I 

111TH CONGRESS 

1ST SESSION H. R. 1704 

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

health services on college campuses. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 25, 2009 

Ms. SCHAKOWSKY introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committee 

on Education and Labor, for a period to be subsequently determined by 

the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service Act to improve mental 

and behavioral health services on college campuses. 

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

3 SECTION 1. SHORT TITLE. 

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

5 Campus Improvement Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) The 2007 National Survey of Counseling 

9 Center Directors found that the average ratio of 


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1 counselors to students on campus is nearly 1 to 

2 2,000 and is often far higher on large campuses. 

3 The International Association of Counseling Services 

4 accreditation standards recommend 1 counselor per 

5 1,000 to 1,500 students. 

6 (2) College counselors report that 8.5 percent of 

7 enrolled students sought counseling in the past year, 

8 totaling an estimated 1,600,000 students. 

9 (3) Over 90 percent of counseling directors be10 lieve there is an increase in the number of students 

11 coming to campus with severe psychological prob12 lems. The majority of counseling directors report 

13 concerns that the demand for services is growing 

14 without an increase in resources. 

15 (4) A 2008 American College Health Associa16 tion survey revealed that 43 percent of students at 

17 colleges and universities report having felt so de18 pressed it was difficult to function, and one out of 

19 every 11 students seriously considered suicide within 

20 the past year. 

21 (5) Research conducted between 1989 and 2002 

22 found that students seen for anxiety disorders dou23 bled, for depression tripled, and for serious suicidal 

24 intention tripled. 


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1 (6) Many students who need help never receive 

2 it. Counseling directors report that, of the students 

3 who committed suicide on their campuses, only 22 

4 percent were current or former counseling center cli5 ents. Directors did not know the previous psychiatric 

6 history of 60 percent of those students. 

7 (7) A survey conducted by the University of 

8 Idaho Student Counseling Center in 2000 found 

9 that 77 percent of students who responded reported 

10 that they were more likely to stay in school because 

11 of counseling and that their school performance 

12 would have declined without counseling. 

13 (8) A 6-year longitudinal study of college stu14 dents found that personal and emotional adjustment 

15 was an important factor in retention and predicted 

16 attrition as well as, or better than, academic adjust17 ment (Gerdes & Mallinckrodt, 1994). 

18 SEC. 3. IMPROVING MENTAL AND BEHAVIORAL HEALTH ON 

19 COLLEGE CAMPUSES. 

20 Title V of the Public Health Service Act is amended 

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

22 the following: 


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1 ‘‘SEC. 520E–3. GRANTS TO IMPROVE MENTAL AND BEHAV2 IORAL HEALTH ON COLLEGE CAMPUSES. 

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

4 with respect to college and university settings, to— 

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

6 health services; 

7 ‘‘(2) foster and improve the prevention of men8 tal and behavioral health disorders, and the pro9 motion of mental health; 

10 ‘‘(3) improve the identification and treatment 

11 for students at risk; 

12 ‘‘(4) improve collaboration and the development 

13 of appropriate levels of mental and behavioral health 

14 care; 

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

16 health disorders and enhance their access to mental 

17 health services; and 

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

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

20 Administrator and in consultation with the Secretary of 

21 Education, shall award competitive grants to eligible enti22 ties to improve mental and behavioral health services and 

23 outreach on college and university campuses. 

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

25 under subsection (b), an entity shall— 


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

2 defined in section 101 of the Higher Education Act 

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

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

5 such time, in such manner, and containing such in6 formation as the Secretary may require, including 

7 the information required under subsection (d). 

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

9 under this section shall include— 

10 ‘‘(1) a description of the population to be tar11 geted by the program carried out under the grant, 

12 the particular mental and behavioral health needs of 

13 the students involved, and the Federal, State, local, 

14 private, and institutional resources available for 

15 meeting the needs of such students at the time the 

16 application is submitted; 

17 ‘‘(2) an outline of the objectives of the program 

18 carried out under the grant; 

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

20 training to be provided under the program, including 

21 planned outreach strategies to reach students not 

22 currently seeking services; 

23 ‘‘(4) a plan to seek input from community men24 tal health providers, when available, community 


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1 groups, and other public and private entities in car2 rying out the program; 

3 ‘‘(5) a plan, when applicable, to meet the spe4 cific mental and behavioral health needs of veterans 

5 attending institutions of higher education; 

6 ‘‘(6) a description of the methods to be used to 

7 evaluate the outcomes and effectiveness of the pro8 gram; and 

9 ‘‘(7) an assurance that grant funds will be used 

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

11 State, or local funds available to carry out activities 

12 of the type carried out under the grant. 

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

14 grants under this section, the Secretary shall give special 

15 consideration to applications that describe programs to be 

16 carried out under the grant that— 

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

18 additional mental and behavioral health services, in 

19 part by providing information on current ratios of 

20 students to mental and behavioral health profes21 sionals; 

22 ‘‘(2) propose effective approaches for initiating 

23 or expanding campus services and supports using 

24 evidence-based practices; 


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1 ‘‘(3) target traditionally underserved popu2 lations and populations most at risk; 

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

4 of, and a willingness to, coordinate with a commu5 nity mental health center or other mental health re6 source in the community, to support screening and 

7 referral of students requiring intensive services; 

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

9 address psychiatric emergencies, including how in10 formation will be communicated with families or 

11 other appropriate parties; and 

12 ‘‘(6) demonstrate the greatest potential for rep13 lication and dissemination. 

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

15 grant under this section may be used to— 

16 ‘‘(1) provide mental and behavioral health serv17 ices to students, including prevention, promotion of 

18 mental health, screening, early intervention, assess19 ment, treatment, management, and education serv20 ices relating to the mental and behavioral health of 

21 students; 

22 ‘‘(2) provide outreach services to notify stu23 dents about the existence of mental and behavioral 

24 health services; 


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1 ‘‘(3) educate families, peers, faculty, staff, and 

2 communities to increase awareness of mental health 

3 issues; 

4 ‘‘(4) support student groups on campus that 

5 engage in activities to educate students, reduce stig6 ma surrounding mental and behavioral disorders, 

7 and promote mental health wellness; 

8 ‘‘(5) employ appropriately trained staff; 

9 ‘‘(6) expand mental health training through in10 ternship, post-doctorate, and residency programs; 

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

12 emerging best practices, including a focus on cul13 turally and linguistically appropriate best practices; 

14 and 

15 ‘‘(8) evaluate and disseminate best practices to 

16 other colleges and universities. 

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

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

19 ‘‘(h) EVALUATION AND REPORTING.— 

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

21 after the date on which a grant is received under 

22 this section, the eligible entity involved shall submit 

23 to the Secretary the results of an evaluation to be 

24 conducted by the entity concerning the effectiveness 


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1 of the activities carried out under the grant and 

2 plans for the sustainability of such efforts. 

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

4 date of enactment of this section, the Secretary shall 

5 submit to the appropriate committees of Congress a 

6 report concerning the results of— 

7 ‘‘(A) the evaluations conducted under 

8 paragraph (1); and 

9 ‘‘(B) an evaluation conducted by the Sec10 retary to analyze the effectiveness and efficacy 

11 of the activities conducted with grants under 

12 this section. 

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

14 provide technical assistance to grantees in carrying out 

15 this section. 

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

17 are authorized to be appropriated such sums as may be 

18 necessary to carry out this section. 

19 ‘‘SEC. 520E–4. MENTAL AND BEHAVIORAL HEALTH OUT20 REACH AND EDUCATION ON COLLEGE CAM21 PUSES. 

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

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

24 mental health services so as to ensure that college students 


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1 have the support necessary to successfully complete their 

2 studies. 

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

4 The Secretary, acting through the Administrator and in 

5 collaboration with the Director of the Centers for Disease 

6 Control and Prevention, shall convene an interagency, 

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

8 begin coordinating and evaluating a targeted public edu9 cation campaign that is designed to focus on mental and 

10 behavioral health on college campuses. Such campaign 

11 shall be designed to— 

12 ‘‘(1) improve the general understanding of men13 tal health and mental health disorders; 

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

15 to the promotion of mental health, prevention of 

16 mental health disorders, and treatment of such dis17 orders; 

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

19 behavioral health and academic success; and 

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

21 early warning signs and reducing the stigma of men22 tal illness. 

23 ‘‘(c) COMPOSITION.—The working group under sub24 section (b) shall include— 


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1 ‘‘(1) mental health consumers, including stu2 dents and family members; 

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

4 ‘‘(3) representatives of national mental and be5 havioral health and college associations; 

6 ‘‘(4) representatives of college health promotion 

7 and prevention organizations; 

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

9 including community mental health centers; and 

10 ‘‘(6) representatives of private- and public-sec11 tor groups with experience in the development of ef12 fective public health education campaigns. 

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

14 shall develop a plan that shall— 

15 ‘‘(1) target promotional and educational efforts 

16 to the college age population and individuals who are 

17 employed in college and university settings, including 

18 the use of roundtables; 

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

20 research-based public health messages and activities; 

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

22 stigma by using the National Mental Health Infor23 mation Center as a primary point of contact for in24 formation, publications, and service program refer25 rals; and 


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

2 a social marketing campaign that is targeted at the 

3 college population and individuals who are employed 

4 in college and university settings. 

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

6 are authorized to be appropriated such sums as may be 

7 necessary to carry out this section.’’. 

8 SEC. 4. INTERAGENCY WORKING GROUP ON COLLEGE MEN9 TAL HEALTH. 

10 (a) PURPOSE.—It is the purpose of this section, pur11 suant to Executive Order 13263 (and the recommenda12 tions issued under section 6(b) of such Order), to provide 

13 for the establishment of a College Campus Task Force 

14 under the Federal Executive Steering Committee on Men15 tal Health, to discuss mental and behavioral health con16 cerns on college and university campuses. 

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

18 Human Services (referred to in this section as the ‘‘Sec19 retary’’) shall establish a College Campus Task Force (re20 ferred to in this section as the ‘‘Task Force’’), under the 

21 Federal Executive Steering Committee on Mental Health, 

22 to discuss mental and behavioral health concerns on col23 lege and university campuses. 

24 (c) MEMBERSHIP.—The Task Force shall be com25 posed of a representative from each Federal agency (as 


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

2 over, or is affected by, mental health and education poli3 cies and projects, including— 

4 (1) the Department of Education; 

5 (2) the Department of Health and Human 

6 Services; 

7 (3) the Department of Veterans Affairs; and 

8 (4) such other Federal agencies as the Adminis9 trator of the Substance Abuse and Mental Health 

10 Services Administration and the Secretary jointly de11 termine to be appropriate. 

12 (d) DUTIES.—The Task Force shall— 

13 (1) serve as a centralized mechanism to coordi14 nate a national effort— 

15 (A) to discuss and evaluate evidence and 

16 knowledge on mental and behavioral health 

17 services available to, and the prevalence of men18 tal health illness among, the college age popu19 lation of the United States; 

20 (B) to determine the range of effective, 

21 feasible, and comprehensive actions to improve 

22 mental and behavioral health on college and 

23 university campuses; 


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1 (C) to examine and better address the 

2 needs of the college age population dealing with 

3 mental illness; 

4 (D) to survey Federal agencies to deter5 mine which policies are effective in encouraging, 

6 and how best to facilitate outreach without du7 plicating, efforts relating to mental and behav8 ioral health promotion; 

9 (E) to establish specific goals within and 

10 across Federal agencies for mental health pro11 motion, including determinations of account12 ability for reaching those goals; 

13 (F) to develop a strategy for allocating re14 sponsibilities and ensuring participation in men15 tal and behavioral health promotions, particu16 larly in the case of competing agency priorities; 

17 (G) to coordinate plans to communicate re18 search results relating to mental and behavioral 

19 health amongst the college age population to 

20 enable reporting and outreach activities to 

21 produce more useful and timely information; 

22 (H) to provide a description of evidence23 based best practices, model programs, effective 

24 guidelines, and other strategies for promoting 


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1 mental and behavioral health on college and 

2 university campuses; 

3 (I) to make recommendations to improve 

4 Federal efforts relating to mental and behav5 ioral health promotion on college campuses and 

6 to ensure Federal efforts are consistent with 

7 available standards and evidence and other pro8 grams in existence as of the date of enactment 

9 of this Act; and 

10 (J) to monitor Federal progress in meeting 

11 specific mental and behavioral health promotion 

12 goals as they relate to college and university 

13 settings; 

14 (2) consult with national organizations with ex15 pertise in mental and behavioral health, especially 

16 those organizations working with the college age 

17 population; and 

18 (3) consult with and seek input from mental 

19 health professionals working on college and univer20 sity campuses as appropriate. 

21 (e) MEETINGS.— 

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

23 at least 3 times each year. 

24 (2) ANNUAL CONFERENCE.—The Secretary 

25 shall sponsor an annual conference on mental and 


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1 behavioral health in college and university settings 

2 to enhance coordination, build partnerships, and 

3 share best practices in mental and behavioral health 

4 promotion, data collection, analysis, and services. 

5 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated such sums as may be 

7 necessary to carry out this section. 

Æ 


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