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97–621 2016

EXAMINING H.R. 2646, THE HELPING FAMILIES 

IN MENTAL HEALTH CRISIS ACT 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

JUNE 16, 2015 

Serial No. 114–55 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

LARRY BUCSHON, Indiana 

BILL FLORES, Texas 

SUSAN W. BROOKS, Indiana 

MARKWAYNE MULLIN, Oklahoma 

RICHARD HUDSON, North Carolina 

CHRIS COLLINS, New York 

KEVIN CRAMER, North Dakota 

FRANK PALLONE, JR., New Jersey 

Ranking Member 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

DORIS O. MATSUI, California 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

PETER WELCH, Vermont 

BEN RAY LUJA ́ N, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

YVETTE D. CLARKE, New York 

DAVID LOEBSACK, Iowa 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

(III) 

SUBCOMMITTEE ON HEALTH

JOSEPH R. PITTS, Pennsylvania 

Chairman 

BRETT GUTHRIE, Kentucky 

Vice Chairman 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

CATHY MCMORRIS RODGERS, Washington 

LEONARD LANCE, New Jersey 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

LARRY BUCSHON, Indiana 

SUSAN W. BROOKS, Indiana 

CHRIS COLLINS, New York 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

GENE GREEN, Texas 

Ranking Member 

ELIOT L. ENGEL, New York 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

DORIS O. MATSUI, California 

BEN RAY LUJA ́ N, New Mexico 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

FRANK PALLONE, JR., New Jersey (ex 

officio) 

(V) 

C O N T E N T S 

Page 

Hon. Joseph R. Pitts, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 1 

Prepared statement .......................................................................................... 2 

Hon. Gene Green, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 4 

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

opening statement ................................................................................................ 6 

Prepared statement .......................................................................................... 7 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 8 

WITNESSES

Creigh Deeds, Senator, Senate of Virginia ............................................................ 11 

Prepared statement .......................................................................................... 13 

Patrick J. Kennedy, Former U.S. Representative (RI), and Founder, Kennedy 

Forum .................................................................................................................... 17 

Prepared statement .......................................................................................... 19 

Jeffrey A. Lieberman, M.D., Chairman, Department of Psychiatry, Columbia 

University College of Physicians and Surgeons ................................................ 23 

Prepared statement .......................................................................................... 25 

Answers to submitted questions 1 ................................................................... 135 

Paul Gionfriddo, President and CEO, Mental Health America ...........................

Prepared statement .......................................................................................... 38 

Steve Coe, Chief Executive Officer, Community Access ....................................... 52 

Prepared statement .......................................................................................... 54 

Mary Jean Billingsley, Parent, National Disability Rights Network .................. 66 

Prepared statement .......................................................................................... 68 

Harvey Rosenthal, Executive Director, New York Association of Psychiatric 

Rehabilitation Services ........................................................................................ 73 

Prepared statement .......................................................................................... 75 

Answers to submitted questions 2 ................................................................... 137 

SUBMITTED MATERIAL

H.R. 2646 3

Congressional Research Service memorandum, submitted by Ms. Schakowsky 116 

GAO Mental Health report entitled, ‘‘HHS Leadership needed to Coordinate 

Federal Efforts Related to Serious Mental Illness,’’ submitted by Mr. Murphy 4

GAO Mental Health report entitled, ‘‘Better Documentation Needed to Oversee Substance Abuse and Mental Health Services Administration Grantees,’’ submitted by Mr. Murphy 5

Statement of the American Roundtable To Abolish Homelessness, submitted 

by Mr. Murphy ..................................................................................................... 118 

Statement of the American College of Emergency Physicians, submitted by 

Mr. Murphy .......................................................................................................... 121 

Statement of the National Alliance on Mental Illness, submitted by Mr. 

Murphy .................................................................................................................. 123 

Statement of the American Psychological Association, submitted by Mr. Murphy ......................................................................................................................... 124 

Statement of the American Academy of Child & Adolescent Psychiatry, submitted by Mr. Murphy ......................................................................................... 126 

S. 1299 6

Page

VI 

Article entitled, ‘‘Fatal Police Shootings in 2015 Approaching 400 Nationwide,’’ Washington Post, May 30, 2015, submitted by Messrs. Tonko and 

Butterfield ............................................................................................................. 128 

1 Mr. Lieberman did not respond to submitted questions by the time of 

printing. 2 Mr. Rosenthal did not respond to submitted questions by the time of 

printing. 3 Available at: http://docs.house.gov/meetings/if/if14/20150616/103615/ 

bills-1142646ih.pdf. 4 Available at:http://docs.house.gov/meetings/if/if14/20150616/103615/ 

hhrg-114-if14-20150616-sd017.pdf. 5 Available at:http://docs.house.gov/meetings/if/if14/20150616/103615/ 

hhrg-114-if14-20150616-sd014.pdf. 6 Available at:http://www.gpo.gov/fdsys/pkg/BILLS-114s1299is/pdf/BILLS114s1299is.pdf. 

(1) 

EXAMINING H.R. 2646, THE HELPING 

FAMILIES IN MENTAL HEALTH CRISIS ACT 

TUESDAY, JUNE 16, 2015 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:07 a.m., in room 

2123 of the Rayburn House Office Building, Hon. Joseph R. Pitts 

(chairman of the subcommittee) presiding. 

Members present: Representatives Pitts, Guthrie, Shimkus, Murphy, Burgess, Blackburn, Lance, Griffith, Bilirakis, Long, Ellmers, 

Bucshon, Brooks, Collins, Upton (ex officio), Green, Engel, Capps, 

Schakowsky, Butterfield, Castor, Sarbanes, Matsui, Schrader, Kennedy, Cardenas, and Pallone (ex officio). 

Also present: Representatives Tonko and Loebsack. 

Staff present: Clay Alspach, Chief Counsel, Health; Gary Andres, 

Staff Director; Leighton Brown, Press Assistant; Karen Christian, 

General Counsel; Noelle Clemente, Press Secretary; Andy 

Duberstein, Deputy Press Secretary; Katie Novaria, Professional 

Staff Member, Health; Tim Pataki, Professional Staff Member; 

Graham Pittman, Legislative Clerk; Chris Santini, Policy Coordinator, Oversight and Investigations; Adrianna Simonelli, Legislative Associate, Health; Sam Spector, Counsel, Oversight; Traci 

Vitek, Detailee, Health; Dylan Vorbach, Staff Assistant; Greg Watson, Staff Assistant; Christine Brennan, Democratic Press Secretary; Jeff Carroll, Democratic Staff Director; Waverly Gordon, 

Democratic Professional Staff Member; Tiffany Guarascio, Democratic Deputy Staff Director and Chief Health Advisor; Una Lee, 

Democratic Chief Oversight Counsel; and Samantha Satchell, 

Democratic Policy Analyst. 

OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH 

OF PENNSYLVANIA 

Mr. PITTS. The subcommittee will come to order. The chairman 

will recognize himself for an opening statement. 

Today’s Health subcommittee hearing will examine the legislation authored by our colleague, Representative Tim Murphy, H.R. 

2646, which is designed to help families struggling with crisis 

caused by mental health disorders. The bill makes available muchneeded psychiatric, psychological, and supportive services for individuals with mental illness and families in crisis. 

2 

With more than 11 million Americans who suffer with severe 

mental illness, such as schizophrenia, bipolar disorder, and major 

depression, many are going without treatment and often families 

struggle to find appropriate care for their loved ones. Since there 

is a patchwork of different programs and sometimes ineffective 

policies across numerous agencies, it is important for this committee to examine ways to fix the broken mental health system by 

focusing and coordinating programs and resources on psychiatric 

care for patients and families most in need of services. 

Over the past several years, Dr. Murphy, a practicing psychologist, has worked diligently to discern the most effective ways to research and treat these illnesses. As chairman of the Subcommittee 

on Oversight and Investigations, Chairman Murphy launched a review of the country’s mental health system beginning in January 

of 2013. The investigation, which included public forums, hearings 

with expert witnesses, document and budget reviews, and GAO 

studies, revealed that the Federal Government’s approach to mental health is a chaotic patchwork of antiquated programs and ineffective policies spread across numerous agencies with little to no 

coordination. The Helping Families in Mental Health Crisis Act of 

2015, H.R. 2646, aims to fix the Nation’s broken mental health systems by refocusing programs, reforming grants, and removing barriers to care. 

I am pleased we are holding this hearing to hear from our witnesses and colleagues about their views on this pending legislation. 

And I look forward to the testimony from each of you today. 

[The prepared statement of Mr. Pitts follows:] 

PREPARED STATEMENT OF HON. JOSEPH R. PITTS

The Subcommittee will come to order. 

The Chairman will recognize himself for an opening statement. 

Today’s Health Subcommittee hearing will examine the legislation authored by 

our colleague, Rep. Tim Murphy, H.R. 2646, which is designed to help families 

struggling with crisis caused by mental health disorders. The bill makes available 

much needed psychiatric, psychological, and supportive services for individuals with 

mental illness and families in crisis. 

With more than 11 million Americans who suffer with severe mental illness such 

as schizophrenia, bipolar disorder, and major depression, many are going without 

treatment and often families struggle to find appropriate care for their loved ones. 

Since there is a patchwork of different programs and sometimes ineffective policies across numerous agencies, it is important for this committee to examine ways 

to fix the broken mental health system by focusing and coordinating programs and 

resources on psychiatric care for patients and families most in need of services. 

Over the past several years, Dr. Murphy, a practicing psychologist, has worked 

diligently to discern the most effective ways to research and treat these illnesses. 

As Chairman of the Subcommittee on Oversight and Investigations, Chairman Murphy launched a review of the country’s mental health system beginning in January 

2013. The investigation, which included public forums, hearings with expert witnesses, document and budget reviews, and GAO studies revealed that the federal 

government’s approach to mental health is a chaotic patchwork of antiquated programs and ineffective policies spread across numerous agencies with little to no coordination. The Helping Families in Mental Health Crisis Act of 2015, H.R. 2646, 

aims to fix the nation’s broken mental health system by refocusing programs, reforming grants, and removing barriers to care. 

I am pleased we are holding this hearing today to hear from our witnesses and 

colleagues about their views on this pending legislation. 

I look forward to the testimony today and yield the balance of my time to Dr. 

Murphy. 

3 

[H.R. 2646 is available at: http://docs.house.gov/meetings/if/if14/ 

20150616/103615/bills-1142646ih.pdf.] 

Mr. PITTS. And I yield the balance of my time to Dr. Murphy 

from Pennsylvania. 

Mr. MURPHY. Thank you, Mr. Chairman. Thank you for holding 

this hearing. 

Our mental health system is broken. Badly broken. It is getting 

worse, and it has to be fixed. Same goes for our handling of substance abuse in this country. Forty thousand suicide deaths in this 

country last year, 42,000 drug overdose deaths, 60 million with a 

diagnosable mental illness, 10 million with serious mental illness, 

like schizophrenia, bipolar, severe depression, 100,000 new cases a 

year. 

The General Accounting Office reviewed this for the committee, said we spend in the Federal Government $130 billion a year, over 

some 112 programs and agencies that don’t work together, have little accountability, and in many cases, don’t have very good results. 

I ask every member of the committee during this hearing, and 

as we work forward on this bill, to stop and think. Imagine you 

have a child who is hallucinating, schizophrenic, out on the streets, 

and you are told that the law says you have no right to know anything about your child’s location, condition, or care. Others presume that having any information is harmful to your own child. Or 

if your child is brought before a judge with concerns for the symptoms and the inability to care for themselves, and the judge says 

it is not against the law to be crazy. I ask you to stop and think 

about that. Are we so lacking in compassion, and are we so ignorant of what serious mental illness is? Would we say it is not illegal to have a heart attack, and walk away from a person with chest 

pains? Or how about dealing with someone with Alzheimer’s, would 

we say it is not illegal to have Alzheimer’s, and wonder the streets 

in winter, barefoot? 

Look, here is the truth. Serious mental illness is a brain disorder, and we must come to terms with this critically important 

fact or else nothing else we do or say today will make any sense 

to anyone. Let me say this again. Mental illness, especially serious 

mental illness, is a brain disorder, and as such, has to be seen and 

treated for what it is. To believe otherwise is folly, anti-science, and 

an injustice to the person, denies them appropriate treatment, and 

sentence them to more imprisonment, homelessness, victimization, 

unemployment, and barriers to care. 

So I urge members to embrace this bill, and I thank all those 

members on both sides of the aisle who have worked with us, and 

the many agencies and organizations who have done this as well. 

This bill is comprehensive, it is a big first step, but it does not fix 

everything. I wish there was a way we could go even further to 

build even more comprehensive changes, especially in dealing with 

substance abuse disorders, but this bill makes substantive changes 

in that so those issues will be addressed. It sets the stage for more 

reform. 

I look forward to hearing from the witnesses, but I especially 

want to thank our witnesses today, and Senator Creigh Deeds, and 

others for coming out to tell your courageous stories. I thank Chairman Upton for helping us schedule this hearing and move this forVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
4 

ward. Let’s make sure we provide more help for folks, so we understand where there is help, there is hope. 

I yield back. 

Mr. PITTS. The chair thanks the gentleman. 

I am now pleased to recognize the ranking member of the subcommittee, Mr. Green of Texas, for his opening statement. Also to 

help welcome one of our former colleagues here. 

OPENING STATEMENT OF HON. GENE GREEN, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GREEN. Thank you, Mr. Chairman, for holding this hearing 

on mental health reform. 

I would like to recognize our former colleague, Patrick Kennedy. 

Good to see you, and thank you for your service and, of course, 

your family. And we keep it in the family. We have a relative on 

the committee. 

The Affordable Care Act made important changes in the field of 

mental and behavioral health. The law expanded access to mental 

and behavioral health services, advanced parity of coverage, and 

enabled states to expand their Medicaid programs so that millions 

of more Americans could access affordable quality coverage. While 

the ACA made great strides toward improving access to mental and 

behavioral health services, the mental health system is still in need 

of reform. 

In our efforts to advance reform, it is critical that the patient remain at the center of our focus. Approximately 10 million Americans suffer from serious mental health illnesses, including major 

depression, schizophrenia, bipolar disorder, post-traumatic stress 

syndrome. The National Alliance on Mental Illness reports that between 70 and 90 percent of individuals have significant reduction 

of symptoms and improved quality of life with appropriate treatment and support. The numbers show that treatment works. Even 

though the overwhelming majority of individuals with mental and 

substance use disorders improved after receiving treatment, almost 

1⁄2 of all adults living with serious mental illness do not receive 

treatment in the past year. Given that the statistics show that 

treatment is effective, and that a considerable number of adults 

still go without treatment, our efforts to improve the mental health 

care system must empower patients and their caregivers with access to a range of treatment and support services. We must also remove barriers to that access. 

In today’s hearing, we are considering several pieces of legislation that seek to reform and improve our mental health care system. They are H.R. 2646, the Helping Families in Mental Crisis 

Act, and H.R. 2690, the Including Families and Mental Health Recovery Act. 

I appreciate my colleague from Pennsylvania, Dr. Murphy’s, endeavor to advance comprehensive mental health reform, and I particularly appreciate his relationship when we have been working on 

this for a few years, including during the Affordable Care Act. I do 

have some concerns about the legislation, that it may not adequately take into account the diversity and complexity of mental 

health needs that patients and their caregivers present. Comprehensive mental health reform must feature community-centered 

5 

options that focus on recovery and prevention. We must ensure 

that reforms are patient-centered and address the full continuum 

of care. 

I look forward to hearing today more about this legislative proposal, and I also appreciate my colleague from California, Congresswoman Matsui, for her efforts to improve mental health care 

delivery and the Including Families in Mental Health Recovery 

Act. The legislation seeks to improve the understanding of providers, patients, and caregivers on how HIPAA requirements apply 

to the mental health space. It will clarify HIPAA privacy standards 

for the release of protected information to patients’ families and 

caregivers, and increase education on this critical issue. 

I would also like to thank our witnesses here today and look forward to their perspectives. 

With that, I would like to yield 1 minute to my colleague, Congressman Kennedy, from Massachusetts. 

Mr. KENNEDY OF MASSACHUSETTS. I thank the ranking member, 

and I thank the committee for holding this important hearing. To 

all of the witnesses, thank you very, very much for your testimony, 

and look forward to your insight. 

There is a familiar face, as I think everybody recognizes. Patrick, 

it is wonderful to see you here. I think you will probably hear from 

your colleagues, it is like you have never left. And that is true because it actually really is true. I get at least once a day people 

come up to me and say, Patrick, it is great to see you again. I get 

introduced often on the House Floor as the gentleman from Rhode 

Island. I get often many of your colleagues relate to me how grateful they are for my leadership on these issues, as they thank me, 

Patrick, for all that I have done. Which, of course, you can imagine 

I say, you are very welcome, and take all of the credit for myself. 

And every now and again, I let you know that, but often I don’t. 

But, Patrick, it is largely to your efforts in Congress that mental 

health parity is much closer to becoming a reality today than it 

was a decade ago, and that the Affordable Care Act has allowed 

16.4 million previously uninsured people get the coverage that they 

need. But I think everyone here would agree that we still have a 

lot more word to do. 

A lack of access to care has had a heartbreaking consequence 

across our country. Just recently, I saw a report that stated over 

1⁄2 of youth battling severe mental illness receive absolutely no help 

at all. Allowing so many children to fall through the gaps in our 

system leads to substance abuse and addiction, crime, and violence. 

In Massachusetts, as you know, we are in the midst of an opioid 

abuse epidemic that cost over 1,000 lives last year alone. Lives of 

the rich and poor, young and old, male and female, black and 

white. Taunton, a city in my district, we have already tragically 

seen 10 people die just this year. It has been 7 years since the Paul 

Wellstone Act was signed into law by President Bush, and another 

year since those final rules went into effect. Lives cut short in 

every corner of our country serve as a stark reminder that true 

parity cannot wait another day. 

I look forward to hearing from each of our witnesses today about 

how the bills we are considering and other legislation can help ensure that loved ones battling mental illness and addiction not only 

6 

have the access to care that they need, but that they can get those 

services without additional barriers. 

Patrick, thank you. 

Mr. GREEN. Mr. Chairman, whatever time I have left, which is 

nothing, I would like to yield to my colleague from New York, Congressman Tonko. 

Mr. KENNEDY OF MASSACHUSETTS. Sorry. 

Mr. PITTS. Recognized for 30 seconds. 

Mr. TONKO. I thank Representative Green and the chair for the 

opportunity. 

I am pleased we are holding this hearing on such an important 

topic, and I wanted to take a moment at the outset to acknowledge 

and welcome my constituent and my friend, Mr. Harvey Rosenthal, 

to the panel. Harvey and I have known each other for many years, 

and have long worked together to better the lives of individuals 

dealing with mental health challenges; most notably, with the passage of Timothy’s Law, which brought mental health parity to New 

York State before even our federal parity protections, which are 

outstanding. As the executive director of the New York Association 

for Psychiatric Rehabilitation Services, Harvey’s passion and advocacy for individuals struggling with mental illness for over 40 years 

is unparalleled. 

So welcome, Harvey. Welcome panelists. I greatly look forward to 

hearing your testimony today. And with that, I yield back the balance of my time. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the chairman of the full committee, Mr. Upton, 

5 minutes for an opening statement. 

OPENING STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. UPTON. Thank you, Mr. Chairman. 

There is no question that mental illness affects millions of Americans and their families, yet sadly way too many are going without 

treatment and their families are certainly struggling to find care 

for loved ones. Following the tragic events of Newtown, Connecticut, this committee led a multiyear review of the federal mental health system. Ensuring treatments and resources are available 

and effectively used for those suffering with mental illnesses has 

remained the real priority of this committee throughout the past 

number of years. 

I particularly commend Oversight and Investigations Subcommittee Chair Tim Murphy who has led and spearheaded our 

thorough review of all federal mental health programs. This committee held a series of public forums, briefings, and investigative 

hearings to determine how federal dollars are being prioritized and 

spent on research and treatment, particularly for serious mental 

illness. To address the flaws discovered in the extensive and wideranging examination, Chairman Murphy introduced H.R. 3717, the 

Helping Families in Mental Health Crisis Act of 2013. And two 

major pieces of that bill became law in the last Congress, and today 

we continue our efforts and look upon building on that success. 

Dr. Murphy has reintroduced his bill in this Congress, building 

upon the previous bipartisan version while updating it to include 

7 

new findings from the committee’s continuing investigation. H.R. 

2646, this year’s bill, would remove federal barriers to care, clarify 

privacy standards for families and caregivers, reform outdated federal programs, expand parity accountability, invest in services for 

those with serious mental illness, and promote evidence-based care. 

Every community, every single one, has been impacted in some 

fashion, and literally every family as well. To our community leaders on the frontlines, in my district, folks like Jeff Patton, who runs 

the Kalamazoo Community Mental Health and Substance Abuse 

Services, we say thank you. And to those families who have been 

impacted by mental illness in some form, Congress is aware, yes, 

we are, of your plight, and we can and we must and we will do 

much better. 

I want to thank our witnesses for taking the time to testify before the subcommittee, particularly my friend, former colleague, 

Patrick Kennedy, Virginia State Senator Creigh Deeds. We have an 

all-star panel, that is for certain. 

And I yield the balance of my time to the vice chair of the subcommittee, Mrs. Blackburn. 

[The prepared statement of Mr. Upton follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

Mental illness affects millions of Americans and their families, yet sadly many are 

going without treatment and families are struggling to find care for loved ones. Following the tragic events of Newtown, Connecticut, the Energy and Commerce Committee led a multiyear review of the federal mental health system. Ensuring treatments and resources are available and effectively used for those suffering with mental illness has remained a priority of this committee throughout the past several 

years. 

Oversight and Investigations Subcommittee Chairman Tim Murphy spearheaded 

our thorough review of all federal mental health programs. The committee held a 

series of public forums, briefings, and investigative hearings to determine how federal dollars are being prioritized and spent on research and treatment, particularly 

for serious mental illness. To address the flaws discovered in the extensive and 

wide-ranging examination, Chairman Murphy introduced H.R. 3717, the Helping 

Families in Mental Health Crisis Act of 2013. Two major pieces of that bill became 

law in the 113th Congress and today we continue our efforts and look to build upon 

that success. 

Dr. Murphy has reintroduced his bill this Congress, building upon the previous 

bipartisan version while updating it to include new findings from the Committee’s 

continuing investigation. H.R. 2646 would remove federal barriers to care, clarify 

privacy standards for families and caregivers, reform outdated federal programs, expand parity accountability, invest in services for those with serious mental illness, 

and promote evidence-based care. 

Every community has been impacted in some fashion. To our community leaders 

on the frontlines, folks like Jeff Patton who runs the Kalamazoo Community Mental 

Health and Substance Abuse Services—we say thank you. 

And to those families who have been impacted by mental illness in some form— 

Congress is aware of your plight and we can and must do better. 

I’d like to thank the witnesses for taking the time to testify before the Subcommittee—in particular former Congressman Patrick Kennedy and Virginia State 

Senator Creigh Deeds. We have an all-star panel for sure. I yield the remainder of 

my time to —————————————————————. 

Mrs. BLACKBURN. Thank you, Mr. Chairman. And to our witnesses, we do thank you so much for being here. We are deeply appreciative of the time, and we know Congressman Kennedy has 

had this as an issue close to his heart for a long time, so we appreciate that you are here to share. 

8 

I think that Tim Murphy deserves a tremendous amount of credit for the work that he has put into working through this process 

for the past couple of years. You have 10 million Americans that 

are in need of services, and who suffer some form of severe mental 

illness. The Federal Government is spending $130 billion a year, 

and people are not getting the services that we need. And in our 

district, Centerstone is a group that we have worked with on these 

issues for a period of time. And we were looking at the homeless 

population, some of the figures related there, and the fact that so 

many of these individuals end up in our jails, and this is something 

that needs to be addressed. They are sick and they need care. And 

in Tennessee, there were a total of 21,246 inmates in fiscal year 

2013. Of those, 11 percent were diagnosed with a severe mental illness, another 21 percent were diagnosed with nonspecific mental 

illness, and 16 percent were prescribed at least one psychotropic 

medication. 

But, see, we have this gap on outcomes and what the deliverable 

would be. And we are so grateful to Chairman Murphy’s leadership 

for helping us hone in on this to make certain that needs are addressed, that there is a process for care delivery, and there is a 

process for these individuals to have a quality of life. 

And so we are going to have questions for all of you today, and 

we thank you for your commitment and for your time. 

And, Mr. Chairman, I yield back. 

Mr. PITTS. The chair thanks the gentlelady. 

I now recognize the ranking member of the full committee, Mr. 

Pallone, 5 minutes for an opening statement. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. Thank you, Mr. Chairman. I know that Patrick 

Kennedy, our colleague, has gotten all kinds of accolades, but I 

want to add to it because, I think many of you know, or maybe you 

don’t, that he was dealing and urging us to pass the Mental Health 

Parity Bill long before we even had it included in the ACA, and 

then he advocated when we were passing the ACA to expand it, 

which is exactly what happened. And I also would mention that he 

is not only an advocate domestically but also internationally. I remember when you and I went to Armenia together, and you went 

there because of the Special Olympics and trying to set up the Special Olympics in Armenia. So thanks for all that you do, Patrick, 

and it is good to see you. 

Today’s hearing gives us the opportunity to discuss an important 

public health issue. According to the National Alliance on Mental 

Illness, approximately 1 in 5 adults in the U.S., or 43.7 million, will 

experience mental illness in a given year. Of those people, approximately 10 million live with a serious mental illness, including 

major depression, schizophrenia, and bipolar disorder. 

We have taken significant steps forward in recent years. The Affordable Care Act’s passage was quite literally the largest expansion of mental health and substance abuse disorder coverage in a 

generation. The ACA prohibits individuals from being denied coverage due to a preexisting mental health condition. It expands eliVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
9 

gibility for Medicaid coverage, and requires most health plans, including Medicaid, to cover mental health and substance abuse services. Not only are services covered, but mental health parity now 

applies, protecting 62 million more Americans. This means that no 

insurer can impose requirements that are more burdensome for 

mental health than they can for physical health. 

Despite these major advances, far too many individuals still go 

without the treatment they need to live long, healthy, and productive lives, and more must be done to ensure coverage translates 

into effective treatments, and actually meets parity standards. 

That is why I am interested in hearing from stakeholders on what 

is working, what is not working, before we move forward with extensive or comprehensive legislation. For instance, Parachute NYC 

is here to discuss an innovative new approach for respite care for 

the seriously mentally ill, and I believe we can learn valuable lessons from this project and others funded through the ACA. 

Mr. Chairman, unfortunately, like last Congress, the first Health 

Subcommittee hearing on mental health is once again a legislative 

hearing on the Helping Families in Mental Health Crisis Act. As 

a result, the subcommittee will focus on solutions as framed by this 

bill, instead of being framed by the needs of individuals with mental illness and the system that serves them. 

While I have concerns with this process, I want to recognize that 

there are provisions of H.R. 2646 that I strongly support, including 

the increased focus on workforce development and the parity enforcement reporting requirements. However, I am opposed to several provisions in the bill, including its changes to HIPAA that 

would weaken the privacy rights of individuals with diagnosed 

mental illness, the conditioning of community mental health block 

grant funding on the presence of state AOT laws or treatment 

standard laws, and cuts in funding to substance abuse programs to 

pay for new mental health programs. As we all know, too often 

substance abuse and mental health go hand in hand, and we have 

a crisis in both areas. So I hope that after this hearing we can 

work together and find common ground to move bipartisan legislation forward that further advances the mental health system in 

this country. 

I would like to yield the remainder of my time to Representative 

Matsui. 

Ms. MATSUI. Thank you, Ranking Member. And I welcome all 

you panelists. And nice to see you, Patrick. 

All of us know that we need to reform our Nation’s broken mental health system, and we should all care about this issue before, 

during, and after a crisis or an event that affects us personally. We 

shouldn’t wait until a person is in an acute crisis to provide needed 

care and services, and we shouldn’t abandon people once the immediate crisis has ended. 

There is a full spectrum of mental health and illness that our 

system needs to address, and a full spectrum of treatment options, 

tools, and services and supports that we need to make available. 

We should not prioritize funding only for the highest level of care, 

such as inpatient hospital beds, at the expense of funding the rest 

of the continuum of care. 

10 

I believe in the power of prevention, and that we need to do more 

to catch many conditions, including mental illnesses, early before 

they progress. I know our current system is flawed, and I look forward to working with my colleagues to fix it. That is why I introduced the Including Families in Mental Health Recovery Act, 

which is one of the pieces of legislation that we are discussing 

today. Stories of patients and their families who suffer mental illness do affect me personally. Time and time again, including what 

will be in testimonies today, I have heard horror stories from patients, families, and providers about what happened when providers could not communicate with caregivers, and information 

wasn’t shared. I hear from providers and families alike in the 

mantra; I couldn’t share because of HIPAA. However, the language 

of the HIPAA law does not prevent information-sharing in 99 percent of the stories I hear. Rather, it is a vast misunderstanding, 

misinterpretation, and overly cautious application of the HIPAA 

law. This is important. There is a problem here, but HIPAA isn’t 

the root cause of it, which means that changing HIPAA won’t fix 

anything. The root problem is awareness of what is and isn’t allowed under the law. 

The bill that I introduced would do 2 simple things. First, formalize HHS Office for Civil Rights Guidance which clearly outlines 

how providers can strike the right balance between sharing information with caregivers and protecting patients’ privacy. Second, it 

requires the development and dissemination of a model training 

program to educate and train providers, administrators, and lawyers, and patients and families on what can and can’t be shared 

under the law. 

I appreciate this hearing, and I look forward to working with all 

of you. Thank you, and I yield back. 

Mr. PITTS. The chair thanks the gentlelady. 

That concludes the opening statements of the members. As 

usual, the written opening statements from the members will be 

entered into the record. 

We will now go to our panel, and I will introduce them in the 

order of their presentations. 

First of all, the Honorable Creigh Deeds, Senator, Senator of Virginia. Welcome. And then our former colleague, the Honorable Patrick Kennedy, former U.S. Congressman from Rhode Island, founder of the Kennedy Forum. Jeffrey Lieberman, M.D., Chairman, Department of Psychiatry, Columbia University College of Physicians 

and Surgeons. Welcome. Mr. Paul Gionfriddo, President and CEO, 

Mental Health America. Steve Coe, Chief Executive Officer of Community Access. Ms. Mary Jean Billingsley, Parent, National Disability Rights Network. And Harvey Rosenthal, Executive Director, 

New York Association of Psychiatric Rehabilitation Services. Thank 

you all for coming today and testifying on this very, very important 

subject. And your written testimony will be made part of the 

record, and you will each be given 5 minutes to summarize your 

testimony. 

So the chair at this point will recognize Senator Deeds 5 minutes 

for your summary. 

11 

STATEMENTS OF CREIGH DEEDS, SENATOR, SENATE OF VIRGINIA; PATRICK J. KENNEDY, FORMER U.S. REPRESENTATIVE (RI), AND FOUNDER, KENNEDY FORUM; JEFFREY A. 

LIEBERMAN, M.D., CHAIRMAN, DEPARTMENT OF PSYCHIATRY, COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS 

AND SURGEONS; PAUL GIONFRIDDO, PRESIDENT AND CEO, 

MENTAL HEALTH AMERICA; STEVE COE, CHIEF EXECUTIVE 

OFFICER, COMMUNITY ACCESS; MARY JEAN BILLINGSLEY, 

PARENT, NATIONAL DISABILITY RIGHTS NETWORK; AND 

HARVEY ROSENTHAL, EXECUTIVE DIRECTOR, NEW YORK ASSOCIATION OF PSYCHIATRIC REHABILITATION SERVICES 

STATEMENT OF CREIGH DEEDS 

Mr. DEEDS. Thank you, Mr. Chair, and thank you, members of 

the committee, for giving me a couple of minutes. Thank you, Congressman Murphy, for making mental health issues—to bringing 

them to the forefront, to helping develop solutions to help families 

in crisis throughout the country. 

When formulating my thoughts about what I wanted to speak 

about today, how best to use my time, I thought about all the compelling stories that have been shared with me from Virginians and 

from people all throughout the United States. Honestly, I thought 

what could be more compelling than the loss of those innocent lives 

in Newtown, the moviegoers in Aurora, the bright emerging leaders 

of Virginia Tech, or the dedicated public servants at the Navy 

Yard. 

In Virginia, we tinkered around the edges of public policy following the tragedy, but the real reform and meaningful work remains. But if we did not act after all those unspeakable tragedies, 

what could I possibly say today to you to press upon you the importance of acting, the importance of coming together and finding solutions, many of which are here before you in H.R. 2646. 

In addition to each of those high-profile cases involving large 

losses of life, there are tragedies of smaller scales. You can read 

about Natasha, a woman with mental illness who ends up in jail 

instead of a mental health treatment facility that can properly care 

for someone with an illness. When the jail attempts to transfer her, 

six members of law enforcement in biohazard suits handcuff, 

shackle, and place a faceguard on her. When she refuses to bend 

her knees and sit in a transport chair, she is tazed multiple times. 

She dies. If she was in a mental health facility and needed to be 

sedated, the staff would have had appropriate options. I can only 

imagine what she was thinking and feeling when all of those men 

entered her cell in spacesuits, and I can only imagine how much 

grief and pain her family is enduring today. 

You can read about Christian, a 17-year-old boy with a knife, 

threatening suicide. Law enforcement was called to the scene, and 

when the boy made movements toward the officer, he was shot 

dead. I can only imagine the shock and horror of his friend who 

had called for help. 

Tragedies happen every day that involve someone in a mental 

health crisis. Most do not make the news. I have heard so many, 

and those stories serve to guide me in my review of the mental 

health system in Virginia. The heartbreak is unbearable. I hear 

12 

these stories, I hear them every day. People reach out to me for 

help every day, and the sad truth is that in many ways, there is 

little I can do to help. The system is not set up in a way that encourages advocacy. 

One of the primary issues I see is HIPAA. We came together in 

a bipartisan way in Virginia to adopt meaningful reforms last year 

and to some extent during the 2015 Session, but nothing we do can 

circumvent HIPAA. I need, the states need, the Federal Government as a partner in reforming the mental health system. Government was not envisioned to work quickly, and we are geared toward incremental policy changes, but I am telling you, the time for 

action is now. Families are struggling. People are dying. People are 

grieving. 

While there is no panacea, there are things to be done to improve 

the lives of people with mental illness, promote better outcomes, 

and to help give some relief to families who are struggling every 

day. We can accomplish this without jeopardizing the civil liberties 

of those with mental illness. 

While I do not like to speak about my own situation, I will end 

briefly talking about Gus. No legislative action either here in the 

District of Columbia, nor in Virginia, will bring back my son, but 

hopefully it will help others keep their loved ones safe. I have four 

precious children. My three daughters make me prouder every day, 

but I have forever lost my son. I worked within the mental health 

system to help Gus when he began to show signs of mental illness. 

He was brilliant. Everyone in this room would envy his adeptness 

in picking up languages, his knowledge of religion, his ability to 

play any instrument he would pick up, and his kindness and 

gentleness to his fellow man. My world was shaken to its core 

when he began showing signs of delusional thinking and sporadic 

behavior. I was just not equipped with the knowledge or the information to help him. HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery. 

Even though I was the one who cared for him, I was the one who 

fed him and housed him, transported him, insured him, I was not 

privy to any information that would clarify for me his behaviors, 

his treatment plan, his symptoms to be vigilant, not—I had no 

idea. I didn’t know his diagnosis, his prescription changes, and necessary follow-up. I had sought to have him hospitalized earlier, so 

he was wary of my having any information. So I was in the dark 

as I tried to advocate for him in the best way I could with the best 

information I had. The last time I tried to hospitalize him, he was 

turned away. We ran out of time, and law enforcement had to release him. 

We have to do better. Not for me, not for the countless other families who have already buried their loved ones, but for those who 

struggle with mental illness and the families that struggle to help 

them. They are crying out for help. They are desperate, they are 

exhausted, and they need your leadership. 

Thank you. 

[The prepared statement of Mr. Deeds follows:] 

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Mr. PITTS. The chair thanks the gentleman. 

Patrick, you are recognized 5 minutes for your opening statement. 

STATEMENT OF PATRICK J. KENNEDY 

Mr. KENNEDY OF MASSACHUSETTS. Thank you, Mr. Chairman. 

First, I think I speak for all of us, Senator Deeds, when we say our 

hearts go out to you. I don’t think there is a person in this country 

that wasn’t moved by your tragedy, and what it speaks to all of us. 

And the notion that we have let all those tragedies go by, and as 

a nation, have failed to act is abominable. And I think what you 

have said is what we all need to hear over and over again; the time 

is now. And, Representative Murphy, thank you for stepping up. I 

know you have drawn a lot of criticism, and this bill isn’t perfect, 

but you have had the fortitude to stick with it and to keep pressing. And you have listened to people and you have shaped legislation that moves us forward. Is it the answer, as you rightly said? 

No, it is just a piece of the answer. But as you said at the very 

start of your remarks, the essential message we need to come out 

of this hearing is that these are real physical illnesses, and they 

need to be treated with the same urgency that we would treat cancer or any other fatal or disability in this country. 

The notion that we treat these issues as moral issues as opposed 

to medical issues is really the central issue before this committee. 

And I am honored to have been honored to work with many of you 

to get the Mental Health Parity and Addiction Equity Act passed. 

And that bill, if implemented, and I have heard comments already 

from many of you including my cousin, Joe, will transform the system because if the liability is on payers, including the Federal Government, to treat brain illnesses like any other illness, then they 

will start to see that an ounce of prevention is worth a pound of 

cure, that investing in early identification and treatment and intervention is the answer. Just like with cancer, just like with diabetes, just like with cardiovascular disease. We don’t wait until these 

illnesses become pathologized before we treat them. But with mental illness and addiction, what do we do? We wait until you are in 

crisis before our system ever starts to kick in. And then people 

blame the system as not working because somehow it doesn’t take 

someone with stage 4 cancer and make them well. 

Are you kidding me? If we don’t intervene early, these illnesses 

do become intractable. But we don’t have to let it be that way. We 

can intervene early. We can save lives. But the basic premise to all 

this is just treat these like you would someone with cancer, and not 

wait around until the illness gets to become worse and in a crisis 

stage. 

So, Representative Murphy, I am sure we will have a chance to 

talk in great length about the details of this bill, but I just want 

to salute you for putting forth a number of issues that we can talk 

about and we can begin to explore as ways to improve the system. 

The system needs accountability. The system needs transparency. 

And you have been a champion of those things, and I think that 

they are—throughout your legislation, and it is why I am honored 

to be here to work with you and my democratic colleagues to make 

18 

sure that this House passes something to answer what Senator 

Deeds put forward to us, and that is to act, and to act now. 

Thank you. 

[The prepared statement of Mr. Kennedy follows:] 

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Mr. PITTS. The chair thanks the gentleman. Thank you for your 

leadership and your passion. 

Dr. Lieberman, you are recognized for 5 minutes for your opening 

statement. 

STATEMENT OF JEFFREY A. LIEBERMAN, M.D. 

Dr. LIEBERMAN. Thank you, Chairman Pitts, Ranking Members 

Green and Pallone, and honorable committee members. I am 

pleased to be here attending this hearing. I also would like to 

thank Representatives Murphy and Johnson for their enlightened 

legislation, and express my gratitude to Representatives Upton and 

DeGette for the critical leadership on the 21st Century Cures. 

I am a Professor and Chair of Psychiatry at Columbia University, and Psychiatrist-in-Chief at New York Presbyterian Hospital, 

and have spent my career doing research on the neurobiology and 

psychopharmacology of psychotic disorders. In addition, I have, 

throughout my career, taken care of patients, both overseeing clinics with trainees, as well as having patients directly in my own 

practice. I am a member of the National Academy of Sciences, Institute of Medicine, and the past President of the American Psychiatric Association. I mention this simply to say that I believe that 

I am in an informed perspective to express knowledgeable opinions 

about the field of mental illness and mental health care. 

And in the course of my career, I can say that I have continuously borne witness to all that Senator Deeds and Congressman 

Kennedy have described to you. The stories are countless, enumerable, and appalling. 

But in the time I have, I would like to make 3 points. First, that 

psychiatry is a scientifically based profession. No different from 

cardiology, neurology, or ophthalmology, although in deference to 

Representatives Burgess and Bucshon, maybe not as advanced as 

obstetrics and gynecology and cardiac surgery. But the second is 

that, although we have an egregious chronic crisis in mental health 

care, this is solvable. You deal with a lot of problems that are not 

solvable. Alzheimer’s Disease in the aging population, global warming, terrorism. This is a solvable problem. And the third is, I want 

to describe what providing quality and comprehensive mental 

health care will do for our country. 

When I was a medical student in third year in the mid-1970s at 

George Washington University, I told my advisor that I wanted to 

go into psychiatry. He exploded and said, what would you do a 

dumb thing like that for, and throw away a perfectly good career? 

Psychiatry was then, and still is, the Rodney Dangerfield of medicine. It doesn’t get the respect it deserves. But that is because for 

the first 150 years of its existence, psychiatry had little to show for 

itself. No scientific information of mental illness, no effective treatments. It could do little to help people with mental illness, other 

than to institutionalize them, and those became appalling snake 

pits. 

But that was then and now is now, and everything has changed 

since the scientific revolution of the latter 20th century, beginning 

with the arrival of psychotropic drugs. And as a result, psychiatry 

has a strong scientific foundation, and an array of evidence-based 

treatments that are effective and safe. 

24 

What this means is that we have the knowledge and the means 

to solve this crisis. To do this though, we have to provide a template of comprehensive evidence-based services to health providers 

at the state, county, and municipal levels, and align financing 

mechanisms to incentivize to providers to adopt these. In addition, 

and this is something that is not widely appreciated, we must dispel the stigma of mental illness, just like we have in our society 

for other things, such as racism, sexism, anti-Semitism. There still 

is prejudice against mental illness and psychiatry due to its inglorious past, but these anachronistic attitudes confuse people, create 

fear and mistrust of mental health care, and deter people from 

seeking and getting help. 

The Helping Families in Mental Health Crisis Act offers a transformative opportunity. If we are successful, and we can be, we will 

lessen the burden of illness and improve the quality of life of our 

citizens. It also alleviates some of the most disturbing and 

dispiriting problems in our society, including domestic violence, addiction, suicide, the mentally ill who are homeless and increasingly 

in prisons, the shocking rates of PTSD and suicide in military personnel, and the recurrent episodes of these civilian massacres and 

mass violence perpetrated by some people with untreated mental 

illness. As a bonus, comprehensive effective mental health care 

would also deter the massive inflation in health care costs driven 

by patients with comorbid mental disorders who receive repeated 

and unnecessary medical and surgical services. 

One final comment is that, it is imperative that in the process 

of revamping our mental health care system, that we be guided by 

scientific evidence and not ideology or opinion. Science guides cardiovascular medicine, oncology, orthopedics, neurology. It should 

guide mental health care as well. 

The 21st Century Cures, I hope, will address an egregious chronic underfunding of the biomedical research community, because ultimately, research is what drives the quality of care. We have the 

means to solve this crisis. We simply need to find the social and 

political role. 

I thank you for having me, and I await your comments and questions. 

[The prepared statement of Dr. Lieberman follows:] 

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Mr. PITTS. The chair thanks the gentleman. 

I now recognize Mr. Gionfriddo for 5 minutes for an opening 

statement. 

STATEMENT OF PAUL GIONFRIDDO 

Mr. GIONFRIDDO. Thank you. I want to applaud this subcommittee, and in particular, Congressman Tim Murphy and Congresswoman Eddie Bernice Johnson, for your leadership in this 

area. 

As a parent of an adult son with schizophrenia, I deeply appreciate this because for so many of us, this is not just a policy matter, 

this is our life. 

As a former state legislator in Connecticut, I know how difficult 

it can be to build consensus around mental health policy. I, therefore, also appreciate the effort of the sponsors to invite so much 

feedback during the past year to use it to shape the proposal before 

you today. In our view, H.R. 2646 is an important start to making 

comprehensive mental health reform a reality in America. 

In these brief remarks, let me focus on some areas that are important to MHA. Its emphasis on moving upstream in the process, 

that is, on intervening before stage 4, is a critical step forward to 

treating mental illnesses like we treat every other chronic disease. 

It includes funds for screening, early intervention, and treatment 

programs. And let me share why this is so important. In the spring 

of 2014, MHA launched an online screening tool through our Web 

site at MHAscreening.org. To date, nearly 1⁄2 million screens have 

been completed; nearly 1⁄2 by people under the age of 25. Two 

thirds screen as positive or moderate to severe for the condition for 

which they have screened, but 2⁄3 of those say they have never been 

diagnosed with a mental health condition. Screening is the doorway 

to services and treatment. H.R. 2646 makes screening, especially 

for children and young adults, a part of the innovation grants, the 

demonstration grants, the Youth Suicide Prevention Program, the 

Campus Mental Health Program, among others. And in legislation 

that emphasizes building on evidence-based programs, we note the 

importance of innovation, because today’s evidence-based program 

is yesterday’s well-evaluated innovation. 

In addition, it is our hope that you will look to expand the opportunities to integrate health and educational services for our children. My son, Tim, has schizophrenia. He is 30 years old today, living mostly on the streets of San Francisco. He first showed signs 

of the disease when he was a young child. Throughout his school 

years, we sought special education services for him, and were frequently rebuffed. This is because those of us making policy a generation ago were not thinking about children like Tim as we implemented our modern special education laws. Today, only 362,000 

children in the country receive special education services because 

of an SED label. That represents only 1 child in every 28 NIMH 

says has a serious mental health condition or concern. This represents too many tragedies waiting to happen. 

MHA endorses the empowerment and elevation of the lead federal agency in this legislation, and we hope you will consider adding two additional responsibilities to it. The first would be to establish a common standard, other than danger to self or others, as a 

39 

trigger to involuntary treatment for SSI, because this is not a clinical standard. The second would be to develop a national plan that 

would result in an end to the incarceration of nonviolent people 

with serious mental illnesses. We also endorse the efforts to enhance the mental health workforce in this bill. At MHA, we have 

a special interest in the peer. And in this legislation, we see an opportunity to develop a properly credentialed peer workforce that 

could work competitively at competitive salaries in clinical settings. 

With respect to AOT, we support the approach in this legislation 

that it takes not to mandate it nationwide. We encourage the committee’s review of language that may appear to be in conflict with 

the intent of the sponsors, and revise it if need be. And we also 

support changes to the privacy rules, because the current rules are 

an impediment to integrating health and behavioral health care. 

You can’t fully integrate care with only 1⁄2 a medical record. But 

as someone who has worked closely in the past in Austin, Texas, 

with community-based providers seeking to integrate care, I worry 

that meeting simultaneously the six conditions may be so difficult 

and time-consuming for providers that many will not try. 

Consider as an alternative this. Clarify the relevant law to eliminate the super authorization needed to share behavioral health information. This will promote integration without compromising an 

individual’s right to manage the release of his or her protected 

health information. Finally, we understand the need to offset new 

expenditures with reductions in other areas, but worry that the offsets might come from existing community health programs. If you 

want to find offsets, please look towards jails and prisons. By sending so many of our children, like my son, Tim, to those 21st century 

asylums, that is where we sent the funding we need for mental 

health services today. 

In closing, for more than a century, MHA has argued, for more 

than a century, that it is well past time to address mental health 

issues in a comprehensive, thoughtful way, and this is a start. Let’s 

work together to remove the stigma associated with seeking help 

for mental health concerns, and the discrimination that occurs 

against those who live with them. Let’s put in place a mental 

health system that allows us all to move upstream, provide the behavioral health services individuals need and deserve early, and 

enforce parity in coverage. Let us address mental health concerns 

before stage 4. 

Thank you. 

[The prepared statement of Mr. Gionfriddo follows:] 

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Mr. PITTS. The chair thanks the gentleman. 

I now recognize Mr. Coe 5 minutes for your opening statement. 

STATEMENT OF STEVE COE 

Mr. COE. Chairman Pitts, Congressman Murphy, thank you very 

much for inviting me to come today. It is a very important legislation, and I congratulate you for your vision. 

As you can see from my resume, I have worked as a CEO at the 

same agency, Community Access, for almost 36 years. I like to tell 

people I may have worked here a long time, but I have had the 

same job for only 1 day. For instance, I wasn’t testifying before 

Congress yesterday. Next week, I will be at a conference in Norway, learning about assertive community outreach programs in Europe. And with hundreds of employees, and 11,000 tenants in 20 

apartment buildings from the Bronx, Manhattan, and Brooklyn, 

something different is happening every day. 

Most of what happens at Community Access is inspiring, which 

is another reason I have worked here so long. As my submitted testimony describes, our organization was founded by family members, led by the brother of a woman who had spent years confined 

to psychiatric hospitals, and then more years cycling between 

squalid housing and more hospital wards. His name was Fred 

Hartman. Fred inspired me, when I met him as a graduate student, studying housing and service models that would break the revolving door cycle, common in the 1970s when states discharged 

thousands of patients into our communities without proper supports. Fred’s day job was Editor of Natural History Magazine, but 

he was really an activist and an organizer. As a white New York 

City kid, he had gotten on a bus and went to help black Americans 

vote in the south. When faced with the human misery and injustice 

experienced by his own sister, he recruited friends and colleagues, 

and created a better mousetrap; an improved model of care that 

would give former patients a safe, stable, affordable home, and 

basic supports. 

Community Access started out renting apartments in rundown 

tenement buildings. Today, we build modern apartment buildings 

with amenities like free Wi-Fi, 24/7 front desk service. But the core 

elements remain the same. People choose their own apartments 

and who they want to live with. They sign leases, they are responsible for their own bills. And our buildings integrate affordable 

housing for families and children, with units for formerly homeless 

people recovering from mental illness, referred directly from the 

New York City shelter system. We even have a subsidy program 

to encourage pet ownership. 

Overall, I feel H.R. 2646 supports many of the principles we embrace; an emphasis on results and outcomes, recognizing the valuable role peers can play in the workforce, support for innovation 

and demonstration projects to test new ideas, and more. But while 

there is a lot to like in H.R. 2646, the principle vehicle offered to 

achieve these results, AOT, is not what Fred would do. He believed 

too strongly in human rights and social justice; passions that I 

share. We can all agree our system of care fails on many fronts, 

and nowhere more than in the provision of crisis services and supports. H.R. 26 acknowledges this fact within the title of the bill, to 

53 

make supportive services available to individuals and families in 

mental health crisis. 

H.R. 2646 doesn’t spell out what these supports should look like, 

which makes potential supporters of reform legislation, like myself, 

extremely wary. AOT is not a defined service. I can mean anything, 

and not much at all. In New York City, for instance, an AOT-assigned individual is given priority access to supportive housing, 

which research shows is the most effective tool in promoting community stability, and is entirely absent in many places. 

What service is going to take its place if this person in crisis is 

homeless? A higher dosage of medication, a 15-minute visit to a 

psychiatrist, a hospital bed? Without standards, AOT can mean 

anything, including interventions that have no evidence-base whatsoever. 

If we want true reform, let’s mandate specific interventions that 

we know work, and many of which are mentioned in H.R. 2646. 

Mobile crisis teams, crisis intervention training for first responders. Only 3,000 of the Nation’s 18,000 police departments use this 

commonsense approach. Patient-centered treating planning, targeted case management, psychiatric rehabilitation services, which 

is evidence-based, peer support and counseling services. Adding a 

guaranteed housing subsidy, and there have been cutbacks continually in Section 8 at the federal level, 24/7 walk-in centers, peeroperated support lines, like we operate with the Parachute NYC 

Program, and reform to the Ticket to Work Program so it actually 

becomes a pathway to a job, would truly transform the lives of millions of Americans with mental illness. 

States are already mandated to provide many services, including 

public education and prisons. How fervently they have chosen to 

embrace these mandates and fund them varies widely, and there 

is no reason to expect a vaguely defined mandate for an AOT program would turn out any better. 

Health care reform, with an emphasis on preventive services, integrated physical and mental health care, and crisis supports to 

avoid costly and traumatic hospital care, is already driving reform 

efforts across the country. H.R. 2646 should look to support what 

is already happening in the marketplace, and not place another unfunded mandate on our State governments. 

Thank you. 

[The prepared statement of Mr. Coe follows:] 

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Mr. PITTS. The chair thanks the gentleman. 

I now recognize Ms. Billingsley 5 minutes for an opening statement. 

STATEMENT OF MARY JEAN BILLINGSLEY 

Ms. BILLINGSLEY. Good morning, Chairman Pitts, Ranking Member Green. Thank you for the opportunity to testify today on this 

important topic that has touched me and my family personally. 

My name is Mary Jean Billingsley. I have a Master’s Degree in 

Counseling and Personnel Services, but more importantly, I am the 

mother and co-guardian of Tim Costello. Tim is 22 years old and 

is dually diagnosed with both significant mental illness and developmental disabilities. Tim lives in Johnson County, Kansas. We are 

one of the families with a positive outcome that would not have 

been possible if the Helping Families in Mental Health Crisis Act 

of 2015 was law when my son encountered his problems. Several 

provisions of this legislation would have had a detrimental impact 

on the work of the Protection and Advocacy for Individuals with 

Mental Illness, the PAIMI program, in addressing Tim’s needs. The 

changes to the PAIMI program in this bill would not help families, 

but would, in fact, harm families like ours. 

Tim’s mental illness manifests itself with certain behaviors. Because of these behaviors, Tim was placed in a psychiatric institution in 2010. He was 17 at the time. In the summer of 2011, Tim 

was going to be discharged with no plan, and without proper supports in place. Without those supports, Tim’s discharge was doomed 

to fail. We were devastated. Because Tim has both significant mental illness and a developmental disability, the different providers 

were trying to pawn Tim off to each other. Tim was always somebody else’s problem. Without the right supports, Tim was going to 

continue to cycle in and out of institutions, at a high cost to both 

taxpayers and Tim’s ability to recover. 

Tim wanted to live in the community. Our family wanted Tim to 

live in the community. This is a right granted under the Americans 

With Disabilities Act, allowing him to get needed treatment in the 

community instead of at an expensive psychiatric institution. We 

contacted the Disability Rights Center of Kansas, the federally 

mandated protection advocacy agency for people with disabilities, 

which operates the PAIMI program. Because of the PAIMI program, DRC was able to help Tim and my family with his complex 

situation. Sorry, I missed a page, excuse me. 

Every brick wall the system threw up against us, the PAIMI program gave DRC the authority to tear it down. Kansas policy made 

it impossible for young adults like Tim to transfer out of psychiatric institutions to community long-term care programs with 

needed supports. DRC was able to negotiate a change in this policy, 

allowing Tim to obtain services through the Money Follows the 

Person Program, and obtain the long-needed supports in order to 

live successfully in the community. 

This bill would prohibit PAIMI-funded programs from engaging 

in much-needed policy work, even using nonfederal dollars. Tim’s 

civil and human rights under the ADA would not have been protected. 

67 

Tim was living successfully in the community, and we thought 

our problems were over, but they were only beginning. Tim then 

faced discrimination simply because of his disability. Some local 

governments in Johnson County, Kansas, started using zoning and 

land use ordinances to attempt to close Tim’s community group 

home, as well as others. A not-in-my-back-yard attitude prevailed, 

targeted against Tim and others, because some did not want those 

people living in their neighborhood. We, again, contacted DRC for 

help. After failed attempts to work with local governments, Tim 

and 16 similar individuals with disabilities urged DRC to file disability discrimination complaints with Housing and Urban Development, alleging violations of federal and state laws. The HUD 

case is currently pending. 

If this bill were law, the PAIMI program would have been prohibited from helping our son with legal advocacy in the housing 

discrimination case because it is not abuse and neglect. The current PAIMI law has no such limitation. Without the help of DRC 

and the PAIMI program, Tim would still be cycling in and out of 

institutions. The resolution of Tim’s current discrimination case 

may require DRC to seek a change in policy through legislation or 

local ordinances, which they currently can do using nonfederal 

funds. H.R. 2646 will prohibit this, and severely limit the remedies 

available for Tim. 

Tim’s case was complicated. The PAIMI program gave DRC the 

ability to engage in every aspect of protecting Tim’s rights, including the flexibility to use nonfederal dollars to engage in needed policy change. Tim’s prior institutionalization and current housing discrimination involves numerous disability rights issues, including 

unjust denial of Medicaid services, violation of rights under the 

ADA and housing discrimination. Often the issues faced by people 

with mental illness are not abuse and neglect, but the problem of 

human and civil rights. 

In closing, this bill would limit the authority of the PAIMI program to cases of abuse and neglect, making it far easy to discriminate against and violate the rights of people with mental illness. 

It would also eliminate advocacy for policy changes, even with nonfederal dollars, on behalf of persons with disabilities, including 

mental illness. Those provisions are bad for families and bad for 

my son, Tim. 

Thank you for the opportunity to testify. 

[The prepared statement of Ms. Billingsley follows:] 

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Mr. PITTS. The chair thanks the gentlelady, and now recognizes 

Mr. Rosenthal 5 minutes for his opening statement. 

STATEMENT OF HARVEY ROSENTHAL 

Mr. ROSENTHAL. Good morning, and thank you for this extraordinary opportunity to testify today. 

I am Harvey Rosenthal—— 

Mr. PITTS. Is your mike on? 

Mr. ROSENTHAL. Yes. 

Mr. PITTS. Yes, go ahead. 

Mr. ROSENTHAL. Thank you. Sorry about that. A person in 43 

years of recovery from a bipolar disorder, with 40 years of experience working in the field, 18 in a hospital, clinic and rehab program, with 22 working as an advocate who has come to sit on New 

York’s Medicaid Redesign Team, its Behavioral Health Workgroup, 

and our Most Integrated Setting Council. 

Thank you for including a recovering person here. I urge you to 

include more of us in these deliberations. 

My experience has told me that the best way to fix a broken system isn’t by forcing people into the exact same services that have 

failed them in the past. It won’t be achieved by reducing privacy 

protections, limiting access to personal and systemic advocacy, or 

by all of a sudden moving sharply to a medical biological bent in 

ways that could undo or jeopardize the extraordinary gains of the 

recovery and consumer-focused approaches that have taken us decades to develop. 

We are not working on my comments. They will tell you, in my 

written comments, they will explain my position. 

I woke up this morning and I felt like I had to use and focus on 

a word that has barely been discussed today, and that is recovery. 

And so as I said before, recovery, rehabilitation, consumer, and 

peer support movements have changed the face of service delivery 

to people with the most serious mental health conditions in this 

country and around the world. Before these movements took hold, 

our system told people they would never get well, never have intimate relationships, never get a job, and never be able to make 

most of their most personal decisions. I know because I saw it 

every day when I worked in the state hospital. We told people that 

they would never get a job, that they would be poor, idle, isolated, 

and segregated from society. They would be permanently disabled. 

The primary treatments of the day were medication and hospitalization. And I know we are talking a lot about that here in the 

bill, but we are not talking enough about recovery. We are talking 

a lot about meds and beds, but not enough about recovery. 

Our movements brought hope to people and their families, many 

for the first time. Hope was, and it is still not enough, a part of 

our toolkit. Even the sickest person can improve and get well. Although they are dissuaded from going to services if the service 

message is that you are sick, that you need to take medication, 

that you can’t make decisions, that you will face coercion, that your 

privacy rights will be violated. It is not a way to engage people. 

I will tell you a way to engage people. We run a peer bridging 

program in the streets of New York City. We work with the hardest to serve; people that are very sick, and don’t have good housing, 

74 

who have addiction and trauma, and are, by definition, hard to 

find, victims of abuse, veterans. These are our greatest challenges. 

We developed a model of peer bridging that hits the streets. Too 

much of our system stays in the office and blames the patient. We 

hit the streets, and we go again and again and again to engage 

people. We work with families. We have helped hundreds of people 

in the city, reduce their relapses and their readmissions by 50 percent. Yet these services have not reached the standard of evidencebased practice. We are talking about research on brains. We have 

to also do research on peer services and recovery services because 

otherwise, we will undo them. 

When we talk about AOT, we are typically mandating people to 

take medicine in a hospital. When we talk about limiting what 

PNAs do, we are fearing that people will get off medications. When 

we are talking about the IMD exclusion, we are talking about more 

beds. We have come a long way to just talk about medications and 

beds. 

And, you know, when we talk about importing all of SAMHSA 

into the office of a new Assistant Secretary, we are gambling on the 

possibility that all of the work that has been done to transform and 

offer hope, recovery, wellness, employment, community integration, 

person-centered and self-directed care, might get lot in a large bureaucracy. 

There are some out here that believe the recovery movement is 

the enemy; that we are not interested in working with the sickest 

individuals. But I can tell you that we have helped tens of thousands of people stay out of jails and prisons and homeless shelters, 

and avoid suicide. We must absolutely be able to really focus in 

funding these programs. So we greatly need to offer the promise of 

recovery to people. You will see in my comments that we support 

a number of the things that Chairman Murphy—we laud him for 

his passion, but we really need to see a full range of recovery services, like Steve has talked about. There is not enough focus here 

in the bill, and it has to be said. 

Thank you. 

[The prepared statement of Mr. Rosenthal follows:] 

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Mr. PITTS. The chair thanks the gentleman. Thanks to all of our 

witnesses. That concludes the opening statements of our witnesses. 

We will now begin questioning, and I will recognize myself 5 

minutes for that purpose. 

Dr. Lieberman, we will start with you. Do you believe that the 

community mental health system, developed in the 1960s, was designed to serve the needs of individuals who experienced the most 

chronic and severe manifestations of mental illness, and if not, 

what are the consequences of this? 

Dr. LIEBERMAN. Mr. Chairman, it may have been designed with 

that intent, but it was really woefully naive and ill-conceived and 

it failed miserably. I mean the idea was to humanize mental health 

care by being able to move patients from institutions into the community, and have them receive an array of support services, including housing, including case management, including medication and 

rehabilitation, but none of that was there, and they simply fell 

through the cracks. And we have never sort of regained traction on 

that program and that population since. 

Mr. PITTS. Mr. Gionfriddo, how has the deinstitutionalization of 

the mentally ill worked out over the past 1⁄2 century? In your experience, why do so many mentally ill individuals pass through our 

criminal justice system or end up homeless, and are these individuals getting treatment while in prison or living on the streets? 

Mr. GIONFRIDDO. Those of us who were policymakers in the 

1970s and ’80s really didn’t understand two things about our system. One was that we were going to have to put front and center 

the kind of clinical services and support services that people would 

need when they were not in institutions. The second was we didn’t 

understand that the pipeline was a pipeline of children, that these 

were illnesses that primarily affect initially children and young 

adults. And so as a result of that, what we have ended up doing 

with deinstitutionalization, the kind that we did in the ’70s and 

’80s, was a reinstitutionalization of people into prisons. And those 

prisons and jails are not at all connected with the rest of the system, and that is a real tragedy. 

Mr. PITTS. Mr. Kennedy, at the present time, how does the IMD 

exclusion impact on the availability of clinically effective inpatient 

treatment options, particularly for Medicaid enrollees? How, if at 

all, would Title V of H.R. 2646 go about fixing that? 

Mr. KENNEDY OF MASSACHUSETTS. Well, first of all, we have to 

understand that if we are going to treat these illnesses like all 

other illnesses, if the illness is critical and needs intensive inpatient treatment, you wouldn’t limit that if it were the cancer patient, you wouldn’t limit that if it was the cardiovascular patient, 

and you shouldn’t limit that simply because the patient is someone 

with a psychiatric disorder. 

So I understand the derivation of this IMD exclusion. It came out 

of the days when people were warehoused, where care was substandard and horrifying, and yet we took a polar opposite approach 

by just not paying for any inpatient treatment as a result. Now we 

have progressed 5 decades, and we are stuck in the same mentality 

as 5 decades ago? No. We should follow the science, treat these illnesses as real illness, and in doing so, treat them if they need to 

84 

be treated in inpatient settings, do so, and not preclude that as an 

option. 

Mr. PITTS. Senator Deeds, why is it important that we have 

enough hospital beds for the most seriously mentally ill who need 

hospitalization? Isn’t a large part of the problem not just the lack 

of sufficient inpatient beds, but also the absence of any systematic 

way for the states to determine in a timely fashion where a vacant 

bed may be located? 

Mr. DEEDS. That is a really good question. The reality is that 

when we moved to a community-based system, we reduced dramatically the number of beds we have all over the country. It is 

not just a national problem, it is not just a Virginia problem, it is 

everywhere in the country. And, as Representative Kennedy said, 

when a person has a heart attack, they are not turned away from 

an emergency room because the emergency room is full. It is just 

like when a person commits murder, they are not turned away 

from a jail because a jail is full. When a person has a mental 

health crisis, we have to find a bed. 

And in my view, hopefully, the larger number of people who need 

to be treated can be treated in the community, and we are not 

going to have to put them in an institution. But also in my view, 

we—and at this time, we have a shortage of beds nationally for 

those who have long-term mental health issues that need some period of institutionalization, sometimes 30 days or more. We don’t 

have the capacity in Virginia to provide that service to people. 

Mr. PITTS. Dr. Lieberman, you wanted to add something? 

Dr. LIEBERMAN. If I could add something, Mr. Chairman. This is 

an egregious problem that is complicated but understandable. 

What happened was that the inpatient length of stay for most individuals with psychiatric illness in the 1960s and ’70s was months, 

if not years. And they were either in state mental institutions, or 

they may have been receiving long-term psychotherapeutic treatment in the kind of euphemistically named institutions out in rural 

areas—typified by what the Menninger Clinic was. And when payers and the government found out the conditions in hospitals were 

terrible, and people weren’t getting better and discharged, and psychotherapy and psychoanalytical treatment wasn’t doing anything 

either for serious mental illness, they said, we are not going to pay 

for this stuff. 

The government health insured—Washington, D.C., when I went 

to medical school in the 1970s, had the highest concentration per 

capita of psychiatrists of any city in the country. Do you know 

why? Because GHI paid for psychoanalysis. That stopped pretty 

quick when there was no evidence to support it, and people started 

getting concerns of health care costs. 

So the kneejerk reaction was to go the other way and to limit 

length of stay, which plummeted down to now the single digit days 

as average length of stay. 

In my hospital, New York Presbyterian Hospital, the largest 

health provider in the New York metropolitan area, the average 

length of stay range—I mean the occupancy rate in the hospital in 

medical surgical services ranges from maybe 60 percent to 85 percent, and in the psychiatry units it is 100 percent always, and the 

psych ED is the same thing. But the hospital, which is struggling 

85 

for financial viability, will never give me another bed because it is 

not financially desirable to do so. And so we are caught in this 

quandary. As Senator Deeds said, if we had an effective mental 

health care system which could deter people coming into it by preventive care, which provided adequate ambulatory care to keep 

people from having to come into the hospital, we would decompress 

this, but it will take time. 

Mr. PITTS. The chair thanks the gentleman. 

My time has expired. The chair recognizes the ranking member, 

Mr. Green, 5 minutes for questions. 

Mr. GREEN. Thank you, Mr. Chairman. I want to thank all our 

panel. 

My experience outside of being a legislator is as a lawyer doing 

probate work in the 1980s in Houston, Harris County. I was so 

proud when we got a Harris County psychiatric center, managed 

by the University of Texas Health Science Center. But we have 

fewer beds there today than we did in 1988, and that is the frustration I think seen around the country. 

But when I was practicing law, I was so happy when I found 

somebody who actually was a veteran because I could get them into 

our veterans hospital that had real treatment, and we didn’t have 

to wait for a bed. And that is our problem, and I know it is even 

worse today because of the growth in our population. 

My frustration back then was that very few insurance policies 

covered mental health. And I know the Affordable Care Act did 

much to advance mental health care largely by extending coverage 

for mental health and substance use disorders. It required new and 

small group insurance plans to cover these services as essential 

health benefits. In addition to advancing parity of coverage, the 

ACA authorized the Center for Medicare and Medicaid Innovation, 

the CMMIs, to test innovative models of care. The first round of 

health care innovation grants CMMI—10 were focused specifically 

on mental health. 

Mr. Coe, in your testimony you described the work Community 

Access has done to create programs that provide innovation and 

tailored services to people experiencing psychiatric episodes. I understand Community Access received the Health Care Innovation 

Grant from CMS to create Parachute NYC, or New York City. 

Mr. COE. Right. Thank you, Congressman. That is correct. Community Access, in partnership with the City of New York, applied 

for a grant to create alternatives to hospital care, and the city 

called it Parachute NYC. It means a soft landing for people in a 

psychiatric crisis. Then the Parachute Program—it actually created 

four residences: one in Staten Island got left out again, but one in 

each borough, as well as enhancing the workforce by adding peers 

to mobile crisis teams, and creating a peer-run support line. So our 

residence opened first in January of 2013, so we have run it just 

for about 2 years. 

We had almost no guests for the first 6 months. We had five, six 

guests. We had a capacity for seven. We had over 100 people in the 

last 5 months. And 25 percent of those were self-referrals. So if you 

put a service out that is an experience that people appreciate, they 

will flock to it. People can come and go. People are encouraged to 

talk to staff. Our staff are all peers. We had 800 applicants for 14 

86 

positions. And then training people on how to talk and listen to 

people, and brought in evidence-based practice to do that. 

New York has made a deal with the Center for Medicaid and the 

Government to reduce actually the usage of hospital use by 25 percent over the next 5 years, including Dr. Lieberman’s hospital, 

which is part of the reform plan, by creating more respite services, 

mobile crisis teams. Our mobile crisis teams take 48 hours to go 

out. In Pierce County, Washington, they take 48 minutes to go out. 

And a family in crisis needs a response, it needs a place to call, 

and then they need somebody to respond when the call is made. 

So Parachute NYC was a package of improving mobile crisis, offering alternatives to hospitalization, offering support lines, and expanding the peer workforce. 

Mr. GREEN. Mr. Coe, do you think that program could be replicated around the country, although I know we have a lot of programs all over the country that actually may not be Federal Government funding, but actually coming from the community? 

Mr. COE. It is a simple model. I think that the idea—and I think 

the resistance that we faced initially was that it wasn’t going to be 

safe, that peers are going to be running it, therefore, it is not going 

to be a safe place for people to go. So we had open houses, we had 

cake sales, we had people come and meet the staff. The staff went 

out and did presentations to agencies so they could see who worked 

there. We also linked to medical facilities and health care. So we 

don’t ignore that safety is first. So you take care of people when 

they come in the door, if you notice a problem, you can seek help, 

but it has to be a system, and it can’t be just one thing. It has to 

be organized, system-wide. And there are very few places around 

the country where they have done that. 

The crisis intervention teams, and a lot of—Arlington, Virginia, 

has a great program. Mental health, police, drop-off centers. Very 

well organized, they meet monthly. That is the kind of comprehensive—— 

Mr. GREEN. OK. 

Mr. COE [continuing]. Service that you can put together. So, yes. 

Mr. GREEN. Thank you, Mr. Chairman. I know I am out of time. 

But, Ms. Billingsley, I wanted to ask you a question. I will submit 

it and we will get a response about the success with your job. So 

thank you. 

Mr. PITTS. The chair thanks the gentleman. 

Now recognize the vice chairman of the full committee, Mrs. 

Blackburn, 5 minutes for questions. 

Mrs. BLACKBURN. Thank you, Mr. Chairman. And thank you to 

each of you. 

I am going to come to Senator Deeds and Rep. Kennedy and Mr. 

Rosenthal. As I said, we have worked on this. Chairman Murphy 

has done such a tremendous job on this, and we want to have a 

piece of legislation that we can put in place, get signed into law, 

and then have that foundation that will work us toward parity. 

With that in mind, what I would like for the three of you that 

I have mentioned, and, Senator Deeds, let’s start with you, to just 

talk to me, give me the two or three things that you think are best 

about the bill that will be most helpful, and then the couple of 

things that probably you think we need to go back to the drawing 

87 

board on. And very quickly to the three of you, and then the others 

of our esteemed panelists, I would like for you to just submit that 

to us in writing. 

I think as we drill down, and as we get something ready to move 

forward, give me your thoughts. This is helpful to us as we plan 

forward. 

Mr. DEEDS. And honestly, I was provided a summary of the bill, 

and that is what I read, and so I don’t know that I have all the 

details to give you the answer to that question precisely. And 

maybe I can do that in writing later on. 

Mrs. BLACKBURN. That is acceptable. 

Mr. DEEDS. The part of the bill that I really like are the changes 

to HIPAA. I hear from so many people—I mean since my son died, 

the last 19 months I get messages, I get e-mail, I get Facebook 

messages, I get contacted by people all over the country every day. 

Mothers and fathers, older brothers and older sisters who care for 

a loved one who has a mental illness, who can’t get the information 

that they are in basically the same situation I am in, and I 

think—— 

Mrs. BLACKBURN. OK. So for you, the number one would be the 

changes to the HIPAA laws. 

Mr. DEEDS. HIPAA, yes. 

Mrs. BLACKBURN. You like that. That is something that would 

help you as a caregiver. 

Mr. DEEDS. It—— 

Mrs. BLACKBURN. OK. 

Mr. DEEDS. I mean nothing is going to help me. I am done. 

Mrs. BLACKBURN. Yes, sir—— 

Mr. DEEDS. But it is going to help the next person. 

Mrs. BLACKBURN [continuing]. I understand, but I mean to that 

type situation. 

Mr. DEEDS. Right. 

Mrs. BLACKBURN. And I appreciate that so very much. And I appreciate your willingness to work with us on this. 

Patrick? 

Mr. KENNEDY OF MASSACHUSETTS. Thank you, Representative 

Blackburn. I would say, obviously, we have all spoken about prevention as the main policy we should all adopt, but I don’t want 

this hearing to end up becoming this false dichotomy that it is one 

or the other. Obviously, payers want to do it on the cheap. So if 

they can hire a bunch of peer support folks, they are going to do 

it. And if they can deny inpatient treatment, they are going to do 

it. So we just have to be mindful that one doesn’t preclude the 

other. 

I like the recovery model. I am a beneficiary of the recovery 

model. But God forbid we use that as an excuse to preclude the 

medical treatment that people need when they are in crisis. This 

is not an either/or issue. We need both. And so I would say that. 

And I would finally say this. 42 C.F.R., if we are going to move forward in the 21st century, we need to have brain illnesses included 

in your medical record or else we are never going to get the comprehensive support that—— 

Mrs. BLACKBURN. OK. 

88 

Mr. KENNEDY OF MASSACHUSETTS [continuing]. Someone needs 

in their care. And I love that about—— 

Mrs. BLACKBURN. OK, so we have HIPAA and we have a bothend approach, not an either/or. 

Mr. KENNEDY OF MASSACHUSETTS. Yes. 

Mrs. BLACKBURN. OK. 

Mr. Rosenthal? 

Mr. ROSENTHAL. Thank you. The parts of the bill that I like the 

best are the focus on integration of health care and mental health 

care, and the better coordination of criminal justice in mental 

health. There is no question that so many of our most vulnerable 

people really have all these issues, and the coordination is essential. 

In New York, thanks to the Affordable Care Act, they are implementing health homes which are linking all of these systems to 

work together. One staff person, one record, one plan. 

The second thing, and I am really just not sure how to read the 

bill, but it looked like something we had talked about, Congressman Murphy, about outreach and engagement. You have a section 

in the block grant section which appears to say that you must have 

a good outreach and engagement plan in order to get the block 

grant, and that the strategies there may or may not have to have 

AOT in them. So I think a lot of us believe that this really aggressive but not coercive outreach and engagement, relentless outreach 

and engagement, is critical, and it seems like you are very focused 

on that, and I think that is tremendous. It is on the front end that 

we are going to have to do the most work. 

And the third thing is the Interagency Serious Mental Illness Coordinating Committee. I think it really brings together all kinds of 

agencies and leads and expertise. The only thing I would say about 

that is it should include SAMHSA and the Centers of Medicaid and 

Medicare. It is the number one funding stream, Medicaid, is in 

America, and that is our best change. The outcomes associated 

with that, the incentives. 

Mrs. BLACKBURN. All right. 

Mr. ROSENTHAL. The things I like the least, well, assisted outpatient treatment really had its origins in New York in a very big 

way. I have been working in opposition of that for a very long time, 

and I do that because I don’t believe it has been proven to be an 

effective strategy. There have been studies, first at Belleview, that 

gave everybody better services, and gave some court orders, and 

the study found it was the more and better services that got it 

done, not the court orders. 

The legislature was so concerned about that that they ordered a 

comparison between voluntary and involuntary—am I out of—— 

Mrs. BLACKBURN. Mr. Rosenthal, I am sorry, my time has expired, and—— 

Mr. ROSENTHAL. Sorry. 

Mrs. BLACKBURN [continuing]. If you can submit this—— 

Mr. ROSENTHAL. I will write it to you. 

Mrs. BLACKBURN [continuing]. In writing. Thank you all so 

much. 

Yield back. 

Mr. PITTS. The chair thanks the gentlelady. 

89 

I now recognize the ranking member of the full committee, Mr. 

Pallone 5 minutes for questions. 

Mr. PALLONE. Thank you, Mr. Chairman. 

I wanted to ask my questions of Mr. Rosenthal. We can’t talk 

about mental health coverage without talking about the Affordable 

Care Act’s Medicaid expansion. Can you comment on how Medicaid 

expansion has expanded access to mental health and substance 

abuse services? And I ask that because, to put this in context, 22 

states have declined to expand Medicaid at this time, leaving 3.7 

million uninsured adults with serious mental illness unable to obtain coverage. And I hope those states will see both the economic 

and moral benefit of Medicaid expansion, sooner rather than later. 

And your answer to this question may provide some reason as to 

why they should do that. 

Mr. ROSENTHAL. Thank you. The Medicaid program of the past 

was a very rigid and limited program, very focused on illness and 

symptom management but not, as I said earlier, about all of the 

domains of recovery that are essential. 

We now have in this country a Medicaid Expansion Program and 

a greater use of Medicaid managed care, where the focus is on outcomes and improved services, and a diversity of services, including 

supports for even the social nutriments of health; housing, employment, things that really matter in peoples’ lives. So the expansion, 

I think, really brings in people who currently are shut out, including people in addiction recovery and some of the programs that 

they require. So it is an extraordinary time to watch Medicaid reform and Medicaid expansion because I think millions and millions 

of Americans, without getting access to that, will be shut out and 

will be subject to poor care and poor treatment. 

Mr. PALLONE. I mean is it fair to say that lack of insurance coverage is not only a significant barrier, but maybe the most significant barrier to someone receiving consistent care for a serious mental illness? 

Mr. ROSENTHAL. Absolutely. 

Mr. PALLONE. OK. 

Mr. ROSENTHAL. And you know where that really turns up is 

people who are in jails and prisons who lose their Medicaid, it is 

shut off, and at that critical moment of discharge, planning, if the 

Medicaid is not in force, people fall within the cracks. 

I read somewhere that people in addiction, if they don’t get help 

in 20 days, 30 percent of them die. It is a very strong figure. So 

Medicaid access is critical, and in that system in particular, people 

are leaving jails and prisons without the services they need, and 

that is why we get so much re-incarceration and tragedy. 

Mr. PALLONE. All right, I wanted a second question about Programs of Regional and National Significance, the PRNS. H.R. 2646 

would create new grant programs that would be funded through a 

20 percent cut on Programs of Regional and National Significance, 

and on SAMHSA’s general funding authority. And I wanted to 

focus on the possible effect of a 20 percent reduction in funding for 

PRNS grant programs. SAMHSA’s Center for Mental Health Services currently funds mental health first aid training for teachers 

and other adults who interact with youth. That training equips 

them with the tools needed to detect and respond to mental illness 

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in children and young adults. That PRNS program received $15 

million in fiscal year 2014 and 2015 to provide grants to states and 

local education agencies. 

So, Mr. Rosenthal, if SAMHSA’s PRNS authority was reduced by 20 percent, $3 million would potentially have to be cut from that 

program. In general, what would a 20 percent cut in grant funding 

for community programs mean to those existing programs? 

Mr. ROSENTHAL. Well, I think it would be a loss of access for 

many, many Americans in need. Certainly, the Mental Health First 

Aid Program has been so critical in educating the communities, the 

police, other important groups, and if that is cut, then that is that 

many communities and that many people and families who won’t 

have the benefits of first aid. 

I am not familiar enough with all of the Programs of Regional 

and National Significance, but I reviewed them briefly, and there 

are a number of recovery programs that, if they were cut by 20 percent, again, where there is a real emphasis on AOT and not 

enough, I think, on the recovery side of things. 

Mr. PALLONE. Well, in addition to cutting mental health programs, H.R. 2646 would cut substance abuse programs to pay for 

those new mental health programs. A program that could be cut is 

funding for states to enhance or expand their treatment services to 

increase capacity and access to evidence-based Medication Assistance Treatment, or MAT. And the fact is America is facing a public 

health crisis related to the misuse and abuse of opioids, and we 

should not be cutting, in my opinion, any funding for that or for 

other SAMHSA substance abuse programs. 

Thank you, Mr. Chairman. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the vice chair of the subcommittee, Mr. Guthrie, 

5 minutes for questions. 

Mr. GUTHRIE. Thank you, Mr. Chairman. 

Senator Deeds, I used to serve in the Kentucky State Senate, and 

you mentioned in your testimony that you had bipartisan efforts at 

the state level. You didn’t really elaborate on those. Can you just 

kind of—for a few minutes of—about a minute or so, what you did, 

and then how the Federal Government can help states doing what 

you want to do there? 

Mr. DEEDS. At the state level, when I went back to the General 

Assembly just a few weeks after all of this happened, to me, my 

scars were red and my eyes were too. People there knew me because I have been in the General Assembly for a long time. I am 

a bipartisan guy. I am a partisan democrat, but I have friends on 

both sides of the aisle. They knew my son, because he had been on 

the campaign trail with me for years. So I was able to cobble folks 

together to get things done, but the reality is that funding is not 

as consistent as it needs to be across the board. We need federal 

organization. And what this bill does in many respects is it takes 

funding and reorganizes it in a way that makes more sense, I 

think, makes more sense for the states, makes more sense for the 

country. 

Mr. GUTHRIE. Well, thanks. And I was going to ask Mr. Kennedy, 

my friend, Patrick, this, but you mentioned HIPAA and how did 

HIPAA specifically block what you were hoping to do, or how did 

91 

it affect your situation? I understand that as a caregiver, you can’t 

get the information you need. 

Mr. DEEDS. Well, I couldn’t get psychiatrists to talk to me or to 

even return my calls. I couldn’t get people in hospitals to tell me 

anything about what was going on with my son. And he was wary 

of me in the first place, so when I got him to go places, I tried for 

a long time to get him to sign a power of attorney or to sign a medical power of attorney to give me access to information. I tried to 

get him to give me that authority on some forms that other people 

had prepared for him, and he just wouldn’t do it. And the providers 

wouldn’t talk to me. I had one provider that sat down and talked 

to me, probably broke the HIPAA law, and maybe it is a lack of 

understanding of the law, but if it is, it is widespread. 

I got an anonymous letter just about 4 months ago from a person 

who told me that he or she had provided care for Gus, and had told 

me some things that touched my heart about their treatment of 

him. I just didn’t have the information beforehand. It seems to me, 

let me just tell you. One woman called me, or she called my office. 

She tried to get her adult son committed through an involuntary 

process. She was successful. But in the hospital, they wouldn’t tell 

her where her son was going. 

Mr. GUTHRIE. Yes. 

Mr. DEEDS. So she couldn’t get him his things, she couldn’t talk 

to anybody there about his experience. That facility wouldn’t even 

return her calls. They just put him on a bus and sent him home. 

How in the world is he going to be kept to schedule, is he going 

to take his medications, is he going to keep his appointments if 

somebody doesn’t know it? That is—— 

Mr. GUTHRIE. Understand. 

Mr. DEEDS. That is what this legislation—— 

Mr. GUTHRIE. Thanks. I have one more question—well, it is not 

really a question, but Ms. Billingsley brought up some concerns. 

And we want to solve problems, not raise more concerns. And 

talked about the PAIMI program, and if I could yield to my friend 

from Pennsylvania to address some of the concerns that you 

brought up, I would like to do so. 

Mr. MURPHY. Well, let me just say this. With regard to some 

things on the protection advocacy issues, now, I can’t say that there 

is much that this panel has said that I don’t agree with, and it 

sounds like some clarification of wording. Our bill does not require 

assisted outpatient treatment. It does not, and that is a misnomer, 

and I see that in the minority memo, so let’s make sure we are 

clear on that. We recognize it can be valuable for some people, particularly those who are cycling in and out of jail, those of have history of violence. We just saw that happen down in Dallas, Texas. 

I think it can help in some cases, but it is not a panacea. But I 

want to make sure that we are focusing on this, and worded this 

in such a way that people can get help and can get that advocacy. 

It is against federal law to use it for lobbying, and I don’t intend 

to change that law, but I want to look at something that does need 

to change. And just to follow up on what you were saying to Senator Deeds about some individuals have claimed that with regarding to releasing any information under HIPAA, it has to be ‘‘as necessary to prevent or lessen a serious and imminent threat to the 

92 

health or safety of a person or the public.’’ So that is the limitation. 

Do you agree with that kind of limitation? 

Mr. DEEDS. I might take it a little broader, but I think that that 

protects a person’s privacy. Somebody has to make a decision that 

it is necessary that the person doesn’t understand what is in their 

best interests, and that the caregiver will provide for that. 

Mr. MURPHY. Which is important, and that is where I think our 

bill tries to broaden that. If that person is not aware, to provide 

you with a diagnosis, treatment plan, time, and place of the next 

appointment—— 

Mr. DEEDS. That is right. 

Mr. MURPHY [continuing]. Medications, that would be helpful to 

you as a parent? 

Mr. DEEDS. That would be very helpful. Critical. 

Mr. MURPHY. I will go back to my questioning later. Thank you. 

Mr. GUTHRIE. Thanks, and my time has expired. I yield back. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentlelady from California, Mrs. Capps, 5 

minutes for questions. 

Mrs. CAPPS. Thank you, Mr. Chairman. And thank you all for 

your amazing testimony. 

For too long, mental health has been left out of our discussions 

about health. I am happy that members of this committee on both 

sides of the aisle have a shared interest in addressing this important issue. My background is a public health nurse, worked in our 

community schools. This is an issue I know well. I have a brother 

who has a history of being bipolar. I know it personally very well. 

Thankfully, we have made great strides in recent years, most notably that all plans must now follow mental health parity rules. 

Many previously uninsured and underinsured individuals with 

mental illness now have access to insurance. This was the greatest 

expansion of mental health services in our history, but now one 

that needs to be built upon. And as written, I am concerned that 

my colleague, Mr. Murphy’s, bill does not comprehensively advance 

this progress enough. We need to work together to do so, because 

it does little to address mental health issues before they reach that 

crisis level, help individuals after the crisis point has passed. It 

pits mental health and substance abuse services against each 

other, despite the fact that for so many individuals, these are intertwined ailments, and needlessly injects partisan politics into the 

mental health space by attaching extraneous abortion language. 

We don’t need to be doing that here. It is not a way to move a bipartisan bill forward to make meaningful change. Our Nation has 

a history of reacting to mental health issues in a very erratic way, 

swinging from one extreme to another. We need to stop the swing, 

and enact thoughtful evidence-based policies if we really truly want 

to make progress. 

I am hopeful that today’s hearing is going to help us look beyond 

a particular bill, and help us have that constructive dialogue to 

move in a positive way. 

Ms. Billingsley, at a previous hearing on this issue I was particularly moved by a woman’s testimony where she described the abuse 

that took place in her group home, and how the protection and advocacy for individuals with mental health program, PAIMI—— 

93 

Ms. BILLINGSLEY. Yes. 

Mrs. CAPPS [continuing]. Helped shut it down and bring her and 

her housemates to justice. I will never forget her testimony. Similar to what you have talked about today. It is equally notable. But 

as you noted, the Murphy bill would tie some of the program’s 

hands to protect these individuals from unlawful discrimination 

from educating policymakers like ourselves about the issues that 

these individuals face. I think that seems really shortsighted. If the 

PAIMI program is prohibited from advocating for the rights of an 

individual with mental illness, where will families turn to ensure 

the enforcement of laws and regulations? 

Ms. BILLINGSLEY. I don’t know where they would turn, and quite 

honestly, I don’t know where our family would be if we had not had 

their help. I can’t even imagine where we would be. I often think, 

and coming here today has brought back quite a bit of this journey 

for our family, it is possible my son wouldn’t be alive today. It is 

quite possible—— 

Mrs. CAPPS. That bad. 

Ms. BILLINGSLEY [continuing]. Because of the downward spiral 

he was in, and we were no longer able to help him. So if that funding was not there, I don’t know what we would have done. 

Mrs. CAPPS. Programs like PAIMI are so critical, and you said 

it, to ensuring that families and individuals with mental illness 

have advocates ensuring that their rights are protected. We don’t 

want, as it seems to be the case in this bill, to tie their hands, and 

that is another indication in my mind that we can do better. 

One bill I am particularly interested in was written by my California colleague, Representative Matsui. Her bill, it is the Including 

Families in Mental Health Recovery Act of 2015, would clarify 

HIPAA privacy rules, and would educate providers, patients, and 

families about the law as well. 

Mr. Rosenthal, may I turn to you? Do you think health providers 

adequately understand what HIPAA permits if a patient is in a crisis situation? In other words, do we have a problem with provider 

education—— 

Mr. ROSENTHAL. Absolutely. 

Mrs. CAPPS [continuing]. Or do we need fundamentally to rewrite 

our privacy laws? 

Mr. ROSENTHAL. I think education is critical. I think HIPAA, as 

I understand it, and also sort of codified, if we could codify OCR, 

the Office of Civil Rights, sort of guidance would make it even 

clearer, but I know that providers at minimum are confused or 

frightened, and at worse, are hiding behind HIPAA rather than 

really—they can listen to families now. They may not be able to 

disclose everything, and there are circumstances where they can 

and they should, and they don’t. So I think—absolutely, I think 

education is critical. We can’t do enough—— 

Mrs. CAPPS. So that is an indication of the ways that we have 

to move past where we are today, even considering this bill. 

I am out of time. I will yield back. 

Mr. PITTS. The chair thanks the gentlelady. 

I now recognize the gentleman from Illinois, Mr. Shimkus, 5 minutes for questions. 

94 

Mr. SHIMKUS. Thank you, Mr. Chairman. And thank you all for 

being here, and for my colleagues for their great questions. I just 

would encourage my colleagues that if we want to have an opportunity to really move a bill, we are going to have to come together 

and be positive and just tweak the language and work this 

through. My colleague, Mr. Murphy, has worked real hard. Patrick, 

it is great to see you again. Senator Deeds and the folks’ testimonies are just heartbreaking. 

And so the easy question, how many of you on the panel are parents? Raise your hand if you are parents. OK. Everyone is a parent. So my question is, when do we stop being a parent? I don’t 

think we do. 

Ms. BILLINGSLEY. No, we never do. 

Mr. SHIMKUS. You know, my mom and dad, thankfully, are going 

to celebrate their 65th wedding anniversary, and if I do something 

wrong, they are in my face. 

So this HIPAA debate—I said that, didn’t I? Dang. That is our 

secret. Don’t tell anybody. But this HIPAA debate is very, very important, and I think we really need to get it right. I still have 

young—not young, but young men who, some of this onset comes 

at different times. And I fear the day where they need help and 

we can’t get access to information. And so I am very encouraged 

by the talk and this whole debate because we want to be engaged. 

My question is to Dr. Lieberman on—asking you if you have any 

sense of what kind of clinical outcomes are associated with the 

emergency department overcrowding for patients requiring medical 

or psychiatric services? 

Dr. LIEBERMAN. Well, the overcrowding and the increased demand relative to capacity simply sort of backs up people who are 

waiting to be seen, makes the health care personnel kind of rushed 

in the process of being able to do the evaluation, and then if the 

disposition is hospital admission, which it frequently is because 

there is a paucity of available beds, they must sit there. In New 

York State, there is a law that you have to make a disposition of 

somebody in an emergency room within 48 hours. It sounds long, 

but many people sit there for longer. We have had patients in the 

emergency room for as long as 6 months. That means they have to 

be fed, bathed. And the reason why this occurs is because if you 

have what is called an intellectual or developmental disability, autism, Fragile X, any of the genetic neurodevelopment disorders, and 

a complicating psychotic disorder, there is no place for you to go. 

So it is ridiculous. 

But it really prompts me to sort of comment on some of the discussion we have had here about the various programs, Community 

Access and so forth, Harvey Rosenthal’s excellent work as a rehab 

director. We are not having a discussion about excluding programs, 

but this is all part of a comprehensive effort. Mental health care 

is disease management, it is not simply a doctor giving a pill, or 

a rehab counselor, finding housing or teaching a skill. But when 

you have cancer and you have to go—let’s say you have breast cancer or prostate cancer or—you go and make a recommendation, surgery, possibly radiation and chemotherapy. If the surgery disrupts 

your musculature, you might need rehab. Oftentimes there is a 

psychiatric component to it. All of these things are a part—right 

95 

now, we can’t provide those because there is not a collocated availability of these services, and a revenue stream for financial reimbursement. So it is all fragmented, and as a result of this—and I 

appreciate the effort here because this—if anything can rise to be 

a bipartisan cause, this should be. This is not like we have to discover something new and mysterious. The expertise, the tools are 

available, we simply have to develop the policy to be able to orchestrate it. And what concerns me is that ideological issues are permeating and kind of diverting attention from the real issues. If you 

look at SAMHSA’s Web site where they have a list of 360-plus 

interventions, there is no mention of medication. Now, I am not a 

cowboy doctor that is going to prescribe massive drugs and say, 

‘‘See me in a month,’’ to people. That is not what physicians do, 

and it is certainly not what psychiatrists do. But how can you have 

a list of interventions with no medication? It is like if you are going 

to go—it is like Steven Jobs, he refused surgery because he wanted 

to try a naturopathic approach. It shouldn’t be exclusionary. We 

need to have a big picture approach to this in order to be able to 

really deal with this problem. And how long is it going to take us 

to appreciate it? How many Newtowns, how many Aurora, Colorados, how many Jared Loughners, is it going to take for this to 

happen? 

Mr. SHIMKUS. My time has expired so thank you. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentlelady from Illinois, Ms. Schakowsky, 5 

minutes for questions. 

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. I apologize to the 

panel, there are concurrent hearings going on. 

I want to especially welcome my friend, Patrick Kennedy, for 

being here. And of all the ways that you have contributed, the 

many ways, I want to thank you for decreasing the stigma attached 

to mental health issues. Thank you for that, Patrick. 

Before I begin my questions, I want to first say I am very concerned that we are unnecessarily seeing antiabortion language included in this bill. We do not need to attach this kind of restrictive 

language on programs that help to prevent suicide and provide 

transitional housing for people with mental illness. And moreover, 

the language in this bill actually goes a step beyond the Hyde 

Amendment and restricts funds from being used to refer a woman 

to abortion services and, if anything, a provision that would probably guarantee increased mental anguish. Women deserve to have 

access to the full range of health services. At a minimum, have a 

right to know what services are available to them. So this language 

continues a dangerous precedent of attaching language restricting 

a woman’s access to reproductive health services in bill that address different topics. 

But let me move on. I would also like to address the drastic 

changes H.R. 2646 would make to the Protection and Advocacy for 

Individuals with Mental Illness Program. In Illinois, our protect 

and advocacy organization, Equip for Equality, has worked tirelessly to advocate for individuals with disabilities for 30 years. Not 

only has Equip for Equality secured housing and services for individuals with mental illness, but they have also worked to affect 

public policy. For example, they worked with state officials to creVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00101 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
96 

ate an adult protective services system which works to prevent 

abuse, neglect, and exploitation of adults with disability. They also 

have advocated for the continuation of services that will allow 

medically fragile children to remain in their communities rather 

than in institutions, and yet this legislation would actually prevent 

Equip for Equality from doing this important work. 

So, Ms. Billingsley, I want to thank you so much for joining us 

today to share your personal story of your family and son, Tim. As 

important as it is for PAIMI to address abuse and neglect, many 

people like Tim face hardship due to their mental illness because 

of discrimination and navigating the complex mental health care 

system. Families are often not able to find the help their family 

member needs, regardless of how hard they try. I have actually experienced that in my own family. 

You said in your testimony that Tim is just 22 years old. Could 

you further elaborate in how Tim’s illness manifests itself, and why 

it is important to Tim to be in the community? 

Ms. BILLINGSLEY. Tim is going to be 23 next month, so he is pretty excited about that. The way his mental illness manifests itself 

is that he is highly needing to have structure on a regular basis 

for him, and he is a very talkative person, and he is very social. 

And if he is isolated for very long, he acts out with that. That goes 

against what he wants to be around with—or be with people. He 

also has a seizure disorder, and I bring that up simply because he 

needs to have family and community around him to help take care 

of that issue if that were to come about, and we have had a few 

situations with that. He currently lives in a home with five other 

young men, and he is very hasty to tell me it is time for you to 

go, which took me a little getting used to, to be quite frank. But 

he has a full life without me, and he needs that community setting 

to live his life well beyond the time I am here. 

Ms. SCHAKOWSKY. So let me ask you this. Do you think you have 

would have been successful in securing Tim’s right to stay in the 

community if the Disability Right Center of Kansas had not been 

allowed to advocate on his behalf? 

Ms. BILLINGSLEY. No, there is no way. 

Ms. SCHAKOWSKY. What would have happened then? 

Ms. BILLINGSLEY. It is kind of similar to what else has been 

shared here today. We wouldn’t get phone calls returned. We 

wouldn’t get responses when we asked about programs. We were 

on waiting lists for services during a time in which my son would 

become violent at home, and there were concerns with the safety 

of our own family. If we had not had their intervention, as has 

mentioned here within 48 hours, when we needed it, we would 

have to have been hospitalized, I am sure. 

Ms. SCHAKOWSKY. Thank you. I would like to ask unanimous 

consent to put into the congressional record, Congressional Research Service memorandum. 

Mr. PITTS. Without objection, ordered. 

[The information appears at the conclusion of the hearing.] 

Ms. SCHAKOWSKY. Thank you. 

Mr. PITTS. Gentlelady’s time has expired. 

Ms. SCHAKOWSKY. Thank you very much, I yield—— 

97 

1The report has been retained in committee files and is also available at:http:// 

docs.house.gov/meetings/if/if14/20150616/103615/hhrg-114-if14-20150616-sd017.pdf. 2The report has been retained in committee files and is also available at:http:// 

docs.house.gov/meetings/if/if14/20150616/103615/hhrg-114-if14-20150616-sd014.pdf. 

Mr. PITTS. The chair now recognizes the gentleman from Pennsylvania, prime sponsor of this legislation, Dr. Murphy, 5 minutes 

for questions. 

Mr. MURPHY. Mr. Chairman, before I start, I just want to ask 

that a couple of things be submitted to the record. One is the GAO 

report this committee requested called Mental Health HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness. 1 Second is the GAO report requested by this committee 

called Mental Health Better Documentation Needed to Oversee 

Substance Abuse in the Mental Health Service Administration. 2

Third is from the HHS Office of the Assistant Secretary for Planning and Evaluation, called Evidence-Based Treatment for Schizophrenia and Bipolar Disorders and State Medicaid Programs. And 

finally, a list of materials I would like to submit for the record, the 

statement from the American Roundtable to Abolish Homelessness, 

and letters of support from the American College of Emergency 

Physicians, the National Council for Behavioral Health, the National Alliance on Mental Illness, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, 

and the American Psychological Association. 

Mr. PITTS. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. MURPHY. Thank you. 

It is an amazing day that all of you are here, and Congress is 

gathered to talk about such a critically important subject. Let’s not 

forget that. We have a massive amount of common ground here. 

We have to link arms together and do this. And I thank my colleagues for their thoughtful comments in this as well. 

Let me dig down in a couple of these things which I think are 

important in this bill. Mr. Gionfriddo, in this bill, we lay out a 

greater emphasis on secondary and tertiary prevention, and say 

you have to put some more dollars into child and adolescent areas 

rather than wait until later on. Could you describe why that is important to you, why you think it is important to focus on those 

areas? 

Mr. GIONFRIDDO. Well, I think it is critically important to focus 

in on children. The date are 50 percent of mental illnesses manifest 

by the age of 14; 3⁄4 by 25. But for a lot of us the statistics don’t 

matter. My son was 5 when he developed signs and symptoms of 

schizophrenia. And he got the 10-year delays everybody else gets 

by the time he got his final diagnosis, 10 years that we lost opportunity after opportunity to change the trajectory of his life. That is 

one of the reasons he is homeless now, not by his choice, but by 

choices we made as policymakers to do that. It is critically important we move upstream. We have to arrest this at stage 1, 2, and 

3. We can’t keep waiting until stage 4. We can’t keep waiting for 

crises to occur, we can’t keep waiting post-crisis, we have to move 

upstream. That is why it is important to me. 

Mr. MURPHY. Now, I might add for my colleagues, what I mean 

by primary prevention is what we tell everybody, secondary prevenVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00103 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
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tion is now you identify the high-risk group, and tertiary is someone who is with symptoms. And that is important because, as we 

go through in the grant programs what the GAO report said about 

SAMHSA is, quite frankly, they weren’t documenting, they weren’t 

evaluating, programs that got grants didn’t stick to their grants, so 

it is important we have that oversight. 

I also want to note with regard to the issues with regard to Medicaid services here, that in this report from Office of the Assistant 

Secretary for Planning and Evaluation, it said only 45 percent of 

beneficiaries with schizophrenia, and 35 percent with bipolar disorder, maintained a continuous supply of evidence-based medications, and received at least one psychosocial service during the 

year. In other words, these reports are saying our system is failing 

pretty bad in this. 

Patrick Kennedy, you and I have talked a great deal about this 

issue of an Assistant Secretary, and their role to get the Federal 

Government coordinated in these symptoms, to follow through on 

parity, and to report back to Congress. You have been here. You 

understand what it is like. What do you see the value of having 

someone go through these 112 federal agencies, get the data from 

the states, and keep Congress’ feet to the fire in this? What do you 

see the value of that in moving forward in the long run? 

Mr. KENNEDY OF MASSACHUSETTS. Well, thank you, Representative Murphy. First, to your previous question to Paul, would say we 

could solve this crisis tomorrow if we intervene on first incidents 

of schizophrenia. There is no mystery in this country how to avoid 

the over-hospitalization and crisis management. We are picking up 

the pieces after people have fallen off the cliff. We know what to 

do. Intervene right away with first onset. Don’t let the time lapse. 

And as Paul said, you permanently change the trajectory of those 

people. So for people who are interested in return on investment, 

your investment is a lifelong disability is averted if you do that 

wraparound services, first incident. 

So, Representative Murphy, I appreciate that being a major 

focus. The raise work that is being done now is the model. Naples 

is the model. The prodromal phase scientifically before symptoms 

is really what our Holy Grail should be. And we can do that with 

scientists like Jeff Lieberman. 

To the answer on accountability, we are in a new post-parity 

world. We have the legal infrastructure to appeal when people 

aren’t being treated equitably under the parity law. And I appreciate the fact in this legislation you have a specific GAO report 

evaluating non-quantitative treatment limits. That is the secret 

way that insurance companies deny care. They keep it behind, of 

course, we have eliminated the quantitative treatment that sets 

premium discrimination, copay discrimination, lifetime limit—that 

is gone. So now where has the discrimination moved? It has moved 

to this non-quantitative treatment limit. 

If we expose that, which your bill, among many other things calls 

for greater transparency and accountability, I am telling you, you 

are going to see a sea change in the way that we move towards this 

problem, because we are not going to be waiting for it to become 

crisis. It is going to be evident to insurers that it is more cost-effective for them to intervene early. So I appreciate that. And the state 

99 

reporting is key because, as you acknowledge in this bill, it is the 

states’ mandate to continue to work in implementing this law. We 

need to have an accountability structure to see how they are doing, 

and I appreciate that also being in this legislation. 

Mr. MURPHY. Thank you. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentlelady, Ms. Castor, 5 minutes for questions. 

Ms. CASTOR. Well, thank you, Mr. Chairman and Mr. Green, for 

calling this hearing today. And I want to thank the panel for relaying a sense of urgency for the Congress to act when it comes to 

mental health. And thank you for your expert recommendations on 

how to improve the bill today. 

And, Congressman Kennedy, it was great to see you a few 

months back at the Florida Mental Health Research Institute in 

Tampa, at the University of South Florida. They presented Congressman Kennedy with the Humanitarian Service Award that is 

very well-deserved. So it is great to see you. 

I want to keep the focus on implementation of the Mental Health 

Parity Act. There is an important provision in the draft bill that 

would require the Department of Labor to submit a report to Congress identifying federal investigations conducted or completed during the previous year regarding compliance with parity in mental 

health and substance abuse disorders under the Mental Health 

Parity Act. Remember, that Act enshrined in law that principle 

that mental health is equivalent to physical health. And the law 

required group health insurance plans covering mental health and 

substance abuse services to cover them at parity with physical 

health services. 

Then the Affordable Care Act extended this principle to the individual health plan market. It also requires that all expanded Medicaid programs, as well as individual and small group health insurance plans, cover mental health and substance abuse services as 

part of the essential health benefits package. That is critical. The 

ACA expanded these benefits and parity protections for 62 million 

Americans. 

But Congressman Kennedy, in the beginning of your testimony 

you referenced the difficulty with implementation. You are hearing 

about insurance companies’ compliance or noncompliance with the 

parity requirements, is that accurate? 

Mr. KENNEDY OF MASSACHUSETTS. Absolutely accurate. And if 

members want to make a difference tomorrow on getting more people care than they have today, write a letter to Secretary Perez 

from the Department of Labor, because Secretary Perez can issue 

greater guidance on all ERISA plans, that is employers’ insurance 

plans, that this should be a greater evaluation on whether they are 

complying with a federal law. He can issue guidance tomorrow. He 

needs to hear from you that you want him to do that, because 65 

percent of the health market is that employer-sponsored health 

care. And our veterans, by the way, are going to depend on their 

health plans, if they are employed, having coverage for their signature wounds of war. 

Two, you could write a letter to Secretary Burwell from HHS. 

She has the authority today to issue greater disclosure requireVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00105 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
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ments on all insurance companies so that we can better understand 

how they do medical management, because as you know, Representative Castor, the key to this is the utilization management, 

how they move those things around. We under parity, by necessity, 

need to know how to compare the way they do utilization management for the mental health patient, to the way they do utilization 

management for the stroke patient, for the cancer patient, for the 

diabetic. If we know how to draw those analogs, we can enforce 

parity because the law would require that they do something different than they are currently doing. 

Ms. CASTOR. Other panel members, are you hearing about difficulties with implementation of the important goals of mental 

health parity? Mr. Gionfriddo? 

Mr. GIONFRIDDO. Absolutely. I think that everybody understands 

that the law has changed, but the implementation law hasn’t fully 

taken place yet. And we deal with this every single day at Mental 

Health America. We are hearing a lot about this, and strongly endorse efforts to try to make certain that we realize all the benefits 

of parity for all the people we care about. 

Ms. CASTOR. Mr. Rosenthal? 

Dr. LIEBERMAN. I can—— 

Ms. CASTOR. Yes, go ahead. 

Dr. LIEBERMAN. I can add to that. When I was in my role as 

President of the American Psychiatric Association, we had to make 

decisions about which litigation to pursue against various insurance companies that were denying benefits or not complying with 

the parity law. And what it ultimately came down to was the fact 

that we had a very strong case in almost all instances, but there 

were such deep pockets on the side of the insurers that financially, 

they just drained us. And so it became a much more complicated 

sort of battle to fight, and I think we are still engaged in that battle. 

Ms. CASTOR. Well, I want to thank you all. Really, I think with 

Mr. Murphy’s help, we can look at ways to improve this. If you all, 

when you are submitting comments back to the committee, would 

make some specific recommendations here. And I also appreciate 

Ranking Member Pallone bringing up the Medicaid expansion, the 

importance of it. The State of Florida, unfortunately, just last 

week, rejected a republican State Senate plan to expand Medicaid 

in Florida. That leaves about 800,000 of my neighbors across the 

State of Florida in that gap, leaves billions of dollars of our taxpayer dollars here in Washington, rather than bringing them back 

home. So if you all can talk to policymakers in the State of Florida, 

please relate to them how important Medicaid expansion is for 

mental health services. 

Thank you. 

Mr. PITTS. The chair thanks the gentlelady. 

I now recognize the gentleman from Virginia, Mr. Griffith, 5 minutes for questions. 

Mr. GRIFFITH. Thank you very much, Mr. Chairman. Thank you, 

members of the panel, for being here this morning, particularly 

Senator Deeds. It is so great of you to be here. Your story is obviously very compelling, and when the incident occurred with your 

101 

son, the entire region was affected by it. And we appreciate you 

being here. 

That being said, one of the reasons I asked to be on this particular subcommittee was so I could talk about rural health care 

issues. And how long have you been in the state legislature, 24 

years? 

Mr. DEEDS. Twenty-four years. Got there one term before you. 

Mr. GRIFFITH. That is what I was thinking. And you live about, 

what, 9 or 10 miles outside of the 9th Congressional District? 

Mr. DEEDS. I used to be one of only two members in the State 

Senate that was on the dirt road, off a dirt road caucus, but the 

other fellow retired, so I am the last one that lives on a dirt road, 

off a dirt road. 

Mr. GRIFFITH. There you go. 

Mr. DEEDS. It is about 9 miles out of the 9th District. 

Mr. GRIFFITH. So that brings up the issue, you worked very hard 

and got some great legislation through in Virginia to make sure 

that there was a mental health bed registry available to the people 

of Virginia. But I noticed in an article late last year that Eastern 

State is getting a lot of patients because they are the location that 

has beds, and they are the beds of last resort. And I am wondering 

if we need to be thinking about encouraging the states to participate in a national bed registry, because you are also not far outside 

the 9th. How far are you from West Virginia—— 

Mr. DEEDS. I am not far from West Virginia at all, and I am—— 

Mr. GRIFFITH. Ten, 15 miles? 

Mr. DEEDS. Probably a little bit further than that, but not very 

far. Twenty-five miles. And national registry might make some 

sense. It might make some sense, but as you know, and we in Virginia have also turned down the Medicaid dollars. They provide insurance to about 400,000 Virginians and about 162,000 of them 

have serious mental illness. Pretty significant for us. 

Mr. GRIFFITH. Yes. And mental—I will agree with you that mental health issues are things that we need to take a look at and be 

very serious about. 

I am also concerned about the HIPAA requirements that you 

weren’t able to know. Whether it is a misunderstanding or not, we 

need to change the language to get rid of the misunderstanding—— 

Mr. DEEDS. Absolutely. Yes. 

Mr. GRIFFITH [continuing]. To make it clearer. I think this bill 

does a lot of that. One of my concerns is, and I know you have only 

read the summary of the bill, is that in the sections on HIPAA, we 

get family members involved, which I think is great. My concern 

is the family member—and I know you have practiced in this area, 

or at least most rural lawyers have, where somebody has abandoned the family when somebody is a juvenile, and you think it 

might be helpful if we put language in there. We have excluded 

people who have a documented history of abuse, but do you think 

it might be helpful if we also excluded family members who have 

abandoned a juvenile—— 

Mr. DEEDS. That—— 

Mr. GRIFFITH [continuing]. Before the incident—obviously, as an 

adult, but when they were a juvenile, abandon them? 

102 

Mr. DEEDS. I think that language needs to be clear. The summary I read does make clear that there has to be some kind of 

caregiver relationship between the family that is going to have information and the person that is affected. 

Mr. GRIFFITH. And I appreciate that. 

I have a little bit of time left. It is great to see you—— 

Mr. DEEDS. Thank you very much. 

Mr. GRIFFITH [continuing]. And appreciate you being here. Is 

there anything else that we haven’t touched on that you wanted to 

touch on? 

Mr. DEEDS. I think we have touched on a whole lot, yes. Thank 

you. Thank you for asking. 

Mr. GRIFFITH. All right, and we have. 

Mr. MURPHY. Gentleman would yield time, or—— 

Mr. GRIFFITH. Yes, well, I can. The gentleman from Pennsylvania 

is requesting my time, and I would like to yield to Mr. Murphy. 

Mr. MURPHY. I thank the gentleman from Virginia. 

Dr. Lieberman, I want to clarify something about HIPAA, because I hear a lot of talk about it, but you are the only one on this 

panel, as I understand, who is a licensed provider who has to follow HIPAA laws in that sense as in your doctor role there. Is it 

just a matter of getting education out to other providers and saying 

if only you follow this, everything is going to be fine, or do you 

think there needs to be some changes in what you are allowed to 

tell loving, caring family members who are the provider? What do 

you think? 

Dr. LIEBERMAN. Referring to in terms of the HIPAA—— 

Mr. MURPHY. In terms of HIPAA—— 

Dr. LIEBERMAN [continuing]. HIPAA discretions? 

Mr. MURPHY [continuing]. I mean the restrictions at HIPAA now, 

what you are allowed to tell someone, is it just educating them or 

do we really need some changes? 

Dr. LIEBERMAN. Right, it is certainly more than education because there is a medical-legal aspect to it that health care institutions are cognizant of, and doctors have the fear of God placed in 

them by not just their hospital CEOs but also the personal injury 

lawyers. 

Mr. MURPHY. So right now then, and along those lines, if you 

were seeing Creigh Deeds, and he says, can you tell me about my 

son, can you just tell me what is his diagnosis, when is his next 

appointment, where is he, I want to get in there. Would you be allowed to say that as existing law is now? 

Dr. LIEBERMAN. Right. Strictly speaking, no. If he is an adult, if 

he is overage, but if you did it, you would be doing it at your own 

risk because you could be sort of challenged. Doctors often do that, 

but I don’t want to get into that because it is the commonsense 

thing to do. 

Mr. MURPHY. OK, thank you. 

Mr. GRIFFITH. I yield back. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentlelady from California, Ms. Matsui, 5 

minutes for questions. 

103 

Ms. MATSUI. Thank you, Mr. Chairman. And I want to thank all 

of you for being here today. Your testimonies have been very compelling, the full range of mental health. 

And first of all, let me just say I agree with Congressman Kennedy about the continuum of care. We should not allow prevention, 

intervention to go against the serious mental illness. It is just a 

continuum of care. This is what we are talking about today. And 

the emphasis should be on the mental health of an individual. And 

I believe in prevention and intervention at the early end, and all 

of the services that have to be provided, and that has been my history. I have always been feeling that way. And I think that what 

is really important here to look at too is the fact that we have been 

focusing many times here on serious mental illness, because we 

know how tragic that is. Whether or not it ends tragically, I know 

in my family, I have a sister who has been severely mentally ill for 

a long time, and during that time, she really did not have the care 

because it was a long time ago. I think today she would probably 

be functioning much better, much like your son, Ms. Billingsley. 

But I would have to say this. I have been affected very much by 

the tragedies that have occurred. I have a couple of friends who 

have adult children who have, they felt, been limited by not being 

able to assist them. And listening to you, Senator Deeds, I feel that 

pain again. And I thought that the importance of this bill, because 

it covers such a broad range, and HIPAA has come up so very 

often, and I think that HIPAA should be not looked at as an enemy 

here, and we can’t use it as an excuse either. I think we really need 

to figure out what can we do with HIPAA. And I have spent a lot 

of time thinking about this, and also asked myself what can we do 

about these situations when it feels like there is no communication 

and no one to turn to. And I really thank you for working with me 

to answer that question, specifically for these issues about sharing 

information and communications between providers and caregivers. 

We have to walk a fine line here. We must protect the patient’s 

right to privacy, and protect them from those who don’t have their 

best interests at heart, but we must also empower families and 

loved ones to be able to help. 

I think my bill strikes that balance. It is not a wholesale change. 

I don’t believe we can do that because HIPAA should cover both 

mental and physical illnesses. It just can’t be one versus the other. 

This bill is really supported by mental health advocates that really 

fall on both sides of the mental health policy issues, as well as 

groups in between. Groups like the American Psychiatric Association, the Bazelon Center for Mental Health Law, the Mental 

Health Association of California. And additionally, I thank Congressman Kennedy and the Kennedy Forum for recognizing the importance of this bill. I thank NAMI, the Treatment Advocacy Center, the National Council for Behavioral Health, the American Psychologic Association, and others for their help. I really feel that this 

is something where we just can’t just say we are going to change 

it. We have to look at it to find out how we can change it, and I 

believe that this bill strikes the right balance. 

And, Congressman Murphy, I also believe that your bill is something we can work with, and I would like to work with you on it. 

And I think you have heard from people on my side of the aisle 

104 

that they feel that there are really good points to this, and there 

are adjustments that have to be made, and I think people on the 

panel have expressed the same also. So I feel strictly that today we 

should feel heartened that we are actually drilling down and trying 

to find some solutions to this, and that to me is probably the most 

important outcome of this because, as we move forward, we pledge 

to do something here that makes real sense. 

And just to comment on my bill here. Mr. Rosenthal, can you describe any situations where it would be important to protect the patient’s right to privacy? 

Mr. ROSENTHAL. I am struggling for a little bit here, I was 

caught off guard. Sorry. I think that patients really want to feel a 

sense of integrity and choice, and I think if they really are already 

feeling fearful, don’t want to feel like their caregivers and the 

therapists are talking whenever possible about them without them. 

Ms. MATSUI. OK. Can you think on the other side of this situation, when it would be appropriate and even necessary for a provider to communicate or share information with a patient’s family? 

Mr. ROSENTHAL. When somebody’s health and welfare and safety 

are at risk, the person or someone else, I think that is critical. So 

I think those are critical sort of—— 

Ms. MATSUI. OK. 

Mr. ROSENTHAL [continuing]. Considerations. 

Ms. MATSUI. All right. I yield back. Thank you. 

Mr. PITTS. The chair thanks the gentlelady. 

The chair recognizes Dr. Murphy for a unanimous consent request. 

Mr. MURPHY. Mr. Chairman, just to correct the record on the 

misrepresentation or perhaps misunderstanding about abortion. I 

ask that S. 1299, the Garrett Lee Smith Memorial Reauthorization 

Act, authored by Senator Jack Reed of Rhode Island, be introduced 

into the hearing record. It is Senator Reed’s legislation, endorsed 

by the American Foundation for Suicide Prevention, which is identical to the language of H.R. 2646, the Helping Families in Mental 

Health Crisis Act on Suicide Prevention. 

Mr. PITTS. Without objection, so ordered. 

[H.R. 2646 is available at:http://www.gpo.gov/fdsys/pkg/ 

BILLS-114s1299is/pdf/BILLS-114s1299is.pdf.] 

Mr. PITTS. The chair recognizes the gentleman from Florida, Mr. 

Bilirakis, 5 minutes for questions. 

Mr. BILIRAKIS. Thank you, Mr. Chairman. I appreciate it very 

much. And thank you for holding this hearing. Very important 

hearing. 

Last December, I had the pleasure of hosting Congressman Murphy in Florida for a mental health roundtable with stakeholders 

from the community. I commend him for the extensive amount of 

time he put into addressing mental health and substance abuse 

disorders. I also serve on the Veterans Affairs Committee, where 

we have extensively focused on mental health issues plaguing our 

veterans, our true American heroes. In 2012, Time magazine wrote 

that more U.S. military personnel sadly have died by suicide since 

the war in Afghanistan began than have died fighting there. Mental health is an important issue, and I am glad we are addressing 

it. Thank you, Congressman Murphy. 

105 

A question for Dr. Lieberman. Dr. Lieberman, training for law 

enforcement that addresses how officers can best approach individuals with mental health or substance abuse issues has been extremely important in my community. Training programs that establish a partnership between law enforcement and mental health 

groups have effectively been implemented in my district. Since this 

legislation provides the creation of such programs, can you provide 

some insight about what effective training might entail, what 

should law enforcement be aware of when encountering individuals 

with mental health or substance abuse disorders in the line of 

duty, how could a lack of training cause an escalation in these encounters? 

Dr. LIEBERMAN. Thank you for that question. This really is a 

very important but also unfortunate situation that has arisen in 

which the law enforcement and criminal justice system has become 

so intertwined with mental illness and mental health care. Every 

time I see a terrible story about a mentally disturbed individual 

being subdued and possibly injured or killed by police, I am thinking why are the police called upon to be first responders? That is 

really not their training. And similarly, in correctional officers in 

jails or prisons, because of the increasing number, that is not their 

training, and even if they do have some in-service training about 

this, it really is not sufficient. 

So I think both criminal—and it is interesting you ask that because just this past Friday, I was speaking to 500 attorneys in the 

Manhattan District Attorney’s Office. They asked me to come down 

to speak to them about mental illness, what the nature of it was, 

what it looked like, and also how could they try and adapt so that 

they could better manage the process of judicially reviewing cases 

of individuals who clearly have mental illness. So this is a growing 

problem. 

I think training is important, both for the police as well as for 

the criminal justice system, but frankly, if we are going to basically 

launder our mentally ill through the criminal justice system, both 

juvenile and adult, we probably need to have mental health professionals embedded with the police and more present within the prisons, in the jails. This is the new normal or the new reality, and 

we need to provide care where it is required. 

I was having a conversation with individuals at that meeting on 

Friday where I offered the observation that, in adult prisons, you 

have people principally who are adults, who are either psychotic, 

with schizophrenia, bipolar disorder, possibly psychotic depression, 

and substance abusing. Predominant diagnoses. In the juvenile detentions, it is kids who have what are regarded as antisocial behaviors and conduct, but in many respects, I would even venture to say 

it is the majority, these individuals start out as individuals who 

have learning disabilities or what is scientifically called pediatric 

cognitive disorders. They have dyslexia, they have ADHD, they 

have nonverbal learning disabilities, and they can’t connect with 

the world socially, educationally, and because they aren’t succeeding, they are getting kind of negative feedback, they react to 

it in an obstreperous or disobedient way, and that leads them down 

this path and they end up in prisons. So it gets to what Patrick 

was saying about, we are sort of addressing this downstream, closVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00111 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
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ing the barn door after the horses have left. But either we give a 

modicum of training to our law enforcement and correctional people, or we embed mental health professionals or we really go for 

the big solution which is preempting the flow of individuals into 

the legal system to begin with. 

Mr. BILIRAKIS. Thank you. Thank you very much. I will yield 

back. I don’t have any more time. Thank you, Mr. Chairman. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentleman from Maryland, Mr. Sarbanes, 5 

minutes for questions. 

Mr. SARBANES. I thank you, Mr. Chairman. I want to thank the 

panel. Patrick, welcome back. It is great to see you. I was talking 

to Dr. Nancy Grasmick the other day when I was working with you 

on brain research affecting early childhood, and she is incredibly 

excited about the work that you all are doing together. And I 

worked for her for 8 years, so I can tell you if she is excited, it has 

to be good stuff. So congratulations on that, and thank you for your 

testimony here today. 

There is no question that we still live in a world where, when 

we see physical pain, our impulse is to treat it, and unfortunately, 

when we see mental pain, our collective impulse often is to look in 

the other direction. And the first step towards remedying that, a 

critical step, obviously, is to make sure that our health care system 

acts with the kind of parity that Patrick Kennedy and others 

fought so hard for, and is now embedded in the Affordable Care 

Act. 

There is this tension as we think about how to distribute resources across a health care system that is more sensitive to issues 

of mental health between, sort of where along the spectrum do you 

place the resources to maximize the positive impact you can have. 

When you are talking about people that are on that spectrum of 

illness, intervening in an earlier stage may be intervening when 

the illness is less acute, more moderate. And so that is something 

that I know we are trying to sort out in the deliberations over this 

bill and other proposals that have come forward. 

It occurred to me that a lot of the debate over what kind of information can be made available to parents, for example, or family 

members of people that are suffering from mental illness, occurs 

because those suffering are of adult age, and that is when these 

protections kick in, which, to my mind, just emphasizes the importance of early intervention, because presumably early intervention, 

intervention at first instance, as Patrick indicated, would oftentimes be intervention that occurs before the individual reaches the 

age of majority and these protections kick in. So if we could promote more of that, we are not going to be diffusing all the situations where you have these kind of competing considerations between privacy and delivering care, but we will be addressing a significant number of them. And also presumably, just promoting a 

broader and more open and more candid conversation among all 

the affected people in the equation so that you begin to build a relationship and a communication, a conversation, that can help support that individual as they move forward. One that includes family members and includes caregivers, and so forth. 

107 

And finally, early intervention, I presume, has to promote parity. 

And we talk about sort of legal parity and health insurance coverage parity, but the greatest challenge we face, obviously, is 

achieving parity in a judgment that society delivers upon one kind 

of illness versus another. And I think that we all want to get to 

a place where our reflexive response to someone who is suffering 

from mental illness is on par with the way we respond to those 

who are experiencing a physical trauma, kind of in the traditional 

sense. 

I am committed to this ongoing conversation. I thank Representative Murphy for putting this in front of us for discussion. I thank 

Representative Matsui for her important contribution to the conversation. It is something we have to continue going forward. 

And I don’t really have any questions, just to thank you all for 

your testimony today. And I will yield back. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentleman from New York, Mr. Collins, 5 

minutes for questions. 

Mr. COLLINS. Thank you, Mr. Chairman. 

Before I get started, I just need to go out of my way to thank 

Congressman Murphy for his tireless work on the important issue 

we are here talking about. As a cosponsor of this bill last Congress, 

I am pleased to see this moving forward. This is certainly one step 

in that process. But I want to particularly thank Congressman 

Murphy for adding into this bill Section 207(d), a version of the Ensuring Children’s Access to Specialty Care Act, which I introduced 

earlier this year with Congressman Joe Courtney. This provision 

adds child and adolescent psychiatrists to the loan repayment program in the National Health Service Corps, or NHSC, for those 

doctors who practice in underserved areas. I believe this is an important step forward in getting mental health treatment to children, and I will continue to work to ensure that all pediatric subspecialties are covered in the NHSC program. 

I think we have covered a lot of the details today, but I did hear, 

Mr. Rosenthal, you mentioned, and I know you are a supporter of 

Obamacare, and we can all agree to disagree on certain things, you 

certainly let it hang out there that because of Obamacare, in the 

Medicaid expansion in those states that have accepted Medicaid expansion, they are offering significantly better different programs in 

mental health than the states that did not accept expansion. And 

I guess in the category of you don’t know what you don’t know is 

always—it has been my impression that with one minor exception, 

which is an optional minor demonstration program dealing with reimbursement for emergency inpatient psychiatric care, with the exception of that, the main thing that the Medicaid expansion did 

was change the income guidelines under which patients would 

qualify for Medicaid. States that accepted the expansion were able 

to get people in at a higher income level than states that didn’t. 

But I wasn’t aware that there was this wide area of different programming, et cetera, et cetera, going on. So I guess all I can do is 

say I kind of take issue with that piece of it which is kind of hung 

out there. But also I just want to bring up, we had under Chairman Murphy, a hearing on SAMHSA, and in that clearly, this committee was generally not happy with some of the outcomes, the exVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00113 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
108 

penditures of money, and so forth. And I know I—correct me if I 

am wrong, but I think the majority of your funding comes from 

SAMHSA, so you are—doesn’t. But I am assuming you are well 

versed in what SAMHSA does. 

Mr. ROSENTHAL. I would say 3 percent of my funding—— 

Mr. COLLINS. OK. 

Mr. ROSENTHAL [continuing]. Comes from—— 

Mr. COLLINS. But I know you do deal with SAMHSA and get—— 

Mr. ROSENTHAL. Yes. 

Mr. COLLINS. OK. So I guess kind of as a pick-up on that particular hearing, I believe this committee would like more local control of dollars, good reporting coming back, because SAMHSA is a 

funding mechanism to get grants out. Could you share with us here 

your thoughts on SAMHSA and how we might have the taxpayer 

dollars go to better use with that funneling mechanism, have you 

got any recommendations? I don’t know that it belongs in this bill 

or not, but we would just be interested in your observations there. 

Mr. ROSENTHAL. Well, as I said earlier, I think SAMHSA really 

helped birth the recovery consumer movement, and my experience 

with them in the contracts that I am working on is really focused 

on peer support, health care integration, employment, things that 

are noncontroversial and very important and significant. I think 

that arguments have been made that SAMHSA needs to be more 

balanced, but I think that the solution of eliminating it is not the 

way to go. We will lose an important resource and decades—— 

Mr. COLLINS. Yes, I don’t think that has been suggested, but like 

some government agencies, I think at some point more accountability, more metrics—— 

Mr. ROSENTHAL. I don’t disagree with that, Congressman. I 

think—— 

Mr. COLLINS. OK. 

Mr. ROSENTHAL [continuing]. SAMHSA needs more accountability. 

Mr. COLLINS. Yes. Well, I appreciate all of your—you would like 

to make a comment? 

Dr. LIEBERMAN. Yes, I mean SAMHSA—— 

Mr. COLLINS. You only have about 30 seconds, but—— 

Dr. LIEBERMAN. SAMHSA’s budget is $3.6 billion. The NIMH’s budget is $1.2 billion. SAMHSA’s efforts to try and provide and innovate mental health care from the perspective of the academic 

psychiatric community has been a disaster. They have not had a 

psychiatrist in a significant position of leadership in that in a decade. There is an ideological bias which pervades the organization. 

In fact, I would go so far as to say that SAMHSA is a proxy agency 

for the antimedical, antipsychiatry approach to mental health care. 

Mr. COLLINS. I can appreciate those comments, and certainly we 

continue to look to Chairman Murphy to lead our discussion in 

many of these areas based on his expertise. And while I don’t think 

anyone would suggest SAMHSA go out of existence, I think we 

want to see our taxpayer dollars go where they should, and perhaps a rebalancing might be appropriate as we move forward, and 

we would certainly appreciate your input on that. 

My time has expired, Mr. Chairman. I yield back. 

Mr. PITTS. The chair thanks the gentleman. 

109 

I don’t see any other Health Subcommittee members present, so 

without objection, we will go to—do we have—— 

VOICE. It is full committee. 

Mr. PITTS. Full committee members. Mr. Tonko, you are recognized 5 minutes for questions. 

Mr. TONKO. Thank you, Mr. Chair. 

I think we need to identify for the record whether or not we 

eliminate the SAMHSA role with the creation of a new structure 

within the Secretary’s position. 

Mr. PITTS. Do you want to respond, Dr. Murphy? 

Mr. MURPHY. What we do is we elevate SAMHSA from an agency 

to having Assistant Secretary of Mental Health and Substance Use 

be the head of that. And so it is not eliminated at all. It is elevated 

in terms of the authority of that. As you know, with these 112 federal agencies out there, someone needs to have enough strength behind their name and title to actually coordinate many aspects of 

this. 

Mr. TONKO. OK. I think it certainly warrants further discussion. 

And Representative Butterfield had to leave. He has asked that I 

request that this article, Fatal Police Shootings in 2015 Approaching 400 Nationwide, be submitted to the record. 

Mr. PITTS. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. TONKO. And I thank you, Mr. Chair. And thank you as well 

to my colleagues. Certainly, Representative Murphy and Representative Matsui have been doing great work to introduce legislation that continues the conversation on how we can best address 

the needs of those struggling with mental illness. 

While I continue to have a number of concerns with the Helping 

Families in Mental Health Crisis Act, I believe that it is a thoughtful and earnest endeavor, and it is my hope that we can all come 

together to move forward, address these concerns, strengthen the 

legislation, and produce a final product. I think it is very important 

that we do that, and that need has been expressed by several on 

the panel here this morning. 

That being said, Mr. Gionfriddo, in your testimony you touched 

upon the issue of funding for the new programs included in this 

legislation, stating that it is emphatically the position of Mental 

Health America that any offsets should not come from existing 

community mental health programs. One of my concerns with this 

legislation as it currently is written is that it is ambiguous on the 

funding mechanisms of many of these programs, and where it does 

speak to funding specific programs, it often reauthorizes them at 

lower levels than currently funded. As the authorizing committee, 

it is our job to ensure that we put our money where our mouth indeed is, and provide clear and unambiguous funding instructions to 

the Appropriations Committee so that together, we can make the 

strong bipartisan case that more funding is needed for mental 

health and substance use programs—— 

Mr. GIONFRIDDO. Yes. 

Mr. TONKO [continuing]. And can you please comment on this 

and, more generally, the need for this legislation to support not 

supplant existing funding for mental health and substance use programs? 

110 

Mr. GIONFRIDDO. Yes, I would be happy to. The first thing is that 

I would certainly encourage the committee to not make any doubt 

about the fact, or have any doubt about the fact that those dollars 

ought to come from someplace else. And, of course, I said in my testimony I think they ought to come from the jails and prisons. I 

think that is the place to get them from because that is the place 

they have been sent to. Too many dollars have been cut. The states cut $4.6 billion from 

mental health agencies between 2009 to 2013, and here we hear 

that we only put the federal level $1.2 billion into IMH, and then 

SAMHSA only put $1.2 billion into the mental health side. That is 

1⁄2 of what the states have cut is the total federal amount. So we 

can’t continue to live with that. If the states aren’t going to do their 

jobs, and they haven’t been doing their jobs in this area, they just 

haven’t, the Federal Government has to step in and figure out how 

to give them the guidance to make sure that they invest this way, 

and make sure they continue to invest early on in the process. 

Mr. TONKO. Thank you very much. 

And can I ask our other panelists to comment on that same question about supporting, nor supplanting existing funding? Senator 

Deeds? 

Mr. DEEDS. Sure. I don’t claim any expertise. I know about the 

Virginia system, but from my perspective, the system overall is not 

working. I don’t think it hurts anything to examine the way you 

spend money and see if you can spend it more efficiently. I have 

been in the state legislature 24 years, I have never believed that 

you solve problems just by throwing money at them. But it is clear 

to me that in some cases, more funding is needed, but we have to 

make sure we are spending money as efficiently as we can right 

now, and I don’t think we are. 

Mr. TONKO. OK. Congressman Kennedy, great to see you. Thank 

you for your hard work. 

Mr. KENNEDY OF MASSACHUSETTS. Well, thank you, Representative Tonko. You in New York passed the parity in New York. We 

acknowledge that. 

I would say that we have to see the forest for the trees. And the 

forest says that if we employ a whole new system, instead of the 

emergency rooms, instead of the jails, we could give better care to 

people and it will cost us less money. And talk about a bipartisan 

plan that would get through Congress. So we need to talk about 

with GAO and OMB new mechanisms to think about mental health 

in a systemic way so that we are not trimming along the edges, because right now, Representative Murphy’s statement that we are 

fiddling while Rome burns is true. We need to look at the more fundamental issues of where the funding is coming overall, and align 

them in between committees of jurisdiction, because a lot of people 

hear about the housing issues which need to be supported, the Department of Labor issues, the job training and support, none of 

that is aligned in our budgets and that is what hobbles our ability 

to have a comprehensive solution to this challenge. 

Mr. TONKO. Thank you very much. Dr. Lieberman? 

Dr. LIEBERMAN. I completely agree. I think it is not a matter of 

reducing funding, but it is a matter of—I think SAMHSA needs to 

be basically rehabilitated, and there is a mechanism in this bill 

111 

which really elevates the stature and importance of mental health 

care which had been under the rubric of SAMHSA. I remember, my 

career goes back to when there was ADAMHA which was the combination of the NIMH and what is now SAMHSA, and there was 

effective oversight and direction then, but for a variety of reasons 

I don’t claim to be privy to, they were separated. The NIMH went 

back into the NIH, and SAMHSA went off on its own, and it has 

been a complete waste ever since. 

Mr. PITTS. The gentleman’s time has expired. 

The chair now recognizes Mr. Loebsack 5 minutes for questions. 

Mr. LOEBSACK. Thank you, Mr. Chair and Ranking Member. 

Thank you for letting me be an interloper here today. I am not a 

member of this subcommittee, and so it is a great opportunity for 

me to speak to some of these issues, and ask a couple of questions. 

First thing I should say, as so many of the folks in this body, I 

have personal experience with this issue. My mom, as I was growing up, and as long as I can remember, as long as she lived, she 

struggled with mental illness. That leads me to the issue of stigma, 

and I am really glad that Ms. Schakowsky talked about that. I 

know that you folks are very aware of that. And, Congressman 

Kennedy, I mean we have talked about this while you were here, 

and you have been such a great champion on these issues. When 

I was on the Education and Labor Committee, we had a lengthy 

hearing, we had Rosalynn Carter come in and talk about this. I tell 

people often as a Member of Congress, if I don’t succeed at anything else on the mental illness front, I am going to be very successful in talking about this issue and doing everything I can to remove the stigma from this issue and those folks who are struggling 

with this issue. And if that is all I succeed then I will have at least 

done something while I am here. 

On the policy front, I do thank my friend, Congressman Murphy, 

for his attempts to do what he can on this front. I know we can 

do better. He knows we can do better. And I have talked to him 

at great length about how we can hopefully work together to resolve some of these issues. 

My big issue today that I just want to mention briefly has to do 

with children, has to do with rural areas, and there are a number 

of us on this panel who are from rural areas. Clearly, children are 

best served by providers that are trained to meet their needs. 

There is no question about that. That may mean a child psychiatrist where one is available, and that is the big issue in many 

ways, but it should also involve pediatricians, I would argue, that 

have well-established relationships with families and that serve as 

a medical home for children. But in Iowa, there are only 53 child 

and adolescent psychiatrists. Now, we only have 3 million people, 

but only 53. And these providers are concentrated in 14 counties. 

That leaves 85 more rural counties without a single provider. Also, 

the provider on average is 52 years old. So the demographics are 

there as well. You know this very well, Dr. Lieberman. 

I am going to be introducing legislation soon that would tackle 

this issue by supporting innovative programs that operate in more 

than 1⁄2 of all states, including my own, Iowa, to provide mental 

health consultation by child psychiatrists, or pediatric primary care 

practices, often called child psychiatry access programs, to enable 

112 

the pediatrician to treat a child in his or her office, or refer to a 

specialist if that is necessary. These programs, I think, show a lot 

of promise. They are being well received by pediatricians and by 

child psychiatrists alike. So I guess I would like to—Mr. 

Gionfriddo, and perhaps Dr. Lieberman as well, and anyone else, 

talk to me about these issues if you would, about the need for early 

childhood intervention and treatment programs, and about how the 

needs of children are different than the needs of adults, and how 

child psychiatrists are uniquely qualified, if you will, to help this 

population, and integrating that as well, as I have suggested. 

Mr. GIONFRIDDO. Well, starting from a nonclinical perspective, 

and mostly sort of a parental perspective about this—— 

Mr. LOEBSACK. That is important. 

Mr. GIONFRIDDO [continuing]. It was absolutely essential that my 

son, at a relatively early age, had access to a good child psychiatrist. He had access to a good child psychologist as well, and they 

together really helped develop a plan. Now, it didn’t work out all 

that well because we couldn’t integrate what the schools were 

doing, and that is a whole other issue we all need to talk about—— 

Mr. LOEBSACK. Right. 

Mr. GIONFRIDDO [continuing]. How we do that with kids. But it 

is absolutely essential that we get those perspectives working with 

parents and the parents’ pediatricians, as you point out, right from 

the start, because together, all of those four parties, if you will, and 

the social workers who assist, and others too, can put together the 

kind of plans that can change trajectories of lives. And that is what 

we have to think about here. We don’t just have these two populations, all these people are going to get better on their own, or 

those other people we have to wait until disaster occurs to treat, 

99.9 percent of the people like my son, somewhere in the vast middle of this, and we can do so much for them if we all work together, 

just like you are going to do so much for us by all working together 

this year. 

Mr. LOEBSACK. That is right. Hey, we have done some of that on 

this committee already, and I think we have already set some good 

examples. 

Yes, Dr. Lieberman? 

Dr. LIEBERMAN. I couldn’t agree with you more. If you talk to any 

primary care doctor, whether it is a pediatrician, a family medicine 

doctor, or an internist, they will tell you that 40 percent of their 

practice or more is psychiatric. And there aren’t enough child psychiatrists, there aren’t enough adult psychiatrists, to go around, 

and we need to have really teams of mental health care providers 

which include all the disciplines—psychology, social work, nurse 

practitioners—that have defined roles and responsibilities. But the 

frontier, the line of first defense, needs to be in the primary care 

system. 

Mr. LOEBSACK. OK. 

Dr. LIEBERMAN. And so mental health education needs to be part 

of all the primary care system. That includes pediatrics, OB/GYN, 

and family medicine. 

Mr. KENNEDY OF MASSACHUSETTS. And I would just add collaborative care models have been validated through 80-plus randomized control trials. So this notion of building this has been demVerDate Nov 24 2008 13:21 Jul 15, 2016 Jkt 037690 PO 00000 Frm 00118 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 114\114-55 CHRIS
113 

onstrated to be cost-effective in outcomes, and why we don’t have 

insurance companies reimbursing for something that is in their 

self-interest in terms of better financial interest and better health, 

is something we still have to work on. But you are right on target 

with trying to bridge this gap in the workforce shortage by having 

more collaborative care models. 

Mr. LOEBSACK. Thanks to all of you. And thank you, Mr. Chair. 

Thank you. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentleman from Indiana, Dr. Bucshon, 5 

minutes for questions. 

Mr. BUCSHON. Mr. Chairman, I yield my time to Mr. Murphy 

from Pennsylvania. 

Mr. MURPHY. I thank the gentleman from Indiana. And just a 

couple of quick questions here. 

Dr. Lieberman, is there anything we can do to really totally prevent schizophrenia and bipolar right now? 

Dr. LIEBERMAN. I think that these conditions are preventable in 

the sense that we can’t cure them, but we can stop them from 

starting. And the way to do that has really already been—a template has been created in the area of cardiovascular disease. In 

1955, President Eisenhower had a heart attack and, I think it is 

known that he loved to play golf, he was a chain-smoker, he was 

obviously in high stress, he had a heart attack. And he went in the 

hospital for 4 weeks, he rested, afterwards they told him to take 

it easy for another 4, 6 weeks and then come back to work. And 

he sort of resumed the same lifestyle, and some years later, from 

a recurrent heart attack, he died. But that stimulated public attention and galvanized research in the medical community and the 

NIH funding. And 50 years later, the morbidity and mortality of 

cardiovascular—arteriosclerotic heart disease is 60 percent less, 60 

percent less. But apart from that, it transformed the way cardiovascular disease was managed. It is no longer wait until somebody 

gets sick and then put them in the hospital or treat them with 

something, it is when you are born, you know what risk factors you 

have. You may have a family history. As you grow, you have to 

watch your weight. Your family may want you to watch your diet. 

You can have your cholesterol measured. There are now gene panels that assess risk for cardiovascular disease. So preemptively, 

these are being addressed. But if you do get into a point where you 

are short of breath and you have chests pain or something, you can 

have a thallium scan, you can have a stress EKG, you can have 

various tests with pre-morbidly, that is your secondary prevention—— 

Mr. MURPHY. Are we getting to some of those, so one comment 

Mr. Rosenthal said by fostering a sharp swing to a more medical 

biological approach to mental health, we shouldn’t be doing that 

necessarily, but I mean—but yet last summer they identified 108 

genetic—genomic markers of schizophrenia. I see that as a breakthrough. I hope we can get there to do these things. 

And let me give a couple of concluding comments. I think I am 

the last person to question here. 

Senator, I feel like I have made a new friend today, and I thank 

you for that. I thank you for your courage and your tenacity as 

114 

well. If every state had someone like you for our Nation, more people like you, we would get this done. Patrick, also a dear friend, 

thank you for your voice on these issues. It is powerful. We have 

to keep that up. Keep it motivated. Jeff Lieberman, I know you are 

dedicated to these things. You are a great voice in saying we can 

solve these problems, and we will do that. Paul, we developed a 

good friendship over this too, and understand we have common 

grounds here. We have to work on these prevention issues. It is 

your work that made substantial changes in this bill. I thank you 

for that. We will keep working on that. And, Mr. Coe and Ms. 

Billingsley and Rosenthal, as I said earlier, there is a lot you said 

I totally agree with, and what we have to do is find the right wording to make sure we have that in there. You have heard a joint 

commitment here as we go through with Ms. Matsui, Mr. Tonko, 

and others here. We have more conversations of this on the floor 

than—of course, the media would never report, but you know what, 

we are actually working together. And maybe that is the news. But 

because we have been so involved in mental health for a long time, 

I began some 40 years ago at this too, but I think of that when we 

are all fresh and wet behind the ears, dealing with the mental 

health field. One of the things that oftentimes struck me is why do 

we do it this way? Why can’t we just help these families? Why can’t 

we just talk to people? Why can’t we use evidence-based care? And 

oftentimes we were told, well, we can’t do it that way because, and 

it shouldn’t be that way. I say psychiatry and psychology are the 

only areas of medicine that are defined by lawyers, and we need 

to make then defined by the patients’ needs, by the consumers’ 

needs, and get involved in a model that says really, yes, we can, 

and not only yes, we can, but we have to. 

Now, with regard to funding on these things, look, I am first in 

line to nag the Appropriations Committee. And now, the Senate 

may have some different rules they can follow, but we have to put 

a bill through that is budget-neutral. We are working hard to find 

some offsets on this. I look forward to working with my colleagues 

on this. I—look, I have no doubt that this equal, equal passion for 

changing these things, and we will do these things together. 

And I ask along those lines if all the members of this panel, all 

the witnesses, all the members of this subcommittee and others, we 

will keep working together. You have given us some great ideas 

today about what we have to do about the wording for this. But for 

all those people who we have lost this year and lost in other years, 

let’s not make their lives lost a lost cause. Let’s join together and 

recognize that we have to make sure that those disappearance of 

their lives shouldn’t be a disappearance of our passion and our 

dedication to this. We can make this happen. I fear greatly for this 

Nation if we do not make this the year that we make these significant and substantial reforms in this. Let’s use our voices together. 

We will not be silenced. We will make some changes here. 

And with that, Mr. Chairman, I thank you for your leadership 

in this as well. We can get this done. Hopefully, next time we get 

together will be for a Markup, or as a group, but with my colleagues, we will work together on some wording of these things for 

their concerns. 

And I—with that, I yield back. 

115 

Mr. PITTS. The chair thanks Dr. Murphy. Thank you for that excellent summary of our hearing today. 

And the chair would like to thank all of the witnesses for your 

patience, for your testimony, your expertise. It has been a very important hearing in this whole path that we are traveling on this 

issue, and the committee will act on this legislation. 

Members who were not here will have questions, I am sure. 

Some of us may have follow-up questions. We will submit those to 

you in writing. We ask that you please respond promptly. 

I remind members that they have 10 business days to submit 

questions for the record. That means they should submit their 

questions by the close of business on Tuesday, June 30. 

Without objection, the subcommittee is adjourned. 

[Whereupon, at 12:48 p.m., the subcommittee was adjourned.] 

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