mental health has no boundaries and so he is spearheading a family helping families in mental health crisis act and so i'm very proud to turn the microphone over to and dear to all of you for whatever reason that is what i want to do is walk to the history of this legislation where we see what is in it and where we stand with all this so we get some sense of where we're going with this just  a curious thing how many of you are in a profession of mental health workers ok good and the rest of you whatever reason you're here which i'll leave it at that but let's talk through this so let's see if this works subcommittee of the committee on energy and commerce energy and commerce also covers health and right away you may recall the senate started talking right about gun control what guns look like how many bullets in a magazine i said wait a min let's talk about what's going on their heads their hearts now it's in their hands the senate course didn't get anywhere with that but i did a systematic review of all federal programs policies and spending we had over twenty hearings forms roundtables in twelve states action going on my thirteen to fourteen state next week twenty cities hundreds of meetings interviews document reviews to government accountability office reports g a o reports one report by office of management budget and we just intensely went through this now this has never been done before never in terms of taking this much of a deep dive in the results were pretty shocking to me so let's see them get us to work so overall we know the sixty million americans with some level of mental illness forty three million adults seventeen million children and ten million adults with serious mental illness schizophrenia bipolar schizoaffective disorder cetera about four million of these folks receive no care at all and there's multiple reasons for that many times they can't get care but also about forty metacognition to know that we know and some just don't have any idea this is critically important and a wall i frequently ran into when members of congress and outside groups would say well if they don't want to care you just leave it at that and if someone doesn't want help you just ignore them and i said no they may not know and then you know someone for example severely depressed has already made a decision their mind to give up and once someone starts down that road they're not really dealing with a reality anymore this is pretty amazing one hundred thousand new cases psychosis every year now let's compare this to other things about thirty thousand cases of the flu and our nation has a massive campaign to  terrible virus insidious terrible what it does we're pumping billions of dollars into that now the number of cases of aids of heart disease everything is nothing really compares to what happens here in the let me show you the more so we phoned in likely to have high blood pressure and anti psychotics particularly second generation anti psychotics let me take increase or diabetes and cardiovascular disease now this alone tells you that this is going to be very expensive in the medical field and a lot of concern needed to go back to that point member said forty percent of people are not aware they're not just denying the not aware they have an illness and so you say no those voices you hear are not real you don't hear them you must be in collusion with someone else and don't understand i really hear those voices so many times and they also will not seek other medical care we also found when it comes to minorities our nation's a disaster african americans are half as likely to get psychiatric treatment it's amazing  forty percent lower for african americans and twenty five percent lower for latinos so start to build a picture based on your race your culture your location it's very very tough so where do you think these people end up in jail exactly that's what we have done to people i'm going to build on that little to show you more of this is so what we find of mental illness rates among in sixty four so over two thirds of people local jail over half of those in a state prison and almost half of those in federal prison are deal with mental illness the mental inmates cost taxpayers three times more than those without a mental illness and actually what happened is many times will tend to spend three to four times longer in jail and many times that's because some with mental illness may also get in prison fight may be teased by other inmates they have another crime they attack a guard there and so they have things they may have gone in with shoplifting charges and now they have a felony assault against a police officer incarcerating some with mental illness according to arkansas study is twenty times more expensive than community based treatment and over eighty percent of mentally ill when they get into jail get no care and seventy percent of people in jail with serious mental illness also have a co occurring substance use disorder so let's so let's build a picture get minority or or whatever you're not going to get much care and what happens is very often we end up arresting people instead of taking care of them and when they get into jail it's incredibly expensive so think of this if a person commits a crime a judge sentences someone in the state or county has to provide a jail cell but if someone is diagnosed with a mental illness nobody has to do anything now on the other hand if you show up an emergency room with chest pains the hospital by law must treat you they must treat you whatever that is for an emergency no they don't have to keep you in there if you don't want to stay but the issue with mental illness is if we don't give people care it gets worse and they become part of this now not only the jails where they may take an act of the four to six times more likely to be the victim of sexual violence to an after poor times more likely to be the victim of physical attack or muggings more likely to be victims of a scam and children with disabilities of four times more likely to be victims of some sort of an attack many times of sexual assault in a one third of homeless americans have a serious mental illness the majority of mentally ill have some level mental illness but we're talking one in three homeless schizophrenia bipolar serious depression etc i was recently in denver colorado where they legalized marijuana i think it's an absolute disaster i went on the flight over there i asked i'm sitting next to some woman who was from denver and i said what's the old psychiatric hospital because every city every state has some old psychiatric hospital words people go there for psychiatric treatment she says the sixteenth street mall so that's a street they've closed off right so it's beautiful trees and artwork and so i said i'm going to go see what she's talking about and the street was many many i can count scores of people stand there shouting at the trees talking themselves people smoking marijuana and these were just people who were smoking pot and were sitting there and contemplating the univers but we know that marijuana use makes psychosis work worse we know that adolescents who use marijuana a regular basis every year they use it increases their risk for psychosis by fifteen percent it is a disaster for people with psychotic symptoms so anybody who thinks oh let's just legalize let me do whatever they want i strongly disagree because in the area of mental illness if you're mentally ill and you're smoking marijuana and you're asking for trouble  now overall we know that individuals with mental illness are not more violent than the general public is a very important we don't want to scare anybody but if you have a history of violence you're not complying with medications you have substance abuse they're all very important predictors of future violent behavior and those with untreated psychosis are fifteen times more likely to be violent when not in treatment so whenever we hear about these high profile case and people say was that person ever diagnosed they have a problem and very often we see they were but they're not in treatment they're often here well they were they refused treatment men or the case of adam lanza's go back to connecticut and stories have been written criticizing his mother for not getting mean care in if anybody has tried to get someone in mental health care who doesn't want to do it who is over age fourteen it's just impossible and their story was she took them to five different schools etc and kept trying to find someone and what we do then with with adolescents and young adults that magic age of eighteen or in pennsylvania fourteen and age eighteen everything stops so although insurance may last hold longer schools everything else just eliminates in the social supports are gone and so we have higher risk eighty percent of the violence committed by those with untreated psychosis or attribute directly to their illness extremely important and that individuals with serious mental illness on anti psychotics or mood stabilizers are forty five percent less likely to commit violent acts or crimes stop taking it will modify their dose and one has to be very very careful has to be very carefully monitored by a psychiatrist and not just anybody but what happens with medications is we have such a shortage of psychiatry is that  ninety two percent of psychotropic medication prescribed pediatric population is done off label seventy six percent of psychotropic drugs are prescribed by non psychiatry now think about it if i said i can't find a psychologist i can't find a psychologist i can find a psychiatric social worker so let's do the best we can oh sorry about that sorry bout that so so here's  a very sobering statistic last year in this country forty three thousand deaths by suicide is that the number you have to forty seven thousand drug overdose deaths we think that's a gross underestimate because that's not really reported well they could be five ten twenty thousand more a thousand murders committed by some as mentally ill half of the mass murders so most mentally ill by ten percent overall and a two hundred fifty serious mental they'll die in a violent encounter with police when they've i just heard  the news today in san francisco a man attacked police shot him grazed the officers head they shot the man he did not die but this is what happens in these encounters this number is incredible overall three hundred fifty thousand deaths related to mental illness so remember what i said before about the chronic diseases people serious mental illness tend to die ten to twenty five years sooner than the rest of the population now this number i tell my colleagues all the time that's nine hundred fifty nine a day die whatever the diseases pick it if we told anybody that something is nine hundred fifty nine people are dying each day related to that disease you'd think congress would hold special sessions and do something about it until i started hammering this point home nothing was being done at all except now and then we would pass some bill with we call it like the suicide prevention or some other mental fund we put a little bit into it and then people would forget about it for years not funded very well and not even determine if it was adequate or if it was working and here's part of our shortage there's nine thousand child and adolescent psychiatrist for seventeen million children with a mental health condition that's one for every over that same period increased just twelve percent power during this time this big increase in suicides and big increase in substance abuse so while the disease is growing the population of those untreated is actually breaking farther away fifty five percent of counties have don't have a practicing psychiatrist psychologist or social worker fifty five percent of counties now add to that if you're a minority if you're in one of these counties you just can't get care greene county south here does not have a child psychiatrist and a child psychologist i know that we went to washington to that used to consult on there she said i can't take any more cases so i take a sibling or another family member but i can't take anymore and that's generally what you find so even the ones that have someone oftentimes a case so to so full they can't take it forty thousand psychiatric beds with a population of three hundred seventeen million don't granted we need to close on these old institutions some of them had a lot of problems some of them were very good but the movie they came by mostly in the one nine hundred sixty three the last bil john f kennedy signed before he was assessing was the move to start to close these institutions and open up more community mental health you may recall his sister it was his sister's serious mental illness and they experimented on her and it was pretty horrific thing but so you had that group saying let's close these places down the state said hey let's save some money or another group of patients rights groups say well if these people don't want to be there get them out so what happened is a lot of people were just put on the street they didn't disappear from died and went to jail some went to emergency rooms many became homeless and so what i say here is we traded the hospital bed for the prison cell the homeless shelter the emergence or room gurney and the county mor some people got treated get better but many were just dumped only once say the nation really has enough beds it's mississippi ok now here's what else happens so if you look at the opioid crisis too because many people this do a diagnosis right so we can't divorce from that that says a shortage of service to providers hospital beds qualified provider shortages insurance companies not covering treatment they cover for a little while but overall most patients don't receive the open space treaty so let's look at this so ninety percent of people with a subsidies disorder don't seek medical attention out of a thousand people nine hundred don't seek it now by the way this these aren't drug addicts are not people who are  laying in the corners in the streets or down the alley these may be people who may be wealthy executives who had back surgery and the doctor gave them a lot of opioids annexing you know after a few months they're hooked on the stuff and they can't get off but some of those are seeking treatment many people are not of those who do seek medical attention thirty seven point five percent on not able to get it ok out of a thousand nine hundred don't seek it thirty seven can't find it we're left to sixty three right and  those who do get treatment ninety percent don't get evidence based treatment so i have one thousand people six people get evidence based treatment half of those relapse no wonder we have a mess in this country again not a psychiatrist psychologist compose social worker psychiatric nurses in here add to that we don't really have much in terms of trained people to cover drug and alcohol abuse and when you take that also to those with a dog diagnosis of substance use drug and alcohol use it's extremely hard to get help and it's not uncommon for me to get calls from other members of congress either they have a constituent or family member and say or do i find help and we just have to get on the phone and call and call and call now if you've got the flu you've got a walgreens they'll give you some and you just go down the road here and out nineteen you'll find there's a doc in a box every five hundred feet and plus that marion care you get it all right in this area in a percent claremont lebanon peters township the south hills but if you're a human subsidies disorder you're pretty much on your own and we wonder why it's getting worse in america all right so i told you what the government accountability office findings so they don't they do studies i was a mate one hundred and thirty billion dollars o nation federally spends by one hundred twelve agencies across eight separate departments but they said the coordination for programs supporting individual serious mental illness is lacking so these one hundred twelve agencies don't work with each other by the way this twenty six homeless program you think they're working i think it's an abysmal failure but what they say is they don't work together they're supposed to meet on a regular basis and geo said they would talk to each other the agencies don't collect data on how mental health dollars are spent he said few evaluations of the program specifically targeting collages did a whole series a program to how to make mantz they had things on the oftentimes sent out notices a how to make a fruit smoothie if you're stressed they had a website of sing along songs for it with animated characters for children for three year olds when we had our hearing we asked the director the agency how much this costs so i don't know one of the members of congress says according to records it's four hundred thousand dollars she said well maybe but i don't know what seems like a pretty substantial grant is it working she's well preventions important always it working well we think it's very important what are you trying to prevent so we're studying that and we couldn't get an answer all we know is a website was taken down soon thereafter four hundred thousand dollars imagine what a mental health agency could do with forty thousand dollars i mean you could keep the you could hire quite a few staff or a year also there was a website in a crisis phone line you could call if you were from the new england boston area in the winter of two thousand and fourteen they got a lot of snow up there this was if you it's snowing i'm not kidding you we should make sure we load that slide on we actually have the websites like i mean it's incredible you know you're upset about the snow call this line will help you with that phenomenal they also when people in flint michigan have the water issue look i know that's of the pursuit well so let's surf the web site and a crisis line for people who are upset about water they need water that's how you take care of that problem right like if you're bleeding you want to sow that up you don't say oh let's talk about you believe you know just fix it so it's so absurd and when i talk to people in new england i said you take advantage of this they said it's no use it's boston it's going to snow and it's going to be cold in winter and we know that so this is the mess of where your tax dollars go so here's what we do on our bill so my bill the helping families in mental crisis act which is out there about four or five years we start off with major change at the top these hundred twelve federal agencies need to be coordinated so we say appoint a person who the assistant secretary for mental health and subsidies disorders this is this is a sector we say must be a psychiatry psychologist up to this point there is no requirement for any credential and so we had people who had a new zero experience a mental health field a lawyer doing this and she focused only on the happy talk and behavioral wellness and patients rights refused treatment they said well you know in the in their forty thousand word document describing what they do not once did they mention the word schizophrenia that one to the mentioned word bipolar and they fell and they were funding programs that actually say that much of that is just your perceptions which is amazing to me it is such gross ignorance pathological in that sense it isn't just denial but there are people who are out there saying no there is no such thing as mental illness is just they called it non consensus reality so if john doe is having hallucinations and talking to boys and seen things instead of that aren't there a quarter of them just respect that i think wait a minute do we also say that if a person who has a stroke would just say well that's just their version their version the world know it's a genuine brain disease and those are the symptoms of it and yet there's people in denial of it so we're saying psychiatrist psychologist their job is a value a coordinate elevate reform these programs get them together find out what we need to do we're also going to have a national mental health policy laboratory of people from a wide range of professions and parents and consumers that will advise here's the areas we think you should be funding for research by the way these are applied grants and these are grants not on goofy web sites or things like that but i'm things that will actually say where do we think dollars are best spent to deal with these things and by the way that member the g a o studies people were not were not even sending back results of what they did and did it work so now we're insisting you must report back what did you do and did it work and i've had we've had some people actually write letters to us complaining the veil was going to make them submit data and they said mom said you can't put us under the microscope to determine if what we're doing is working we can't provide evidence for you when i say within do something else but it's amazing how people actually fought back against  provide data and they said what if our data shows it's not working then you do something else then you modify that i mean it is so absurd and it just gets angry with so few dollars out there and so many people hurting the problem and by the way plot what has happened last twenty years for heart disease death rates have gone down lung disease is going down eight death rates going down strokes gone down auto accidents gone down the several things have gone down suicides up and climbing  across states and promote innovation so the secondary and tertiary prevention is extremely important primary prevention we tell everybody wear seat belts everybody don't smoke right and that's ok but secondary is saying now we're going to target high risk groups so who are the high risk groups who for suicide for example ok people with a history in the family certain age groups over sixty five or psychosis of serious mental illness begin to show based fourteen had fifty percent seventy five percent of the cases show up by age twenty four a member he said before age eighteen most supports drop and even though people are supposed to continue to have health insurance to cover you tell a twenty six if you're living with your parents if you're not living with your parents and those people are parents kick them out are the same going to be on my own they've got nothing nothing and by the way medicaid makes it worse and i explain how it makes information and it's going to require federal agencies to hold meetings with stakeholders including patient advocates to produce an action plan to get parity there that's going to h s health and human services to be required to publish any serious violations of parity compliance they have to give a report to conference going to clarify this the point is we're going to keep the heat on insurance company you've got to do these things then here's some other things are going to do innovation demonstration grants these are the ones that are going to go to communities and states and do something new can demonstrate you can do it for multiple years school based treatment to get this done in schools for children with already signs of mental illness this is not necessarily the child is in the intermediate that they're fully integrate into the rest of classroom but some children really need a much wider range of care when the moving came through is everybody get out of out of the special schools put them all in the classroom what happens is what i see is they can't get the comprehensive treatment that they need even though they may have wraparound services and to aid in the classroom oftentimes the distraction of the problems make it worse for them telling mental health will help us it's nowhere near enough but remember what i said you know the number of people who don't have any access this will help so of  pediatrician's office you can have instant access to a psychiatrist by the way this important because of the psychologist is the warm handoff in their office ninety four percent complaints of follow up if they say give someone a card and say it drops less than forty five percent heart problems right then and i'm told that if you're having a baby the problem deliver it right when you're there send you home right but what happens is when it comes to mental health services when it comes to substance abuse when they're not providing care in the emergency room here's a card most people do no complains when they start treatment in the emergency room says come on you know to talk to a drug abuse counselor you have an addiction disorder let's start it increases the fall of rape by fifty percent when you have it right away so we think this is going to help a great deal it's a great start christ intervention training for police forces so when the police encounter a mentally ill person many times to make a serious mistake in how they handle it when the police are trained the rates of violence of course are recent arrests plummet we want some of this also to go to police departments that may have an embedded license counts or you can also arrive on the scene with the police and say let me talk to this person calm down and let's make a decision now instead of taking him to jail maybe taking the hospital to call some else the family some who don't murder someone but these are where the judge can say you are going to stay in outpatient care where i can put an inpatient care because when you're treatment you're doing fine but you're going to see an outpatient care you report back to me on a regular basis when this has been done they've seen reduce reductions homosassa arrests incarceration by seventy five plus percent satisfaction by eighty five ninety percent so it works a sort of community treatment programs where we provide make sure that the system where the counter social workers know the community are going in finding the people hopefully then guiding the back to programs we also fix the shortage of these the federal barriers so i've said before you know when someone is  a minority or something that makes it worse where some of the things we talked about this number of beds forty thousand beds much of that is medicaid says so that you can't get to a psychiatric hospital for has more than sixteen bachelor's medicaid says if you're between ages twenty two and sixty four and you're poor and you need psych bed and all they have is hospitals with seventeen eighteen nineteen beds and you're not allowed to go to we're not paying for you go up we're not paying for it so what want to figure that out now think about this what if we did that for i don't know cancer let's get rid of these oncology clinics and we have no more cancer let's get rid of cardiovascular wings and hospitals and we'll have normal heart attacks what do you say than what it was it's a big improvement because it may take two to three weeks just to stabilize a person medication and this is ok if you enter the hospital the sixteenth of the month and it carries over to the next month not so good if you get in the first month work that out in time there's also the same day doctor rule so if you are again i medicaid express so you bring a seventeen year old son in the doctor's office and say my son's dropped out of school he screams at himself all the time he's paying the windows in his bedroom black he won't talk to friends anymore  he just plays strange video games he jabbering all the time now that physician will say let's have them talk to my purse i called a psychologist was right in the office right now this oh you're on medicaid can you come back another day because i can't see the same day the parity implementation in force where they're doing and we're also adding more treatment for eating disorders which was another area that was blocked because a lot of insurance companies say well treat the kidney failure which is a liver failure what treat is other failures but when eating disorder well just go home and it was such a cruel denial and that the number one was that for women how does it work it's what's the most lethal dose like it a condition right in terms of just by that alone i think issue is this when i describe before the point about people with a serious mental illness have other chronic illnesses and if they're not treated that person tends to die ten to twenty five years sooner so what happens if someone sees a doctor and maybe the doctor knows a kids get diabetes he's got to get treatment what do i do well that doctor is not allowed to inform the family i may say look you've got to come back and see these doctors and the person doesn't do it and that's why so many them get into this slow motion death sp a chronic illness what what happens here is we want this to be that understand that most mentally ill can care for themselves but they have substantial cognitive impairments with more to talk about and signals you and mortality so this is all we are saying this is a problem but the prognosis improves when caregivers are involved dramatically improves so we're saying it's for those who are totally incapacitated families can see  tell us when a doctor can talk to the family we want them to basically able to facilitate treatment so it's very even such things as when someone's discharge from a hospital psychiatric hospital maybe they've been there for a month or two and they go home pick them up say can you tell me what medicines he's on can tell me diagnosis what i'm supposed to do and they say no we're not telling you anything how absurd and how cruel that is or someone had a suicide attempt and the doctors say look we don't want to we don't have bed space we don't want to take that person to court we want to do all those things can you just go home and promise you won't do it and believe me this happens here i've talked to patients the community on a friday is they discharged me because i'm i don't even want to go i'm scared to death in the family has not been told what the diagnosis is more things but it is july and went through the house by a vote of four twenty two to two those two people don't vote for anything so we don't count them as came out of committee unanimous so now it's in the senate's hands the senate  it's got some political games on it in terms of some people don't want people have a win before the election which is a terrible tragedy and i remind my senate colleagues nine hundred fifty nine deaths today one hundred suicide today what are you the other research change we have in here so we're saying push the house version or get the senate version done and we'll look at them emerging together and take the best of both bills so i hope it's something you can talk with people about but any ways you can track it by look at my web site murphy that house  not directly no we've done a number of the things with with veterans changes with the v a which obviously needs serious help with those service changes but doesn't directly deal with that although i prefer having more providers and communities will help because many veterans are not near veterans hospital and nor do they want to take hours or days to get somewhere and they want to be able to make the weekly visits or twice a week visit or whatever that might be to deal with those issues related to combat and better off having psychologists psychiatrists and other train clinicians close to home so this will help increase those numbers nowhere near as much as i want but it is a by the way i might recommend a movie coming out november fourth mel gibson's movie called hex old ridge i saw it in a preview the father of the character the movie's about himself as a war one veteran with his own this and my love to see is every student who feels the need to take a need to ring the star spangled banner go see this movie and see them with this guy somebody protested and say i'm not going to serve i don't like my country said for religious reasons i don't want to kill anybody but i will save lives and this movie is one of those whole roic courageous movie she'll never see i warn you it's violent but without the violence you would understand we went through i mean if this is a this is not just you know batman killing people for the sake of this you have to understand the horrors of war so you know the heroism and the courage and the faith that das head is pretty amazing so that's good yes sure well a lot of it is the cost and the difficulty with it so whether you're going into plastic surgery or or pietro's or whatever your happened just on on that alone with i don't necessarily want to do it the second thing about that is it's extremely demanding i mean you have patients who twenty four hours a day may be fighting with you he calls a middle night to deal with things across the board so what happens is a person may have a heart problem and since over half of people the chronic illness diagnosis develop depression the doctor right away also here has a prescription for an anti depressant and not really problem with payments it's a problem with reimbursement it's a problem with loans it's problems with the lifestyle of extremely demanding extremely demanding but nonetheless i'm trying to encourage a lot of youth in america say hey we're trying to get more providers and if we can help pay off some of their loans if we can help with their post doctoral training we think that helps a little reduce some of that in some areas of health care some doctors will get the loans paid off if they provide some public services but what we're trying to do is in the area of serious mental illness get out there now there's a lot of providers will say you know i just kind of want that nice suburban practice where kids are refusing do their homework or they're getting flight to that's right so what happens in emergency rooms by the way that's a derogatory term used in emergency rooms for the mentally ill do they know what it is the congo murs get out of my emergency room and what i know a lot of doctors won't use it up and down and you hear it jumping up again so think about this you have an emergency room it's a busy you have auto access coming in you have injuries coming in you have people the flu coming and you have heart attacks strokes all this going on in the police bring in a couple  now the police are trying to say well let's let's say you got to watch this person we can take him to jail like this in the merge of doctors what am i going to do with this and they're looking to see if that person makes a threat to harm themselves or someone else if they make that threat then they can move to the next step of a three o two commitment that means that position is got to go and testify in front of someone to say that person needs to be committed and many times doctors say let's get a psychiatrist in here that's their specialty in the psychiatry and get in there doing valuation if they also then witness this person is saying i'm going to kill myself or someone else and then they can say ok we're going to commit you for seventy two hours that's not enough time to do anything anything you can't get a person to stabilize a medication seventy two hours so if that person continues to make threats now they can do longer term involuntary commitment but the person says as a kid  we have no bed that's why many people go to emerge from maybe bored it is what is called for hours or days or weeks or sometimes months waiting for bed you may have recall the case of the state senator in virginia his son  gus made a threat they took him to a local hospital they tried to find bands they couldn't find beds his father trying to get information from the hospital house would tell him his father who testified in front of us senator he says look i raised him i closed him i fed him i pay for  n everything and when it came time to taking care of him they wouldn't tell me anything so after hours of this they sent him home with his dad and gus stabbed his dad to kill him and then ends of killing himself so  what do we help there because we didn't have enough beds there was no place to put them and that's that's what happens it's a terrible terrible tr well i thank you for that i hope you will write your senators be in touch with me i've got a business card here so please at least go to my murphy that house that gov sign up for my weekly email and news and along those lines you'll be able to keep up to date and not only this bill but everything else because in most cases the press won't tell you what we're doing and washy see you think we're fighting all the time but the fact that we can get this bill done with wide bipartisan support is what the washington post called a remarkable achievement we can do this if we work on things together so thank you very much ok