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tv   Mental Health Care  CSPAN  December 29, 2017 11:32am-1:06pm EST

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>> booktv in prime time tonight on c-span2 started at 8 p.m. eastern. >> the assistant health and human services secretary for mental health and substance abuse testified before the senate h.e.l.p. committee recently about suicide prevention programs and efforts to combat the opioid epidemic here tennessee senator lamar alexander chairs the h.e.l.p. committee.
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>> the senate committee on health, education, labor and pensions will please come to order. this morning we're holding a hearing entitled implementation at the 41st century cures act responded to mental health needs. senators cassidy and murphy were the leaders in this committee on mental health reform and in the senate. and those reforms included in our 21st century cures act. senator murray is not here today so she asked senator murphy to fill in for her, and i've asked senator cassidy to chair most of this hearing, or at least until 11:45. i will come back and attended but but i think it's appropriate senators cassidy and murphy share the hearings, especially given the extensive work in the area and their leadership and interacting the legislation last year. after our witness testifies,, senators will have five minutes
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of questions. national, young adult with a full-time job who also attends college. in june 2014, two days before 25th birthday experienced his first schizophrenic experience. since then shawn has been admitted to the band about psychiatric hospital five times, spending ten weeks receiving psychiatric treatment. sean recently wrote me saying, this may seem slightly depressing but my story does not in there. the doctors and staff i encounter at the hospital and at the center stone clinic taught me to live productively again in society. i had been free of the hospital for hole you're never going atomic taken medication, return to work and even paid off a car. i'm currently enrolled in tennessee state university as a junior pursuing a degree in psychology. sean is one person out of nearly 10 million in the united states with a serious mental health
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condition. without this treatment is story could've had a very different outcome. in tennessee about one in five adults have mental illness according to the tennessee department of mental health and substance abuse. that is more than 1 million tennesseans. over 230,000 of them have what is considered a serious mental illness. over the past few years this committee has worked in a bipartisan way to update part of the federal mental health system including programs of the substance abuse and mental health services administration which we call samhsa. for the first time in over a decade. as i sit at the beginning this effort was championed by senators cassidy and murphy as well as senator collins and other members of this committee. the reforms were part of the middle health reform act which passed this committee on march 16, 2016 and were included in the 21st century cures act which majority leader mcconnell called the most important legislation congress passed last year.
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today marks the third hearing on the documentation of the cures legislation. we hope the updates in this law will help more americans access quality, evidence-based mental health care. as i said when when we began hearing on the every student succeeds act, the lost up with the paper it's printed on if it is not implemented properly and 19 to ensure that the 21st century cures act is fully and properly implemented as well. our focus today is to hear how samhsa is in fomenting the mental health privations in tears. of the 10 million americans with assist mental health illness, and that includes severe schizophrenia, bipolar disorder, major depression, millions go without treatment as family struggle to find care for loved ones. most of the services and treatments for people with mental illness are provided by the private sector such as vandevelde or through programs run by the states. the largest role in the federal
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government is enough of money spent through medicaid in partnership with the states. the federal government also plays a role through samhsa which while relatively small compared to medicaid and responsibility states have is critically important to improving the availability and quality of prevention screenings, early intervention and treatment programs and recovery services. tennessee received over 80 million and samhsa grants last year. prior to our work on cures, federal mental health programs had not been updated in over a decade and a coronation between federal agencies was not as effective as it could have been. i hope today we will learn more about how implementation of those provisions is going, how has coordination improved among federal agencies on the best way to assist those with mental illness. for example, we hope promising research into early intervention programs at the national institutes of health would
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translate into clinical applications for patients. we also included updates to the samhsa lock grants to states to ensure the funding is best because the needs of those suffering from mental illness. in addition to improve the care patients receive, we encourage the adoption of proven scientific approaches to treatment so i would like also to have the agency started to incorporate evidence-based approaches for treating mental health. we hope the reforms would help increase integration between primary care and mental health care, and sure insurance coverage for mental health disorders is comparable to insurance coverage for other medical conditions and strengthen suicide prevention efforts. dr. mccance-katz, , i witnessed today, serves as the first assistant secretary for mental health and substance abuse. a position we created in the 21st century cures act. she has new authorities to cures to work with states and federal agencies and help more americans receive the treatment they need. i look forward to hearing about
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the progress being made to ensure more people can receive the help they need and have positive outcomes like sean. i would now like to turn that sharing of fishing over to senator cassidy, and senator murphy will make an opening statement and then senator cassidy will make a statement and then senator cassidy, you can take it from there. thank you very much. >> thank you very much, chairman alexander. thank you to both you and ranking member murray. thank you fly me to sit in her place and senator cassidy four years of our partnership on this issue. it is indeed fitting we are holding this hearing on the one-year anniversary of president obama signed the legislation that established this new position at the department of health and human services. dr. mccance-katz is is the firt ever assisted sector for mental health and substance abuse, position that is long overdue. it is also almost five years to
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the day since the terrible tragedy at center elementary school when a young man with serious mental illness killed 21st graders and six adults. let's be clear, there is no inherent connection between mental illness and violence. america has no more meticulous than any other country and yet we have a gun violence rate that is 20 times higher than comparable nations. we also know when people fall through the cracks of our fractured mental health system it can have a devastating impact. in the aftermath of that tragedy republicans and democrats were able to come together to pass the mental health reform act which was part of the 21st century cures act which represents the first comprehensive overall and reauthorization of our nation's mental health lost in a generation supported by the middle h.e.l.p. committee, garnered equal support from both parties and it could not happy with the bipartisan ship of this committee which is of course a testament to chairman alexander and ranking member murray.
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legislation most important provision is the part that builds upon the mental health parity and addiction equity act. by strengthening enforcement of that pie making more transparent for americans. still there are two recent reports that illustrate how far we still need to go to fully achieve that vision of parity. a couple weeks ago the third nationwide perry report which found more than one out of three respondents with private insurance have difficulty finding a mental health therapist but with only 13% reporting difficulty finding a medical specialist. similarly, a study found insurers pay primary care providers 20% more of the same types of care that they pay addiction and mental health specialists including psychiatrists. in many states the disparity in payment rates were two to three times greater rates higher for medical doctors for people practicing medicine below the
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neck the nose or practicing medicine above the neck. fortunately the 21st century cures act law provides additional authority to the trump administration on parity at hope will begin to see these privations and committed sin. also credit the position of assistant secretary, and a four step to make sure there is one person at the top of the leadership whose fullest sophist -- solely focus on these issues. other provisions include several grant programs to clear coronation mental health treatment the creation of the first ever infant an only child mental health grants. there's a section for workforce development. after running from consumers and providers about how there was confusion about hipaa and when it was allowable to share personal health information we included new authorization for hhs to develop educational materials to help patients and clinicians and family members better understand when these disclosures can take place. there are other elements that will likely come up today.
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we have to remember none of the programs we authorized in this bill matter if we don't find them. congress has an awful habit of talking a really good game on mental health and addiction, but then never being willing to actually meet our better with resources. the current labor hhs appropriations bill doesn't yet include funding for the new programs in the field we passed last year. even worse, the repeal bill that republicans try to push through the senate earlier this year would've cut medicaid to funding by over $800 billion that medicaid is the nation's primary payer for mental health treatment. but the legislation we passed is part of the 21st century cures act, it is still groundbreaking and properly funded it will stabilize. and so i'm deeply thankful again to the kennedy for the work in making this bill possible for calling this hearing. lastly i would just like to ask in this consent that ranking member yarmuth -- ranking member
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murray opening saving be placed in the record. >> without objection. >> thank you. >> many of you know i'm a physician who work for 25 years in louisiana charity hospital system, and i learned a couple of lessons to one when the patient has the power, the system finds a up to serve the patient what he or she gets the help he or she needs. what i observe is those with serious mental illness have no power. they are just, the inability to act upon the resources that are available are lost by the disorder which is in their mind. this is not just an experience with fellow has worked in a public hospital for the uninsured. it is a mixed breeds of us all with a family member, an associate, so we went to high school with. we all know someone who seem to have such promise and the promise was snuffed out by serious mental illness. and their ability to execute our totally lost because of that. now government has a a role and government has a role at its
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best to help those are most vulnerable. there's been a tangle of efforts by government to attempt to help those who had serious mental illness. i was so privileged to work with senator murphy and others on this committee the mental health bill of 2016, and we created a position that dr. mccance-katz is the first tool to create the authority to untangle this mess and to some outtake this whole mishmash some effective some not, , some would be affected if coordinated of government programs and lined them up to help those with serious mental illness. we are now about the one-year anniversary of that bills signing, and this is a hearing to look at the effectiveness of this. let me say sometimes these committees are confrontation. this is about collaboration and cooperation, how do we work together with this newly created position so that we can better
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serve those folks who have lost their power for almost anything because of serious mental illness. my goal is that when the 24 year old has her first psychotic episode it is her last psychotic episode. and when she is 50 she doesn't look back upon the single event as a life defining event leading up to the breakup of her marriage, the loss of her children, loss of her health but rather she looks back as a distant memory from which she grew and actually became a better person. that is the goal of all of us. we look forward to your testimony today, dr. mccance-katz, to ultimately restore holders and return power to the patient. thank you for being here, and now i will make your introduction. i am very pleased to welcome doctor elinore mccance-katz today, to today's hearing. dr. mccance-katz is the assistant sect for mental health and substance use at the
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substance abuse and mental health services administration. the 21st century cures act created the office of assistant secretary for mental health and substance use, replacing the role of samhsa administered. dr. mccance-katz formally serve as the chief medical officer for the rhode island department of behavioral healthcare development of disabilities and hospitals. before that she served as chief medical officer for samhsa. welcome again, dr. mccance-katz. you have five minutes to give your testimony, and we shall hear from you now. >> thank you so much, senator cassidy, senator murphy, and members of the health education and labors pension committee. thank you for inviting to testify today. one year ago today the 21st century cures act was signed into law in the substance abuse and mental health services administration has been actively limiting its provisions in concert with our colleagues and the department of health and human services, state and local
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governments, tribal entities and other stakeholders. for over 25 years i served people with serious mental illness and serious substance use disorders. it is such a privilege for me and an honor for me to serve as the first assistant secretary for mental health and substance abuse to as the assistant assist secretary of state my duty seriously. the cures act has asked that the assistant secretary look at the submitting research findings and evidence-based programs to improve prevention and treatment services, which are grants are subject to performance and outcome evaluations, consult with stakeholders to improve health services for those with serious mental illness, and children with serious emotional disturbances. and we and i work actively on that are part of strengthening leadership and accountability at samhsa include a strong clinical perspective. the cures act codified several of the chief medical officer and we've taken this further by expanding the office of the chief medical officer to include two additional psychiatrists and
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nurse practitioner. a new component of saturated by the cures act is a national mental health and substance use policy laboratory. the policy lab would promote evidence-based practices and service delivery models to evaluating models that would benefit further development and to expand replicating or scaly evidence-based practices across a wider area. the interdepartmental serious mental illness coordinating committee was established by the cures act to ensure better coordination across the federal government to address the needs of individuals with serious mental illness and serious emotional disturbance as well as their families. i was pleased to chair the first meeting of the chanting and late august which was attended by key chelators info, as well as 14 highly qualified nonfederal members. the ismic is been working within five key areas of focus come strengthening federal coordination to improve care closing the gap between what works and what is offered, reducing justice involvement and improving care for those just
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and fall. make it easy to obtain evidence-based behavioral healthcare and developing inet strategies to increase availability and affordability of care. as required by the cures act the ismic report will be delivered to congress today. i will just show you this. we are very pleased to bring it to congress on time and i hope that you will be pleased with it. >> i'll scratch that question off my list. >> the cures act reauthorize the committee mental health services block grant and codify the first psychosis set aside. set aside his vital important to ensuring individuals developing receive timely appropriate treatment. if we can intervene early with needed treatment psychosocial services people are better able to live with her illnesses. i song support the reauthorization in the cures act of assisted outpatient treatment or aot program in fiscal year 2016 samhsa implemented and aot grant program and awarded 17
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grants. sanchez has parted with the assistant secretary for planning and evaluation to implement a cross site evaluation which will assess the effectiveness and impact of this program. one important area the cures act address was suicide prevention. in 2015 over 44,000 americans died by suicide, and there are over 1.1 million suicide attempts annually in the united states. the cures act authorized samhsa existing national suicide prevention lifeline. in 2017 lifeline is already answered over 1.27 million calls surpassing by 100,000 those recorded for all of 2016, and we're not done with 2017 yet. suicide remains of the second leading cause of death for individuals 18-24. the cures act reauthorize the memorial act which provides grants to states and tribes to reduce. at the same time the highest rate of suicide in america is among adult 54-65.
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prior to the cures act there was no authorized suicide prevention program for adult at samhsa. we are grateful for the authorization of the adult suicide prevention program. as a result we have awarded grants 40 suicide which is a program that implements suicide prevention and intervention programs within health systems. insuring children and adolescents at risk for an living with the ever health systems receive the support they need. the national child traumatic stress initiative was reauthorize by the cures act and does provide resources to individuals impacted by natural disasters and other dramatic events. as directed by the cures act sanchez working collaborative with the hhs office of civil rights on guidance that would clarify permitted uses and disclosures of protected health information by healthcare professionals under hipaa to
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improve communication with caregivers of adults come with serious mental illness in order to facilitate treatment. with the passage of the cures act we continue to recognize the critical role of behavioral health parity and ensuring equitable high-quality health and behavioral healthcare for all americans. samhsa has conducted to parity policy categories to improve parity implementation in the commercial insurance market, medicaid and the children's health insurance program. hhs parody website has been updated to include information from a public listing session assets of the insurance parity portal which provides information for individuals who may experience of violation. much work has been undertaken and across hhs two of them at the cures act but we know this work is far from over. there are many more individuals and families struggling with mental and substance use disorders that neato. i look forward to continue a strong partnership with congress to help these people and their families, and to answer any questions.
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thank you. >> senator murphy, , would you like to go first? >> thank you mr. chairman. thank you, dr. mccance-katz. we are very excited that you're doing fantastic work in this position. he got a lot on your plate but we are excited up of the early deliverables. i wanted to make the first ask you to talk about more about the question of integration and you referenced it in your testimony but i'd like you to talk a little bit more about the work that can be done at hhs and through cms to try to bring together our behavioral health system and the rest of our healthcare system. whether the proper ways to do that are working through state governments, whether you are new payment mechanisms that we could develop through cms to try to marry together these systems pick its an anachronism, the idea that we have one system of
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healthcare for your neck got and get to walk across town to find somebody that will treat the rest of your body. it's a slow progress, slow progression to fix that. in part because of the way we find mental health and mental health services. there is at least one grant program in santa designed to take this on but tell me what you been doing since you been on the job to try to promote integration. >> so thank you for that question. because i think we're doing a fair amount. we have funded programs that are bidirectional and that was to the cures act, so that behavioral healthcare can be put into primary care settings, and primary care into behavioral health settings. we also have a program that again congress brought into being a couple of years ago and is now in the process of
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implementation, and that is for the certified community behavioral health centers. these are programs that are focused on behavioral healthcare but require that both serious mental illness treatment and substance use disorder treatment as well as physical healthcare can be in the same setting for individuals, primarily diagnosed with mental health disorders. so that's very important. we work collaboratively with cms we are talking with them about what kinds of innovations they might be able to look at in terms of ongoing funding. i will personally advocate for the continuation of the cc bhc, the community behavioral health center program. because even though we have an evaluation out, we know that they work very well because the integrate care. and they pay for that care and that's the other thing about the ccbhc. we have seen as providing the
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payment for services. i think it's going to be very important to establishing these kinds of centers. we also work collaboratively at samhsa, with other operating divisions that provide direct care including a much larger organization that we are but we provide a lot of technical assistance and opportunities for training for their providers on behavioral health issues. same with indian health service. and i also since i started had my chief medical officers establish a relationship both with herself and the indian health service to make sure that these things move forward. >> often states regulate behavioral healthcare centers and primary care or federally qualified health care centers through different agencies. when they try to combine the often at some simple regulatory hurdles like the number of fire drills are different in the two different locations.
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so when they go on to one site that often are sort of being overregulated. i hope that is something to help states try to overcome. one final question on hipaa. i mentioned it in my testimony. a lot of confusion out there in the community as to what clinicians can share with family members, with caregivers. we gave you the ability to develop some new guidance to try to make it clear. i think mostly to providers, about when they're actually able to share information with a family member or a caregiver. i know you're working with the office of civil rights within hhs on guidance but just wanted you to give us an update on what we might be seeing that come forward. i think it would be really helpful to everybody in the community. >> so yes, i can definitely comment on that. for one thing, i think today you
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will get a series of informational documents from the office of civil rights that further clarify when information can be shared. i spoke with him actually yesterday at hhs about site told me that would be delivered to cox today, just as our ismic report is coming to you today. a few weeks ago the office of civil rights put out a guidance to practitioners about what can be shared in emergency settings. so one of the big sources of confusion has been when a person comes into an emergency department, for example, with an opioid overdose, can that information be shared with caregivers, loved ones? the answer has often not been should because mistakenly practitioners think this is covered by the federal federal confidentiality statutes related to substance abuse treatment. this is that substance abuse treatment. this is treatment of a medical emergency and under hipaa were able to show that paper also
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it's also true that are exceptions under 42 cfr. and so we've had one guidance out to practitioners about what they get you under emergency situations that went out in november. we are working on another document that will further clarify both hipaa and 42 cfr in the same document. .. >> i'm going to ask you being tight with your answers because i have a lot to answer. follow up with what senator murphy asked you about. that is great you're following
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up with hipaa guidance. do have this availability to continue continuing education credit or legal credit or nursing credit? i find those kinds of things can be trees falling in the forest, if you make it ceu before the end of the year and everybody has to get they're credits in, it has a little more bang? >> exactly. we have a number of training programs at smsa. they address a wide variety of topics. the issue of sharing information. >> will they be continuing education credits? >> absolutely. we offer no cost to providers. it is oriented towards nurse practitioners, pas mainly. we have -- >> you have to get continuing legal credits, i will say that because it will be lawyer calling in the middle of of the night, hey, can i share information? if the lawyer says no, they will not do it.
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>> you are exactly right about that. as somebody who worked in a hospital setting i can tell you they can be a very big barrier to sharinging information. >> lawyers and problems. can't imagine. but anyway -- >> actually our chief medical officer, one of the things she is working on developing a network with hospitals and the hospital, national hospitalizations to exactly address these kinds of issues. >> legislation, collectively ours, we have reporting requirements. and, clearly, you just got so measure, could be money which is wasted. so, first, has smsa put the state plan requirements in place for the fiscal year 2018 block grants? how are you measuring compliance by the states in terms of reporting? how does smsa take into consideration compliance with the reporting section and how well states are performing when they decide to award a grant?
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>> so we have a required government reporting system, that is used by all of our grantees including the states and in the block grant funding. i will tell you i'm not satisfied with the data as it is currently collected. i think that we could do a much better job of getting information and that requires a certain set of steps that we need to go through but i will tell you since i've started we have made good progress on that. we will be approaching omb to further hone those questions that will be more informative about those programs. >> let me ask as well because i've actually spoken to colleagues about this medicaid is not required to robust i report data. i understand when it comes to mental health it is called braiding. smsa block grants with medicaid dollars with medicare dollars et cetera and it us all put together for a package. cms has one set of reporting
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requirements and smsa has another. has there been any initiative between smsa and cms to somehow coordinate these reporting requirements perhaps to unlock some of which cms holds but smsa could use? do you see where i'm going with this? >> i see where you're going. i can tell you this part of the role of the assistant secretary position to reach out to other divisions, other agencies, other departments. so i have asked for a meeting with cms. that will be happening soon. this is one of several topic areas we've been addressing. i talked to folks at samsa they say this is a big hurdle. they do not know a way we could pair those data. i do understand what you're getting at but i will be talking with cms about that and see if we can bring together people to look at that. >> let me also say this is about collaboration and cooperation. i would suggest, i suspect senator murphy, certainly my
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staff would love to meet with your staff how we facilitate that. we're paying a lot of money to the federal government for medicaid and have pretty poor outcomes for medicaid. when you control everything you still have poor outcomes. we need to have better reporting requirements. if it take astute to make that happen, or some sort of oversight, sometimes that makes it work bet. so, want to work on that. so at least murphy and cassidy's staff would like to meet with your staff regarding that. >> got it. >> okay. i have some other questions. i'm almost out of time. now i think i go to senator franken. >> thank you, mr. chairman. good to see you again, doctor. when i meet with people in minnesota who are struggling with mental illness and substance abuse disorders i often hear about the stigma people experience. mental illnesses are often not regarded as physical conditions. rather sometimes seen as moral failings. and we all know that is just not
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the case. my predecessor, senator paul wellstone made it his life's work to fight for people with mental illness, pushing seeslessly for mental health pairtry. one of my honors as senator of minnesota is carrying on his work on mental health and championing policies that help promote parity. i'm proud that the affordable care act expanded parity protections to people who don't have employer sponsored coverage and seek care in the market and 21st century cures bill calling on the federal government and key stakeholders to come up with a action plan to improve mental health parity laws. dr. mccance-katz, you referred to the listening sessions the administration held this past july. patients, advocates, providers explained many times people can not provide in network providers, face high
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out-of-pocket costs an have to fight with insurance companies just to get services covered. stakeholders called for more enforcement, transparency from insurance companies, and agency guidance. the actions the administration has taken thus far fall short of these demands. what will you do, commit to doing, in your new role to improve transparency from insurance companies, and transform the parity portal into a meaningful resource for consumers? >> yes. thank you, senator, franken. and i will tell you that that is a work in progress. so, one of the things, one of the reasons that i agreed to come back into federal service is because i want to advocate for people living with mental and substance abuse disorders. is i'm going to be an advocate for as long as i'm in this position. one of the things i think is very important for people to be able to get access to care and
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when they have barriers that are put in place by arbitrary insurer limits it is unfair. so i am working with people at hhs around this parity portal to try to make sitting that will be more functional for consumers. right now it has been updated so that at least people will be, will be shunted to either socio or department of labor depending what their problem is but i would like to see this something much greater and something that consumers could actually use to get information but it will take time. >> i'm so glad to hear you say that. for years we've heard a growing and urging cry from clinicians and tribal leaders about the opioid epidemic and in particular its impact on indian country. that is why in the indian affairs committee i asked indian
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health service acting director admiral how the administration could address this issue and the opioid epidemic in indian country more broadly. he recommended we first bring tribes to the table and second consider community and culturally-specific drug prevention and treatment programs. i pushed for language in the 21st century cures act that leaders at smsa consider unique needs and circumstances vulnerable subpopulations of native americans in their programs. what are you doing to support and expand culturally-based treatment programs for individuals living in indian country, especially those suffering were opioid addiction and other substance disorders? as part of your answer can you describe how you're engaging with tribal communities and working to develop and implement these culturally specific programs? >> yes. so we have an on going, we actually have a office of tribal
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affairs at smsa. we have ongoing meetings with tribal leadership. when i came to smsa i learned that one of the addiction technology transfer centers specifically put in place to assist tribal nations was going to end. that has now been funded. there is a funding announcement out. >> very good. >> we will choose a grantee who will work work with tripes toe meet their cultural and substance needs. we have our chief medical offices meeting with theirs, working with them around what kind of technical need they recognize and smsa can help them with.
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we have a lot of training programs that are quite good. >> thank you. i am out of time. we spoke about supportive housing. i want to continue that conversation as we reach that body. people with mental health disorders and addiction get services thank you for engaging the conversation before the hearing. thank you mr. chairman. >> thank you. >> senator whitehouse. we in the association got in theca. rar and cures act, got extra billion dollars spent on opioid
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treatment. the first half of that was already distributed. we hope and expect the second half will come through and at the end of this year, funding measure. whatever that ends up looking like. we're very much counting on that. in the last one the measure which the funding was distributed to states didn't coral rate to the rate of the opioid epidemic, the intensity and severity of the opioid epidemic in that state. nor did to go to the recently-passed cara bill. i hope when we move forward on this, you are in a position to structure the grant process for the second half billion, in such a way that it more accurately addresses the high-impact states and that it better connects to the cara bill. i think you can probably do that in the terms of the grant
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application request that you structure from samhsa. i want to hear from you where you plan to go with that? because the high-impact states kind of got, not treated so well. >> so my understanding of this situation is if we make any kind of changes to the previous funding announcement, then all states would have to reapply for the money. i can just tell you that we've been hearing from lots of states about their concerns in having to reapply for the money and the decision was made to have the, to not have any substantive changes in the second-year funding, for that two years that billion dollars, 500 million each year. >> so for the sake of the process convenience for all the high-intensity states are going to pay the price? >> so, so i would say a couple
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of things, one when that decision was made i did go back and we looked very hard and we did find money and we put a few funding announcement out that does prioritize those states that have been hardest hit by the opioid epidemic. i will continue to do that. in addition the other thing that i have been able to do is to, is to reallocate funding so that we're building a new technical assistance program that will be individualized to every state. so those sits, that are hardest hit who have certain types of special needs, we will have local technical assistance available to them we think will be important to help them implement as efficiently and effectively as possible. going forward from, from that two years of funding whatever congress and the president decide upon we will look at that, be very much aware of the kinds of issues you just raised.
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>> please also be an advocate for additional spending in this area in the cara programs in particular. i think we were able to get $170 million in the last funding measure. >> yes. >> that's 2% of the $8.6 billion that the pharmaceutical industry makes selling just the prescribed opioid products, setting aside the illicit stuff that comes over the border. so 2% up against the devastation that we're seeing in the context of a multibillion-dollar industry, i would consider a beachhead, not a victory. hope you agree? >> yes, sir. >> last quick thing, this is a rhode island-specific thing. the health insurance commissioner as you know in rhode island is taking a look at parity compliance of the
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insurance companies in rhode island and i know you're looking at that at the national level. can i just make sure you've got somebody on your staff coordinating with rhode island to make sure you're sporting their work and is pulling smoothly together on parity disclosure and enforcement? >> yes. two things. one, samhsa has develop ad parity tool kit for insurance commissioners that we made available to all the states, and two, we have an office of around health, health care reform issues and that, we have a person who works individually with the states and with insurance commissioners within the states. >> terrific. >> we will make sure that happens. >> time's up. thank you, appreciate it. >> chairman alexander. >> thank you, dr. mccance-katz, welcome. i want to follow up with senator white houses question -- senator whitehouse's question. if i remember right it was his
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language we put into the cures act to make sure the money distributed too into account high-impact states. am i correct about that? >> the problem is, it was based, as i understand about the number of opioid deaths. >> but we did put language in. >> big state you will have a big number, did you doesn't mean you will have a big impact so -- >> our intention, dr. mccants cats, was to recognize the, was to distribute money to high impact state that was our intention -- >> i think the intention was not accomplished. >> so what do we need to do to accomplish our intention? you're saying that it would be impractical to cause all the states to reapply again. i can see that but, there will be more money coming for
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opioids. we don't know yet when or where or how much but, is it, is it the language about the difference between high-impact states, i mean the number of total deaths or number of per capita deaths, is that the issue? or what kind of language would you recommend that we include in any new funding so that we direct money with a particular sensitivity to high-impact states? >> so, senator alexander, i was not here in the previous administration when the decision was made. >> yeah. >> however my guess would be that they were trying to implement as congress directed. >> right. >> and i don't know that -- >> what would be a better way to do it? i'm not trying to criticize them. i'm just trying to say if you're doing it today, how would you do it? >> yes. and so for the new funding announcement that we just put out, what we said was, we were looking at the rate of opioid
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overdose deaths within the state, and the rate of increased year-over-year. that tells you how hard a state is being hit. >> will that affect the second round of funding? >> when the second round of funding comes forward, absolutely we'll be looking -- looking -- -- >> that doesn't require a new source of funding -- >> if new source of funding everybody would have to apply -- >> wait a minute. second half billion dollars is what you just described, does what you just described apply to at that second half billion dollars? >> no. >> but you would recommend what you just said would apply to any new money? >> exactly. >> and would you work with our staff so if we write that properly, if our intention is to recognize high-impact states we do it in a correct way so we don't get surprised by it? >> i absolutely will do that, yes. >> okay. now let me ask you this, in 2014
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congress required states, i remember the discussion with senator whitehouse and i want to see that his -- we tried to implement his intention and we can keep working on that. >> i'm just so grateful that you followed up that way, chairman. i appreciate it. >> yeah. in 2014, congress required states to set aside 5% of community mental health block grant funds for serious mental illness. the cures act increases requirement to 10. that sounds good but increases flexibility states have might be different in rhode island and california. what is your opinion about the increase from five to 10%? does that hurt or help the ability for the states to respond with the needs with those that have serious mental illness? >> vast majority of payment for services delivered to people
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with serious mental illness is not from samhsa. the block grant, increase of 10% causes a focus on something very important, that is early identification of episode psychosis. we know the longer a person goes without having they're psychotic thinking or treated more refactory their illness becomes over time. that 10% in the block grant does a tremendous amount of good raising awareness of this important issue. >> how does that encourage early, early prevention? if you just, the language you just focus on serious mental illness, isn't it or does it say something about early? >> it talks about early identification of serious mental illness. >> early identification of serious mental illness. >> yes. >> it is not the serious, but it is the early that is the key to effective treatment? >> but we consider psychosis to
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be indicative of serious mental illness. >> so you think that the 10% helps? >> i absolutely do. >> because of the push toward early identification of serious mental illness? >> yes. and we know that the onset of most psychotic disorders is in adolescence and transitional age youth. so this is really very important to the lives that these folks will be able to live going forward. >> thank you, mr. chairman. >> senator hassen. no thank you very much, senator cassidy, and mr. chairman, thank you, for holding this hearing. and dr. mckatz talk about a states impacted by horrible epidemic taking lives across our country but in new hampshire our
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men at -- fentanyl, heroin, opid it is killing us in highest per capita death rate in the country. we were targeted by fentanyl dealers. i was at a funeral saturday where a woman buried their second daughter because of an overdose. the woman had been in recovery. the disease is taking all of our efforts, but i'm grateful to everybody on the committee and add my concerns and frustrations what you heard from senator whitehouse. i expressed them directly to the secretary. the fact that states were uncomfortable reapplying is not an excuse in terms of the decision that was made with the second round of this funding. towards that end, senator alexander, senator capito, coons, senator manchin and myself have a bill in called the targeted opioid funding act that
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would change the formula and make clear what kind of priority we should give to per capita death rates and i would love the committees attention and collaboration on the bill. but even if we fix this formula under the cures act, we know the cures act money is only for two years. we know there is no quick fix for this epidemic. we desperately need funds to fight this epidemic. we need the administration to tell us what is uply mental resources its to turned tide. i appreciate it being at the white house in october when the president declared this a public health emergency but so far we haven't seen any follow-up to that declaration. we've seen no proposal from the administration for the funds that we need to tackle this epidemic everywhere in our country, an epidemic not only taking lives but in new hampshire i think the year was 2014 or 2015, cost us over
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$2 billion in our economy. so dr. mccance-katz, have you had conversation about need for additional funding with hhs and the white house? why hasn't this administration called for additional funding or proposed additional funding so we can get the dollars and row sources to the front lines where it is so needed? >> senator hasan, i think that there are there are lot of efforts looking at move any that is available. my understanding the administration is interested in working with congress developing those ideas that something the president and congress can agree on to bring resources to bear. >> this congress made it very clear we support additional funding to fight this but we
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need an partner in the administration to stop talking and start funding. and so i would look forward to continuing those conversations. i also wanted to follow up with another question because, we know how complex the opioid use disorder is. it is often accompanied by a variety of mental health disorders, including for example, post-tramatic stress disorder. this leads to complex and sometimes very dangerous outcomes. veterans and other populations with ptsd and co-occurring pain conditions are often prescribed higher doses of opioids putting them at greater risk for accidental overdose and deaths. treating one disorder does not address the symptoms of the other. it is imperative we work to insure patients have access to comprehensive treatment to address both substance use disorders and mental health needs. doctor, has the mental health provisions in the 21st century cures act helped samhsa
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he help evidence-based treatment programs and mental health disorders and opioid use disorder? >> yes, i believe they have and specifically i can speak to the issue around the department of defense and veterans affairs which cures addressed and which, has developed into a very strong relationship where samhsa works collaboratively and we specifically addressed issues of the mental disorders and opioid epidemic as well as suicide. those are the big issues that we are working on right now. and we also can use the information that we learn from the va, which actually does a lot of research of its own and we share this and we promulgate it to communities. >> i thank you for that and the division of integrated health care in this area. i'm most concerned we are delaying some of our work that
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would be made possible with extra funding because of the stigma attached as many of the other speakers, senators have referenced and i appreciate very much your efforts. >> thank you. >> doctor, good to see you. good to see you. i read a book some months ago by sebastian younger, a small little book called, "tribe." he discusses in the book the challenges our veterans face as they try to reintegrate back into society. it makes the point from evolutionary standpoint we're more, we're more comfortable in tribal societies, like military platoons, embedded in the military structure than we are in the current atomized society where people tend to feel lonely. there are challenges of reintegration and adaptation. he turns on its head the challenges our veterans are
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facing. the problem is not per se with the veteran but may be with the broader society. it's a very interesting read. and when i lay that line of argument, that analysis on top of the study, the depths of despair study that we see increasing rates of morbidity among middle-aged men, white men in this country and the reason for the debts is heightened suicide, alcohol use and so forth. start to think loneliness is really driving some of the mental health issues in our country. can you give me your assessment of that perhaps popular reading of the literature? >> i do think, i do think those are important points. i actually think that there is actually research data that says that people who are isolated,
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who will endorse loneliness and feeling ostracized within their communities have, die at much younger ages. so that is an important issue? just something that is, is this, it is a driver, is what i'm hearing. a driver of some of our mental health challenges. are there evidence-based approaches to intervening in this problem, if not solving it, to mitigating the challenges. if so, what is that evidence base? what interventions work? >> yes. so, so, senator young i think this is a topic in evolution but i do think there is some accumulatinging evidence for the value of recovery supports as they not only to substance abuse disorders but to mental disorders and so one of the things that i'm working on and this is one of my priorities
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actually, is to bring psychiatric medicine into closer contact and collaboration with community recovery supports. it is not enough to provide care, psychiatric medical care. people need those recovery supports in their communities. they can be veteran-based. they can be faith-based. they can be -- >> right, right. >> you get where i'm going with that. i think that will go a long way towards assisting people to live the fullest life. >> seems consistent with common sense, that there is, there is more needed than medicating these problems away. people need genuine human contact. they need relationships that are meaningful to them. they need to feel like they're part of a broader community, a meaningful part. so i just have a couple of minutes left f we could turn to
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how the federal government incorporates or fails to incorporate feedback loops in terms of addressing mental health, and policies we have. there is a recent governing magazine article on this written by a health economics professional at harvard med school, a former obama administration official. and the authors advocate including a tiered-evidence approach with cures dollars to allow for scaling up of evidence-based approaches while concurrently supporting field-generated innovations. have you considered including a tiered evidence approach in some of your programs? say the national mental health substance abuse policy lab? >> thank you for that question, senator, and i think we spoke a little bit this when i was going through the confirmation process. >> i want to publicly speak about it. >> yes. and so the answer to your question is yes. we are. and i'm very happy to be able to
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tell you that the policy lab is being stood up now. we've hired a director whose, i think is very experienced and knowledgeable person who is going to do exactly that kind of work. >> great. i continue to of course have great interest in this. we'll be following up toe you and your staff to see how we're supportive from a legislative standpoint. thank you, mr. chair. >> senator franken. >> thank you, mr. chairman. i was glad to hear you talk about recovery supports. we had rebecca boss from rhode island, i know you're from rhode island. >> i used to work for her. >> she ising doing unbelievable work. in rhode island they have recovery coaches what they're called. they do exactly what you're talking about, getting into the community. one of the things that we put in 21st century cure, into the cures act is more crisis intervention training for police. we talked before the hearing
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about judge lifeman, steven lifeman in miami-dade who has implemented a system where people with mental illness and substance abuse, who get arrested, instead of going to jail which they used to do and costs a tremendous amount of money, or going to emergency rooms which costs a lot of money, getting them housing and getting them wrap-around services. that is something i think that you know, talking about, i know that senator young and i have talked about housing as a way -- we've done this in henapin county in minnesota. that is something i want senator young and others on this committee to keep advocates for and keep thinking about, i will be bugging even from outside.
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i want to, and, i want to talk about indian country again. and, senator hassan talked about ptsd. talked about trauma. and we see a tremendous amount of trauma in indian country, not just the historical trauma but the trauma of extreme poverty, of domestic violence, and drugs and sexual abuse and all of the, those things and. that's why we see such high incidence of opioid deaths in indian country. i went to a rehab for teenagers in northern minnesota a couple years ago and i've been visiting a number of rehabs. i had never seen such kind of
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hopelessness in a rehab. usually when you go to rehab there is people feeling hope at a certain point and what i really got was these kids, most of them had started with use with their parents and, the hopelessness that i saw what they were going back to and they seem to be going back to -- this is true also, not, without indian country. i was in rochester, minute south, where we had a roundtable on opioids and a woman whose daughter gotten treatment, went back and fell in with the old crowd and is now gone. one of the things that i was thinking of again, with housing is, a model of and maybe piloting this, of a sober living housing in indian country where instead of going back to where
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you, back to where you were living, going to a facility that has people like you, you know and it could be very close to or on the reservation but where you're getting continuous support and being tested and you have a fellowship of the people there who are living sober too. especially opioids, this is long, long term thing. this isn't five days of, you know, of detox and 28 days. it is much longer thing than that. that is something i would really like to advocate for, going and going forward. so, and one last thing about culturally specific in indian country. i think it is very important but i did a roundtable in
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minneapolis and one of the providers there, one of the counselors said to me, i said what does that mean, culturally specific? she said when an indian woman sees me as her counselor, because i'm indian, she knows that i know what she's been through. i think culturally specific means more than just a cultural thing. i think it means actually in indian country making sure that we train the providers. so, thank you. >> yes. and i agree with you, yes. you're quite right. >> thank you, doctor. >> senator warren. >> thank you, mr. chairman. dr. mccance-katz, one of the most important things we did in cures, was create an office of assistant secretary of mental health and substance abuse,
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which is what you've been nominated to head up. we need to ramp up our response to the opioid epidemic and that means using every single tool in the tool box. and one tool is to put more resources into mental health. so, can i ask you to tell us why it is so important that we address mental health if we want to beat back the opioid crisis? >> yes, and thank you for that question. because there is such a very high rate of co-occurring mental disorders with substance abuse disorders and the genesis of these mental disorders often predate the substance abuse disorders. we know if we don't address the disorders, if we treat one we need to treat both. >> i appreciate that it is clear making progress on the opioid crisis means putting resources
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into treating mental health disorders. medicaid is the largest funding source for mental health services but samhsa has a number of other programs that help fund services that are not covered through public or private insurance. the mental health services block grant and a group of other grant programs called the programs of regional and national significance are samhsa's main mental health programs providing funding for all 50 states and supporting the work of mental health agencies of local governments, and of non-profits who are working in this area. these programs are absolutely critical to improving mental health in this country. and they serve millions of americans, but let me ask you, dr. mccance-katz, is everyone who needs mental health care able to get that help right now? >> i would say the short answer
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to that is no. >> no. and why not? >> there are a variety of reasons. one thing we know people who need this kind of assistance don't want it but then there are also barriers that prevent people from getting the care and treatment that they need. it can be very difficult to access care. >> right. do you have an estimate how many people need mental health treatment who aren't able to get it? >> i think our data told us somewhere around 12, 13 million people. >> that's really stunning, stunning number. and now, the mental health services block grant and problems of regional and national significance are samhsa's two largest mental health programs. combined we spend less than a billion dollars a year on those programs. so let me ask you, the white house council of economic advisors released a report last month estimating the cost of the opioid crisis to this country. do you know what figure they came up with?
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>> i'm guessing it was pretty high. >> it was pretty high. $504 billion. so think about that. the cost to this country annually of the opioid crisis more than half a trillion dollars. that is in 2015 alone. that is where we have the most recent data, and we are investing only 1/5 of 1% of that amount in helping samhsa tackle the mental health piece of this problem. i think we need to do more and that's why i have called for an additional billion dollars of funding in next year's budget, that would double the samhsa's budget and double what they put into the two largest mental health programs. yesterday the national council which represents 2900 mental illness and addiction organizations wrote me a letter and i i want to quote what they
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said. they said now is the time to support the highest possible levels of funding for health care programs in the federal budget. today, this morning, the massachusetts association for behavioral health care sent me a separate letter requesting that congress double these funds. i could not agree more. that doubling the funds for these mental health programs would give millions more americans access to the help they need and astronomical cost that the opioid crisis is costing our country. thank you for being here. thank you, mr. chairman. >> thank you, mr. chair and good to have with us, dr. mccance-katz. i want to talk about the issue i hear from the law enforcement community. that is the intersection of mental health and people who are in jails and prisons who shouldn't be. i have a lot of tough sheriffs, tough law enforcement sheriffs and police chiefs who lament the
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fact that their jails are filled with people who have diagnosed, but untreated or sometimes never diagnosed mental health conditions. they feel, these people shouldn't even be in jail. but if they're not treated, they will do something to harm themselves or others they will end up in jail. they feel like they're being asked to be the mental health provider for a society that doesn't fundamental health services. they feel compassionate anger about that, but resource challenge that makes it harder for them to do their job. so i really want to ask about that i also talk to police chiefs sometimes after high-profile incidents of police shooting of somebody for example. they will say, at bottom, some of this was the police approached somebody out after mental health need and were not completely trained on that. then it spiraled into something worse. that can often become a flashpoint for community anger but at the bottom of it there was an untreated mental health issue. so that is what i want to talk
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to you about. the 21st century cures act had some important provision around mental health and the criminal justice system and interdepart menial coordinating committees. that is long acronym. for the attorney general to develop a pilot program to divert eligible offenders from the federal courts and prisons to the drug and mental health courts. can you talk with us about what the work the coordinating committee is doing in conjunction with the criminal justice division and has the attorney general and justice department been supportive in these efforts? >> so, a lot of questions there, but yes, so the the ismic, interdepart mental coordinating committee. they are good partners with us. we expect that to continue. this is five-year process.
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you will get the report from the committee today. >> right. >> and the issues around the interface between serious mental illness and the justice system did is one of the primary focus and support support. we will tell you that we have programs at samhsa dedicated to diversion, mental health courts. we have programs for offender reentry so they don't get lost through the cracks because my own experience having run the state hospital system in rhode island where we worked with the department of corrections was that we frequently would get folks back because they didn't get into appropriate outpatient care at the time they were leaving and even though we might provide treatment to them while they were incarcerated, that stopped. so the ismic has addressed this. i hope you will be pleased with some of the recommendations that we will be working on. >> he very much look forward to reading it but the thing i'm
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most familiar with the at state level is the use of mental health courts which are significant. can you talk a little bit how the mental health court system is working at the federal level, some of the things we might be reading in the ismic report about that? >> what you will be reading that we need more, more of these types of programs. and these programs can be, they are very effective in diverting people away from incarceration into treatment, appropriate care, including medication because a lot of these individuals need medication and have not gotten it and don't continue to get it. so that is also part of what the ismic committee recommended, that the issues around civil commitment last be looked at to try to maintain a person in care once they leave. also the other thing that we talk about in the report is the crisis center, the use of a crisis center that is
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specifically geared to the treatment of people who have substance abuse and mental disorders rather than going to an emergency department which is not an appropriate placement where law enforcement often gets stuck. so those kinds of intervengeses can be helpful freeing up law enforcement and get people the care they need. >> i'm near the end of my time, but if others jump for second round should i go ahead? naloxone, many. questions you asked have been about opioid issues. i have worked with colleagues to work a saved lives act which was incorporated partially into kara. i was pleased to see that was a bipartisan effort. what is making naloxone available to more at-risk populations and can you speak to the availability of prescribing guidelines? >> so prescribing guidelines, we have at samhsa an opioid
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overdose prevention teal kit that speaks to all the available formulations of naloxone. it is in process of being updated because there are recently approved fda formulations so that is available. we also encourage coprescribing. we train on coprescribing. we have through cara and through cures, we have programs available that train first-responders and also provide for funding for purchase ofnal locks own and -- naloxone and distribution of that hoax sown. >> thank you, mr. chairman. >> yes. dr. mccans, i have sort of a follow-up, and follow up to not only what i asked earlier but a previous hearing where you were talking about opioids. if my previous line ever questioning i was asking how we monitor outcomes. last committee i asked how we monitor a specific program. if we have treatment program a and treatment b and treatment
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program a has high recidivism rate with a lot of folks being perhaps overdosing in in an emergency room two weeks after discharge, we have program b where they have a more effective approach and we don't see that sort of thing on billing data or however, and i would ask you last time if samhsa was instituting those kind of review processes. i think the answer i got, great idea, but probably not at this point in relation to what i asked earlier is it possible for samhsa to do that without cooperative agreement from cms, for billing data, to see some marker of recidivism, for example, emergency room visit after discharge? you follow what i'm saying? what i'm getting at how do effectively get at programs treating people for addiction and find out whether those programs are effective and the taxpayer gets the best deal for
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her dollar and more importantly the patient gets the best outcome in recovering from their addiction? thoughts? >> so the issue around cms and their billing data is one we have to work on, but, which are so yes, i'm reviewing all of samhsa's data collection programs right now. we are going to be making that data more available publicly. so it is not just a matter of -- these would be our programs we're funding but not just a matter of collecting that data so we can sigh whether the programs are good but making it available to the public. so we're working with our center for behavioral health statistics and quality to look at means by which we make the data more available. the other thing we do, i will tell you that for the str program program i'm a clinician. >> str? >> state targeted, 500 million a year for the two years.
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i'm a clinician and i love clinical work. i'm meeting with my staff about every single grantee and we're looking at every single state and how they're doing with their money. >> let me ask. is there common way is is how we wish you to evaluate? really absent billing data apparently only available from cms, seems like it would be very difficult to evaluate recidivism rates, somebody moving to another local. some are in geographic distance from the place where the patient begins, right? so if there is a way to evaluate without billing data, one, does it exist, two, and is cms promulgating this and this how we want to you evaluate and this is how we wish you to do so? >> the answer to your question is we have several evaluations of this program and monitoring states to make sure they're using evidence-based practices. with very one being evaluated by
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cdc and another by a contractor. that data will be made available publicly so that is on going, that is an ongoing project for samhsa. >> by the way i don't personally think the data should be used punitively but also total quality management. >> other thing we do because we're working so closely with the states and because we have a new program of technical assistance we'll be asking the states to bring forward data on their programs because they have abilities to see whether -- >> data available for the general public or for congress to review, the first set of it? >> so i don't know the exact answer to that but i will find out and get to you about that. >> fantastic. senator murphy? >> thank you very much. follow up questions. two on the challenge of broadening our mental health workforce. senator kaine accurately talked about diverting individuals out of the criminal justice system.
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often the first interaction with the criminal justice system is at school. many kids with mental illness, run into a police officer and be sucked into the criminal justice system never to emerge. we talk a lot about mental health first aid training. shouldn't, to the extent that schools have police officers on site, shouldn't every single school-based resource officer have some basic training identifying mental illness so they can divert kids away from jails, into treatment if they present with symptoms? >> yes. without endorsing a particular program, yes, but yes i believe that is the best way to approach that issue, absolutely. >> then tell me about samhsa's work to develop peer capacity. peers occupy a very specific and useful role in treatment. lots of emerging data telling us that, for many people in
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recovery that peer connection is what matters most. what is, give me an initiative samhsa is working on now to try to broaden and improve the quality of peers in our sim today. >> so samhsa had a pretty substantial role in the development of the peer workforce. however, it is my view that samhsa, no government agency should be in the business of trying to figure out how to accredit a particular type of workforce. so what we are doing, we have an office for consumers and families that is working with some national organizations on developing criteria for accreditation of peers. the states are all different. they do it differently but we're working with states and with the stakeholders to move that process along. it's, i believe, that peers need to be integrated into the health
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care team because it is so important to not just give medical care but also the recovery services so that is what we're working towards. >> one last question, follow-up on conversation we're having with senator cassidy. you mentioned that you were not satisfied with the data that you were receiving from states. i think that is in relation to the block grants. can you just tell us why you're not satisfied with the data that you're getting? is it the amount of data or the quality of data? what's the problem that you're seeing? >> because, because the data does not tell us anything about diagnoses, it doesn't tell us anything about really basic standard of care issues like did a person get medication assisted treatment? how do i know if a program is working if i don't know the standard of care? we're changing that to so what are you getting right now? >> we get number of people
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served. we get things that proximate certain types of diagnoses. did you feel sad? did you, do you use certain substances? but that is not enough to tell us what these programs are doing for who, and what does and doesn't work. >> thank you for your focus on data. i agree with senator cassidy, to the extent we avoid duplication with requirements, something the states should work together on. >> and i would echo that and i thank the administration for appointing you because you seem as irritated about some things i am irritated about and i suspect that you are and there are good things to be irritated about. i want to finish by thanking senators alexander and murphy for calling, convening, participating in this. also thank you, dr. mccance-katz for excellent testimony. the hearing record will remain open for 10 days. members may submit additional information for the record during that time if they like. thank you for being here today.
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the committee stands adjourned. >> thank you. [inaudible conversations].
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>> coming up on say spend to come a congressional hearing on the effectiveness of sanctions. then, a senate hearing with the chair and other members of the nuclear regulatory commission or to that, a look at fuel efficiency standards for cars with representatives of the auto industry and in the arm and a advocacy group later, california attorney general on lawsuits he
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felt because the trump administration. tonight, on c-span2 the tv in prime time with interviews with a number of nonfiction authors. we started 8:00 p.m. eastern with the parents of trade on martin, sabrina fulton and tracy martin on their sons life and death and their book. then, milo on his book "dangerous". after that, arizona senator jeff flake on his views on politics they and his book. also, harvard professor danielle allen examines mass incarceration in her book. we close with former fox news host gretchen carlson on sexual harassment and her book "be fierce". book tv in prime time, tonight. >> sunday night on afterwards,
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christopher scalia son of the late supreme court justice antonin scalia talked about his book. he's interviewed by los angeles times as supreme court correspondent david savage. >> when he delivered often and was his stump speech. was looking forward to finding a written version of that because i loved that speech and thought it was in grade including a wonderful passage where he compared the living constitution approach to a television commercial from the 1980s where a prego commercial where someone is making pasta, heating up store-bought pasta sauce and the husband says to his wife, you are using this store-bought sauce and not doing it homemade, what about the oregano and at the wife says it's in their. what about the pepper? it's in their. the garlic? it's in there and might dad would say we have that kind of a
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constitution now. you want a right to abortion, it's in their. right to die, it's in their. anything that is good and true and beautiful is in their no matter what the text says. >> watch afterwards sunday night at 9:00 p.m. eastern on c-span twos book tv. >> second session of the 115th congress starts next week. the senate is back on generate third, and will welcome two new democratic lawmakers, alabama doug jones and minnesota-- minnesota tina smith the house of representatives returns later on january 8. in the new year, congress needs to consider a government spending bill because current government funding runs out january 19. also, on the calendar this year's state of the union address. house speaker paul ryan has invited president trump to address a joint session of congress on january 30.
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when congress is back in session, the senate is live here on c-span2 and the houses lied on our companion network c-span. ♪ >> c-span student camp. of the tweets say it all. student camming action with video editing. this group showed us how it's done with two stellar interviews in one day. these a student asked hard-hitting questions about immigration reform in the dream act. we are asking students to choose a provision of the u.s. constitution and create a video illustrating why it's important to our competition is open to all middle school and high school students grades six through 12. $100,000 in cash prizes will be awarded. the grand prize of $5000 will go to the student nor teen with the best overall entry. the deadline is january 18.
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get contest details on our website at student ♪ >> the health financial services subcommittee on monetary policy and trade subcommittee held a hearing on the effectiveness of us sanctions against hot-- countries like iran and north korea. to state department officials testified about how countries tried to get around to sanctions and potential legislative changes to boost the effectiveness of sanctions. >> committee will come to order and without objection the chair isho


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