinner, women who had been 
incarcerated and the mental stress that they were dealing with being 
incarcerated. One woman, I know, Congresswoman, she discussed having 
her sentence with a 6-month old child that she had to stop 
breastfeeding because she had to go to prison, a woman, 2 weeks after 
giving birth, having been sent to prison for being a girlfriend of a 
drug dealer. These are the kinds of things that women in America have 
been dealing with.
  Mr. Speaker, I am so grateful to Congresswoman Lawrence for taking 
the lead on supporting women in this country, for talking about 
inequities and always dealing with issues that affect those Americans 
who cannot speak here in these Halls.
  Mr. Speaker, I yield to the gentlewoman from Michigan (Mrs. Lawrence) 
to discuss these issues with us.
  Mrs. LAWRENCE. Mr. Speaker, I want to thank the gentlewoman from the 
Virgin Islands for her leadership. It is imperative that we use our 
platform as Members of Congress to highlight the crisis of mental 
  So often when we talk about gun violence, it leaves the crisis of gun 
violence and goes to mental illness; but we have not, as America, taken 
the steps we need to take.
  Black and African American communities, we are seeing 13.2 percent of 
the U.S. population who are identified as Black or African American; of 
those, 16 percent has a diagnosed mental illness in the past year.
  I had a friend of mine, she is a therapist, and we had a roundtable 
in the community that I hosted on mental illness. The T-shirt she 
wears, says: ``I'm an African American. I go to church. I believe in 
God. And I see my therapist.''
  So often in our community you hear the words, ``just pray about it 
and God will fix it.'' But you don't say that to someone who has heart 
disease. Yes, we pray and, yes, we believe in God, but we also must get 
the healthcare we need. Mental health is an issue that we are facing.
  And when we talk about women, we just had this amazing, informative 
dinner tonight, and the stress, the abuse, the separation, and they 
were giving us examples: at 3 in the morning, hearing the weeping and 
crying of women who have not seen their children, would just love to 
put their arms around them, those who are in prison and have no clue 
why they are in there, and to have the guards tell them that they have 
to perform sexual acts if they want to see their children, and if they 
fail to do it, they deny them access.
  When these women come out of prison, they are broken and they are 
wounded. And the major issue that we need to confront, when you talk 
about women surviving and their mental health, the number one criteria 
for a woman to be reunited with her children is housing.
  If a woman has been imprisoned, she has no income. She comes out 
homeless. She is living in a shelter, and she cannot provide the 
housing, and so she is still not joined together with her child. And 
she is confronting her children, being a free woman, who are crying, 
saying: Mommy, when are we going to go home together again?
  And another issue, think about in Washington, D.C., a two-bedroom 
apartment, and the law requires that, if you have a boy and a girl, you 
have to have at least a three-bedroom apartment. Can you imagine the 
costs? And how can a woman afford that?

  We have so many historical issues that have impacted the 
socioeconomic resources, the economic resources, that there are 
disparities by African Americans today. The socioeconomic status, in 
turn, is linked to mental health.
  People who are in prison, people who are homeless, incarcerated, or 
have substance abuse problems are at a higher risk for poor mental 
health. And putting people who are mentally ill in prison has become 
the norm in America.
  Instead of us stepping up and using our ability to provide mental 
health, we incarcerate. And we see the victims of people with mental 
illness killing people through gun violence, and all we do is have a 
moment of silence, and we talk about, well, we knew something was wrong 
with them.
  We heard a parent on the TV, because we just had another shooting, 
and he was saying: I tried to get help and no one would help me. I knew 
my son was mentally ill. I cried out.
  We must change this in America.
  I thank the gentlewoman so much for giving us an opportunity to bring 
this voice and, hopefully, shake America awake to this issue. We have 
so much work to do. We need to see our physical doctor, and we need 
mental health, as well, in America.
  Ms. PLASKETT. Mr. Speaker, I would like to also acknowledge the work 
that another Member of Congress, Max Rose, does in mental health 
related to veterans. We know so many of those veterans are, in fact, 
African American, coming back home after having served this country, 
facing already racial disparities, facing issues of race in America, as 
well as the trauma of what they have been through in serving us.
  We are grateful for that support to those veterans so that they can 
sustain themselves, get back to being productive in this country. I 
want to thank the gentleman for that work that he has done.
  But I just want to close with letting people know about some 
statistics and then giving them a charge.
  According to the American Psychiatric Association, African Americans 
are less likely to receive guideline-consistent care, less frequently 
included in research, and more likely to use emergency rooms or primary 
care rather than mental health specialists. Only one in three African 
Americans who need mental healthcare receive it.
  Plaguing issues of poverty, mass incarceration, and financial 
hardship have increased mental illness and suicide in the African 
American community.
  I just want to give people a charge: Start the conversation about 

[[Page H8954]]

health with your peers. Show compassion. Do not be judgmental. Your 
language matters.
  Advocate, if not for yourself, for your family, for your community. 
Write down all the things that make you upset, for example, media, 
police brutality, poor perception/narrative of African Americans. Write 
it down and embrace your voice.
  In the Black community, more people promoting solidarity are talking 
about their struggles publicly, but we need more people to share their 
experiences. We are at our best when human connection and connectivity 
happen. Share your story.
  I thank the men and women who, across the Nation, are fighting to end 
the stigma, do the research, and make mental health treatment more 
accessible in the Black community, including our own, in the Virgin 
Islands, Dr. Janis Valmond, deputy commissioner for health promotion 
and disease prevention, who has provided a lot of the information I had 
  The Congressional Black Caucus uses this Special Order hour to let 
America know what is happening in our community.
  Mr. Speaker, I yield back the balance of my time.
  Ms. JACKSON LEE. Mr. Speaker, I thank my Colleague Congresswoman 
Plaskett for anchoring tonight's Congressional Black Caucus Special 
Order on Mental Health.
  Mental health includes our emotional, psychological, and social 
wellbeing. It affects how we think, feel, and act.
  It also helps determine how we handle stress, relate to others, and 
make choices.
  Those experiencing mental health problems can have difficulty 
thinking, experience mood swings or inappropriate emotional reactions 
to everyday events, and behavior or engagement with others could be 
  Many factors contribute to mental health problems, including: 
biological factors can include individual brain chemistry; traumatic 
life experiences, such as the sudden death of a loved one, involvement 
in a major accident, traumatic experiences during times of war or as a 
consequence of serious illness; family history of mental health 
  People can experience different types of mental health disorders, 
such as: Uncontrolled anxiety, behavioral, eating disorders (anorexia, 
and bulimia are two frequently cited problems); substance abuse; mood 
problems such as overwhelming feelings of sadness, personality changes; 
psychotic behavior, and suicidal thoughts.
  African American adults are 20 percent more likely to experience 
mental health issues than the rest of the population.
  25 percent of African Americans seek treatment for a mental health 
issue, compared to 40 percent of white individuals.
  The reasons for this drop off include misdiagnosis by doctors, 
socioeconomic factors and a lack of African American mental health 
  Adult African Americans living below poverty are three times more 
likely to report severe psychological distress than those living above 
  African Americans are less likely than white people to die from 
suicide as teenagers, African American teenagers are more likely to 
attempt suicide than are white teenagers (8.3 percent v. 6.2 percent).
  The number of professionals that provide mental health care:
  Only 6.2 percent of psychologists,
  5.6 percent of advanced-practice psychiatric nurses,
  12.6 percent of social workers, and 21.3 percent of psychiatrists are 
members of minority groups.
  According to the National Association on Mental Illness (NAMI), only 
3.7 percent of members in the American Psychiatric Association and 1.5 
percent of members in the American Psychological Association are Black.
  African Americans of all ages are more likely to witness or be 
victims of serious violent crimes.
  Exposure to violence increases the risk of developing a mental health 
condition such as post-traumatic stress disorder, depression, and 
  African American children are more likely than other children to be 
exposed to violence, which can have a profound, long-term effect on 
their mental health.
  Some African Americans even see mental illness as a punishment from 
  Up to 85 percent of African Americans describe themselves as ``fairly 
religious'' or ``religious,'' and they commonly use prayer to handle 
stress, according to one study cited by the American Psychiatric 
  Nationally, suicide is the 10th leading cause of death among all 
Americans--over 47,000 people died by suicide in 2017.
  On average, there are 129 suicides per day.
  In 2017 there were an estimated 1.4 million suicide attempts.
  From 1999 through 2015, 1,309 children ages 5 to 12 died of suicide 
in the U.S.
  Suicide is the third leading cause of death among Black youth 
(Suicide is the second leading cause of death among all youth just 
behind accidental deaths).
  A report published in the JAMA Pediatrics, found that the rate of 
suicide for Black children ages 5 to 12 died by suicide exceeded that 
of White children.
  A study in the Journal of Community Health showed that suicide rates 
among black girls ages 13 to 19 nearly doubled from 2001 to 2017. For 
black boys in the same age group, over the same period, rates rose 60 
  Black youth are about half as likely as their White counterparts to 
get mental health care.
  Trauma and Suicide: Among urban males, PTSD is associated with 
increased suicide attempts.
  African Americans living below poverty are three times more likely to 
report serious psychological distress than those living above poverty.
  While African Americans are less likely than white people to die from 
suicide as teenagers, African American teenagers are more likely to 
attempt suicide than are white teenagers (8.3 percent v. 6.2 percent).
  Less than 2 percent of American Psychological Association members are 
Black/African American, some may worry that mental health care 
practitioners are not culturally competent enough to treat their 
specific issues.
  African Americans are 10 percent more likely to experience serious 
psychological distress than their white counterparts.
  70 percent of youth in State and local juvenile justice systems have 
a mental illness (While just 14 percent of all youth under 18 in the 
U.S. are Black, 43 percent of boys and 34 percent of girls in juvenile 
facilities are Black.).
  Incarcerated youth die by suicide at a rate 2 to 3 times higher than 
that of youth in the general population.
  The LGBTQ+ community is 4 times more likely to die by suicide than 
their straight peers.
  The 2015 U.S. Transgender Survey found 40 percent of respondents had 
attempted suicide in their lifetime--nearly nine times the attempted 
suicide rate in the United States population at large.
  The Trevor Project estimates that more than 1.8 million lesbian, gay, 
bisexual, transgender, and queer youth seriously consider suicide each 
  The frequency and intensity of bullying that young people face are 
  1 in 7 students in Grades K-12 is either a bully or a victim of 
  90 percent of 4th to 8th grade students report being victims of 
bullying of some type.
  56 percent of students have personally witnessed some type of 
bullying at school.
  71 percent of students report incidents of bullying as a problem at 
their school.
  15 percent of all students who don't show up for school report it to 
being out of fear of being bullied while at school.
  1 out of 20 students has seen a student with a gun at school.
  282,000 students are physically attacked in secondary schools each 
  15 percent of all school absenteeism is directly related to fears of 
being bullied at school.
  According to bullying statistics, 1 out of every 10 students who 
drops out of school does so because of repeated bullying.
  Suicides linked to bullying are the saddest statistic.
  David Ray Ritcheson was a victim of adolescent bullying. He was 
bullied, beaten and tortured nearly to death because of his race. He 
spent 3 months in a hospital as a result of his injuries and underwent 
more than 30 surgeries to repair his battered body.
  His courage in the face of such violence was reflected in his 
willingness to come before Congress to tell his story. His courage 
inspired members of Congress to pass the Matthew Shepard and James 
Byrd, Jr. Hate Crimes Prevention Act which became law. [Public Law No: 
  Negative attitudes about mental illness often underlie stigma, which 
can cause those suffering from mental illness or their families not to 
seek help or deny clear symptoms of mental illness.
  The stigma of mental illness may cause the mentally ill to delay 
treatment, experience job discrimination, lead to the loss of 
employment, loss of housing, or cost personal relationships, and 
undermine successful recovery of those with mental illness or substance 
  To overcome stigma, we need to avoid using generic labels such as 
``retarded'' or ``the mentally ill'' and terms like crazy, lunatic, or 
slow functioning.
  According to the Behavioral Risk Factor Surveillance System, most 
adults (88.6 percent) agreed with a statement that people are generally 
caring and sympathetic to persons with mental illness.
  Adults with mental health symptoms (77.6 percent) agreed that 
treatment can help them lead normal lives.

[[Page H8955]]

  However, only 24.6 percent of those surveyed who had mental health 
disorders believe that people are caring and sympathetic to persons 
with mental illness.
  Psychiatrists advise that emphasizing abilities and not limitations, 
when talking about someone who has a mental illness is important for 
the self-esteem of the mentally ill.
  Everyone has strengths that are not related to a mental illness, and 
these should be the focus of those seeking help for the mentally ill in 
their lives.
  We have to change cultural and socially acceptable language and 
behavior toward the mentally ill--mental illness is nothing to laugh at 
or make light of.
  Mental health care disparities exist due to:
  1. Reluctance and Inability to Access Mental Health Services impacts 
the care of African Americans.
  Approximately 30 percent of African American adults with mental 
illness receive treatment each year, compared to the U.S. average of 43 
percent. Here are some reasons why.
  2. Distrust and misdiagnosis
  Historically, African Americans have been and continue to be 
negatively affected by prejudice and discrimination in the health care 
  Misdiagnoses, inadequate treatment and lack of cultural competence by 
health professionals cause distrust and prevent many African Americans 
from seeking or staying in treatment.
  Socio-economic factors play a part too and can make treatment options 
less available. In 2017, 11 percent of African Americans had no form of 
health insurance.
  3. Provider Bias and Inequality of Care
  Conscious or unconscious bias from providers and lack of cultural 
competence result in misdiagnosis and poorer quality of care for 
African Americans.
  African Americans, especially women, are more likely to experience 
and mention physical symptoms related to mental health problems.
  For example, they may describe bodily aches and pains when talking 
about depression.
  A health care provider who is not culturally competent might not 
recognize these as symptoms of a mental health condition.
  Additionally, men are more likely to receive a misdiagnosis of 
schizophrenia when expressing symptoms related to mood disorders or 
  Members of minority communities often experience bias and mistrust in 
health care settings.
  This often leads to delays in seeking care.
  Those seeking mental health services, must be informed on how to best 
determine the best person to provide them with care.
  Key factors should include whether the mental healthcare providers 
  Cultural Competence in Service Delivery
  Culture--a person's beliefs, norms, values and language--plays a key 
role in every aspect of our lives, including our mental health. 
Cultural competence is a doctor's ability to recognize and understand 
the role culture (yours and the doctor's) plays in treatment and to 
adapt to this reality to meet your needs.
  Cultural competence is important because cultural competence in 
mental health care results in misdiagnosis and inadequate treatment.
  African Americans and other multicultural communities tend to receive 
poorer quality of care.
  To improve the chances of getting culturally sensitive care patients 
should go directly to a mental health professional because this is 
their area of expertise, if they do not feel comfortable right away, a 
primary care doctor is a great place to start.
  The primary care doctor might be able to start the assessment to 
determine if a patient has a mental health condition or help refer them 
to a mental health professional.
  When meeting with a provider, ask questions to get a sense of their 
level of cultural sensitivity.
  No person seeking help should feel bad about asking questions.
  Health care providers expect and welcome questions from their 
patients since this helps them better understand the patient and what 
is important to them.
  Some of the essential questions that should be asked are:
  Have you treated other African Americans?
  Have you received training in cultural competence or on African 
American mental health?
  How do you see our cultural backgrounds influencing our communication 
and my treatment?
  How do you plan to integrate my beliefs and practices in my 
  The answers to these questions should inform the patient seeking 
medical care.
  Its is also important for the patient to know the clues that indicate 
that the medical professional may be biased in how they communicate 
with the patient regarding their medical condition.
  There have been tremendous advancements in medical care that include 
therapies and medications that allow persons with serious mental health 
conditions to lead productive and full lives.
  The Affordable Care Act takes a positive step forward to address the 
issue of mental illness and access by making it a requirement that all 
healthcare plans contain care for mental illness and substance abuse.
  Because of the health care law, for the first time insurance 
companies in the individual and small group market are required to 
cover mental health and substance abuse disorder services as one of ten 
categories of essential health benefits.
  Additionally, health insurance providers must cover mental health and 
substance abuse services at parity with medical and surgical benefits 
(which means things like out-of-pocket costs for behavioral health 
services must generally be comparable to coverage for medical and 
surgical care).
  The Affordable Care Act expands mental health and substance abuse 
disorder benefits and the parity created by the law protections 
approximately 60 million Americans by assuring coverage.
  The Affordable Care Act is one of the largest expansions of mental 
health and substance abuse disorder coverage in a generation.
  As part of the White House roll out of the Affordable Care Act a $100 
million commitment to improve access to mental health services was 
  The Affordable Care Act is providing $50 million to assist community 
centers provide more mental health services. The Department of 
Agriculture will provide an additional $50 million to finance rural 
mental health facilities.
  The health care law requires most health plans to cover recommended 
preventive services like depression screenings for adults and 
behavioral assessments for children at no cost to consumers.
  In the State of Texas it is expect that 5,189,000 people will have 
access to mental health and substance abuse assistance programs.
  Post-traumatic stress disorder is a psychiatric disorder that can 
occur following the experience or witnessing of a life threatening 
event, such as military combat, natural disasters, terrorist incidents, 
serious accidents, or physical or sexual assault in adult or childhood.
  PTSD, one of the most prevalent and devastating psychological wounds 
suffered by the brave men and women fighting in far off lands to defend 
the values and freedom we hold dear.
  A suicide bomber, an IED, or an insurgent can obliterate their close 
friend instantaneously and right in front of their face. Yet, as 
American soldiers, they are trained to suppress the agonizing grief 
associated with those horrible experiences and are expected to continue 
on with the mission. And carry on they do, with courage and with 
  PTSD can cause problems like: Flashback or feeling like the event is 
happening again; Trouble sleeping or nightmares; Feeling alone; Angry 
outbursts; and Feeling worried, guilty, or sad.
  The fact of the matter is that most veterans with PTSD also have 
other psychiatric disorders, which are a consequence of PTSD.
  About 30 percent of the men and women who have spent time in war 
zones experience PTSD.
  More than half of all male Vietnam veterans and almost half of all 
female Vietnam veterans have experienced clinically serious stress 
reaction symptoms.
  PTSD has also been detected among veterans of other wars.
  Estimates of PTSD from the Gulf War are as high as 10 percent.
  Estimates from the war in Afghanistan are between 6 and 11 percent.
  Current Estimates of PTSD in military personnel who served in Iraq 
range from 12 percent to 20 percent.
  We need to ensure that no soldier is left behind by addressing the 
urgent need for more outreach toward hard to reach veterans suffering 
from PTSD, especially those who are homeless or reside in underserved 
urban and rural areas of our county.