I 

114TH CONGRESS 

2D SESSION H. R. 4374 

To amend the Public Health Service Act to improve mental and behavioral 

health services on college and university campuses. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 12, 2016 

Ms. SCHAKOWSKY (for herself and Mr. TONKO) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Education and the Workforce, for a period 

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL 

To amend the Public Health Service Act to improve mental 

and behavioral health services on college and university 

campuses. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Mental Health on 

5 Campus Improvement Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) The 2011 Association of University and 

2 College Counseling Center Directors Survey found 

3 that the average ratio of counselors to students on 

4 campus is nearly 1 to 1,879 and is often far higher 

5 on large campuses. The International Association of 

6 Counseling Services accreditation standards rec7 ommends 1 counselor per 1,000 to 1,500 students. 

8 (2) College Counselors report that 10.8 percent 

9 of enrolled students sought counseling in the past 

10 year, totaling an estimated 2,000,000 students. 

11 (3) Over 90 percent of counseling directors be12 lieve there is an increase in the number of students 

13 coming to campus with severe psychological prob14 lems; today, 44 percent of the students who visit 

15 campus counseling centers are dealing with severe 

16 mental illness, up from 16 percent in 2000, and 24 

17 percent are on psychiatric medication, up from 17 

18 percent in 2000. 

19 (4) The majority of campus counseling directors 

20 report that the demand for services and the severity 

21 of student needs are growing without an increase in 

22 resources. 

23 (5) Many students who need help never receive 

24 it. Only 15 percent of college and university students 

25 who commit suicide received campus counseling. Of 


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1 students who seriously consider suicide each year, 

2 only 52 percent of them seek any professional help 

3 at all. 

4 (6) A 2012 American College Health Associa5 tion (ACHA) survey of more than 98,000 college 

6 and university students revealed that, within the last 

7 12 months, 51 percent of students report having felt 

8 overwhelming anxiety, 31 percent felt so depressed it 

9 was difficult to function, and 46 percent felt hope10 less. The ACHA survey found that 7.5 percent of 

11 students have seriously considered suicide in the 

12 past 12 months. 

13 (7) The National Research Consortium of 

14 Counseling Centers in Higher Education found that 

15 6 percent of students have seriously considered sui16 cide in the past 12 months. The Research Consor17 tium found that of those who have seriously consid18 ered suicide in the past 12 months, 52 percent 

19 sought no preferred help and only 54 percent told 

20 anyone that they were considering suicide. 

21 (8) Research conducted between 1997 and 

22 2009, and presented at the 118th Annual Conven23 tion of the American Psychological Association 

24 found that more students are grappling with depres25 sion and anxiety disorders than did a decade ago. 


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1 The study found that of students who sought college 

2 or university counseling, 41 percent had moderate to 

3 severe depression in 2009, that number was 34 per4 cent in 1997. 

5 (9) A survey conducted by the University of 

6 Idaho Student Counseling Center in 2000 found 

7 that 77 percent of students who responded reported 

8 that they were more likely to stay in school because 

9 of counseling and that their school performance 

10 would have declined without counseling. 

11 (10) Students with psychological issues often 

12 struggle academically and are at risk for dropping 

13 out of school. Counseling has been shown to address 

14 these issues while having a positive impact on stu15 dents remaining in school. A 6-year longitudinal 

16 study found college and university students receiving 

17 counseling to have an 11.4 percent higher retention 

18 rate than the general college and university popu19 lation (Turner & Berry, 2000). 

20 (11) A national survey of college and university 

21 students living with mental health conditions, con22 ducted by the National Alliance on Mental Health, 

23 found that 64 percent of students who experience 

24 mental health problems in college or university and 

25 withdraw from school do so because of their mental 


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1 health issues. The survey also found that 50 percent 

2 of that group never accessed mental health services 

3 and supports. 

4 SEC. 3. IMPROVING MENTAL AND BEHAVIORAL HEALTH ON 

5 COLLEGE CAMPUSES. 

6 Title V of the Public Health Service Act is amended 

7 by inserting after section 520E–2 (42 U.S.C. 290bb–36b) 

8 the following: 

9 ‘‘SEC. 520E–3. GRANTS TO IMPROVE MENTAL AND BEHAV10 IORAL HEALTH ON COLLEGE CAMPUSES. 

11 ‘‘(a) PURPOSE.—It is the purpose of this section, 

12 with respect to college and university settings, to— 

13 ‘‘(1) increase access to mental and behavioral 

14 health services; 

15 ‘‘(2) foster and improve the prevention of men16 tal and behavioral health disorders, and the pro17 motion of mental health; 

18 ‘‘(3) improve the identification and treatment 

19 for students at risk; 

20 ‘‘(4) improve collaboration and the development 

21 of appropriate levels of mental and behavioral health 

22 care; 

23 ‘‘(5) reduce the stigma for students with mental 

24 health disorders and enhance their access to mental 

25 health services; and 


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1 ‘‘(6) improve the efficacy of outreach efforts. 

2 ‘‘(b) GRANTS.—The Secretary, acting through the 

3 Administrator and in consultation with the Secretary of 

4 Education, shall award competitive grants to eligible enti5 ties to improve mental and behavioral health services and 

6 outreach on college and university campuses. 

7 ‘‘(c) ELIGIBILITY.—To be eligible to receive a grant 

8 under subsection (b), an entity shall— 

9 ‘‘(1) be an institution of higher education (as 

10 defined in section 101 of the Higher Education Act 

11 of 1965 (20 U.S.C. 1001)); and 

12 ‘‘(2) submit to the Secretary an application at 

13 such time, in such manner, and containing such in14 formation as the Secretary may require, including 

15 the information required under subsection (d). 

16 ‘‘(d) APPLICATION.—An application for a grant 

17 under this section shall include— 

18 ‘‘(1) a description of the population to be tar19 geted by the program carried out under the grant, 

20 the particular mental and behavioral health needs of 

21 the students involved; 

22 ‘‘(2) a description of the Federal, State, local, 

23 private, and institutional resources available for 

24 meeting the needs of such students at the time the 

25 application is submitted; 


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1 ‘‘(3) an outline of the objectives of the program 

2 carried out under the grant; 

3 ‘‘(4) a description of activities, services, and 

4 training to be provided under the program, including 

5 planned outreach strategies to reach students not 

6 currently seeking services; 

7 ‘‘(5) a plan to seek input from community men8 tal health providers, when available, community 

9 groups, and other public and private entities in car10 rying out the program; 

11 ‘‘(6) a plan, when applicable, to meet the spe12 cific mental and behavioral health needs of veterans 

13 attending institutions of higher education; 

14 ‘‘(7) a description of the methods to be used to 

15 evaluate the outcomes and effectiveness of the pro16 gram; and 

17 ‘‘(8) an assurance that grant funds will be used 

18 to supplement, and not supplant, any other Federal, 

19 State, or local funds available to carry out activities 

20 of the type carried out under the grant. 

21 ‘‘(e) SPECIAL CONSIDERATIONS.—In awarding 

22 grants under this section, the Secretary shall give special 

23 consideration to applications that describe programs to be 

24 carried out under the grant that— 


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1 ‘‘(1) demonstrate the greatest need for new or 

2 additional mental and behavioral health services, in 

3 part by providing information on current ratios of 

4 students to mental and behavioral health profes5 sionals; 

6 ‘‘(2) propose effective approaches for initiating 

7 or expanding campus services and supports using 

8 evidence-based practices; 

9 ‘‘(3) target traditionally underserved popu10 lations and populations most at risk; 

11 ‘‘(4) where possible, demonstrate an awareness 

12 of, and a willingness to, coordinate with a commu13 nity mental health center or other mental health re14 source in the community, to support screening and 

15 referral of students requiring intensive services; 

16 ‘‘(5) identify how the college or university will 

17 address psychiatric emergencies, including how in18 formation will be communicated with families or 

19 other appropriate parties; 

20 ‘‘(6) propose innovative practices that will im21 prove efficiencies in clinical care, broaden collabora22 tions with primary care, or improve prevention pro23 grams; and 

24 ‘‘(7) demonstrate the greatest potential for rep25 lication and dissemination. 


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1 ‘‘(f) USE OF FUNDS.—Amounts received under a 

2 grant under this section may be used to— 

3 ‘‘(1) provide mental and behavioral health serv4 ices to students, including prevention, promotion of 

5 mental health, voluntary screening, early interven6 tion, voluntary assessment, treatment, management, 

7 and education services relating to the mental and be8 havioral health of students; 

9 ‘‘(2) conduct research through a counseling or 

10 health center at the institution of higher education 

11 involved regarding improving the mental and behav12 ioral health of college and university students 

13 through clinical services, outreach, prevention, or 

14 academic success; 

15 ‘‘(3) provide outreach services to notify stu16 dents about the existence of mental and behavioral 

17 health services; 

18 ‘‘(4) educate students, families, faculty, staff, 

19 and communities to increase awareness of mental 

20 health issues; 

21 ‘‘(5) support student groups on campus that 

22 engage in activities to educate students, including 

23 activities to reduce stigma surrounding mental and 

24 behavioral disorders, and promote mental health 

25 wellness; 


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1 ‘‘(6) employ appropriately trained staff; 

2 ‘‘(7) provide training to students, faculty, and 

3 staff to respond effectively to students with mental 

4 and behavioral health issues; 

5 ‘‘(8) expand mental health training through in6 ternship, post-doctorate, and residency programs; 

7 ‘‘(9) develop and support evidence-based and 

8 emerging best practices, including a focus on cul9 turally and linguistically appropriate best practices; 

10 and 

11 ‘‘(10) evaluate and disseminate best practices to 

12 other colleges and universities. 

13 ‘‘(g) DURATION OF GRANTS.—A grant under this 

14 section shall be awarded for a period not to exceed 3 years. 

15 ‘‘(h) EVALUATION AND REPORTING.— 

16 ‘‘(1) EVALUATION.—Not later than 18 months 

17 after the date on which a grant is received under 

18 this section, the eligible entity involved shall submit 

19 to the Secretary the results of an evaluation to be 

20 conducted by the entity (or by another party under 

21 contract with the entity) concerning the effectiveness 

22 of the activities carried out under the grant and 

23 plans for the sustainability of such efforts. 

24 ‘‘(2) REPORT.—Not later than 2 years after the 

25 date of enactment of this section, the Secretary shall 


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1 submit to the appropriate committees of Congress a 

2 report concerning the results of— 

3 ‘‘(A) the evaluations conducted under 

4 paragraph (1); and 

5 ‘‘(B) an evaluation conducted by the Sec6 retary to analyze the effectiveness and efficacy 

7 of the activities conducted with grants under 

8 this section. 

9 ‘‘(i) TECHNICAL ASSISTANCE.—The Secretary may 

10 provide technical assistance to grantees in carrying out 

11 this section. 

12 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated such sums as may be 

14 necessary to carry out this section. 

15 ‘‘SEC. 520E–4. MENTAL AND BEHAVIORAL HEALTH OUT16 REACH AND EDUCATION ON COLLEGE CAM17 PUSES. 

18 ‘‘(a) PURPOSE.—It is the purpose of this section to 

19 increase access to, and reduce the stigma associated with, 

20 mental health services so as to ensure that college and 

21 university students have the support necessary to success22 fully complete their studies. 

23 ‘‘(b) NATIONAL PUBLIC EDUCATION CAMPAIGN.— 

24 The Secretary, acting through the Administrator and in 

25 collaboration with the Director of the Centers for Disease 


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1 Control and Prevention, shall convene an interagency, 

2 public-private sector working group to plan, establish, and 

3 begin coordinating and evaluating a targeted public edu4 cation campaign that is designed to focus on mental and 

5 behavioral health on college and university campuses. 

6 Such campaign shall be designed to— 

7 ‘‘(1) improve the general understanding of men8 tal health and mental health disorders; 

9 ‘‘(2) encourage help-seeking behaviors relating 

10 to the promotion of mental health, prevention of 

11 mental health disorders, and treatment of such dis12 orders; 

13 ‘‘(3) make the connection between mental and 

14 behavioral health and academic success; and 

15 ‘‘(4) assist the general public in identifying the 

16 early warning signs and reducing the stigma of men17 tal illness. 

18 ‘‘(c) COMPOSITION.—The working group under sub19 section (b) shall include— 

20 ‘‘(1) mental health consumers, including stu21 dents and family members; 

22 ‘‘(2) representatives of colleges and universities; 

23 ‘‘(3) representatives of national mental and be24 havioral health and college and university associa25 tions; 


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1 ‘‘(4) representatives of college and university 

2 health promotion and prevention organizations; 

3 ‘‘(5) representatives of mental health providers, 

4 including community mental health centers; and 

5 ‘‘(6) representatives of private- and public-sec6 tor groups with experience in the development of ef7 fective public health education campaigns. 

8 ‘‘(d) PLAN.—The working group under subsection (b) 

9 shall develop a plan that shall— 

10 ‘‘(1) target promotional and educational efforts 

11 to the college- and university-age population and in12 dividuals who are employed in college and university 

13 settings, including the use of roundtables; 

14 ‘‘(2) develop and propose the implementation of 

15 research-based public health messages and activities; 

16 ‘‘(3) provide support for local efforts to reduce 

17 stigma by using the National Mental Health Infor18 mation Center as a primary point of contact for in19 formation, publications, and service program refer20 rals; and 

21 ‘‘(4) develop and propose the implementation of 

22 a social marketing campaign that is targeted at the 

23 college or university population and individuals who 

24 are employed in college and university settings. 


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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary to carry out this section.’’. 

4 SEC. 4. INTERAGENCY WORKING GROUP ON COLLEGE MEN5 TAL HEALTH. 

6 (a) PURPOSE.—It is the purpose of this section, pur7 suant to Executive Order 13263 (and the recommenda8 tions issued under section 6(b) of such Order), to provide 

9 for the establishment of a College Campus Task Force 

10 under the Federal Executive Steering Committee on Men11 tal Health, to discuss mental and behavioral health con12 cerns on college and university campuses. 

13 (b) ESTABLISHMENT.—The Secretary of Health and 

14 Human Services (referred to in this section as the ‘‘Sec15 retary’’) shall establish a College Campus Task Force (re16 ferred to in this section as the ‘‘Task Force’’), under the 

17 Federal Executive Steering Committee on Mental Health, 

18 to discuss mental and behavioral health concerns on col19 lege and university campuses. 

20 (c) MEMBERSHIP.—The Task Force shall be com21 posed of a representative from each Federal agency (as 

22 appointed by the head of the agency) that has jurisdiction 

23 over, or is affected by, mental health and education poli24 cies and projects, including— 

25 (1) the Department of Education; 


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1 (2) the Department of Health and Human 

2 Services; 

3 (3) the Department of Veterans Affairs; and 

4 (4) such other Federal agencies as the Adminis5 trator of the Substance Abuse and Mental Health 

6 Services Administration and the Secretary jointly de7 termine to be appropriate. 

8 (d) DUTIES.—The Task Force shall— 

9 (1) serve as a centralized mechanism to coordi10 nate a national effort— 

11 (A) to discuss and evaluate evidence and 

12 knowledge on mental and behavioral health 

13 services available to, and the prevalence of men14 tal health illness among, the college- and uni15 versity-age population of the United States; 

16 (B) to determine the range of effective, 

17 feasible, and comprehensive actions to improve 

18 mental and behavioral health on college and 

19 university campuses; 

20 (C) to examine and better address the 

21 needs of the college- and university-age popu22 lation dealing with mental illness; 

23 (D) to survey Federal agencies to deter24 mine which policies are effective in encouraging 

25 and how best to facilitate outreach without duVerDate Sep 11 2014 02:22 Jan 13, 2016 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H4374.IH H4374

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1 plicating efforts relating to mental and behav2 ioral health promotion; 

3 (E) to establish specific goals within and 

4 across Federal agencies for mental health pro5 motion, including determinations of account6 ability for reaching those goals; 

7 (F) to develop a strategy for allocating re8 sponsibilities and ensuring participation in men9 tal and behavioral health promotions, particu10 larly in the case of competing agency priorities; 

11 (G) to coordinate plans to communicate re12 search results relating to mental and behavioral 

13 health amongst the college- and university-age 

14 population to enable reporting and outreach ac15 tivities to produce more useful and timely infor16 mation; 

17 (H) to provide a description of evidence18 based best practices, model programs, effective 

19 guidelines, and other strategies for promoting 

20 mental and behavioral health on college and 

21 university campuses; 

22 (I) to make recommendations to improve 

23 Federal efforts relating to mental and behav24 ioral health promotion on college and university 

25 campuses and to ensure Federal efforts are 


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1 consistent with available standards and evidence 

2 and other programs in existence as of the date 

3 of enactment of this Act; and 

4 (J) to monitor Federal progress in meeting 

5 specific mental and behavioral health promotion 

6 goals as they relate to college and university 

7 settings; 

8 (2) consult with national organizations with ex9 pertise in mental and behavioral health, especially 

10 those organizations working with the college- and 

11 university-age population; and 

12 (3) consult with and seek input from mental 

13 health professionals working on college and univer14 sity campuses as appropriate. 

15 (e) MEETINGS.— 

16 (1) IN GENERAL.—The Task Force shall meet 

17 at least 3 times each year. 

18 (2) ANNUAL CONFERENCE.—The Secretary 

19 shall sponsor an annual conference on mental and 

20 behavioral health in college and university settings 

21 to enhance coordination, build partnerships, and 

22 share best practices in mental and behavioral health 

23 promotion, data collection, analysis, and services. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary to carry out this section. 

Æ 


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