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HELPING FAMILIES IN MENTAL HEALTH CRISIS 

ACT OF 2013 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

APRIL 3, 2014 

Serial No. 113–136 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Missouri 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

FRANK PALLONE, JR., New Jersey 

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 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

SUBCOMMITTEE ON HEALTH

JOSEPH R. PITTS, Pennsylvania 

Chairman 

MICHAEL C. BURGESS, Texas 

Vice Chairman 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

CATHY MCMORRIS RODGERS, Washington 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

RENEE L. ELLMERS, North Carolina 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

FRANK PALLONE, JR., New Jersey 

Ranking Member 

JOHN D. DINGELL, Michigan 

ELIOT L. ENGEL, New York 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

GENE GREEN, Texas 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

HENRY A. WAXMAN, California (ex officio) 

(III) 

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. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 2 

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

New Jersey, opening statement .......................................................................... 4 

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

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

Prepared statement .......................................................................................... 6 

Hon. Henry A. Waxman, a Representative in Congress from the State of 

California, opening statement ............................................................................. 8 

WITNESSES

Sylvia Thompson, Patient Advocate and President, National Alliance on Mental Illness, West Side Los Angeles ...................................................................... 10 

Prepared statement .......................................................................................... 12 

David L. Shern, Interim President and CEO, Mental Health America, Alexandria, Virginia ........................................................................................................ 22 

Prepared statement .......................................................................................... 24 

Answers to submitted questions ...................................................................... 125 

Nancy Jensen, person with lived experience, Wichita, Kansas ........................... 30 

Prepared statement .......................................................................................... 32 

Mary T. Zdanowicz, Attorney, North Eastham, Massachusetts .......................... 41 

Prepared statement .......................................................................................... 43 

Michael Welner, M.D., Founder and Chairman, The Forensic Panel ................. 50 

Prepared statement .......................................................................................... 51 

Answers to submitted questions 1 ................................................................... 131 

SUBMITTED MATERIAL

Statement of the American Psychiatric Association, submitted by Mr. Pitts .... 86 

Article entitled, ‘‘The Definition of Insanity: How a federal agency undermines 

treatment for the mentally ill,’’ The Wall Street Journal, March 31, 2014, 

submitted by Mr. Pitts ......................................................................................... 88 

Statement of Robert Bruce, submitted by Mr. Pitts ............................................. 90 

Article entitled A Mental-Health Overhaul: A Congressman produces a set 

of good ideas for a difficult problem, the Wall Street Journal, December 

26, 2013, submitted by Mr. Pitts ........................................................................ 99 

Op-Ed by Hon. Tim Murphy, The Philadelphia Inquirer, January 26, 2014, 

submitted by Mr. Pitts ......................................................................................... 101 

Statement of the American Bar Association, submitted by Mr. Pitts ................. 103 

Statement of the National Disability Rights Network, submitted by Mr. Pitts . 105 

Statement of the National Coalition for Mental Health Recovery, submitted 

by Mr. Pitts ........................................................................................................... 108 

Statement of the Citizen Commission on Human Rights International 2, submitted by Mr. Pitts .............................................................................................. 85 

Statement of the Consortium for Citizens with Disabilities, submitted by 

Mr. Pitts ................................................................................................................ 112 

Page

IV 

Statement of the Bazelon Center for Mental Health Law, submitted by Mr. 

Pitts ....................................................................................................................... 118 

1 Dr. Welner’s response to submitted questions for the record can be found 

at http://docs.house.gov/meetings/if/if14/20140403/102059/hhrg-113- 

if14-wstate-welnerm-20140403-sd002.pdf. 2 The statement can be found at http://docs.house.gov/meetings/if/if14/ 

20140403/102059/hhrg-113-if14-20140403-sd008.pdf. 

(1) 

HELPING FAMILIES IN MENTAL HEALTH 

CRISIS ACT OF 2013 

THURSDAY, APRIL 3, 2014 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. 

The subcommittee met, pursuant to call, at 10:31 a.m., in room 

2322 of the Rayburn House Office Building, Hon. Joe Pitts (chairman of the subcommittee) presiding. 

Present: Representatives Pitts, Burgess, Murphy, Blackburn, 

Gingrey, Lance, Cassidy, Guthrie, Griffith, Bilirakis, Ellmers, 

Upton (ex officio), Pallone, Capps, Schakowsky, Green, Butterfield, 

Barrow, Christensen, Sarbanes, DeGette, Tonko, and Waxman (ex 

officio). 

Staff present: Clay Alspach, Chief Counsel, Health; Mike 

Bloomquist, General Counsel; Sean Bonyun, Communications Director; Karen Christian, Chief Counsel, Oversight; Noelle 

Clemente, Press Secretary; Brenda Destro, Professional Staff Member, Health; Brad Grantz, Policy Coordinator, Oversight and Investigations; Sydne Harwick, Legislative Clerk; Robert Horne, Professional Staff Member, Health; Katie Novaria, Professional Staff 

Member, Health; Sam Spector, Counsel, Oversight; Heidi Stirrup, 

Health Policy Coordinator; Tom Wilbur, Digital Media Advisor; 

Ziky Ababiya, Democratic Staff Assistant; Karen Lightfoot, Democratic Communications Director and Senior Policy Advisor; Karen 

Nelson, Democratic Deputy Committee Staff Director for Health, 

Anne Morris Reid, Democratic Senior Professional Staff Member; 

and Matt Siegler, Democratic Counsel. 

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 Chair will 

recognize himself for an opening statement. 

Millions of Americans suffer with severe mental illnesses, such 

as bipolar disorder, schizophrenia, and major depression, and many 

of them, and their families, struggle to find the treatment and help 

they desperately need. 

I would like to commend my colleague from Pennsylvania, Dr. 

Murphy, for his yearlong investigation into mental health issues 

and for proposing H.R. 3717, the Helping Families in Mental 

Health Crisis Act. Briefly, this bill would reform the Community 

Mental Health Services Block Grant program by changing adminisVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
2 

tration, improving data collection, and by requiring treatment 

standards to facilitate care. It would enhance Medicaid payments 

to Federally Qualified Community Behavioral Health Centers 

(FQCBHCs), make adjustments to HIPAA and FERPA—the Family 

Education Rights and Privacy Act—privacy regulations, and expand access to certain medical records for qualifying caregivers; 

create an Assistant Secretary for Mental Health who will be responsible for coordinating spending at all federal agencies on mental health, including at the Substance Abuse and Mental Health 

Services Administration (SAMHSA). It would make changes to key 

Justice Department regulations that impact at-risk or imprisoned 

individuals with mental illness. It would increase federal funding 

for certain Medicaid providers and research at the National Institutes of Health. It would institute liability protections for physician 

volunteers at FQCBHCs, and it would reform existing mental 

health programs at SAMHSA. 

I would like to welcome all of our witnesses here today. We look 

forward to learning from your expertise and experience. 

[The prepared statement of Mr. Pitts follows:] 

PREPARED STATEMENT OF HON. JOSEPH R. PITTS

The Subcommittee will come to order. 

The Chair will recognize himself for an opening statement. 

Millions of Americans suffer with severe mental illnesses, such as bipolar disorder, schizophrenia, and major depression, and many of them—and their families— 

struggle to find the treatment and help they desperately need. 

I would like to commend my colleague from Pennsylvania, Dr. Murphy, for his 

year-long investigation into mental health issues and for proposing H.R. 3717, the 

Helping Families in Mental Health Crisis Act. Briefly, this bill would: 

• Reform the Community Mental Health Services Block Grant Program by changing administration, improving data collection, and by requiring treatment standards 

to facilitate care; 

• Enhance Medicaid payments to Federally Qualified Community Behavioral 

Health Centers (FQCBHCS); 

• Make adjustments to HIPAA and FERPA (the Family Education Rights and Privacy Act) privacy regulations and expand access to certain medical records for qualifying caregivers; 

• Create an Assistant Secretary for Mental Health who will be responsible for coordinating spending at all federal agencies on mental health, including at the Substance Abuse and Mental Health Services Administration (SAMHSA); 

• Make changes to key Justice Department regulations that impact at-risk or imprisoned individuals with mental illness; 

• Increase federal funding for certain Medicaid providers and research at the National Institutes of Health; 

• Institute liability protections for physician volunteers at FQCBHCS; and 

• Reform existing mental health programs at SAMHSA. 

I would like to welcome all of our witnesses here today. We look forward to learning from your expertise and experience. 

Thank you, and I yield the remainder of my time to 

—————————————————————. 

Mr. PITTS. I will yield the balance of my time to the gentleman 

from Pennsylvania, Dr. Murphy. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Mr. MURPHY. I thank the chairman for convening this hearing, 

and I want to thank the witnesses for being here as well. 

3 

In light of yesterday’s tragic shooting at Fort Hood involving a 

soldier under treatment for a behavioral health disorder, and news 

this week out of Pittsburgh of a mother who said she heard voices 

commanding her to drown her two young children in a bathtub, today’s hearing has a sad element of timeliness to it. But let us keep 

in mind, most persons with mental illness are not violent, and tragically, are more frequently the victims of violence, but you will 

never hear the breaking news of a homeless man being robbed or 

beaten or a person with mental illness losing their job. 

Over the last year, the Oversight and Investigations Subcommittee I chair held a series of forums and hearings to review 

our Nation’s mental health system, and this bill, the Helping Families in Mental Health Crisis Act, is a result of those hearings, and 

with anything, there is misinformation about this legislation, which 

is why I am glad you have convened this hearing so we can continue to work forward on perfecting it. 

Fifty years ago, our Nation confronted the atrocities of asylums, 

warehouses for those whose illnesses medical science could not yet 

treat, and at that time this committee moved legislation to close 

those places and help individuals live in the community. Many 

were getting treatment and many were not, and for half a century 

operated under the illusion that having done something, we did the 

right thing. We didn’t. 

Unfortunately, that illusion has been shattered by the heartbreaking daily tragedies that prove our mental health system is 

broken and failing the very people who need help most. The stories 

are haunting and the numbers are staggering. 3.6 million people 

with serious mental illness don’t get treatment. There are over 

40,000 suicides a year, 20 soldier suicides each day. Another 1.3 

million attempted suicides. 

There is only one child psychiatrist for every 2,000 children with 

a mental health disorder. It is a system where the three largest 

mental health hospitals are actually jails, and there is a shortage 

of 100,000 psychiatric beds nationwide for those who are in acute 

crisis. 

A rule to protect privacy needs clarification because it has frustrated a countless number of physicians and members and generated over 70,000 complaints, and the mental health agency that 

until recently employed as many dentists as it did psychologists 

and psychiatrists, and this is what the American taxpayer buys for 

$125 billion. 

That is why we introduced this bill, to engage in meaningful reform. It has several of those elements that just presented by the 

chairman in empowering parents and caregivers by breaking down 

the barriers that prevent communication, increases access to acute 

care psychiatric beds, provides alternatives to inpatient care 

through assisted outpatient treatment, and expands access to the 

underserved and rural populations; creates an Assistant Secretary 

of Mental Health to scrutinize federal programs and promote evidence-based care; ensures mental health patients enrolled in Medicare and Medicaid have access to the full range of medications that 

keep them healthy and out of the hospital; advances critical research at the National Institutes of Mental Health like the Brain 

Research Initiative; promotes promising evidence-based care like 

4 

the recovery after initial schizophrenic episode; improves quality 

and expands access to integrated medical and mental health care 

at community mental health providers, extends health information 

technologies so mental health providers can communicate and work 

with primary care physicians, and ensures greater accountability 

from the Substance Abuse and Mental Health Service Administration. 

For far too long, those who need help have been getting it the 

least, and where there is no help, there is no hope. We can, must 

and will take mental illness out of the shadows of ignorance, despair, neglect and denial and into that bright light of hope, and it 

starts with the Helping Families in Mental Health Crisis Act. 

I look forward to hearing the comments of our witnesses today. 

I yield back. 

Mr. PITTS. The chair thanks the gentleman and now recognizes 

the ranking member of the subcommittee, Mr. Pallone, for 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, Chairman Pitts. 

This is our subcommittee’s first proceeding on mental health during this Congress, and while I am thankful to you for finally convening a panel to talk about this critically important issue, I remain conflicted and disappointed that you have decided to move 

straight to a legislative hearing. 

For over a year we have had personal and staff discussions about 

the importance of the Health Subcommittee examining mental 

health in light of some heartbreaking events in the past couple of 

years, and despite this today, I and other members of the subcommittee are at a significant disadvantage because we haven’t 

been afforded an opportunity to be at the forefront of evaluating 

and focusing on mental illness. As the Health Subcommittee, we 

should be the ones putting a full-scale effort into reviewing this 

and understanding it better. 

Mental illness is an important public health issue. According to 

numbers from the National Alliance on Mental Health, it is estimated that one in four adults experience a mental illness during 

the course of a given year. That is about 55.7 million people. Meanwhile, only about 60 percent of people with mental illness get treatment each year. Of these people, approximately 11.4 million adults 

in the United States live with a serious mental illness, which includes, among others, major depression, schizophrenia, and bipolar 

disorder. Individuals with serious mental illness can be treated effectively, but unfortunately, it has been so difficult for those who 

need services to break through the stigma and weigh the obstacles 

associated with mental health, even though we know how important mental health is and how interlinked it is to all aspects of 

health and quality of life. 

What some people may not realize is that mental illness is not 

an isolated public health problem. Cardiovascular disease, diabetes, 

and obesity often coexist with mental illness and treatment of the 

mental illness can reduce the effects of these disorders. So it is 

5 

proven that people, families, and communities will benefit from increased access to mental health services. Despite recent vigorous 

debate about America’s mental health policies, there has been no 

clear solution yet. However, we made some significant steps over 

recent years. The first significant milestone was the Paul Wellstone 

Mental Health Parity and Addiction Equity Act, which makes sure 

that large employer-based insurers cannot charge more or place 

greater restrictions on mental health benefits that they do for medical benefits. This parity law marked a dramatic and historic step 

for the rights of Americans with mental health and addiction illness. When I was the chairman of the Health Subcommittee, I was 

proud to help play a critical role in enacting this bipartisan legislation. 

Of course, the parity struggle is not over. The implementation of 

this law is critical. Specifically, we need to ensure that there are 

measures in place for meaningful reporting on compliance with the 

law. 

Another significant milestone was passage of the Affordable Care 

Act. It includes a number of provisions aimed at improving coverage for and access to mental health services. So let me point out 

some of the critical details in the ACA. First, people can no longer 

be denied coverage because of preexisting conditions, and this includes mental health illness; more access to the Medicaid program, 

which has always provided a number of mental health treatments. 

Mental health treatment now comes standard. Every health plan 

sold through an exchange has to cover a variety of medical services, 

which includes mental health and substance abuse treatments. 

And finally, the ACA extends mental health parity to all Americans, not just those who are covered by large employers, again, 

building upon the Paul Wellstone law. 

Mr. Chairman, these are just the highlights of the law the Republicans aim to repeal. The ACA also includes a number of provisions that specifically list mental health and substance abuse as 

priority topics in programs like the National Prevention Council, 

health workforce development initiatives and medical homes, and 

there is still a lot more to do. People will only benefit from the 

progress we have made if services are available and if those who 

need help are not afraid to seek it. We need to build from these 

laws to support the continuum of mental health services at all levels of government. 

That is why I believe we must support efforts to increase awareness about mental health and reduce the fear, shame, and 

misperceptions that often prevent people from getting the help they 

need, and I am committing to spreading the message that it is OK 

to talk about mental health because treatment is effective and people do recover. We must find out which treatments are the right 

treatments and how we can best identify Americans who need help, 

and that is why agencies such as the Substance Abuse and Mental 

Health Services Administration and NIMH are so important. 

So Mr. Chairman, there are a number of Democrats on the committee who have introduced legislation and expressed interesting in 

working together to improve mental health in this country. I hope 

that if you choose to move forward on the bill under consideration 

today that we can find common ground and pass bipartisan legislaVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
6 

tion. I have some serious concerns about some of the provisions of 

H.R. 3717 but I remain committed to working with you and my 

other colleagues on the committee as we make mental health a priority. 

Thank you, Mr. Chairman. 

Mr. PITTS. The chair thanks the gentleman and now recognizes 

the chairman of the full committee, the gentleman from Michigan, 

Mr. Upton, for 5 minutes for an opening statement. 

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

Mr. UPTON. Well, thank you, Mr. Chairman. 

Mental illness affects millions of Americans and their families, 

yet sadly it is a subject often left unmentioned in Congress and in 

communities across the country, and we are working to change 

that. Yes, we are. Ensuring treatments and resources are available 

and effectively used for those suffering with mental illnesses has 

been a priority of this committee throughout the 113th Congress. 

Since January of last year, Oversight and Investigations Subcommittee Chairman Tim Murphy has spearheaded a thorough review of all federal mental health programs. The subcommittee and 

the committee held a series of public forums, briefings and investigative hearings to discern how federal dollars devoted to research 

and treatment into mental illness are being prioritized and spent. 

I want to commend him and those of efforts, and those of the ranking member of the Oversight and Investigations Subcommittee, 

Diana DeGette, to ensure a bipartisan focus on these vital issues. 

To address the gaps discovered in the extensive and wide-ranging examination, Chairman Murphy introduced H.R. 3717 last 

year, the Helping Families in Mental Health Crisis Act of 2013. 

The bill addresses issues that are important in diagnosing and 

treating individuals with serious mental illness. It would reorient 

federal funding for mental health to improve the delivery of mental 

health services and help improve the lives of mental health patients and their families. 

I am pleased that two important provisions of that bill were included in H.R. 4302 that the President signed earlier this week, 

which was sponsored, of course, the overall bill by Chairman Pitts. 

The first provision will help local jurisdictions implement assisted 

outpatient treatment grant programs, and the second will improve 

access to community mental health services, bipartisan and bicameral support for both of those provisions. 

I would just like to add that to those families who have been impacted by mental illness in some form, Congress is aware of your 

plight and we can do better. 

I yield the balance of my time to the vice chair of the subcommittee, Dr. Burgess. 

[The prepared statement of Mr. Upton follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

Mental illness affects millions of Americans and their families, yet sadly it is a 

subject often left unmentioned in Congress and in communities across the country. 

We are working to change that. Ensuring treatments and resources are available 

7 

and effectively used for those suffering with mental illnesses has been a priority of 

this committee throughout the 113th Congress. 

Since January 2013, Oversight and Investigations Subcommittee Chairman Tim 

Murphy has spearheaded a thorough review of all federal mental health programs. 

The committee held a series of public forums, briefings, and investigative hearings 

to discern how federal dollars devoted to research and treatment into mental illness 

are being prioritized and spent. I want to commend Chairman Murphy’s efforts, and 

those of the Ranking Member of the Oversight and Investigations Subcommittee, 

Diana DeGette, to ensure a bipartisan focus on these vital issues. 

To address the gaps discovered in the extensive and wide-ranging examination, 

Chairman Murphy introduced H.R. 3717, the Helping Families in Mental Health 

Crisis Act of 2013. The bill addresses issues important in diagnosing and treating 

individuals with serious mental illness. It would reorient federal funding for mental 

health to improve the delivery of mental health services and help improve the lives 

of mental health patients and their families. 

I am pleased that two important provisions of H.R. 3717 were included in H.R. 

4302, the Protecting Access to Medicare Act of 2014, which was sponsored by Health 

Subcommittee Chairman Pitts and recently signed by the president. The first provision will help local jurisdictions implement assisted outpatient treatment grant programs, and the second will improve access to community mental health services. 

I would just like to add that to those families who have been impacted by mental 

illness in some form—Congress is aware of your plight and we can do better. 

I’d like to thank the witnesses for taking the time to testify before the Subcommittee this morning. I yield the remainder of my time to 

—————————————————————. 

Mr. BURGESS. Well, I thank the chairman for yielding. I really 

do not have prepared comments this morning but I did feel obligated to respond. 

I am the vice chairman of this subcommittee as well as the vice 

chairman of the Oversight and Investigations Subcommittee, and 

in total, the committee through its subcommittees, this represents 

the eighth dedicated hearing to mental health and mental health 

issues between the Oversight and Investigations Subcommittee and 

the Subcommittee on Health and the full committee in general. So 

it is not from lack of attention. Chairman Murphy has made this 

the centerpiece of his chairmanship of the Oversight and Investigations Subcommittee, which is appropriate but that is not a legislative committee, so today we are in the Health Subcommittee, and 

Chairman Pitts is encouraging us to have this legislation hearing 

on Congressman Murphy’s efforts. 

And then as a Texan, I just have to say across the country, our 

hearts are heavy because of what we saw down in Fort Hood last 

evening. When the news stories began to break, I am sure I felt 

the same as everyone else across the country felt: oh, no, not again. 

It seems like just a few months ago that we were down for the memorial service for the 13 soldiers who were lost in November of 

2009, and now we are facing another series of questions surrounding another incident yesterday. 

We know there will be an investigation. We know there will be 

answers to the questions that are forthcoming, but right now 

please let us keep in our thoughts the soldiers at Fort Hood, their 

general officer corps, of course the people in Killeen, Texas, Harker 

Heights, Coppers Cove, those communities. I will tell you from 

firsthand experience during the memorial service 4 1⁄2 years ago, 

those communities came together and embraced the soldiers at 

Fort Hood and let them know they were not acting alone. Our military has been under great stress for the last decade. Surely this is 

something they didn’t need but we can all stand in their support. 

8 

Thank you, Mr. Chairman. I will yield back. 

Mr. PITTS. The chair thanks the gentleman and now recognizes 

the ranking member of the full committee, Mr. Waxman, 5 minutes 

for an opening statement. 

OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. WAXMAN. Thank you, Mr. Chairman. 

One in four adults has a diagnosable form of mental illness in 

any given year. More than 10 million Americans are living with serious mental illness, conditions like schizophrenia and major depression. But even as the demand for mental health services has 

increased, there has been an unprecedented decline in state public 

mental health spending. The Federal Government has stepped in 

to help fill the gap. The increased coverage provided by the Affordable Care Act and the mental health benefits it requires will make 

a substantial improvement in the lives of Americans who need 

these services. Already more than 7 million Americans signed up 

for insurance coverage through the marketplaces that includes 

mental health and substance use disorder services at parity with 

medical and surgical benefits. 

The expansion of Medicaid in many states, but not all unfortunately, has also made a huge difference, giving millions more comparable behavioral health coverage. But there is certainly more 

that can be done. 

Today’s hearing is focused on one bill, legislation introduced by 

Congressman Murphy, H.R. 3717, the Helping Families in Mental 

Health Crisis Act of 2013. There are some provisions in H.R. 3717 

that I strongly support. I support reauthorization of programs with 

strong bipartisan backing like the Garrett Lee Smith Suicide Prevention program and National Child Traumatic Stress Initiative. I 

support the provisions recognizing the important work of the National Institute of Mental Health on brain research that will help 

us better understand the causes of mental illness. I support the 

campaign to raise awareness regarding mental illness among our 

young people, and I support the proposal that would extend electronic health record meaningful use incentive payments to mental 

health providers. 

But I must express deep concern about other provisions in this 

bill. I think the bill broadly redefines the privacy rights of individuals with a diagnosed mental illness. This could discourage many 

people who need to come forward for care from seeking necessary 

treatment if they fear their privacy won’t be protected. The bill cuts 

federal support for mental health services administered through 

the Community Mental Health Services Block Grant and conditions 

States’ ongoing support on the adoption of new federal standards 

for involuntary treatment that would displace current law. So you 

have the Federal Government cutting the funds but saying if you 

are going to get funds that are left, you have to do it the way we 

tell you to do it. This has always been a State responsibility. This 

is a one-size-fits-all response. I am not sure if that is the best way 

for us to approach it. 

9 

It proposes a dramatic reorganization of mental health authorities in the Department of Health and Human Services that would 

minimize the role of the main agency on mental health—the Substance Abuse Mental Health Services Administration—and would 

reverse efforts to better coordinate mental health and substance 

abuse activities. Separation of these two programs—I can’t understand the reasoning behind it. And the bill undermines the important work of the protection and advocacy programs that protect the 

rights of people with mental illness from abuse and neglect. 

The bill has an important provision in it that I think we need 

to look very carefully at, and that is the expansion of Medicaid coverage that we are going to mandate under Medicaid, and I think 

the responsibility of the states that have been paying for it and 

shifting those costs to the Federal Government. This could be billions and billions and billions of dollars at a time when we hear 

so often from the other side of the aisle we can’t afford the entitlements of Medicaid the entitlements of poor people, and a lot of poor 

people have the greatest problem in accessing mental health services. 

Last year, I and other Democrats introduced mental health legislation but key provisions from that legislation are absent in Congressman Murphy’s bill. Any bill we advance should include investments in mental health first aid, mental health in the schools, and 

mental health provider workforce development. We should be looking at all ideas that have been put forward and working in a bipartisan manner on legislation to achieve our shares the goal of improving our system. 

I want to thank all of the witnesses for appearing before us 

today. In particular, I want to take a moment to recognize Ms. Jensen, who will share her own personal history with mental illness 

and road to recovery. I also want to acknowledge Ms. Thompson, 

who is a constituent of mine, and will discuss her experience as the 

daughter of a mother with serious mental illness. And Ms. 

Zdanowicz, I know family members close to you also have a history 

of mental illness, and that is true of Dr. Shern as well. It takes 

a great deal of courage for you to come here and speak out publicly 

about such difficult experiences, but it is important for the subcommittee to hear your perspectives and to share it with our other 

colleagues in the Congress. 

Thank you, Mr. Chairman. 

Mr. PITTS. The Chair thanks the gentleman. That concludes 

opening statements. All members’ opening statements will be made 

a part of the record. 

I have a UC request. At this time I would ask unanimous consent to enter these documents into the record: one by the American 

Psychiatric Association, a Wall Street Journal article titled ‘‘The 

Definition of Insanity: How a Federal Agency undermines treatment for the Mentally Ill,’’ a statement by Robert Bruce, another 

Wall Street Journal article dated December 26, 2013, and an oped by Congressman Murphy that appeared in the Philadelphia Inquirer January 26, 2014. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. PITTS. We have one panel today with five witnesses. I will 

introduce them in the order that they speak. Unfortunately, our 

10 

first witness, Dr. Michael Welner, is still on a train delayed. He 

will be coming in at any minute. He is Founder and Chairman of 

the Forensic Panel. Ms. Sylvia Thompson, Patient Advocate and 

President of the National Alliance on Mental Illness; Dr. David 

Shern, Interim President and CEO of Mental Health America; Ms. 

Nancy Jensen, a person with lived experience, and Ms. Mary 

Zdanowicz, Attorney and former Executive Director of the Treatment Advocacy Center. 

Thank you all for coming. Your written testimony will be made 

a part of the record. You will each be given 5 minutes to summarize your written testimony, and we will begin with Ms. Thompson. 

Ms. Thompson, you are recognized for 5 minutes. 

STATEMENTS OF SYLVIA THOMPSON, PATIENT ADVOCATE 

AND PRESIDENT, NATIONAL ALLIANCE ON MENTAL ILLNESS, WEST SIDE LOS ANGELES; DR. DAVID L. SHERN, INTERIM PRESIDENT AND CEO, MENTAL HEALTH AMERICA, 

ALEXANDRIA, VIRGINIA; NANCY JENSEN, PERSON WITH 

LIVED EXPERIENCE, WICHITA, KANSAS; AND MARY T. 

ZDANOWICZ, ATTORNEY, NORTH EASTHAM, MASSACHUSETTS 

STATEMENT OF SYLVIA THOMPSON 

Ms. THOMPSON. Thank you, Mr. Chairman and members of the 

committee, Representative Waxman. My name is Sylvia Thompson 

and I am a Professional Care Manager as well as President of 

NAMI’s West Side Los Angeles affiliate, but that is not why I am 

here today. 

Today I am my mother’s daughter. My mother was severely mentally ill from as far back as I can remember. So growing up in my 

family was like living in a combat zone. It never felt safe because 

of her drastic mood changes, paranoia, grandiose ideas, impulsivity, 

delusions, depression and inappropriate anger often directed at me. 

As much as we loved our mother, my family was powerless to help 

her because she did not believe she was ill. It is called anosognosia. 

It affects up to 40 percent of those with schizophrenia and bipolar 

disorder, and that is a conservative estimate. Because she didn’t 

believe she was ill, she would not stay in treatment so she could 

not take care of herself nor could she take care of me. She had suicidal ideation, delusions, hospitalizations, believed I was possessed, 

and would disappear for days or weeks. 

I am a firm believer in self-determination but for those that are 

capable. We must recognize there is a whole group of people like 

my mother who are too ill to self-direct their own care. Just take 

a look at the news. We can’t pretend these people don’t exist. These 

tragic stories like this morning, they are not the face of mental illness. They are the face of mental illness that is severe mental illness that is left untreated. 

Our helpline is flooded with calls from family members of individuals who are imprisoned by their delusions and hallucinations. 

Parents beg for treatment and cannot get it. The current mental 

health system doesn’t help them because their child is too ill to volunteer for treatment. The police can’t help until after they become 

11 

dangerous. It can’t be a recovery model or a medical model. We 

must embrace both because one size does not fit all. 

Sometimes the recovery model works but sometimes assisted outpatient treatment or involuntary hospitalization is initially necessary to get somebody on the recovery path. AOT would help the 

few who have a past history of multiple arrests, violence or hospitalizations caused by refusing to stay in treatment. Studies show 

AOT reduces homelessness, incarceration, suicide, arrest, and yes, 

violence. It saves money. It reduces force and it saves lives. We 

need more hospital beds. California has only five state hospitals 

with less than 7,000 beds. Because of that, Californians with severe 

mental illness are four times more likely to be incarcerated than 

hospitalized—four times. That would never be tolerated for cancer 

or Alzheimer’s disease. Even at its best, California would be short 

over 10,000 hospital beds to help the most severely mentally ill get 

stabilized. We can’t pretend that hospitals are not needed. 

We have to free family caretakers from HIPAA handcuffs so they 

can provide care to loved ones. How can someone ensure their loved 

one has transportation to an appointment if they don’t know when 

the appointment is, or ensure they stay on their medications if they 

don’t know what the medicines are. We have to prioritize the most 

severely ill and stop funding non-evidence-based programs and 

groups that impede care for the most seriously ill. 

Congress created SAMHSA to target mental health services to 

the people most in need. Only four in the 288 programs in 

SAMHSA’s national registry of evidence-based practices focus on 

severe mental illness. That is four out of 288. 

I urge you to pass H.R. 3717. I am not a politician, I am not a 

legislator, but I am someone who has spent her life in the trenches 

personally and now professionally. It is wonderful to want to improve mental health for everyone but in the process we absolutely 

cannot ignore the most severely ill. They are the most vulnerable 

and they need your help. 

My mother struggled my whole life. Before we gained guardianship, she was living in a state of squalor surrounded by stacks of 

newspaper, rotten food, human feces, dead rodents. That was how 

she self-directed her care. No one chooses that life. But you should 

also know, she spoke seven languages fluently. She knew every 

opera libretto and she was a gifted pianist. She was passionate, she 

was creative and she was loving. She was someone’s daughter, she 

was someone’s sister, she was someone’s wife, and she was the 

mother to six amazing children who were desperate for her to be 

well again. 

My mother’s inability to acknowledge her illness was not a 

choice. It was a symptom that trapped her and robbed all of us of 

her greatness, robbed me of my mother. I am proud to be my mother’s daughter. I inherited her passion, her creativity, her outsidethe-box thinking. In her memory and to prevent others from going 

through what she and our family did, I implore you all to please 

work together to pass H.R. 3717. Thank you. 

[The prepared statement of Ms. Thompson follows:] 

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

Dr. Shern five minutes for his opening statement. 

STATEMENT OF DAVID L. SHERN 

Mr. SHERN. Thank you, Mr. Pitts, members of the committee. I 

am the Interim President and CEO of Mental Health America, 

which is the Nation’s oldest mental health advocacy organization. 

We are 105 years old this year. We were founded by a person who 

had bipolar illness and have throughout our history stood very 

firmly for the full inclusion of people with mental illnesses in every 

aspect of American life. We have 240 affiliates around the country, 

approximately, and are very concerned with America’s mental 

health from a public health perspective. 

Prior to joining Mental Health America, I was a tenured Professor and Dean at the University of South Florida and a mental 

health researcher, a psychologist by training, and I spent my professional career really studying systems of care for people with severe mental illnesses, and of particular relevance, I think, for our 

discussion today was a program, an NIMH-funded program that we 

conducted in New York City, an experimental program using psychiatric rehabilitation technology to engage and serve persons with 

severe mental illnesses who are homeless, living on the streets of 

New York City, about 60 percent of whom also had very serious addiction disorders. We were able through the use of peer counselors 

who are involved in the program and a very well understood technology, psychiatric rehabilitation technology developed by Boston 

University to engage this very difficult to treat, most in need group 

of individuals. We did that by emphasizing the fact that they had 

choices in terms of how they could organize their recovery and empowered them to express those choices and empowered our team, 

our treatment team, to enact those choices. 

Through that process, we successfully housed the majority of clients. We significantly reduced their level of psychiatric symptomatology. We improved their quality of life. 

The important point is, I thought about these issues a lot, and 

it is clear to me that we have technologies that can be used to engage individuals in care. We don’t always do it, but those technologies are available to us and our challenge is to try to implement them more effectively. 

I am also a family member. I think everyone here is a family 

member. I have a feeling if we queried the committee, we would 

find out that there is not one degree of separation between many 

of us and a family member who has a mental health problem. My 

nephew had severe bipolar disorder, particularly when he was in 

high school, and even though I knew all the people in the United 

States who developed the evidence-based practices for this because 

of the inadequate system of care, in this case in Pueblo, Colorado, 

we couldn’t get Kyle what he needed. Fortunately, my family had 

the resources to get him into residential care and he is doing fine 

now, but we went through a very difficult time, a time when he 

was confused about what was going on with him and so I am very 

sensitive to these issues. 

The reason that I left academia and entered advocacy was to try 

to close this gap between what we know and what is routinely 

23 

available to people, and there are many aspects, as many of you 

have commented already, many aspects of this legislation that are 

very important and that will seek to do that, to expand coverage, 

and as many people have expressed, we are very enthusiastic and 

supportive of those. 

There are, however, some aspects about which we are very concerned. We are concerned with the emphasis on assisted outpatient 

treatment. It is very clear to us that the issue is having a full engagement-oriented system of care for individuals and making those 

services available to those individuals. We are concerned with expansion of the IMD exclusion, focusing only on one type of care 

when we realize, as Dr. Arthur Evans testified last week, that is 

in fact a continuum of care which is most important. 

We are concerned with what we conceive as an attack on the protection and advocacy system and what we conceive as some very 

fundamental misunderstandings about the role of the Substance 

Abuse and Mental Health Services Administration in leading the 

Nation’s health. From our perspective, SAMHSA has led every 

major mental health reform during the last 50 years. Is our system 

what we think it should be? No, it is fragmented, it is broken and 

it is not responding to people. Do we have the technology to make 

a difference? Yes, we do. Are we implementing that technology? No, 

we are not. There are several aspects of this bill which will help 

with that. However, there are some premises and some assumptions that are very concerning for us and that we feel ultimately 

will damage the system and will make it in fact more difficult for 

people to access the services that they need. 

We have made big progress with the Parity Act and enacting 

that as part of the Affordable Care Act, which was bipartisanly 

adopted by the Senate Finance Committee in the initial markup of 

the bill. It is a chance for us to live into the possibility of that Act 

to get people the services that they need. 

Thank you, Mr. Chairman. 

[The prepared statement of Mr. Shern follows:] 

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Mr. PITTS. The Chair thanks the gentleman and now recognizes 

Ms. Jensen 5 minutes for an opening statement. 

STATEMENT OF NANCY JENSEN 

Ms. JENSEN. My name is Nancy Jensen, and I am the author of 

‘‘The Girl Who Cried Wolf,’’ which tells the story of my lived experienced as a person with mental illness and a survivor of the terrible 

place called Kaufman House in Newton, Kansas. 

The story of Kaufman House vividly shows why parts of this bill 

destroying the funding and effectiveness of both PAIMI and recovery programs must be removed. This bill slashes funding for 

PAIMI’s program and takes away their ability to combat evil and 

protect the rights of people with mental illness including the right 

to choose their treatment. 

If this bill is law, the Kaufman House would still be terrorizing, 

abusing and enslaving people with mental illness. As a former resident, I know how terrible Kaufman House was. They called what 

they were doing therapy. It was not therapy. It was sexual and 

emotional abuse. The Kaufmans forced their so-called patients to 

be nude and do bizarre acts, sex acts, while they videotaped it. I 

was forced to be naked, to sleep on a filthy floor and use a bucket 

for a toilet. I was degraded and told I should never get married, 

never have a child, never join a church, and that I would never get 

a job. Well, as a proudly married mother with both faith in God 

and a job, I proved Kaufman wrong. 

The PAIMI program shut down this house of horrors when no 

one else would or could. The PAIMI program freed my friends and 

helped get us justice. I was the first former resident to tell the 

State about the evil. Eleven other Kansans made reports after me 

but the State did absolutely nothing. 

How did PAIMI programs shut down Kaufman House when the 

State adult protective services could not? Well, first, the PAIMI Act 

gives protection and advocacy agencies powers and independence to 

gain access in places like Kaufman House to investigate and shut 

them down. Without a court order, the APS was turned away. Second, PAIMI programs provided the P&A enough funding so that it 

could properly investigate the Kaufmans, and PAIMI freed us and 

got us the right treatment and then pressed for policy changes. 

Third, and perhaps the most important, with PAIMI, the victim is 

the client. The client is in charge. With the APS, they serve the interests of the provider and the State. 

Long story short, thanks to PAIMI and its special powers and 

funding, the Kaufman House was shut down and we obtained the 

right type of treatment, and Arlan and Linda Kaufman were found 

guilty of over 60 charges. The Kaufmans are in prison today and 

I am here testifying. How cool is that? 

This bill also takes away the PAIMI program’s ability to educate 

policymakers. The PAIMI program worked with me as a survivor 

to change policy so future Kaufman Houses can never happen 

again. Licenses are now required, guardianship laws are fixed, and 

now there is an abuse and neglect unit. 

PAIMI does not just help victims of abuse. This bill makes it 

harder for people with mental illness to find housing, employment 

31 

and education. It prevents individuals with mental illness from receiving the treatment they choose. 

Another important lesson from Kaufman House is the need for 

recovery programs like alternatives conference. You must have recovery programs to have recovery. 

Finally, I believe this bill is misnamed. The Helping Families in 

Mental Crisis Act? Well, I want to respectfully point out to the subcommittee that the focus needs to be on helping the individual with 

mental illness and crisis and through recovery. Yes, families are 

really important support but the focus needs to be on the person 

and their recovery. 

Thank you. 

[The prepared statement of Ms. Jensen follows:] 

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Mr. PITTS. The Chair thanks the gentlelady and now recognizes 

Ms. Zdanowicz for 5 minutes for an opening statement. 

STATEMENT OF MARY ZDANOWICZ 

Ms. ZDANOWICZ. Thank you, Mr. Chairman, members of the subcommittee. 

I have been involved in advocacy for people with severe mental 

illnesses and their families for many years, and I really have no 

hope that some of the things that have created barriers to treatment would be addressed until Congressman Murphy introduced 

the Helping Families in Mental Health Crisis Act. 

I too want to talk about the protection and advocacy program, 

and while I think the original intent of the program and the original practice of the program was very important, it has lost its way, 

and I will share a personal experience that is very difficult to talk 

about. My sister has schizophrenia. She has been ill since she was 

18 years old. She has spent most of her adult life in state psychiatric hospitals. For the most part she has received good medical 

care and they have protected my sister, who is very vulnerable. But 

in 1998, the State hospital that she was in closed. She was moved 

to a hospital that had less than 500 patients, but because of the 

loss of beds due to the hospital closure, the patient population grew 

from 500 to 750 patients by 2007. I knew what was happening at 

the hospital to some extent, and I was able to get her moved to a 

facility that was safe, but a few years later I was able to get her 

medical records, and I found out what was really happening and 

just how bad things were, and I am still haunted to this day by 

what happened to patients that didn’t have a family to protect 

them, and the protection and advocacy organization was nowhere 

to be found. 

The problem is that the bill that created protection and advocacy 

was enacted in 1986. The first finding in that bill is that patients 

or persons with mental illness are vulnerable to abuse and serious 

injury, and so it created a federally funded organization independent of States to monitor care of patients in hospitals and facilities. Now, at that time there were 250,000 people in State psychiatric hospitals. Now there are fewer than 35,000, and the protection and advocacy organizations have changed course as a result, 

and not necessarily in a good way. 

I will give you an example from Massachusetts, which is the 

State where I live. That organization reported spending more than 

$250,000 on lobbying, federal funding on lobbying against State 

measures, and more than $100,000 actually went to professional 

lobbyists, but it isn’t just lobbying that is the problem. In Massachusetts, that organization got government funding to conduct a 

study of community services, which to me is very important because I have a brother with schizophrenia who lives in a group 

home and I am his guardian, and I work very closely with staff and 

the management of that group home to make sure he is safe in the 

community. But I was appalled when I read the report, and one of 

the findings was that guardians should not be involved in protective measures that should be used for individuals living in the community, and a finding that GPS devices that are used for people 

who have a history of wandering and getting injured are a violation 

42 

of individual rights. It is just a perversion. If you look and compare 

with the Alzheimer’s Association view on that, they find it an appropriate use of electronic devices to have a comprehensive safety 

program for people who need it and may be unsafe in the community. 

So I want to say that Congressman Murphy’s bill really will do 

what it is named, and that is, it will help families who are in mental illness crisis. 

Thank you. 

[The prepared statement of Ms. Zdanowicz follows:] 

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Mr. PITTS. The Chair thanks the gentlelady, and notes that Dr. 

Welner still has not been able to get here. If he comes in during 

the panel, we will permit him to give his testimony at that time, 

but I will begin the questioning now and recognize myself for 5 

minutes for that purpose. 

[The prepared statement of Mr. Welner follows:] 

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Mr. PITTS. Ms. Thompson, in your experience, has the HIPAA 

privacy rule been misapplied to the effect that it serves as a barrier 

for helping the very people responsible for providing care in the 

community? 

Ms. THOMPSON. Absolutely. 

Mr. PITTS. Could you expound on that? 

Ms. THOMPSON. What my experience was with HIPAA was that 

my family was consistently kept separate from my mother’s medical needs, health care needs, psychiatric needs. We were unable to 

talk to physicians until we got guardianship at the end, which we 

weren’t able to get guardianship until the last 9 months of her life 

because of the difficulty in gaining access to physicians telling us 

what was going on. As a professional advocate, I learned how to 

communicate with doctors. Most family members don’t have that 

knowledge. I was fortunate enough to have gone through the training and professional experience to be able to tell a doctor he doesn’t 

have to say anything to me but he has to listen to me. Most family 

members don’t know that that is their right to say something. And 

so there is a lack of education on both sides, and the continued hiding behind HIPAA has got to stop. 

Mr. PITTS. Ms. Zdanowicz, in your opinion, how has the legacy 

of deinstitutionalization of the mentally ill worked out over the 

past half century? 

Ms. ZDANOWICZ. Well, this is one of my most passionate issues 

because I have seen the effect of closure of state psychiatric hospitals, and that is why I think the IMD exclusion is so important. 

I view it as discriminatory provision because it is the only population that is precluded from Medicaid coverage in hospitals. 

A perfect example is when the hospital is closed where my sister 

was and she was moved to the other hospital, and there were not 

enough hospital beds left, which created this overcrowding, which 

just prevented people from getting treatment. Now, on the other 

hand, I do want to recognize, Congressman Pallone, Congressman 

Lance, that New Jersey has what is a gem in terms of psychiatric 

hospital treatment, and that is the Greystone Psychiatric Hospital, 

and that is where my sister is now and she is receiving just superior treatment. So it can be done correctly. But if you continue to 

close hospitals, there won’t be enough beds, and people will end up 

where they are now: in jails and prisons. I just finished a survey 

of all the jails and prisons across the country, and I can tell you, 

they are the new psychiatric hospitals. 

Mr. PITTS. Ms. Thompson, back to you. If you could choose one 

thing that the government could have done to help your family, 

what would it be? 

Ms. THOMPSON. Just one? 

Mr. PITTS. Well, you can name more than one. 

Ms. THOMPSON. It would be that my mother was protected from 

herself. I come at this from so many different angles. I understand 

patients’ rights. I wholeheartedly believe in them. I help fight for 

them. But when someone lacks the capacity, there is no shame in 

lacking capacity. When someone lacks the capacity, we need to take 

care of them, and that did not happen with my mother. She fell 

through the cracks over and over and over again, and if there had 

been more support for her, there would have been ongoing treatVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00061 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
58 

ment for her. When my mother went through treatment, she would 

come back and everything would go back the way it was because 

there was no follow-up. She came home, and we didn’t have the 

ability to do what we do. 

I see it with families now. A family member, a son or daughter 

is hospitalized for a 72-hour hold and gets discharged home and 

the parents don’t know how to create the right environment to keep 

that person on the road to recovery. They don’t have the skills. 

There needs to be ongoing support. There needs to be more IMD 

beds. There needs to be this ongoing system of support for family 

members and for the person with the diagnosis. 

Mr. PITTS. My time is expired. The Chair recognizes the ranking 

member, Mr. Pallone, 5 minutes for questions. 

Mr. PALLONE. Thank you, Mr. Chairman. I am trying to get two 

topics in with Dr. Shern, so if I cut you off a little bit, it is because 

I am trying to get to the second set of questions. 

The first relate to ACA and compliance with parity laws. As I 

said, Mr. Chairman, I am pleased we are having this hearing but 

I am troubled by a number of provisions in this bill, but it is a 

wide-ranging effort to address some important issues. 

I wanted to discuss again the Affordable Care Act and the Mental Health Parity and Addiction Equity Act. The Mental Health 

Parity can enshrine in law the principle that mental health care 

is just as important as physical health care, and then the Affordable Care Act not only extended this principal to the individual 

health insurance market but also required 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 benefits package. I hope my Republican colleagues understand that they are voting to repeal these advancements for mental health when they support the Ryan budget or 

vote to repeal the ACA. 

So questions. Dr. Shern, what is your view of the importance of 

health insurance coverage and mental health parity and expanding 

access to treatment and improving health? 

Mr. SHERN. It is absolutely critically important. Because of the 

development of the mental health treatment system in the United 

States, we have systematically discriminated against individuals 

with mental illnesses. That was largely repaired with the parity 

bill and further extended into markets that the parity bill didn’t 

apply to by its unanimous incorporation into the Affordable Care 

Act. Getting to people sooner with effective care is critically important in terms of trying to stem these problems. Insurance access is 

a major impediment for individuals with mental health and addiction conditions is critically important. 

Mr. PALLONE. And then secondly, these laws were clearly major 

steps forward but effective implementation and enforcement are essential. What more can Congress do to ensure health insurers are 

fully complying with the letter and the spirit of both the ACA and 

the parity law? 

Mr. SHERN. I think that this House bill that is under consideration provides an excellent opportunity to provide resources to the 

Department of Labor and to the Department of Health and Human 

Services to assess the degree to which the parity bill is being effecVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00062 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
59 

tively implemented across the United States and to provide ongoing 

guidance to insurers and payers and primary consumers about 

what they should expect to be their rights under this bill and the 

appropriate boundaries with regard to insurance coverage. So it is 

a complex bill. Equity in coverage is not something that is easily 

determinable. It has a large State influence, so I think it is very 

important that we systematically monitor it, and that would be a 

very helpful addition to this legislation. 

Mr. PALLONE. All right. Thank you. Now, I want to get to this 

Wall Street Journal editorial, which I think the chairman introduced into the record. They ran an editorial that sharply criticized 

SAMHSA’s effort to provide services that help individuals prevent, 

treat, and recover from mental health disorders, and they called 

SAMHSA the vanguard of the legacy advocacy and anti-psychiatry 

movement, accused the agency of wasting taxpayer dollars on programs that do not help those with the most serious mental illnesses. Obviously these are very serious allegations. How would 

you respond to this editorial’s characterization of SAMHSA? 

Mr. SHERN. It is, from my perspective, almost entirely inaccurate. If you look at the major—we talked about the deinstitutionalization and the problems with deinstitutionalization, and that 

surely was a policy that was well intended but very poorly implemented. If you look at every major reform since deinstitutionalization in terms of improving services for people with mental illnesses, 

many of the things we talked to you about today, SAMHSA has 

been the champion of the reform. They started the Community 

Support program, which is the first effort to try to build an adequate community treatment system for people with severe mental 

illnesses. They started the Child and Adolescent Support program. 

With Congress’s support, they implemented the Assistance with 

Care Act. They have implemented acts around people with dual 

disorders. We could go on and on and on. 

I think one of the things that is unfair is this characterization 

of SAMHSA as an entity that is anti-psychiatry, anti-treatment, 

anti-medication. That is just not true. 

Mr. PALLONE. The editorial also claims that very few of 

SAMHSA’s evidence-based programs focus on individuals with serious mental illnesses. Can you comment on SAMHSA’s work in that 

area? 

Mr. SHERN. Our estimate is that over 80 percent of—no one remembers that SAMHSA is an agency that addresses both mental 

health and substance use issues. If you look at the mental health 

portion, our estimate is about 80 percent to 85 percent of their resources are spent on issues related to and persons who have severe 

mental illnesses. So again, I just feel this is a gross 

mischaracterization of the SAMHSA program. 

Mr. PALLONE. Thank you. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the vice chairman of the full committee, Ms. Blackburn, for 5 minutes for questions. 

Mrs. BLACKBURN. Thank you, Mr. Chairman. I thank each of you 

who are witnesses for being here and for adding to the work that 

we have done. I do want to thank Dr. Murphy for the work he has 

done with our committee. I think that because of the work he has 

60 

done and concerns that we are hearing from our constituents, especially now that we are highlighting this issue, we have learned 

about the size and the scope of untreated mental illness and exactly where it affects families and individuals. 

We have also, and Ms. Thompson, this speaks to some of yours, 

we have talked about the privacy laws and the impact that that 

has on public safety and also looked at federal resources and how 

those are utilized, and you are certainly adding to that discussion 

today and we appreciate it, and we are pleased with the components that the new legislation would put in place, some redirection, 

some refocusing, and we think that those are good and they are appropriate. 

I do have a couple of questions that I wanted to ask, and I will 

be brief on these. 

Ms. Thompson, I did want to come to you first. I want to thank 

you for sharing your story. As we looked at HIPAA and FERPA 

and the privacy issues. What I would like to hear from you, as we 

look at reforms, through what you have experienced firsthand and 

what you have learned through your caregiving and your advocacy, 

give me maybe the top three or four things that you would say this 

is what you need to change as you look at HIPAA and FERPA reforms. Do you have that laundry list? Could you give that to us? 

Ms. THOMPSON. I don’t know if I have a laundry list but I can 

tell you that I think what is important is that when somebody is— 

if somebody—I work with the developmentally disabled population 

as well. It is automatic. They have a condition before the age of 18, 

so there is no HIPAA violation. The parents are clearly the guardian. They become the guardian. They go through what is legally 

necessary. 

Mrs. BLACKBURN. Been through the qualification? 

Ms. THOMPSON. Correct. What happens with mental illness is 

that oftentimes that doesn’t present until after the child is no 

longer a child, so at that point you are trying to shut the barn door 

after the horse has left, if you will forgive the analogy. There need 

to be some qualifications in place with HIPAA that make it clear 

when somebody is not able to make decisions when there is a question as to their safety or the safety of others, that relinquishes professionals, that doesn’t allow them to keep their hands tied. 

Mrs. BLACKBURN. OK. So almost like a revisit of a power of attorney? 

Ms. THOMPSON. Yes. Right now you can try to get the individual 

to sign off but if somebody doesn’t think they are ill, they are not 

going to sign off permission. That doesn’t mean they are not ill and 

not in need of help. 

Mrs. BLACKBURN. So you would encourage us to have some type 

of allowance or avenue that that oversight you could negotiate? 

Ms. THOMPSON. Like a waiver, and maybe that—I don’t know. As 

I said before, I am not a legislator. I don’t know. Maybe having— 

if the physician deems it necessary or maybe getting two physicians to deem it necessary that HIPAA can be broken in this instance. It can’t just be because somebody is going to commit a 

crime or they are going to kill themselves. They need to get help 

before that. 

61 

Mrs. BLACKBURN. OK. Ms. Zdanowicz, I can tell you want to 

weigh in on this. I see you nodding your head. 

Ms. ZDANOWICZ. I have to agree completely. I actually would say 

the same thing. I was unable to get information about treatment 

for my brother and sister until I got guardianship, and I paid 

$5,000 to get guardianship for my sister, who was in agreement. 

She did not object to it. But I had that in order to get information, 

but even with that, for example, when I know my brother is in a 

hospital, a particular hospital, I have been told he was transferred 

there, and I call and they say we can’t tell you if he’s here, and 

then I will fax my guardianship papers and they’ll still say HIPAA 

prevents us from talking with you, and then I learn later that they 

have changed his medication in a way that I already know is not 

helpful and there is nothing I can do about it, it is too late. 

People don’t understand HIPAA, and I often tell families, if you 

are told that they cannot tell you anything about your family member, you are still free to tell them what they need to know about 

your family member. It is a terrible obstacle for families to help, 

and I totally support the revisions to that portion of the bill. 

Mrs. BLACKBURN. Thank you. Yield back. 

Mr. PITTS. The Chair thanks the gentlelady and now recognizes 

the ranking member of the full committee, Mr. Waxman, 5 minutes 

for questions. 

Mr. WAXMAN. Thank you, Mr. Chairman. I want to apologize to 

the panel because there is another subcommittee meeting at the 

same time, and I have been required to go back and forth. 

Ms. Jensen, I want to start by thanking you for being here today 

and telling us your story. It is a deeply personal one, and I was 

struck by the utter failure and inability of authorities in your State 

to bring an end to the terrible abuses of people with mental illness, 

including yourself, at the Kaufman House, that is, until the P&A 

became involved. Can you elaborate on whether or not Kansas was 

an outlier and not adequately addressing complaints about the 

Kaufman House prior to the P&A’s involvement? Do you think it 

is unique? 

Ms. JENSEN. All I can say is that there were 12 complaints to the 

Adult Protective Services, and he even sued Adult Protective Services, and so they quit coming to the door. And so I believe that I 

know for a fact if it wasn’t for PAIMI, Kaufman House would still 

be going on. 

Mr. WAXMAN. We have heard from witnesses today that P&As 

lobby, and in fact, in the testimony, you worked with the P&A to 

change laws that would prevent future Kaufman Houses through 

licensure requirements, guardianship laws and the establishment 

of an abuse and neglect unit. Can you clarify whether the federal 

funding was used for these activities and any other lobbying activities? Do you know? 

Ms. JENSEN. No, there was no federal funding. I and my friend, 

we just never wanted it to happen again, so we were volunteers. 

We did it ourselves, and it was educating us on the issue but there 

was no financial spending of federal funds to get these laws passed. 

Mr. WAXMAN. Proponents of the PAIMI proposals in H.R. 3717 

claim these provisions will return the program to its roots but it 

seems to me that an 85 percent reduction in federal funding would 

62 

do much more than that. How would a funding reduction of this 

magnitude impact the ability of the P&A in Kansas and P&As 

around the country to protect the rights of people with mental illness? 

Ms. JENSEN. I am so scared that if you take PAIMI away, and 

that is what would happen, there wouldn’t be any protection for us 

if we were being abused, neglected or exploited. There wouldn’t be 

anyone coming in and taking us out of that situation in order to 

talk to us and investigate the situation, and I just ask you not to 

do that. 

Mr. WAXMAN. Well, your testimony is very persuasive and I 

think quite valuable to us to hear that point of view. 

I want to ask Ms. Thompson and Dr. Shern, I am pleased that 

my colleagues and I have some points of bipartisan agreement on 

issues before us. We all believe that mental health care is an essential part of our health care system. We agree that we need to work 

to end the stigma that surrounds seeking treatment, and we agree 

that we need to invest in community-based approaches for care so 

that individuals who need help are able to get it. I think everybody 

here on the panel would agree with these goals as well. But I also 

believe that witnesses invited by both Republicans and Democrats 

today agree that expanding access to health insurance and improving health coverage of mental health services are critical. 

Ms. Thompson, as a general matter, do you think individuals 

who have health insurance have a better chance of getting into 

treatment for their mental health conditions? 

Ms. THOMPSON. I am sorry. Can you—— 

Mr. WAXMAN. If you have health insurance, don’t you have—— 

Ms. THOMPSON. Oh, absolutely. 

Ms. WAXMAN. And do you think including mental health coverage 

as an essential health benefit and requiring it be covered at parity 

with physical health were important steps forward? 

Ms. THOMPSON. Yes. 

Mr. WAXMAN. And Dr. Shern, do you agree with that? 

Mr. SHERN. Absolutely. 

Mr. WAXMAN. I think, Mr. Chairman, we could learn a lot from 

these witnesses. There is a lot more to the ACA than we can fit 

into 30-second attack ads. But it advances a number of essential 

priorities that both sides agree on, and I hope we can agree that 

it is here to stay, that we should build off of these things that we 

agree on in the law rather than constantly focus on repealing or 

undermining it. 

I see my time is over and I will yield back the balance. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the vice chairman of the subcommittee, Dr. Burgess, 5 minutes for 

questions. 

Ms. ZDANOWICZ. Mr. Chairman, if I may? 

Mr. PITTS. Go ahead. 

Ms. ZDANOWICZ. I did want to just elaborate on one point that 

was made, and that is about the money that is used, the federal 

funding to lobby, and that is documented. You can find that in IRS 

reports and State lobbying reports that in fact federal funding is 

being used to lobby, and professionally, I have seen it done. I have 

been up against lawyers of protection and advocacy organizations 

63 

lobbying in State capitals against State legislation. So it does happen, and it is not the original mission, and it takes away from what 

they are supposed to be doing. 

Mr. WAXMAN. And it is in violation of the rules that say that 

they cannot use that money for lobbying. 

Ms. ZDANOWICZ. And so I think that in order for them to be able 

to do what they are supposed to do, which is monitor like they did 

when you were being abused, I think that would be a significant 

improvement. So thank you. 

Mr. PITTS. The Chair thanks the gentlelady and now recognizes 

Dr. Burgess 5 minutes for questions. 

Mr. BURGESS. And please let the record reflect the generosity and 

time that I gave to the ranking member of the subcommittee. We 

don’t often have areas of commonality, so I thought that was important to have that follow-up. 

The majority of my questions were for Dr. Welner. One of my big 

objections to these types of hearings is we never have an M.D. 

Thank you for calling an M.D. Unfortunately, because of travel 

issues, he has not been able to join us, so I am going to submit my 

questions to Dr. Welner for the record. 

Dr. Shern, your discussion with Ranking Member Pallone 

brought some things to mind, and really, this is more of just reminding people of the process, yes, the budget process, the legislative process, process in the agencies. Go back just for a little bit 

to the Mental Health Parity Act, and I don’t know how many people now remember, the Mental Health Parity Act, introduced by 

one of our colleagues, Patrick Kennedy, indeed, we had hearings in 

this subcommittee many, many years ago. The Mental Health Parity Act was used as the vehicle to pass the Troubled Asset Relief 

Program, two absolutely unrelated proposals. Now, I just want to 

be clear. I actually opposed both of them, so that no vote actually 

did double service that day, but to think that we passed something 

of the magnitude of the Mental Health Parity Act and its effect 

upon caregivers and third-party payers as a vehicle to bail out 

banks, I am still bothered by that nexus. But nevertheless, that is 

what happened. The Mental Health Parity Act had not actually 

been scored, to the best of my recollection, by the Congressional 

Budget Office. I think it estimated some significant budgetary outlays over a 10-year period but be that as it may, now the Affordable Care Act actually passed sometime after that, about a year 

and a half after that, and was signed by the President in March 

of 2010. The part of the Affordable Care Act dealing with essential 

health benefits was actually subject to a rule. The rule was supposed to be published and concluded in August of 2012. I don’t 

want to seem cynical here but the actual rule was delayed until a 

couple days after Election Day in 2012. I don’t know why the Administration would see an advantage to doing that but apparently 

there was. And if you will recall, much of the difficulty that subsequently happened to the Affordable Care Act was because of that 

delay. The governors were required to disclose whether or not they 

would participate in state exchanges on November 18th. The essential health benefit rule was published on November 8th. So that 

gave them precious little time to actually evaluate, is this a good 

idea or a bad idea for my State. To be fair, they were given two 

64 

extensions but finally by January 2013 the governors had to declare. Twenty-six States said no, thank you, we are not doing an 

exchange. Four States said well, maybe we will do one but we will 

let the Federal Government set it up. So the fact that so many 

States were not doing their own exchanges and that task then fell 

to the Federal Government and clearly the Center for Consumer 

Information and Insurance Oversight was not up to the task of 

standing up a massive new information technology project in the 

8 months that they had available, and I think we all know the 

story on that. 

But here is the issue. OK, Mr. Pallone is right. The Mental 

Health Parity Act and the ACA, the nexus of those two things does 

affect stuff. None of that—because the way the Congressional 

Budget Office works, we only get information about bills before we 

pass them. Sometimes we don’t even get that. But we only get that 

budgetary information as the legislation is coming through the 

process. We don’t get a rescore by the Congressional Budget Office 

when the rulemaking happens. So if you take the combination of 

the Affordable Care Act and the essential health benefits, when the 

Mental Health Parity Act was passed it said we are not requiring 

you, Mr. Private Insurance Company or Mrs. Private Insurance 

Company, to offer mental health benefits, but if you do, they need 

to be on a par with other medical services that you offer. So I am 

concerned that there were companies that were going to drop out 

of the mental health business. A year later, we had the Affordable 

Care Act passed and it says this is part of your essential benefit 

package. 

I am from Texas. I will never attribute to coincidence that that 

can be adequately explained by conspiracy, but the Mental Health 

Parity Act was passed in 2008 and the rule was not published until 

last November, and I can’t help but wonder if the reason the rule 

was not made public until all of the Affordable Care Act stuff was 

in place was because this is going to blow the cost way beyond anything that anyone projected for the Mental Health Parity Act or for 

the ACA. I don’t know the answer to that question. I think it is 

one that we are going to have to ask our Congressional budget 

writers to help us with but it just underscores the difficulty of making budgetary decisions on these types of issues. There are always 

things in the future that will affect them. 

Thank you, Mr. Chairman. I have rambled enough, and I will 

yield back. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the gentleman from Texas, Mr. Green, 5 minutes for questions. 

Mr. GREEN. Thank you, Mr. Chairman, and Dr. Shern, I think 

we are in agreement that our country has a long way to go to improve mental health systems. I am also from Texas but in an earlier life I actually did probate work, and one of my judges, who was 

a friend, appointed me to do mental health work, do the probable 

cause hearings and the commitment hearings, and it opened my 

eyes to the Texas mental health code, and actually as a State senator, we were able to change some of it. 

I appreciate Dr. Murphy’s leadership for many years on this 

issue. I have some concern about part of the legislation, the MedVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00068 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
65 

icaid IMD exemption. My concern is cost shifting from the State if 

the State does it to the Federal Government. 

But I want to get to the follow-up on my colleague from north 

Texas. Dr. Shern, the Affordable Care Act included demonstration 

in 11 States to test whether undoing the IMD exemption for emergency psychiatric care and letting federal funds pay for the care in 

IMDs that States would concurrently provide would improve service to the population. It is my understanding we don’t yet have 

enough information to know whether this demonstration is successful. My question is, it seems to me that before we move ahead and 

spend billions to supplant the State funds, we ought to see if this 

demonstration yields any positive results. Can you update us on 

any of those demonstration projects? 

Mr. SHERN. I am not aware that evaluations have been completed. Our position would be quite consonant with yours. When 

that provision was discussed and been made part of the Affordable 

Care Act, there was a concern that looking at only one element in 

a system of care just really wasn’t the appropriate way to think 

about how to build an effective community care system. And so we 

maintained and the law was enacted that this had to be evaluated 

as part of a system of care initiative. Our recommendation is that 

there be no changes to the IMD law until the results of that evaluation are complete. 

Mr. GREEN. OK. The Congressional Budget Office, they haven’t 

officially scored the provision. My understanding is, it is quite expensive, tens of billions possibly. If we had tens of billions of dollars to spend on improving the mental health system in the United 

States, how would we direct it and where should we really be looking to invest that money to see the greatest improvements? 

Mr. SHERN. Well, I think that we have heard a lot this morning 

about the importance of assertive engagement-oriented outreach. 

Ms. Thompson talked about how important some of that was for 

her mom and how it would have been helpful had that continued 

when her mom came home. The committee heard in testimony from 

Dr. Arthur Evans, who runs the Philadelphia mental health system, about how critically important that there be funds available 

for crisis alternative services, for peer engagement and outreach 

services. We know a lot about what we can and should do, and I 

would much prefer to see those funds spent on fully developing a 

continuum of care in communities with assertive outreach and engagement. 

Mr. GREEN. Well, I am familiar at least in Houston, Harris 

County, with some of the substantial reforms that have been made 

in the last 20 years, for example, our Harris County Hospital District. When I would first go see a client or a patient, it was literally 

dismal. It looked like a holding cell in the hospital. But they have 

created a diversion now to where you actually have committed to 

mental health treatment, and it is a partnership between the University of Texas where we have a psychiatric hospital in Houston, 

but it is doing better but we have less psychiatric beds in Houston, 

Harris County than we did in the 1980s. So that is our big concern. 

I am pleased with Dr. Murphy’s bill. It includes a provision to 

extend the liability for doctors who volunteer in behavioral health 

clinics. He and I have had legislation for a number of years. It has 

66 

passed this committee and somehow the Senate doesn’t do it. It 

would expand for our FQHCs and not just behavioral mental 

health clinics but our FQHCs where volunteer physicians could go 

in and be under the Federal Torts Claims Act, and that makes so 

much sense. While it is a good step forward in increasing the mental health workforce, much needs to be done to develop professionals. 

Mr. Chairman, both on our Health Subcommittee and I know on 

our Oversight Committee Dr. Murphy is doing, there are a lot of 

examples of things happening all over the country based on local 

community success, and I think this panel shows that, that maybe 

we should, since we do have the Affordable Care Act and mental 

health parity issues, then maybe we ought to look at some of those 

examples from around the country and see what we can do to make 

sure we get the best bang for our federal dollar to help our States 

and the local communities, because, again, oftentimes it is our hospital districts that are providing some of that care. 

So I appreciate it, and I yield back my time. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the gentleman from Pennsylvania, Dr. Murphy, 5 minutes for questions. 

Mr. MURPHY. Thank you. I want to thank all the panel for being 

here. I really appreciate your time. 

A quick question to start off with. I am just going to ask each 

one of you if you have read the bill. Ms. Thompson? It is a yes or 

no. 

Ms. THOMPSON. Not the whole bill. 

Mr. MURPHY. All right. Dr. Shern? 

Mr. SHERN. Not the entire bill. 

Mr. MURPHY. Ms. Jensen? 

Ms. JENSEN. I didn’t hear the question. 

Mr. MURPHY. Have you read the bill we are talking about? 

Ms. JENSEN. Yes, I read the bill. 

Mr. MURPHY. The whole thing? 

Ms. JENSEN. Yes, the whole thing. 

Mr. MURPHY. Thank you. Ms. Zdanowicz? 

Ms. ZDANOWICZ. And yes, I have read the whole thing. 

Mr. MURPHY. Thank you. Ms. Jensen, did anybody else in your 

testimony today advise you on things to say? 

Ms. JENSEN. Of course not. 

Mr. MURPHY. So I am not sure where you got this statement 

from, that it would make it harder to get housing and education. 

If there is a point in that bill where you feel that is, will you make 

sure you let me know? Because I want to fix that. Would you let 

me know? 

Ms. JENSEN. I don’t understand what you are saying, sir. 

Mr. MURPHY. You had said in your statements that the bill 

would make it harder to get housing and education. If there is a 

place in the bill where that occurs, would you let me know, because 

I want to—— 

Ms. JENSEN. If you take PAIMI away, we have a hard time getting help with housing and education. 

Mr. MURPHY. I don’t agree, but thank you. 

67 

Dr. Shern, I am just not clear. Are you a clinician that treats patients? 

Mr. SHERN. No, I am a research psychologist. 

Mr. MURPHY. OK. Thank you. You said SAMHSA does not support programs that are anti-treatment. Are you familiar with the 

Alternatives Conference? 

Mr. SHERN. I am. 

Mr. MURPHY. Are you aware that Alternatives is short for Alternatives to Treatment? 

Mr. SHERN. My interpretation of Alternatives, it is not alternatives to treatment, it is alternatives available for people to make 

choices about how to best engineer their recovery. 

Mr. MURPHY. Do you think everybody is capable of making that 

choice? 

Mr. SHERN. I think everybody is capable of understanding what 

is important to them. 

Mr. MURPHY. Ms. Thompson referred to something called 

anosognosia. Do you know what that is? 

Mr. SHERN. I have heard it described, yes. 

Mr. MURPHY. OK. I am disappointed you don’t know what it is. 

It is critically important, so I have to go into a little lesson here. 

If a person has a stroke on the right side of their brain, and on 

the left side, their arm doesn’t work, a characteristic of that is if 

you say to this person try and move your left arm and they don’t 

and you say I think you are having a stroke, you need to go to the 

hospital, that person may say it is no big deal, I don’t know what 

that is all about, that is anosognosia. 

About 40 to 50 percent of people with severe mental illness, 

schizophrenia, if shown a videotape of them hallucinating, delusional, they don’t know who they are, they think they are the angel 

Gabriel, Jesus, whatever else, and if you say do think that is OK, 

they will say sounds OK to me, I don’t understand the problem. 

What Ms. Thompson is referring to for those people who are not 

capable of making decisions on their own to have someone else assist them so that they have a right to get better. Would you agree 

that such persons may need some assistance that they are not capable of making on their own? 

Mr. SHERN. I think the way that you specifically have characterized the situation, people would meet the criteria for not being 

competent and—— 

Mr. MURPHY. Good. We are in agreement there. And do you 

think in the Alternatives Conference, which spends about $600,000 

a year of taxpayers’ money, do you think we should be paying for 

conferences that have things called unleash the beast: primal 

movement workshop, how to make collages, dancing, interpretive 

yoga or how to stop taking your medication? Do you think taxpayers should pay for that? 

Mr. SHERN. I think it is very important that we have an 

open—— 

Mr. MURPHY. I am asking, do you think taxpayers should pay for 

those items when we are so short on funds? Do you think we 

should be paying for that for people who have severe mental illness? 

68 

Mr. SHERN. I think that it is very important that we have an 

open forum to discuss the various—— 

Mr. MURPHY. I appreciate that. I didn’t ask you about an open 

forum. So I am going to take that as a yes and you are afraid to 

say yes. 

Do you know in SAMHSA’s—no, it is true. Come on. I want to 

have an open discussion. In SAMHSA’s documents that describe 

their strategic plan, it is about 40,000 words, how many times does 

it mention the word ‘‘schizophrenia’’? 

Mr. SHERN. You know, I have not had an opportunity to count 

them. 

Mr. MURPHY. Well, it is easy to count because the answer is zero. 

Do you know how many times it mentions the word ‘‘bipolar’’? Zero. 

So when you say SAMHSA is focused on severe mental illness, my 

problem is, it is not, and when I had the leader of SAMHSA in my 

office and I said would you change anything, she said no. 

So what I see here is, I think SAMHSA plays a very important 

role. I want to see it keep on doing that. But I want to make sure 

we get back to evidence-based care, and I am assuming you would 

be OK with that. 

Mr. SHERN. Absolutely. 

Mr. MURPHY. That if a program shows that it can work, make 

it work. 

Mr. SHERN. Absolutely. 

Mr. MURPHY. And let us do that, and why I am concerned here 

is that throughout the Federal Government, we have got money in 

the Department of Defense, Veterans Affairs, Education, HHS, who 

knows where else, and we have to make sure we have got programs 

that work, and the ones that work, expand them, and if they don’t, 

eliminate them, and if they are redundant, merge them, and that 

is what I want to have happen with this bill. 

On the parity issue, real quick, I just want to say that there is 

parity for people who have private insurance in the Affordable Care 

Act. There is not parity with Medicaid, so if you have more than 

16 beds, you are not going to get it, and if you see two doctors on 

the same day, you are not going to get it. 

The last question I want to address to Ms. Zdanowicz. Dr. Shern 

called the Journal editorial a gross mischaracterization of 

SAMHSA for leading an anti-psychiatry movement. Do you have 

any comments on that with regard to SAMHSA and providing 

money or grants to groups that fight treatment or discourage treatment? 

Ms. ZDANOWICZ. Yes, and in fact, I have read many of the State 

applications for grants from SAMHSA, CMHS, and when you read 

those, you find very little reference to the most severely ill. Much 

of it is about, this is how we are going to get people out of State 

psychiatric hospitals. It is about how we are going to—if we just 

offer people what they want and make sure that we are really nice 

to them, that they are going to be just fine and it is going to settle 

their symptoms. But the question is, well, what if the person wants 

is a semiautomatic machine gun to shoot you because they think 

that you are the devil? Well, then what do you do? Well, then you 

call the police and you get them into jail, and if there was ever a 

form of coercion, that is it. 

69 

Mr. MURPHY. Thank you. I have to yield back. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the gentlelady from California, Ms. Capps, 5 minutes for questions. 

Mrs. CAPPS. Thank you, Mr. Chairman, and I would like to 

thank all of our panelists for your testimony today. I want to single 

you out, Ms. Jensen, because yours was so personal, and I appreciate that you are willing to tell your story. 

Dr. Shern, mental health is an important issue that members of 

this committee on both sides of the aisle have a shared interest in 

addressing. I worked in our community in public schools before 

coming to Congress as a public health nurse and so I have had experience with this topic, and I am really pleased that today it is 

being discussed. 

We heard from the testimony that there are some provisions in 

this bill that have widespread support and others that are perhaps 

problematic. I know that other members of the committee have also 

expressed interest in the topic and introduced legislation on mental 

health, and I hope that moving forward we can have an open dialog—the chairman just mentioned that—about all of the proposals 

and ideas. 

That being said, Dr. Shern, are there any provisions not included 

in H.R. 3717 that you feel are important to the improving mental 

health system? 

Mr. SHERN. Well, as we have said on a number of occasions, I 

think that understanding that a full continuum of engagement-oriented and assertive outreach services are critically important for 

effective services for people with severe mental illnesses. Additionally, and I think that Dr. Murphy mentioned this in his remarks 

or Mr. Pitts, we are continuing to learn about the importance of 

early identification for people who are going to develop disorders 

that have psychotic features, and I think it is critically important 

that we do a much better job at early identification of people who 

are going to have the more severe illnesses, and we are developing 

a reasonable evidence base about the things that are helpful to 

them because that can stem disability. I am also very excited about 

the peer movement, the use of persons who themselves are in recovery to help with these engagements and follow a long process, 

and also with appropriate supervision to provide the kind of extension of the mental health workforce that is going to be required. 

Mrs. CAPPS. Yes. Well, that is the point I wanted to pick up on 

because Dr. Welner in his written testimony that I read, he noted 

the importance of having enough mental health professionals. 

Maybe that is a whole other hearing, particularly it seems to be a 

hole in this bill and one that I think we should be addressing with 

more specificity. 

Dr. Shern, one of the key principles both sides of the aisle agree 

on is that we need to do everything possible to encourage individuals, and you talked about outreach, struggling with mental illness 

to seek treatment. That is actually part of the stigma, recognition 

and the clear sort of lack of understanding that we have about our 

brain and issues that affect it. Treatment does prove to be very 

helpful, as we heard today, and is more successful I think than 

some of the public seems to recognize, and early detection, just as 

you said, and regular treatment are so essential for preventing 

70 

those rare and tragic cases where individuals become violent toward themselves or others, and we know people with mental illness 

are actually more likely to be victims, so that is a piece of the story 

that needs to be clearly said as well. 

But the stigma demands, I think, and we should be desirous of 

ways to address the stigma. Privacy concerns are also intimately 

related. That is why I am concerned about the changes to our 

health privacy law that this bill proposes. It creates entire new 

standards for individuals who have what the bill loosely defines as 

serious mental illness, and that is a loose definition, unfortunately, 

and I know these are difficult areas to find the right path but that 

is something we really need to get to. 

Dr. Shern, first, can you help us clear up a key point of fact? 

Does HIPAA always require patients to give their permission before information is shared or do providers have flexibility if there 

is a threat or if they believe the patient lacks capacity? 

Mr. SHERN. It is my understanding that there is flexibility. You 

know, I was thinking also the Virginia Tech shooting, and when 

people looked at FERPA and HIPAA then, it was clear that there 

was a lot of misunderstanding about the bill and in emergency situations that can be found. 

Mrs. CAPPS. Yes. 

Mr. SHERN. So part of the thing I think we need, and I think Ms. 

Thompson would agree, is just better public education about what 

those laws actually mean. 

Mrs. CAPPS. I am glad you put that on the record. 

What impact will the changes proposed in the bill have on people’s willingness? Is that a concern to you, people’s willingness to 

seek treatment for mental illness? 

Mr. SHERN. It is a concern of mine, a concern of my organization, 

given the coercive nature of some of the outpatient treatment programs. 

Mrs. CAPPS. Thank you. I yield back. 

Mr. PITTS. The Chair thanks the gentlelady and now recognizes 

the gentleman from New Jersey, Mr. Lance, 5 minutes for questions. 

Mr. LANCE. Good morning, and thank you, Mr. Chairman, and 

thank you for your leadership on this issue, and thanks to Dr. Murphy as well for his leadership. 

Earlier this week, a bill on which I had worked with Congresswoman Matsui of this committee, the Excellence in Mental Health 

Act, was included in a larger piece of legislation, and I am pleased 

that the President has signed that into law and I certainly want 

to work with all members of this subcommittee and the full committee as we move forward on this challenging issue. 

Ms. Zdanowicz, as I understand it, your sister spent quite a few 

years in New Jersey facilities including the now-closed Hagedorn 

Psychiatric Hospital in Hunterdon County. I grew up in Glen Gardner where that facility was located. Before it was related to psychiatric concerns, it was related to tubercular concerns. 

It is clear from your testimony that many mental health facilities 

in this country are currently unable to meet the needs of their communities. In your judgment, would passage of legislation in this reVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00074 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
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gard help in States across the country including States like New 

Jersey? 

Ms. ZDANOWICZ. Absolutely, and the closing of Hagedorn Hospital was a travesty. That is the hospital I mentioned that was a 

safe hospital that she was transferred to. She got excellent care 

there. And it was closed. And she then moved to Greystone which, 

as I mentioned before, is a gem. It is a wonderful hospital. But as 

a result of the closure of Hagedorn, it is virtually impossible to get 

anyone into a State psychiatric hospital now, and in fact, the State 

has implemented what I will call a gatekeeping process that prevents people—when a psychiatrist says this person needs to be in 

a psychiatric hospital because they need more than two weeks of 

treatment, they can be shut down by a nurse who is reviewing the 

process just because the State is trying to keep the population 

down. 

Mr. LANCE. Before your sister was at Hagedorn, what was the 

State hospital before that where she was? 

Ms. ZDANOWICZ. That was Ancora in south Jersey. 

Mr. LANCE. In southern New Jersey, yes. 

Ms. ZDANOWICZ. And it was a very bucolic setting. It was a very 

nice hospital when she first went there. There were less than 500 

patients, and the care was very good until because of the closure 

of the previous hospital the population grew to 750 and it was truly 

bedlam because the hospital, the staff were not able to handle it 

and that was when I was able because I had the resources to get 

her moved to a safer hospital. But it wasn’t until the Department 

of Justice came in at the request of the State and investigated it, 

protection and advocacy was nowhere to be found, and in fact, I 

called them at one point, but that was not on their radar screen. 

They were more concerned with other issues like legislation for 

AOT and fighting that. 

Mr. LANCE. Thank you. Let me say that I was honored as a child 

to know Garrett Hagedorn, who was a State senator from Bergen 

County, and I had the privilege of being the minority leader in the 

State senate before I came here, and I have worked on these issues 

and hope to be able to continue to work on these issues here in 

Washington, and thank you for being with us today. 

Let me say that there are, Mr. Chairman, community mental 

health facilities in the district I represent such as the Richard Hall 

Community Health Center in Bridgewater, Township, in Somerset 

County, and I hope that these fine efforts can continue and that 

we can work in a bipartisan capacity on this very important issue 

and we are reminded yet again so tragically of the importance of 

this issue based on what happened at Fort Hood yesterday. 

Mr. Chairman, I yield back the balance of my time. 

Mr. MURPHY. Would the gentleman yield? 

Mr. LANCE. I certainly would. 

Mr. MURPHY. I just want to point out, there are misunderstandings in the HIPAA law, and Dr. Shern, you have never been 

involved in a case and you shouldn’t already have an opinion on 

it. 

This bill does not undo HIPAA laws. It clarifies them, and we 

want to work on language. I have been talking with Representative 

DeGette on this too. We want to make it so that all those things 

72 

that are also in the regulations that go along with the law are 

clarified. It doesn’t change anything, but there are a lot of misunderstandings. Clinicians misunderstand this all the time, so we 

want to make sure work to clarify that, but it doesn’t change the 

law. Thank you. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the gentlelady from Virgin Islands, Dr. Christensen, for 5 minutes 

for questions. 

Mrs. CHRISTENSEN. Thank you, Mr. Chairman. I want to ask 

some questions to Dr. Shern about the bill and its impact on 

SAMHSA because the bill makes some significant changes to the 

way the Federal Government’s mental health investment is structured within the Department of Health and Human Services, particularly in Substance Abuse and Mental Health Services Administration. I want to make sure that I understand the impact these 

changes could have, particularly to the Community Mental Health 

Services Block Grant and programs of regional and national significance. 

Dr. Shern, starting first with the mental health block grant, how 

would H.R. 3717 impact this program? 

Mr. SHERN. Well, it is my understanding that the block grant 

would be moved to the Assistant Secretary’s office and would have 

a different type of oversight than it currently has now, providing 

less flexibility to States, for example, in terms of how those funds 

are used. 

Mrs. CHRISTENSEN. So do you support provisions in this bill that 

would condition States’ receipt of block grant funding on newly established federal involuntary patient or outpatient treatment 

standards and specific criteria for outpatient treatment? 

Mr. SHERN. No, we wouldn’t support that. 

Mr. MURPHY. Could the gentlelady ask him to clarify what that 

means because I am not sure. 

Mrs. CHRISTENSEN. What do you mean? I asked if he would support the provisions that would condition the receipt of block grants 

on newly established federal involuntary inpatient or outpatient 

standards, and he said no, he would not. 

Mr. MURPHY. But I am not sure he read or understood the section there. It would simply say that States—and I appreciate 

the—— 

Mrs. CHRISTENSEN. Is this not on my time? 

Mr. MURPHY. I am sorry, ma’am. I was asking to yield. I was just 

trying to clarify. Thank you. 

Mrs. CHRISTENSEN. If I have time, I will yield at the end. 

As I am sure you are aware, SAMHSA has general authorities 

to conduct programs of regional and national significance in mental 

health and substance abuse prevention and substance abuse treatment. I understand funding through these authorities accounts for 

approximately 35 percent of SAMHSA’s mental health budget and 

25 percent of substance abuse spending. Title XI of H.R. 3717 

would terminate any program by the end of the fiscal year that is 

not explicitly authorized or required by statute shall be terminated. 

So how will this impact SAMHSA’s ability to continue initiatives 

pursuant to PRNS authorities like the Minority Fellowship program and National Suicide Prevention Hotline? 

73 

Mr. SHERN. It is my understanding that through the appropriation process, Congress can direct and influence SAMHSA’s agenda. 

So in many ways, those kinds of relationships between the legislative and executive branch are already in place. The programs of regional and national significance are extremely important. Most of 

the innovative processes, particularly around systems of care issues 

and many of the things we are talking about today, have come 

through that program. So anything that would further constrain 

that, we would oppose. 

Mrs. CHRISTENSEN. And in your testimony, you convey support 

for an initiative to improve interagency coordination of mental 

health and substance abuse programs within the Department but 

you seem to have some reservations about the way H.R. 3717 approaches coordination of HHS programs in mental health through 

the establishment of that new Secretary position. Could you elaborate on the reservations you might have about that? 

Mr. SHERN. Well, our sense is that the Administrator for 

SAMHSA is a direct report to the Secretary of Health and Human 

Services, and so in some sense, interposing another layer of government between SAMHSA and the Secretary doesn’t seem to us to be 

particularly helpful. Additionally, we believe, and I think this was 

mentioned earlier in testimony today, that it is a lot more than 

HHS that is involved in mental health care. Housing is involved, 

Justice is involved, Labor is involved, et cetera, et cetera, and we 

would concur with Drs. Richard Frank and Sherry Gleed in their 

analysis of the mental health system in this country saying that coordination needs to occur literally at the White House level because 

it is those interdepartmental issues which are important. Additionally, I think since President Bush’s commission and its findings, 

there has been increasingly interdepartmental cooperation without 

imposing any additional structural changes to the government. 

Mrs. CHRISTENSEN. Is there anything else you would like to add 

about any other areas the bill could negatively impact SAMHSA? 

Mr. SHERN. Well, I think that sort of overbureaucratizing and 

overregulating and trying to more narrowly focus the agenda of 

SAMHSA around a particular set of concerns or issues which, generally, I think, are well represented already in their portfolio will 

not be helpful. Certainly, as in any human endeavor or any area 

of government, there are ways that things can be improved. I think 

that the organization has been mischaracterized in editorials and 

publicity surrounding that and that anything that can further 

those kinds of issues will be harmful to the people of this country 

and their mental health. 

Mrs. CHRISTENSEN. Thank you. I yield back my time. 

Mr. PITTS. The Chair thanks the gentlelady and now recognizes 

the gentleman from Louisiana, Dr. Cassidy, 5 minutes for questions. 

Mr. CASSIDY. I yield to Dr. Murphy. 

Mr. MURPHY. I thank the gentleman. 

Dr. Shern, you already mentioned you didn’t read the bill so is 

there a specific place in this bill that you can make reference to 

where you have these concerns about the Secretary of Mental 

Health and what that person will do to limit care? Is there some 

74 

specific page or paragraph you can reference to clarify your conclusions? 

Mr. SHERN. I am sorry, Dr. Murphy. I am not understanding the 

question. 

Mr. MURPHY. Well, you made a statement to the gentlelady that 

this person who would be the Secretary of Mental Health would 

over bureaucratize and complicate some of these issues. Is there a 

specific place in the bill you can tell me where it says that? I need 

a specific. I don’t need concepts or philosophy. Because what we are 

trying to do at this hearing is work to improve the bill. So if you 

think there is something in there, it is important this committee 

has accurate information and not impressions. Is there something 

in the bill? If you don’t, you can get back to me on that. That is 

OK. 

Mr. SHERN. The question I was responding to had to do with conditioning the receipt of block grant funds based on States having 

effective assisted outpatient treatment, and it is my understanding, 

and correct me if I am wrong, that that is in fact a provision of 

the bill. 

Mr. MURPHY. There is a provision of the bill. That is not the 

issue with the Secretary of Mental Health. 

Mr. SHERN. That wasn’t the question, though. 

Mr. MURPHY. Well, part of it. You said it would over bureaucratize. The person who now handles SAMHSA, do you know what 

her degree is in, what her background is? 

Mr. SHERN. She is an attorney. 

Mr. MURPHY. Exactly. Haven’t we done enough with treating 

people with mental illness as legal cases? We have closed our hospitals and filled our prisons. We close our treatment centers. We 

have not given adequate funding to community mental health centers and we have replaced the hospital bed with a flophouse or a 

blanket over some steam grate. That is wrong. I think it is immoral. That puts us in a third-world category. 

Mr. SHERN. I agree with you completely. I think it is one 

thing—— 

Mr. MURPHY. I want for the record—yes, there is a lot to do. A 

person’s background should meet their role. Now, I respect that 

you are here, but also, it is important to understand, you don’t 

treat patients. You have never been involved in a patient case. You 

have never been involved in a HIPAA discussion. You haven’t, and 

that is important. You are here as a citizen. But I want to make 

it very—— 

Mr. SHERN. I am here as a research psychologist. 

Mr. MURPHY. I understand, sir, but you haven’t read the bill, 

OK? Sir, along these lines, let me clarify for the committee, the 

Federal Government spends $125 billion a year across many agencies. The Department of Defense has spent $100 million and the 

group just said that the money they spent on resilience programs 

and other things doesn’t work. DOD has to go back and say what 

did we do wrong. Well, we found out that some of the things they 

are doing are in clearly good programs with regard to evidencebased programs, and some of it is not, and they need to make sure 

people are following the program. The VA spends a lot of money 

in mental health but unfortunately, a study said that about 20 perVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00078 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
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cent of the time when someone goes into a VA hospital for mental 

health services for PTSD, they get appropriate care. The rest of the 

time they don’t. That is wrong. Judiciary spends a heck of a lot of 

money and in many States on jails. That is wrong. We should be 

treating these people. 

We have had many witnesses before this committee that do that. 

The purpose of the Secretary of Mental Health—and I think you 

are demeaning the quality of this. I don’t want someone who is 

dealing with 60 million Americans that one out of five or one of 

four people who deal with it in life to be some back bench low-level 

person. I want this person to have some power and mojo. I want 

this person to be a clinician of an M.D., Ph.D. or D.O. level. I want 

this person to be one who has access behind their title, Assistant 

Secretary of Mental Health, to be able to walk into the office of Judiciary, Defense, the VA, Education, HHS and say we want your 

information, we need to know if your programs work or don’t work 

or if they are redundant. We have got to make this system work. 

Sir, for the last 20 years that SAMHSA has been around, it has 

gotten worse. Now, SAMHSA has done a lot of great things, and 

I applaud them for that, and we want to keep them going. I am 

not interested in getting rid of them. I am interested in beefing 

them up. But I am also saying we need evidence-based programs 

around this country. 

There is a lot of misinformation being thrown out today, so I am 

frustrated, but I also know, you know what? That is the nature of 

the mental health community. For the first time since Kennedy 

was President, for the first time in the last 50 years we have an 

opportunity in this Congress to say we need to overhaul this system. There have been some great programs that have come 

through. I applaud Congressman Kennedy and Senator Wellstone. 

Some of those things have been marvelous. But it has been piecemeal, and I want us to really approach this in a comprehensive 

way but sometimes in the mental health community, we are so 

used to dealing with dysfunction in ourselves, we don’t understand 

when we have an opportunity. 

So here is what I am recommending. When you are given a comment and you haven’t read the bill, say I haven’t read the bill, OK? 

And with regard to this, what we want, what I want is from everybody and all the agencies throughout spreading rumors about this 

bill too to my colleagues and other people, send me ideas for 

amendments. Let us work on this, but let us not play this game. 

Thank you. I yield back. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the gentleman from North Carolina, Mr. Butterfield, 5 minutes for 

questions. 

Mr. BUTTERFIELD. Thank you very much, Mr. Chairman, and 

thank the witnesses for their testimony today. I will try to look 

around Mr. Tonko and see all four of you. That is the advantage 

of being on the bottom tier. That is fine, Paul. That is fine. 

But thank you for holding today’s hearing. Certainly, mental 

health is a very important issue. It is an important issue to all four 

of you. It is an important issue to us and certainly to the people 

that I represent in North Carolina, and so that means that we 

have to do all that we can at the federal level to ensure that people 

76 

who are living with a mental illness receive the treatment and support they deserve. 

Some of my colleagues certainly know in my prior life I was a 

trial judge in North Carolina, served for 15 long years in 32 counties in my State, and so I have seen firsthand what mental illness 

can do not only to families but to communities, and so I thank you 

for your passion. 

I have read most of Mr. Murphy’s bill, and I think it is a good 

step, a step in the right direction. Certainly, there are many improvements that we can make, and I thank the chairman for offering us an opportunity to offer amendments to the legislation and 

there will be several. 

There are many different people involved in the continuum of 

care for mental illness and it is important that we recognize another category, and that is the role of social workers in the continuum of care and the important role that they play in mental and 

behavioral health infrastructure in our country. The importance of 

the social work profession will continue to increase as the mental 

and behavioral health challenges impact a growing percentage of 

the population. According to the U.S. Bureau of Labor Statistics, 

the need for social workers specializing in mental health and substance abuse is expected to grow by 23 percent from 2012 to 2022. 

That is 10 years. That rate is much faster than the average for all 

other occupations. Social work is built on a foundation of integrated 

care working directly with patients, but in settings including hospitals and schools and substance abuse prevention and treatment 

programs and family service settings and long-term care facilities. 

Social workers have a history of working with and across disciplines including psychiatrists, pharmacists, nurses and others 

and will play a central role as we seek to improve health outcomes 

for people with mental and behavioral issues. 

I understand that part of the goal of this hearing is to identify 

and fill gaps that exist in the health care workforce in an effort to 

meet the unique needs of different populations such as our veterans and people living in urban or rural communities or adults. 

Let me go to Dr. Shern if I can very quickly. We know that 

health professions other than M.D.s and Ph.D.s have a growing 

role in meeting the mental health needs in the United States. Can 

you talk about your experiences and/or best practices working with 

other professionals in an integrated and team-based approach? 

Mr. SHERN. Yes, well, I think that that integrated team-based 

approach that involves several different disciplines is essentially 

the state of the art in terms of how services are best delivered, particularly for people who have complex conditions or have, in this 

case, severe mental illnesses, and I think that there are real opportunities and real challenges that we confront in terms of adequate 

health care workforce in general and trying to understand and articulate different roles, particularly roles for paraprofessionals, 

peers and others and certainly including social work. You know, all 

of this that we are talking about in terms of the integration of care, 

understand that people live in communities, interact with complex 

systems, that is the hallmark of social work’s approach to these 

issues. So I think many disciplines are involved. I think the best 

treatment involves a multidisciplinary team and I think that is baVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00080 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
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sically considered state of the art in terms of services for people 

with severe mental illness. 

Mr. BUTTERFIELD. How do you see an integrated team-based approach involving social workers and pharmacists and nurses and 

others in addition to psychiatrists contributing to the success of 

this legislation and addressing mental health needs? 

Mr. SHERN. Well, it is clear from research actually that was done 

in the 1970s that multidisciplinary teams can both save money in 

terms of decreasing utilization of the most expensive resources and 

improve outcomes, and the disciplines that you mentioned in your 

question would be the disciplines that typically would be involved 

in those kinds of multidisciplinary teams. 

Mr. BUTTERFIELD. Finally, let me go to you, Ms. Thompson, and 

thank you very much for your very passionate testimony. On another day I will share with this committee my personal story. I too 

grew up in a home with a mother who had mental illness. It was 

paranoia. She was not a harm or threat to anyone except herself, 

but it had a significant impact on her family and her work. So 

thank you for your testimony. 

Do you think this legislation does enough to recognize and encourage an integrated team-based approach to addressing mental 

health needs of patients and their families? 

Ms. THOMPSON. As I said earlier, I haven’t read the entire bill. 

From my understanding, it addresses—the issue I have with what 

has happened in my experience was that there was no quality of 

life for my mother, so whatever it takes to create an ability for people to have a better quality of life, whether they know what it is 

or not, whether they are able to recognize it for themselves or not, 

that I feel we have an obligation to do that. 

Mr. BUTTERFIELD. Thank you. My time is expired. I am sorry. 

Mr. PITTS. The Chair thanks the gentleman and now recognizes 

the gentlelady from North Carolina, Ms. Ellmers, 5 minutes for 

questions. 

Mrs. ELLMERS. Thank you, Mr. Chairman, and thank you to our 

panel. Each one of you has very important information for us 

today, and I would also like to congratulate and thank my colleague, Mr. Murphy, for the work that he has done on this issue, 

especially in relation to the HIPAA situation. As a nurse before 

coming to Congress, I know that much of the misinformation is parochial and it is misinterpreted or overinterpreted and the clarifications are necessary so that each health care professional can understand what can be relayed because it is a very crucial time. 

So with that, I do have a question for Ms. Zdanowicz and for Ms. 

Thompson. Both of you are doing important work, and your stories 

are compelling on a personal level as well. In North Carolina, the 

past 10 years, the suicide rate has spiked significantly from about 

18 percent to 22 percent. I represent Fort Bragg, and this affects 

our military, as you know, and our soldiers as well. In fact, a statistic that I am reading here that is provided for me says that actually this year into 2014, there have been more soldiers who have 

died by their own hand than those on the battlefield. Now, death 

in itself is not to be embraced. However, when we look at that statistic, we know the effects are incredible and that we need to deal 

with this issue. 

78 

Obviously, medical beds, or patient beds, and psychiatric beds 

are so essential, and we are in more need today than ever. Today, 

North Carolina has only eight beds in a State psychiatric hospital 

per 100,000 people. So I believe we are at the lowest ratio, and one 

of our largest hospital systems in my area of North Carolina, Wake 

Med, is basically struggling with this issue. They treat an average 

of 314 patients a month whose primary diagnosis is psychosis, and 

this is up one-third over the last 2 years. Any given time, there are 

25 to 50 patients with a diagnosis of mental illness of some form 

that are not necessarily in a dedicated psychiatric unit but are having to be placed in other areas of the hospital, and as you can 

imagine, that is difficult for the patient, the family and then also 

the health care professionals who are taking care of them. 

Ms. Zdanowicz, can you give us some points and guidance on how 

we can improve this mental health bed situation? 

Ms. ZDANOWICZ. Well, I would love to tell you that we could convince States to increase the number of beds and increase the number of long-term and intermediate-care beds that are just disappearing but that is not going to happen, and that is why assisted 

outpatient treatment is so important because it is a way of keeping 

individuals who are not safe in the community without medication 

on treatment, and there is empirical evidence to show that it reduces hospitalization, reduces incarceration, which, as I mentioned 

before, the jails and prisons are the new State psychiatric hospitals. If we don’t have those kinds of facilities, we have to have 

a way of ensuring that people who don’t realize that they are ill, 

that won’t take their medication any other way have a means of 

getting that support, and it is not just a court order of somebody 

telling them. It comes with services. And I know people who have 

experienced it, and it does not scare people away and in fact it improves their lives. So unless we can get more beds, this is a solution with the population we are talking about, not everyone but the 

population we are concerned about. 

Mrs. ELLMERS. Thank you. 

And Ms. Thompson, I just want to thank you for the work that 

you are doing. In Randolph County, which is one of my counties 

that I represent, the crisis intervention training for law enforcement is making a significant difference. Basically this is sponsored 

by you and NAMI, and it has been incredible work in the ability 

to have those law enforcement officers in the situation, know when 

they have to react and be able to engage and deescalate the situation, and it has made a huge difference. However, we need to continue to show that this program is working and we need greater 

coverage and reaching out to some of the other law enforcement. 

How can we extend this program? Do you know of the barriers? I 

know I am running out of time, but can you identify the barriers 

that we can address that might actually be able to help this situation? 

Ms. THOMPSON. The situation in terms of getting more people informed? 

Mrs. ELLMERS. Yes, or getting this program in place for more law 

enforcement to learn about—— 

Ms. THOMPSON. This program is vital. You need to give people 

the tools on how to deal with people in crisis, because if you don’t, 

79 

that is where the abuse comes from. That is really the abuse in the 

police department. That is where all of that comes from is because 

you are asking them to deal with something that they have no 

knowledge, that is not their skill set, and it is not fair to them and 

it is not fair to the individual. 

But that needs to be funded. I mean, there is no way—we can’t 

do it alone. NAMI is trying desperately. We are a volunteer-based 

organization. We are a nonprofit organization. We try to reach out 

to law enforcement as much as we can. We need help. We need 

funding. 

Mrs. ELLMERS. Thank you so much, and again, thank you to our 

entire panel. 

Thank you. I yield back the remainder of my time. 

Mr. PITTS. The Chair thanks the gentlelady and now recognizes 

the gentleman from Florida, Mr. Bilirakis, 5 minutes for questions. 

Mr. BILIRAKIS. Thank you so very much, Mr. Chairman. I want 

to thank the panel for their testimony and of course coming to 

Washington and sharing with us. 

In addition to being on the E&C Committee, I also serve as Vice 

Chairman of the Veterans’ Affairs Committee, and we have held 

several hearings over the years on the mental health issues and of 

course, it is an extremely important issue. As a matter of fact, 

Time magazine wrote back in 2012 that ‘‘more U.S. military personnel have died by suicide since the war in Afghanistan began 

than have died fighting there.’’ When they take their own lives, 

these deaths diminish us as a whole. It leaves behind spouses, children, parents, and siblings who must deal with the loss and their 

own grief. 

So when I look at H.R. 3717, and thank you, representative Murphy, for filing the bill, the Helping Families in Mental Health Crisis Act, I look at it from the viewpoint of our veterans and their 

families, in addition to the general population. 

I want to thank the witnesses again for coming here today and 

talking about these issues. It is so very important. It is an invisible 

wound that millions grapple with each day. It carries a stigma, as 

you said, and we need to help remove the stigma so people aren’t 

afraid to seek help. Mental health issues are just as serious as visible physical wounds, in my opinion. We must responsibly address 

this problem. Too many Americans and their families are suffering, 

and they deserve proper care, in my opinion. 

Your experiences dealing with family members with mental 

health issues, or living with it, or treating it helps inform a lot of 

us in the debate. Again, thank you for being here. I really appreciate it. 

And I would like to yield the rest of my time to Representative 

Murphy. 

Mr. MURPHY. I thank the gentleman for yielding. 

A couple other clarifying points I want to make for members. 

This bill does not cut 85 percent of federal funding for the programs. It does not. There are multiple sources for that federal 

funding. This is one of them. And so it is very important that people are dealing with the facts. 

Also, Dr. Shern, you referred to a coercive feature of assisted outpatient treatment that would make people seek treatment. Are you 

80 

aware of the programs Ms. Zdanowicz is talking about here with 

regard to the evidence on when AOT can work to reduce incarceration, et cetera? 

Mr. SHERN. Yes, I am. 

Mr. MURPHY. So what I am trying to find out here, and I recognize not all States do things the same way. 

Mr. SHERN. Right. 

Mr. MURPHY. For example, California has one county that does 

this; the rest don’t. And some States do it better than others. I 

think New York does a pretty good job on that. 

But in this bill, are you aware of how we define who would qualify for assisted outpatient treatment? 

Mr. SHERN. Generally, yes. 

Mr. MURPHY. Well, we very narrowly defined that. They to be incarcerated before, had multiple hospitalizations, but the rest we 

leave up to the States because I think States should decide a lot 

of this too. So I want to make sure we are making it clear. There 

is no coercion involved here but we are saying States have to have 

something on the books. 

But let me ask the panelists this—— 

Mr. SHERN. Can you clarify that a bit, the no coercion involved 

in assisted outpatient treatment? 

Mr. MURPHY. I am saying with regard to the States, they can put 

this together any way they want but we are saying—— 

Mr. SHERN. Coercion of the States? 

Mr. MURPHY. Yes. What we are saying here is that as an alternative to just waiting until someone is in imminent danger, until 

someone has a knife to their head or someone else’s. We want to 

provide a mechanism by which people are not just waiting for that 

‘‘someone is about to die’’ standard. That is something established 

in the 1700s. We need to be doing more. 

So what I want to ask here is, I am open to other ideas, and 

what else could we do to make sure people—we have this integrated care, this wraparound care. I mean, we know when someone 

is in an acute crisis, that they need a lot of help and long term. 

What would be a couple of those things? Ms. Thompson, can you 

think of anything that we should make sure we include here? 

Ms. THOMPSON. Well, I think how HIPAA is addressed is vital 

because, you know, waiting until somebody is at a risk to themselves and others is waiting way too long to help them. We are 

waiting way too long to step in. 

Mr. MURPHY. So making sure we have some way that families 

can participate more would be helpful? 

Ms. THOMPSON. That is correct. 

Mr. MURPHY. Dr. Shern, do you have any recommendations of 

ways we could help provide some integrated wraparound services? 

I mean, we have some in here now under the Excellence in Health 

Care. You don’t have to answer now but if you can provide us some 

ideas, I would love to hear them. 

Mr. SHERN. Sure, and I think we have a pretty good evidence 

base with regard to that and I think that where AOT has been 

shown to be successful is in New York where there was a $125 million appropriation to enhance services. 

81 

Mr. MURPHY. Ms. Zdanowicz, do you have any other suggestions 

that we can do? I know you are in support of AOT but any other 

things States should be doing? 

Ms. ZDANOWICZ. Well, I mentioned earlier, I just finished a survey of jails and prisons around the country, and this is where we 

need more help, and it is something that is being overlooked. I 

think it is coming to the forefront now. But that is where are so 

many people with mental illnesses who are refusing treatment, and 

what happens to them in those situations, I have talked to jails 

and learned just how horrible and dangerous and heartbreaking it 

is, and I think it is something that we have to focus on and not 

only just providing treatment in the institutions but keeping them 

out of the institutions, and I have talked to police officers trained 

to deal with people with mental illness. I was in a meeting where 

they asked, after hearing all the evidence, you know, the recoverybased peer support programs the State provides, a police officer 

stood up and said well, when I call the State, I can’t get any help 

for this homeless person who is psychotic and delusional. So I think 

those are the areas that we need to have more integrated services. 

Mr. MURPHY. Mr. Chairman, for the record, I just want to point 

out that in support of what Dr. Shern is saying, a report says that 

ACT works but a report says we also found evidence in the case 

manager data that receiving AOT combined with ACT services—assertive community treatment—substantially lowers risk of hospitalization compared to receiving ACT alone. So we will work with 

you on that. Thank you. 

Mr. PITTS. The gentleman yields back. The chair now notes that 

the subcommittee members have concluded their questions, and 

without objection, the Chair recognizes the gentleman from New 

York who is also on the full committee, Mr. Tonko, 5 minutes for 

questions. 

Mr. TONKO. Thank you, Mr. Chair. 

Preliminarily, I state to our colleague and my friend, Mr. Murphy, that many of us are engaged in regard to this bill. We have 

read the bill and have sent you specific suggestions on how we believe the bill can be improved. We all agree that there are serious 

issues that need to be addressed but there are also serious reservations out there to some provisions in the instant bill. I think your 

intent is right, and we want to continue to work with you, but it 

needs to be a collaborative process. I commit to keeping an open 

dialog here so as to exchange on behalf of the issues and to recognize the importance of the issues here, the people most importantly 

impacted by mental health disorders and mental illnesses are of 

high need. So we need to recognize that and move forward with the 

sense that more than one point of view needs to be exchanged here 

in order for us to move forward most effectively. 

I also want to make the record clear that the protection and advocacy organizations are already precluded, prohibited by federal 

law from using any federal funds for lobbying purposes. Any lobbying activities conducted by these organizations, most notable organizations, are done with private dollars. Certainly, this would be 

restricted as lobbying activities with private funds which as I am 

sure my colleagues on the other side of the aisle would agree with 

in the way of yesterday’s Supreme Court ruling could raise signifiVerDate Nov 24 2008 14:25 Jun 04, 2015 Jkt 037690 PO 00000 Frm 00085 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-136 CHRIS
82 

cant free-speech concerns, and I think those free-speech concerns 

are essential here for these organizations using private dollars. 

With that being said, I thank you again, Mr. Chair, for the opportunity. This issue is near and dear to my heart. I served in the 

New York State Assembly before coming to Congress. One of my 

proudest achievements in 25 years of service in that body was 

Timothy’s Law. I was the prime sponsor of mental health parity in 

New York. I have the utmost respect for the mental health community and for those who advocate. Their resilience, their determination is stellar, and I recognize that, and I recognize the work done 

by the Oversight and Investigations Subcommittee to examine 

issues surrounding mental health. 

While there are many aspects of this bill with which I strongly 

disagree in its current form, I think that the intent is right on and 

it is in the right place, and I hope that we can continue to have 

bipartisan discussions to improve the bill. Those struggling with 

mental illnesses deserve nothing less. 

So Mr. Shern, in your testimony you speak to the fact that our 

treatment systems should be welcoming rather than frightening. I 

couldn’t agree more. And I think everyone in this room recognizes 

that voluntary community-based treatment is always preferable 

and leads to better outcomes in the long run. 

One of the more difficult questions we are weighing as a panel 

is what circumstances more coercive forms of treatment, whether 

this is assisted outpatient treatment or inpatient hospitalization 

might be necessary. In your opinion, when is it appropriate, if ever, 

to resort to these more coercive forms of treatment when dealing 

with an individual with serious mental illness? 

Mr. SHERN. Well, I think, in situations in which a person doesn’t 

have the capacity to make the decisions necessary to preserve their 

safety or is a threat to another person, which is the standard sort 

of commitment that laws that exist across the country. At that 

point in time we have provisions for involuntarily treating individuals. When we implemented our New York City program, our Manhattan program for people who had severe mental illnesses and 

were living on the streets of New York, I personally witnessed people literally running from our program because of—literally running, jumping onto the Staten Island Ferry by slipping under the 

door right before the ferry took off rather than be engaged by our 

program. So I personally have experienced people running from 

care because of coercive interventions. 

Mr. TONKO. And Mr. Shern, does the evidence show that assisted 

outpatient treatment programs are more effective than similarly 

resourced assertive community treatment programs? 

Mr. SHERN. It is my understanding that those situations in 

which AOT has been shown to be effective both in the Duke trials 

and in the New York State experience were situations in which 

there were enhanced services available. Compelling people into a 

service system that doesn’t exist is not going to make a difference. 

Mr. TONKO. And when States have adopted more expansive needfor-treatment standards for civil commitment, have we seen an impact on individuals seeking care voluntarily? 

Mr. SHERN. Coercive interventions can chase people from care. 

83 

Mr. TONKO. Thank you very much, and with that, I yield back 

as I see I have exhausted my time. 

Mr. PITTS. The Chair thanks the gentleman. The Chair overlooked one member of the subcommittee, so at this time yields 5 

minutes to Mr. Griffith from Virginia. 

Mr. GRIFFITH. Thank you very much, Mr. Chairman, and I apologize to both you, Mr. Chairman, and to our panelists. I have been 

involved in another hearing as well and so I have been running up 

and down the stairs trying to make sure I got here. 

I want to agree with Representative Tonko in saying that putting 

this forward by Dr. Murphy is a big step. Somebody has to put it 

forward. We have been studying it for a little while. He decided to 

take that leap, and I commend him for that because that is very, 

very important. There are things in a bipartisan fashion that we 

can work on to improve the bill, and I heard Dr. Murphy say earlier he is looking for those suggestions. 

That being said, I also want to underscore that HIPAA does have 

to be addressed. It doesn’t mean we want to undo the principles of 

HIPAA. It doesn’t mean we want to, you know, let everybody have 

access. But we heard so much testimony from so many family 

members who wanted to help, people who loved the individual with 

mental health problems who wanted to be there for them, and in 

many cases were not able to be there to take care of them because 

they were blocked. They were blocked from having the necessary 

knowledge to know whether or not they were a risk to themselves 

or to others. They were blocked because they didn’t know exactly 

what was going on. So we have to improve that. 

Where I would like to see improvements in this bill is in figuring 

out how to define that because when you look at Section 301, we 

have a real opportunity to work on that across the board, all parties coming together and figuring out how we do that. My concerns 

particularly relate to two groups of individuals. You have got the 

elderly. It is pretty obvious that with an elderly person, if you have 

competing children—I used to do divorce work in my small town 

private practice. I did a lot of criminal work. People will fight over 

all kinds of things and particularly when it becomes mom or dad, 

family members get into a fight. So we have to figure out a system 

where if you have got a child who hasn’t been involved in mom’s 

life for 20 years, that they don’t come waltzing in and knock Ms. 

Thompson out because all family members get it. 

Also, I worry in that same situation, that young men, we have 

heard so much testimony that young men particularly in that suspect group, 14 to 18 is a problem but 14 to, I think it was 28— 

Dr. Murphy can correct me on my ages—where there is a lot of 

onset of first signs of mental illness and they don’t get treatment. 

Fourteen to 18, parents are still involved. On that 18th birthday, 

they get knocked out. And whether that is what HIPAA is supposed to do or not, it is the way it is interpreted, and if you are 

worried about a lawyer suing you for giving away the information, 

you are not going to do it as a doctor. No matter what different 

people may think it means, Dr. Murphy is right. We have got to 

clarify it. But then I also worry if you have too big a door for people 

to get information, does that estranged father come back in, never 

84 

having participated in his son’s life and now the son is 22 and he 

decides he wants to come in and knock mom out. 

So that is the scenario that I am looking at. I think we can make 

improvements. And with that, Mr. Chairman, I yield to Dr. Murphy. 

Mr. MURPHY. I thank the gentleman. I also thank you for your 

commitment to help us improve that language. It is important. We 

have had too many people raise concerns so we have to do it the 

right way. 

Dr. Shern, you had mentioned that you are aware—well, let me 

ask you, are you aware of any study at all, empirical, published 

study, that supports your understanding that broader commitment 

standards drive people away from seeking treatment? Are you 

aware of any particular study offhand or can you provide that for 

us? 

Mr. SHERN. I can look into it. I am not aware of any offhand. 

Mr. MURPHY. OK. I appreciate that, because you made the statement. I want it backed up with evidence. 

I also want to say that what I was reading before, the quote I 

forgot to reference is where it said that AOT combined with ACT 

services substantially lowers risk of hospitalization compared to receiving ACT alone. This is the study done by Duke University Policy Research Associates and the University of Virginia School of 

Law on the New York State assisted outpatient treatment program 

evaluation. So there is a lot we can learn from New York. 

One other thing I want to mention, when I refer to some of the 

concerns I have, and Ms. Jensen, you brought a very compelling 

story forward on what happened with that horrible place you were 

in, and I am glad you fought hard to shut it down, but also some 

of these groups also cause some problems too. A case we heard was 

from Joe Bruce. His son William was diagnosed with some psychosis. He was in Maine. And these advocates came in. This family 

was completely cut off from being able to talk to their son, which 

is a HIPAA issue, yet these advocates could talk to him, coached 

him during a hearing on this, and told him to say when he was 

asked if he was going to be a harm to himself or someone else say 

no. He listened to their coaching. He was dismissed from the hospital. He went home. He took a hatchet and chopped his mother 

to pieces. 

This was very moving testimony this committee heard. We don’t 

think a group like this has any business telling someone get them 

out of treatment altogether. We want professionals involved who 

are looking out for the best interest of the patients all the way 

through. 

Mr. Chairman, I want to thank you for this hearing today. We 

have heard some powerful information. I look forward to working 

with my colleagues on both sides of the aisle on this. The good 

news is, we have elevated this to the level of Congressional discussion instead of keeping it in the dark shadows. We have understood 

that this isn’t just an issue of violent mentally ill. We have to work 

together. I am excited about this, and I want to leave with a message of hope for the many people who are struggling with mental 

illness. We will continue to listen to you. We want to work together. We have got to change this system and help you all. 

85 

*The information has been retained in committee files and is also available at http:// 

docs.house.gov/meetings/if/if14/20140403/102059/hhrg-113-if14-20140403-sd008.pdf. 

With that, I yield back. 

Mr. PITTS. The Chair thanks the gentleman, and thanks him for 

his leadership on this issue. This has been a very important hearing, very compelling testimony, very informative. Thank you very 

much to the witnesses for coming. 

Now, we have members who may have follow-up questions who 

were not able to attend. They are in other hearings. We will send 

you the written questions. We ask that you please respond promptly. Do you have something? 

Mr. TONKO. Yes, Mr. Chair. We ask that these documents be included in the record. 

Mr. PITTS. We have a unanimous consent request to include in 

the record testimony of the National Disability Rights Network; a 

letter from the American Psychiatric Association; testimony by the 

National Coalition of Mental Health Recovery; testimony titled 

Helping Families in Mental Crisis Act, H.R. 3717 by the Citizen 

Commission on Human Rights *; a letter by Consortium for Citizens with Disabilities; and testimony by Judge David Bazelon Center for Mental Health Law. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. PITTS. I remind members that they have 10 business days 

to submit questions for the record. That means members should 

submit their questions by the close of business on Thursday, April 

17. 

Thank you again very much for attending. Without objection, the 

subcommittee is adjourned. 

[Whereupon, at 12:48 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

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[Dr. Welner’s response to submitted questions for the record has 

been retained in committee files and can be found at http:// 

docs.house.gov/meetings/if/if14/20140403/102059/hhrg-113-if14- 

wstate-welnerm-20140403-sd002.pdf.] 

Æ