Tim Murphy

Mr. MURPHY

Mr. MURPHY. Paul, I thank the House and your leadership for moving so many bills dealing with the opioid problem that are both life changing and life saving. It is rare that so much is done in this Chamber, that to think about the 60-plus thousand, maybe 100,000 lives lost every year by this, it is clearly something that is going to save massive numbers of people.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, owing to a leave of absence for personal reasons, I was unable to cast votes on October 4th and 5th. Had I been present, I would have voted as follows: On Roll Call No. 553, the Rep. Grijalva Progressive Caucus Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.'' On Roll Call No. 554, the Rep. Scott Congressional Black Caucus Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.'' On Roll Call No. 555, the Rep. McClintock Republican Study Committee Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.'' On Roll Call No. 556, Rep. Yarmuth Democratic Caucus Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.'' On Roll Call No. 557, Adoption of H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Aye.'' On Roll Call No. 558, Approval of the Journal, I would have voted ``Aye.''

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank my friend from Arizona for her dedication to helping veterans. It will be often cited that 20 veterans a day take their own lives. It is important that we take a deeper dive into why that is because, as a society, we want to know. There will be upwards of 40-some thousand suicides this year in our Nation. Even one is too many. And I know that organizations that deal with suicide prevention want to see that drop considerably. But there is some understanding that is important for us to know what we can do and what stands in the way. I want to note that those who serve in the military are about 1 percent of the population. Those who have served in World War II, Korea, and Vietnam are dying off fast from natural causes. But a great many of those veterans who do take an act of suicide are above age 50. Many of them have never served in combat. Characteristic groups, such as the Army National Guard and reservists are among those who do have some higher rates. It has been interpreted that perhaps one of the reasons for that is that they do not stay with their cohorts after combat. They go back home, come back on weekends, but don't have that same day-to- day support. We also know the military, very much so after Vietnam, when you were done with your time, when you got your points, you were gone. You could be in the middle of a battle, and you would be picked up by helicopter and taken home with encrusted blood still on your uniform from your friends, but you were sent back to the States--no chance to recover, no chance to develop from that, no chance to even get a checkup from the neck up, and, as a matter of fact, that was not even done. So for those who did serve in Vietnam and Korea and World War II, you just went back to life. We have learned it is important to do more for people, and we do try and understand what is it, the characteristics among those who have taken their own lives, or tried to, that causes that to happen. First of all, it is worth noting that about 70 percent of those who have taken their own lives who were veterans have not been involved with the VA hospital system. That is extremely important to know. They are not involved. Now, that could be a number of reasons. It could be veterans who were not eligible for involvement at the VA. Many reservists and guards are not unless they served Active-Duty time, and even that is a limited timeframe. They also may have not been early identified when they came out of the military that would make them eligible for services. And, quite frankly, in many cases, it just is not near their home. A study that was done with people at Fort Carson, Colorado, of 70- some folks who had attempted suicide, found that the number one reason that they gave, out of a list of 33 possibilities, was they wanted to end emotional distress. They simply wanted the pain to stop, and they ran out of ways to make it stop. I reflect on the life of my father, who is now gone for other reasons, but one day when I was at home from college--and he himself was a World War II veteran--I heard his soft voice calling from the bathroom, and to see him there with a lot of blood on him, because he had just attempted to cut his arms and kill himself. Luckily, he did not. We got him care. But I believe for him, he certainly would have been in this category. He just wanted the pain to stop. I don't think it was PTSD or his old signs of war. I think it was, perhaps, other distress as he dealt with his own alcoholism, or did not deal with it very well at that time, and the financial distresses of raising a family, and we just didn't have money, but it was enough to affect me--lifetime--in terms of trying to understand and dedicate my life to helping those in psychological need. I should mention, on September 11, I got my honorable discharge, so I am no longer in the Navy. I miss it every day, because I loved that time working with servicemembers who had traumatic brain injuries and post-traumatic stress and a wide range of other problems, but here are a few things that I learned from them that are very important. One is, if you want care in mental health, you just can't get it, not only because there may not be a VA near you, but even if there was, many persons who are dealing with panic and anxiety and depression don't want to leave the house; many with post-traumatic stress disorders do not want to go onto a bus or into traffic or into congested areas, because that can bring back some terrible memories for them. The very thing they need is to get treatment, but the very problems they have prevent them from getting treatment. Now, we have passed legislation here that deals with choice to allow veterans to get that care closer to home. But can they get it? Well, tragically--not just sadly but tragically--in the area of mental health services, half the counties in America have no psychiatrist, they have no psychologist, they have no clinical social worker, they have no psychiatric nurse practitioner, and they have no licensed drug treatment counselor. In other words, it is not available. If you just look at those, for example, with a substance abuse disorder, of the 22 million, about 75 to 80 percent of them also have a mental health problem and they are at higher risk for suicide. And certainly if we have a veteran who has substance abuse and depression, they are at higher risk. But look at this group. For every 1,000 people with a substance abuse disorder--for every 1,000 people--900 do not seek treatment. Out of the 100 who do seek treatment, 37 have got nothing available to them. Of the 63 who have something available, only six get evidence-based care. So it is no wonder when we talk to veterans, and they say, ``I tried getting help, but this person didn't understand. I couldn't get help. It was a problem that was ongoing,'' at some point they reach that point where they want to just end their emotional distress. I remember visiting the house of a veteran. The mother had called me and said: ``Can you help him? He won't go to the VA. He won't get help.'' I made a house call. The VA doesn't do that, but I made a house call. And without revealing too much, I will just say that it was pretty clear he had a lot of medication around his house. His apartment was pretty unkempt, food lying around, bottles, dozens and dozens of bottles of medication unopened, each one from the VA, because probably each time he went to the VA, they said: ``How are you doing?'' ``I am not doing well.'' ``Here. We will just increase your dosage,'' or, ``We will give you a different medication,'' but the system was not set up to say, ``How are you doing? What else can we do to care for you?'' It simply was not set up to go to his home and help him out when he missed his appointments, when he was no longer employed, when he had isolated himself from society, when, like so many people, covered the windows of their bedroom with camouflage or some other dark thing so the light doesn't get in, don't watch TV, just stay away from the world, this shrinking world that constricts you like a snake around the throat until they see no more reason to live. I remember going to the VA hospital and mentioning, ``You know, I know the Marines are famous for not leaving anyone in the field. What do you do about some of these other folks with mental health problems?'' They said, ``We don't go out to their homes.'' I said, ``Why not?'' ``We just don't do that.'' ``Why not?'' ``We just don't.'' I agonize over that as being a Navy healthcare provider to know this doesn't sound like the Marines. The Marines don't leave someone out there. Are we so constricted and tied up by rules that we can't even go and reach out to them? But that is part of the problem, that we need easier access to local care, we need care that reaches out to veterans, and not just say, ``Hey, listen, if you really want to get help, why don't you suck it up, pull up your bootstraps and go out and get help,'' because some of them are not able to do that yet. Many of them feel, as a veteran, ``I have faced tougher battles. I can't let people know I am weak or I am struggling.'' Many of them have addiction disorders, and they don't want people to know that they are weak and they are struggling. To those veterans, I say this is not a sign of failure. It is like if you are in the battle and bullets are coming at you and grenades are coming at you and incoming fire is coming at you, the last thing you want to do is deny it is happening. You have to acknowledge it is happening. What do you do? You get on the radio and you call for help. That is what we have to make sure veterans understand, that that is what this is about, depression and panic and anxiety as well. We need more providers. I have had legislation on a mental health bill to get more providers. We recently voted on some things in amendment to the Labor-H bill here to get a little bit more, but we need thousands of more providers, psychiatrists, psychologists, social workers, licensed drug treatment counselors. We don't have that. If Congress really wants to help, we have to do more of that, but part of the problem is this, too: they oftentimes, in the field, have such massive student loans. And relative to other areas of medicine and healthcare, they get paid so little, they may choose not to go into these areas of mental health care. So for those who are the most vulnerable, we make it the most difficult for them to get care. Add to that the idea of, who among those who are mental health providers actually have training and understanding of military healthcare, understanding military medicine, understanding military life? I was commissioned 8 years ago, and I know that when I went on to officer school, and I went to training, you have got to learn a lot. The Marines say, ``I learned to shoot a gun, and I can polish my shoes better than anybody,'' but there is more to it than that. It is understanding the words, the acronyms, the lifestyle, what a person goes through. We could certainly do much better, if not just saying let's hire people at the VA, but have a program for civilian mental health professionals, one, to recruit more; two, to pay for more reimbursed student loans to get them in the workforce; but also, quite frankly, to give them more regular orientation of what it is like to be a member of the military. Let them observe boot camp. Let them understand this. I will give you an example. Once a soldier who I was treating, he said he had given up getting care for a while. He said the third time he had to explain to his therapist what an MRAP was, he said, ``Give it up.'' The MRAP is a military vehicle, commonly known vehicle. Now, every branch of the military has their own acronyms, and I don't pretend to know them all, but if a person doesn't even know the basics, you lose that sort of connection with the patient, and they give up. The other issue here is that we need to be able to have a system that monitors the medication closely. It is very common that if someone is on medication, they are a polypharmacy event; that is, they are taking so many medications, and then they will take other medications that counteract the effects of those medications, and then they will take other medications to deal with the side effects of those medications. It was not uncommon for us at Walter Reed to have a patient on 8 or 10 or 15 or more meds that they were on. We found that we reduced them down to one or two. But with medication comes weight gains, comes increase for diabetes, comes other problems, comes stresses in the family, comes situations where they are estranged from their spouse, difficulties with children, episodes with anger. These aren't bad people, but they see their life deteriorating, they see questions with regard to what is happening through their employer, they wonder about their future, they may have taken poor medication, but sometimes they just give up. There is a quote by author Steve Goodyear, who had quite an inspirational quote. I hope, Mr. Speaker, if there are veterans listening tonight, they take this to heed. Mr. Goodyear said: My scars remind me that I did indeed survive my deepest wounds. That in itself is an accomplishment. And they bring to mind something else too: they remind me that the damage life has inflicted on me has, in many places, left me stronger and more resilient. What hurt me in the past has actually made me better equipped to face the present. That is a message I want veterans to hear, that having moments of depression or anxiety or worry are as normal as feeling tired or hungry, but we know when you get in a downward spiral, it gets worse. I don't want veterans to give up. I don't want veterans or members of the military feeling that they have so much emotional distress, this is the only way to end it. I understand the feeling, but I also know that, as members of the community and members who are veterans, we wrap our arms of hope around those veterans to say there is help out there, and we as Congress Members have an obligation to make sure we are providing those services. It pains me when I think that sometimes we can come up with funding for all sorts of programs, but for this 1 percent who say, ``I am willing to take a bullet for you, I am willing to die to defend my country, its Constitution, and its flag,'' we as Congress ought to be able to say we are willing to put some money in to help you get more services. Also some advice for those veterans who may be listening: It is extremely important to follow a few guidelines in your own life, too, besides not giving up, but physical fitness that you were forced to do in the military and boot camp, and all those pushups and sit-ups and running and pullups we did, they had a reason; because when you stay physically fit, it affects your brain functioning and it improves it, and it is one of the things that is used to fight off depression and other problems. Two, you have to have an attitude that is focused on positive things. You can make it. Many times, part of that attitude, an essential part, is a strong faith in God, a strong belief there, which gives you that attitude to say, ``I can do it.'' Navy SEALs talk about the way you eat an elephant is one bite at a time; the way you temper steel is with fire; that pain is weakness leaving the body; that courage is something that is built through experience and focus. It is not something that just comes, but you build that attitude. So you have fitness, you have attitude. Another part is sleep. Many studies I have seen--I think it was Dr. Germain at the University of Pittsburgh who did studies that said perhaps sleep is a greater factor with post-traumatic stress, anxiety, and depression than anything else, and a big part of this is just getting enough sleep. Members of Congress, we deal with this a lot in terms of our own hectic lifestyle, and we know many constituents, because of their workload, their anxiety in the family, they don't get enough. It is essential. It doesn't necessarily mean you are crazy, you have problems, but that is an important part. Further, training, knowing what you can do, whether it is in the workplace or the military, we know it is essential. Making sure one eats right. It sounds obvious. I don't want to make this in any way sound small, but making sure one is actually eating a healthy diet is an important part of fighting off suicide, fighting off depression. Then making sure that people are paying attention to relax, to rehabilitate themselves, to do their own personal checkup from the neck up to make sure they are dealing with these things. None of those things I just mentioned require help from a doctor. All of those things are essential to healing and getting better. When one reaches the point where you say, ``You know what, I need a little help here; I need to call in support on the radio; I need a quick response team; I need to pop some smoke; get some help in here,'' that is okay. I want veterans to know not only is that okay, that is what we are supposed to do. You call in help. We don't need dead heroes on the battlefield. We certainly don't need them in the streets or the homes. We need people who are saying: Understand, that even though it may be tough to get help, there is help out there. There is help out there. People want to facilitate and help you get better. I don't want anybody to feel that this is the way to end emotional distress. It is a permanent solution to a temporary problem, and even if that problem seems to have been going on for years, I know people can and do get better. I have seen it time and time again. The soldier or veterans that thought: I can't go on; I have to give up. They can turn that life around and become a contributor. One has a few choices. One can be a victim and say: You know what? I am under this giant boulder. I will never get better. The weight is too great. I am too weak. I cannot move on. There's no hope. Or you can move on to another stage and say: I am going to be a survivor. On the first part, you say: I am helpless because of what is happening. When you are a survivor, you say: You know what? I am going to move on despite what is happening. I will pray more. I will engage more. I will do more. But every day I will wake up and commit more to get through that day to do something that is important and meaningful. I don't need to set up a goal of 10 years from now, but let me get through that day. Let me find some things I can do and focus. It is extremely important. But beyond that, beyond being a victim or a survivor, is a third stage, and that is being a thriver, someone who says: I am going to make sense out of what I have done, and it is going to make me a stronger person. What I said here in the quote from Steve Goodier where he says, ``What hurt me in the past has actually made me better equipped to face the present,'' if I am in a tough situation, if I am in a situation where I, myself, look at it and I have despair and I lack hope for my own future and I turn towards someone, give me someone who has been there before. Give me a veteran. Give me a soldier who understands boot camp and what is it like to be yelled at and lack sleep. Give me a veteran who has been on the battlefield. Give me someone who has been out to sea and understands what it is like to be months without seeing your family. Give me someone who has been there and says: I made it; so can you. I want veterans to have that sort of hope. We have our obligations in Congress: get more providers, make sure the VA is responsible. But since most people aren't near a VA, we can do a lot to help them. I hope that this Veterans Suicide Recognition Month is something that sometime in the future we can put behind us and make it a thing of the past. We can do that if veterans themselves make those decisions to get help, and if we as the Congress make some decisions to get them that help, and society itself says: Stop having pity on them. Give them help out of affection and love and respect. And, by the way, that respect also includes a lot of people who play professional sports, who have no idea what it is like to have someone shoot at you and try to kill you. Stand up. Have a backbone instead of a wishbone. A lot of veterans don't really want to hear that life is tough for you when you make more money in 15 minutes than they will make in a lifetime. Show some respect for those folks. And then as we as a society recognize what they have given to the last full measure, we will be able to provide the kind of things they need and save some lives. Too many times I have gone to a ceremony. You fold a flag 13 times and hand it to a grieving widow or widower. How much worse it is when they take their own life, because the stigma among the family is there was nothing else you could do, and all of us feel helpless when that happens. Let us make sure we are not part of that problem and, instead, we are part of the solution to celebrate and help our veterans so these things don't continue to happen.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Chairman, this is the last of my amendments on this. Although this House overwhelmingly passed the authorization for these, as did the Senate, money was not allocated towards it. While I understand there is a priority to treat substance abuse, but even with that, many times there is nowhere for someone to go. Back in the 1950s, we had over half a million psychiatric hospital beds in this country. I think at the time the population of the United State was 150 million. Now, with a population close to 317 million to 318 million, we have about 40,000 hospital beds and a shortage of 100,000. The only State that actually has an adequate number of beds is Mississippi. All the rest are at a critical shortage. So what happens when a person has a drug overdose and needs to get into treatment? What happens when a person has a psychiatric breakdown? Well, generally what happens is the police arrive, not the paramedics. They arrest the person. Many States actually say: Let's put these people in a jail cell, because there is no bed. Or, if they take them to the hospital, the hospital says: Let's just give them some medication to stabilize them and let them back out because we can't hold them. We have no place for them to go. What happens, many times these people are boarded, that is, they remain in an emergency room bed, which is no place for someone with a psychiatric crisis. Sometimes they will be tied to their gurney; sometimes they are in the hallways; sometimes they are, for days or weeks or several weeks, waiting for a psychiatric bed and nothing opens up. I thought when Dorothea Dix said let's close down the jail concept, that was prevalent in our country back then, let's have nice hospitals for them. Historically, they said that was a good move, but what happened is these psych beds closed down starting widely in the 1980s and continuing until now. There simply is no place for them to go. Let's remember that President Kennedy's last bill he signed before his assassination was to begin this process of closing the beds but having community-based treatment, but America and Congress have not kept that promise. There is a story of a Senator from Virginia by the name of Creigh Deeds. Some may remember in the news when his son Gus had a crisis and Senator Deeds took his son to a hospital. There they waited hour after hour after hour while the hospital tried to find a hospital bed available for him. Finally, he said they couldn't find any beds: Take young Gus home, and let's see what happens in the future. When Senator Deeds took his son home, his son stabbed Senator Deeds, trying to kill him; and when Senator Deeds ran to get help, he survived, but his son did not because he shot himself with a bullet-- because there were no beds. Now, this particular amendment doesn't create beds, but what happens is sometimes there are beds available in other communities; but short of a hospital calling hospital after hospital after hospital to find a bed for someone, which may be an hour or two drive away, there is no place for them. Surely, we understand the idea: Do we continue to put these folks in hospitals and jail cells? Do we dump them back in the street and let them be the forgotten homeless whom we walk over? Do we send them back home and risk further harm to them? Do we have them tied to a gurney and given a chemical sedation, a chemical straightjacket to wait until something opens up? What this amendment does is it is $10 million in grants to develop and maintain or enhance the database of inpatient psychiatric facilities and crisis stabilization units so we can begin to address this bed shortage. Rather than lead people away from care, this is a way of helping hospitals get that care and instill States to put together programs to speed this up. We still have to work with CMS to create more beds and stop some of the ridiculous rules that they have in there, but what do we continue to tell the mentally ill? ``We will get around to it''? ``We couldn't do it this time''? ``Good luck''? ``I am sorry your son died''? When does this end? Will we hear more excuses that we can't do anything about it because we had a $5 billion cut? What do we do with Americans who are dying from this over and over? Thomas Jefferson once said: ``I tremble for my country when I reflect that God is just, that His justice cannot sleep forever.'' We have a chance to make a difference in the justice for the mentally ill, or will we once again turn a blind eye and say we can do nothing? Mr. Chairman, I ask that Members vote for this amendment to try and save some lives. Mr. Chairman, I yield back the balance of my time.

Mr. MURPHY of Pennsylvania. Mr. Chairman, I have an amendment at the desk.

Mr. MURPHY of Pennsylvania. Reclaiming my time, knowing that when my friend says something, I consider that a bond. Mr. Chairman, I yield back the balance of my time, and I withdraw my amendment.

Mr. MURPHY of Pennsylvania. I yield to the gentleman from Oklahoma.

Mr. MURPHY of Pennsylvania. Mr. Chairman, I want to restate the problems that exist at SAMHSA. The General Accounting Office, during the multiyear investigation of the subcommittee which I chair, the Oversight and Investigations of the Committee on Energy and Commerce, came back and said that 80 percent of the grants for SAMHSA are not evidence-based. There is a serious problem in that agency. Instead, they funded absurd programs, such as making fruit smoothies; and a $400,000 website for toddlers to sing-along songs, which they told us was about prevention. We asked: What are you preventing? They said: We will get back to you on that. They also had workshops on getting in touch with your inner animal, making masks and collages; interpretive dancing; a website and crisis line for people in the New England area when they had heavy a snowfall so they could call in. They have workshops on how to tell people to get off their medications. They had a $25,000 oil painting for their office, which graces their hall, of people sitting on a rock, which gives them mental health awareness. I might add, the only thing I am aware of is a total waste of money. And, of course, an alternative conference, which continues this year as well, spending, I think, $150,000 or so to hold their conference at the luxurious Boston Park Plaza Hotel. I don't want to hear from that agency that they don't have money. This particular program redirects them so they get reset in terms of evidence-based care. It forms a panel of people with expertise in medical psychiatric areas, including consumers. It is there to provide direction and guidance for an agency that has been without direction and guidance. It is there to make sure that we redirect the way SAMHSA is going so that it gets in the area of really treating mental illness. Let me say this--let me use the words of Dr. Elinore McCance-Katz, the current Assistant Secretary of Mental Health and, therefore, the de facto head of SAMHSA. She said: ``. . . SAMHSA does not address the treatment needs of the most vulnerable in our society. Rather, the unit within SAMHSA charged with addressing these disorders, the Center for Mental Health Services, chooses to focus on its own definition of `recovery,' which generally ignores the treatment of mental disorders, and, as a major initiative under `recovery' services, focuses on the development of a `peer workforce.' ``There is a perceptible hostility toward psychiatric medicine: a resistance to addressing the treatment needs of those with serious mental illness and a questioning by some at SAMHSA as to whether mental disorders even exist.'' For example, they state that psychosis is just a different way of thinking for some experiencing stress. They also focus on activities that don't directly assist those who have serious mental illness. She adds that: ``Significant dollars are spent on hotlines for callers who may be experiencing suicidal thinking. . . . '' But I might add that during this whole time, while death rates decline for heart disease, lung disease, AIDS, and accidental deaths, et cetera, they went way up for suicide. They increased steadily for substance abuse. It is a failed agency, along those lines. She says that there are pressing needs, but nowhere in SAMHSA's strategic initiatives do they even address psychiatric treatment of mental illness as a priority. I know we have to change this. I would like to ask of my dear friend, the chairman of the subcommittee, is there a way we can talk more about this and address this in the future to see that this is addressed adequately?

Mr. MURPHY of Pennsylvania. Mr. Chairman, I have an amendment at the desk.

Mr. MURPHY of Pennsylvania. Mr. Chairman, let me say this: I have got to tell you that this is distressing to me. I know what my colleague meant by false crisis, but this is a crisis for children. The children in America with mental health problems cannot get care. Members of Congress have an opportunity to put a small amount of money to make a big difference for children who cannot get that care. What we can do and what my colleague from Oklahoma said is we need to cut some things. One of them is stop the ridiculous wasteful spending at SAMHSA. If they can fund $400,000 websites and going to luxurious hotels, they can certainly do something that actually puts providers there so children can change the trajectory of their lives. I have just known too many families who suffer through this. I hope that as Members vote on this, they remember those families in their districts and decide this is a way to send a signal that we can make a big difference in the lives of many. Mr. Chairman, I yield back the balance of my time.

Mr. MURPHY of Pennsylvania. Mr. Chairman, I reserve the balance of my time.

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

Mr. MURPHY of Pennsylvania. Mr. Chairman, this amendment increases access to pediatric mental healthcare by providing $9 million in grants to improve access to behavioral integration and pediatric primary care. I thank the chairman of the Labor, Health and Human Services, Education, and Related Agencies Subcommittee for his agreement to our other amendment to boost the workforce. We have a massive workforce shortage in the field of mental health. What good is it to have good wishes among Members of Congress for treatment, yet people can't get it? There is a shortage of child and adolescent psychiatrists for the 17 million children with a mental health condition. We have 9,000. We need over 30,000. There is a shortage of psychologists, and 36 States have a shortage of psychiatric nurses. As a matter of fact, half of the counties in America have no psychiatrists, no psychologists, and no clinical social worker. So for children with primary mental health problems, it is a desert for treatment. They sit on long waiting lists. Their symptoms worsen. A study called the RAISE Program--Recovery After an Initial Schizophrenia Episode--found that if we provided treatment initially for those who show their initial psychotic episode, it improves their prognosis over their lifetime. But delaying treatment actually causes them harm. When you have no care, you have that harm. For those few psychiatrists and psychologists out there, what are they told to do in rural areas? Travel from one office to another to try and give them access, with valuable hours of time taken up. They can't provide that care. This $9 million helps provide mechanisms by which pediatricians and family practices can have telemental health. We know that when a warm handoff occurs in the office--and that is when the family or the child at that point meets a psychiatrist or that psychologist--the actual follow-up rate is over 99 percent. A large number--over 80 percent-- continue follow-up right through treatment. However, when they are given a referral, that actual follow-up is around 50 percent, and only 11 percent of people complete treatment. That is why you need to have some level of face to face. This issue of at least providing telemental health gives people that face-to-face approach. Since 50 percent of serious mental illness cases emerge by age 14, and 75 percent by age 24, this is the critical period in the life of someone who is developing serious mental illness to have care. We can no longer just say that we are going to let pediatricians be the primary providers for mental illness treatment when that is something that they do not have the specialty and training. The number of psychiatrists there to treat children is declining relative to the needs. The problems among children, as I mentioned previously, continue to go up. I might also add here that this does not reduce any spending among the critical funded and authorized programs within SAMHSA. But let me say where some of the money goes in these SAMHSA programs. The GAO did a study and found that 80 percent of the grants are not using it for evidence-based care. SAMHSA, instead, spends their money on ridiculous, embarrassing programs: making fruit smoothies if you are stressed, $400,000 on a website for toddler sing-along songs, getting in touch with your inner animal workshops, making masks, making collages, a website and crisis hotline for people in the Boston area who had snow anxiety during a snowstorm, teaching people interpretative dancing, $25,000 for a painting of people sitting on a rock at SAMHSA headquarters, an alternative conference funded by SAMHSA at the luxurious Boston Park Plaza Hotel. And we can't fund something that will save children's lives? It makes no sense to me. Mr. Chairman, I reserve the balance of my time.

Mr. MURPHY of Pennsylvania. Mr. Chairman, let me add to this. Yes, there was money in the Cures bill for opioid abuse for 59,000 people who had died from drug overdoses, but 350,000 people will die this year related to mental health problems. I want to make sure that Congress is not, once again, in a situation where we are having another moment of silence for some suicide, for some child or young adult that got violent and shot someone or ran their car into a crowd, or something else. We have got to start putting money into these programs. Five million dollars barely scratches the surface, but it is like that old adage of the man who came across a child throwing a starfish back in the ocean. The person said: ``You can never take care of all of them.'' But the child said: ``It will make a difference for this one.'' This will make a difference to a few children. How do we explain this to a parent whose child is suffering, who can't get services, that what we have is we couldn't transfer money within an existing account, it doesn't add any more, and it doesn't eradicate any programs, but it is something there especially at a time when this is so life threatening? You can't explain that to a mom or a dad. During all the time in the course of working this bill, we heard from thousands of people telling their horrific and sad stories. I spent the last 42 years of my life working as a psychologist. I have seen the faces of those who have gone to the funerals and seen those wasting away in prisons. I do ask that this amendment be adopted. Mr. Chairman, I yield back the balance of my time.

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

Mr. MURPHY of Pennsylvania. Mr. Chairman, this amendment is for infant and early childhood mental health promotion, intervention, and treatment. It provides $5 million in grants to develop, maintain, or enhance infant and early childhood mental health promotion, intervention, and treatment programs, including programs for infants and children at significant risk of developing or showing early signs of or having been diagnosed with mental illness, including serious emotional disturbance. This was passed and authorized in the Helping Families in Mental Health Crisis Act last year in Congress in which it was passed 422-2--near unanimous. The importance of this is that, across the United States, up to one in five children suffers from a mental disorder in a given year, according to the Centers for Disease Control and Prevention. This equates to more than 17 million young people who meet criteria for disorders that affect their ability to learn, behave, and express emotions. This small $5 million amount is about 29 cents per child, hardly enough to do much when distributed over that many, but it can do a great deal when distributed for a few. If you follow the course of children with mental illness, untreated mental illness, of course, leads to very troubled adults and other problems. I might add that this is National Suicide Prevention Week, and among children, suicide rates are climbing. In fact, over the last 20 years, suicide rates have climbed overall in this country. But, tragically and alarmingly, they have grown a great deal among children. How do we tell families of children who have completed a suicide or attempted a suicide that we couldn't come up with the money for this, and, instead, we thought other programs were more important? This money comes from the existing programming budget. It does not take away from vital programs. But I want you to know that there has been a 54 percent increase of suicides among children under age 12. Thirty-seven percent of those child suicides are Black children. The rate among African-American children ages 5 to 11 has doubled over the last decade. This provides critically important services for children. It appears that schools are the most important place where treatment can take place. Only 23 percent of prekindergarten programs have onsite or scheduled visits from psychiatrists and psychologists, according to the Child Mind Institute. The current workforce consists of approximately 7,500 child and adolescent psychiatrists. We need 32,000. Eighty-five percent of all psychotropic medications for children are written by primary care practitioners, not psychiatrists, so we end up with serious problems here as suicides grow and as mental health problems grow. This small amount of money is taken from existing funds, not from any other programs, to make sure we are providing services for these children. Mr. Chairman, I reserve the balance of my time.

Mr. MURPHY of Pennsylvania. Mr. Chairman, I have an amendment at the desk.

Mr. MURPHY of Pennsylvania. Mr. Chairman, I have an amendment at the desk.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Madam Chair, I demand a recorded vote.

Mr. MURPHY of Pennsylvania. Madam Chair, I just want to say, investing in the AOT program, Congress says it is worth it to ensure the most vulnerable among us have the treatment they need, instead of being in ERs, or jails. This pilot is extremely important. It saves money. It saves lives. And for Members to reflect back on this, I hope they would rather say: I helped fund a program known to save lives. SAMHSA has been reported many times by the GAO to waste a lot of money. This saves lives, and I urge people to vote for this amendment. Madam Chair, I yield back the balance of my time.

Mr. MURPHY of Pennsylvania. Madam Chair, I reserve the balance of my time.

Mr. MURPHY of Pennsylvania. Mr. Chair, I want to speak on this amendment, which provides some additional funding for assisted outpatient treatment. The underlying bill has in it $15 million, and we are asking for it to be raised to $20 million. First of all, I want to say where the money is coming from. This is within the budget of SAMHSA. This is not new spending. It is not additional spending. But over my years of investigating mental health in the United States and the conditions, and then led to my introduction of the Helping Families in Mental Health Crisis Act, which, by the way, this House passed 442-2, this level of funding was authorized in the bill. It is already authorized there. It is to come from the SAMHSA account, not new spending. Let me describe what assisted outpatient treatment is. Understanding that there are about 60 million Americans with mental illness, and 10 million have severe mental illness, it is important to note that our prisons are filled with people who have mental illness. On some level, 60 to 80 percent of people in jail have a mental illness. That is no place to be treating someone. But, unfortunately, they may have a crime they committed, and in many cases it could simply be vagrancy, it could be other issues, too, where they may have become violent, they may have had other problems associated with that, but a person with mental illness is 10 times more likely to be in prison than to be in a hospital bed. We don't have enough hospital beds. Ninety percent of the psychiatric hospital beds in this country have been closed down since the 1950s. Now we need 100,000 more, but instead what we do as a society, we throw them in prison. A few years ago, when New York passed Kendra's Law, when a young woman was killed by a mentally ill person, they realized that had he been in treatment, it likely never would have happened. So rather than having someone, if we can't put them in a hospital, can't get them treatment, the idea of assisted outpatient treatment is, when a patient can be stabilized by remaining on their medication, by having their counseling, perhaps supportive housing, supportive education, supportive employment, their life can turn around. So what happens is, a court, a judge, protecting this person's own rights, civil rights on every level, will say to this person: I am not going to involuntarily commit you to a hospital. Your crime doesn't rise to the level--it is not a felony or something like that--it doesn't rise to the level of prison, but what they say is: We are going to require, however, that you stay in treatment, require that you take your medication, that you stay in counseling, and you do other things as prescribed by the court. Now, most States allow this, but here is the problem: in many counties in America, they don't have the ability to pay the administrative costs to handle this. So this amendment provides a mechanism whereby people can do this. So understand, the assisted outpatient treatment is a civil-legal procedure whereby a judge can order an individual with a serious mental illness to follow a court ordered treatment plan in the community. Here is another thing about this: Does it work? And the answer is yes. In a Duke University study of the New York AOT program, it said 90 percent of the people said that AOT made them more likely to keep appointments or to take medication; 88 percent said they and their case manager agreed on what is important for them to work on; 87 percent of them said they were competent in their case manager's ability to help them; 87 percent had fewer incarcerations; 83 percent had fewer experienced arrests--and the point is, they had an increased number of arrests prior to being in AOT, and then afterwards it declined precipitously. Eighty-one percent said AOT helped them get and to stay well; 77 percent fewer experienced psychiatric hospitalizations; 75 percent reported that AOT helped them gain control of their life; 74 percent fewer experienced homelessness; 55 percent fewer experienced suicide attempts or physical harm to themselves; 49 percent fewer abused alcohol; 48 percent fewer abused drugs; 47 percent fewer physically harmed others; 46 percent fewer damaged and destroyed property; and costs were cut in half. This small amount of money--and believe me, it would cost perhaps 10 or 20 times more to really do this thoroughly--is there to help people in mental health crisis. We could either continue to throw people in jail, continue to see crimes happen--and by the way, when a mentally ill person is in prison, 80 percent of them get no treatment. We put them back on the streets and the problems occur again. The House passed this. It came out of committee unanimously. We need to do this for America. We don't want to read more statistics on a mentally ill person who harmed someone, primarily because they were not in treatment. This is our opportunity to save lives. This is our opportunity to do something about this. And I do ask that the House pass this small amendment out of an existing budget, no new spending, to provide an additional $5 million for assisted outpatient treatment. Madam Chair, I reserve the balance of my time.

Mr. MURPHY of Pennsylvania. Mr. Chair, I have an amendment at the desk.

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Chair, I was unavoidably detained. Had I been present, I would have voted ``yea'' on rollcall No. 416. Amendment No. 5 Offered by Mr. Griffith

Mr. MURPHY of Pennsylvania

Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank my friend from Oregon, and I thank all the Members speaking here tonight. I want to say, as you saw, this was a bipartisan coalition of Members. We are much better off working hand in hand to pass legislation that changes issues than standing next to each other as pallbearers for another 59,000 people in our Nation next week. Mr. Speaker, with that and with some hope that we can pass this legislation and save some lives, I yield back the balance of my time.