Transcripts For CSPAN2 House Hearing On COVID-19 Impact On Mental Health 20240712

Obviously is being held remotely. All members and witnesses will participate Via Videoconferencing as part of our hearing microphones will be set on mute to eliminate background noise. Members and witnesses, youre going to have to unmute your microphone each time you wish to speak. So i just say that as a reminder and as a little housekeeping issue, but please remember to do that. Documents for the record can be sent to megan mullen at the email address we provided to your staff. All documents will be entered into the record at the conclusion of the hearing. The chair now recognizes herself for five minutes for an Opening Statement. Lets see, where is the clock on the screen . There it is, okay. In any given year, one in five adults experience a Mental Illness such as depression, anxiety, or bipolar disorder. But 2020 has been a year like no other. In a recent poll, half of adults report that their Mental Health has been negatively impacted due to the coronavirus. One can only imagine the mental impacts on the American Family were grieving the loss of their loved ones due to the virus. The economic downturn is also taking a mental toll on our fellow americans. Studies found for every 1 increase in the unemployment rate, the suicide rate increases by 1 to 1. 6 . Despite the frequency of Mental Illness, too many suffer in silence. Mental health is a neglected part of our Health Care System, with less than 40 of people with Mental Illness receiving any treatment. This is because of the high cost of care, insufficient Insurance Coverage, limited options due to poor provider reimbursement, and an antiquated system that too often relies on prisons, jails, and shelters. Were so fortunate to have former congressman Patrick Kennedy as a witness today. He has led the way in attacking the stigma of Mental Health by being open about his own journey and advocating for transformational changes to our Mental Health system. He was the author of the 2008 Mental Health parity and addiction equity act, which promised to require Health Insurers to treat Mental Health care the same as physical health care. Unfortunately, years after its passage Health Insurers still deny too Many Americans coverage because they dont follow the letter and spirit of the law. The good news is there are many strong bills to address these issues. Today were considering 22 bills. There is clearly bipartisan demand to address this crisis. The legislation were considering cover the recent increase in suicides, Racial Disparities in Mental Health outcomes, telehealth, coverage parity, and access to Mental Health services in schools. A very, very important one. Several bills also address the Mental Health issues caused by covid19. The pandemic is fueling Mental Health problems while also hurting the ability of caregivers to deal with the crisis. Mental Health Programs are struggling to treat an influx of patients while awaiting funding that congress appropriated, but hhs has been slow to release. Our health as a nation, both physical and mental, will be tested in the months ahead. Aristotle said, even calamities have a soul and can teach us a wise life. I view this calamity as an opportunity to correct the wrongs in our society and create hope for recovery for all. Now i yield the remainder of my time to rep joe kennedy who is been a leader on this issue. Madam chair, thank you. Grateful for your leadership and yielding this moment and obviously great to see my cousin patrick here in front of the committee and grateful for all of his work. The Healthcare System is broken. Our Addiction Treatment system is broken. All of us here today bring stories of constituents and loved ones who felt that the gaps that were wide and a bulletin whiting. The pandemic did not create these gaps. It highlighted them and ensure many of us already knew that im adult system is underfunded and over prioritizing over stigmatize. We are beyond the point of cosmetic fixes and incremental change. We need substantive systemic reform. We need legal Mental Health parity i quit my cousin patrick as an vision. We need to put teeth behind it that holds insurers accountable for violations they commit on a daily basis. Theres another critical step forward. The three alone will not protect those who need our protection most. Only action and to reform will do that. I look for to working with all of my colleagues to accomplish that in the weeks ahead. Thank you so much madam chair and think all of our colleagues for addressing this critical issue. Thank you, congressman kennedy. Yields back to the chair now recognizes dr. Burgess, the Ranking Member of our subcommittee for five minutes for his Opening Statement. Please remember to unmute. Maybe i have. So i thank the chair and i thank your willingness to work on this productive bipartisan agenda for the subcommittee. I respect and i am grateful for your respecting my request that we have a hearing on Mental Health and the coronavirus. It was a topic that we were slated to talk about prior to the outbreak, but now that the outbreak has occurred it is becoming even more serious. The human loss, job loss, the isolation that americans a a pe due to this pandemic make it and even more critical topic. At the very beginning of this crisis the American Psychiatric Association Found that onethird of americans felt it seriously affected their Mental Health. That reality compounded with the existing prevalence of Mental Health and Substance Use disorders make this issue urgent. Urgent. According to the National Institute of Mental Health, nearly one in five adults lives with a Mental Illness. Ensuring proper support are in place for families to manage and treat these illnesses should be a priority. So there are 22 bills before us today and many of these bills have bipartisan consensus. I appreciate that you have included the bills i i mentiond in my letter, specifically h. R. 3539, the Behavior Interventions guidelines act which i worked on with dr. Drew ferguson of georgia. We had successful behavioral intervention programs in schools in our state and that inspired us to Work Together. For me it was hearing from the leadership at Texas Tech University Health Science centers and the program to provide training for Behavioral Health intervention and tell a behavioral Health Services at schools in rural west texas. School age children are primates identify and treat behavioral Health Issues before they worsen. I believe this bill is even more important now. Students have been away from school and friends during a difficult time, and some may be keeping with the loss of loved ones or being home with family, a difficult family situation. I hope we will advance this bill towards market. Other bills cover a wide range of important issues from approving the National Suicide prevention hotline to extending the authorization for qb Services Block grants. These bills will ensure stable high Quality Resources for those in need. When issue not addressed today is the Mental Health of the frontline Healthcare Worker, and this is especially important now, and i believe this has long been a serious issue in our Healthcare System but has taken on added importance with the additional stress that caring for the seriously ill coronavirus patient entails. I do have concerns about the medicare bills. I do oppose opening medicares definition of what is a physician. I do support telemedicine. Its been critical drink the coronavirus for Many Services but we must make sure appropriate guardrails are in place because we dont want it to be used in a probably has been noted. We must also seriously about it resources are better focus on getting psychologists and psychiatrists into underserved areas. I informed you need devote some time to process. There is a strong bipartisan commitment to improve our nations Mental Health so im frustrated by the majorities willingness to make even small changes to some of the bills to accommodate some concerns prior to this hearing. When compromise was clearly possible, we didnt. When some of these bills easy to enact, still what we were introduced very partisan bills us of what weve been working on to secure republican support. Unfortunately this has become all too predictable in the Public Health space in this congress which is sad because historically it is the Public Health space where this subcommittee comes together to legislate the most. It also concerns me we are considering bills as introduced rather than the language negotiated as part of the bipartisan effort if this is not the first time the majorityminority have had an agreement on top the majority of the goalpost. It makes it difficult for members on this side of the dice to trust you and the agreements that are made, ignoring our requests, a reasonable request actively harms the legacy of this committee. And it did not need to happen. I am puzzled why did. You should fully expect members to file a nimitz should bills be brought up to market that you were unwilling to engage with us or our staff and then refuse to acknowledge our proactive outreach and ignored are flagged concerns. My expectation for supposedly noncontroversial markup is that you will not notice these bills, but the ones with the general agreement had occurred. Many issues but especially Mental Health should rise above are some politics. We should come together to change the landscape and provide the muchneeded resources to individuals who are struggling with Mental Health issues. And i will yield back. The gentleman yields back. Everyone was not on when i said this earlier, but we expect votes between 11 15 and 11 30. We are not going to recess since we will be voting in shifts. So the full Committee Chairman mr. Pallone has agreed to chair the hearing when i go over to the capital to vote. So thank you for that. The chair now recognizes the chairman of the full committee, mr. Pallone, for five minutes for his Opening Statement. And remember to unmute, please. Thank you, chairwoman eshoo for convening todays legislative hearing on 22 bills to improve both quality and access to Mental Health care in america. And, of course, want to welcome back our former colleague Patrick Kennedy who i have to come everyone knows now, if you dont i will tell you, is a new jersey resident. Actually a resident in jersey shore which on particularly fond of. I understand come from the ocean state to the jersey shore, so youve been there for a few years now so i really shouldnt be welcoming you, i thank you. Good to you, patrick. This hearing is particularly timely as our nation is simultaneously confronting a Global Health crisis, a severe economic downturn, and centuries of systemic racism. All three of these crises are understandably triggering distress for millions of people and it is compounded by the fact that many people are isolated from family and friends. It is no wonder that nearly half of americans are reporting that their Mental Health has been negatively impacted due to worry and stress in recent months. Mental health is an essential part of our Overall Health and wellbeing. Thanks to this committees work, we have made progress to better incorporate comprehensive Mental Health care into our Health Care System. We have improved Insurance Coverage for Mental Health services though the Mental Health parity act of 1996 and the Paul Wellstone and Pete Domenici Mental Health parity and addiction equity act of 2008. Thanks to the Affordable Care act millions of americans now have access to comprehensive Health Insurance plans that include Mental Health care services. The aca dramatically improved access to Mental Health and Substance Use disorder benefits by requiring individual and Small Group Insurance plans to cover these benefits. As a result, millions of americans can now access Mental Health services and Substance Use Disorder Treatment without fear of exorbitant outofpocket costs that all too often deter people from seeking treatment. The aca also applied Mental Health parity requirements to individual market plans. We continued to build on this progress in 2016 when president obama signed the 21st century cures act into law. It expanded access to Mental Health services for children through medicaid, improved coordination between primary care and behavioral Health Services, and reauthorized Important Programs including those focused on Suicide Prevention. Again, thank you, congresswoman degette an upton for the role in that. Taken together, these legislative changes have made a true difference in americans lives, but there is more work that must be done to help people in need. In 2018, more than 47 million americans said they suffered oh from a Mental Illness over the past year, including more than 11 million who had a serious Mental Illness. Research estimates that more than 7 million American Children have a Mental Health disorder. Tragically, far too many of these conditions in children go unidentified and untreated, and research has found large disparities in access to Mental Health services among black and latino children. We also know that people experiencing Mental Illness are at a higher risk of developing Substance Use disorder. According to surveys, roughly half of individuals experiencing Mental Illness will also experience a cooccurring Substance Use disorder. This underscores the importance of expanding access to both Mental Health and Substance Use Disorder Treatment. This is particularly important as we continue to respond to the Opioid Epidemic that claims 130 lives every day, as well as emerging epidemics involving cocaine and methamphetamine use. Unfortunately, suicide has also been on the rise. In 2018, more than 10 million americans seriously contemplated suicide and 1. 4 Million People made nonfatal attempts. Suicide is now one of the top ten leading causes of death in the United States and is the second leading cause of death among young people ages 10 to 34. Today, less than half of those with Mental Health conditions get treatment with many citing the inability to pay for services as their primary reason for not seeking treatment. Individuals in need of care also often cite stigma and fear of discrimination as reasons for not seeking treatment and many others report difficulty gaining access to providers due to workforce shortages. All of this speaks to the urgent need for additional action to help those in need. That is why we are considering a variety of policies, including proposals to improve teleMental Health, Mental Health parity, Mental Health services for students and in the emergency room, and Suicide Prevention programs. Taken together, these proposals are focused on improving our nations wellbeing. I want to thank our witnesses eight everyone. This as has been mentioned a bipartisan issue for our committee. Many people spoke of how come when people told their individual stories which is often difficult and i admired those who do that. And again thank you, chairwoman issue. This is really important legislative hearing. We do intend to move bills. Thank you again. We thank the chairman of the committee, and he yields back. Its now a pleasure to recognize the Ranking Member of the full committee, mr. Walden of oregon, for his five minutes of him for Opening Statements. Good morning, madam chair. Thank you very much, good morning. Madam chair, i thank you for holding this evening. I think its really important hearing and one that we have a lot of work to do on. I which are some frustration at the outset about the bills and the lineup. Im hopeful that we can work through, as dr. Burgess it can some of these legislative initiatives were always found some agreement but we are hearing the underlying bill not agree to. As chairman pallone said this is always been bipartisan work, Mental Health issues, did not take us by our Voter Registration and theres a lot of bipartisan work to be done here. I also must express station. I had trouble getting on so maybe thats where my frustration starts this morning, but were going to roll through with the vote because the way we are voting in the elongated voting at all, i know some of our members are a little concerned about missing out on some of the presentation in the q a with the hearing going on. I think for future we should have a discussion about how to do that. Too many of us have lost loved ones because of suicide. Like my friend, former oregon u. S. Senator smith, tragically lost his son Garrett Lee Smith one day before his 22nd birthday. I work with senator smith on the original dear lee Smith Memorial act which provides information and training for Suicide Prevention, surveillance and Innovation Strategies for all pages that i was proud to see this Important Program reauthorized and expanded in cheers. Many of the bills before study will further improve crisis intervention and Suicide Prevention. Looking forward to working with our colleagues in the majority to move these bills through the legislative process. Consideration could not come at a more pressing time. As we all know covid19 and resulting economic downturn have impacted the Mental Health and wellbeing of all americans. A recently released report predicted that an additional 150,000 americans could die because of suicide or drug and alcohol misuse as a result of the pandemic. These deaths from despair as theyre called will likely increase as continued lockdowns further isolation and deepen the economic downturn. States will need resources to help prevent them. I am concerned one of the bills would make states ineligible for Mental Health and Substance Use disorder grant if they cannot meet the bills mandate. Under this bill certain states would be stripped of all funding including Substance Abuse prevention and Treatment Community Mental Health Services Block grants. My friends in the dripping of consent is that these are logistically impossible to meet me states do not have yearround legislatures are furthermore, cutting states critical funding at a time when eating at the most is not acceptable. I wish the majority take the time to work with us on language and some of the bills today but recovered that and look forward to working with you as we go forward. With that, madam chair, i will yield back since with votes coming up. I think the judgment and he yields back. I now would like to introduce our witnesses for today. First, the honorable Patrick Kennedy. He is the founder of the Kennedy Forum as well as, as we all know, a beloved former colleague of the house of representatives, and a representative, where he represented rhode islands, the first Congressional District welcome to you, dear patrick. Thank you for being with us. It means everything to us to have you with us. Dr. Arthur evans, chief executive officer of the American Psychological association here welcome to you and thank you for being with us. Dr. Jeffrey geller is the president of the American Psychiatric association and the director of Public Sector i. T. At the university of massachusetts medical center, school i should say. Thank you, dr. Geller. Ms. Arianna gross is a National Youth Advisory Board member of the Sandy Hook Promised students against violence everywhere, called save, promise club. Welcome to you and thank you for being with us we are so pleased. We really are. Its an honor. So former congressman Patrick Kennedy, you are recognized for five minutes, and please remember to unmute. We dont want to lose one word offered to us. Thank you. Thank you, madam chair. Its a great to see you always, your family. And they just want to say in addition to your main family, it was nice that you shared your opening remarks with family, my cousin joe, who does everything i tell him to do on Mental Health, and im so honored that hes he is a member of this committee which as such important jurisdiction over this critical issue to our nations health. And they want to thank chairman pallone for his leadership, chairman burgess and chairman walden for the opportunity to address all of you and, of course, as a look in the screen i see some of my former colleagues, and that so grateful for the opportunity to see your face, some of whom are covered by face masks. Kudos to you for sending a standard and a model. So, you know, i get acknowledged for having some great courage on this, and it often was the case with my great colleague and coauthor of the Mental Health parity and addiction equity act, republican jim ramstad. I appreciate this is a bipartisan process, special on Mental Health which affects every family. We can go around and say it is one in four or 50 , but we all know in her own lies its every family. And jim always used to say, patrick has got the same kind of profile in courage as his uncle president kennedy. I would always stop and and i t encourage about coming forward. Because what happened and he was the guy that i was in drug rehab with at 17 wrote about being in drug rehab with me in the national enquirer, and he sold his story to the national enquirer. So basically i had no out. It was one to keep the fact that i suffered from addiction from an early age private. I didnt want anyone to know. And what ended up happening was i had no choice in the matter. I came from a public family and, unfortunately, Everything Else it always made public. I would say that was probably the best thing that ever happened to me in my life, in the sense that, for one thing, as a congressman i didnt have any fear for being an outspoken proponent for Mental Health. And it was because i didnt have to worry about the press reporting about what i was a supporter of Mental Health. Because they somehow had the goods on me, you know, that they could hold it against me, that i would disclose this private factor in my life. And also helped address the main point, and that is that we keep these premises secret. These illnesses being secret are the reason why they are exacerbated. So let me just say, in recovery we say we are only as as our secrets. And i would say even though we have made great progress on Mental Health, we are still very sick as a nation because we keep these things secret. I also think the recovery we have these phrases like, you know, you have to walk the walk, not the talk the talk. And in a country we have really just talked the talk. We have never walked the walk on including Mental Health and Addiction Treatment in our country on far as we would cancer, cardiovascular disease, or any form of treatment that we would expect from our medical system. And then finally i would say that denial is the big issue here. And we all know going up in families where there is alcoholism and addiction and Mental Illness that we dont like to talk about these things. And i frankly think the reason we as a nation have not addressed this issue is because we are still in deep denial about these illnesses and their pervasiveness. The evidence and exhibit a in that is a fact that congress and the country has really never appropriated the necessary resources for this crisis. And they have never enforced the parity act which as i i said wa bipartisan bill that simply says treat these illnesses like other chronic illnesses. And until there is that same urgency towards enforcing and until theres that same money backing up our words that these are really equal illnesses, we are really still in denial as a nation. I look forward to hearing my other counterparts testify and answering any of your questions. My time is up. Thank you for letting me share. Thank you. We need to heat your words, patrick. Thank you very much. Now i would like to recognize dr. Evans. You are recognized for five minutes, please remember to unmute, doctor. And thank you again for being with us. We so appreciate it. Thank you. Chairwoman eshoo, Ranking Member burgess count numbers of the subcommittee on health, thank you for this opportunity to testify today. The mecca Psychological Association is a leading scientific and professional organization representing psychology in the United States with more than 121,000 researchers, educators, clinicians, consultants and students as its members. Even before covid, our Mental Health system is facing severe challenges. Less than half of the individuals with a Mental Health disorder receive treatment and only about one in nine individuals with a Substance Abuse disorder receive treatment. The tragic result is that we have multiple crises happening simultaneously. We had a pandemic that is creating a number of psychological challenges for individuals. We have on top of that and economic crisis that is also contributing to the psychological distress of americans. Then on top of that more recently we have been dealing with systemic racism and the impact that has on many of our fellow americans. All of this results in data that show consistently across a number of different sources that we are seeing increases in anxiety, depression, posttraumatic stress disorder, and eating disorders. This is having a disproportionate impact on marginalized communities. The Public Health term for this is pandemic, a disease that is spreading rapidly as a result of social inequality and injustice impacting those already at high risk for poor health. To address this, we need a populationbased approach that targets appropriate interventions across a population, including addressing social determinants of health. Example of the power of addressing social determinants like housing, when i worked as commission for Behavioral Health in the city of philadelphia. My Agency Working with the Housing Agency leverage section eight housing funding with medicaid funding for Mental Health services to address homelessness. Was a major step forward and my fellow panelist and good friend, congressman kennedy will forever deserve our thanks and gratitude for leading this fight. Proud to be along with the American Psychiatric association and many other groups. Unfortunately parity has not reached its sole potential and we need support for the parity bill before the committee for law. We need to give patients better access to Mental Health and Substance Use. The access act will incentivize Mental Health in rural and underserved areas making psychologists available fob Mental Health bonus payments. I want to thank the bills longtime champion congresswoman, and congressman mullen, and cosponsors forte and congressman long for their support. Id also like to highlight congresswoman matsuis teleMental Health expansion act or telehealth expansion act. Theyve expanded telehealth treatment which has been critically important in helping patients get the help that they need during covid. Also, congress should make most of these telehealth permanent. In addition to the bills that ive already mentioned, we support many others before you today, including the Behavioral Health coverage transparency act, and the Mental Health parity compliance act. The Mental Health services for students act. The pursuing equity in Mental Health act and hr6645 to provide additional funds to the National Institute of Mental Health for Research Related to the Mental Health effects of covid. Finally, i commend the leadership on the range of Suicide Prevention bills before you today. Notably, cochairs of the Suicide Prevention task force, congressman kempco and congressman bayer, as well as congresswoman gustos. Story for that. And members of the committee. Im greatly im grateful for this opportunity to testify today and i look forward to working with you to advance these important pieces of Mental Health legislation, and i am happy to address any of the questions that you might have for us today. Thank you very much, dr. Evans, for your important testimony. The chair is now pleased to recognize dr. Geller. Youre recognized for five minutes for your statement and please unmute. Welcome to you. Thank you very much. Chairwoman, ap distinguished members of the subcommittee. Thank you for allowing me the opportunity to testify before you today. My name is dr. Jeffrey geller, Massachusetts Medical School and staff at the worcester hospital. And throughout the covid pandemic i work on site daily to treat severely mentally ill patients and psychiatry. Im also a parent. One of my sons who has interlek tum disabilities goes to work daily at b brigham ap Womens Hospital and i worry about his health more than my own. It is unmasked clear Racial Disparities and inequities and were pleased to see this as part of todays focus. I am agoing to highlight a few areas from my written testimony. First the covid crisis made the value of your actions to facilitate telehealth clear. Access to video and awudio only have allowed them to receive care and minimizing their risks of contracting or spreading covid19. Telehealth is popular with patients and our members, has reduced noshow rates dramatically. And has been quite effective. It is essential that current telehealth authorization, not end prematurely. Theyve been acting with psychology and others to ensure continued access to health, telehealth for our patients beyond the current emergenciment we strongly encourage hr5201 introduced by representatives matsui and johnson which would permanently exempt Mental Health services from the geographic and site restrictses. And the bill 884, which defined the positions to medicare. Psychiatrists, psychologists and other team members like nurses, physicians assistants, social workers and care managers help patients by contributing in our own areas of expertise. The goal is unclear since medicare recognizes and allows psychologists to provide services, theyre trained to perform and to practice independently in medicare and appropriate settings. The psychologists are not physicians. Psychologists do not have medical training. A psychiatrist treats a patient with medical illness and comorbid illness in medical settings. A psychiatrist has to recognize medical disorders masquerading as medical disorders. You cannot be equipped to do this without a medical school background. Hospital programs require comprehensi comprehensive, structured, multimodal. And we know health care is by a teamworking together to provide coordinated services, but this legislation would do the opposite, further fragment and create unnecessary and dangerous silos. Existing guardrails are there for a reason. Administrative hurdles can be addressed without going to the extreme, like inappropriately defining psychologists as physicians under medicarement we suggest the subcommittee focus attention on the oppressive array of proposals before you on which there is board agreement and little controversy. Finally theres Mental Health parity. Both apa and my fellow panelists Patrick Kennedy and unified Mental Health ab Substance Use Authority Champion parity law in 2008. Failed to end discriminatory practices. Numerous investigations by the state department and department of labor revealed systemic parity violations again and again. The parity proposal introduced by representative kennedy and the bill proposed by representative porter and health plans, medical Management Practices and there by enhanced compliance. We support both bill porter and bi billrakis bill because many are applied to the state regulated plan. I appreciate the opportunity to testify on behalf of the american association, and we look forward to accessibility, affordability of Quality Health care across our nation. Thank you. Thank you very much, dr. Geller. Weve learned a lot from your testimony and look forward to asking you questions and so appreciate the role that you play in todays hearing. I now have the pleasure of recognizing miss ariana grass. Youre recognized for five minutes and please unmute. Welcome to you. Thank you. Good morning, and thank you to the subcommittee chairwoman, Ranking Member and subcommittee on health for having me here today. My name is Arriana Gross in covington, georgia. Im serving as one of the tenure board members, against student violence anywhere and reforms in 1989 after the death of a 17yearold who died from gun violence. Today there are over 3, 500 clubs across the nation in all 50 states. The state club in my Community Mentor youth and empower us to protect our pools and communities from all forms of violence including suicide. We do this by promoting Student Health and wellness and recognizing signs of violence and how to seek help. For example, in response to fighting at our school we created an antibullying project and schools have positive messages about themselves and others and put them on walls around the school and providing opportunities of thinking about themselves and their peers. Because of covid our state club is holding weekly with primarily for the Mental Health of student. We have an opened this to the community at large because Everyone Needs help. As a students i know that Mental Health and wellbeing are more important than ever before. Suicide is leading cause for students and boys on the rise. This one is preventible. 70 of students who die from suicide will show a warning sign or tell a friend and covid is making this worse. For some students home isnt the safest place, with nowhere to go, its become stressful, lonely and dangerous for some students. Ive seen firsthand the need for Mental Health n our school a year doesnt go by without a suicide. And ive known of Elementary Students who died nigh suicide. And im concerned that were stuck in a pattern of mourning, as something normal instead of seeing them as preventible and tragic. As students, we see everything, in class, in the neighborhood, and on social media. Were on social media sites that you probably havent heard of. We see way more than our parents, teachers and adults and were not able to help we need the tools to know how to help in order to save lives. Trust me, weve seen and been through way more than you realize and we can and want to help. Our Safe Promise Club teaches how to spot that friend who might be struggling. I recently had a friend who was struggling not comfortable talking about to parent or teacher. And she talked to me and made sure that she was supported. T the it goes beyond school walls. As part of the black community in the south there is stigma saying you have Mental Health issues. Once you to, finding help, when i need today see a therapist i had to travel two hours from my home. This shouldnt be the case and you should get help at school. And unfortunately, theyre only qualified to help with academics and not Mental Health professionals. Students dont have the opportunity to talk with struggling emotionally. We need our minds on academics. We need your help in creating a system of support in our schools. Allow us to be the eyes and ears of our peers. Give us the tools and training we need to know when our friends or ourselves may be struggling so we can speak up and prevent suicide. Once we speak up, give us Mental Health professionals in our schools. I ask the committee to vote in favor in support of the act for students. They will help support Mental Health and wellness, to train students on Suicide Prevention and provide more. The affect of covid on our Mental Health whether we talk about it or now. We have the power to help and i ask that you act now to prevent another one of my friends from suicide. Thank you very much. Thank you very much for your excellent testimony. We now, weve completed the testimony of our witnesses and ill well move to member questions and i recognize myself for five minut minutes. Four questions. First to patrick, patrick, you wrote the Mental Health parity and addiction equality act. You have referenced it. Others have. Its not working. Thats what you essentially have said. So as we move forward, i mean, we have 22 bills. What im interested in mostly, as we weave different bills together, what are the major pillars of reform to our entire Mental Health system in the count country . As your cousin joe said, we have a lot of broken pieces. So what are the major pillars that you would advise us that need to be reford, including getting your legislation to finally have teeth in it . Is it because its missing money . Or did we miss something in the legislation . So thats my question to you. Thank you. And i would say it all revolves around the money and you know, as we know, you see whats important based upon what you spend your money on and clearly, when Mental Health gets. 04 of the cares act funding, it says a lot about where Mental Health is in this country and when you see how many routine violations by Insurance Companies there are of i should say discriminatory practices against people who live in your districts and family members and friends just because their illnesses happen to originate in their brain or other organ in their body. And as were learning with black lives matter, so many things weve come to take for granted are just routinely accepted and i think we are in denial as a nation about Mental Health. I mean it is weve been at it a long time accepting it as a marl failing and in the a medical failing. That gets you to think that someone is to blame as if they get up on a given day and think that, you know, trying to lose their job if they have one or sacrifice their housing because they jeopardized the rules of their housing or that they alienate their friends or family members is all part of what someone voluntarily chooses to do in any given day, which of course we know is not the case. Why cant our country get over the fact that these are by logically baseded disorders and behaviors, but a symptom of them. Thats what the neuroscientists at nih tell us. I would say if we can understand that as the premise, why wouldnt the payment models, which were, by the way, reimbursed for all kind of Health Benefits rather than sick benefits for cardiovascular disease, i mean, ive been on lipitor for 20 years, right . Apparently our Health Care System thinks that its best if i dont die from a stroke or a heart attack in 10 more years and theyve invested that much in me, but when it comes to Mental Health, theyre just missing in action and yet, we allow that as a society. We dont enforce parity laws both at the state or federal level. There are now some states that are doing a terrific job in stepping towards that, but as far as your concern, our department of labor, i know, which is regulated by one of your colleagues committees, needs to step up and pass an enforcement action so that we hold these insurers accountable. But thats what i would say in a long winded way for your question. Sorry for taking up too much time. No, i hang on every word that you say. Just very quickly, dr. Evans, and dr. Geller, i only have a minute left. But would either one of you like to weigh in about major pillars and how you would reform the system . So i could respond to that. I think that Patrick Kennedy is exactly right in the entire history of our country, we have always tied together any reform in Mental Health care with saving money. Dorothea dix who traveled around this country and testified before the house and senate said two things in every one of her messages, we can save money and we can do whats right. If were going to address this problem we have to say we are going to do whats right and its going to cost us for some money. You go in for surgery for cancer, no one asks how much money is that going to save. I think my time thank you very much, doctor. I think my time has expired. And so, i now will call on, recognize dr. Burgess, the Ranking Member of our subcommittee for his five minutes to ask questions. Sure, and thank you. I thank the chair, dr. Geller, i want to thank you for raising the concerns you did with hr884, it seems like too often in this subcommittee we dismiss or ignore or devalue the benefits of the medical curriculum that could actually bring to a persons background and i appreciate you for highlighting that. One of the other things that i mentioned in my Opening Statement is my concern about and i dont think we have a bill in front of us today that is specifically looking at helping our Front Line Health Care providers. We knew that suicide was a problem amongst our colleagues prior to the onset of this coronavirus epidemic and i know it is more pronounced now. So do you have any recommendations for us for us on this subcommittee . Were working through these things and have a full Committee Markup at some point, perhaps the catco legislation or some other legislation where would you see it where we could modify it to more properly account for and perhaps impact positively our front line Health Personnel . I can tell you that besides prejudice and discrimination in relationship to presenting with a Mental Illness, a major problem for physicians and nurses and other licensed personnel is the fear that they will lose their license to practice if they report that theyve had treatment for Mental Illness. When i applied for a license and renewal every three years, generally, im asked the question in almost every state, have i sought psychiatric treatment and am i mentally impaired or do i believe im mentally impaired . If congress could address that problem, i think that it would make front line and Health Care Workers more willing to seek treatment. The second is, we need to do a Massive Campaign to educate the population about what Mental Illness is. We are familiar with a very ineffective Massive Campaign, currently. In terms of how to protect onesself from covid, but weve also experienced a very Successful Campaign to remove the prejudice and discrimination against homosexuals in the time of the aids crisis, we dramatically turned that around. In the 1940s and 1950s we actually did the same thing with breast cancer. Nobody would even say the word cancer. So we know how to do it and thats what we need to do. Well, i thank you for those observations. I do mr. Kennedy, i wanted to ask you, representative ferguson and i had introduced a bill 3539 and i think i see in your written testimony you talk about social and Emotional Learning and as our last witness testified, often times amongst the student population, they can quickly identify for you who, perhaps, is having trouble. So do you have any thoughts, have you had an opportunity to look at 3539 . Is there any advice you would give us for perfecting that . Patrick, you need to unmute. I have that trouble all the time. Im sorry, thank you, dr. Burgess for prioritizing that. You know, its shocking. Literally, as shocking as it is that we dont address Mental Health in our Health Care System is that we dont address Mental Health in our Education System because how are children supposed to learn when their megdulas are on fire and cortex cant operate because theres no coping mechanism skills involved. No social learning skills developed. I think that you are absolutely on point that this needs to be a priority and it will be an enormous protective factor for especially since were seeing suicide rates skyrocket. This will help kids learn how to mediate their impulses, which of course, this is the key pafactor helping to do that and thank you. Our time is limited here. Thank you, thank you. And i do want to ask you though, because you reference in your testimony that probably the largest Mental Health Treatment Facility in all of our districts is our county jail and were looking now at people who are asking for reduction in funding for Law Enforcement. Do you see a problem developing here . No, you know, im familiar you should also ask judge lightman who has successfully turned around a major bond for an additional jail down in florida and he took that money and he put it into Supportive Housing for those with severe Mental Illness, predominantly schizophrenia diagnoses, bipolar one, and what he ended up doing is reducing the total docket in his jurisdiction dramatically, such that they didnt have to build a new jail to house all of the people, because a good 30 of them were people who were being arrested for routine, you know, charges, loitering, all kind of what they call nonviolent offenses. That could be better picked up by a Mental Health system, but frankly, as we are all talking about today, is nonexpectation tent. So our criminal Justice System has become the default mode. In fact we dont have a Mental Health system. All i would say to you, its not necessarily the case that less is less. If it can be redirected towards what we know is more, which is reducing the total number of people in our criminal Justice System by providing those services which arthur evans and others spent their lives providing. The Supportive Housing he walked about in his Opening Statement. I thank you for that. Redirecting is part that have process not just eliminating. I thank you for your input. Im going to followup with you off line because youve raised points id like to discuss to you. The gentlemans time is expired. I cant help, patrick, but think of our good friend and his wife, but nor m and Judy Ornstein who have done work in this and the example you used from florida relative to the criminal Justice System and bringing justice to those that have the Mental Health issues and using the dollars in a very, very smart and effective way. Now, mr. Polone is voting. Mr. Butterfield is not there. I believe miss matsui is to be recognized now for her five minutes of questions. Thank you very much, madam chair and i really do appreciate you calling this hearing today. Its such an important subject because its such a subject that is impacting so many of our own lives. Before i get to my questions i do want to acknowledge that tremendous pressure our Community Mental Heal Community Mental Health centers to meet the demands. Given the role of the providers, its unacceptable and the Coronavirus Relief funds i look at working to avoid permanent losses to the Behavior Health infrastructure. Prior to this pandemic, my enc colleague, representative johnson and i introduced the teleMental Health expansion act. Legislation that expands access by moving medicare sites, restrictions for tell Mental Health services and the patients home. Our Sacramento Centers have been using telehealth to help patients get regular health treatment. And a local has seen overall encounters in patient visits increase by almost 50 . And now conducting 80 via telehealth. Remarkably, they have a noshow rate of just 10 compared to 40 for facetoface visits. With that in mind, i wanted to ask you about this new reality of life for virtual care. Dr. Geller, can you expand on lifting restrictions on Mental Health services via telehealth expanded Patient Access during the pandemic . It does have a remarkable effect. First of all, we have shifted, the previously psychiatrists did a poll and approximately 65 had not previously used telehealth and now about 85 are using telehealth for about three quarters of their patients. Okay. And many patients have difficulties getting to pilo appointments, particularly in the period of social distancing, they have no way to get to appointments, theres no Public Transportation or no Public Transportation anybody with intelligence would use because of infection rates. They cant physically get to appointments. There are people across the country in rural area that had difficulty before covid and now its close to impossible. Telehealth actually makes Psychiatric Services available, a huge percentage of the population that didnt previously have available services. All right. So the combination of allowing for visual as well as telephone only services, is very important and many patients have no idea how to use the equipment. Exactly. Thats very important. Mr. Kennedy, my former colleague, at the outset of the pandemic, cms made certain that all connected Health Services would be reimbursed at the same rate as inservice, why is payment parity critical for sustaining the use much telehealth . Its obviously a key provider in ability to provide the Services Necessary because while there is a suspension now and people are using it, thats not going to continue millions the biggest payer of all, cms. Steps up and starts paying for it. And by parity. Its deemed equally effective. Especially in addiction medicine. Exactly. To inperson. Why we wouldnt pay the same is beyond me and you guys need to really sit on cms to do that and you also, to your point, congresswoman matsui, you have to do, like you said, make sure the money you already appropriated for Health Care Relief goes to Mental Health providers. They are the ones getting the shortest of the short end of the stick in terms of the money because it went through medicare as a mechanism, not through medicaid as a mechanism for appointment, just as a highlight for your colleagues who dont know why their Behavioral Health providers are barely hanging on, if at all right now in their districts. Well, thank you very much. I really want to thank you, patrick, for your advocacy. Its been unbelievable. Medicare beneficiaries now more than ever access telehealth treatment for Mental Health services regardless of where theyre located. And we look ahead to support similar proposals for even the teleHealth Services and i see that my time has already gone so yield back. Thank you. The gentle woman yields back and were all very grateful to you, congresswoman matsui for your special leadership. This is not only a Public Health issue for congresswoman matsui, its highly personal. As patrick said in his Opening Statement. We have family members. We have family members and so we carry those experiences and those wounds with us and you certainly have and thats why your advocacy and your work is so important. The chair would now like to recognize with pleasure the Ranking Member of the committee, mr. Walden for his five minutes of questions. Mr. Walden with us . Then well go to mr. Upton. Well, thank you, madam chair. I really appreciate this hearing. Its really terrific to see my, ill say old friend. Patrick and i go back a long way. I was one of the team with rammer and him, and looked at Mental Health parity a long time ago, but obviously we still need to step up. We need to do more and his friend advocacy with other key players, certainly in our committee, really makes a difference and i think that the point that he made early on where one in four families directly, but lets face it, every family, mine, too, directly impacted by suicide and things that we know we can do to really make a difference to begin this to turn that around. Its startling statistics and Everything Else. Ive got a couple of questions and want to follow up with, i guess, with what doris was talking a little about earlier and that is the impact of telehealth. You know, we hear so many cases of folks, patients, not showing up at doctors offices. Telehealth is a real key and of course, we know that there are so many areas around the country that are underserved, that dont have access to broadband. I know that mr. Cliburn and i have been very active in introducing some legislation. I think youll see some additional legislation that we are going to be introducing literally in the next couple of days that would require actually to auction off some of that spectrum and for states like mine, underserved, michigan is going to get about a billion dollars in the next 10 years, 108 Million Dollars for the next 10 years. And ive got areas that, in my district, without a four lane road and without broadband. Kids go back to school this fall their access with elearning is obviously extremely limited without that access, but as we look at the benefit of what we can do not only working with cms, but also working to make sure that patients have access to that, i look at what we might be doing with 21st century cures, 2. 0. And Diana Degette and i have had good conversations how we might be able to expand telehealth and cms to make sure that we impact those services. I might ask both dr. Geller and evans, what additional things can we do as it relates to telehealth for Mental Health services . Well, congressman, i would say a couple of things. One is that in addition to supporting the principle of telehealth and as you noted, it helps with access for a variety of people, not only in rural areas, but in urban areas, when i was a commissioner for Mental Health, we had immigrant communities in our city that had fairly large immigrant populations that didnt have Mental Health professionals who spoke their language in the city. So telehealth was a mechanism that we could use to reach those communities that even in urban areas can be a challenge in serving. There are a couple of things, one of them is to understand that for many people who dont have broadband, having telephonic access for telehealth is extremely important. We fought very hard for that provision with cms, and fortunately, we were able to get that, but its not just having Video Conferencing ability, which many communities dont have, but its also being able to do telephone ic care as well, which is very important. So i think making a longterm commitment to this is going to be very important for continued acce access. I might add this. An nih funded study found at that patients admitted to Emergency Departments due to deliberate selfharm had a high suicide rate in the year following their discharge. How important is it to screen for suicide risk in Emergency Departments and followup care . Its extremely important. One of the things we know is that for people who die by suicide. Most of them, the majority have visited a Health Care Practitioner within the last year. And there is a High Percentage of people who die by suicide who have had an Emergency Department visit within a relatively short time in relation to their suicide. So doing universal screenings in Emergency Departments is very important. Having surveillance mechanisms, but i can tell you as someone who is overseeing Mental Health systems, one of the most important aspects of this is to have connections between Emergency Departments and the local Mental Health system. Too often people are evaluated. If theyre not meeting criteria for involuntary commitment, theyre discharged without a good connection, and thats where you see a lot of the problems with people who die by suicide, who have had recent visits to Emergency Departments. Thank you. My time is expired. Clock goes way too fast. Actually, we all have i have 20 different questions i want to ask, but i cant. The gentleman yields back and thank him for his questions. The chair would now like to recognize the gentleman from North Carolina and a gentleman he is, mr. Butterfield. Mr. Butterfield, i want to ask you i have to vacate the chair to go over to vote so i ask you to fill the chair and be recognized for your five minutes of questions, and thank you. Thank you to the chair. I just left the floor a few moments ago and they are indeed waiting fwor youment so thank you for allowing me to sit in your chair for just a few minutes. The chair will now recognize himself for five minutes. Let me just start with our dear friend Patrick Kennedy. Patrick all the members on both sides of the aisles have said such nice things about you and i just want you to know that theyre all deserving, we appreciate you and miss your service here in the congress, but thank you for your incredible work youre doing all across this country. Patrick, while we have made progress in normalizing conversations and reducing stigma about Mental Illness, it is clear, it is so clear and youve made that abundantly clear in your Opening Statement, we have such a long way to go. You note in your testimony that the Mental Health and equity act have not been recognized and Many Americans are encountering barriers when seeking professional help. Im sure that many individuals give up, they absolutely give up after receiving denials or limited benefits. Barriers to care can close a window for opportunity for the individual to get the help they need resulting in harm, serious harm to the individual and as you point out in your testimony, societal and economic losses to our community and our country. And we all know in experiencing crisis on so many different fronts from covid to the economic of Police Violence against africanamericans, now more than ever, the process to seek help should not be a barrier to receiving help. Question, what should we do . What should we do to enforce Behavioral Health standards and regulations to ensure the beneficiaries are not encountering needless road blocks to receiving the care that they need when they need it . Thank you so much. Obviously, youve got about of your committee a couple of different bills, both of which are very, very important to help bring Greater Transparency to really what Insurance Companies deliberately obfuscate, which basically, they hide behind this seeming confusion as to how they determine someones medical necessity. Well, we have in the federal law very clear guidelines that are now being adopted by all of your respective states to bring absolute clarity based upon the administrative rule to enforce the federal parity act and then, so, i would basically encourage you to pass those parity bills that you have before you. Because as you said, what its really about is Insurance Companies know that its going to take forever for you to appeal their denial. Theyre counting on it as a cost of doing business. So, so many people just who are in a Mental Health crisis, families in a Mental Health crisis, they have nowhere near the wherewithal to challenge a major payer, a major Insurance Companies so they give up. Thats what the Insurance Industry counts on. And as a result, the Insurance Industry reduces its total liability to provide care because they basically deny care, and yet, if you looked at the comparable between the percentage of care they deny thats Mental Health and addiction related, versus the amount of care that they deny thats medical and surgical related, you would see a huge disparity and what your bills before your committee do is, well, that they will require that to be opened up for the light of day so that theres transparency and i think that if theres transparency, Insurance Industry will be loathe to put together any plan that when evaluated will clearly illustrate that theyre discriminating, because as you know, gk, through your long work on behalf of civil rights, the more you bring transparency and open it up, the less people have the opportunity to discriminate because ultimately people dont want to be caught discriminating or they shouldnt want to be caught discriminating, i should say. So thank you for that question. Thanks for your service and friendship. Thank you as well. I have one other questions for dr. Evans, it looks like the gentleman is running out of time so im going to yield back the balance of my time and recognize the next republican, im being told who that is right now. It looks like our friend john simpkins. Youre recognized for five minutes. Thank you, congressman butterfield and patrick, great to see you. I was interested in the exchange between fred upton and dr. Evans and kind of on my line. I represent, 102 counties in illinois, i represent 33 of them and so what covid has cause today happen, which is, kind of a side benefit, its forced us to ease some of the regulatory burdens on the telehealth. And so, i know, dr. Geller, in your testimony, you talk about telepsychiatry and then we go into this i think a lot of our concern is, if somethings working, when this covid crisis failed, i mean, when it ends, we dont want some of these reforms that were kind of created for emergency purposes. Wed like to see them continue. I just think thats helpful. Everybody understands theres underserved areas, money is going in, whether its for us, usda rule development, the sec, even some individual states are now starting to put more money to broadband deployment and laying fiber. So, first of all, let me go to dr. Geller. I think ive heard requests from 22 months extension or more, and i guess, what well be asked is why. Not just because of my perception thats a huge benefit, but do we need time to extend this program now to gather data and how long should that be and what kind of data are we looking at . Dr. Geller. So yes, we do. And an extension should allow for study and we can look at various outcomes in terms of access and we can also look at something i mentioned before, but its unfortunately incredible of importance and that is cost. Because while its going to cost more upfront as people have Services Available and access more services, theres a high likelihood theres going to be a significant down side of savings not having people go to the emergency room and not having people with inpatient admissions. We need to look at clinical variables and economic variables, to see if its working. We need to include the capacity for physicians to work with each other through telehealth, so that we have a coordinated care across the board and that should address lots of the problems in rural counties. Yeah, what would you think would be a time frame that we would need to gather this data . Welcome, thats an excellent question because we expect even after the infectious aspect of this pandemic is over, that were going to have a Mental Health pandemic that could go on for quite some time. And we dont really know how long that is going to be. The ap doesnt have any official position on how long that should be. If you were asking me, i dont think we could know the answer in less than five years. Yeah, i think thats important for us to hear because i am, again, this is in such a great opportunity to exercise and show the benefit of telehealth. And in your world and also just in the, you know, the medical practice field for underserved, unserved communities in rural areas. Dr. Evans, you want to add anything to to debate on period of time and our push to keep this, when they ease the regulatory burdens, we want to make sure that we dont reimplace them once someone thinks this is over. Well, i think its important to keep it and to recognize that telehealth is only a means to answered. Its a mechanism to provide services that we know work for people. As dr. Geller referenced in his point, one of the things that we know is that there are significant offsets on the physical health side when people have access to Mental Health care. Not only will people be able to address their Mental Health challenges, but well see things on the physical health care side. I think this is really critical. Our organization has been working on getting access to members of the rural communities. We have relationships with foreign aid and the farm bureau and were currently working with sansa on a program to train individuals to work with people in rural communities. And one of the things that is really clear, we can do our part as an association to train people and to encourage people, but we need to have the infrastructure available so that people can get those services delivered. So, i appreciate your question. My time expired, thank you. And i yield back. Thank you, mr. Shimkus. The chair now recognizes the chairman of the full committee, mr. Pallone for five minutes, please remember to unmeet, frank. Thank you, gk. Patrick, i want to go back and patrick, i know everyone keeps asking you about the promise of the federal parity law that you sponsored and what more needs to be done and you talked a little you certainly talked a lot about it, but i want to kind of drill down again. We have these two important bills introduced by your cousin, representative joe kennedy, and representative porter, na would strengthen the enforcement of Mental Health parity laws and increase parity regarding how the Health Insurance is complying with the lawment i want to ask you about both of those things. Looking back at implementation of parity law over the past decade. Can you discuss the challenges with the enforcement and oversight, basically transparency . I know you dont think its been fully realized, but you know, what remains to be done to deal to achieve parity, looking at the enforcement and the transparency, if you would in a little more detail . Well, for one thing, having one inspector for over 1500 pla plans, obviously lets the, you know, the whole process go to pieces because how are we going to have any accountability if theres no oversight . Two, what we need to do is strengthen the requirements that theres kind after Forensic Audit of the way that insurers make the medical necessity determinations and they need to know on the bills proposed before the Committee Really demonstrate how that all works and you know, thats a process in evaluating whats known as the nonquantitative treatment limits, medical critercry tear crucial to people getting this in a timely manner. I know that dr. Evans as well as dr. Geller, they know how they get micromanaged well beyond what they would expect if they were any other area of health care delivery. And just need more staff there is a call by the whole community for 20 million would dramatically improve department of labors. I mean, we have nearly 80 of all people in our country are covered under arissa plans so their oversight is obviously by department of labor. Most people dont know that, but so i would encourage all of you that in your jobs as federal members, this is the exactly in your purview. You need to have your department of labor step up its game. Its absolutely unbelievable, in the times where we are losing more people to suicide and overdose and alcoholic deaths than we are covid, more than covid, and what do we spend . We cant even get 20 million to even and by the way, for my republican friends, enforcing parity means that making sure Insurance Companies dont give the heisman to Mental Health and addiction such that our taxpayers have to pay the difference here, because thats ultimately what happens, is because payers never really fully adhere to this federal parity law, what they end up doing is pushing the cases, cases down, down, out, out, out the door while they dont assume any accountability and then who pays . The taxpayer pays through our corrections system, through your policing system, through our firefighters and all of their disproportionate side gobbled up by people who are homeless on the streets all because early on, you know, payers tried to save money and they pushed it onto the taxpayers and really, in essence, this is corporate welfare of the first order. We are allowing our the Richest Companies in our country, the health care Insurance Companies, who by the way, are sitting on a boatload of cash because they never had to pay any bills for the last five months, and theyre denying Mental Health still, and you cant even make this up and who is paying for this . The hardstrapped taxpayer is paying for it in innumbererable ways, including through medicaid and also through their local property tax base. So if i were both a liberal conservative, parity would be a big issue for me. Thank you, patrick and thanks for all of your work over the years. Thank you. Okay. Thank you. And i see anna is back as well. Anna is back. I went as fast as i could. I want to thank mr. Butterfield for stepping into the chair. I believe that mr. Walden is the next to question. Is he there . Going, going, gone. Not so. Well return to him. Its a pleasure to recognize the gentleman pr virginia, mr. Griffith for your five minutes of questions. Thank you, madam chair, can you hear me . Yes. All right. I appreciate it. I have submitted for the record, a letter from jennifer feis, many of you may have heard of her sister, head of the columbia Allen Hospital in new york city. The doctor endured weeks of stress as she helped covid19 patients and battled the virus herself. Eventually the responsibility for human life sh, responsibili for human life and she became physically unable to continue, and looked for help for a weakened medical state and she believed her license to practice was at risk and could be over. Approximately two weeks later she took her own life. And the bills today address important issues, but none would have alleviated dr. Breens concern. We must consider the Mental Health providers on the front lines of a pandemic. I dare say few individuals could endure the struggles that dr. Breen faced without help. I know somebody talked about it earlier, i was on the way to vote and i was listening, even though i was going over to vote, but for dr. Evans and or dr. Geller, do you believe that doctors should be able to seek help without fear ofline of licensure . I spoke to that earlier, and the answer to the question is absolutely. The question should states be able to ask the question on your license application . And most states in fact ask the question. We have got to start a Major Campaign to address prejudice and discrimination. We used the word stigma, but i think its actually an unfortunate word. If we use the word prejudice and discrimination, we would understand that its the same prejudice and discrimination against minorities. It is prejudice and discrimination to think that if a person has a Mental Illness, theyre not capable of functioning. Panel member right here, Patrick Kennedy, who addresses that throughout his life and hes actually one of millions of examples. We have clubhouses that help people go back to work, all sorts of interventions and i mentioned in my introductory remarks, i have a son with pretty significant intellectual disabilities who keeps people alive every day in his job by delivering medical supplies that are necessary to the functioning of the hospital. So, yes, emphatically, we need help from congress to remove prejudice and discrimination and treat it just like all other prejudice and discrimination. Congressman, if i could add something . Yes, sir. Your point is a really good one and one of the big challenges of the way we deal with Mental Health in this country, and references, is almost entirely reactive. And we wait for people to have a diagnosis before we intervene. One of the things that we have to start doing and working upstream, start providing services to people before they need before theyre in crisis. Before they have a diagnosis. One of the things that the American Psychological association is doing is developing information and in fact for Health Care Workers is one of the groups based on psychological science that tells people how they can help to manage and mitigate their stress and to do selfcare that will reduce the likelihood that their psychological distress is going to lead to. The majority of reason people miss their followup appointment is it didnt have money to put gas in the car. And the other is one of the reasons that we have affected attendance at followup visits is that its a doctor who initiate the contact. I can tell he and my own experience, ive had lots of contact with persons as i forgot about my appointment. Lo and behold we had the appointment anyway because i contacted them. I guess that makes a huge difference in rural areas. The telemedicine cant but tk about expanding the ability of a number of people to be able to provide help you are not currently licensed to do so. I think thats important one of the things thats happening in global Mental Health is the notion of task shifting. Not all of the functions that Mental Health professionals do necessarily need to be done by a highly trained Mental Health professional. Many of those things can be, other people can be trained to do. In addition to that, pierce support is extremely important, both in terms of engaging people peer keeping people retained in treatment, and otherwise supporting people in longterm recovery. It absolutely is something thats important, another important element to a wellrounded Mental Health system. Thank thank you very much. I yield back. The gentleman yields back. Its a pleasure to recognize our colleague from maryland, mr. Sarbanes, for his five minutes of questions. Thank you very much, madam c. Can you hear me okay . Very well, thank you. Thanks for this hearing. The patrick, its great to see you. And to all of the other panelists, thanks for your testimony today. The New York Times recently ran a piece written by an emergency physician in arizona title i am a Healthcare Worker, you need to know how close i am to breaking. Arizona is among the states experiencing some spikes in the covid19 cases right now. This position makes clear the impact of responding in treating high numbers of Covid Patients are obviously more than physical. This was true in new york city, other hardhit medical communities a lack of the personal protective equipment and testing and respirators and so forth. We know the stress of this is like nothing we have seen before. Its taking a huge toll on our healthcare workforce. There are bills under consideration, katie porter our colleague has a bill that would provide support to states and communities for frontline Healthcare Workers, for workforce training. Paul tomko as has a built as te impact of covid19 on Mental Health of americans including Healthcare Workers. Both of these have been included in a modified fashion in the heroes act. I want to speak a little bit, its been touched on i think in response to some questions from congressman burgess. But maybe dr. Geller and dr. Evans you could share your perspective on the best way to deploy the support the Mental Health support and counseling for Healthcare Workers. Because obviously one avenue for this is through the institutions, hospitals, the Community Health care clinics where they work. But is there also a role to play for sort of a separate resource to be brought to bear that comes from outside the four walls of a hospital, for example . So if you could speak, if you could design the best program through Employee Assistance program and other measures to help those Healthcare Workers are on the front line, what would that look like . Ill start with dr. Geller and then dr. Evans, if you have any thoughts as well. Three components. First is that you have to have the services onsite and immediately available. To those of us in healthcare is terrible to say no, we will not leave at the end of the ship because its the end of the ship when the people that are dying. You have to have services immediately available. Second is the advantages again of telehealth. You are much more likely to have a Healthcare Worker who has gotten home and can call into somebody than somebody after working 16 hours and acting them to go to somebodys office. And the third which dr. Evans alluded to previously is proactive Wellness Programs that are available right on site. So if im in the emergency room i can take half an hour and go to a yoga class. Sure. What i would add to that is peer support is extremely important as dr. Geller mentioned earlier in his testimony that often people in the medical and nursing professions dont want to reach out for help. So what we found in working with over 65 nursing associations, how important it was to have peer support groups on floors that people can access, can have access to immediately. In addition to that the kind of selfcare information that we have provided for Healthcare Workers is really important because what we do is we talk about, heres an exercise you can do when you are extremely stressed. And then we give people the Science Behind why that works and why that is an effective strategy. It really is accommodation making sure people have access to care, that there is pierce support, that there are options to help people understand things they can do themselves and ultimately ensuring people can have access to care when they need it. Thanks. As you know, for oncologists, particularly pediatric oncologists and others, they have the support systems. The mayo clinic where i went to drug rehab, i learned all about this because they incorporated frankly a lot of the same recovery debt for people with addiction were for people with doctors who were experiencing enormous stress in their jobs and needed ways to learn how to manage their own stress and feelings. Thanks very much, patrick. As i close, hanky for your leadership and advocacy in this area. Two things im coming away with from this call that youve emphasized her with got to address the stigma and went to put the resources behind these efforts. Thank you, madam chair. I yield back. We thank the gentleman for his excellent questions. He yields back. Has mr. Walden come back . I can recognize him. If not, then the chair will recognize mr. Bilirakis for his five minutes of questions. Is he on board . Not now . Then the chair will recognize mr. Long for his five minutes of questions. Thank you, madam chairwoman. Yes. Nice to see you. I am here. Dr. Geller, could you describe for me the benefit you have seen from patients receiving care for Mental Health services via telehealth during covid19 . In your opinion have the flexibility provided by congress and the Trump Administration facilitated access, the needed Mental Health and Substance Use Disorder Services during this pandemic . The greater flexibility and access to telehealth i think has made a tremendous difference. The inclusion of the ability to have telephone appointments has made a tremendous difference. People have referred several times to people who dont have broadband access, but the population is much greater. I have a gentleman who hasnt bought a new electronic piece of equipment since the johnson administration. His favorite activity is to set him listening to his records on his record player. Before covid we met every month for 25 years. He only talks to his brother and to me, the only two people he talks to in his adult lifetime. He and i have telephone contact every week, every month. And if we didnt have that ability, he would be without services and probably be hospitalized. So it is make a huge difference. Also as i indicated previously, particularly for people have trouble keeping track of appointments or had some disorganization, i initiate the contact often by phone so that i can track them down and they actually have an appointment. I think its making a world of difference, and congress should be taking movements to extend this far beyond the infectious pandemic. Ill stay with you, dr. Geller. Rural Mental Health in springfield, missouri, i chair did about a year, you napa go. I also chaired or recently durg the pandemic but i know that the convention of the Mental Health come telehealth thing a lot, and it is very, very vital, very, very important. They also just issued a hard grant which we were happy to see but i know how bored telehealth is an appreciate your comments. The u. S. Is facing a serious shortfall of Mental Health Behavioral Health officials, professionals as you know. What will it take to attract more students into this field . There are several things. One is we need a program, a much expanded program on loan forgiveness. People can get out of the end of the training with half a Million Dollars in debt. Thats going to direct them to highpaying specialties, not to lowpaying specialties. So many people in primary care. We need people in psychiatry. And pediatrics, lowpaying specialties. So dont forget this would make a big difference. Increase in gme slots, that is medicare funded residency slots, directing those slots to underserved areas. Third is minority fellowships and though should be directed the specialties that are underrepresented like psychiatry. Those are all efforts that are within the purview of some of the bills that we face will make a big difference to the workforce. Thank you. Im going to go to ms. Gross next if i can. Thank you for being here in speaking to us about what you doing in your community to promote Student Health and wellness. You say that students receive, as student you see way more parents, teachers and other adults by joy not given the tools to help their friends struggle Mental Health. Can you talk about your experiences in the Safe Promise Club come what tools would be beneficial for you to help a friend struggling with Mental Health and for creating a system of support for students in your school . Yes, thank you for the question. So one thing say has taught me is being able come for chef to be able to make it with people. Thats one thing to focus on is reaching out and getting into committees. And the one thing is we go out and talk to different schools and build committees were people feel comfortable expressing themselves with each other. What somebody feels safe enough to speak about. We have trusted Adult Training so we train people to bring the committees together by being there for students because students, we go through a lot. I think that at least in my perspective thats why we need our peers as well as help within our schools. Because we dont have a lot of that around us. And so save has allowed me to learn how to do that so i can help my peers. So i know how to explain how i can help them. Thats one reason why im here today. Im here today to get this message out and the people know there is help beyond just being in a in a state where you dont feel comfortable. So just offering that. They taught me how to communicate and how to build communities so people feel comfortable. Very good. Thank you again very much a vineyard today, and thank you to all our witnesses here today for participating. Madam chairwoman, i yield back. Thank you. The gentleman yields back and i thank him especially for the question that he asked of the witness, because the student population is just so important and we really need to address that and make sure they get exactly what they need. The chair would like to recognize the gentleman from oregon, mr. Schrader. Is he available . Not seeing or hearing him, the chair recognizes mr. Kennedy. Mr. Kennedy available . Not in his chair. Then the chair will recognize the gentlewoman from New Hampshire, ms. Kuster, for her five minutes of questions. You need to unmute. Thank you. Thank you very much. Thank you, madam chair. I appreciate this hearing, and i appreciate the opportunity to address you on this important issue. Here in New Hampshire weve had a dramatic increase of depression, anxiety, trauma ad grief as a result of covid, and we are struggling as well with changes to the Economic Impact on our health care providers, particularly Mental Health providers. 83 of small and large group Substance Use disorder providers have experienced what they were described as a significant Financial Hardship as a result of covid. 48 of those providers had to cancel income generating event while 74 have incurred unanticipated expenses including ppe. Across the board we have seen and experience of loss building revenue of 23,000 per organization in just the first three months. I wanted to focus my question on some of the conversations we had been having today, including the impact on Substance Use disorder, the Opioid Epidemic has taken a a big toll here inw hampshire. We have a dramatic increase in deaths from opioid overdose as well as focusing in on trauma. We had some conversation, i think it was mr. Burgess, talking about Mental Health and Substance Use Disorder Treatment in prisons and jails. I wanted to direct my questions to dr. Geller. You had mentioned this in your written testimony. I have legislation, the humane correctional healthcare act, which would repeal the medicaid inmate exclusion and allow health care to follow an individual through the Justice System so that they could access Mental Health and Substance Use Disorder Treatment while incarcerated. Could you comment on that, dr. Geller . And how that could make a difference in terms of outcomes. And i think there was also comment about how people are being incarcerated for their Mental Health challenges. I think representative kennedy talked about that. I think that your state motto, live free or die, now has another meaning. It means that im going to live free of services, and im going to die. So it is extremely important here i am personally delighted by that notion about removing the medicaid exemption. I thought for a very long time we would never solve this problem if people cant get funded services because they happen to get incarcerated when many times the get incarcerated because they had a psychological problem. I think that can make a huge difference. In terms of, you also mentioned small providers, and that is something that Congress Needs to attend to because they are really the bedrock. The Public Sector Substance Abuse programs, community Health Centers are really taking care of the disenfranchised population and they had a tremendous problems currently because they are not beneficiaries of most of the covid funding that has been coming from the federal government. I wanted to also ask, i recently was visiting with excuse me, my time is getting short. I also was visiting with our state prison recently and i was told that 100 of the women in the state prison are survivors of trauma, sexual assault, Domestic Violence, abuse and neglect as children. Im very concerned during covid, i i chair a task force to end sexual violence. Its a Bipartisan Task force. We recently had a roundtable about the increased incidence of sexual assault, entering the stadium order children that are at home with their perpetrator, predator. Do you get any concerns, or how come we go about this as we reopen . And again, my time is short. Just really quickly. One of the problem we have is circular. I said patients who, when they get released from jail and they fall into that series, category, commit crimes to go back to joe because its the only place they have what they can feel any safety and comfort. Thats a a huge problem in our society. A new problem with Domestic Abuse is a significant problem. We a people staying at home together, people who are afraid to report. People are afraid to leave home to report. We have to be cognizant of that phenomenon, specifically address it. It has not been talked about a great deal. I thank you, madam chair did i yield back. I very much appreciate this hearing and a think these are critically important issues for us to address, especially now during covid. Thank you. I yield back. The gentlewoman yields back. We thank her for her excellent questions. I see the Ranking Member of the full committee has returned, just took his mask off. The chair recognizes my good friend from oregon, mr. Walden, for his five minutes of questions for thank you, madam chair. I appreciate it. I appreciate this hearing and encourage our witnesses in the work they do in the communities and in our schools. Thank you for what you do. Its good to see our former colleague here on the screen as well, and sure appreciate your continued speaking out on these so important issues. We are getting there but not fast enough and is more to people. Thats part question what to direct you, patrick. What is it when you look at these bills, and there are some we all agreed on, some we will work things out on but what are the gaps . What are we missing especially as it relates to the data that could better inform us on things to do . Money is on an issue. Mental Health Resources are always an issue. We tried to increase funding in communities like we did to the opioid legislation. As you look at these and you know the realities of washington, what are we missing . Thank you. I would say that if i had a magic wand i would fully fund the Nurse Family Partnership in this country which would ensure that every at nist mom would be able to get the wraparound services. The payoff of that is so well established but the problem in our Health Insurance system as in society is we dont often measure the longterm payoff. If its not a quarterly payoff for an annual payoff, we really dont see the real Value Investing in Mental Health early, to the previous question, about trauma and really doing the kind of systemic things in society that could mitigate the impact of trauma. So in terms of, obviously that parity laws to enhance, i could answer more to their politico to you. Right. Particularly could be helpful with an addition to that. I would your first instance of schizophrenia. If i had a magic wand i would not only do Nurse Family Partnership, i would say that every first instance of schizophrenia in this country we provide coordinated Rapid Response. If you do that you would permanently change the trajectory of longterm comorbidities and illnesses due to mental ells in a dramatic way. And i see this every day. And for the life of me i dont know why as a nation we do not make that a done deal on a bipartisan basis. You would automatically reduce the number of people in jail, in prison in our country overnight. I dont know why our general accounting office, if i were you, chairman, i would find a way to gao or omb come up with some kind of accounting it because you all know, you dont say anything you cant find offsets for, and thats part of the problem here. We all know this stuff works but you have to find a way of justifying to spend money on those things, because invariably it will come out of other programs that you think are equally worthwhile. But, frankly, may not have the pound per square inch of a path of a solution that these do. Its really good counsel. I i did a town meetings over yes ago. One part of my district, i remember we are doing some of the opioid issues and mental issues. One of the Law Enforcement people made that case picky said look, we get somebody in, we pick them up because theyre off their meds. We get them into him in this case county jail setting. We get them back on their meds, they are stable and we know once they are released were going to pick them up again. This seems to be a huge gap still in the country, trying to get that help to people. We are part of a pilot and may be going on in New Hampshire as well where we have Mental Health people that intercede before the arrest occurs. They are there 24 7 on site and even able to do diversions to keep out of jail, get them the help they really need. I think thats a focus that seems to work. Ms. Gross, thank you for speaking at the thank you for the leadership that you have provided. When it comes to kids, what are we quoteunquote old people missing . What can we do more . We know where missing a lot silage is stipulate that can but from your perspective. I think a lot of what we need is his people to listen. A lot of times what we think and feel are downplayed because they are just kids. They dont know what they are feeling. I think thats why, from my perspective, coming around and allowing our peers to be able to be there for us, through the stand up after having more professionals who know exactly what were going through and know that kids can go through these kinds of things really important. Giving the voice and you listen to, because like we all said, we had concerns of a go through a lot. Suggesting able to people who listen and care is really important. I appreciate that and thanks for your work. Madam chair, thanks again for this hearing and i yield back. The gentleman yields back, and thank him for his excellent questions. Its a pleasure to recognize the gentleman from massachusetts, mr. Joseph kennedy, for five minutes. Excuse me, madam chair, thank you and thank you for calling this incredibly important hearing. Patrick, ill start with you, my friend. You mentioned in your Opening Statement in the written part, by want to have you have the opportunity to remind us how long ago that you able to get the Mental Health parity and Addiction Treatment act enacted . Ten years. Over ten years. Eleven and change i think. Time flies. Asked why youre in congress, im not. Time flies. There we go. So almost 12 years later though, there are real district are still ensures that are not compliant with the federal law, right . Exactly. To highlight that the department of labour conducted 18787 investigations in fiscal year 2017 and found 92, almost 50 of those surveyed, when not comply. In december gao jlp met with enforcing the department of labor and hhs, and found violations of the parity with corbett and recommended evaluating whether not targeted auditing is an effective method for Mental Health degree parity. Youre familiar with those . Yes. One of the things that Mental Health parity Addiction Treatment act along with parity laws did was insure plans provide how to make a decision. Almost after 12 years all plans should be doing this and have that information already readily available. This is what want to turn to dr. Because interest of eclectic reporting this information already should be difficult for them to make that available in really . Early . They should not and it should be required to do so. So knowing youre not an insurer but are provided but it an Insurance Company would make alterations and give a false impression of compliance with the disparities . Im sorry to say it would not surprise me. Doctor, if a health plan is not compliant in providing Mental Health service to think that should be Public Knowledge . Absolutely. Do you think it should be proactively publicized in some capacity to protect current and future enrollees . Absolutely, because the enrollees have no capacity to do this on their own. Do you know how many health plans are in the department of labor alone, dr. Geller . Im sorry, i do not. 2. 2 million roughly. So 2. 2 million different plans covered by do ul alone. I believe because white him a point of fact these have not yet come close to earning a truss or the patients trust we not only need to random robust and immediate knowledge but also Public Disclosure parity complex hold them responsible for parity violations. The point on this is to force, as patrick articulate before, to actually have teeth behind those requirements to allow for that investment to be made up front to talk about the partnership of nurses. One of the challenges we have is we dont have those incentives put in place to require or incentivize that investment up front to provide access to patients and care for patients which is why the largest providers of Mental Health behavior in this country are the jails. In l. A. And chicago. We talk to the shares for my home state in. 98 of people with access i should say 90 of people of healthcare coverage, you talk to the sheriffs that run our jails and the telly between 8090 of incarcerated individuals find any given night are suffering from Substance Use disorder, Mental Illness or both. In a state 90 coverage we are so failing people with Mental Health illness. I want to come back to the fact that patrick is worked on this for a long time. Of us have on this committee but Behavioral Health coverage trends bear to act would improve Enforcement Authority to increase transparency and have it made available to the public, and that public peace is so critical because, as you said, doctor, theres a way patients could possibly get access to this particularly it plans on making information available. How do we possibly hold people accountable if there is no remedy for it . Joe, if i can say so right on. And i think it Congress Responds by actually saying youre not allowed to sell Health Insurance product anywhere else in our market if you dont adhere to our laws. I mean, imagine a Health Insurer coming in and saying i want to sell it to your market, its a very lucrative thing for an insurer to go to sell their insurance product in a given state. Why doesnt the state would have a big barrier and say you are not about to sell in our state if you discriminate against the most important set of illnesses affecting our people . What your bill is calling for is the ability for that to be transparent, to get out so that state legislatures can start to enact similar laws like that too will provide some accountability. And to your point on the numbers, its hard to believe but in your colleagues committee overseeing dol appropriation that only one inspector, i should correct myself from earlier, 2500 plans, that one inspector has to oversee 2500 plans for one inspector. You need to pass your bill. You need to have greater money to support enforcement over all, and you need to give these states more authority to invoke the own Accountability Measures by making this more public like a legislation calls for. Thank you, cousin. Grateful. Im grateful for your flexibility. Good to see again. Takes a joining us. I just back. The gentleman yield back, look forward to your legislation becoming law, mr. Kennedy. And thank you, patrick, for all of your responses. We are just learning so much from you about what we actually need to do. The chair would now like to recognize the gentleman from florida, mr. Bilirakis, 45 minutes of questions. Thank you, madam chair. I appreciate it very much. Im especially appreciative to me consideration a few of my priorities, h. R. 4861, h. R. 7293, h. R. 3165. Also wanted to flag a bill introduced with congressman de soto, h. R. 5473, the enhanced access to support essential behavioral Health Services act which builds upon the support for patients and communities act to allow medicare and medicaid to reimburse for behavioral Health Services delivered through telehealth. I hope we can consider this great bill in the future, madam chair, and also want to say hello to my former colleague, Patrick Kennedy, who always did a great job on these issues. Thanks for being here, patrick, and giving us all your great advice. Dr. Geller, this question is for you. Our nation is in the midst of [inaudible] we have an audio problem. We are going to im going to give him my computer to work off of, madam chairwoman. Thank you. Okay. Make a little adjustment for that time, mr. Bilirakis. Madam chair . Yes. Okay. I apologize. We want penalize you for the time out. Okay, very good. Thank you. Proceed. Thank you. I appreciate it very much. Ill start with dr. Geller again. Our nation is in the midst of a suicide crisis as you know. Over the past several decades suicide rate has risen sharply, increase 31 since 2001. At the same time Emergency Departments which are often placed within our Healthcare Systems to provide care for people who are at risk for suicide at inconsistent protocols for screening and creating highrisk patients. For this reason i introduced h. R. 4861 the effective suicide screening and assessment in the Emergency Department act. This bill will assist hospital Emergency Department and improving their ability to identify and treat those who may be suicidal. What is the potential impact of covid19 on the risk for suicide, and what role in hospitals especially Emergency Departments play in identifying and treating individuals who are at risk for suicide . Dr. Geller, please. Thank you. The effect of covid on suicide is a substantial and actually multifactorial. One is the response to an individual in the stress of the potential for infection. Another is grief, loss, and significant depression from people who are losing family members to covid19. The third which is probably the newest information is that we are seeing in some recent data from the United Kingdom that there is a direct neurocognitive effect on some patients from the covid. That is, it affects their brain, there is increased risk of strokes it is also other psychiatric presentation. So we have three rather distinct ways that covid is invisibly affecting suicide. We are not doing something right in this country. Of all the developed country in the world, will the only one, the United States, who is seeing increased rate of suicide while the other countries are saying decreased rate of suicide. I think you build a section important. Not only should we be doing suicide screening for people who show up who have psychiatric problems, we should have a high index of suspicion of people who show up for other reasons. Just like where a high suspicion when a kid joseph with a bunch of broken bones that may be there as parental abuse, we need people who when youre doing the valuation for whatever reason are paying attention to a suicide risk. We also need then continuous followup so that people dont get lost that day or minute they walked out of the emergency room. Thank you very much. Ms. Gross, thank you for your testimony again today. I have seen firsthand the power of promised plugs [inaudible] my kids go in my district. Last fall and and i agree withu that students are equipped and able to prevent all forms of violence. Ombudsman peter and i had a recent introduction of the suicide training and awareness nationally developed for universal prevention, the standup act which encourages states, tribes in schools to create policy for students Suicide Prevention training utilizing samhsa by best practices, training and technical assistance. You mentioned that the Save Promise Club trained you on how to notice the signs and talk to your classmates who may be struggling, and you have done that. We appreciate it so much. If students like you were not trained in your school and there were not Save Promise Club, what do you think you and your classmates would do if they were struggling with Mental Health . If you can answer that question, i would appreciate it. Yes. First of all i would like to thank you for the question. Thank you for supporting the standup act. I think its on board. In my mind are in my perspective, kids begin to start showing signs kids would show signs that theyre going to something so they wouldnt be able to express it. He kids dont feel comfortable doing that site might celeb kids getting in a fight because might be going with you can get out of this aggravation or so far because it whenever anyone who was like them, like another student whos going to the same thing to talk to the they wouldnt have someone to relate that on the you would see kids with their grades dropping, like their future really, colleges all the stress that is put on you, its [inaudible] thats why think in my perspective the save act is so important because it allows us to save lives by being there for people who are like us and allow students to step in and help and give another hand to something that is so important. Thank you so very much. Madam chair, i guess i dont have much time left. Well we always have more time. The gentleman yields back and i thank him for his excellent questions. Thank you so much. I am pleased to recognize the judgment from new york, mr. Engel, or his fibers of questions. Thank you, madam chair. And thank you, chairman pallone, chairwoman eshoo for holding todays important legislation to address ongoing Mental Health crises in the United States. My district in new york which includes the bronx and westchester is bent at the epicenter of the nations coronavirus outbreak. This pandemic has taken an untold physical and emotional toll on my constituents. All Health Officials have reported a surge in covid19 related mental and Behavioral Health problems. As doctor evans noted in his written testimony Text Messages from the federal government distress outliner up 1000 in the month of april. There was also a a growing conn about a rising suicide which before the pandemic had increased by nearly 30 in new york state since 2000, nationally was the tenth tenthg cause of death. Dr. Geller, i would like to ask you can you please explain why the coronavirus pandemic has exacerbated the suicide epidemic . Wow. There are several reasons for that, congressman. First is a reaction to a pandemic where people are required to quarantine. People are spending much more time without social supports, and for people with depression that increases depressive symptoms. Second, we have a generalized feeling of helplessness, and the feeling of helplessness is already a key component of depression. So we increase depressive symptoms. People dont have contact with family that theyd use for support. People are losing family members and they cant even attend a ceremony like the funeral, and that is exacerbating depression. So we have people who have depression whose symptoms are much worse, and we have people who are developing symptoms it did previously have it. As i mentioned in my testimony before, the newest information is were getting direct effects of the covid19 on the brain itself, which is affecting peoples functioning and also increasing rates of suicide. The help reduce rates of suicide in the United States, i offered the effect of suicide screening and assessment in the Emergency Department act with congressman bilirakis so it was bipartisan. Studies show as many as 11 of all patients visiting the hospital Emergency Department are at risk of suicide, but only a fraction of at risk patients are ever identified. This Bipartisan Legislation would provide 100 million over five years to help Emergency Departments improve the identification assessment and treatment of patients at risk of suicide. Madam chair, i ask unanimous consent to submit into the record a letter of support from 48 advocacy groups in support of our legislation. I think the gentleman for his requested we will take up all of the request requests en bloc ad of todays hearing. Thank you. Doctor evans come in your written testimony you called the nation rising rate of suicide pandemic. Since the nations Emergency Department, counting close to 50 of all patients healthcare visits each year, do you support a more focused approach on identifying and treating patients at risk of suicide while theyre still in in the Emergency Department such as the approach provided in h. R. 48061 . I do. I think its very important. We see a hypersensitive people who died by suicide that an emergency room visit within the last year. And when we dont screen people for suicide, we are missing an opportunity to intervene. I do think though its really important to look at this issue as a systemic issue. When we design our interventions for suicide we have to do the kind of clinical intervention that you are talking about that or one of one group will start to think about the network of Resources Available here i mentioned earlier the parts of having a connection between the Mental Health system and Emergency Departments but its also important to have Intervention Service that dont require people to actually need to be hospitalized or need to be admitted to the service before they can intervene. Those other things that help people have a level of support when your feet and Emergency Department. They dont meet criteria for being admitted but they can be followed in the community reducing the likelihood theyre going to get into crisis without having a connection to a Mental Health professional. Thank you. Thank you, madam chairwoman. Thank you. The gentleman yields back. The chair would now like to recognize doctor bushong from indiana. Is he available . If he is not then we will go to to mr. Carter of georgia. You are recognized for five minutes for your questions. Are you there . No, okay. Are you unmuted . I am unmuted now, thanks to the Ranking Member to us here holding my hand making sure i do everything correctly, and appreciate him very much. Thank you, madam chair and thank all of the fantasy. This is certainly a very extremely important subject, but and i certainly support legislation that when we discug today but i do feel like we need more time to work on some outstanding issues and to come to a mutually agreeable place. Ive been a practicing pharmacist for many years and i know firsthand and from personal experience as well but also to professional experience that Mental Health is not a partisan issue. Mental health is a very personal issue and a very serious issue. Not only Mental Health but addiction, and actually afford and we have to address this in a partisan fashion, and a bipartisan fashion, excuse me, and make sure were getting everything right. I really do, im one of feels like the administration has a fantastic job during the pandemic especially expanding telehealth. Its been said telehealth is at ten years of expansion in one week. I think that is true. Before this started there were almost 11,000 telehealth visits a week. Now its over 1 million per week. Telehealth is here to stay and its something weve got to work on. Once asked dr. Evans and dr. Geller if i could come both of you wrote in your testimony that congress and the administration can do more to build upon the rapid success of telehealth. What can specifically we do to expand telehealth and the patient usage of the service as well, of course, i will with dr. One is that we can ensure that telehealth includes telephonic services, that is the use of a telephone as ive described before. The second is that we can ensure that, as of late has been mentioned previously, parity reimbursement, that there should be no difference if a person comes to an appointment or if a person is seen through telehealth. Third, we should be putting in components to allow for collaborative care through telephonic and other electronic means. For example, the psychiatrist is chordata can with the primary physician and thats a billable service. All those would make quite significant differences as compared to what we had before covid19s. Dr. Evans, if i can ask you, one of the things that we have come to notice during this and come to realize is a lack of Health Services in our rural and minority communities. How can telehealth help us in that respect . It can provide services to people who would otherwise not receive them. One of the other issues when you talk about telehealth and one of the things we have toothaches or to work on these the issue of providing those services across state lines. Right now telehealth is limited and regulated by within the state. There are few exceptions to that. When you think about areas of the country where you are not enough practitioners and other areas of the country where you have an abundance of practitioners, one of the ways to solving the problem in rural and front to parts of the country is to allow providers who are licensed to work across state lines. Its something were working on at the American Psychological association, and its really essential for this to address some of the disparities that we see. Thank you, doctor evans. Congressman kennedy, wanted to ask you as i said earlier as a practicing pharmacist and also as a pharmacist legislator, in the Georgia State senate in 2009 i sponsored legislation to create a Prescription Drug monday program son incident overages and i think weve done a good job of managing our open prescriptions for patients that in the lasting effects are still there. What weve seen is just recently in the last year weve had Overdose Deaths have gone up 11 . Theyve gone gone up 11 . With everything weve done in the way of addiction, and thats something thats very concerning to me and wanted to ask you howw to think we can utilize telehealth to help us to treat this and to treat addiction . How can we encourage providers and patients to seek out treatment through telehealth . Thank you so much for your question, congressman. As you know as a pharmacist addiction is addiction is addicted to it could be opioids today but it could be benzodiazepine tomorrow. As in the one of the real impacts of weve never noticedn the string so far is benzodiazepine prescriptions have got over 30 since covid hit. 30 . Not only has Alcohol Consumption far surpassed even very high rates, but now we have this. So as a pharmacist you are saying the full scope of what people are prescribed. Thats crucial data. We narrowed it to open because it was the quote Opioid Crisis. But as we know its really an addiction crisis where opioids for one thing but it could also include any number of other drugs i could also get people in trouble. So thank you so much, congressman. Its great you are serving as someone with experience that you bring to this effort and keep asking these important questions. Telehealth can definitely help in a number of ways, and great, thank you. Thank thank you, thank all te panelists and thank you, madam chair and i yield back. The gentleman yields back. Its a pleasure to recognize our colleague from california, mr. Card is come for his five minutes of questions. Thank you very much, chair eshoo and also Ranking Member burgess and to all the witnesses, thank you for your testimony, your expertise and your Practical Knowledge you are sharing with us. Were going to a pandemic and lets pray for all those families have been affected on all the loved ones who lost family members. Im glad to see us discussing the legislative ive expressed concerns in previous things about our disjointed Mental Health system and distort wave of Mental Health problems that experts were are approaching. As mr. Kerry did make there is no help without Mental Health. Support for schools is very important. All of our witnesses identified schools as a piece of the puzzle as a special click here are student perspective. Ms. Gross, thank you for being with us today and thank you for sharing your experience is with us. Mr. Kennedy, you mentioned goals around social and Emotional Learning and addressing the student drama. How could the federal government best support schools with these goals and Mental Health overall . Thank you, congressman. At first i would overhaul the way we think of education so that we understand there is no education without Mental Health conscious liquids if there said there is no help without Mental Health. How can the body learn numeracy, literacy when the mind cant absorb information because of what we understand neurobiological he that prefrontal cortex is inhibited. The domain of dr. Geller but i will let him talk about that. The bottom line is we need to give our kids the ability to modulate their emotions. Just like their workout and learn other skills they have to practice these skills. Those are problemsolving skills, coping mechanism skills. And if they learn these they build resilience. And, frankly, unfortunately too many of us we learn all these skills after the fact it would be so much better for all of us if our kids have these skills as early in life as possible and we would be able to stick with him rather education or careers. Dr. Evans, you mentioned some challenges schools are facing. Some of my colleagues and i working on a bill. What type of support from samhsa would be most beneficial for schools and School Systems right now . Its important to look at schools in a comprehensive way. In my role as a commissioner i worked very closely with School Superintendents and the system i was commissioner for, and one of the things is to help teachers have the skill set to recognize when children and youth are having Mental Health problems and challenges. Its a big issue. I also think implementing evidencebased approaches like School Climate programs, which have been shown to reduce that only violence but to improve School Climate is really important. That kind of services that you heard ms. Gross talk about, and by the way i am a former connecticut person, really proud of her being able to articulate some of the needs of students. Not every child needs to see a Mental Health counselor or to get into a Mental Health program. Having people, whether they are youth and peers or even counselors who are simply giving an opportunity for children to talk to them is also very important. And then finally having connections to Mental Health services. In my system we actually embedded those Services Within schools so the children got high level Mental Health services there. So really its a range of things ranging from educating teachers all the way to having services that meet the needs of children who have more high in needs. Thank you. We dont have time on this discussion to discuss the lack of diversity when it comes to Service Providers in the field in general, whether its Mental Health or physical health. Hopefully we can forget ways which in this country can encourage and get young people to get into the mental and physical health space so they can be more of the doctors who look like the patients they are serving. Ms. Gross, when it comes to education, dont you think its just as important that students identified within each other, not just the parent excuse me, not just the teachers that identify when a a student is having a crisis but the students come if we gave them the knowledge and experience to identify peertopeer, dont you think that would be a good way for us to reduce the incidents on School Campuses . Yes. Thanks for the question. That is definitely important because think about it, teachers spend about 45 minutes to an hour with the student everyday and class. We we get that time working on projects and be with the friends spinning that kind of time. We have to follow a social media to use people that have Constant Contact with. What we see is really important in fighting this cause. Thank you, very much. My time is expired. I yield back. Thank you, madam chair. The gentleman has completed his questions. Is dr. Bush on available wax i dont see him. Yes, im coming. Okay. Im starting my video, as we speak, thank you. The gentleman is like a nice for his five minutes of question. Glad you are here. Hanky. Just another brief that he had recanted deal with. For so i want to thank you for holding this important hearing. This this is a work we need to e focused on i think during challenging times in this pandemic and i think Mental Health gets overlooked. During the midst of covid19 ive spoken directly to Mental Health facilities across my district, and the increase and challenges, and ill see the increase in calls to their help lines has been dramatic during the pandemic you would be surprised. One center i talk to witt from receiving two to three calls a week other suicide hotline to upwards of 20 or more calls every week. One part of my district, talking to First Responders that normally go out on a suicide call once or twice every two or three months, its once or twice every two or three weeks during the pandemic. Its created a pretty substantial toll on the Mental Health of our society. We also have spoken to universities who are now left trying to figure out to provide continuing therapy for the outofstate students. I wasnt aware this until i talked to one of my president s at one of my universities. Theres a lot more College Students better getting therapy on campus i think that people understand. They shared with me the difference this therapy has on the students and its troubling they cant continue to provide that continued care to the students in many cases just because now the students are all over the country. This particular university has people from 50 states and foreign countries. The issues of course our reimbursement, liability and sometimes technology. As was pointed out, contingent care passed the first visit is really important. Therefore, as we continue to look to improving Mental Health and Mental Health through telehealth, this is an issue i hope we can address. A lot of College Campuses are starting to pay more attention to this. Theyre building on Pierce Services which is a really effective way to reach students. I think its also important for us to not only make sure that there are services on campuses but there are active efforts to reduce stigma against people reaching out for help. One of the things we do is a survey year looking at some of these issues and one of the things we notice that the Younger Generation is much more likely to reach out for and be open to receiving Mental Health services so thats a good thing but we know that we still have more work to do there in terms of continuing to reduce that stigma so people will reach out for help what can we do in congress to help facilitatethis type of activity . I think its continuing to support efforts to embed Mental Health services on College Campuses. Its also encouraging innovative situations. In philadelphia we started to do Mental Health screenings and make them available in the community but then took those same screening tools and put them in a kiosk and encouraged students towalk up in the Student Center , take a 10 minute screening which did not do a diagnosis but it would tell the student whether or not they were exhibiting symptoms that were consistent with depression or anxiety and then it gave them information on how to connect to those Mental Health services so for a millennial population that is really accustomed to using technology, using these kind of Innovative Strategies as an effective way of reaching students who would otherwise not get that help. Excellent, thank you. Doctor geller, can you talk briefly because my time is running out about the complexity of managing mental and physical Health Patients and what the challenges are there. Its usually more complex than we think. Is much more complex than we think. As i mentioned before lots of Mental Illnesses present with psychiatric presentation have to have the ability to differentiate. We have a clear example of that now as i indicated with the Central Nervous system presentations so if somebody shows up with psychosis and their positive, mistakeis to send them home. The psychosis may be a direct effect of the covid19 infection and there are hundreds of examples of medical presentations like psychiatric disorders. Just briefly madam chairwoman, i was a physician before i was in congress for the witnesses and the complexity of dealing with both physical and Mental Health problems at one time is becoming more and more i think prominent in the medical community, realizing that you have to deal with some medical issues and with these patients that have Mental Illness or youre not going to get them through their Mental Illness and support them so thank you for that and i yield back. The gentleman yields back and i would just say that youre a doctor for life. And we are blessed to have you. The chair now will recognize the gentleman from vermont. For his five minutes of questions thanks very much and i want to start with the teleHealth Services. My friend Mister Carter would say telly health. Its been terrific in vermont and the president and congress havedone a good job taking advantage of it. Doctor geller you talked about ive had a lot of feedback from practitioners that contrary to what i expected, the interactions are often times not only easier but more intimate. That one practitioner told me about being able to go on a virtual walk with someone in a rural part of vermont and also how at times it would be relevant for members of the family to be able to participate in the calls. Can you comment on that, the effectiveness from establishing that intimate relationship and trusting relationship that soessential for the person seeking help and the provider getting help . It works in both directions. Theres something to be said for being in the same room but ive had lots of experiences with patients in the telepsychiatry where not only are they more willing to speak that you have opportunities or in the moment experiences that you can then bring into therapy so i have a woman whos a single mom with four kids and sometimes her kids run in and interactions take place and then we can talk about what just took place so you are in the moment with patients and that can make a huge difference. Another question i have aboutMental Health is this. Ill probably get this wrong but theres some conditions like bipolar schizophrenia that are chronic with acute episodes that require medication and constant treatment. As so much of Mental Health seems to be an outgrowth of loneliness, depression or erosion of humidity stability , lack of jobs, communities getting hollowed out. And one of the challenges we face in congress with our bipartisan commitment to addressing opioids is that it really is afterthefact, its not providing the underpinning of security folks need in the community. Of stability and relationships, stability in their social network. How much of the explosion in Mental Health situations that we have here do you see as having a connection to the erosion of those communities of jobs, support structures and so on . Because so much that youve indicated of the suicide level in new york was below us here. Maybe ill start with you doctor. What youre referring to, we call in the field social determinants of self and we know that there are certain things that we experienced that can lead to challenges from for us both physically and mentally. And as you noted, things like losing your job, being under a lot of stress. Being homeless, all those things are stresses that can lead to Mental Health challenges. Our field has not done a good job of understanding or at least incorporating into our clinical approaches and understanding of the social determinants and using that information to actually help people. I mentioned in our testimony, my oral testimony the importance of addressing issues like homelessness as a way of actually improving peoples Mental Health. With respect to that and following the activity were seeing around the black lives matter, are we in many cases focusing too much on police as the responders rather than the kind of Rapid Response team that doctor kennedy said we would need. Patrick, maybe you could address that. Thank you so much peter and i think obviously when you look at the fact that so many of our jails are filled with people with Mental Illnesses and addictions that clearly a better response and Occupying Police time would be to make sure that proper First Responder teams are in place to our Mental Health aid responders and of the like. So obviously i hope thats in your number of things that you can consider today and it would certainly be a terrific allocation of resources or if you will reallocation because i think any firefighter will tell you these days especially they spend more of their time trying to do First Response to overdoses and Mental Health crisis and they do putting out fires and the same with Police Officers read most of the cases they get home to may present as a criminal justice issue clearly have a Mental Health at the root cause. I want to say thank you to carry on a gross for her excellent testimonyand the work he does. The gentleman yields back and thank him for his excellent question. The chair is pleased to recognize the gentleman from oklahoma. Mister mullen for his five minutes of questions. Thank you madam chairand i appreciate you holding this hearing. Because it is an important issue. Its something obviously i have been working on for quite some Time Starting with the 42 cfr part two. Which i was glad to see was aligned with and put in with the care zach and so mister to me, this is a question for you i know our offices at spoke multiple times about this. I appreciate your insight and feedback while we were taking this fight on 442 cfr part two. Your feedback was instrumental and you provided some inputs in there that i think helped with my colleagues on the other side of the aisle which this was a bipartisan approach in its Committee Area how does this important measure with aligning part two help in the time that we find ourselves in especially when we see an increasing Mental Health crisis going on because of the pandemic. Thank you Mister Mullen and thank you for your leadership on this. I appreciate it very much and i think as we just heard doctor geller talk about the poetry of psychiatric symptoms with physical symptoms and conditions and the bottom line is when i go into the er, if im going in with covid or Something Else and they dont understand about my underlying psychiatric issues or in the case of addiction, they do not know that i asked m someone whos suffered from a chronic disease of addiction which has a better chance of killing me and any other illness that i face. I face a couple of them but nothing as critical as the life or death issue of having to fight addiction as a disease which by the way when i go tomy doctor my doctor doesnt ask me about my addiction. Because its not in my Electronic Medical record. The doctor has a pen, electronic pen these days to prescribe anything they want and if they do not know that i have the disease of addiction they are practicing medicine without a license. Thats why, thank you for that 42 cfr because there are hundreds of thousands of my fellows in america who are dying because their medical system does not know they have a underlying addiction because it doesnt show in the emr theyve been treated for addiction so i just assume if youre protecting my privacy with respect to anything else thats supersensitive and sexually transmitted diseases are protected by hipaa. And i should say Mental Health could be protected by and in addition could be protected by hipaa as well. I think this is about protecting patients health. Its why its important to have 42 cfr fixed. Thanks. You have been very passionate about this and it was something that affects all of us. In your opening segment you said this. Every family is affected by this and mine is no different and in oklahoma we benefited from Mental Illness and opioid and mass issue which a lot of times Mental Illness runs handinhand with that too because theyre trying to self medicate and all of our families have been devastated by this. I just want to tell you again i appreciate it and thanks for your insight and your insight on that to. Doctor evans, theres been an increase of almost 900 percent of Mental Health crisis outlines this year. Now more than ever the you think its appropriate, more appropriate to remove some of the barriers prohibiting some of the treatments that could take place for people that are suffering from Mental Illness . I appreciate that question congressman because as you know, youve been a supporter of 884 which removes barriers in the Medicare Program for psychologists. It is a real travesty that in 2020 we have administrative barriers that prevent people from getting the care that they need. That legislation would allow 2 things. One is to ensure that seniors who right now are experiencing what one of the worst Mental Health crisis is of our lifetime have access to psychological care and a second thing is to make sure that psychologists are eligible for reimbursement for the incentive payment to work in some of the rural areas and underserved areas that we talked a lot about in this hearing. Our seniors have significant Mental Health needs normally. They have exorbitant Mental Health needs under this current crisis. And it is just not right that it is not right to deny them that care. When there are ways to remove these barriers and let me just say that the barriers that were talking about have been removed for podiatrists, theyve been removed for optometrists, for a lot of other doctor really trained professionals. And the administrative barriers are talking about are only in the Medicare Program. Theyre not in the ba , theyre not in child care, theyre not in any private insurance. Its only the Medicare Program where we have the most Vulnerable People in our society and i appreciate your support and other members of congress so that we can remove thatbarrier and focus on making sure everyone gets the care they need. Thank you doctor evans and madam chair, sorry about going over there i appreciate your indulgence. Thank you for your good work Mister Mullen. The gentleman yields back. A pleasure to recognize doctor rowe is from california for his five minutes of questions. Thank you very much. We are very happy to have this hearing today on such a critical issue. This is especially important at this very time as we are seeing anxiety and stress levels go up during this pandemic. This march for example the disaster helpline supported by the Substance Abuse and Mental Health Services Administration saw an 891 percent increase in calls compared to march of last year. The Mental Health system in our country was already strained prior to the Public Health crisis which is why its more important now than ever to look at ways to expand accessto Mental Health for all americans. Its worth noting that if the aca were to be overturned, Health Insurance plans would no longer have to cover dental health and Substance Abuse Disorder Services including Behavioral Health treatment as an essential Health Benefits. Having spent my career prior to coming to congress as an Emergency Department physician i can tell you from firsthand experience some of the access issues individuals face. Often times individuals with an acute Mental Health episode and up in the Emergency Department, sometimes because there is literally nowhere else to go. And in the emergency physician needs to make a decision. Either they hold them for a psychiatric evaluation for Suicidal Ideation or they hold them because they cannot find any transfer beds, any Mental Health hospital beds or they discharge them and are unable to start treatments or get them the care that they need because theres not enough primary care kissing psychiatrists on the community or other Mental Health professionals. The biggest concern is lost to followup. At the turn that we use when you discharge somebody knowing that they need follow on care but unfortunately because of thesystem , systematic problems there lost to follow. The Emergency Physicians want to find the appropriate care for the patient before releasing them and want to have them, hand them off directly to the next provider knowing full well once that patients walks out the door the chances of them taking the next step drops dramatically. Emergency departments across the country to implement it innovative approaches to securing follow on care for their patients by putting in place Transportation Systems to get their patients from the hospital to the Rehab Facility or tracking regional inpatient bed capacities or coordinating with area dental Health Providers in a Team Community approach but they dont always have the resources or capacity to do as much as they want to do area that is why i introduced hr 2519 improving Mental Health access from the Emergency Department act of 2019 which would create a Grant Program for Emergency Departments to transition patients into more appropriate care or longerterm treatment. Doctor geller, can you talk about the specific barriers Emergency Departments have to be able to give their patients a warm and off to their follow oncare . Sure and as youve indicated most of Emergency Departments operate like silos. They have no relationship whatsoever to the services that follow unless those services happen to be within the same fiddle as the Emergency Department so your bill is making huge steps forward in that regard. The second piece of this is we dont have enough beds and thats so people sit in Emergency Rooms where they told the long period of four lengths of time weve had people sit in Emergency Rooms for up to 30 days looking for a bed. Why cant we find a bed from the emergency room . Because we have people in general hospitals we dont have enough beds. Why do wehave some people in general hospitals . They can six months to get transferred in somestates the Public Sector. We also have jails because we dont have enough beds so we need coordinated services and we need funding for that and to build an excellent job with that but its coordinated with anadequate number of psychiatric beds. What are some of the barriers the patients face when their discharge for follow on care that go beyond the lack of beds or locations . And how could it grantshealth . The grant can happen because were asking people who are in distress and may have depending upon their diagnosis problems with social skills, problems with organization and were saying heres a phone number, you follow up. You call that phone number they get a recording so that this bill would actually create steps that are going to facilitate Emergency Rooms to make sure theres a warm handle and as you well know theres nothing more important than a warm handbook. Thank you very much. The gentlemans time has expired area and its a pleasure to recognize the gentleman from montana mister jean forte for his five minutes of questions. Thank you chairwoman and i appreciate the Committee Hearing to discuss legislation to improve our Mental Health care system. I appreciate that legislation i introduced with my friend from virginiamister buyer was included in this hearing. Argo hr 4585 the campaign to prevent suicide on legislation would direct the cdc and samsung to conduct a National Suicide prevention education graham. This includes advertising for the new 988 number for the National Suicide prevention lifeline. It would also encourage individuals to engage with people showing signs of suicidal behavior instead of ignoring them. We introduced this legislation to complement the efforts of mister stewarts legislation to designate 988 as the suicide hotline and mister goes legislation to ensure funding to implement the designation. To better respond to those in crisis we need to have a shorter number. People need to know about it and it needs to be resourced so that those in crisis dont call and get put on hold or get a busy signal. Esther stewarts legislation is already been voted out of the communications subcommittee. I hope hr 4585 and hr 4564 can join it in a bipartisan markup at full committee soon. These bills were needed before the nation entered this unprecedented elf and economic crisis. With hundreds of millions of americans worried about their health and millions out of work and restricted from social interactions, its important, more important now than ever. I supported legislation included in the farm bill to prevent farm suicides and the need to address this in all walks of life has only grown. People are hurting in montana and across our nation. We should be able to Work Together to help make the suicide hotline work in this crisis. Madam chair, i asked for unanimous consent to enter into the record letters of support for hr 4585 on the American Foundation for Suicide Prevention and Mental Health liaisongroup and vibrant. I want the gentleman to note im going to take up the request for unanimous consent on block at the end of todays hearing so thank you. I also appreciate we considered legislation to extend the use of telehealth for Mental Health services so doctor geller, i want to go back to the top of telehealth. We talked about it a lot today. My home state of montana frequently ranks among one of the worst states for suicide in our country. We have a population is mostly rural and its extremely hard to find Mental Health providers for these communities. Can you talk specifically about how mental telehealth for mentalservices, Mental Health services help fill this gap in Rural America . Absolutely. It can make all the difference and i know how long it tookme to get to one farm event. It makes Services Accessible to anybody no matter where they are and if we include as ive said before a telephone component, it doesnt matter whether you have access or not electronically. You can useyour telephone and it means in terms of both the issues you talk about with the crisis number , we know that a significant number of successful suicides are impulsive acts. If a person has the ability to dial three digit and get immediate attention, that can absolutely interrupt that impulsive act so between that and the ability to access a professional no matter where they are in the state of montana or anyplace else in the United States i think we can make a significant inroad and as a footnote, every major, every state should have across the state whether a billboard that say what number that is and what its purpose is. Thank you doctor keller. What additional steps, doctor evans mentioned earlier practicing across state lines but for both you gentlemen, what additional steps do we need to make sure that we can get quality Mental Health services into Rural America . I think the legislation i mentioned earlier, 884 which allows psychologists to practice to the full extent of their license is one example of that. It is clear that we need Technological Solutions and telehealth does that. We need policy Solutions Like interstate contacts that allow people to work but we also need to make sure that the providers are there to provide those services and the legislation that youre supporting, 884 does that and we appreciate that. Could doctor geller comment briefly on that point as well . Im sorry, go ahead. I think we have to have more opportunities for medical education, more attention to employing people to underserved areas like if i go to an underserved area in montana i can get loan forgiveness and if i can respectfully disagree, i do not believe that psychologists are going to increase access. There aresome ways in which its potentially dangerous, for example psychologists running a partial hospital program. I yield back. The gentleman yield back and thank him for his excellent questions. The gentleman from michigan, miss dingle is recognized for her five minutes of questions and i want to thank all the members for their patients. We are living in a new era, everything takes more time. I cant help but think that todays hearing is some of the best time spent, but it still takes patienceon the part of members so i thank all of you and the gentlewoman is recognized for her five minutes of questions. Thank you madam chair and also it takes time in the states to us answering these questions and i think the Ranking Member. This is a subject thats very important to me like many others here and i think the fact that the communities chosen to highlight this issue is important because quite frankly during normal times Mental Health access remains a significant challenge. I guess i listened to patrick and its wonderful to see him at the beginning of this talking about, he and i have been friends and we talked in the department about this. One of the things we havent talked about as much as i thought we might is eliminating the stigma. Too many people are afraid to acknowledge this is a problem. Like him, my father was a drug addict at a time no one ever talked about it and had a number of horrific incidents and ultimately died. When i tried to save himand i tried for years in and out of the system. But ive learned a lot and too many people are still afraid to even acknowledge that they have a problem and it is in every family. The jails have people that should be getting help and they need Mental Health treatment. They dont need to be in a prison but there are a lot of people sitting in their own jobs that need help that only now have a problem because theyre afraid what someone will say and thats only made it worse. Seniors have told me weve made a decision that if they get covid theyre going to die because nobody cares which is horrible. I deal with a lot of, i feel theres a lot of Domestic Violence cases etc. And a Law Enforcement has been doing well this entire period. We need to be talking about this and our Mental Health systemis broken. I hate talking about money because when you were talking earlier, we dont have enough psychiatrists going into this. We had an incident, an unfortunate one with a college student. At Central Michigan university where we knew he needed help. He went to the hospital and with no doctor available to take care of him they called his parents to come get him and when his parents came his father was a sheriff in illinois and he shot and killed histwo parents because there was nobody to help him. There was no bed available. When i learned that only one person had gone to psychiatric residency in michigan there. Weve got to, we have to incentivize. This is Something Else i want to talk about down the road but Mister Kennedy, thank you for yourlongstanding advocacy and all that youve done. Weve talked specifically about what sort of cuts will nonmedicaid state and local Mental Health and Addiction Services space if we dont provide these needs in the next fewweeks. Thank you gabby and by the way, my book the dean is right next to my bed. Im so grateful for that book and nice words that your husband mentioned and i loved him and loved being scolded by him when i wasnt following the proper rules of the house. I know how proud he still is up in heaven of your carrying on that tremendous legacy of Public Service so sorry for wasting all that time but this is to say that youre a great person and im so glad youre there. We dont, the Mental Health budget i think we can agree is the first thing to go. And the reason is the cause there are a lot of people raising their hand saying that youre a consumer like if you had cancer or heart disease. You dont have a big cancer society, american heart foundation. God bless nonnie an hsa but theyll be the first to remind you that they are fully underfunded as an advocacy group. So basically youre either in jail, in an institution, or youre in a 12 step meeting and youre supposed to remain anonymous. Which means that there is no public advocacy going on there unfortunately. So im just trying to paint for all of your colleagues, very well put debbie that this is the first area of government that theyre going to see as able to be disposed of the cause youre not going to get the cry that you will get if you try to cut many other areas of state and county funding. Thank you madam chair and im already out of time. You. The gentlewoman yields back. Its a pleasure to recognize our good friend from illinois , congresswoman susan brooks for her five minutes of questions. Indiana, im sorry. Thank you madam chairwoman and i apologize. Im having some technical difficulties with my wifi here in my office but i just want to thank the chair for having this really important hearing. I know you and the Ranking Member, you requested it as well and its important that we focus on Mental Health. Especially during this time of covid. I appreciate the panelists providing us their expertise area in the last congress i would lead an additional Law Enforcement Mental Health wellness actand i think , we got thatsigned into law. Providing more resources for those frontline workers area i want to talk a little bit more and go back to providing more and more resources for those frontline workers, particularly the Healthcare Workers and what theyre experiencing area firefighters, First Responders still who are our First Responders who are going into homes and helping people who may be ill. But also particularly those Healthcare Workers and i think doctor evans or maybe im sorry, doctor geller talked about the stigma of those providers seeking help because of their license sure and because, and id like to talk about that a little bit further and doctor geller, what is it that you believe we should do because im going im an attorney. Often with licenses you have to indicate whether or not you have sought psychiatric help. Is your position that we should no longer be having that on applications whether youre going to be a police officer, a lawyer, a doctor, a teacher . How is it that we address that doctor geller . Because you agree that i do think it keeps people from accessing and it does build on the stigma of accessing services. A twopart answer i think. We have had an explosion of attention to Health Inequities or black people. But we have had Health Inequities for black people in this country for 300 years. We need an explosion of attention to the discrimination and prejudice against people with Mental Illness. Thats the first part of the second part specifically is whats the purpose of that question . Whats the relevance on my licensure application, or your licensure application as in determining as to whether or not ive ever sought psychiatrictreatment. They dont ask me if ive had it if im a dermatologist. If theres some concern that . To be a broad question about impairments because i could be repaired because i have a mental disorder as just as easily as i could because i have a psychiatric disorder so i think the question should be changed if were concerned about impairment and that should be the same across the spectrum. A psychiatrist should not preclude me frombeing a doctor , from being an attorney or from being the schooljanitor or from anything else. Thank you very much. Id like to ask miss gross and thank you so much for sharing one of my high schools in the district of indiana actually created a stigma free club created by a young man whose mother suffered from Mental Illness and that was all about. Education. How might we educate young people around the country about the warning signs of suicide or increasing the number of. Educators and counselors we get involved at that High School Level and then maybe in college. What do you think we gotto do . I think that you know how the beginning of the school year theres often times put aside for orientation or getting into the school and you might do some Career Training but i feel like we could use that time to put in place just a little bit of learning that people can understand how to help their peers to cause its so important in order to be a good student you have to have a great Mental Health and i feel like if we dont use things like the standards act we can be failing our students in that regard because the Mental Health and wellbeing of our students is so important and how wellthey end up doing. So as you said before, getting that little bit of time. It doesnt even haveto be a lot as long as we can make sure they have the information they need. We can teach them about what their classes are going to be for a little bit of collusion about what they might want to do in the future area if there time that willimpact the future. Thank you for your leadership and i yelled back madam chairwoman. The gentlewoman yields back. Its not a pleasure to recognize the gentlewoman from illinois, miss kelly for her five minutes of questions. Thank you madam chair and the ranking for bringing us together to discuss Mental Health issues and i thank all four witnesses for being willingto testify today. In 2003 the National Academic study found that even when controlling for barriers of care, minority patients have worse outcomes than white patients. The report found both explicit and implicit racial bias contributed to these health outcomes. As we all have heard by now minority communities show a disproportionate number of cases. This is compounded by pandemic related shutdowns and layoffs hitting minority communities especially hard because we are the essential workers. These parallel economic and medical crisis are a recipe for stress, anxiety and grief within the community of color yet too often these same communities lack as you know access to care and Mental Health services. Doctor evans, how can we address disparities in access to Mental Health care and treatment for communities of color. We have to do anumber of things. But first, one of the things in my role as commissioner and a tutor for the state, its really clear that while we need to make sure that services are funded, we also need to make sure we work on the communities understanding of the importance of Mental Health. The big difference we have to make in the Mental Health system are how we deal with Mental Health is to move from thinking about Mental Health is about them too thinking about until health as about us. That means all of us and we need to understand Mental Health is as important as our physical health and all of us have some Mental Health issues going on at some point in our lives. It reduces the stigma and makes it much easier for people to reach out for help. We also have to make sure we policies that are directed at communities that are effective. When i was a commissioner i made sure that the immigrant communities particularly the small communities that didnt have a loud voice got funding or areas of the community that had deserts in terms of Healthcare Providers and services in those communities. There is no way around making sure that the resources are in the places and directed to the people that need them. Thank you. I wanted and doctor, that the pursuing equity in Mental Health act was funded culturally. But they would also provide support for more students of color to enter the Mental Health workforce. Doctor geller, regarding the creation of culturally competent workforce, your organization as a task force to adjust racism within psychiatry. What are some of the barriers task force has found and what are you doing to address the issues. The task force has just begun at work so i cant answer on the taskforces extent but i can answer in terms of the apa. You have very long work on healthcare inequities. Disparities. And we have all sorts of educational material that is directly related tothat subject matter. Also, we have a were working on deploying personnel outside of traditional offices. Its besides having a financial resources, you have to send services with people going to get them if you want to meet the needs of a black man in a community, you got to have somebody sitting in the barbershop. Despite the pandemic gun violence continues to plague communities in my district. A bipartisan solution to cyclical violence act of 2020 with great grants Extension Programs including infinite Partner Violence and trying to stop the crisis. Doctor evans, then you discuss how cycles of violence and influence the Mental Health of trauma victims and violence prevention programs assist in reducing the burden of violence and Mental Illness and im a big gun violence prevention person. Im not against guns but we have such easy access to guns that has to contribute to the suicide levels also. You just commend you for your leadership around cdc and the data because thats a critical piece in reducing these disparities. It is important to have community interrupters to interrupt violence in communities but its also important to connect those efforts with addressing trauma. One of the things happens and we would talk about in my work is that people hurt people but when people are traumatized, theyre much more likely to continue that pattern of traumatizing others so a big part of addressing Community Trauma and violence helps to reduce both of those when you combine those and your efforts to reduce violence and trauma. Thank you so much, im out of time. Take care. I yelled back. The gentlewoman yields back. Our pleasure to recognize the gentleman from ohio, mister latter from his five minutes of questions. Nice to see you. You need to unmute area you need to unmute. Are you unmute it . The gentleman needs to unmute. We cant hear you. We cant hear you mister latter. How do we begin . Mister latter, we cant hear you. There he is. There you are. Can you hear me now . We can hear you now, thank you. Having a little technical difficulty. Thats all right, the gentleman is not for five minutes if i could ask unanimous consent to submit some letters for the record. The chair announced earlier the unanimous consent request unblocked at the end of the hearing. Thank you madam chair. Day, were shining a light on the importance of improving Mental Health in our country and i like to thank you for allowing me to label to the subcommittee for this hearing. Before i ask my questions i like to highlight how covid19 has taken a toll in every aspect of our life. Mental health conditions, Substance Abuse disorders and suicide have risen drastically over the past few months rent the White House Drug Policy Office has released a troubling specific. A shared drug Overdose Deaths have increased 11. 4 percent in just the firstfour months of 2020 compared to the first. Last year. The social repercussions of covid19 have caused stress and anxiety in our community providing care and assistance to those offering the most especially during this Global Pandemic. Fyi authored the creating resources to improve situations of inherent severity act or the crisis at red the crisis would diverge, direct state to utilize funds for the Mental Health block grant for crisis careservices and improve care individuals experiencing a psychiatric episode. Again, i want to thank our witnesses for their attendance todayand if i may begin with doctor geller. Doctor geller, your testimony indicates Mental Health Crisis Services can help those with Mental Illness by limiting their contact with the criminal Justice System by reducing visits to the er. As you know ive introduced legislation to provide resources into the Mental Health block grant to enhance their Crisis Services. Whats special about the Crisis Services and how do you communities and benefit from having more ofthem . Crisis services take many forms. They can be resending mobile crisisintervention , they can ride with Police Officers. They can be involved with divergence from the court. Crisis services, we have known will diver people from higher levels of care and diapering people from higher level of care will allow those levels of care to be available for people who actually need them so not only is the individual beneficiary on getting the Crisis Services, the assistant is a beneficiary because they can talk to people who need higher levels of care. That legislation is important and will benefit the psychiatricpopulation. Wouldnt it also decrease costs as we are not having those folks at the er and alsoincarceration . I know ive visited in northwest ohio ive had a lot of the sheriffs say unfortunately they are the first place thatthey bring folks that need care. On the psychiatric side but they cant provide those services. Thats a double edged sword because it may absolutely decrease costs. Its going to have people not go to places that they dont need but its also going to do case findings, that is it going to find people who need services that would have gotten but lets just say its cost neutral. It cost neutral given a lot more people to services that may need. At the bottom line, we will serve more peoplemore effectively without spending more money. You very much and to our former colleague, Mister Kennedy area suicide Drug Overdose and alcohol use killed more than hundred 80,000 americans in 2018. How is covid19 increasing anxiety or depression for these americans. Again, that number is startling because are counting all the time number of americans who are dying as a result of the covid. It seems that were losing just as much if not more to these illnesses and we are not hearing about it at all. Were not hearing a word about it. The silence in this is deafening. Covid forces people to say isolated, removed. Disconnected and people who have addiction, Mental Illness like isolation so this adds gasoline to the fire isolation is not good for your Mental Health a coping mechanism for people who do have addiction and Mental Illness and its reinforced by the messages were getting in society now that says we shouldnt talk to or connect with each other so i think it could obviously as weve seen from the science had enormously the currentnumber of tragedies. Thank you to our witnesses again and madam chair thank you for letting me wait onand i yelled back. You are always welcome, pleasure to recognize a fellow californian. Thank you madam chairwoman. Its an important hearing today. Im sorry. Ive got to ask my colleagues to mute. You need to unmute please. I think hes unmute it now. The gentlewoman can proceed and we will add another 10 seconds on. And not have you lose anytime. Thank you madam chairwoman for holding this very important hearing today to address Mental Health in the country. Doctor evans, you have mentioned many things that ive been talking about and can relate with. Often times i am somebody who says we all have Mental Health issues and there is a question as to what degree do we have been so to hear you say that today just reaffirms what ive seen, what ive experienced throughout my life and across the board also talked about the importance of looking at the social determinants of health which i think is so critical that i represent a community and a district that includes compton and watts. We have people who worry about getting shot as opposed to worrying about the next School Report that sue and what impact that has on their Mental Health and what those factors have on a child in the importance of us looking at that is so important that ive introduced a bill to address the social determinants of health that will create a program specifically at the cdc to address these social determinants of health and create partnerships with local Public Health agencies so they can also address this issue so thank you for bringing that up. I think this hearing is great. We need to have more of them on Mental Health. Mental health touches every part of our lives whether its nonviolence or homelessness certainly now under covid19 we have family members who experienced addiction and i think it goes across the board that we hear it day in and day out. Mister kennedy i want to follow up with you on a topic that my colleague brooks brought up on the application. I want to share quickly a personal story. When i was in college, i was applying to be an intern in the white house and i remember seeing the application asking if i had ever seen a Mental Health professional and my father had been terminally ill for all of my last 10 years, i think it was the 10 years of his life which was me being in college and i remember thinking to myself geez, as i leave, i ended up getting the job at the white house that if i end up leaving and seeing aMental Health expert , i cant work in government if i go and having that had me even secondguessing whether i should seek any Mental Health services. We heard doctor geller talk about his lease to change the question and maybe we should eliminate the question or if were going to change it i wouldask that it should be on an application. Thank you, ill just add that the green berets which no one would think had any Mental Health problems. Theyre the best of the best in our military. They are awarded and take advantage of more Mental Health than any other branch of the service. Why would the green berets who are the best of the best have so much Mental Health provided . Because our nations military has figured out that in order to have the best of the best, all of those that theyve invested so much in in terms of training, they need to be on their game and they need to be able to minimize anything that might compromise their ultimate ability to meet the task of the mission. Now, why as a nation dont we take that same attitude that the United States military has taken . That chairman of the joint chiefs of staff has taken and that is shaky Mental Health make you mentally healthier. We are to be encouraging evil in this country to seek mentalhealth. That should not be a disqualifying factor. If anything it ought to be a rewarding factor to focus. So for the same reason im for eliminating checking the box for those who have been in our criminal Justice System for whom king that after theyve already paid their dues to society, totally hinders theirability to move on in their life. Same thing with this, we need to eliminate this check in the box as well. And i think that the job that youre going for, theyre up to the criteria and whether youre able to meet that criteria want to be the criteria area not some question about whether youve ever taught Mental Health. That should not be disqualifying criteria but thank you so much or letting me eat up all that time with an answer. I will certainly follow with some of our other witnesses. My time is expired. Thank you madam chairwoman for having this hearing again and we need to have more on this critical issue. I think we need to as well. Thank you again missberrigan. Its now, the chair now recognizes a wonderful addition to our committee. The gentlewoman fromdelaware , miss rochester for five minutes ofher questions. Thank you madam chairwoman and thank you to the Ranking Member and thank you to the witnesses today. As has been said this is a crucial hearing not only are Mental Health issues a crisis in our country, we couple that with an economic crisis. I come from a state that has a Farming Community and we seem to asides rise in the Farming Community. Add onto that transport and think about our essential workers and frontline workers and thus just the stresses and pressures there then more recent, the Racial Injustice issues that weve been facing as a country and you know that this is an important time for us to be having this conversation and to be really dealing with it. For committees of color, their persistence disparities in Mental Health and in 2018, 16 percent of africanamerican adults reported having a Mental Illness and in 2017 suicide was the second leading cause of death for African Americans ages 15 to 24 area in fact, the suicide death rate among black youth has been increasing faster than any other racial or ethnic group. I actually have legislation that im working on right now that is really taking a look also at the issues of trauma and policing in the africanamerican communityand access to Mental Health. I want to address the question to mister gross and thank you so much and also congratulations on your leadership but also on your focus on the arts as well because i do think theres a connection between Mental Health and the arts as well. And in your testimony you said quotes, trust me. Weve seen and been through more than you realize and we can and want to help. Thats what you said of the and i was wondering if you could talk a little about two things. One, we talk a lot about the stigma associated with Mental Health and the shame. Do you feel your generation is more focused on cutting help then they are on the stigma or the shame or do you feel that thats still a problem and also how does social media and theinternet contribute to that . Do students want help or is it that stigma still there . I kind of see both. Students today i feel like we kind of have set away the statement. As soon as i feel like sometimes older generations sometimes its like you are young, you dont know how you feel. I feel like sometimes you feel like we wont be understood. Our problems wont be understood because weve grown up in a unique set of times. The way we understand things is a lot different. In my perspective i think having a appears to be able to help us to these times is very important especially social media. Social media is both a good and bad thing. I see that as a place were a lot of kids feel comfortable expressing themselves to of the kids who go to the school at all the friends that understand the issues. Thats one thing so great about our generation is a lot of times we can be a a very Strong Community which we can rely on. There are so many people that ive been able to call on who are just supported me when i need it. In my perspective thats why its so important to yes, use social media and to see where trying to eliminate the stigma so working together to kind of create that bond and achieve what we are all here for. Thank you for your answer. For the doctor gellert and dr. Evans, dr. Geller will follow up as well but how could expand access to culturally competent care like h. R. 5469 do help reduce those systematic barriers, systemic barriers . What else do you recommend congress due to address these barriers . Any attempt to create services is going to help people feel like the person at the other side of the door is going to be responsive. One of the Things Congress should really consider is increasing the Mental Health block grant. Thats because you have much more flexibility within the block grant and good in the Medicare Program which is the other major funder of Mental Health services and our public system. I think the block grant gives each state the ability to have Flexible Services that are geared towards the unique Cultural Roots within their states. Thank you, dr. Evans. Dr. Geller, i have run out of time so i will yield back to the chairwoman. I thank the gentleman. She yields back. Pleasure to recognize the gentleman from ohio, mr. Johnson, for his five minutes of questions. Thank you, madam chair. Especially for giving me the opportunity to weigh in today and speak in favor of legislation that our h. E. L. P. Subcommittee is considering and you are always welcome. Thank you very much. I appreciate it. I know my friend dora matsui and i work very closely together on issues that are important to the help subcommittee and im proud today we will be talk about one of those. Even in normal times without a Global Pandemic raging around as many of our fellow americans suffer from severe anxiety, depression and Substance Use disorders. Unfortunately as weve heard in the testimony today, all of the evidence is point to the fact that covid19 is severely exacerbating these problems. I think the experts here today would agree to fight this problem effectively its imperative patients keep the regular Mental Health treatment schedule. Fortunately confiscate the Trump Administration temporary authority to waive burdensome restrictions on accessing tele Mental Health from the safety of their home. Telehealth has proven to be a convenient, effective and Popular Technology with the American People. The covid19 pandemic will end at some point and when it does what we will do with teleHealth Services, thats still a big question. Will patients and providers now taking advantage of this convenient new service be left in the lurch . You all might remember last congress the passage of the support act, wideranging legislation to combat americas Opioid Crisis. This Bipartisan Legislation which many of us worked closely on was overwhelmingly passed on the floor and included provisions to waive restrictions for Medicare Beneficiaries seeking used telehealth treatment for Substance Use disorders and occurring Mental Health needs. If we all can support teleMental Health for those with a Substance Abuse problem, and psychological issues along with a Substance Abuse, theres no logical reason why we cant finish what we started and make this care available to those with standalone Mental Health needs as well. This is what its time to pass the teleMental Health expansion act, which are introduced as a mitchard with congresswoman doris matsui. This Bipartisan Legislation will ensure that Medicare Beneficiaries can access Mental Health care, regardless of where they live or where they are able to travel. Dr. Geller, just a couple of quick questions. Let me start with you, and thank you for your support of this legislation. Dr. Evans, feel free to chime in here as well. In your experience and in the experience of your members can you quickly walk us through the consequences someone who has who is suffering from Mental Health issues a Substance Use disorder, undergoing regular therapy visits suddenly stopped showing up . Do these individuals regress from the progress they have made . Absolutely. Thats a high risk. Other risks that go along with that regression are for people with medications if they abruptly stop those medications, there can be dire consequences, lifethreatening consequences and that leads to increased rate of suicide. As i said before i strongly support your bill. Another thing nobody has mentioned today is many of you come from states where in the winter you cant get there from here. This then does that mean people miss their appointments because it doesnt depend upon the use of transportation to get those appointments. The difference i think is spoken by our members who as i said before, 64 have never used telehealth before covid19. 85 are seeing that we now and this, very little negative feedback. As i mention we have made some progress but its well known Mental Health problems and drug addiction can be related, especially during the stress of a Global Pandemic. If an individual in need of Psychiatric Care can get access to effective treatment for apps to telehealth, could this help prevent them from developing problems with Substance Abuse disorder in the future . Absolutely. It can prevent them from somebody other two before, selfmedication. Thats one of the hypotheses, or increased Substance Abuse. That is they cant get the services they need so i resort to drug and alcohol. It also can affect people who are being treated for substances in terms of increasing their use of substances despite the treatment. So for both of those populations is extremely important. Madam chair, ive exceeded my time and i thank you for your indulgence. I yield back. Thank you, mr. Johnson. The gentleman yields back. Apply should recognize the gentleman from illinois, mr. Rush, for your five minutes of questions. Thank you, madam chair. This has been a very, very important and powerful hearing that you are having. Madam chair, something of this at personal to me in a number of different ways. I have my oldest grandson right now reported to the hospital in atlanta, georgia, for mental psychiatric evaluation. Im praying for that, that he can get the help that he desperately needs, even as we speak you have all of our prayers. Certainly mine. Madam chair, im going to lament for the legislative approach and look at a broader question. Dr. Evans, let me ask you how, when you regard macro aggression and micro aggressions, that is associated with racism, accounting for the undiagnosed and untreated Mental Health status of africanamerican communities in this nation, and if you would also include your views on how does the white superiority complex contribute to ptsd of racially and gender minorities in the u. S. . I just want you to address this because our nation right now is tiptoeing on the subject of racism, and how it is completely unbearable for a significant segment of our society. I think its an issue we just cant ignore, and these are issues that are front and center. Can you address your views on my question . Sure. I think your framing of it is exactly right, that we can no longer ignore that racism has an effect on Mental Health of africanamericans. One of the things that is been hopeful about the recent dialogue is that we dont have to continue to make the case that racism has psychological impact. There are a number of scholars in psychology will documented what is called racebased traumatic stress. That is, the daily stressors that happen to africanamericans and other people of color based on their race. I want to give you quick anecdote. Recently after some of the protests i casually mentioned that i had been stopped by police. I have been patted down. My car has been searched. I have been followed, and my colleagues were surprised by that. They had no idea that any africanamerican man of my age has had that experience. Although its a universal experience. Those daily kinds of experiences that people face have cost, and that cause is in terms of stress. We do an annual survey and our survey indicated just been one month alone that we saw a 15 increase of stress that africanamericans were experiencing. This was right before the george floyd death. Its really important that we, as we look at the broader social issues around racism, that we understand there is a psychological and a physical impact that we also have to address. Could i address that just really quickly . Absolutely. Racism is a Mental Health problem for everybody. Its not just black folks. If were going to change that, white folks have to understand that it has negative consequences to their Mental Health, and may need to do something about that. Right. I absolutely agree. Stress is pandemic, especially in africanamerican communities when white folks have to understand that the privilege and the maintenance of their privilege, their status also carries with it an enormous amount of stress. And also the fact that they can look and see other american citizens who are denied the opportunity for freedom, justice and equality and also creates stress in the white communities. Madam chairman, i think my time might be up night if i had time for one final question, i would like to ask this line of questioning. I am familiar with the writings of the psychiatrist and i dont know whether or not his conclusions or his methodology or his views are pertinent to what we racial condition here and psychosis here in america. Are either of you familiar with the writings of doctor frantz and have you seen any of his work appropriate for discussion, at least here today in contemporary america . The chair which is ask that you be very succinct because it is a a man and have passed the gentlemans time. Please answer. He had a significant effect on chester pierce your chester pierce was a psychiatrist who actually came up with the concept of microaggression, so he lives today. Thank you. Thank you very much. I give can madam chair. I yield back. The gentleman yields back. The chair is pleased to welcome back to our subcommittee, ms. Schakowsky from illinois. You are recognized for five minutes per thank you so much, madam chair, for allowing me to participate today. I wanted to first give a big shout out to my dear friend Patrick Kennedy. I think that are you still here, patrick . I am here. Great to see you, too, jan. I just want to acknowledge the fact that it think you have that such an Important Role not only in conveying property from asian but eliminating stigma which is still the curse of Mental Health in many ways, and because of that thank you for saving the lives here i know that there are thousands of people were willing to accept and feel good about getting the help they need. Let me move on. By 2030 the number of psychiatrist in the United States is projected to decline by 20 from 2017 levels. Thats why i first introduced the medicare Mental Health access act in the 100 11th congress, which would allow psychologists to utilize their full scope of practice. And now judy hsu congresswoman judy chu and i are cosponsoring a bill which would do just that. And the Older Americans have a higher rate of psychotropic drug use, they are also less likely to receive any care from a psychiatrist. In my district, i want to give a shout out to dr. Kenneth sims, a psychologist from a hometown of chicago who runs a Group Practice that provide Psychological Services to residents of Nursing Homes throughout the chicago area. So much needed now. Dr. Evans, i want to ask you this. Do you believe that expanding medicares statutory definition of physicians to include psychologists would enhance the availability of help for patients that need it . Yes, i do, and im so appreciative and were so appreciative of your support of this legislation. I want to address some misinformation that we heard here today. The legislation does not try to redefine psychologists as physicians. Psychologists are not interested in that. What psychologists are interested in is being able to practice to a full extent of their training and their licensure without administrative barriers. I find it ironic that in this hearing where weve talked about needless administrative burdens requiring people jump through hoops to get services, that we would have this as an issue. The reality is that the Medicare Program is the only payer, the only payer that does this. Not medicaid, not tricare, not the v. A. , not any private payer. Requiring psychologists to have to go through a psychiatrist to get to provide services is just unconscionable at a time when our seniors are isolated. They are experiencing anxiety. They need direct services. I will just leave you with this. I get correspondence from psychologist who have experienced those barriers where a physician told a psychologist who was waiting to be able to provide services, waiting for an order from a physician, he was told to his face that the psychiatrist said to his face, i dont believe in psychotherapy. Im not going to provide that order. That is unconscionable, and we cannot allow those kind of barriers in 2020 to continue to exist. It doesnt exist in any of the program and we should not discriminate against seniors in the Medicare Program we should get the Services Just like they would if they were in private insurance, ba, or any other place. I couldnt agree with you more especially at a time when we need more, not fewer providers. For the services. Particularly first seems that everyone and all psychologists should be able to practice to the full scope of their licensing. Finally let me just ask, madam chair, i ask unanimous consent to enter a letter into the record from rosencrantz, a large and well respected Behavior Health provider serving my district that is unfortunately looking at laying off staff and closing programs. We need to help organizations like this, and we need to allow psychologists finally to be able to do a qualified work that they do. With that i yield back. Thank you. Thank the gentleman, and on your unanimous consent request, the chair announced earlier that all of the requests will be taken up en bloc at the end of the hearing. I think at least 70, so yours will be included in that. Now its a pleasure to recognize another wonderful, important wonderfully important member from the full committee who is waiting on today. The gentleman from new york and a good friend, an important legislator, mr. Tonko, you are recognized for five minutes. You need to unmute. Can you hear me . Yes. Thank you, madam chair. Thank you for allowing me to wave on and for your hosting this very important discussion. And thank you to all of our witnesses that have joined us today. Its always good to have our friends from a Mental Health Community Joining us come into my former colleague and friend representative Patrick Kennedy, welcome home. With the covid19 crisis and associated economic downturn were really facing enormous challenges when it comes to our nations Mental Health. The threat of coronavirus has instilled in so many of us and president feeling of fear and anxiety. But those living with illness or Mental Health condition, this stress must be magnified. We also know that dislocation and social isolation are key risk factors for Substance Use. Despite the heroic efforts of those in the treatment and Recovery Community during this time. We know many will become disconnected from support systems that help them stay on the path of recovery. As we were to tackle these multiple Public Health crises we must ensure that we have the Knowledge Base need to understand the scope of the challenge before us which is why i authored h. R. 6645, the covid19 Mental Health research act. This legislation would authorize 100 million annually over the next five years for the National Institutes of Mental Health to study impact of covid19 pandemic and impact it has had on the Mental Health of americans and in particular frontline Healthcare Providers. Dr. Geller, can you speak to why the covid19 pandemic presents unique Mental Health challenges and why such a Research Program would be useful in helping to calibrate our response . Its unique because we have not only infectious pandemic, we have Mental Health pandemic. You cant fix a problem if you dont know what the problem is. So the research that you are proposing be funded, which apa highly supports come with answer such questions as we know theres a disproportionate amount of covid19 and africanamericans. We know theres a disproportionate rate in hispanics. But we also know theres a disproportionate rate of covid in poor people. We need Research Just to figure out what degree is poverty account into this and what degree is the fact that africanamericans have sickle cell anemia accounting for this . If were going to fix the problem with understand the problem, and your bill will help us understand the problem. Dr. Evans, h. R. 6645 specific requires a National Institutes of Mental Health to examine the Mental Health impact that covid has had on populations that have traditionally been by Mental Health services. Can you speak specifically as to why this is an important topic to study and general have needs of underserved populations might be different than the populations at large . I have been doing research for 30 years and i am trained in excremental psychology. I will tell you one of the big challenges with a lot of research and one of the hallmark of research is you dont generalize the populations on which you have not done the research. The problem we have in our country is that we dont always have robust samples that include all the populations that we are talking about that are at great risk for some of these conditions. Thats number one that we do that. Its also important to have researchers who are from the communities that are being research can understand those communities, one, so they can design studies that would be more accurate but also so they can do the proper interpretation of that data. And finally i just want to give props to you because theyre doing this research. Something we need and one thing i would add to the kind of research they are doing, is to do much more Clinical Services research, Implementation Research that is closer to where services are being delivered. Establishing something in a lab is one thing or in in a study t what we really need our studies in real world settings can understand some of the implementation issues and making sure we take the science that we have spent money on and accurately translated into real world settings. Thank you. Congressman kennedy, in may the Census Bureau reported more than onethird of americans are Self Reporting signs of anxiety or depression, representing huge jump from prepandemic numbers. What do you think these figures mean to you and what consequences do you think well see in American Society in the years to come as a result . Thank you, paul, i thank you for your leadership both in the state legislature in new york for you came to congress and then carrying that on in congress. I cant help but think a huge uptick in the prescribing of incident has a been, benzodiazepine, coupled with huge increase in Alcohol Consumption and then of course coupled with the new commercialization of marijuana, that we dont have the kind of major tsunami of addiction that we are creating right now that is not going to be fully realized for another few years. We are still reeling from the Opioid Crisis which we never quite got our arms around, and just thinking were at the fuel to the fire. We should be very mindful of the fact this is going to get as we are discussing today a much bigger Public Health crisis going down the road. Thank you. Thank you very much. Madam chair, thank you for your leadership and i yield back. The gentleman yields back. Its a pleasure to recognize the gentleman from california, mr. Peters. Welcome. You are part of the committee. Its wonderful to have you with us today. So five minutes for your questions. Thank you very much madam chairman thanks thinks drivings important hearing. Today im considering critical those to improve americas Mental Health. Hearings like this is a importance of the members and make now when the coronavirus is taking a mental and emotional toll on every single american. Im thankful and grateful my vipers and bill brings awareness to national delivered to universal prevention act or the standup act included in todays hearing and what to think mr. Bilirakis for introducing this bill with me. It will help combat suicide. Since 2010 suicide has been the second leading cause of death among youth and young people between the ages of ten and 24. A study published in october 20, 2000 adolescent suicide rates for young people aged 12 to 19 increased by 87 from 20072017. 87 in one decade. This concerning rise in suicide coupled with other senseless deaths like shootings and acts of violence in School Points to a serious Public Health crisis that was long before the covid19 pandemic. There is no question covid19 will influence the Mental Health of our nations children. Students having separate from their friends, classes and would all like a mini and the future is uncertain. These turbulent circumstances excess of the stressors Mental Health challenges and heightened risk of suicide. Adolescent suicide and violence against others is preventable. 70 of people who die by suicide tell someone in their plan or demonstrate warning signs, and 80 of School School shooters tell some of their plans prior to acting. However, youth and adults need to recognize the warning signs and know how they can intervene. Trainings help educate and empower students to know the signs of Suicidal Ideation and connecting connect into the care that they need. Standup act would do just that. Its supported by Sandy Hook Promise, and this bill would require states, Public Schools and tries to influence common sense evidencebased policy to prevent suicides in order to receive project awareness grants which promote Mental Health Awareness Among schools and communities. We have to prioritize early prevention, give educators administrate the tools to stop violence before it happens. I visited the school last november in my district where a Sandy Hook Promise to get administered training which displayed at the standup act would be limited and white so important we give students the tools they need to help peers that may be struggling to in addition to Sandy Hook Promise the standup act is back over 50 organizations including all of the witnesses here today, thank you very much. The American Foundation for Suicide Prevention, the National Association of school psychologists. Madam chair, i i would add a matter of record to support for these administrations, and these are organizations to list the things for the record to be considered later. It will be on blanche with the other unanimous consent requests. And and i want to thank my fw Committee Members for supporting this bill. Just some brief questions for ms. Gross will want to thank for speaking about the students today. You mention you were trained as a Save Promise Club emmett till identify those warning signs, talking to peers, talking to adults. I question is does your school provide any type of Suicide Prevention or Mental Health prevention training to all students in your school outside of the Save Promise Club . And if not how do you think your school could train all students . Thank you, and do you want to thank you for leading this act. Its so important for youth today. My school actually does not have any programs that focus on our wellbeing or offer students the help outside of school. That leaves a lot of since had to go out on the vote and go seek help. That can be hard for a lot of people especially. I had to travel two hours to go seek help. One way i think they could do this is simply by taking on bit of time at the beginning of the school year, how a lot of times we do Career Training for something similar to that, introductions to your class and things like that, take just a bit of that time and teach people how to others. I think that would be most effective. You mention students are struggling during covid. Could you talk more about what its like to be a High School Student in class is going virtual and the challenges you have senior classmates struggle with . I dont every much time so maybe you could be brief. Right. For me, i have trouble focusing outside the classroom. I know its particularly hard for cnet because they dont get a prompt if they dont get to graduate and so and trent for the caps in the event the excited with the list that all use with. It something missing out on. The stand at and getting mental a professional schools that students can rely on and give them access to what the need that most definitely allow kids to cope with these hard times. Great. Thank you very much. Thanks for being here, everyone and madam chair, thank you for r your leadership and i yield bac back. The time of the gentleman has expired, and i think we are nearing the end of our hearing. Last but not least, the very gentleman from arizona, mr. Moran. Thank you for joining us today waiting on mr. Ohalleran and pick you five minutes for questions. Thank you, madam chair. I appreciate the opportunity to waive onto the committee. On this critical issue i worked on parity when i was in the legislature for year after year after year. Im still sad to see that it is not being addressed in the appropriate way. I also we need to change that. Yes. Covid19 has expose something that those of us living in Rural America have known for a long time. We have a shortage of psychiatrists, psychologists, therapists and other important mentalhealth professionals and support groups. Telehealth can help but broadband speeds are still too slow in many parts of my district and in many places telehealth should not fully or cannot fully replace the ability for patients and the physician to see each other with their provider. According to the Rural Health Information hub, supported by hhs and her son, 14 of the counties in arizona are designated a shortage of area for Mental Health professionals. This is not a new issue. This shortage business but real america having a high prevalence of Mental Health issues including Substance Abuse disorders, in urban areas. High levels of poverty, food insecurity, and over time people suffer in silence and lack of providers, the Early Intervention in peoples Mental Health more challenging. This pandemic is going to be the footprint into the future. The issues on tribal lands are even more stark. In fact, for young americans, indian and alaskan native people ages 1534, the Youth Suicide rate is 1. 5 times higher than the national average. There are tribal communities where that rate is ten times the national average. For this reason i helped lead h. R. 1191, the native american Suicide Prevention act. This bill ensures that states work with tribes and native americans organizations to ensure that statewide Suicide Prevention programs are actually culturally sensitive and effective. This legislation i hope this Committee Considers in the future. As i mentioned earlier rural areas have higher rates of suicide, high rates of Mental Health issues, and high rates of Substance Abuse. Dr. Evans and dr. Geller, we have talked about these problems the route the hearing, throughout decades. But in your opinion how do we best insure providers practice in in these rural and tribal areas . What can congress, the administration and even the medical community itself do to help solve these problems . I think of a few things. One is we are partnering with samhsa to train providers on the unique issues of people and rural communities. Just like different ethnic groups have culture, there is a cultural perspective for people who live in rural areas, and Mental Health professionals need to know how to work with those communities. I spent some time last year with farm aid, and one of the things many people dont actually recognize is that farmers are experiencing a significant crisis, unlike any crisis that weve seen in the have much higher suicide rates. I think we have to Pay Attention to come if the legislation does it. We havent to remove administrative barriers that make it hard for practitioners to practice in those areas. And we have to make sure that people have the incentives, financial incentives. Thats one of the reasons we are very supportive of h. R. 884 which provides financial incentives to afford psychologists to work in these underserved areas come not only in Rural America but underserved communities and urban areas and suburban areas as well. Daca, think youre an much. Dr. Geller, im going your questions. Madam chair, i yield. The gentleman yield back. We thank him for joining us. Are there any other members that have joined us that were not recognized earlier . Not hearing anyone. For the benefit of the members, i want to remind them that pursuant to committee rules, each member has ten Business Days to submit additional questions for the record to be answered by the witnesses. To the witnesses, i ask that you respond as probably as possible to any questions that are submitted to you. I want to thank each one of the witnesses. Let me start with the youngest. Arianna, youre just hit the ball out of the park. You have really explained to us exactly the way it is on the ground in your time, and your life, and that of your peers if we have learned a great deal from you. We are going to build on it and use your testimony to improve the system for young people across our country. Dear patrick, dear patrick, i dont know if you can see behind me but that portrait is right here with me. He is with me every day, and i think that he, hes always been proud of you, but today exceedingly proud of you. You have given us testimony both from the outside understand how the inside works. And so what you have said, what you have shared with us is invaluable. Thank you for raising the point about the green berets. Very few people think the green berets would ever need, have any issues relative to Mental Health. This expands across humanity, across humanity. A friend of mine just alerted me to something last evening, and that is that there is going to be a powerful and revealing documentary on hbo entitled the weight of gold. And that documentary is going to explore the Mental Health challenges with deeply personal details about olympic sports figures. Now who would have thought of that . But when you mention the green berets, i thought of this, that i just learned about last evening. So i want to acknowledge one of the executive directors, michael lynchburg advise me of that. We are going to take what you have given to us, patrick, and really likes you for spending well over, each one of you come over for hours with us. This is one of the longest hearings the subcommittee i think its ever had, at least since ive been chair. But every second, every second has been really 18 karat gold because we have learned from you and were going to build on it. Patrick, you are always welcome to be with us, and we are especially grateful to you today. To bulk of the doctors, youve given us magnificent testimony, not only your years of experience, which is on hold display, but also your depth and breadth of knowledge. Because you practice medicine, and so you see it and you feel it and you treat it firsthand. To dr. Evans, thank you for doing even layers deeper to demonstrate the curse of racism and the toll it takes on the entire human being. And we will certainly be taking all of that into consideration with the bills that have been written by members. So to the four witnesses, you have broadened and enhanced our thinking. I think you have been highly instructive to the American People today, that have listened and watched. I would ask, i know that you will keep yourself available so that in the interim period as we are looking to market these bills up, the any additional advice that members may have, that they be able to access that from you because you have just been so outstanding. I will just in on this note, and it was one of the things i sit in my Opening Statement, that with the enormous challenges, i mean just extraordinary, breathtaking challenges, our country has today, i think that we need to view them as opportunities. That we can right the wrongs in our society, that we can address full health of all americans, and that when we do that, that we are saying that the real is justice for all. And then finally i think that when we are called and judged, that we will be judged on how we cared for each other. And i think more than anything else thats what the hearing was about today. I think each one of you. I would like to ask the Ranking Member if he will join in a unanimous consent request, because we have 69 documents, mr. Griffith, and i dont think you want him to go through every single one of them. They are all important. Every member has what they put in, the obviously feel very strongly about. We want that to be part of the record, so will you join me in unanimous consent request to approve what has been entered for all the documents that it been entered into the record . Yes, maam. Thats wonderful. I have to buy you a nice ice cream sundae or something for that. Well, thank you to all of the witnesses. Bless you. Thank you to the members, your excellent questions, all the time you gave us today. And with that the h. E. L. P. Subcommittee and the house of representatives [inaudible] gk. I was just saying goodbye to patrick. Goodbye and thank you to everyone. I i thought i mightve done something wrong. I see that congresswoman rochester is still with us, g. They are waiting saying thank you. Clean slate bill. Thank you, thank you. Wonderful. Wonderful to be together. God bless all of you. God bless our country. May we do the right thing for it. Byebye, everyone. Thank you. Love you. Thank you. The committee is now adjourned. Coming up the Washington Post is hosting a discussion on the evangelical vote in in the0 election. Live coverage at 1 p. M. Eastern. After that a look at how technology is helping the black lives Matter Movement and other activist groups. You can see that by the 2 p. M. Eastern. The u. S. Senate will gavel in at 3 p. M. Debating the nomination of u. S. District judge in california. You can watch live Senate Coverage here on cspan2. Tonight on the communicators , netflix foundr and Ceo Reed Hastings and business professor erin meyer discuss the an orthodox Workplace Culture behind one of the Largest Tech Companies in the world in the book no rules rules. You have to do what you think is right to help the customers and the company. You cant be trying to please your boss, me. You are not allowed to let me drive the bus off the cliff. You have to fight for the benefit of the company. In general we say dont seek to please your boss. Seek to please the customers and to grow the company. So we want people to actively think independently, not just to implement their bosses wishes. Watch the communicators tonight at eight eastern on cspan2. There are 50 days until election day 2020. His headline from the front page of usa today with 50 days election day voters are anxious, where it of it trump and biden