tv Key Capitol Hill Hearings CSPAN January 21, 2016 12:00pm-2:01pm EST
somebody who just got depressive disorder and you find out and started 10 years earlier and the consequences of the disorder will not show up for another 10 years. so the mental disorders, especially depressive disorder, predicts onset of stroke, dementia, heart attack, diabetes. it predicted more powerfully than risk factors we know. somebody with depressive disorder has a higher risk for heart attack than those with diabetes. the point is these start early. they take a long time and the consequences for physical illness are very strong. and we need more research to figure out why these consequences are occurring, but also the consequences have been stated for primary health care for psychiatric care, because now the primary care doctor is interested in saving the life of his patient and that means he should screen for depressive disorder and other disorders and
learn how to do it. we should make that technology available. i want to say that there are a range of prevention programs for mental and substance abuse disorders, many of them. and they have beneficial outcomes proven years or even decades following the intervention. most of these prevention programs are social interventions early in the life course prior to the onset of the disorder. in the school system, for example, or even shortly after birth. those preventive interventions are one of the unused resources, i would say. and as a tiny aside, there have been breakthroughs in genetics, especially the methylation issue which shows that the tendency
for a gene to operate or not operate is affected by the environment. in the future, we will be studying how genes and environment work together. when we study that, we will be oriented with the social environment, the way it works with genetic material and that is the way that mental disorders have their occurrence. the failure to help people with severe mental disorders is the most glaring problem in our mental health system, and it turns out that severe mental illness like schizophrenia, you know this, senator alexander, they are associated with a shortened lifespan by even two decades. somebody with schizophrenia will die 20 years earlier. they are not dying from schizophrenia, they are dying because we are not paying attention to the prevention.
like the lipid-lowering drugs. nobody chooses to be schizophrenic. it happens to them. it seems like we owe them that. in building programs related to brain research, i want to mention that the national institute of mental health has lost its focus on public mental health. and also it is abandoned. these new programs have confused andge range of researches puzzled the international community. has vitiated the probability of developing programs for substance abuse disorders. the orientation is the action
from my point of view, the action is prevention, preventive intervention early in the life course, mostly social. and thank you for your time. thank you,xander: dr. eaton. mr. rasheen? mr. rasheen: let me first share my journey of mental illness. it started three weeks into my first semester. i was struck with a panic attack. i had my first episode and then second in the spring of 2000. my next weeks were filled with sleepless nights and i ate sporadically. i had visions of jesus, spoke foreign linkages. my parents rushed me to a
psychiatric hospital and are diagnosed with bipolar disorder. last 18 years of my life have been defined by mental illness. yet with proper treatment and persistence, i have recovered and achieved wellness. there are millions of americans who are thriving in the face of mental illness. teachers who rise every morning to face their anxiety and students. veterans with lingering and visible scars of ptsd who will still provide for their families. many are thriving, but many are not. to serve everybody living with mental illness, we must take steps to address stigma, access to medication, and peer support. i began speaking in 2012 openly about my struggles to thousands of individuals with mental illness, family members, law enforcement, communities, teachers, and students.
since 2013, i have been talking about mental illness as a presenter. i have delivered presentations and i have spoken to more than 20,000 students across this country. after one of my presentations, a petite african-american girl shared with me that she was self-harming. when i asked if she told anybody, she said no, i have not. then she lowered her shoulders. i told her, that is ok. thank you for being brave in telling me. she went to her school counselor, the same that her family members advised her not to go to. because she saw the importance of openly addressing stigma, the young girl's silence was dissolved and she was able to get help that she needed. education is essential to ending the shame around mental illness. for many, medication is an
integral part of treatment. medication has and continues to play a key role in my life. i still take antidepressants every morning. they are central to my recovery and wellness. finding the right combination of meds, which at times was very harsh, but thankfully by working with my doctor i found the right combinations. the struggle to find a correct medication is an arduous task for many. it can literally mean the difference between life and death. a young man i know went to therapy and at least 50 different medications. 20 years after his first manic episode, he is now an advocate. because he had access to medications, he is now helping others work toward wellness. we must keep medications protected and affordable to
people living with mental illness. doctors and patients must have a choice in finding the right treatment as the wrong treatment can lead to substance abuse, exhausted caregivers, and even death. however, medication alone cannot sustain wellness. another key component of this bill is peer support. the power of relating to others cannot be understated. isup i have interfaced with a quintessential example of the power of the peer. a member mentioned in an e-mail chain that he had lapsed into depression. within one hour, there were responses to his e-mail, one member saying, i will come pick you up. they truly understood the power and emotional strength of that
support group, and that emotional support can shatter the weighted chains of depression. i am happy to say that this member is doing well and he is really doing well now. having language, codifying what peer support looks like is a component to mental wellness. mr. chairman, ranking member murray, and others, i am testifying as a voice for people who are living with mental illness. my journey does not represent the full breadth of living with mental illness. my presence here today gives a face to millions of americans who are struggling and striving in the face of mental illness. recovery should be an option for all. bill 1945 is a pronounced step in that direction, and i am respectfully urging the committee to move forward on this bill. and i would say that millions of people are depending on the transformation in how we address mental mental illness in america.
senator alexander: thank you. we will now have five-minute questions from senators. mr. rahim, what advice would you have to someone who knows a person who may need help? how do you persuade them they should seek help, whether they are a family member or friend? mr. rahim: i get that question all the time. i speak at support groups, and that is the billion-dollar question. we cannot persuade anybody to do anything they do not want to do. senator alexander: what is your approach?
mr. rahim: education, we can change how we respond with education. we can change how we respond to people. there are programs out there that students and people can take and it will change the way they interact with the loved ones and to thereby helping them understand what a loved one is going through. when i was in psychosis, because of the way my parents changed, they were able to get me help. senator alexander: dr. eaton, what is your experience? dr. eaton: one thing that is possible is a program and high -- in high schools that would be built into the curriculum. you can build into the curriculum without too much trouble, a module on depressive disorder, psychosis, so people are aware of these and think of them as illnesses just as any other illness.
then it becomes part of the stigma reduction idea. they become less resistant. there are also in high school screening programs. the teen screen program was implemented in thousands of high schools across the country, in which you screen high school students oriented toward depressive disorder. you mentioned suicide as being an important cause of death, for for teenagers, it is the third most important cause of death. programs and high schools to make people aware of the issues around mental illness. senator alexander: you were critical of nih. dr. eaton: nimh. senator alexander: the institute that deals with mental health. congress has increased funding for that. i hope there is a bipartisan interest in doing more. if you were there, what would be your focus? dr. eaton: i'm completely
supportive of more funds for mental health justified by the burden of disease i mentioned. the orientation has been away from -- we can no longer apply for grants with diagnosed of that diagnostic categories as the outcome. that is silly. i would change that orientation. samsa is a very important agency, and i think to some extent the nimh has shied away from mental health orientation. samsa does not have the has.tise that nimh when i worked at samsa for 2 days a week, there was not one psychiatrist there. as i left, one psychiatrist had joined. there was only one
epidemiologist at the national institute of health. that is the failure in public mental health. : you mentioneder 30 years ago, i was a governor at that time. what advice would you have for states, based on your experience and perspective, about the focus should be as they move ahead with dollars, both federal and private? >> trying to take care of as many people as possible, as cost-effective as possible -- moving further upstream towards prevention and earlier you cantion so that take care of more people as they start to show symptoms, or where they are at risk for symptoms. one problem 30 years ago is that we were waiting until people had severe mental illness until we
started treating them. now with the public health model, we are trying to move further upstream to early intervention. trying to spread the dollars out. we still have to take care of who are severely mentally ill. but trying to get to those earlier, as we are with the first episode psychosis. and even earlier, trying to deal with children's mental health. senator murray: mr. rahim, thank you so much for sharing your story with this committee and all the work you have been doing with people across the country. your message that people are not defined by their mental illness is a powerful one. i appreciate that. i wanted to ask you -- as you talk with young people, what are the most common forms of stigma you hear about? mr. rahim: yes, so one of the
most common forms are i don't want my friends to know, i do want my family members to know. or even sometimes parents, students that want to talk about it, but they have parents that don't want to help them get help. senator murray: so they fear their parents will -- mr. rahim: oftentimes there is a guilt associated aroud, is my child broken, sick? sometimes when the students come to them, they actually want the help, but sometimes the parents are reticent in not getting them to help that they need. a lot of students are willing and open to talk, especially putting the conversation out there. senator murray: so having someone else beside your parents is critically important. i also hear from parents, too, they don't know who to call when their child says that. my child is telling me they had
their issue, but i do not know who to call. what do you tell them? mr. rahim: sometimes there is a bridging of a gap between resources and what is known. the key component is what is available and knowing it's ok to seek those resources. your child is not broken or bad if something happens to your child. it is providing that bridge to the knowledge gap. there are resources and it's ok to use them. senator murray: great, thank you very much. ms. blake, the work you do in the emergency department is critical to our health care system. we all know that. i know that the patients that come through your door or at the most vulnerable points of their lives. otherwise they would not be walking through that door. once a patient is stabilized and we know they need more specialized care, we know there is an acute shortage of inpatient psychiatric beds.
you refered to that. it is certainly a critical issue in my home state. one study ranked my state 48th on psychiatric treatment beds. we are seeing more discussion on that in my state. i wanted to ask you, what happens to a patient in the emergency department if there are no psychiatric treatment beds? you mentioned this in your opening statement. but what do you do? ms. blake: we essentially keep them there in that room. we give them three meals. they are stuck there until we can either, a, find a facility willing to take them. sometimes if the 72-hour hold has expired, we have no choice but to allow the patient to go. and they go back into the community. but generally speaking, they will go from our hospital to the next hospital that is closest.
senator murray: dr. eaton? dr. eaton: i spent time in victoria, australia. they have a linked medical records system. they can dial up and find the nearest mental hospital bed in the entire province in a few minutes. senator murray: do you not have access? ms. blake: we do not have that access where i am. in preparation for this, i did an informal poll of my colleagues throughout the country. this is not just a problem in florida or washington. this is every single state in the country. i would say this is the top issue in emergency departments right now across the country, holding on to these patients. one hospital in the south part of palm beach county, they had 14 patients waiting for psychiatric beds.
senator murray: as mr. rahim pointed out, people don't know who to ask, hospitals don't have a place to go, and we have a huge hole in the system. ms. blake: there are not enough resources to place these people, get them screened and into treatment programs. but, two, the follow-up when they are released from that facility. they are put back on the street. if they don't have any place to go to follow up to get further treatment -- their medications, to have someone they can go to if they start to have a problem -- so many of these people are homeless. they get put back out and they have no place to go. they have no resources. they have no way to follow up with a physician. they have no way to get their medication.
senator alexander: senators collins, baldwin, and cassidy. senator collins: in rural states like maine, patients with serious mental illness all too often lack access to the care that they need. as i look at federal policies, at times federal policies exacerbate the problem of access. we still don't treat mental illness the same way we treat physical illness in this country from the perspective of federal reimbursement policy. which s pretty stunning in this day and age. you mentioned to that congress recently passed senator cardin's bipartisan bill, which i
pleased to be a cosponsor of, which extends an important demonstration project that addresses psychiatric bed shortage this blake has talked about. maine is one of the pilot states under that program. it has already seen very promising results because federal medicaid matching payments are being allowed for free-standing psychiatric hospitals for certain emergency psychiatric cases. similarly, the cassidy-murphy bill, which i cosponsored, will go further by lifting the imd exclusion for psychiatric patients with an average length of 20 days or fewer. that should help more people get the assistance that they need.
could you talk a little bit more about this issue and how the restrictions on medicaid funding to freestanding psychiatric hospitals affect access to care? dr. hepburn: yes, thank you for the question. access is a major issue. following up on the previous discussion, there is a culture problem where individuals are expected to go into a psychiatric unit. if someone is in the emergency room for another type of problem and there are not beds for that discipline, they put them into an another open bed in the hospital. there are no reason those with psychiatric problems could not go into a medical bed with a sitter if some hospitals decide to do that.
the second answer is an increased use of technology. the third, the imd demonstration, has shown private psychiatric hospitals have about the same cost per episode as acute general hospital psychiatric units. 30, 40, 50 years ago, the private psychiatric hospitals kept people for months, sometimes years. that has changed. the average length of time and the cost per episode is about the same. there is not a good reason from a financial standpoint or a clinical standpoint to differentiate between private psychiatric hospitals and acute general hospitals with psychiatric units. senator collins: i think you raise an excellent point. it is that the practices of the past are dictating the reimbursements of today
. as we've talked to the administrators and psychiatrists, staff, families, and patients at one of the psychiatric hospitals in maine, part of this pilot project, they are seeing exactly what you have said. they are not keeping people forever. they are not abusing it. but they are allowing people to get the care that they need because it is being reimbursed for those individuals in the age span of 19 to 64 that now cannot get reimbursement. dr. eaton: just another comment. emerging technology may be helpful. there is record linkage in victoria, australia. that is coming. we can link records more easily. in baltimore, 85% of people with
schizophrenia own a cell phone. there is a way of contacting these people. technology is being developed. they are not really therapies, but locating devices. i think that is in our future also. senator collins: thank you. senatorlexander: -- alexander: senator baldwin have to step out so we will go to senator murphy. senator murphy: thank you all for taking this issue so seriously, for putting us on a path to a bipartisan product out of this committee and a path to bring this to the floor this year. i think this is one of our opportunities in 2016 to be able to move something substantive and bipartisan on the floor of the senate. i thank all of you for being here today. i think we have covered the question of capacity. i thank senator collins for her specific questions. let's think about how this would relate to our lives. if we were to bring our child to
the emergency room around dinnertime and we sat there with our child all evening, we sat with them all overnight, and we didn't get appropriate care for a child until noon the next day, we would call for people's heads at that institution. we would be outraged. that is not the outlier when it comes to people being admitted to the e.r. with mental health diagnoses. that is the average. and yet we accept it as commonplace. there is a reason that is happening. we have closed 4000 inpatient beds since 2007. in the last 2 years alone, we went from 91 million americans living in an area designated as a mental health shortage jurisdiction to 97 million americans.
we are going the wrong way on capacity as need is increasing. it is no mystery as to why we are hearing these stories. as senator murray pointed out, another failing of the system is the lack of coordination. the fact that we have so many people trying to do good things, but they are not talking to each other. and for complex patients, it is often not clear who is in charge. for a child, is it the school, the clinic, the primary care physician? mr. rahim's story was captivating. you are courageous to continue telling it. i want to ask you about coordination. about the barriers that patients face in trying to find a quarterback for their care, the worry that is involved in trying to figure out which provider is the best place to start, where they eventually go to get the care they need.
how do we do a better job of coordinating all the good things that are happening in the system so that is easier for patients to navigate? mr. rahim: i can take a step back and share what happened with me about 17 years ago. my parents were able to bring my directly to a hospital in queens. you talk about the waiting area being chaotic. i had hallucinations in the waiting area. i thought i saw jesus and prophets. i was able to get hospitalized that night and get medication that night. i was able to get in the ward that night, and i spent two weeks there. that early care is so critical. i was able to get that in that moment. to speak to the larger issue, i think having that immediacy of care is so critical. i know it was critical for me. senator murphy: dr. eaton, i
sen. murphy: dr. eaton, i wanted to explore an issue that you raised. this realization that if we don't spend money on mental health, we are going to spend money somewhere else. the fact is that a diabetes diagnosis alone does not put you in the top 5% of spenders in the medicare-medicaid system. in fact, the depression diagnosis alone does not put you in the top 5% of spenders. it's the combination of the two. as you point out, if you have depression, you are much more likely to acquire another major and expensive physical health disorder. can you talk a little bit about the connection between a mental health diagnosis and a very expensive and burdensome physical health diagnosis? and why and little bit of spending on the mental health side prevents from the spending a lot of money on the physical health side? dr. eaton: i wish that i knew more. that is been replicated 10
times. the logic is very strong. on the one hand, treating the mental health disorder will almost certainly lower the risk for the physical disorder later on. but also moving upstream, even farther than first episode psychosis. if can identify people at risk for psychosis, or at risk for depressive disorder, not at the first episode. that will have downstream consequences. the problem is it is complicated because it takes a long time. we have not done a lot of longitudinal studies to determine whether depressive disorder contributes to risk for stroke. in the u.s. we don't have the a tendency to do these kinds of studies. i don't think i have answered the question well.
but i think we need longitudinal research to understand how it is that the body and mind evolved over time from age 15 when somebody's at risk for suicide or depressive disorder, to the age of 45, when they are at 5 times the risk of a heart attack because of that. mr. chairman: thank you senator murphy. senator cassidy. sen. cassidy: this is a topic that is inherently tragic. but that all of you senators are here gives us some optimism in the midst of this. so thank you all. dr. eaton, let me ask -- you describe in your testimony about the lack of coordination between federal programs. i am trying from that -- drawing from that that you feel there should be changing how these programs coordinate with or we
will spend our tax dollars ineffectively. dr. eaton: there is huge redundancy in epidemiological research. each of these organizations conducts a suvery. dr. eaton: it would pay to study the coordination of those agencies. sen. cassidy: you brought up some thing that tim murphy brings up a lot. samsa has a lack of psychiatrists. dr. eaton: it is amazing, i agree.
sen. cassidy: i told dr. hepburn, we need to start basing federal research on objective criteria instead of inertia. right now, do you include the cost of incarceration in your societal cost? dr. eaton: those daily do not include that typically. incarceration is a horrible horrible problem. many of us think that the prison and jail system is the de facto mental health system in the united states. sen. cassidy: my national sheriff's association says he is the most active mental health
provider in his parish. dr. eaton: in cook county, that is true also. we don't even have a good survey. sen. cassidy: we have heard testimony that the right drug is so necessary to keep somebody in balance. i have learned that when some one enters a jail, their medicines may be stopped or on contract. it may be a drug substituted. if we don't have some way to divert folks that are mentally ill out of the jail, they might go into a sitting that would make a situation super chaotic. is that a fair statement? dr. hepburn: the point you made, if somebody comes in on medication and that medication is not continued, it can have a negative impact on their ability to recover. sen. cassidy: thank you.
mr. rahim, great testimony. tell you though, the fact that you speak about peer groups as if it is something unique, i get the sense that it needs to be expanded. as good as it is, we don't have pure groups proliferating across the country. is this an exception for you? mr. rahim: i know there are peer groups across the country. sen. cassidy: are there all over the place, or no? mr. rahim: i can't speak to all of the place. but the depressive and bipolar support of line, they are based on peers and wellness. i do think that is a key component. if i knew -- when i was going through the stick of my
medication-- sen. cassidy: let me stop you. anything that would promulgate peer groups would be great. mr. rahim: 100%. sen. cassidy: man, if we could put you on a bottle and sell you, we would all be better off. a lot of people start feeling well, they stop taking their medicine, and they are back with ms. blake. what motivated you to take your medicine? what would you recommend to others to encourage them to stay on the path of recovery? mr. rahim: medication does not define who you are. yyou are defined by your experience. sen. cassidy: the appropriate mindset, number one. what else? mr. rahim: number two, knowing that you have to go through accommodation. there is no one medication that
is a panacea for mental illness. that is why more researchers is needed. know that you have different, nations. you are not defined by your mental illness. having the ability to self report to a doctor, know how the medications are affecting you and your treatment as well as your body. know that you will have weight gain. you will have some sort of response in reaction. i think those are key components. one, trial and error. different combinations. know that they do not defined who you are. sen. cassidy: thank you, i yield back my time. sen. warren: for a lot of plans, mental health parity is the law, but it sure does not seem that way. i survey by the national alliance on health found that 50% of respondents had been denied coverage for mental or
behavioral health care compared with only 14% denied for physical health care. i hear way too many stories from people in massachusetts about how hard it is to get insurance coverage for the care they need. let me start here. dr. hepburn, what do we know about the number of those being denied services they need, why they are being denied, if they are filing complaints, and if they ever end up getting the care that they need. dr. hepburn: yesterday i called the maryland parity project. it is hard for them to know what the numbers are. when they look at how difficult it is to submit a request for review, it is so tedious it will take years. i ask for a recommendation. they said something will have to change.
sen. warren: you are citing we don't even have good data on any of those four questions. mr. rahim, if someone had trouble getting health coverage for mental health services, is there one place that anyone in this country could report a problem and get some help from? that is the information we need right here. mr. rahim: i don't know. sen. warren: that is part of the problem we have. connecticut created an office of the health advocate to help people navigate the insurance system and assist when they were denied coverage. in 2014, that office returned nearly $7 million to consumers, the most frequent cases they deal with every year -- denials of mental health coverage.
my colleague from massachusetts, joe kennedy, introduced the behavioral health coverage transparency act last month to try and create a patient parity portal to provide consumers run the country a one-stop shop for information about parity and a central place to submit complaints about coverage. let me ask you this dr. hepburn, would a central place for people to go with problems about insurance coverage for mental health problems help consumers and give regulators that are information about where to focus their enforcement actions? dr. hepburn: absolutely. sen. warren: this could make a real difference from what you are saying. good. as we move forward, i would like to work with you senator alexander and murphy, on making sure that consumers have a
central place to turn to for help when they are denied coverage and a central place where we want get the information so that we can enforce the law currently on the books. thank you. thank you mr. chairman. mr. chairman: thank you senator warren for the suggestion. senator franken. sen. franken: both chairman and ranking member for this series of hearings. you highlighted the nurse-family program assisting moms before and after birth.
i believe prevention is very important. that is why i helped advance the mental health in schools act, which will increase access to mental health services in school settings. mr. eaton, what percentage of individuals with mental illness experience onset before the age of 18? dr. eaton: it depends on what mental disorder you are talking about. before 18, for depressive disorder it is about -- the full-fledged disorder is about 20%. the beginnings of it are available -- 50% of the people that become depressive before 30 are already experiencing symptoms at age 15. they would be potentially
identifiable, depending on if we could get the tools to do that. for schizophrenia, i think it would be similar. it has much more sudden onset at age 18-25, something like that. the signs of psychosis and negative symptoms are there at the age of 15 and 20. sen. franken: i think this is why if we expand and enhance mental health services in our schools, we will serve ourselves well. i want to ask about rural suicides. a study made by d journal of american medical association shows that rural adolescents commit suicide at approximately
twice the rate of teens in urban areas. this disparity has increased over time. between 2004-2013, suicide rates rose by 7% in metropolitan areas, but 20% in rural areas over the same period. the research shows that these differences are driven by the lack of treatment options in rural areas, provider shortages, and stigma. as a cochair of the senate rural health caucus, i find this deeply concerning. dr. hepburn, you have previously served as a national suicide prevention advisory board. you represent the state program mental health directors. can you explain why suicide rates have been driven up so dramatically in rural areas?
dr. hepburn: i think you answered it, which is basically access issues. one of the thing that is important is to look at how we can advance technology to get to the rural areas. edit time when the internet is reaching people all over the world, there is not a good excuse for being unable to reach young people in rural areas. a problem we sometimes get is the lack of payment for those services done through telemental health. in this day and age, internet services should be made available in the same way that every other service is available. by doing that, we can increase access to those kids. sen. franken: which is one of the reasons we need to make sure that every area in america is
wired. this is something that i hear when i go to rural minnesota. providing incentives to mental health service providers in rural areas also. we just need them in this country. we have a provider shortage, is that right? would that be helpful? dr. hepburn: absolutely we have a workforce shortage. the average age in the field is 58. we have to use technology as a way as compensating for the. sen. franken: thank you all for the work you are doing. i think we are beginning to understand how important this is in this congress and this country.
i think we have seen some good things happen in this congress. i want to thank the chairman and ranking member again. mr. chairman: thank you senator franken. senator whitehouse. sen. whitehouse: following up on senator warren's questions, it strikes me that one of victories we have achieved has been to bring mental health out of the shadows and de-stigmatize it. not completely, not as much as it should be, but there have been some real victories. i want to commend my former delegation member, representative patrick kennedy of rhode island on the parity act, which has helped make that the law of the land as opposed to just a good social change. in addition to the problem of
getting insurance coverage, is there not also the underlying problem that our infrastructure for mental health treatment was basically built during a heavily stigmatized period, when very few people came forward? it was designed to address a fraction of the real mental health problem. in rhode island, we have some of the best mental health facilities in the country. our best in show world-class facilities, and yet they are all they are. you get beyond that, and you have difficult situations. often there is a crisis before you get into the mental health care system. because there simply isn't adequate coverage, particularly in children's mental health. i see that is the case in rhode island.
you all have a perspective from your national organizations. all heads are nodding, let the record reflect. mr. rahim: i can also speak to that. when i have spoken in 12 different schools, we did a four week follow up, are students ashley going to seek help? out of 200 students i talked to, 84 went to a teacher or school psychologist. if they are ready to seek that help, where do they go? if, people are ready to talk especially the young people, where do you go once you are ready for that help? sen. whitehouse: our victory in the stigma era has created a problem in the infrastructure area, in my opinion. in the judiciary committee, we
will be considering a bill called the comprehensive addiction recovery act. very often self-medication is a solution. not a good one, but one that people use when they face a mental health problem. can i ask for the record, if each of you would have a look? i think your organizations are already aware about the comprehensive addiction recovery act. a hearing is coming up in the next weeks. i would like to have your organizations opionions here that i can take there. the last question is about emergency rooms. ms. blake, you live in that
world. i have spent overnight in our emergency room just to witness what takes place. there is an enormous amount of response delivered in the emergency room. people come in the middle of the night, the police have no else to bring them, they take them to the er, bingo, now it is your problem. the er is not suited for dealing with that. if you good comment a bit more on how big a role that task plays in your workload and how much it is diminishing what else you can do. but also i'm interested in how comfortable that the electronic health records of that person are accurate and complete as to the mental health history of
that individual. is that a good or bad thing? i get the feeling that the regulations for privacy are preventing information on these mental health records. ms. blake: we had a 26-year-old gentlemen coming to the emergency room for a heroin overdose. we stabilized him. in the process of taking care of him, i got a phone call from a gentleman in virginia, who was trying to locate his son, who had been sent down to our county for treatment for rehab and substance abuse, who had walked
away from his rehab center. it turned out it was the patient i was taking care of. the problem was that i could not tell him because of hipaa, number one because the patient was unconscious and could not give me permission to do so. his son also had bipolar disorder, and had been off his medications. had we been able to release that information somehow, it might have changed the whole way retreated this patient. more importantly, it broke my heart to not be able to tell this man that his son was safe in the emergency room and will be able to recover. i think we look at some limited circumstances where certain information could be released. i certainly understand the privacy issue.
but it would be very helpful. in order to access someone's medical records, you first need to their permission. someone who might be in a mental health care crisis may not have the capacity to be considered to sign permission for it. sen. whitehouse: thank you. my time has expired but that was a terrific point. mr. chairman: senator murray? sen. murray: this has been an important hearing and i want to thank all of our witnesses today. we have a lot of work ahead of us. making sure communities have access to mental health professionals, integrating primary health care, breaking down barriers that stigma creates. that is a full plate, but an important one for us to tackle. i look forward to working with you on moving his agenda forward.
mr. chairman: ms. blake, thank you for bringing that up. touching hipaa is like touching and electric wire, but maybe that is what we are paid to do sometimes. as we look at our mental health decision, we should consider that circumstance. if you have a specific suggestion for the exemption, we would like to have it. maybe your organizations have that. ms. blake: we can put that on our agenda. mr. chairman: we are moving pretty fast here. ms. blake: we have a meeting today. [laughter] mr. chairman: well, good. thank you for the testimony from
all four of you. the hearing record will remain open for 10 days. members may submit additional information for that time. thank you for being here today. the committee will stand adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]
blizzard, but republicans fell short today in an attempt to override a veto on new epa water regulations that would assert power over small waterways like streams and wetlands. 52 senators move forward with an attempt to override the president's veto. they needed 60 votes. three democratic senators joined with republicans to veto the override. senator collins of maine was the only republican to vote against. coming up, we will take you live to sacramento to hear from california governor jerry brown and his state of the state address. we will have that live shortly here on c-span. >> c-span's campaign 2016 is taking you on the road to the white house for the iowa caucuses. 1 onning monday, february c-span and c-span two, we bring you live caucus coverage.
at 8:00, we begin coverage with the republican conference and on c-span two, live conference of the democratic caucus. >> more road to the white house covers today. this with two of the two democratic candidates with bernie sanders holding a townhall meeting at 7:00 p.m. eastern. hillary clinton is also on the campaign trail talking to supporters at the university of iowa scheduled to begin tonight at 8:30. here is a look at the recent ads in the campaign.
>> just a reminder, we are going to go live to sacramento for california governor jerry brown for his state of the state address. as he enters his six year of governor, he has held the position previously. after scoring victories last year on his signature priority on climate change. governor brown will lay out his next agenda for california. los angeles times writes that governor brown will deliver a state of the state on general optimism, but short on new ideas. the state of the state address from sacramento is coming up next on c-span. will take you live next to sacramento for governor jerry
state, theetary of -- our statex .reasurer john chung controller, the honorable betty lee. [applause] >> our superintendent of public instruction, the honorable tom -- our insurance commissioner. [applause] >> from the board of equalization, we have the chairman of the board from district 3, the honorable jerome horton. [applause] >> from district 1, the honorable george runner.
today from the diplomatic corps who are seated in the gallery. we have members today from the league of california cities in class. [applause] my good friend, former averez.john a perez -- [applause] welcome to all of our distinguished public officials, special guests were joined with us in the chamber today. honor and privilege to make two introductions. first, before i turned it over to my partner in the senate, let me just say, governor brown, since it's my last state of the state as speaker, it has been an
honor and a privilege to work with you these last two years. to call bush a rainy day fund, a reserve, to turn our fiscal responsibility around, and also create him privately -- important programs to help hard-working californians and your leadership envisions i have enjoyed. thank you. [applause] it is my great pleasure to introduce my partner from the red carpet, we have worked incredibly well together as i look at my last state of the state. i want to thank you for the partnership and work we have done in this last budget. i want to thank you for helping this get together, the tax credit, childcare, educational funding, it has been an honor to work with you.
with that, let me introduce to you the pro tem of the california state senate, kevin deleon. [applause] thank you so much. i also want to thank you for your strong leadership as speaker of the california state for the partnership we have forged together to help improve the human conditions for all individuals. let's give it up for diplomatic speaker, toni atkins. [applause] >> madam speaker, colleagues, fellow californians, today's
state of the state address is more than a simple formality of elected office. today's occasion is the ultimate tribute to the social contract that binds us. that was a celebration of our progress and also the acknowledgment of the fierce urgency of now. today, weak knowledge in the spirit of dr. martin luther king , this is the time for vigorous and positive action. unlike here and our great state of california, across this nation are political discourse -- been soured by toxic brew bigotry. laste underscore but, year, and the seat of government , californians of every race, gender, religion, and identity ofted and -- it was a year
remarkable a consummate across age branch of government. together, the california state assembly, the senate with the incredible governor of the state of california, governor jerry brown. we rose to address the inequities of terrorist in the gender wage gap in the novel challenges placed by ever evolving that allergy -- technology. together, we partially remove consistent barriers to threats of future generations. americansoven that as , we can be comparably diverse without being divergent. after all, california is the state of 40 million singular histories. as dr. king said, we are all tied in a single garment of destiny. our joint family is not free of
distinction -- this function. for many, these are indeed the best of times, too many of our brothers and sisters throughout california, these are still very difficult times. too many, we are still disenfranchised or at risk of still being left behind. to truly reckon with the flaws will require tireless innovation, relentless optimism, and continued partnership and bipartisanship. that is what as the head of the senate i look forward to working with my partner, madam speaker toni atkins with the upcoming speaker elect mr. anthony and the incredible governor jerry brown who's the best governor in united states of america. [applause] >> in the true spirit of unity,
it is my honor to introduce californians of tenant governor, my friend, the honorable devon christopher newsom, [applause] >> thank you all of you. i thought it would pick up on what kevin was saying. it is interesting that we live watching the news in nations and people being torn apart by racial and religious, ethnic controversies and feeling terror. in the spirit of what kevin was saying, think about where we are. in california, the most diverse
state in the world's most diverse democracy. i have long believed, i imagine many of you share the sentiment, that despite tragedy in san bernardino, many have said that the world looks to all of you to see that it is possible to live together, advance together and prosper together across every conceivable difference. --t makes california great what makes california great today is that our best, we do not tolerate that diversity. we celebrate our diversity. we celebrate all of our interesting differences. at the end of the day, we were night -- unite around the things that meet us together. the individuality that dr. king talks about. it is in that spirit, the spirit of our state, the spirit that defines the state of dreamers and entrepreneurs, innovators.
a state that is long prided being -- i proudly introduce the governor who has tosistently kept his promise the people of our great state. the fundamental promise that you do not have to be -- to be progressive. allpromise that he has kept the while, as kevin was just saying, by resisting the temptation of name-calling, resisting the dictation of scapegoating, resisting the 10 tatian to tear other people down. a governor who is relentlessly focused on the future, but also focused on how to practically manifest that future. how to bring a future forward. he has done it on the environment, health care, education, and as i imagine, we will hear in a brief moment what
he is pledging to do to help us address our aging infrastructure needs in the state of california. timepirit that defines the , california is the greatest date and our nation. nationsown is our greatest governor. ladies and gentlemen, colleagues , edmund g brown jr. [applause] gov. brown: thank you.
friends and fellow citizens, it was 41 years ago that i first spoke. at that time, my father was surprised to see me make it to the governorship at such a young age. now, i'm surprised that i'm still here. go, unless iars to take my surplus campaign funds and put a felon initiative to allow third term governors to seek a final fifth term. [applause] gov. brown: it is a light note. back then, california was amazingly dynamic and it still is. here know this
land as any place which draws people from every part of the world because of the tolerant, creativity, and share openness. there is much to be thankful for. we live today in a world that is profoundly uncertain. what happens far away can touch us directly. a slowdown in china or turmoil canraq or syria or anywhere send the stock market reeling input california jobs in state revenues in jeopardy. somee battle far away, comes right to our soil is the unprovoked and brutal attack in san bernardino. what occurs daily consummate parts of the world could occur here. that is what we have to be prepared and vigilant. i wish that was not the case, but it is. at the state capital, we think we have more control over things that we actually do.
events and policies set the pace and shape the world we live in. the challenge is to solve today's problems without making those of tomorrow even worse. we face a future that is partly determined, and yet in many ways unknown. our job is to face the fact that we do now and prepare for the many unknowns as best as we can. you are not going to hear me talk about new programs today. i'm going to focus on how we stick to the commitments we already have. let's start with the budget. since the second world war, we have experienced 10 recessions. economists are unable to pinpoint when a recession will begin or how long it will last. historically, california's budgets have been built around forecast that assume uninterrupted growth. just looking at the last two
recessions, we noticed that ongoing state spending accelerated into the downturn. if you out of the deficits and surpluses to the year 2000 2016, you find the total deficits for several times as large as the surplus, resulting in painful and unplanned cuts. schools, child care, courts, social services and other state programs were deeply affected. so were our universities, we had to reduce classes and double tuition. i do not want to make those mistakes again. recession will cut our revenues by $55 billion over three years. that is why it is imperative to build up the rainy day fund, which was just recently approved by the voters and invest our temporary surpluses into badly
needed infrastructure. let us also be realistic of our current tax system. california is a very progressive, but volatile income tax that provides 70% of general fund revenues. if we were to minimize the cut,spend, wend, must build a very large reserve. we also know that inequality has risen sharply in recent decades. we have seen the disappearance of many lower-class dobbs and the growing share of income taken by the top 1%. 0.1% more so by the top this contrast sharply with the virtual stagnation in the --
the average worker pays 360 times. such inequality is reinforced by a national, regulatory, and tax policies and driven by globalization and relentless influx of cheaper goods at outsourcing of higher-paying jobs. technological change also plays its part. sophisticated software, robotics , and global communication. andourse, this creates jobs makes available phenomenal amounts of information, but it also makes for higher -- a huge number of low-paying service jobs. california has not been passive. programsxpanded many to counteract these powerful trends. we raised the minimum wage. we are now the first income tax credit -- we strengthened strong
prevailing wage laws. we made sure that 6.5 million workers will be paid for sick leave. for low income students, would provide over $2 billion in grants and pagan roman fees for fees fory enrollment 65% of college students. in may, we will start providing full health care coverage of the children of undocumented workers. [applause] most importantly, this is truly monumental, we wholeheartedly embrace the affordable care act. [applause] as a result, we are now enrolling 13.5 million californians at another 1.5
million and covered california. this is a historic achievement that will provide health security to so many who have not otherwise afford it. under the area where we are leading the nation, is providing health services to people in their own homes. in the process, give jobs to their providers. , we havepast two years expanded this and home service program by serving more recipients in giving current recipients more cowards -- hours of care and giving overtime pay to those workers who provide those services. [applause] gov. brown: while these programs are enormous, so is the cost. in four years, total medi-cal by $23 billiong in estes state begins to pay for each year of the millions of new
enrollees, the cost of the fund will also rise. paid12, the general fund $15 billion for medi-cal. by 2019, that number is expected to be $25 billion, an increase of 2/3. in just two years, total spending will jump by $2 billion in 20% increase. turne economy reaches a point, it is crucial to plan for these increased costs. i ask you, republicans and democrats, to seriously consider the newly revised financing reform. other states have taken advantage of this federal program in california should not shortchanged itself. this is not a tax increase, no matter what anyone tells you. arithmetic is simple. california comes out a clear winner.
please, give it your consideration. [applause] gov. brown: do i detect a few republicans? [laughter] gov. brown: the strong economic recovery in the passage of proposition 30 has allowed us to increase spending in public schools and community college to $47.3 billion in 2011 to $71.63 billion this year. that is a 51% increase in overall spending -- provide for the unique challenges that face low income students, english learners, and those in foster care. this pattern of educational spending reverses the historic practice of assuming that all students encounter similar circumstances.
formula now inol its fourth year recognizes this fact with extra funding to enable educators to overcome the barriers that confront non-english speaking families and those with low incomes. i am proud of how california has led the country in a way that is returning control to local school districts. decades, it has been a national movement to micromanage teachers from afar. to increasingly minute and prescriptive state and federal regulations. california has successfully fought that movement and has now changed its overly intrusive test heavy state control to a true system of local accountability. we also know that the state has made other commitments. once we have yet to fully pay for. our retirement liabilities and lifelong health benefits for state and university workers
total $220 billion. year, the budget must allocate billions to slowly chip away at these obligations. we have taken steps to reduce the future costs of these pensions and put the teacher solidm back on its fiscal building. today, we have set aside a total amount to pay for 72 billion of future retiree health benefits. these liabilities are so massive, that ignoring them will not allow us to pay them off. this little sex fashion and emotion of chipping away with an obligation of three decades to pay for something that is already been promised. -- particularly before we make new commitments.
we have failed to a knowledge -- acknowledge that they will unfairly burden future generations of californians with these debts. another obligation we have to face is our deteriorating infrastructure. s and facilities and our parks, prisons and state hospitals, serious deficiencies abound. billion toto use $10 repair and replace aging structures. neglecting what we have built over many years and move -- letting it further deteriorate makes no sense. our overall statements -- maintenance estimates $70 billion.
we have no choice but to maintain our transportation infrastructure. yet, doing so without an expanding and permanent revenue source is impossible. that means, at some point, soother -- sooner rather than later, we have to bite the bullet and create new fees for this purpose. roadsy or another, the must be fixed. [applause] on the bright side, the joint toether of both parties secure passage of proposition 1. with our california water action plan, it establishes a solid program to do with the drought
and longer-term challenge of using our water wisely. our goal must be to preserve california's natural beauty and make sure a vibrant economy on our farms, cities, and for all the people who live here. a series of actions must be taken. we have to recharge our aqui fers, recycle, capture storm water, build storage and just -- conveyance, and invest in new technology. all the while, recognizing that there are limits. achieving balance between all of the conflicting entries is not easy. that i willyou listen and were patiently to achieve results. a[applause] water goes to the
heart of what california is and what it has been over centuries. putting fish against farmer misses the point and distorts reality. one of us and creature that dwells here forms a complex system that must be understood and respected. droughtthe immediacy of , there is the overarching threat of a warming climate. regrettably, the last year was the hottest on record. there are still those, particularly in washington who are in denial. this is what they cannot deny, that carbon pollution that exist all over the world is causing serious injury and respiratory diseases to people of all ages, especially the young and very old. thankfully, the rest of the world has heard the message. humankind must change the ways and radically be carbon eyes --
environment.the california was there leading the way. [applause] gov. brown: over 100 states have mo2mou.ed to our the goal is to bring capital greenhouse gases to two tons per person. that will take decades, but we are on our way. [applause] gov. brown: we know that disasters happen. , they floods, earthquakes will occur and we must prepare to respond. maintainingequires a solid reserve.
this morning, i talked about the difficulties that lie ahead. let us not forget how far we have come. was011, the state deficit $27 billion. unemployment was 12%. now, the budget is in surplus. [applause] gov. brown: standards have raised our credit ratings three times. [applause] we paid down accumulated debt, $26 billion worth. [applause] you should apply, because there may not be too much coming after this. [laughter] to. brown: we created funds offset the next economic downturn. [applause] gov. brown: we have increased
funding for schools by 51%. we are covered under medi-cal, 13.5 million people and a 74% increase. we elected a first contacts credit. -- income tax credit. toraised our minimum wage $10 an hour and that is 80% higher than the same minimum. created jobs have been and unemployment has dropped in half. -- 2 million jobs have been created and on employment has dropped in half. global recovery has a lot to do with that. we should applaud, but we cannot control good health. it is clear that california is still the great exception.
>> without objection, the governors state of the state address will be printed. we will join the joint convention -- >> more road to the white house coverage today. we start with bernie sanders who is holding a town hall meeting in new hampshire at 7:00 p.m. eastern. after that, hillary clinton will be talking with supporters at university
of iowa at 8:30 p.m. there is a look at the recent campaign ads.
>> is the one candidate for president who has everything it takes to do every part of the job. she was never let anyone -- shut down planned parenthood. you will take on the gun lobby in finally get equal pay for women and stop the republicans from ripping all of our products away. on february 1, stand up for hillary, because if you want a president who knows how to keep america safe and build a stronger economy, hillary is the choice. >> i am listening to you, i'm fighting for you, and with your support, i'm going to deliver. i'm hillary clinton and i approve this message. as president, i would defend this nation and do
it responsibly. i voted against the war in iraq. we must never forget the lessons of that experience. isis must be destroyed, but we should not do it alone. we need an international coalition with muslim boots on
>> discusses books written by the 2016 presidential candidates. >> everyone at think has interesting stories and their lives. politicians who are so single-minded in this pursuit of could be ideology, it interesting. when they put out these memoirs, they are sanitized. d and therefore minimum controversy. >> said night at 8:00 eastern on c-span q&a. lynchey general loretta said that the president's recent actions on government action is constitutional.
>> madam attorney general, we thank you for joining us today. ,s chairman of the subcommittee i believe it is my duty to the american people to probably oversee the department of justice and ensure that any funding provided by the subcommittee is used as congress intended and within the bounds of the constitution. it is clear to me that the american people are fearful that president obama is eager to strip them of their second amendment rights. let me be clear, the second amendment is not a suggestion, it is an individual right protected in the bill of rights and has been recognized by the supreme court. with that in mind, i'm very concerned with the recent executive actions for two main
reasons. obama i believe s far too willing -- the president has said that he believes that the way he wants us to, he must act alone. our constitution will not allow for this action and the american people will not stand for it. amnesty to executive thousands of illegal immigrants, or increased gun control -- the president has acted alone. however, what the president fails to remember is, we have a system of checks and balances. the system was created to ensure that power was not concentrated in a single branch of the federal government. haspresident i believe accelerated the use of the executive -- to allow new levels. secondly, none of these
executive actions that president obama has proposed would have prevented the recent tragic events in our nation, whether a terrorist attack or a single gun crime. i believe those responsible should be held accountable and that we must work to prevent it from happening again. as we have seen time and again, this president has used tragic events to push his political agenda. i believe he is more interested in grandstanding than engaging -- than actually doing the work necessary to protect this country. in the wake of the terrorist attacks in san bernardino, president obama did not address our law enforcement failures, which allowed the terrorists to live among us. he also did not look at making changes to our immigration system after he clearly failed us by allowing an individual who should have been known to be a violent extremist to enter our country. 'sstead, the president
immediate response was to propose an additional gun control measures. let's be clear, criminals and terrorists are not buying their guns from gun shows, gun stores, or collectors. criminals, by definition, do not follow the law very we live in a dangerous world. the american people are looking for us to do everything in our power to keep them safe. the next time a terrorist attack occurs in this nation, innocent law-abiding americans as have the ability to protect themselves and their loved ones from harm if they so choose. it is our responsibility to preserve their right and not limit them. i believe most of us know this president has made no secret of his desire to restrict the second amendment right of law-abiding citizens. the american people deserve and expect more from the president. they also expect more from their members of congress and i intend to live up to their expectations
. this subcommittee will have no part in undermining the constitution and the right that it detects. >> thank you very much and i congratulate you in holding a hearing with opening the session in taking up the topic of the issue of guns and their excessive availability in our society. this hearing tackles the very pressing issue of guns and gun violence. an average of 300 americans are shot every day, many of them will die, almost one third here -- we need to change our nation's culture of violence and we need to stop guns getting into the wrong hands, of criminals, mental illness, without infringing on the rights of law-abiding citizens to purchase firearms.
i do support the president's measure on guns. he is within his cost to small authorities to act in many of these activities, like adding more and agents, have been strongly supported by this committee. last year's omnibus under your chairmanship really showed our commitment to enforcing existing laws and staff in order to do it. i look forward to hearing loretta lynch's testimony today on the president's recent announcement on guns and the impact it will have on the american people and will it make us safe. no message, no talking points. will that help the american people? we respect the constitution and also its impact on the justice department's authority to deal with this. we will also listen to the
testimony of outside witnesses on the second panel. these people are well experienced, and also a father who would talk about the grim things that happened at sandy point. no one is immune from gun violence, whether a congresswoman trying to meet with york vigilance, gabby gifford. whether you are children going to elementary school in wonderful, suburban community called sandy hook. whether you are simply going to movies or going to a community college. we're sitting in a charleston church of the iconic civil rights struggle to study the lord's word and welcome in a stranger to end such a terrible tragedy. our president has been at that funeral as he has been at so many. he says we have to do something. we look forward to this and what
the president's proposals will be in the new year. the budgetary recommendations he put behind, we look forward to the president's recommendation. i am particularly interested in strengthening the instance of criminal background checks, back logs and technological glitches, people who want to go by the law are frustrated. we have to enhance the fbi's capacity to run background checks while at to do a lot of other background checks. are there new ways to do this and train local law enforcement? this is not only a justice department program. i just left a hearing where we are holding a hearing on mental illness. for so many people who are victims of gun violence, the volatile combination of mental illness and access to guns are dangerous. mr. chairman, i look forward not
to me talking and listening to myself, but listening to the attorney general and this wonderful panel you have invited to participate today. let's solve the problem and not get involved in constitutional arguments. let's help our american people be safe and secure, in their homes, neighborhoods, school, and house of worship. >> welcome to the committee again. your written testimony we made part of the hearing record. proceed as you wish. loretta lynch: thank you. good morning and the distinguished members of the subcommittee. i greatly appreciate the opportunity to appear before you today to discuss the steps the department of justice is taking to reduce gun violence and ensure smart and effective enforcement of our nation's gun laws. as the subcommittee well knows, our nation faces an epidemic of gun violence that has taken a devastating toll on communities throughout the country.
every year, tens of thousands of americans are injured or killed in armed robberies, domestic disputes, tragically, suicide, accidents, shootouts, and heinous acts of mass violence. law enforcement officers shot down by defending their communities to children killed and tragic accidents, our friends and family members, our neighbors and fellow citizens, are being taken from us day after day. as the list of tragedies involving firearms has grown, the american people believe we must do more to stem the tide of gun violence. this administration is committed to doing our part. the executive actions the president announced two weeks ago, including the measures i recommended to him, are essential components of the effort. they are important steps within the executive's power to clarify existing legal provisions, to focus enforcement effort, and stir innovation.
i have confidence that the common sense steps are lawful, consistent with the constitution as interpreted by the supreme court and the laws passed by congress. for example, the gun control act lists people not allowed to have firearms. such as felons, domestic abusers and others. congress has require that background checks be conducted as part of sales made by federally licensed firearm dealers to make sure that gun stayed out of the wrong hands. the actions announced by the president, which focus on background checks and keeping guns out of the wrong hands, are fully consistent with laws passed by congress. the new executive actions will bring progress on a number of fronts. by clarifying what it means to be engaged in the business of dealing firearms, we raised awareness of and enhance compliance with laws that are already on the books.
by issuing new regulations, we ensure that licensed dealers will report them if they are lost and stolen in transit. those trying to acquire some of the most dangerous weapons through trust or corporations undergo background checks. by enhancing our national system's background check, we will be better prepared to keep guns out of the wrong hands in the first place. by increasing access to mental health care treatment with a proposed $500 million investment to the department of health and human services, also referred to as hhs, we will not only be helping those in need but also curbing gun debt. the majority of which, tragically result from suicide. by supporting research on gun safety technology, we will be laying the groundwork for a safer future, and drawing on our strength at the most technologically advanced nation on earth. the steps i have outlined in the
actions that president obama has described are all well reasoned measures well within existing legal authorities, and build on work already underway. they clarify laws that are already on the books. clear notice will help ensure those laws are followed. they direct important resources to our law enforcement agents. these men and women deserve to have the support they need to do their difficult jobs effectively. they lay the groundwork for to easilyrnment provide more information to our background check system and helping people with mental illness gain access to care. in addition to helping people get the treatment they need, we must make sure we keep guns out of the hands of those who are prohibited by law from having them. and they invest in research and promising technology that will make weapons safer. problem-solving through innovation has been one of our country's biggest strengths. mr. chairman, vice chairwoman, i
am confident these actions will help make our people safer, our communities more secure, and our law enforcement more effective. i also have no illusions that these measures by themselves will end gun violence in america. at a time when there is so much work to be done and so much capacity for progress, there are many areas where only congress could act. we will welcome the opportunity to work with you to further these goals. that is why i am so grateful to have the opportunity to speak with you today about how we could work together to reduce gun violence in this country. i look forward to continuing the conversation in the days ahead as we discuss how to keep a promise to protect and defend every american's right to safety, security, and life and liberty. i look forward to answering your questions. thank you. >> thank you. as i said earlier, the constitution is not a
suggestion. you would agree with that? that the constitution of the united states is not his objection. loretta lynch: i agree it is the law of the land and the law we are all sworn to uphold. >> the rights of the people of this nation are not recommendations? >> i agree with you on that as well as your previous opposition. >> the second amendment is part of the constitution and the bill of rights. loretta lynch: it is an important part of the first set of amendments. >> you agree that the rights granted by the second amendment are equally as important as those granted by the first and fourth and fifth amendments, seventh amendment, and so forth? you say it is all an integral part of the constitution? loretta lynch: i believe the bill of rights and the subsequent amendment are an integral part of the constitution, as well as the case laws that seek to interpret
them. >> you said you worked closely with the president to craft these executive actions. to go as far as the president could legally go without overstepping. while we may disagree about whether or not the president has overstepped, and i am sure we would, i am concerned that the president is slowly shifting away at our second amendment rights. can you guarantee us that there is legal authority from the president to take the actions that he has taken and can you provide specific laws or court cases that support that position? loretta lynch: with respect to the recommendations i made to the president, as indicated in my earlier remarks, i believe they are consistent both with the constitution and existing case law that interprets the constitution. specifically the heller case handed down by the supreme court that defined the second amendment and clarified the
individual's right to bear arms, as well as the agency's right to promulgate guidance as well. with respect to actions taken, i am confident they are consistent with the law of the land come under the president's authority, because they seek to enforce existing laws and strengthen the provisions congress has directed that we undertake to keep american people safe, such as the background system. they seek to enhance protections for those with mental illness, providing greater treatment for them. another goal i know the subcommittee supports. >> each time there is a mass shooting, the issue of expanded background checks reenters the public debate. i think we must look at the facts. the facts are that most of those actions are carried out to individuals who would not have been prevented from obtaining a firearm. the sandy hook crimes were committed by a man who shot his mother and stole her guns.
the virginia tech shooter pass a background check to get his guns much like those that commit similar crimes in fort hood, aurora, chattanooga, and the list could go on and on. more recently the terrorist responsible for the attacks in san bernardino obtained their guns the rate straw purchase, which means a background check without it helped either. yet we keep coming back to this issue. , couldttorney general you go through these examples and tell us having -- how having firearms licensees would alter the outcome of those events. ms. lynch: i do not believe we are able to look back and find a specific measure to prevent a specific crime.