Tim Murphy

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman from Oregon, and truly my friend. I think when people look at Congress and wonder if people can work on issues in a bipartisan way, I am sure if someone looked at our voting record on other issues, we would probably be a bit different. That is okay. What still stands is that we are able to come together with a common issue. I have no idea if this man is Republican, Democrat, registered to vote, nor should that matter to us. I have never asked a patient in my 40 years of practicing. I know he is the same way, too. We do this because compassion dictates. Sometimes we are our brother's keeper, and we need to do the right things. I do value your input on this bill. We have made a number of modifications. I know that, in committee, Democrats have offered several amendments which I want to incorporate and which look at specific funding for a number of things. We need more psychiatrists and psychologists. We just have to have them. We have to put money into that. We need more programs in there. We need to bolster community mental health services. We need to make sure that there is oversight over what States are doing with those dollars in order to make sure they are putting dollars into effective programs and not into frivolous ones. That is one of the roles Congress has is to be the watchdog over that. I am proud to say, in front of the Nation, that you have been awesome in this, and I want to continue to work with you. We will solve this will issue.

Mr. MURPHY of Pennsylvania. Exactly.

Mr. MURPHY of Pennsylvania. I thank the gentleman. Mr. Speaker, what the gentleman is referring to is also something called assisted outpatient treatment. That is a program whereby 45 States and the District of Columbia--maybe 46 States now--have this. When people have a history of incarcerations, of arrests, of violence and when they are not in treatment, a judge protects their rights and may review their cases in terms of saying they can be put in inpatient care. If the judge says they do not meet the standard of imminent danger of harming themselves or someone else, assisted outpatient treatment is what may be warranted for them, which means the judge simply says: You are going to stay and continue to take your medication. You will continue to see your therapist and work on this. That being the case, when New York State did this, it found a reduction in incarcerations and homelessness by some 70 percent. It was pretty dramatic. It found satisfaction by over 80 percent, and it found costs go down by 50 percent. It is something on which we in Congress need to continue to work. We did pass legislation, which puts the appropriations of $15 million to help States do that, but we have a long way to go. It is a long way to go based upon what I said. I think it is 1,820,000 people so far who have commented. They have seen this on my Facebook page and have commented on it. I want to read some more comments--some heartbreaking lessons--people are making. One is by the name of Kari Butler, who wrote on my Facebook page: They are falling through the cracks. Easier to just put them in jail with high bail. They do make medication for people like him, my nephews, which is to say one is in jail now since November--no release until August--mostly because he didn't follow up like he was supposed to. The prosecutor did a mental evaluation on him to see if he could withstand court, and he concluded he could; but something is not right here. He has assaulted officers and has been tased three times and has not been affected. Five police officers, it took, to get him into the back of a car. They tased him in Walmart--once in front of the whole store. On it goes. There are many people with mental illness out there. This person writes: I don't believe public servants have been trained properly to treat mental illness. I don't know what to do to help people who get the help they need to be productive. One might say one of the aspects of our bill is to provide training for police officers--what is called emergency treatment for them. When police officers have been trained in that, we have actually seen--and the police officers like this, too--that they can quickly identify, if this is a mentally ill person in crisis, what they can do to deescalate the situation and prevent it from becoming harmful or deadly. Here is another point that has been written by Amethyst Lees: First off, the health system is horrible, and I worked inside a mental institution and saw firsthand what it is like. Depending on where I was, the people were not getting their needs met or were being ignored. I even saw an incident where a man was waiting for 15 minutes for two staff members to stop talking about football just to ask for some ice. He never got his ice because he lashed out for being ignored, and, of course, he was restrained in a chair for an hour for getting angry. Marianne Kernan writes with regard to Cody Miller: Talk to him. Our mental health system is shameful. I know, as I work daily with this population, many times, their treatment is inhumane. Some with dementia or Alzheimer's wouldn't be treated this way if they had a break with reality. It is a sad commentary on our lack of knowledge of dealing with serious mental illness. Here are some more stories. Angie Geyser writes: My 13-year-old daughter, Morgan, was in police custody for 19 months before she finally received treatment for her schizophrenia. We had to pursue a civil commitment to make it happen. Now she is back in juvenile detention where she has no access to the outdoors and is not allowed to have physical contact with her family. The treatment of the seriously mentally ill by the criminal justice system is appallingly inhumane. Frede Trenkle writes: Two weeks ago, a stranger that I have been married to for 13 years came into my home, sprayed me with pepper spray, took a knife out in front of my two kids, and threatened to cut his throat. The police took him away and put him in a mental health hold. I chose not to press charges and just requested that he get help. This was his second hospital stay in a month. The hold was supposed to be for 7 days. Four days later, he got out, and I am sure because he had a plane ticket out of the State. He convinced someone out there that I was the threat. He denied ever having a knife. He manipulated the system. I received abusive texts before I changed my phone number and he sent terrible emails. I only wish he could get the help he desperately needs wherever he is, but because of the unchecked mental illness, I now have two beautiful girls, without their father, and both needing their own mental health counseling. How do we help our system on all ends? Another woman writes: If you want people like this young man to get help, we all need to be okay with paying more taxes and closing privatized prisons. The prison system has become the dumping ground for the pervasive mentally ill. Another one writes: My uncle has schizophrenia. He disappears for months at a time. I worry constantly about him being hurt by law enforcement. He was living 50 miles away, in the woods, on his father's property, in a camper, and was threatened with a gun by a neighbor because he was walking in the fields, talking to things only he can see. The cops were called, and they showed up with weapons drawn. Then they took him away and locked him up for a month. He is only 32, but the police assumed he was on drugs. He was having a psychotic episode. There is not enough education in the judicial system about mental illness, and innocent people are being killed through the ignorance. Another woman writes: My question is this: As the mom, where should we direct the young people with schizophrenia? Hospital care is effective, but it seems to be temporary: 6 months in and 2 years out; repeat. Has anyone found or used or heard of any successful treatment going on at treatment facilities? The answer is yes. Actually, one of the programs in H.R. 2646, the Helping Families in Mental Health Crisis Act, is for something called RAISE, Recovery After an Initial Schizophrenia Episode. We have learned that, since schizophrenia and bipolar illness and severe mental illnesses are emerging in adolescent and young adult years, if one gets to someone early, with a low dose of medication, with proper evidence- based treatment, the prognosis is much, much better; but when we don't treat someone, every time someone has what the lay public calls a nervous breakdown or a psychotic break--a crisis--we have to understand that, over time, these lead to neurological damage. These are not harmless episodes. This is not just someone who gets upset. This is a real psychiatric disorder that comes from the brain and leads to problems, and that is why we see these problems grow. Here is someone who doesn't quite understand the problem. A woman by the name of Julie writes: I am very much against the families of mentally ill patients having the power to put their loved ones away against a patient's will. Let the doctors determine if the patient has a problem, not the family. Often, the family just doesn't want to deal with the illness, so they want the person to go away. Someone by the name of Robin Duffey writes: Julie, you don't know what you're talking about. There are more of us that do care, but because of the mental health laws, we are unable to make decisions for very sick family members. People with schizophrenia don't realize they are sick. They think their hallucinations are real, along with the commanding voices they hear. So how can such an ill person make a logical decision to get the help they need? The answer is: they can't. The doctors have to follow the laws that are in place, which is they cannot recommend committing a person unless they are an immediate threat or danger to someone or themselves. Yes, Julie. There are some families that don't want to be bothered, but I was not one of them. I highly recommend you to do research on the subject before you spout your ideas. Read the Federal and State laws. Indeed, that is what we are trying to do with H.R. 2646. There are a couple of thousand more comments on my Facebook page, Mr. Speaker, and I certainly ask people to go and read them. They are heartbreaking. They are horrifying. They are tragic. They are true. They go on and on because our Nation refuses to acknowledge this. Until we pass this bill and start making changes--we can predict it-- in the time that I have been speaking here, there have been several more suicides; there have been more homicides; there have been more mentally ill people whom we have abandoned; there have been people who have had chronic illnesses and who have died, because the people with serious mental illness, for multiple reasons, tend to die 10 to 25 years sooner than the rest of the population because of the fact that 75 percent of those with mental illness have at least one chronic illness, 50 percent have at least two chronic illnesses, and a third have at least three chronic illnesses. I mean things like heart disease, lung disease, infectious disease, diabetes. They get sick and they, oftentimes, are not treated. Many times, they don't seek treatment. We let them go in this slow-motion death spiral and ignore them. We have closed the hospitals. We have put them in prisons. If they are out of control and if the police bring them to the emergency room and if there are no beds available, they tie them down to the gurney, where they may wait for days--or weeks, in some cases--where they are, perhaps, given some sedative--a chemical straightjacket, if you will-- to calm them down. That is not treatment. That is abusive. That is our Nation that is doing it, and Congress is culpable in this because we refuse to act. Once again, there will be a tragedy somewhere. I shudder to think-- and I hope it is not anybody here who is injured--that, somewhere out in America today, this is going to happen. Once again, we will gather for a moment of silence; the gavel will come down; and we will go back to our regular order of business. It is sad and it disgusts me, but that is what we face: all of this closing of hospitals and not opening up community mental health; Medicaid's saying you can't see two doctors in the same day; Medicaid's saying you can't go to a hospital with more than 16 beds; HHS' saying we can't tell parents anything, so they are left in the dark; the Substance Abuse and Mental Health Services Administration, which funds programs that teach people to make collages, to do interpretive dances, to get off their medication, to make masks and other things that have nothing to do with serious mental illness. We need to change the system, and that is what H.R. 2646 does. It takes that office of SAMHSA and changes it so that the director of it is the Assistant Secretary of Mental Health and Substance Abuse. That person needs to be a doctor or a psychiatrist who is trained, either an M.D. or an osteopath or a psychologist, but someone who understands the field and not just someone who is saying: Well, let's just do these other ``feel good'' programs. The city of New York just did this, too, where the mayor put up hundreds of millions of dollars for programs that were, supposedly, for the mentally ill. They weren't for the mentally ill at all. They were programs like parks and bike trails and ``feel good'' programs to help people with sadness, not to deal with depression and serious mental illness. How long can we continue to fool ourselves? As for this whole idea that says ``leave it up to them if they want to choose; don't provide them the help; make it the most difficult for those people who have the most difficulty,'' all of this, Mr. Speaker, is more commentary and evidence of the grand experiment of stopping all treatment under the misguided, self-centered, and projected belief that all people who are mentally ill are fully capable of deciding their own fate and direction, regardless of their deficits and disease, and that they have the right to self-decay and self-destruction, which overrides their right to be healthy. The most fundamental, dangerous, and destructive hidden undercurrent of prejudice is the low expectation that your disability is as good as it gets. The shift to consider changes in how we treat severe mental illness is the pendulum that needs to swing the other way. The grand experiment has failed in closing down all the institutions and care and stopping all treatment and not allowing community mental health. It is a principle that operated under the misguided, self-centered belief that people are always fully capable of deciding their own fate, regardless of their deficits and disease, and the right to self-decay and self-destruction overrides this right to health. In so doing, we have come to comfortably advocate our responsibility to action and live under this perverse redefinition that the most compassionate compassion is to do nothing at all. It further bolstered the most evil of prejudices that the person with disabilities deserves no more than what they are. Under that approach, no dreams, no aspirations, no goals to be better can even exist. Indeed, to help a person heal is a head-on collision with the bigoted belief that the severely mentally ill have no right to be better than what they are and we have no obligation to help them. This is the corrupt evil of the hands-off approach in the antitreatment model, and that perversion of thought is embedded in the glorification that to live a life of deterioration and paranoia and filth and squalor and emotional torment trumps a healed brain and the true chance to choose a better life. This is the movement of hatred and stigma toward the mentally ill disguised as the right to let them be sick. That hatred may be embedded in our own anger, our own resentment, and one's own past experiences projected as blame or misattribution of the lives of others or maybe our own fear and loathing of the mentally ill. Either way, the outcome is tragically the same. So we can have more moments of silence or we can have times of action. I hope the Energy and Commerce Committee picks this up. I hope that more Members of Congress will sign on as cosponsors of H.R. 2646, the Helping Families of Mental Health Crisis Act. The day that bill signs into law, it will begin to save lives. It will begin to make a difference in people's lives. Of all the other things we do down the road here for images or to push polling--I can tell you this, that the polling on this bill is in 70s and 80s. As politicians, we think, wow, if something polls at 55 percent, vote for it. My concern is: Will America wake up and look toward Congress here and say: When we had a chance to do something to save lives, did we act, or are we once again just caught up in moments of silence? Thomas Jefferson said something along the lines of: ``Indeed I tremble for my country when I reflect that God is just and His justice cannot sleep forever.'' We are in that same position now. We can either have the courage to stand up, take action, and help the mentally ill or we can sit in silence. I hope this Chamber soon takes up H.R. 2646, the Helping Families in Mental Health Crisis Act. Mr. Speaker, I yield back the balance of my time.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. I yield to the gentleman from Indiana (Mr. Bucshon).

Mr. MURPHY of Pennsylvania. I thank my friend from New York in his ongoing support for these issues dealing with mental illness. Now I would like to call upon my friend from the State of Oregon, Earl Blumenauer, who has been a great champion on these issues as well. Many times we have conversed about this. I appreciate my friend's guidance and support on this issue. I know your heart is in this and you are dedicated to it. Mr. Speaker, I yield to Mr. Blumenauer.

Mr. MURPHY of Pennsylvania. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks.

Mr. MURPHY of Pennsylvania. Mr. Speaker, let me start off with some sobering news. I call it the body count. Last year, 2015, in the United States, there were 41,000 suicide deaths in this country. There were 45,000 deaths from drug overdoses. Many of those folks suffered from depression. There were an estimated 1,200 homicides by people who are seriously mentally ill. About half of all deadly police encounters occurred with someone who is mentally ill. There is an unknown number of mentally ill who died 25 years sooner because they tend to die of chronic illnesses. There is about one homeless person per day in Los Angeles who dies. We know about 200,000 homeless people in this country are mentally ill. It is a sad case in any numbers. But if you add those numbers up, even the most conservative version is that there were some 85,000 deaths last year related to mental illness--and it is probably much higher--and more have died from mental illness-related problems than the total United States combat deaths of the entire Korean War and Vietnam Wars combined. That is sobering, but it is worse. It is worse because we could prevent a large number of these mental illness problems. We could save many of those with mental illness from their early demise. We could save their families from suffering. But, unfortunately, the Federal Government is the problem. Let me lay out this evening in this Special Order some of the particular problems that we have. In particular, for those who are low income, Medicaid itself is one of the biggest discriminators against people with mental illness getting treatment. First, consider this. Fifteen percent of Medicaid recipients have serious mental illness. That is far more than the general population. Serious mental illness is things like schizophrenia, bipolar illness, schizoaffective disorder, and severe depression. Thirty-one percent of those on SSI have serious mental illness. Twenty-six percent of those with Social Security disability have serious mental illness. In the general population, by the way, there is only about 1 percent with schizophrenia. About 2.6 of the general population have been diagnosed as bipolar. So look at how much higher those numbers are among the poor. That makes sense. Because mentally ill people are three times more likely to have low income as a result of their mental illness. Low-income individuals are three times more likely to have mental illness, many as a result of being poor. Poverty and homelessness are both associated with serious mental illness. Both are associated with inadequate primary care and preventative care. But here are some ways that Medicaid makes it harder for people with mental illness to get care. First of all, there is a rule called the same-day doctor rule. If you take someone to the doctor and the internist or family physician is very concerned that person has a mental illness, they are told they have to come back another day before they can see the psychiatrist. That is a serious problem. Because when you have the warm handoff in the doctor's office, you have 95 percent that will return versus less than half if they have to come back another day. And treatment is the key to getting better. There is a 16-bed rule from the Institute of Mental Diseases which says that, if the hospital has more than 16 beds and you are between ages 22 and 64, we are not paying for it. The problem with that is that serious mental illness tends to emerge in 50 percent of the cases by age 14 and in 75 percent of the cases by age 24. So at the very time when problems are emerging, the very time when someone may have their first serious crisis that may require some inpatient care, they are told there will be no room. Only 45 percent of Medicaid recipients with schizophrenia actually get evidence-based care. Only 35 percent of those with a bipolar diagnosis who are on Medicaid get evidence-based care. Listen to this statistic. Ninety-two percent of low-income children and foster children are prescribed drugs off label--those are drugs that are not approved by FDA--according to an HHS Inspector General's report, and many of those prescriptions, according to the report, are done without clinical justification. The homeless with schizophrenia have a rate of hospitalization for complications of hypertension almost twice as high as others. Fifty percent of individuals with schizophrenia are noncompliant with treatment regimens during their illness and don't adhere to medications. They need assistance in doing so. Also, half of those with serious mental illness have at least two chronic physical health conditions, such as chronic pulmonary disease, infectious disease, cardiovascular disease, gastrointestinal problems, and these people are generally in poorer health. So what happens is that those with serious mental illness and a number of other clinical aspects have compromised physical symptoms and we don't have a place to treat them. We used to have 550,000 psychiatric hospital beds in the 1950s. Now we have less than 40,000. During that same time, the population of the United States climbed from 150 million to over 300 million today. So where do people who have an acute mental health crisis go? Sadly, whether it is acute or chronic, about 200,000 of our homeless are mentally ill. Twenty-eight percent of them get some of their food out of a garbage can. We also have a large portion of those with mental illness filling our prisons. When we closed down those psychiatric hospitals, some got better. But, basically, we traded the hospital bed for the prison cot, a blanket over a subway grate, an emergency room or a gurney or a slab in some morgue. The incarceration rate among the seriously mentally ill is 16 percent of the population. Some 60 percent of the incarcerated may have some level of mental illness. And then what happens in the area of violence? Well, in general, people with mental illness are no more violent than the rest of the population. But when untreated serious mental illness occurs, they are 16 times more likely to be perpetrators of violence. As I said before, there are over 1,000 homicides a year, and we have no idea how many are victims of crime. Estimates are it is 6 to 10 times greater. What happens if a person with mental illness is not treated? The longer a person waits for treatment for a psychotic episode, the longer it takes a person's illness to come into remission. That means it costs more. For bipolar illness, the sooner a person starts lithium, the greater their improvement. It means it would cost less if we treated them. Delusions, hallucinations, and other severe symptoms increase the longer treatment is withheld. As far as the costs go, the cost of schizophrenia alone far exceeds that of coronary artery disease. The mortality rates of schizophrenia are far more than breast cancer. The costs of serious mental illness in this country are about $55 billion in direct costs and $70 billion in indirect costs, but there is also the added cost of emergency room care, added cost of primary care, and the cost of treating their other medical problems. The deinstitutionalization move in this country is associated with much higher suicide rates, such that, while our country has made great strides in reducing mortality rates over the last couple of decades in heart disease, auto accidents, HIV/AIDS, stroke, and cancer, we have seen huge increases in suicide rates and drug overdose deaths. As a Nation, we should be ashamed of that. As a Congress, we should be ashamed if we do nothing about this. That requires a great deal of change on our part. That means we are going to have to do something to help people with mental illness get treatment. Half are simply not compliant and don't adhere to their medication. They get worse. Their medical problems get worse. The Medicaid bills get higher. Half of those with serious mental illness, as I said, have two or more chronic physical health conditions, and it gets worse for them. There are several things we must do to treat this. Tonight we are going to hear from a number of Members of Congress. First, my friend Jim McDermott of the State of Washington will speak. We will talk about a number of the issues before us and what we must do in Congress. I yield to the gentleman from Washington (Mr. McDermott). (Mr. McDERMOTT asked and was given permission to revise and extend his remarks.)

Mr. MURPHY of Pennsylvania. I thank Dr. McDermott. He has been, really, a champion of mental health issues in his career and on this bill as well. I want to point out, the bill he is referring to is our Helping Families in Mental Health Crisis Act, H.R. 2646. It is bipartisan. It has 183 cosponsors today--50 Democrats, the rest Republicans--because we all recognize that when you are dealing with someone with mental illness, in the 40 years that I have practiced as a psychologist, I have never once asked any of my patients what party they are. We know that mental illness affects people regardless of gender or race or age, certainly not by party. We also know, however, that getting care is tougher. Studies have said that if you are Black, your chances of getting treatment for your mental illness are even tougher. In fact, in Los Angeles County, 9.6 percent of the population is Black, and yet they constitute 31 percent of the L.A. County jail prisoners, and they have a lower likelihood of getting psychiatric medication. Although most crimes committed by people with mental illness tend to be nonviolent, after they have repetitive incarcerations, they tend to serve four times longer sentences when they are mentally ill than someone who is not. So that is what we mean when we say we have filled our prisons and we have increased our costs with this. I yield to my friend, the gentleman from Arkansas (Mr. Hill), to also talk about the things we need to do and our problems with mental illness.

Mr. MURPHY of Pennsylvania. I thank the gentleman so much for his kindness and his support for this legislation. As has been said, whenever one of these tragic killings occur or when some tragedy occurs, we have our moment of silence, and then we do nothing. We have a chance to do something. America demands it. I know that the overwhelming majority of Americans expect us to do something more than talk about it, particularly when so many family members are struggling. As we closed many of these institutions, what we ended up with is families themselves being the ones that are being told, here's your son, your daughter, your brother, your sister, your mother or father; go take care of them. By the way, we are not going to give you much information on them. We are not going to provide you much support, unless that person, indeed, is a danger to themselves or others. I have heard from many family members that they have called the police when they have had troubles at home, struggling. By the way, with mental illness, when someone's out of control, we call the police. With other illnesses, you call paramedics because we recognize that that is a disease that needs help, like when someone is having a heart attack or something else. But with mental illness, out of our fear, out of our stigma, or other things, we call the police, and the police are oftentimes not fully trained to do this. Then we tell the parents, well, good luck, and take care of them. We are not going to give you much information. That whole grand experiment of closing down the hospitals, which those asylums needed to be closed down, but the stopping institutional care and stopping all treatment, that whole process has actually shown more failures than successes, especially when we have not provided community-based treatment. We provide treatment for so many other diseases, but when it comes to mental illness, we fall far short. And we somehow have this idea, this misguided and self-centered and projected belief of our own, that people are at all times fully capable of deciding their own fate and direction, regardless of their deficits and diseases, and that the right to self-decay and self-destruction overrides the right to be healthy. But remember what I said earlier about people with severe mental illness and having so many other chronic illnesses and somehow going into the slow-motion death spiral, we walk right by and pretend that that is okay. It is not, and it shouldn't be. Somehow, in so doing, we comfortably abdicate our responsibility to action and live under this perverse redefinition that the most compassionate compassion is to do nothing at all. It further bolsters those most evil of prejudices we have that the person with disabilities deserves no more than what they are. We will leave it up to them. Under that approach, there are no dreams; there are no aspirations; there is no goal to be better that can even exist. Indeed, to help a person heal is some head-on collision with this bigoted belief we have that the severely mentally ill have no right to be better than they are, and we have no obligation to help them. This is the corrupt evil of this hands-off approach and, in some cases, the antitreatment model and the things that we have lulled ourselves into, this somnolence where we become comfortable with crossing the street or stepping over a homeless person, when we fear those, when we hear the title, the term, ``mental illness.'' It is this perversion of thought embedded in the glorification that to live a life of deterioration and paranoia and filth and squalor and emotional torment trumps a healed brain and the true chance to choose a better life. What a sad state of affairs our Nation has to become easy with that, and what a sad statement it is about this Congress for taking so long to take action on this. I don't know how we look ourselves in the mirror and continue to delay this. A number of my colleagues also feel very strongly about this issue of mental health. I yield now to the gentleman from Louisiana (Mr. Abraham) to take a few minutes to talk about his perspectives of what we need to do with mental health.

Mr. MURPHY of Pennsylvania. Thank you, Doctor. I appreciate your comments and your support for this bill and, of course, your practice in the field and understanding our needs. A couple of points you made there I want to elaborate on. You said that there are 112 Federal programs identified scattered across 8 departments that deal with mental health. There are 26 programs for the homeless. But many of these programs have not met since 2009, and according to the General Accounting Office report, it is uncoordinated. A patchwork quilt would be a compliment because a patchwork quilt is at least stitched together and our mental health approach is not. Part of this bill is to create an office for the Assistant Secretary of Mental Health and Substance Abuse Disorders. That doctor would then be charged with meeting regularly with these programs and agencies to get them to work together. Where there is unnecessary redundancy, get them to merge. Where there is exemplary programs, let's expand it. But, above all, get treatment back to the States and back to the communities where they can do the most good with evidence-based programs that work. I will elaborate more on these in a minute, but first I want to call upon my friend, Chris Gibson, from New York for a few minutes.

Mr. MURPHY of Pennsylvania. I thank the gentleman for his comments. I will add to that in the sense that about 10 people per hour die related to mental illness, and it is probably much more than we know of. I thank you for your good counsel, too. I may have been doing this 40 years, but I have a lot to learn in the field of mental health. I have learned a great deal from colleagues and from people like Paul Gionfriddo of Mental Health America or the leaders of the American Psychological Association, the American Psychiatric Association, and from Fuller Torrey. There is a whole host of names in this country who continue to write about and talk about this and show us research on this. Osteopaths, physical therapists--you name the field--and social workers are out there talking about the problems that we have with this. You are right. It is the most compassionate thing to make some changes on this. I know one of my colleagues who is also in the Energy and Commerce Committee with me, Susan Brooks, would like to comment on this as well and talk about our needs now, what we need to do in mental health.

Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank my friend, Mrs. Brooks. I might say that we have all heard those stories from families. I am sure there are families watching tonight, Mr. Speaker, who will consider contacting a Member of Congress and share that story as well. Nothing is more painful than to hear the story of a parent like you described, a nightmare of a parent to be told that their child has a problem and there is nothing the government will let them do about it. How difficult that must be. While waiting for my other colleague, Doug LaMalfa, of California, to come forward, I want to mention a couple of things on the bill that have been referenced. As I said before, the bill has an assistant secretary for substance abuse and mental health disorders that would organize the programs. It would drive evidence-based care for programs such as response after an initial schizophrenic episode, assisted outpatient treatment, and assertive community treatment, or programs like the National Child Traumatic Stress Network, which is an exceptional program. It is a government-funded program that does exceptionally good, high-quality work. We know that we have to build a mental health workforce to take care of our extreme doctor shortage. There simply aren't enough psychiatrists, psychologists, or clinical social workers. When we have 9,000 child and adolescent psychiatrists, we need 30,000. We have too few clinical psychologists and others who want to work with those with serious mental illness. As I said earlier, we have to fix the shortage of mental health beds, places that treat people who are in crisis, instead of putting them in jail, sending them back on the street, or strapping them to a gurney in an emergency room, giving them a five-point tie-down and some chemical sedative. We have to eliminate that same-day doctor barrier which says you can't see two doctors in the same day. We have to empower parents to be part of the treatment plan, because right now they are still harnessed and kept away from them. I yield to the gentleman from California (Mr. LaMalfa) for some of his comments.

Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman for his support. While waiting for my friend John Katko of New York to come forward, I want to reflect on how long it has taken us to do this. What we used to do up through the 1800s is just throw people in jail. Then along came an activist by the name of Dorothea Dix, who saw the abysmal conditions in our prisons for the mentally ill, saw them chained to walls in squalor and filth, beaten and abused. She spoke up to have institutions built that would be better respites for them. Indeed, that took place for awhile, but then they became overcrowded, and that was part of what we shut down. As my other colleague talked about, Mr. Blumenauer mentioned that then we thought, well, we have other outpatient care for them. That promise never came through. This legislation would, as I mentioned before, allow us to have more providers in psychology, psychiatry, social work. It would also merge the mental health and substance abuse dollars to allow States to use both. We have got to be treating mental health and substance abuse dollars, not to cut either one, but to make sure that a person with substance abuse disorder and mental illness can be treated. It would bring accountability of spending Federal funds for grants. Our bill would establish a national mental health policy lab within SAMHSA, Substance Abuse and Mental Health Services Administration, and set scientific objective outcome measures. It would also have an interagency serious mental illness coordinating committee, which could coordinate the Federal spending in mental health and make suggestions to the Assistant Secretary's office and to Congress and bring together government offices with experts in the field to develop reforms in the mental health system. We want to have alternatives to institutionalization and jail diversion. Assisted outpatient treatment is one version; assertive community treatment is another one. We are making sure that we provide the wraparound services for the mentally ill person instead of dumping them into jails and leaving them there only to get worse. And we want to advance early intervention and prevention programs, where this bill establishes most of its funding there to make sure we have those programs. I yield to the gentleman from New York (Mr. Katko), someone whom I have also gotten to know pretty well over this bill, with his own passion for this issue as well.

Mr. MURPHY of Pennsylvania. Mr. Speaker, how much time do I have remaining?

Mr. MURPHY of Pennsylvania. Mr. Speaker, let me close with these statements. With 60 million Americans out there with some form of mental illness this year and 10 million or so with severe mental illness, they all have families. I hope those families wake up and speak up. I hope they contact their Member of Congress. I know that mental illness can be treated, but it cannot be treated if we ignore it and it gets worse. I don't want more tragedies here. I hate to wish any of these tragedies on my colleagues in Congress, but I know it will happen. We will be here again for moments of silence. We will have more Members that face this suffering in their own families and in their communities, and we should not allow that. I hope that soon we can call forth H.R. 2646, the Helping Families in Mental Health Crisis Act, because to delay it is to cause more harm, to deny it is to cause more death. Let's finally do something to help turn this problem around with mental health in America. Mr. Speaker, I yield back the balance of my time.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, at approximately 8:40 p.m. on February 25, 1991, an Iraqi Scud missile blasted through the temporary barracks of the 14th Quartermaster in Dhahran, Saudi Arabia. Headquartered in Greensburg, Pennsylvania, the 69 members of the water purification unit were deployed to Saudi Arabia for just 6 days when the attack occurred. Twenty-eight soldiers died that day, and 99 were wounded, including 43 in the 14th. The Scud attack proved to be the single most devastating attack on U.S. forces as the 14th Quartermaster suffered the single greatest number of casualties of any Allied unit during Operation Desert Storm. To commemorate the 25th anniversary of this attack, I am introducing a joint resolution that honors the soldiers who were lost and wounded and their families. The State of Pennsylvania lost more servicemembers during Operations Desert Shield and Desert Storm than any other State. A monument now stands in dedication at the Greensburg Army Reserve Center commemorating the 69 names of the detachment soldiers. They were fathers, husbands, and sons. They were daughters and sisters. They were all citizen soldiers serving their communities, serving their country, and giving their lives to both. I call on Members of Congress to cosponsor this resolution and honor the service and sacrifice of the 14th Quartermaster of the United States Army.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, as Americans celebrate Christmas, millions of families will have an empty chair at the table for a relative who is lost in our failed mental health system or one of the more than 80,000 mentally ill who died this year. They suffer from a brain disease of serious mental illness, but they also suffer from Federal policies stopping them from getting treatment: Medicaid rules that say you can't see two doctors on the same day, you can't go to a psychiatric hospital with more than 16 beds, and perverse priorities of the right to be sick instead of the right to be well. Mr. Speaker, this holiday season, let us give our families a gift of hope. Members should cosponsor H.R. 2646, the Helping Families in Mental Health Crisis Act, and let compassion dictate. We must stop the suffering, stop the congressional delays, and finally take action because where there is no help, there is no hope.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, next week is the third anniversary of the sad tragedy at Sandy Hook Elementary School; but it is also time to recall all those other cities in America where tragedies have occurred: Tucson, Colorado Springs, Lafayette, Charlotte, Chattanooga, Dallas, Houston, Roseburg, Isla Vista, the Navy Yard, and closer to my district in Pittsburgh, Franklin Regional High School. What is common among these tragedies is the lives lost. I keep in my office photographs of some of the children whose lives were lost at Sandy Hook--Benjamin Andrew Wheeler, Dylan Hockley, and Daniel Barden-- as well as those of teachers and other people from the school. A day doesn't go by that I greet them in the morning and throughout the day and remember their lives, snuffed out too early. But, sadly, the body count is more than just them when it comes to dealing with what people with severe mental illness and violence do. The body count this year is amazing. There will be 41,000 suicide deaths, 43,000 deaths from drug overdose, perhaps 1,000 to 1,500 homicides, perhaps a couple hundred people who encounter the police and are mentally ill and end up with their death, an unknown number of homeless who die that slow-motion death of homelessness, and those who are mentally ill that die 25 years sooner because of other chronic illness. The body count this year will be greater than the U.S. combat deaths in Korea and Vietnam combined. Will that wake us up to do something in this Chamber? There are several things we must do: We must reform the agency called SAMHSA, which has used Federal money over the years for the most ludicrous and preposterous things; from designing art for pillowcases to collages and other aspects. We must reform the 112 Federal agencies that we pump money into every year to deal with mental illness. We have to deal with the shortage of beds. We have to get rid of the same-day doctor rule. We have to bring in more psychiatrists and psychologists who can provide treatment. We have to provide more early intervention and prevention, a greater workforce. And this Chamber has to stop postponing action on reforming our mental health system and bring to the floor H.R. 2646. I have been working with a wide range of Democrats and Republicans over the last couple of years to reform this bill, revise it, and perfect it. But at some point, if we are serious about helping those with serious mental illness, we have to bring it for action. Part of what happened is we closed all these asylums years ago and thought that if we provided some treatment for people, things would get better. States failed to provide that treatment. We shut down hundreds of thousands of psychiatric hospital beds and leave people still dumped into a system where they don't get care. Our current mental health system is hugely discriminatory. The most fundamental, dangerous, and destructive hidden undercurrent of prejudice is low expectations; that your disability is as good as it gets. The shift to consider changes in how we treat severe mental health is a pendulum swinging the other way. The grand experiment has failed of closing down all the institutional care and stopping all treatment. It is a principle that operated under the misguided self-centered and projected belief that all people at all times are fully capable of deciding their own fate and direction, regardless of their deficits and disease, and that the right to self- decay and the right to self-destruction overrides the right to be healthy. Those children at Sandy Hook had rights. The people throughout the country who are mentally ill have the right to be well and not just the right to be sick. But to maintain the current philosophy that many have, we abdicate comfortably our responsibility to action and live under the perverse redefinition that the most compassionate compassion is to do nothing at all. It further bolsters the most evil of prejudices that a person with disabilities deserves no more than what they are. Under that approach, no dreams, no aspirations, no goals to be better can even exist. Indeed, to help a person heal is a head-on collision with a bigoted belief that the severely mentally ill have no right to be better than they are and we have no obligation to help. This is the corrupt evil of the hands-up approach in the anti- treatment model. That perversion of thought is embedded in the glorification that to live a life of deterioration, paranoia, filth, squalor, and emotional torment trumps a healed brain and a true chance to choose a better life. We have to change this trajectory. When we leave for the holiday period here, we will go by another month before we can bring this bill to the floor. Two hundred and forty people will die each day being a victim or perpetrator because of the mentally ill. For goodness sake, if we are going to do anything to help this country, Mr. Speaker, let's bring H.R. 2646 for a vote on this floor and fix this problem in America.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, the recent terrorist attacks in Paris are a stark reminder that we cannot risk the safety of our country. I am asking Pennsylvania Governor Wolf to suspend the Commonwealth's participation in the President's Syrian refugee resettlement initiative. The administration has not provided any details of a thorough screening plan to thwart ISIS infiltration. Meanwhile, the Director of National Intelligence, the Director of the FBI, and the Secretary of Homeland Security have told Congress they cannot properly screen refugees coming from Syria and the surrounding regions for national security threats. We have an obligation to protect Americans from those who seek to take advantage of our generosity at the expense of innocent lives. The President and Governor are pushing to make America the home for tens of thousands of refugees. We have 50,000 homeless veterans within the USA and 1,500 in Pennsylvania. If we want to welcome someone home, let's start instead with our homeless veterans.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, our mental health system is abusive and neglectful to those with a serious mental illness. Worse yet, these policies disproportionately impact minorities and the poor. African Americans are 50 percent less likely to receive psychiatric treatment. Outpatient mental health spending for African Americans is 40 percent lower. While there is an overall shortage of mental health professionals, only 3 percent of psychiatrists and 2 percent of psychologists are African American. The rate is similar for Latino mental health professionals and worse for Native Americans. If you are a minority or low income and have a serious mental illness, you are more likely to end up in prison, where 80 percent of inmates don't receive any treatment. If you are low income, Medicaid makes it harder for you to access inpatient mental health treatment, won't let you see two doctors on the same day, and says, you can't take the medications your doctor prescribed. Stop this discrimination. I ask Members to cosponsor and pass the Helping Families of Mental Health Crisis Act, H.R. 2646. People with serious mental illness can and do get better with help, but where there is no help, there is no hope.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Madam Speaker, I move that the House do now adjourn.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Madam Speaker, I yield to the gentlewoman from North Carolina (Mrs. Ellmers), a member of the Energy and Commerce Committee and a cosponsor of this bill.

Mr. MURPHY of Pennsylvania. I thank the gentlewoman for her comments and for her continued pursuit of making sure we pass this. This bill was first introduced over a year ago, reworked with a lot of bipartisan input, Members of Congress from both sides of the aisle, and also from many, many organizations. The other day, some 23 organizations delivered a letter to some Members of Congress saying they want to see comprehensive mental health reform. This is the first and the most comprehensive mental health reform our country has seen. The last time some efforts were made, it was the very last bill that President Kennedy signed before he was assassinated to begin to make some change in our country to move away from the asylums and towards community mental health. Unfortunately, that dream only came partially true because what happened is we closed those asylums. Back in the 1950s, we had 550,000 psychiatric hospital beds in this country. At that time the population of the country was 150 million. Now the population of the country is over 316 million, 320 million, and we only have 40,000 psych beds. Now, Madam Speaker, some of that is because we have come up with more effective treatments, better ways of identifying and diagnosing people, better medications, and, quite frankly, those asylums of yesteryear needed to close. Many times they were homes of abuse and given nicknames like snake pits, cuckoo's nests, and other derogatory terms because they were so bad. But then along came community medical health centers, and that was supposed to pick up the slack. As States found that they could close these asylums, they looked and saw that they could save some money, and they didn't put the money into mental health services, nor did the Federal Government. What happened instead was the people traded the hospital bed for the jail cell, for the homeless shelter, and for the morgue. That is where we are today. Now, it is not for lack of trying because, indeed, the Federal Government has spent a lot of money--some $100-plus billion a year--on this, mostly through disability payments, but some for Federal programs. Madam Speaker, what I want to do tonight is now talk about 10 things we can do as a nation to deal with this, 10 things we must do. First of all, the General Accounting Office report that we commissioned from the Energy and Commerce Committee, we said: Tell us what programs there are in the Federal Government that deal with mental health and, more specifically, serious mental illness. I was amazed to hear how many there were, 112 agencies scattered across eight departments. It is a dysfunctional and uncoordinated system. It is a system that really does not have central control. It is a system that has not even met among these agencies for years, even though one of the agencies, SAMHSA, Substance Abuse and Mental Health Services Administration, is supposed to be the lead agency to say get together and meet. They hadn't even met since 2009. By the way, when we had a hearing on this in the Oversight and Investigations Subcommittee, they said: Oh, we will start doing that soon. But this report that came out that excoriated the Federal programs said that they are not only uncoordinated, but nobody even checks to see if what they do works. They are programs with the Department of Defense; Veterans' Affairs; Education, Health and Human Services; HUD. The list goes on and on. I think there are 20-plus programs for homelessness. There was redundancy and there was overlap, but it is not coordinated. We make it the most difficult for those who have the most difficulty. So here is number one of what we want to do. We want to have the office of the assistant secretary for mental health and substance abuse created--a new office, but not new money. We do not need any money for this. We take the current office of SAMHSA and elevate that title of the person who runs that agency to the level of an assistant secretary. That person's job will be to create an annual report to Congress to tell us the state of the States, tell us how they spend their money that they get from the Federal level, tell us what are the best practices out there that can serve as models for other States, collect that data. Right now what we do get is data on numbers of suicides. We get some homicide data, but we really don't get that much on homeless data. We have so-so quality of data for substance abuse, what happens there. But for the most part, no one asks about these agencies and coordinates them. This person's job is to do this. More so, this person is going to have to be a mental health provider, someone who understands the field. The last Director of SAMHSA was an attorney, perhaps well-intended, but did not understand the field. Just like you would not appoint someone to head the Joint Chiefs of Staff to run the Army who is not a general or the Navy who is not an admiral, you need someone to run this who knows what they are doing. In addition to coordinating these agencies, what they would do is give a report to Congress of which ones can be eliminated because they are redundant, merge the money together, make more money available, and send more money out to communities. Let Congress then act to revamp these multiple organizations to do what is most effective to get funding back to the communities and to the people where it is needed, not to stay in Washington, D.C. I think President Reagan talked about perhaps some proof of eternity is a Federal program. What we don't want to have here is the continuation of programs that exist just for the sake of employment. Programs should exist for the sake of doing the right thing for people out there, and right now, we have a failure. The second item is to drive evidence-based care. Another General Accounting Office report which came out talked about some of the abysmal conditions here. They were saying that agencies had difficulty identifying programs supporting individuals with serious mental illness because they didn't always track whether or not such individuals were among those served by the program. Again, SAMHSA in the past--which is supposed to lead these organizations--doesn't really track to say: What are the evidence-based programs you are doing? When we had a hearing on these issues, SAMHSA told me afterwards they would change nothing. They do list some evidence-based programs, but the evidence base is oftentimes people who do programs and say: Take my word for it, it works. If it works, why do we have millions of people with mental illness? Why do we have 4 million people not getting any care at all? Why do we continue to fill our jails, homeless shelters, and morgues with people with mental illness? There are some excellent programs out there, quite frankly, but there are also many that need to be changed. As part of this process, it was stated in the GAO report that many of the programs hadn't completed their evaluations, many had no evaluations, some were underway, and 17 programs had no evaluation completed and none planned. So the government was not even looking to see if what they were doing had any value. We are going to change that, Madam Speaker. We are going to make sure the programs that are out there have evidence-based care. The National Child Traumatic Stress Network is an excellent program that does a great job. Another program is called RAISE, Response After Initial Schizophrenia Episode. It does a great job because they work in terms of getting care early in someone's life when they first show symptoms. It is called the prodromal stage. When you get to someone early, you improve their prognosis. But a lot of these other programs-- and I will highlight some of the sloppy and irrational programs we have out here tonight--can make a difference if they are done the right way. Madam Speaker, it is important to note that with regard to serious mental illness, about 50 percent of those with serious mental illness, it will emerge by age 14, and about 75 percent of the cases by age 24. Every time a person has what the public popularly knows as a breakdown, or we refer to it as a psychological or psychiatric crisis, there is harm that occurs to the person, psychological harm and neurological harm, because it is a brain disease. So it is important to get to people early on. That is why we want evidence-based care that really and truly does that and not programs that are fluff. We want them to have outcome measures and determine them. By the way, Madam Speaker, just the opposite of that, some of the things that SAMHSA has funded in the past have also been programs specifically geared toward telling people to stop taking their medication. When people have anxiety, they have plans in telling you how to drink a fruit smoothie. None of those are evidence-based care, and none of those treat people with serious mental illness. Number three, go to the mental health workforce. We have a serious, serious shortage here of providers. Even if you wanted to get care, you can't get care in many counties. I think perhaps one-fourth or one- third of counties in Oregon do not even have a psychiatrist in them. Many do not have a clinical psychologist or clinical social workers or peer support teams with the adequacy to meet the need. It is the same across the Nation. What happens here is there are about 9,000 child psychiatrists in this country. We need 30,000, precisely for the reason I said before, that these problems emerge during those adolescent and young adult years. If you don't have the right qualified people, you can't treat them. Similarly, clinical psychologists, counseling psychologists, clinical social workers, and peer support teams specifically trained and available to be out there, we have massive shortages. Part of the job of the assistant secretary is going to be to identify what do we need in communities and how do we get them. Our bill authorizes, for the first time, minorities to work with fellowships. We also authorize people to be volunteers at community health centers. This is one of the bizarre things that only the Federal Government can do. If you want to work at a community health center, you can work, and your medical malpractice insurance is covered. If you want to volunteer, it is not there. Now, think about this. If there are some well-intended and compassionate--as I know many are--mental health providers who want to volunteer maybe an afternoon a week, give of their time to help, they are not allowed to do it because the center can't afford their malpractice insurance because they would have to pay the regular rate as opposed to a Federal plan rate. Our bill also authorizes that they can volunteer. We also authorize programs with telemedicine so that when a pediatrician or a family member identifies someone in need of care, they can access them immediately if need be, especially in rural areas and faraway areas where there is not enough support there. The next one is the shortage of mental health beds. I had mentioned earlier this grave shortage where we had 550,000 beds in the 1950s; we have 40,000 today. It is a serious crisis-level shortage in every community. During one of our hearings, Senator Creigh Deeds, a State senator in Virginia, testified. Many are familiar with his story. He was a former gubernatorial candidate in Virginia, and he took his son, Gus, with him oftentimes campaigning around the State of Virginia. Gus played a musical instrument, and they enjoyed their time together; but sadly, Gus deteriorated. When his father, who raised him, fed him, and clothed him, took him to a hospital for care, the hospital said: We don't have any psych beds. As they made calls and tried to find more in Virginia, they couldn't find any. Young Gus was sent home with his father. They wouldn't provide many details, but they sent Gus home. Gus took a knife and attacked his father, nearly killing him. Creigh escaped, and Gus then killed himself, all because of a lack of beds. Madam Speaker, there was a story last week in The Washington Post about another Virginia man, a 24-year-old man who was arrested for $5 worth of shoplifting at a 7-Eleven in Virginia. He was taken to jail for shoplifting. But upon recognizing that he had a serious mental illness, they wanted to get him to a hospital. Again, there weren't beds available. So he stayed in that jail, I believe, over 70 days, often naked, covered in his own feces, refusing to eat, and losing 40 pounds. Ultimately, he died for lack of a bed. Now, that is not the only problem that is out there. Understand that we don't want to bring back those asylums, but when a person is in that crisis mode, it is not appropriate to bring them to a jail. It is not appropriate to leave them in an emergency room for hours or days or weeks sometimes waiting for a hospital bed to open up, and it certainly is inappropriate to discharge someone without any wraparound services or care. But what happens is, when you have a bed shortage, you cannot get care for crisis by qualified persons. We don't have the providers. We don't have the places. It is important for someone to have a clean and calm and caring environment separate from other environmental stresses and problems so you can work with them and stabilize them, perhaps get them on medication, help them relax, help organize things for home care or outpatient care for them. Sometimes that takes a few days. Sometimes that takes a couple weeks. But the idea is you need a place for them. Without beds, oftentimes a staff simply cannot do a thorough evaluation and they sometimes then will simply make an uninformed and premature release of the individual, of the consumer, saying, ``Well, he doesn't seem that bad. We will send him home,'' not really understanding whether or not that person is a threat to themselves or someone else. Understand this, that even with the brain diseases of schizophrenia and bipolar, when questioned, someone could be in a position where, when asked if they are going to harm themselves or someone else, they would say, ``No. I am fine. Really, it is okay. It was just a disagreement I had.'' They can keep it together for a little bit. And if a staff is already saying: Look, we don't have hospital beds. Let's send him home,'' they will be sent home without really knowing the seriousness of their illness or providing full services. Further, if you want to evaluate if someone is a threat to harm themselves or someone else or in imminent danger of that, many times the doctors and the courts are reluctant to go through that process. Many times they are looking for another out. And many times--like in Pennsylvania, it is called a 302 procedure-- they will bypass that or they will say to the patient, ``Can you just voluntarily commit yourself or promise you will be okay and you will go out and get care?'' I want to add this because it is very important while the President and other people are talking about access to guns and talking about background checks. You can't do a background check if you don't have a background record--you can't do a background check if you don't have a background record--and if there is no place to help people when they are in crisis. And if doctors and judges are not going to have someone involuntarily committed, there is no record. There is nothing that can appear on the national list to prevent a person from purchasing a firearm. There was no time spent in a hospital where staff can truly evaluate are these delusions and hallucinations which can be controlled with medication, will the person be stabilized, are they a risk threat. You can't do that. We need more beds, and our bill says there will be more. This is one of those areas of incredible prejudices and bigotry. You see, Medicaid has this rule that, if you are between the ages of 21 and 64, you cannot go into a private hospital that has more than 16 beds. Now, think about that. If you have money, you can go in a hospital. If you are low income, you are out of luck. You are on the street. It is a different standard that is grossly unfair and incredibly prejudicial. And again I go to this point, that those who are minorities or low income are treated the worst. A person is ten times more likely to be treated in a jail cell than in a hospital if they are seriously mentally ill--ten times more likely. And, yet, that treatment in a jail cell is not appropriate at all. It is not treatment. Oftentimes they are put in isolation. They may get in a fight with a guard. What started off as a small charge may end up as a felony assault charge. A person with serious mental illness oftentimes for the same crime will spend four times the amount in jail as a person who is not mentally ill. And all along, if we had the proper place to treat them, we could have done that. Our bill lifts this 16-bed cap, this ridiculously absurd 16-bed cap, and says, instead, we would like to have an average length of stay of less than 30 days. That can be achieved. In about 98 percent of cases, it can be achieved. And, by the way, it is far less expensive to have someone in a psychiatric hospital bed than an emergency room by about four times. Some studies have gone as high as saying it is about 20 times less expensive to have them in outpatient care than in a jail cell. We would save a lot more money if we fixed this crisis shortage, worked on other outpatient care to transition people out, and wrap them around with the necessary services so they could go out more stable. Point number five: We eliminate the same day doctor barrier, another one of those ridiculously prejudicial rules out there that Medicaid has that harms those of low income. I mentioned a number of times that the prodromal stages of adolescents and young adulthood is when serious mental illness begins to emerge, those first symptoms that sometimes someone may think is a little bit strange, there is something different about this person. Perhaps their grades are dropping. Perhaps they are not taking care of themselves the way they used to. Perhaps they are withdrawing from relationships and friends. Those could be early signs of a bigger problem. But it takes, between first symptoms and first professional treatment, on average, 110 weeks, over 2 years, of waiting time between first symptoms, in part, because people are not aware of what to look for in the symptoms, but, in part, because they are not connected with other providers here and, even when they are, they are not allowed to do anything. The same day doctor rule is a Medicaid rule which says you can't see two doctors in the same day at the same location. So here is the problem. If a pediatrician says to a mother or father, ``We are very concerned about your teenage son''--who is in the later years, 17 or so--``I would like him to see a psychiatrist right away because I am very concerned about the behaviors you are describing to me'' and then, when that doctor realizes that that person is on Medicaid, basically, Medicaid says, ``We are not paying for it,'' how cruel and abusive is that, to say to someone, ``Just because you have low income we are not going to cover the services here'' when this is a critical time? When you have that warm hand-off in the doctor's office, there is a 95 percent likelihood that the person will follow up, according to a study by Children's Hospital of Pittsburgh. When you wait and you say, ``Here is the number. Call it another day,'' that likelihood drops below 45 percent. And when you miss that golden opportunity to help a person in times of need, that person may be very reluctant to come back for care in the future. We fix this by saying we are going to drop that same day doctor rule. Number six: We have to empower parents and caregivers to be part of the solution. Twenty years ago HIPAA laws came out that said, ``In order to help your insurance be portable, we want to protect the records.'' Good idea. ``We wanted to make sure records had privacy.'' Good idea. But HIPAA moved from the place where we are supposed to assist care and confidentiality to the point where it impairs care. It has gone too far. Let me give you a couple of examples. Right now a doctor--and I am a psychologist. If I know a family member brings someone in to see me, I can listen to them in a very passive mode, but I can't provide them any information. That is helpful. They are giving me vital information for history. If I don't have the accurate history, a provider does not have accurate history, you can't accurately diagnose. You don't know if the person has been on medication before, does it work or not work, who has this person seen before, what sets them off, are they doing better, what are their symptoms. If I don't have or a provider does not have that information, they may miss making the accurate diagnosis and then not be able to provide proper treatment and follow-up. When that occurs, harm can follow. Now, if I get the information, great. But what happens if that family member is not there? The provider can't go out and seek other family members and friends to get that information because HIPAA laws are seen as barriers to that. Because as soon as a doctor at a hospital calls and says, ``Your adult son is in the hospital. I need to ask you some information about it,'' that doctor has already violated HIPAA laws by identifying the person's son is in a hospital. Now, think about this, though. A parent, the person who was caring and loving throughout a lifetime, committed to their family member, a brother, a sister, someone's mother or father, they are prohibited from being part of the care team by HIPAA laws. A stranger, some appointed worker, someone who may see them as they roll in and out of their job, even if they care and they burn out, they will be maybe sitting next to a family member in court and simply say, ``I can't tell you anything about this family member. You will have to find out for yourself.'' Here is another problem, though. Not only are you impaired from getting diagnostic information, you can't evaluate medications. But understand that people with serious mental illness are often at high risk for other medical problems, in part, because their hygiene may be poor, they may not take care of themselves, may not see doctors, et cetera. But they also are in a situation where they may take some medications that make them high risk for diabetes or heart disease. And without getting a family member to help them with that, they do not have the ability to properly treat them. My goal in this bill is to simply say that, in cases where someone has diminished capacity to take care of themselves where, in absence of treatment, they become gravely disabled, a provider may tell a known caregiver--so notice I have already set the bar pretty high--may tell a known caregiver a few simple facts: the diagnosis, the treatment plan, the treating doctors, time and place of appointment, and what are the medications they are on. No therapy notes are allowed to be exchanged. We specifically prohibit that in this bill. But that is important. And, by the way, I might add one other thing. As I hear a lot of people talking about the concerns of why didn't a parent do anything, why didn't they know anything in some cases, like the young man at Virginia Tech who killed so many students or the gentlemen in Oregon or at Sandy Hook Elementary School in Connecticut, it is because providers cannot do a risk assessment. They cannot contact a family member and say, ``Can you tell me if this person has any morbid fantasy and fascination with death, with extremely violent video games, with dark Web sites? Do they have weapons that are unsecured? Do they talk about violent issues? Have they made threats before?'' You can't do that risk assessment. Without that, you end up not knowing the risk. Number seven: States receive money for mental health services and substance abuse disorders. Those dollars are about $500 million for mental health and about $600 to $700 million for substance abuse. The odd thing about this is States are not allowed to mingle that money. They can't braid it together. Even worse is that many people with a substance abuse disorder have a mental illness and many people with mental illness will turn toward other substances to self-medicate. And, yet, the person will have to go to two different providers, two different clinics, to get care instead of one. We drop that barrier and say Federal grants should go to States in a way that help the States work this best. Number eight: We want to bring accountability to the spending of Federal funds. Now, here is where we have seen in another GAO report the absolute absurdity and cruelty of how money is spent. A GAO report done this last summer told us that many times documents and applications for many who receive grants were not reviewed. They couldn't tell you what the application criterion was to get an award. They didn't have program-specific guidance. Information was missing or not readily available. They didn't even know where it was stored. You couldn't follow the paper trail to see where it was. And so what happens is no one knows how this money was spent. But let me tell you some of the absurd things we have found money is spent on, our tax dollars. How about this? A Web site last winter was posted by SAMHSA for the people of Boston to help them with their worries about snow. That is right. They posted a 1-800 number you could call if you had snow anxiety. These are people from New England, for goodness sake. They know how to handle snow. But our tax dollars went to help them understand it. There are Web sites that tell you to drink a fruit smoothie if you are anxious, programs that tell you how to make a mask, programs that we fund to how to make collages, a painting in SAMHSA's headquarters that cost $22,500 of two people sitting on a rock surrounded by other people--$22,000. When we asked the director of SAMHSA what that was for, they said it is more mental health awareness. The only thing I am aware of is it is a waste of money and that money could have gone to help pay someone's salary to actually treat a patient. Well, it gets worse. A Web site for 3-year-old children, the cost of $426,000, with animated characters and sing-along songs. The purpose, we asked the director of SAMHSA, prevention. ``Prevention of what?'', we said. ``Well, we think prevention is good.'' ``Well, what does this prevent and what does it do and does it work and does it do anything?'' We waited for weeks to get an answer and we still don't have it 1 month later. By the way, they took the Web site down when we shined a bright light on it, saying, ``What does this do?'' We want accountability to this spending. There will be different grant programs now--demonstration grants, innovation grants--where people will know what these grants are. They can look at them as scientific studies in a blind review to make sure it is going to quality programs that really make sense. No more of this behavioral wellness stuff, but truly working at things that make a difference. Number nine: Develop alternatives to institutionalization and have real jail diversion. I said already what happens to so many people with mental illness. They end up in jail. Forty to sixty percent of people in prison have a mental illness. And what this does is it helps provide some extra funding for States that have wraparound services for those who have this history of violent incarcerations, arrests, mental illness. New York has a program called Assisted Outpatient Treatment. Their program, which means a judge will say you need to stay in treatment at an outpatient level, has found they reduced incarcerations by 81 percent. They reduced homelessness by over 70 percent. They reduced admissions to emergency rooms by over 70 percent. They had patient satisfaction, consumer satisfaction at over 90 percent. And they cut costs in half. States have different programs here. About 46 States have something on the books. But many of these States do not put these programs in practice because of the big cost. We know States will save a lot of money once they start doing this. But what we want to do is take people out of this cycle, this revolving door of jail and risk and more damage, and say that States need to have programs where it wraps around services for that person. Don't just dump them from jail onto the streets and expect a problem because it will erupt again. Make sure those services are there. Make sure the person stays in treatment. Now some say, well, that is unfair. Some say that might be an involuntary commitment, that it puts people there against their will and you impair their rights. But I say this, that a person with serious mental illness 40 percent of the time is not even aware they have a problem and so many times they refuse treatment or their past run-ins with the police and other hospitals because they don't want to be there, they don't want to get treatment. If we provide quality, compassionate, accessible care, they may get that, but not under the current system. We want to make sure they have that care, and we will provide the funding to do it. Number 10, advance early intervention and prevention programs: A lot of what our government spends money on is what is called primary prevention, the things we do for everybody, like don't smoke, wear a seat belt. But what happens is, in the area of mental illness, those wellness programs like I described before that are out there, the silly things that SAMHSA does, are not an effective use of dollars. Secondary and tertiary prevention is valuable. Secondary is when you recognize someone is at risk, but not with symptoms. Tertiary is when they have symptoms and you try and help them get better. By focusing money on the programs I mentioned before--the RAISE program or others, the Child and Adolescent Traumatic Stress Network-- you can move the dollars where they need to be funded and stop this silliness. Now, I should say this while I am talking about SAMHSA, that despite two GAO reports that criticize them--and one time afterwards I had the director of SAMHSA in my office and I said, ``Okay. Here is your opportunity. Would you change anything?'' And she said, ``No. I wouldn't change a thing.'' Another time during one of our hearings one of my colleagues said, ``On a scale of 1 to 10, how would you rate yourself on your programs?'' And the director said, ``I would give myself a 10,'' despite all these failures. That is the reason why we need to have an assistant secretary of mental health. That is the reason why we need to make these changes. This is the current reason why we have so many of these problems. Before I wrap up here, I want to yield a couple of minutes to the gentleman from Pennsylvania (Mr. Thompson), who has also been involved in the field of wellness and is also a supporter of this bill.

Mr. MURPHY of Pennsylvania. In my closing minute, let me say this: As I opened up, this will be known as the bloody summer of 2015. Let this time be the autumn of our compassion in 2015. The time is now. We have 40 newspapers around this country that have published endorsements for this legislation. We have 133 bipartisan cosponsors. I plead with my colleagues to please become a cosponsor to this bill. I beg leadership. Let's no longer have a blind eye to this, let's no longer have a moment of silence, and let this be the time of our action. Let's pass H.R. 2646, the Helping Families in Mental Health Crisis Act, and let's bring compassion and care to the many families in America who are suffering from mental illness and show them that that twilight, as the sun sets, is indicating that there soon will be a dawn of great hope in America. I yield back the balance of my time.

Mr. MURPHY of Pennsylvania. Madam Speaker, this evening, just before votes, I went outside on the balcony here of this Capitol to watch the sun set. It was one of those beautiful evenings of crimson and gold and gray clouds silhouetted against the twilight glow of the evening. And then I glanced over to the buildings here at the Capitol and was suddenly brought back to reality when I saw so many flags on our buildings flying at half mast, flying at half mast because, once again, we are remembering the tragedies that have shaken our Nation time and time again. This has been a bloody summer, a bloody summer of many attacks that have been associated with folks with mental illness. I know most people with mental illness are not violent, and I know that there are many other tragedies that occur; but tonight, during this week, which is Mental Health Week in America, I want to highlight, Madam Speaker, what we must do as a nation, what we cannot continue to push aside. Just think of what happened this summer, just a few examples: June 13, attack on the Dallas Police headquarters by a man who had a history of family violence and mental instability; July 23, Lafayette, Louisiana, a shooting in a movie theater by a man who had had a judge's orders to send him to a mental hospital in the past; August 16, Antioch, Tennessee, a movie theater attack; August 26, Roanoke, Virginia, a live, on-air shooting, a tragic scene of a reporter being killed, and a cameraman; August 28, 2015, Houston, Texas, while a deputy police officer was at a gas station, riddled with bullets by a man who had a history of mental illness; September 22, the son of a State senator, former State senator of Virginia, killed a man, and also killed himself in Bowling Green; And this last week, October 1, in Roseburg, Oregon, nine people were killed, and the gunman killed himself in another tragic scene. There is more to it than this, of course. In this country last year, 125 people with mental illness were killed in some sort of a police shooting where the police oftentimes did not even know, but the confrontation grew and ended in a death. It is estimated there were somewhere between 1,200 and 1,500 murders in this country this last year by people with mental illness. But more than that, there are 10,000 or more, maybe 20,000, maybe 100,000 people with mental illness who are the victims of crime. Some are killed. There are thousands and thousands of people who are homeless, who die that slow-motion death of homelessness, of their physical ailments and their illnesses. There were 41,000 suicide deaths, 1.2 million suicide attempts that required some medical care, 43,000 substance abuse overdose deaths. This list goes on and on and on. And what happens is, when we treat people with mental illness early in their life, their prognosis is improved. In many cases, they can go on to have fruitful lives. But when it is untreated, they likely develop other problems, not just with mental illness, but social, job, and physical health. Persons with serious mental illness, in treatment, are 15 times less likely to engage in an act of violence than those who are not in treatment. In America, some 60 million people in any given year will have some diagnosable mental illness, from the very mild and transient ones, which we all experience, to severe mental illness, such as schizophrenia or bipolar or extreme depression. But of those with serious mental illness, about 4 million of those 11 million will not have any treatment for a variety of reasons: treatment may not be available; they may refuse treatment; or what happens so often with those with serious mental illness, they are characteristically unaware that they have an illness--it is a brain illness, a serious mental illness--like a person with Alzheimer's or stroke or traumatic brain injury, a person who may not even know that they have a problem. What do we do about this as a nation? Mostly we just talk. Sadly and tragically, what we do here in the House of Representatives, we will have a moment of silence, but it is not followed by action. What we need is not more silence. We need action. Madam Speaker, we need people in this country to rise up and say: This is the time. This is the day. This is the issue where we are, once and for all, going to do comprehensive reform of our mental health system in America. Our mental health system in America is fragmented at best, a system with regulations that are abusive and neglectful towards those with serious mental illness. And more so, it is worse if you are a minority or low-income. This is odd because in a field that is filled with some of the most compassionate and caring people I know, people I have had the pleasure to work side by side with in my role as a psychologist, we have Federal policies and State policies that leave their hands tied, their eyes blinded, and their mouths gagged to prevent treatment from occurring. Ultimately, the individuals suffer and their families suffer. Tonight we will review what the problem is and what can be done systemically, thoroughly, and definitively, what this country must do if we are serious about treating mental illness. One of my colleagues from the Toledo area, who represents northern Ohio, is with us now. I yield to the gentlewoman from Ohio (Ms. Kaptur).