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tv   U.S. House of Representatives  CSPAN  October 6, 2015 8:00pm-9:01pm EDT

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what are we doing? not much. the grow america act is totally stalled. it's not going anywhere right now. but we've got 23 days. so what are we proposing, are we proposing something that will increase the rail capacity in the united states, that will combine rail, ports and highways into a system to provide for goods movement, freight movement, integrated? no, we're not going to do such a thing. other countries do it, hey, but this is america, we just like to fall behind, so where are we with the grow america act? some of us have introduced it, some of us think we ought to do something like this, that we really ought to pay for our infrastructure. oh, by the way, this doesn't raise gas tax, doesn't raise diesel taxes, but it does
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require that those american corporations that have skipped out on their obligation to their home country bring their profits back to the united states and be taxed. we maintain the existing excise tax on gasoline and fuel and pay for the rest of this by having american corporations by their just due to this nation. by repatriating their foreign earn, hidden off somewhere in ireland or some other tax haven, not taxed, even though they're american corporations. some of this stuff is too good. apple, an american company. all of their manufacturing is overseas and most of their profits are overseas. because even though it's invented here, even though the softwaring even though the new equipment is invented in california, it is licensed in ireland and the profits stay in ireland and are taxed there at
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very low percentage. not fair to america. so those profits would come home from other companies as well and billion fill this $476 over six years. i want to just go through some of this and then we'll wrap this up. the grow america act would provide $52 billion a year for highways. we're presently spending $41 billion a year for highways. so we're looking at something $11 billion more for highways. maybe there won't be so many potholes. maybe one out of four bridges in the united states will get repaired. right now, they're deficient. they could full down. they're insufficient in capacity. maybe. maybe we can do that. now the senate's done a little better. the senate has passed a highway bill that's $46 billion a year. which is $5 billion more than
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we're currently spending. that's good. it's a five-year program that's only paid for in three years. huh? how does that work? it doesn't. but it's a good start but the grow america act, $52 billion a year. anybody take buses in the united states? anybody take bart in california? or the metro system in los angeles or here in washington, the metro, or the subways in chicago, new york, atlanta, and so forth? that's called transit. we're presently spending about $10 billion, $10.6 billion a year on transit. supporting these transportation systems. the senate bill adds about $2 billion. so they go to $12.5 billion. the grow america act, let's get on with it. let's build those systems. $19 billion. without raising your fuel taxes. but if you happen to be those
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american companies that have skipped out on their obligation to this nation, they're going to wind up paying their fair share. for go from $10.6 billion transit, annually, to $19 billion in the grow america act. remember i put some of these trains up here? we presently spend $1.4 billion on our rail system, not the transit, just the heavy rail system. the senate would go to $2.2 billion and the grow america act ould go to $4.7 billion. are we going to do this? not likely. not likely. we have perfected a childhood game here in the house of representatives and the senate. in fact, your american government has affected this -- perfected this game. something, when you didn't have a ball to kick around, you'd
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kick a can around. it's called kick a can down the road. we've perfected that. i think we've done it more than 30 times in the last decade and a half with transportation. we're highly likely to do it again. as the attention of america and the attention here amongst all of us is focused on the speakership fights, which will culminate at the end of october, when the speaker retires and we'll have a new vote. and in the intervening 23 days, are we going to focus on a transportation program for america? or are we going to focus on the internal politics of the house of representatives? i tell you where i'd put my money. i'd put my money on the house of representatives worrying about the internal politics of who is going to be the next leader. and not paying attention to what america wants us to do. america wants taos pay attention to their needs. not to the internal politics of
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this place but to the needs of america. american jobs. for american workers. can we build ships? oh, yeah, we can build ships. can we build liquefied natural gas tankers? you bet we can. we're already building ships that are fueled by liquefied natural gas. we're doing it in san diego. we know how to do this. we have to ramp up, we're not going to build 180 ships in one year but we sure could over the next two decades. but maybe we care more about the petroleum industry than about the american worker. and the american sailor. and the ship yards of america. i'm afraid that's the way it's likely to be. i notice that i'm joined here by an extraordinary woman from the, what used to be the manufacturing center of the united states, the midwest. ohio, to be quite clear. marcy kaptur, i've been going on
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for more than i probably should have in time but boy, these are important issues. these are really important issues. please join us. ms. kaptur: i thank the gentleman from california for being an extraordinary leader on make it in america and restoring prosperity to all corners of this country and the citizens of california really have sent an amazing congressman to speak on behalf of the nation and the importance of making items in america is probably a tragedy over the last three decades that we have accumulated over $9 trillion in trade deficit, which translates into lost wealth, lost income for america's families and ultimately, a budget deficit we just can't get under control because people aren't earning enough and so much economic activity has been outsourced that there are many who have forgotten how much
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manufacturing actually matters. so i agree with the gentleman. make it in america, grow it in america, use the technology of america to transform farm field products into ethanol and biodiesel, let us use the sun, let us invent our way forward to become energy independent because at some point, not in our lifetimes, but at some point over the next 00 year the oil wells will run dry an even the natural gas fields currently being discovered in highway and pennsylvania, which are mother load supplies with horizontal drilling, those are finite. they will be gone. the world with many more people will have to figure out how to sustain life. the gentleman has addressed many of these issues in terms of energy production, america's need to become energy secure, which would create prosperity here at home and the investments of hard infrastructure on rail, on over-the-road air transportation, i have to add
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port, and in my part of the country, the great lakes seaway so in need of infrastructure improvement. great lakes meeting, looking for ways in our transportation bill where we can make more investment in that sing fully can economically again. i unite with you in your efforts to make america fully strong again and make it in america. and lead us down that path. mr. garamendi: you have been a leader on this issue for many, many years. certainly in your territory of ohio, you saw what happened when the manufacturing plants left. but they're coming back. we can make policy to do that. i think you may have other things you'd like to bring to our attention, you're certainly welcome to do so. i think with that, it's time for me to say enough.
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maybe i've said too much already. so i would yield back my remaining time, madam speaker and let you go on to the next order of business. the speaker pro tempore: the entleman yields. 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. mr. murphy: thank you, madam speaker. this evening, just before votes, i went outside on the balcony here of this capitol to watch the sun set. it was one of those beautiful
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evenings of crimson and gold and gray clouds silhouetted against twilight glow of the evening. and then i glanced over to the buildings here at the capitol, suddenly brought back to reality when i saw so many flags flying at half-mast, flying at half-mast because once again we're remembering a tragedy that's -- the tragedies that shook our nation time and time again. this has been a bloody summer. bloody summer of many attacks that have been associated with folks with mental illness. i know most people with mental illness are not violent. i know that there's many other tragedies that occur. but tonight, during this week, which is mental health week in america, i want to highlight, madam speaker, what we must do as a nation. we cannot continue to push
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aside. just think of what happened this summer. just a few examples. june 13. attack on the dallas police headquarters by a man who had a history of family violence and mental instability. july 23, lafayette, louisiana, shooting in a movie theater by a man who had a judge's order to send him to a mental hospital in the past. august 16, ant oklahoma, tennessee, a movie theater ttack. august 26, roanoke, virginia, live, on-air shooting of a tragic scene of a reporter being killed an her cameraman. august 28 20 15, houston, texas. while a deputy police officer was at a gas station, riddled with bullets by a man with a history of mental illness. september 22, the son of a state senator, former state senator of virginia killed a man and also
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killed himself in bowling green. and this last week, october 1, roseberg, oregon, nine people were killed when a gunman -- and the gunman killed himself in another tragic scene. there's more to it than this, of course. in this country, last year, 125 people with mental illness were killed in some sort of police shooting. where the police oftentimes did not even know but the confrontation grew and ended in a death. it's estimated somewhere between 1,00 and 1,500 murders this past year by people with mental illness. delst 10,000 or more, maybe 20,000 or more with mental illness who are victims of crime. there are thousands of homeless who die as a result of their
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illness. there were 41,000 suicide deaths, 1.2 -- 1.2 million suicide attempts that required some care. 4 ,000 substance abuse overdose deaths this list goes on and on and on. what happens is, when we treat people with mental illness early in their life, prognosis is improved and in many cases they go on to have fruitful lives. but when it is untreated, they're likely to develop other problems, not just with mental illness but social, job and physical health and persons with serious mental illness in treatment are 15 times less likely to engage in an act of violence than those who are not in treatment. in america, this year, some 60 million people will have some diagnoseable mental illness, from the mild and transient ones we all experience to severe mental illness such as
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schizophrenia, bipolar or extreme depression. of those with mental illness, about 11 million people, about four million of those 11 million will not have any treatment, for a variety of reasons. treatment may not be available. they may refuse treatment. or what happens so often with those with serious mental illness, they're characteristically unaware they have an illness. it is a brain illness. a serious mental illness like a person with alzheimer's or stroke or traumatic brain injury. person who may not even know that they have a problem. and what do we do about this as a nation? mostly we just talk. sadly and tragically what we do here, we'll have a moment of silence. but it's not followed by action. and what we need is not more silence, we need action. madam speaker, we need people in this country to raise up and say, this is the time, this is
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day, this is the issue where we're once and for all going to do a comprehensive reform of our mental health system in america. our mental health system in america is fragmented at best, it is a system with regulations that are abusive and neglectful towards those with serious mental illness and more so it is worse if you're a minority or low income. this is odd because in a field that is filled with some of the most compassionate and caring people i know, people i have had the pleasure to work side by side with as my role as a psychologist, we have federal policies and state policies which leave their hands tied, their eyes blinded and their mouths gagged to prevent treatment from occurring. and ultimately the individuals suffer and a their families suffer. -- and their families suffer. tonight we will review what the problem is and what can be done
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, systematically, thoroughly and definitively what have this country must do if we're serious about treating mental illness. one of my colleagues from cleveland, in the toledo area, represents northern ohio, is with us now, marcy capture. i'm sorry, before we go -- marcy kaptur. i'm sorry, before we go to her we have an announce from the rules committee. ms. foxx: i send to the desk two privileged reports from the committee on rules for filing under the rule. the speaker pro tempore: the clerk will report the titles. the clerk: report to accompany house resolution 461, resolution establishing a select investigative panel of the committee on energy and commerce, report to accompany house resolution 462, resolution providing for consideration of the bill h.r. 3192, to provide for a temporary safe harbor from the enforcement of integrated disclosure requirements for mortgage loans transaction as under the real estate
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settlement procedures act of 1974 and the truth in lending act and for other purposes. and providing for proceedings during the period from october 12, 2015, through october 19, 2015. the speaker pro tempore: referred to the calendar and ordered printed. the gentleman from pennsylvania ay continue. mr. murphy: thank you. i now yield to the gentlewoman from ohio. ms. kaptur: i thank congressman murphy for yielding me time and i want to say how fortunate the country is that the people of pennsylvania have elected you here to serve the people of our nation with the strong background that you have and with the obvious depth of knowledge that you have about those who are mentally ill and the compassion you have in a field that is very difficult, where the answers still remain incomplete. and i wanted to be on the floor this evening to say to those who are listening in the chamber, to those who may be
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listening outside, your efforts to draft the helping families in mental crisis health act is a watershed moment in this congress. i've served in this congress a lot longer than the others on the floor this evening and i , sadly, in 1998 when we lost two of our capitol police officers, jacob chestnut d john gibson, and a diagnosed schizophrenic receiving federal s.s.i. benefits, but off his medicines and estranged from his family, headed on a rampage all across the country, all the way from the west to here, and delusionally he set out to quash, i guess, a purple force he had tracked here to the capitol. he broke into the majority leader's office, all the staff went under the desks, and i
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thought, well, maybe this is the moment that congress will finally face up to the violent impulses that have fallen right at our knees. i said, but i would wager one of two things will happen. either we will finally cut the mustard and do what's right or we will have more barricades and armed officers. well, it was the latter option that actually happened. and as we mourned the deaths of nine innocent victims the umpqua community college, i commend the congressman, congressman murphy of pennsylvania, for putting a bill forward that forces us to probe deeply the pattern of these mass shootings. we need to know the perpetrators, we understand the perpetrator in oregon had served in the u.s. military. for a very brief time. he was discharged. and my question to the u.s. military is, why?
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why was he discharged and did you discharge him to care if you saw a pattern that needed treatment, or did you close your eyes too, because that has happened repeatedly in the u.s. military, though i must say that they are doing a little bit better. because some of their own members have now been killed around the country. because of individuals who face very severe illnesses in their own lives and have simply never had the kind of doctor to help them come out of the dark shadows of the existence in which they have been living. many of these individuals have been abandoned by their families. many timets they're expel -- many times they're expelled from school. as you look around the country and you see the people who commit these heinous, heinous crimes, and then many times take their own life, they are completely alone or they're living with one member of their family, abandoned by their other family members, and as
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the gentleman from pennsylvania has said many times ending up homeless, the victims of attacks themselves, or many times out of whatever is happening in a very ill brain, taking it out on the rest of society. probing deeply into mental illness requires a discipline that congressman murphy has and an understanding that no congress yet has had. that my openia is symptomic of what is happening across our nation. more security but no significant attention to those who show out-of-control and violent tendencies, those tragically mentally ill citizens that are driven by their illness to harm others. if someone had a broken back we have special wards. what happens to the mentally ill in the district that i represent and across this country, some of them end up in the jail, 75% of those in incarcerated in northern ohio -- incarcerated in northern
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ohio have dual diagnosis of mental illness and substance abuse. what does that tell news is our jails have become the depository for this nation's mentally ill. i'm not saying that individuals diagnosed with mental illness are more likely to commit crimes, i agree with congressman murphy that most of them become victims of crimes. because they aren't thinking straight. and it doesn't have to be this way. the bill that congressman murphy has written and has vetted and worked with different groups and individuals and which i support and a host of other members do on a bipartisan basis, is supported by one of the most important organizations in our country, the national alliance for the mentally ill. i have the highest respect for this them. 2646 fixes the nation's broken mental health system by refocusing programs, reforming grants and removing federal barriers to care it. names an assistant secretary for mental illness at the department of health and human services and it encourages more meaningful involvement from family members and care givers
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who frankly at this point many times just give up because they have this force within their home that they cannot contain. rather than just paying tribute to those among us who have been lost and those who save them at risk to their own lives, can we not elevate the solution to efforts that can help prevent further tragedies? we think about the capitol shootings, we think about sandy hook, we think about virginia polly technic, the u.s. leads the world in mass shootings. there have been 294 mass shootings in 2015 alone. and each one gives us an indicator of the possible sign of untreated mental illness. each one represents a failure of our society. and dispelling the stigma of mental illness for those who suffer remains a task unfinished. when do the elected representatives of the american people say enough? america can do better. america must do better.
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let's create a pathway by passing h.r. 2646, to immediate treatment for those mentally ill citizens dangerous to others and dangerous to themselves. congressman murphy, i can't thank you enough. i don't recall a bill which has such broad bipartisan support. you have worked so hard to go around the country, this is not a partisan issue, this is an american issue. i hope america can lead the world in trying to find a better way. the suffering that we see in our districts, in community after community after commuferte community, broken families -- community, broken families, broken people. this doesn't have to be in our country. in the hearing that you conducted in cleveland, i learned something really important that i didn't know. and that is that in the way that the reimbursement occurs to hospitals for people seeking care, that research and mental illness is not even -- it's at the bottom of the list. because reimbursement doesn't
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flow the same way, so as we try to find answers to what's going on in the human brain, with the is he creation of such chemicals -- secretion of these chemicals that people who are healthy have at a normal level, those two don't have that system working for them have big problems. but yet if doctors try to get research dollars to solve -- to figure out what's going on in the human brain, the reimbursement system we have simply doesn't work. i didn't know that. and so i thank you for coming to ohio because i am focused on that like a lacer beam and it is a part of the -- laser beam and it is a part of the answer, so thank you for allowing me some time tonight on the floor. we want to help you and i hope those listening will find co-responsers from their different parts. country to help you move this -- parts of the country to help you move forward. thank you. mr. murphy: thank you. i would now -- now like to yield a few moments to the
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gentlelady from north carolina. evplevpl thank you to the gentleman from pennsylvania -- mrs. ellmers: thank you to the gentleman from pennsylvania. i too want to thank him for his tireless work on this effort. this is such an important piece of legislation in dealing with mental health and putting necessary reforms in place. the gentleman has truly been an absolute champion on this issue and h.r. 2646 is such a meaningful piece of legislation and will help in so many different ways. mental health in this country is a crisis. and it is an epidemic. and there are so many families across this country that are dealing with this issue. you know, the gentleman came to my district a little over a year ago and we had a wonderful round table discussion and there were so many individuals who came to it, so many family members who came to it, to speak on this issue. and they were so appreciative of the fact that there was
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actually some legislation that was being developed to deal with issue. these are families that have nowhere else to go. and in my experience as a nurse and health care, but then also as my experience has gone forward in taking care of those in my district, but then traveling across the country, meeting with families and talking with individuals, how much this affects their lives and they truly -- it's almost amazing when you start having the conversation about this piece of legislation, because i don't even think they think that anybody wants to help them anymore. i think they feel so far and left behind that it isn't even in their mind that someone is out there looking for an answer and helping in a way that will be meaningful into the future. the gentleman from pennsylvania has done extensive work with so many groups, so many patient advocacy groups, his own
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personal knowledge as a child psychologist has played into this issue. there are certain barriers that are in place and they're in place because we've put them there. well meaning, well intended, hipaa laws, all of these things that have been put in place to help protect patients and their privacy and their issues and yet it prevents us from being able to understand the situation. it prevents families from being able to get care for their loved one, maybe an adult child of parents who are struggling it -- to help their child, their son, their daughter, they may be out on the street, they may be at home, they may have issues, they may not be working, they may -- i mean, there are so many different things that can be happening and they know that that individual needs help and they have no one to go to. this legislation will change much of that. it is a step in the right direction, there's much more
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that needs to be done. we were just talking a moment about our jails, our prisons and how many of those who are within those walls and those bars literally are there because they have mental health issues. that, yes, they may have committed a crime, yes, they may have found themselves in a terrible situation and ended up in jail, possibly even drug abuse, but the bottom line is the mental health issue that lies there. and when we're talking even about issues of fiscal responsibility in this country, when i think of how much money we will save and how much of a difference it will make if we deal with this issue in the way that it needs to be dealt with, so i am a co-sponsor of this legislation, this is an incredibly important piece of legislation, it is bipartisan, it is for every american in this country, every american in this country that is dealing
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with this issue, with a loved one, with a friend, we all have them, we all walk down the streets and see individuals who we know are homeless and we know that the root cause is mental illness. we can change something in this ountry and we need to come together as a whole house of representatives to pass this legislation. again, i want to finish by thanking the gentleman from pennsylvania one more time for his tireless efforts. you have truly been the champion for every mental health issue and this piece of legislation, passed by the house of representatives, will be a monumental step in the direction of mental health reform. mr. murphy: i thank the gentlelady for her comments and for her continued pursuit of making sure we pass this. this bill was first introduced
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over a year ago, reworked with the input, bipartisan input, members of congress, both sides of the aisle an also from many, many organizations. the other day, some 23 organizations delivered a letter to some members of congress saying they want to see comprehensive mental health reform. this is the first and most comprehensive mental health reform our country has seen. last time some efforts were made, it was the very last bill that president kennedy signed before he was assassinated to begin to make change in our country, to move away from asylums and toward community mental health. unfortunately that dream only came partially true because what happened is we thosed the asylums back in the 1950's, we had 550,000 psychiatric beds in this country. that's when the population of the country was 150 million. now the population of the country is over 316 million or 320 million and we only have
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4,000 psych beds. some of that is because we have come up with better treatments,, better medications and frankly, those asylums of yesteryear needed to close. many times they were sites of abuse an given nicknames like snake pits and cuckoo's nest and other derogatory terms because they were so bad. community health centers were supposed to pick up the slack but states saw they could save some money and didn't put the money into mental health services, nor kid the federal government. -- nor did the federal government. instead people traded a hospital bed for the jail cell, for the homeless shelter, and for the morgue. and that's where we are today. now it's not for lack of trying because indeed, the federal government has spent a lot of money. some $100 billion plus a year on
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this, mostly through disability payments, some for federal programs. what i want to do tonight is talk about 10 things we can do as a nation to deal with this. 10 things we must do. first of all, the general accounting office reports that -- report that we asked, we commissioned from the energy and commerce committee, we said, tell us what programs there are in the federal government to deal with mental health and specifically serious mental illness. i was amazed to hear how many there were. 112 agencies scattered across eight departments. it is a dysfunctional and uncoordinated system. it is a system that really does not have central control. it is a system that has not even met among these agencies for years. even even though one of the agencies, the substance abuse mental health services agent, is supposed to say get together and meet they haven't met since 2009. when we had a hearing on this in
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the oversight and investigation committee, they said, we'll start doing that soon. but this report that came out that excoriated the federal programs said they're not only uncoordinated, nobody even checks to see if what they do works. there's a program in the department of defense, veterans affairs, education, health and human services, h.u.d., the list goes on and on. i think there's 20-plus programs for homelessness. there was redundancy, there was overlap. but it's not coordinated. we make it the most difficult for those who have the most difficulty. so here's item one we want to do we want to have the office of the assistant secretary for menl health and substance abuse created. a new office but not new money. we don't need money for this. we take the current office of sahmsa and elevate the title of the person who run that agency to the level of assistant secretary. that person's job will be to create an annual report to congress, tell us the state of the states. tell us how they spend their
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money that they get from the federal level. tell us what are the best practices out there to serve as models for other states. right now what we do get is data on number of suicides. we get homicide data. but we don't have much on homeless data. we have so-so quality of data for substance abuse, for what happens there. but no one asks about these agencies and coordinates them this person's job is to do this. more so, this person has to be a mental health provider, someone with understands the feltled -- field. the last direct of sahmsa was an attorney, perhaps well-intended but didn't understand the field. just like you wouldn't appoint someone to head the joint chiefs of staff to run the army who is not a general or the navy who is not an admiral, you need someone to run this who knows what they're doing. in addition to coordinating these agency, they would give a report to congress on which ones can be eliminated because they're redundant. merge the money together, make more money available, send more
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money out to communities. congress has to revamp these multiple organizations to do what is most effective to get funding back to communities and people where it is needed. not the -- not to stay in washington, d.c. i think reagan talked about eternity e proof of is a federal program. what we don't want to have here is continuation of tram -- programs that exist just for the sake of employment. programs should exist for the sake of doing the right thing for people out there and right now we have a failure. evidenced item, derive based care. another general accounting office report which came out talking about some of the abysmal conditions here, we're saying that agencies had difficulty identifying programs supporting individuals with serious mental illness because they didn't always track whether or not such individuals were
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among those served by the program. again, sahmsa in the past which is supposed to lead these organizations, doesn't really say, what are the evidence based programs doing? when we had a hearing on these issues, sahmsa told me afterwards they would change nothing. they do list some evidence-based programs but the evidence base is oftentimes people who do programs that say take my word for it, it works. if it works, why do we have millions of people with mental illness? why do we have four million people not getting any care at all? why do we continue to fill our jail and homeless shelters and morgues with people with mental illness? there are some excellent programs out there, but there's also many that need to be changed. as part of this process, it was fated in the g.a.o. reported, that many of the programs hadn't completed their evaluations, many had no evaluations, some were under way and 17 programs had no evaluation completed and none planned.
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so the government was not even looking to see if what they were doing had any value. we're going to change that. we're going to make sure the programs are out there with evidence-based care. the national child traumatic stress network, an excellent program, does a great job. response ogram called after initial schizophrenic episode, raise, does a great job. they get in early in someone's life. when you get to someone early you improve their prognosis. a lot of other programs, i'll highlight some of the sloppy and irrational programs we have out here tonight. could make a different if they're done the right way. it's important to note that with regard to serious mental illness, about 50% of those with serious mental illness will emerge by age 14. in 75% of the cases by age 24. every time a person has what the public knows as a breakdown, we
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refer to it as a psychiatric crisis, there's harm that occurs to the person. psychological harm, neurological harm, because it's a brain disease. it's important to get to people early on. that's why we want evidence based care that really and truly does that and not programs that are fluff. we want them to have outcome measures and determine this. by the way, just the opposite of that, some of the things that sahmsa has funded in the past have been programs specifically geared toward telling people stop taking their medicine. when people have anxiety, they have programs telling you how to drink a fruit smoothie. none of those are ed-based care and none of them treat people with serious mental illness. number three, building a mental health work force. we have a serious, serious shortage here of providers. even if you wanted to get care, you can't get care in many counties. i think perhaps it's a fourth or a third of the counties in oregon do not even have a
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psychiatrist in them. many do not have a clinical psychologist or clinical social workers or peer support teams with adequacy to meet the needs. that's the same across the nation. what happens here is there's about 9,000 psychiatrists -- child psychiatrists in this country, we need 30,000. precisely because those problems emerge in the adolescent and young adult years. if you don't have the right qualified people you can't treat them. clinical psychologists, clinical social workers, peer support teams, specifically trained and available to be out there, we have massive shortages. part of the job of the assistant secretary is going to be to identify what do we need in communities and how do we get them. our bill authorizes for the first time minorities to work with fellowships. we also authorize people to be volunteers at community health centers. this is one of those bizarre things only the federal government can do. you know, if you want to work at
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a community health center, you can work and your malpractice insurance is covered. if you want to volunteering it's not there. think about this. there are some well intended, compassionate, as i know many are, mental health providers, who want to volunteer, maybe an afternoon a week, they're not allowed to do it because the center can't afford their malpractice insurance. they'd have to pay the regular rate as opposed to a federal plan rate. our plan, our bill also authorizes that they can volunteer. we also authorize programs with telemedicine so that when a pediatrician or family member identifies someone in need of kear they can access them immediately if need be, especially in rural areas and faraway areas where there's not enough support there. the next one, the shortage of mental health beds. i mentioned earlier, this grave shortage where we had 550,000
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beds in the 1950's, 40,000 today. it is a serious crisis level shortage in every community. during one of our hearings, a state senator in virginia testified. many are familiar with the story. he was a former gubernatorial candidate in virginia he took his son gus with him campaigning around the state of virginia. gus played a musical instrument and they enjoyed their time together. but sadly, gus deteriorated. when his father who raised him, fed him, clothed him, took him to a hospital for care, the hospital said, we don't have any psych beds. as they made calls and tried to find more in virginia they couldn't find any. young gus was sent home with his father. they wouldn't give the father any details they sent gus home. gus took a knife, attacked his
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father, nearly killed him, gus then killed himself. all because of a lack of bed. there was another story, a 24-year-old man, arrested for $5 worth of shoplifting at a 7-eleven in virginia. he was take ton jail for shoplifting. upon recognizing that he had a serious mental illness, they wanted to get him to a hospital. but again, there weren't beds available. so he stayed in that jail, i believe over 70 days, often naked. covered in his own feces, refusing to eat, losing 40 pounds. ultimately died. for lack of a bed. that's not the only problem. but understand we don't want to bring back asylums but when a person is in crisis mode, it is not appropriate to bring them to a jail. it's not appropriate to leave
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them in an emergency room for hours or days or weeks sometimes waiting for hospital bed to open up. and it's certainly inappropriate to discharge someone without any wraparound services or care. what happens is, when off bed have care.ou can't we don't have providers, we don't have the places. it is important for someone to have a clean and calm and caring environment, separate from other environmental stresses and problems, so you can work with them and stabilize them. perhaps get them on medication. help them relax. help organize things for home care or outpatient care for them. sometimes that takes a fedes. sometimes that takes a couple of weeks. but the idea is you need a place for them. without beds, oftentimes the staff simply can't do a thorough evaluation. and they cannot make an early -- they sometimes then will simply make an early and uninformed and
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premature release of the individual, of the consumer, saying, well, he doesn't seem that bad, we'll send him home, not really understanding whether or not that person is a threat to themselves or someone else. understand this, even with the brain diseases, schizophrenia and bipolar, when questioned, someone could be in a position where they'd if asked, are you going to harm themselves or someone else, they'll say, no, i'm fine, they can keep it together for a little bit. if the staff says, we don't have beds, let's send them home, they'll be sent home without knowing the seriousness of their illness or providing full services. . further if you want to assess that, many times of doctors and courts are reluctant to go through that process. many times they're looking for another out. many times, like in pennsylvania, it's called a 302 procedure, they'll bypass that can ey'll say the patient,
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you voluntarily commit yourself or promise you're be ok? you go out and get care. i want to add this, because it's very important. while the president and other people are talking about access to guns. and talking about background checks. you can't do a background check if you don't have a background record. you can't do a background check if you don't have a background record. and if there's no place to help people when they're in crisis, and if doctors and judges are not going to have someone involuntarily committed, there is no record. there's nothing that can appear on the national list to prevent a person from purchasing a firearm. there is no time spent in a hospital where staff can truly evaluate, are these delusions and hallucinations which can be controlled with medication are they a risk threat? can't do that. we need more beds and our bill says there will be more.
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this is one of those areas of incredible prejudice and bigotry. you see, medicaid has this rule that if you're between age as 21 and a 64 you cannot go into a private hospital that has more than 16 beds. think about that. if you have money, you can go to the hospital. if you're low income, you're out of luck. you're on the street. different standard that is grossly unfair and incredibly prejudice and again i go to this point that those who are minorities or low income are treated the worst. a person is 10 times more likely to be treated in a jail cell than in a hospital if they're seriously mentally ill. 10 times more likely. and yet that treatment of jail cell is not appropriate at all, it's not treatment. oftentimes they're put in isolation they may get in a fight with a guard, what started out as a small charge may end up as a felony assault charge. person with serious mental illness oftentimes, for the same crime, will spend four times the amount in jail as a person who's not mentally ill.
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all along, if we had the proper place to treat them, we could have done. that our bill lifts this 16-bed cap. this ridiculously be a a surrender 16-bed cap. and says instead, we'd like to have after an average length of stay of less than 30 days. that can be achieved in about 98% of cases. by the way, it is far less expensive to have someone in a psychiatric hospital bed than emergency room. by about four times. and some studies have gone as high as saying it's about 20 times less expensive to have them in outparent care -- outpatient care than in a jail cell. we would save a lot more money if we fixed this dry sis -- crisis shortage, worked on outpatient care and wrapped them around with the necessary services so they could go out more stable. point number five. we eliminate the same-day doctor barrier. another one of those ridiculously prejudicele rules
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out there that medicaid has that harms those of low income. i mentioned a number of times that theed a a less ements and young adulthood is when serious mental illness begins to emerge. those first symptoms that sometimes someone may think is a little bit strange. something different about this person. perhaps their grades are dropping. perhaps they're not taking care of themselves. perhaps they're withdrawing from relationships and friendships. those could be early signs of a bigger problem. but it takes on the average, between first symptoms and first professional treatment, on average, 110 weeks. over two years of waiting time between first symptoms. in part because people are not aware what to look for in the symptoms, but in part because they're not connected with other providers here. and even when they are, they're not allowed to do anything. the same day doctor rule is a medicaid rule which says you can't see two doctors in the same day. at the same location, so here's
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the problem. if a pediatrician says to a mother or father, we're very concerned about your late teen son. your teenage son who is in later years. 17 or so. i'd like him to see a psychiatrist right away because i'm very concerned about the behaviors you're describing to me. then when that doctor realizes that that person is on medicaid, basically medicaid says, we're not paying for it. how cruel, how cruel and abusive is that? to say to someone, just because you have low income, we're not going to cover the services here. when this is the critical time, when you have that warm handoff in the doctor's office, there's a 95% likelihood that the person will follow up according to a study by children's hospital of pittsburgh. when you wait and you say, here's a number, call another day, that likelihood drops below 45%. and when a person, when you miss that golden opportunity to help a person in times of need, that person may be very
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reluctant to come back for care in the future. we fix this by saying we're going to drop that same-day doctor rule. number six. we have to empower parents and caregivers to be part of the solution. 20 years ago hipaa laws came out that said, we will -- in order to help your insurance be portable, we want to protect the records. good idea. we want to make sure records have privacy. good idea. but hipaa moved from a place where we're supposed to assist care and confidential to the point where it impaurs -- confidentialy to the point where it impairs care, it goes too far. i'll give you a few examples. i'm a psychologist. i can listen to a passive mode. i can't provide any information. that's helpful. they're giving me vital information for history. if i don't have the accurate history, a provider does not have accurate history, you
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can't accurately diagnose. you don't know if the person's been on medication before, does it work or not work, who has this person seen before, what sets them off, what are their symptoms? if i don't have -- if the provider doesn't have that information, they may miss making the accurate diagnosis. and may not be able to provide proper treatment and follow-up. when that occurs, harm can follow. now, if i get the information, great. but what happens if that family member is not there? the provider can't go out and seek family members and friends to get that information. because hipaa laws are seen as barriers to that. because as soon as a doctorate a hospital will call and say, your adult -- adult son is in the hospital, i need to ask you information about, it he's already violated hipaa laws by identifying their son is in the hospital. think about. this a parent who is committed to their family member, a brother, a sister, someone's mother or father, committed, that's all they're going to work with, they're
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prohibbletted from being part of the care team by hipaa laws. a stranger, some appointed worker, someone may see them as they roll in and out of their job, they purn about -- burn out, you may be sitting next to a family member in court and say, i can't tell you anything about this family member. you have to find out for yourself. here's another problem though. not only are you impaired from getting diagnosic information, you can't evaluate medications. understand that people with serious mental illness are often at high risk for other medical problems. in part because their hygiene may be poor, they may not take care of themselves, see doctors, etc. they also are in a situation where they may take some medications that put them at a higher risk for diabetes or heart disease. without getting a family member to help them with that, they do not have the ability to properly treat them. my goal in this bill is to simply say that in cases where someone has diminished capacity
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to take care of themselves, where in absence of treatment they become gravely disabled, a provider may tell a known care giver, so notice, i've already set the bar pretty high, i mean, tell the known caregiver a few simple facts. the diagnosis, the treatment plan, the treating doctors, time and place of appointment, and what are the medications they're on. no therapy notes exchanged. we specifically prohibit that in this bill. but that is important. by the way, i might add one other thing. as i hear a lot of people talking about the concerns of why didn't a parent do anything, why didn't they know anything in some cases like the young man at virginia tech who killed so many students or the gentleman in oregon or sandy hook elementary school in connecticut, it is because providers cannot do a risk assessment. they cannot contact a family member and say, can you tell me if this person has any morbid fantasy and fascination with
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death? with extremely violent video games, with dark websites? do they have weapons that are unsecured, do they talk about violent issues, have they made threats before you? can't do that risk assessment. and without that you end up with not knowing the risk. number seven. states receive money for mental health services and substance abuse disorders. those dollars are about $500 million for mental health and $600 million or $700 million for substance abuse. the odd thing about this are states are not allowed to ming that will money. many people with a substance disorder have mental illness and many with mental illness will turn toward substances to self-medicate. the person who with would to go to two different providers, two different centers to get help for one. we drop that. number eight. we want to bring accountability to the spending of federal
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funds. here is where we have seen, in another g.a.o. report, the absolute absurdity and cruelty of how many is spent. -- money is spent. a g.a.o. report done this last summer told us that many times documents and for am acations -- am acations, for -- applications, for many who received grants were not reviewed. they couldn't tell what you the application criteria wagget was to get an award. they didn't have program-specific guidance. even information was missing or not readily available. they didn't even know where it was stored. you couldn't follow the paper trail to see where it was. and so what happens is no one knows how this money was spent. but let me tell you some of the absurd things we've found our money was spent on, on tax dollars. how about this, a website last winter was posted for the people of boston to help them with their worries about snow. that's right. number ed a 1-800 could you can call if you had
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no anxiety. our tax dollars went to help them understand that. there's websites to tell to you drink a fruit smoothie if you're anxious. programs that tell you how to make a mask, programs how to make cladges, a painting that cost $22,500 of two people sitting on a rock surrounded by other people. $22,000. when we ask the director what that was for, they said, it's for mental health awareness. the only thing i'm aware of is it's a waste of money. that could help pay someone's salary to help treat a patient. it gets worse. a website for 3-year-old children that cost $426,000 with animated characters and hinge-along songs. the purpose we asked the directer? prevention. prevention of what, we said. we think prevention is good. what does this prevent and what does it do and does it work and do anything? we waited for weeks to get an
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answer and we still don't have one, months later. by the way, they took the website down when we shined a bright light on it saying, what does this do? we want accountability to this spending. there will be different grant programs now, demonstration grants, innovation grants, where people will know what these grants are, they can look at them as scientific studies in a blind review to make sure it's going to quality programs that really make sense. no more of this behavioral wellness stuff. but truly working at things that make a difference. number nine. develop attorneys -- alternatives to institutionalization and have real geodiversion. i said already what happens to so many people with mental illness they end up in jail. 40e% to 60% of people in prison have a mental illness. what this does is it helps provide some extra funding for states that have wrap-around services for those who have this history of violence, incarcerations, arrest, mental illness. new york has a program called
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assistant outpatient treatment. a judge will say, you need to stay in treatment as an outpatient level has found they reduced incarcerations by 81%, homelessness by over 70%, they reduced admissions to emergency rooms by over 70%, they had patient satisfaction, consumer satisfaction by over 90% and they cut costs in half. states have different programs here. 46 states have programs on the books but many don't put these programs in practice because of the big costs. states will save a lot of money. we want to take people out of this revolving door of jail and risk and more damage and say that states need to have programs where it wraps around services on that person. don't dump them on the street. make sure the services are there and make sure the


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