Help . We could hone in on that question and see what the federal government can do to improve our ability to determine who needs help and our ability to identify the person or agency whose job it is to provide the help, and then we will have provided some service. It helps to put a face on who needs help. As a former governor, i look at things from my background and perspective, as i know most of us do. About 22 of tennesseeans reported having a Mental Illness last year. That is more than 1 Million People. This is according to our state department of Mental Health. About 5 had a severe Mental Illness. That is nearly 250,000 tennesseeans. That is a lot of people. About 40,000 had a major depressive episode. The funding that helps meet the needs for that comes in some part from the federal government. About 22 of what tennessee spends, im told, is federal dollars. The rest is state dollars. In Community Services, state appropriations are about 70 of the Mental Health fund. While the State Government has a role, it is a support role, and it ought to make things easier instead of harder. In preparing for this, it seems to me that putting a face on the individuals that need help one group would be a 9yearold boy, who has always been pleasant but suddenly started defying his teachers. His grades slipped, and he did not want to go to boy scouts, did not want to play with his friends, so they reached out to a pediatrician who was able to get professional assistance. He was diagnosed with a mood disorder, and he began to improve and was sleeping better, so it was a success story. Another case might be a 17year old who had no behavioral issues growing up. He started noticing lights in the bathroom. Sounds of water irritating him. He began having trouble sleeping. He began to hear voices telling him to throw rocks at people. He was finally diagnosed with schizophrenia, but only after he had multiple episodes. Those boys represent two of the largest groups that need help, and i will be interested in finding out from our witnesses how well we are doing in helping them get the help. Finally, i will be especially interested in asking federal agencies as well as state and local witnesses that are here what we can do at the federal level to make things easier to identify who needs help and who can provide the help. Are there administrative things we can do . Are there funding things we can do . Are we putting up roadblocks that make it harder for you to provide services . If we are, this is the place to identify them and see if we can correct them. Mr. Chairman, i look forward to this, and i thank you for holding the hearing. Thank you very much so, senator alexander. Now we will turn to our witnesses. On our first panel, we start with pamela hyde, the administrator of the Substance Abuse and Mental Health services administration. Ms. Hyde was nominated by president obama and confirmed by the u. S. Senate in 2009 as the administrator of samhsa. She has served as a state Mental Health director, state Human Services director, city housing and Human Services director, as well as ceo of a private, nonprofit managed Behavioral Health firm. She is a member of or has served as consultant to Many National organizations including the john d. And catherine t. Macarthur foundation, the American College of Mental Health administration, and the United States department of justice. Our second witness is no stranger to this committee. Dr. Thomas insel, director of the National Institute of Mental Health at the National Institutes of health. He has been director since the fall of 2002. Prior to that, he was professor of psychiatry at emory university, and he was the founding director for the center of behavioral neuroscience, one of the largest science and Behavioral Centers funded by the National Science foundation. He has published over 250 scientific articles and four books, including biology of parental care in 2003. He is a fellow at the college of narrow psychopharmacology neuropsychopharmacology there i said it. We thank you both for your background, for what you have done in this area of Mental Health, both in research and practicality, and your statements will be made part of the record in their entirety. I would ask we will start with ms. Hyde. I will ask if you could sum it up in five, seven, eight minutes, Something Like that. Then we will get to questions. Thank you for holding this hearing today. It is an important day. You will hear today about the prevalence and burden of Mental Illness and the critical needs in our country for understanding treatment and support services for those who experience Mental Health conditions. Samhsas mission is to reduce the impact of Substance Abuse and Mental Illness on american communities, and there is significant overlap between those sets of conditions. They currently exist largely outside the mainstream of American Health care with different histories, structures, funding, incentives, practitioners, and even in some cases, different governing loss. It is time that changes. Behavioral health is really essential to health, that mental and Emotional Health and freedom from Substance Abuse and addiction are necessary for an individual, a family, or a community to be healthy. Almost half of all americans will experience symptoms of mental or Substance Abuse disorders in their lifetime, and yet, of the 45 million adults with any Mental Illness in a given year, only 38. 5 of them receive the treatment they need. Of the almost 22 million adults with Substance Abuse disorders, only 11 receive the treatment they need. For children and adolescents, only about one in five receive the treatment they need. Cost, access, and recognition of the problems this treatment are the primary reasons this treatment is not received. But it does not have to be this way. Treatment is effective, and people do recover. The institute of medicine reported in 2009 that half of adult Mental Illness begins before the age of 14, and 3 4 before the age of 24. We can and must intervene early to address these issues for our young people and for our nation. Behavioral health is a public issue, not a social issue, and it can be tackled and addressed in an Effective Public Health approach, driven by data, focus on prevention, and support of policies that treat and restored to health. I would like to talk about the Affordable Care act for a minute because it will provide one of the largest expansions of Mental Health and Substance Abuse coverage in a generation, by helping over 65 million americans have access to additional Behavioral Health benefits that they do not have now. They have already prescribe it it has already provided screening for depression, suicide, and added many programs in its quality measures and has added additional coverage opportunities for youth. It will ensure that Insurance Plans offer coverage at parity with other benefits and as one of the 10 essential health categories. As part of the president s plan to protect children and communities, he outlines specific actions and initiatives to help ensure adequate coverage of Mental Health and Addiction Services. The administration issued a letter to state health officials, making it clear that Medicaid Expansion plans must comply with the parity requirements of the Mental Health parity and addictions equity act of 2008. In addition, the administration will issue final regulations governing how existing health plans that offer Mental Health and Addiction Services must cover them at parity. The president s initiatives to ensure students and young adults receive treatment for Mental Health issues includes samhsa lead proposals such as a new program called project aware, which would bring together state officials, schools, communities, families, and youth, to promote safety, prevent violence, and identify Mental Health conditions early and provide treatment. A proposed new Grant Program would provide a pilot to model innovative state and Community Based initiatives and strategies, supporting young people ages 16 to 25. The president s workforce proposal would provide training for more than 5000 additional Mental Health professionals to serve students and young adults. Finally, with the department of education, hhs will soon launch what we are calling a National Dialogue on Mental Health to help change the conversation and galvanize action about our childrens Mental Health. We have come a long way in the prevention, treatment, and Recovery Support for mental and addictive disorders, but we have a long way to go, and we can do better. Thank you for your time today, and i would be very pleased to answer any questions you may have. Thank you very much. Now we will turn to dr. Insel. Welcome, once again. Please proceed. Thank you, mr. Chairman, Ranking Member alexander, and members of the committee. It is a real honor to be here, and it is a real pairing to have hyde administrator hyde and me on the same panel. As a person coming to you from the National Institute of Mental Health and the National Institutes of health, my role is around the Research Related to Mental Illness and thinking about how to come up with the science that will lead to better diagnostics, better therapeutics, a better understanding of what you called a silent epidemic, and that is an interesting term for this. I know we have not met for some years to talk about this, so it is particularly for us important to get this out on the agenda. It is clear that in some ways this is a response to the response to the tragic event that happened in december in newtown, connecticut, and if it takes an event like that to focus the nations attention on the needs of those with Mental Illness, it is terrible to say that, but at least perhaps one of the opportunities that can be taken now is to think about how we do better by those with Mental Illness and how we make sure that events like this do not happen again. I will not read my testimony, and to save time, i think we are both eager to get to your questions, but perhaps to preempt some of those questions, let me take a couple of minutes to discuss what might help in terms of how we think about Mental Illness some of the definitions and science as we understand it. First of all, very common disorders depression, ptsd, eating disorders, and many others there are about 10 or 12 that we focus on these are real illnesses with real treatments, and they affect about one in five americans overall, including youth, as we will say in a moment. Today, we will probably talk seriously about serious Mental Illness, a term for those people that are severely disabled, often by a psychotic illness, which occurs perhaps in about one in 20, so it is not quite as common, but it is an important piece of the story we need to talk about because these are the people who are most severely impaired. As pam mentioned and was already mentioned by you, senator, it is critical to understand that unlike talking about cancer and diabetes and Heart Disease, when we talk about Mental Illness, we are talking about illnesses that began early in life. These are in fact chronic disorders of young people, and it requires a different mindset when you think about how you detect, intervene, make sure that you can make a difference. That is one of the reasons these disorders have the highest disability rating or the highest morbidity overall because they start early and tend to be chronic. We know these are treatable disorders, but there is a significant delay in getting treatment, and even those young people who have these most severe illnesses like schizophrenia on average, the delay between the onset of symptoms and when they get diagnosed and treated is somewhere between one or two years, which seems extraordinary because you are talking about a sentence that seem disabling and obvious. It is especially unfortunate because weve learned that the secret to having the best outcomes is Early Detection and Early Intervention. That is what Biomedical Research has taught us. You have to get early you have to get there early in the process if you want people to have the best outcome, and we do not do that here. One of the things we need to talk about, going back to your comments about who needs help and who will be responsible for providing help, is why the delay . How do we do better in making sure people get involved earlier in the process . Just a comment about violence and Mental Illness because it will come up, i think it is on a lot of peoples minds most violence has nothing to do with Mental Illness, and most people with Mental Illness are not violent. In fact, we generally worry more about people with Mental Illness being the victims, not the perpetrators of violence. The science certainly supports that. There are two conditions where we do need to think about this. Violence and Mental Illness will intersect. One of those is the psychotic illnesses like schizophrenia that start early, usually adolescence. People who have not received treatment are at greater risk for violence, either because they are paranoid and rationally feel they are under attack, or sometimes because of hallucinations or voices telling them to do something horrific, as you mentioned with your example, senator alexander. Far more common is the second issue, violence against the self. Suicide is a far more common problem. 38,000 suicides in the country each year that is more than one every 15 minutes. 90 of these involve Mental Illness. By contrast, there are less than 17,000 homicides with less than 5 involving Mental Illness. When we talk about violence and Mental Illness, when we talk about safety and security, when we talk about access to means or duty, the primary objective is protecting people with Mental Illness, appears, and community. Theres a lot to be done. It is more still art than science, and i would say that is true, by the way, of heart attacks as well as cancer. But even without being 100 certain on the predictions at the individual level, we can do a lot towards prevention, and you will hear about that in the conversation today. At nimh, we spent much of our investments focusing on Mental Illness before psychosis begins, the way we do today with cancer and Heart Disease and thinking about how to intervene early. I will stop there, except to say that this is an extraordinary time in terms of the science of Mental Illness. We are in the middle of a revolution because of what we are learning about the brain. We think of each of these disorders as brain disorders. We think about our interventions in terms of how they affect individual brain circuits. We have made tremendous strides over the last 50 years you cited president kennedys launching of the Community Health program, which began with congress on february 5, 1963. We are almost exactly at the 50year anniversary. A lot has happened at that time, but we have a long way to go. I look forward to your questions about how we can do better going forward. Thank you. I will start a round of five minute questions. I just want to again focus on the