Chair Sanders Senate committee on health, education, labor, and pensions will come to order. And were delighted to welcome our panelists who were going to hear from in a few minutes. Let me begin by telling everybody what they already know and that is it is no great secret that in America Today we have a Mental Health crisis and that crisis has been exacerbated by the horrific covid pandemic, which we have experienced. And this is a crisis that has hit all of us, but i think especially the younger generation. In America Today, 40 of parents report being either very or extremely worried that their child is struggling with anxiety or depression. According to a recent survey by the centers for disease control, nearly one out of every three teenagers in america reported that the state of their Mental Health was poor. Two out of every five teenagers felt persistently sad or hopeless. And tragically one out of every five teenagers in our country have seriously considered suicide. How frightening is that . Tragically, suicide was the second leading cause of death for young people between the ages of 10 and 14. And it was the third leading cause of death among teenagers. All of us understand that the pandemic has had a huge and Lasting Impact on the Mental Health and wellbeing of our country and our young people. Let us never forget sometimes its easy to forget we remember the Million People who died during the pandemic, but over 200,000 children, often children of color, by the way, lost one or both of their parents to covid. And think about the impact thats that had on their lives. Further and i think were going to hear more about this later. Our kids have become less connected humanly to each other. This is kind of a new phenomenon, and dr. Murthy has written about this and im sure will be speaking about it this morning. Instead of building trustee, health trusty, healthy relationships with their friends, teachers, mentors. Increasingly, children are turning to their phones and social media to feel connected. And what kind of impact does social media have on the Mental Health of our nations youth . Thats an issue that we got to explore at Great Lengths as a nation. According to a recent study, 32 of teen girls said that when they felt bad about their bodies, instagram made them feel worse. More than 40 of instagram users who reported feeling unattractive said that the feeling began on instagram. About 25 of teenagers who reported feeling not good enough, inadequate, said it started on instagram. Im sure the same can be said about other social media platforms. And lets be clear. And something i think this committee in months ahead will get into. We are up against some of the best minds in the world who keep coming up with new ways to get teenagers addicted, addicted to their websites in order to sell them more products and make more money. And thats what we are going to have to address. But its not just social media. As dangerous as that may be. Kids in vermont and ive been around to a lot of high schools, some Community Colleges in my state. But around this country as well, worry about the kind of future that awaits them. They wonder if their political leaders in this country and around the world will address Climate Change or whether the world that they and their kids will grow up in be increasingly unhealthy and uninhabitable. And i really do wonder, walking here today through the smog and the smoke that washington, d. C. , is experiencing right now, how in new york city its a bad day but you wonder what impact it has on the kids who wonder, is this the future for they . And what that does to them psychologically. Yesterday, on another issue, i had the occasion to meet with people who came to the capitol who lost loved ones as a result of gun violence in schools. And i was stunned. In vermont where kids worry when you were young you went to school. It was a safe haven. Now they wonder if some terrible thing might happen. And when we talk about the anxieties facing young people, we cant ignore economics. Everything being equal if we dont get our act together, the young people will have a lower standard of living than their parents. Right now 60 are struggling paychecktopaycheck. All i have to say is the pandemic has exacerbated a bad situation. It is there. As political leaders in our country, its our job to address it. Senator cassidy, the mic is yours. Senator cassidy thank you, mr. Chairman. Everybody here knows a fellow american struggling with Mental Health issues. Everybody watching knows. School closures, isolation from the covid19 pandemic exacerbated, almost concentrated this among those who are younger. According to the c. D. C. From 2021 to 2022, the percent of teenagers that felt sad or hopeless increased to 42 . Those considering suicide, seriously considering suicide goes from 19 to 22 . To say its troubling is the kind of not have an adequate adjective. This is terrible. The goal of this hearing is how do we improve access to quality Mental Health care for young people. We must highlight that congress has done a lot in recent years to improve Mental Health care and access to children and all americans. We have walked this ground. We need to see what our recent work has accomplished, need to measure its effectiveness, and then to figure out what gaps remain. Now, just for context, we know this for decades the nations Mental Health system was dysfunctional, underresourced, not getting Crucial Services to americans who were facing Mental Health issues, especially those in underserved areas. I worked in a hospital for the uninsured and the underinsured for 25 years. I worked with this. Now, before i go on, let me give a shout out to senator chris murphy. He and i will 2015 led the Mental Health act, a historic bill to increase access to quality Mental Health care for all americans. And i remember chris at that time saying, bill, theres some things we agree on, a lot of, and a few we disagree. Lets focus on that which we agree and leave the other for another day. And by that we did something which lamar alexander, then the chair of this committee, said he didnt think two freshman senators could do. It was both an insult and praise in there. [laughter] but we accomplished it. And lamar went on to say it was the most profound most profound reform of Mental Health law in the previous 30 years and we were both honored. Now, we teamed up again this past year to reauthorize this and to reform it to better address the needs of americans. We increased funding for Mental Health block grants to better serve children at risk for serious Mental Illness, expanded telehealth care and increased Mental Health workforce programs, focusing on treating children in underserved populations. And i could go on. Now, additionally and again, im going to give a shout out to murphy once more. In response to the tragedy in uvalde, Congress Passed the bipartisan Safer Communities act which invested a billion dollars to children can have access to Mental Health care whether theyre in a pediatrician office, school, emergency room or Mental Health center. I had the privilege to work with him. Congress passed it. The legislation invested 8. 6 billion to expand Certified CommunityBehavioral Health clinics to all 50 states, offering 24 7 Crisis Intervention Services, outpatient Mental Health, and Substance Abuse services, case management, increasing access to primary care for americans, especially those who are lower income and uninsured. It provided 2 billion for schoolbased Mental Health treatment to Train School Personnel to better help students through a crisis, to increase care for children suffering from trauma, to Fund Prevention programs, to decrease bullying and violence at school and much more. Additionally, the Safer Communities act instructed the department of education and the department of health and Human Services, both represented here today, to improve guidance to schools, particularly those in local excuse me in small or Rural Communities to more easily build medicaid for schoolbased Mental Health services. And well talk and hear more about that during the first panel. Im proud of the work that congress put into this legislation and signed into law, and these achievements show there is a strong bipartisan support for addressing youth Mental Health issues. But and i say this all the time at home these grants and programs only make a difference if state and local government are aware of them and apply and show local leadership in order to participate. We need this local leadership to use these resources to make sure the assistance reaches those who need it most. What we cant do is pretend that congress hasnt done anything and that we must start anew. That, sweeping the debt clean so to speak in our minds, not acknowledging the base upon which we build, will create duplicate, inefficient programs, wasting dollars and wasting effort. By the way, the chair just echoing the chair, and i agree wholeheartedly, the resource Congress Appropriates should not be wasted. Now, congress cant solve this on its own. Throwing money at an issue without accountability is not the solution. There has to be complete buyin from the executive, from states, local government, tribal leaders and Community Organizations, among others to make sure these programs work, as congress intended. There is legislation up for reauthorization that requires attention. As i mentioned in the last weeks hearing, they have nine Health Care Authorizations awaiting for programs that expire in september. One of these is the support act, which helps individuals that is dealing with Substance Abuse disorder and increases help for those children suffering from trauma. There are 50 individual provisions in the support act that falls in this committees jurisdiction. The fact that the committee has two months left to reauthorize the programs and we have not considered bipartisan text, let alone marked them up, is concerning. I reiterate reauthorizing the support act and these other eight healthrelated bills on time, bipartisan must be the committees top priority. As Ranking Member of the committee, improving our federal programs so theyre more effective and having greater reach is crucial. So let me finish by saying i look forward to hearing from our witnesses as we can better address the Mental Health crisis to make sure more young people have access to quality Mental Health and that the resources already allocated are used effectively. Thank you. I yield. Chair sanders thank you, senator cassidy. Now were going to hear from our witnesses. Our first witness will be vice admiral vivek murthy who is the Surgeon General of the United States of america. In my view, dr. Vivek, has done an extraordinary job in talking about the Mental Health crisis and the crisis of loneliness and many, many other issues. Dr. Vivek, thanks very much for being with us. Murthy. Dr. Murthy thank you so much, chairman sanders, and thank you Ranking Member cassidy for your work on issues related to mental haegs health. Im dr. Vivek murthy. I have the pleasure of surging as serving as Surgeon General. Im most importantly here as a father of two Young Children who is concerned about their future and the future of kids across america. And im here to speak about what i believe is the defying Public Health issue of our time and thats the youth Mental Health crisis. It now threatens the health and wellbeing for millions of our children. In 2021, more than two in five High School Students, including almost 60 of girls and 70 of lgbtq youth reported feeling persistently sad or hopeless. Nearly one in five High School Students reported making a suicide plan. And this followed a 57 increase in the suicide rate among young people in the decade prior to the pandemic. In response to this crisis in december, 2021, i issued a Surgeon Generals advisory on protecting youth Mental Health. And i did this to call our nations attention to this urgent issue and for the need to act. Over the last two years, im grateful that congress in a bipartisan basis and the Biden Administration have made unprecedented investments to strengthen the Mental Health care system and to connect more youth to care. And these investments have already started to help children and families. But as all of you know, we have much more to do. Last month my Office Released two new Surgeon Generals advisories. One on our epidemic of loneliness and isolation and the other on social media and youth Mental Health. Together, they explore two important drivers of the Mental Health crisis. Regarding loneliness and isolation, we now understand that social disconnection is both exceedingly common and profoundly consequential. About one in two adults are reporting measurable levels of loneliness and social disconnection is an increased risk of not only depression, anxiety and suicide, but also heart disease, dementia, stroke, and premature death. The loneliness epidemic has hit young people particularly hard and they have the highest rates of loneliness across age groups. The time young people ages 15 through 24 spend in person with friends declined by more than 50 from 2003 to 2019. Furthermore, theres been a decline in participation over the last half century in Community Organizations that are traditionally brought us together including faith organizations and recreational leagues. Second, though, im increasingly concerned about the harmful impact that social media is having on youth Mental Health. Despite universal use theres inadequate evidence to say it is helping children. There is growing evidence to associate social media with as lessent harm. When their particularly susceptible to peer comparison, the data show youth who spend more than three hours a day on social media face double the risk of experiencing symptoms of depression and anxiety. This is deeply worrisome because on average teenagers are spending 3 1 2 hours a day on social media. Excessive social media use can disrupt activities that are essential for Healthy Development like physical activity, sleep, and inperson interactions. For example, a third of adolescents are telling us they stay up until midnight or later on week nights in front of their screens. And much of that is in fact social media use. In addition too often kids on social media are exposed to extreme, inappropriate and harmful content. Indeed nearly half of adolescents are saying social media makes them feel worse about their bodies. Two other drivers of youth Mental Health crisis that i just want to note briefly, one is trauma, which has become all too common in young peoples lives, particularly from violence and abuse and the loss of loved ones, incarceration, addiction and death. When they go through these childhood experiences we know it has an impact on their physical and Mental Health. Their confidence in the future has been undermined by the serious challenges they are set to inherit from economic inequality and Climate Change to racism and gun violence. This is what they say to me time and time again when i meet with young people around the country. The bottom line, our kids cant afford to wait longer for us to address the youth Mental Health crisis. We need to expand our efforts to make sure every child has access to highquality, affordable, culturally competent Mental Health care. But we must also tackle the root causes by addressing the potential harms of social media through age appropriate health and Safety Standards and data transparency requirements, by investing in schoolbased programs that equip children with the t