II 

109TH CONGRESS 

1ST SESSION S. 1177 

To improve mental health services at all facilities of the Department of 

Veterans Affairs. 

IN THE SENATE OF THE UNITED STATES 

JUNE 7, 2005 

Mr. AKAKA introduced the following bill; which was read twice and referred 

to the Committee on Veterans’ Affairs 

A BILL 

To improve mental health services at all facilities of the 

Department of Veterans Affairs. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Veterans Mental 

5 Health Care Capacity Enhancement Act of 2005’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) Mental health treatment capacity at com9 munity-based outpatient clinics remains inadequate 

10 and inconsistent, despite the requirement under sec-
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1 tion 1706(c) of title 38, United States Code, that 

2 every primary care health care facility of the De3 partment of Veterans Affairs develop and carry out 

4 a plan to meet the mental health care needs of vet5 erans who require such services. 

6 (2) In 2001, the minority staff of the Com7 mittee on Veterans’ Affairs of the Senate conducted 

8 a survey of community-based outpatient clinics and 

9 found that there was no established systemwide 

10 baseline of acceptable mental health service levels at 

11 such clinics. 

12 (3) In 2004, the Department of Veterans Af13 fairs workgroup on mental health care, which devel14 oped and submitted a Comprehensive Mental Health 

15 Strategic Plan to the Secretary of Veterans Affairs, 

16 found service and funding gaps within the Depart17 ment of Veterans Affairs health care system, and 

18 made numerous recommendations for improvements. 

19 As of May 2005, Congress had not received a final 

20 report on the workgroup’s findings. 

21 (4) In February 2005, the Government Ac22 countability Office reported that the Department of 

23 Veterans Affairs had not fully met any of the 24 

24 clinical care and education recommendations made 

25 in 2004 by the Special Committee on Post-Trau-
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1 matic Stress Disorder of the Under Secretary for 

2 Health, Veterans Health Administration. 

3 SEC. 3. REQUIRED CAPACITY FOR COMMUNITY-BASED OUT4 PATIENT CLINICS. 

5 (a) STRENGTHENING OF PERFORMANCE MEASURES

6 FOR MENTAL HEALTH PROGRAMS.—Section 1706(b)(6) 

7 of title 38, United States Code, is amended by adding at 

8 the end the following: 

9 ‘‘(D) The Under Secretary shall include, as goals in 

10 the performance contracts entered into with Network Di11 rectors to prioritize mental health services— 

12 ‘‘(i) establishing appropriate staff-patient ratio 

13 levels for various programs (including mental health 

14 services at community-based outpatient clinics); 

15 ‘‘(ii) fostering collaborative environments for 

16 providers; and 

17 ‘‘(iii) encouraging clinicians to conduct mental 

18 health consultations during primary care visits.’’. 

19 (b) INFLATIONARY INDEXING OF CAPACITY RE20 QUIREMENTS.—Section 1706(b) of title 38, United States 

21 Code, is amended by adding at the end the following: 

22 ‘‘(7) For the purposes of meeting and reporting on 

23 the capacity requirements under paragraph (1), the Sec24 retary shall ensure that the funding levels allocated for 
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1 specialized treatment and rehabilitative services for dis2 abled veterans are adjusted for inflation each fiscal year.’’. 

3 (c) MENTAL HEALTH AND SUBSTANCE ABUSE SERV4 ICES.—Section 1706(c) of title 38, United States Code, 

5 is amended— 

6 (1) by inserting ‘‘(1)’’ before ‘‘The Secretary’’; 

7 and 

8 (2) by adding at the end the following: 

9 ‘‘(2) The Secretary shall ensure that not less than 

10 90 percent of community-based outpatient clinics have the 

11 capacity to provide onsite, contract-referral, or tele-mental 

12 health services— 

13 ‘‘(A) for at least 10 percent of all clinic visits 

14 by not later than September 30, 2006; and 

15 ‘‘(B) for at least 15 percent of all clinic visits 

16 by not later than September 30, 2007. 

17 ‘‘(3) The Secretary shall ensure that not less than 

18 2 years after the date of enactment of this paragraph— 

19 ‘‘(A) each primary care health care facility of 

20 the Department has the capacity and resources to 

21 provide not less than 5 days of inpatient, residential 

22 detoxification services onsite or at a nearby con23 tracted or Department facility; and 
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1 ‘‘(B) a case manager is assigned to coordinate 

2 follow up outpatient services at each community3 based outpatient clinic.’’. 

4 (d) REPORTING REQUIREMENT.—Not later than 

5 January 31, 2008, the Secretary of Veterans Affairs shall 

6 submit a report to Congress that— 

7 (1) describes the status and availability of men8 tal health services at community-based outpatient 

9 clinics; 

10 (2) describes the substance of services available 

11 at such clinics; 

12 (3) includes the ratios between mental health 

13 staff and patients at such clinics; and 

14 (4) includes the certification of the Inspector 

15 General of the Department of Veterans Affairs. 

16 SEC. 4. COOPERATION ON MENTAL HEALTH AWARENESS 

17 AND PREVENTION. 

18 (a) AGREEMENT.—The Secretary of Defense and the 

19 Secretary of Veterans Affairs shall enter into a Memo20 randum of Understanding— 

21 (1) to ensure that separating servicemembers 

22 receive standardized individual mental health and 

23 sexual trauma assessments as part of separation 

24 exams; and 
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1 (2) includes the development of shared guide2 lines on how to conduct the assessments. 

3 (b) ESTABLISHMENT OF JOINT VA–DOD 

4 WORKGROUP ON MENTAL HEALTH.— 

5 (1) IN GENERAL.—Not later than 180 days 

6 after the date of enactment of this Act, the Sec7 retary of Defense and the Secretary of Veterans Af8 fairs shall establish a joint workgroup on mental 

9 health, which shall be comprised of not less than 7 

10 leaders in the field of mental health appointed from 

11 their respective departments. 

12 (2) STUDY.—Not later than 1 year after the es13 tablishment of the workgroup under paragraph (1), 

14 the workgroup shall analyze the feasibility, content, 

15 and scope of initiatives related to— 

16 (A) combating stigmas and prejudices as17 sociated with servicemembers who suffer from 

18 mental health disorders or readjustment issues, 

19 through the use of peer counseling programs or 

20 other educational initiatives; 

21 (B) ways in which the Department of Vet22 erans Affairs can make their expertise in treat23 ing mental health disorders more readily avail24 able to Department of Defense mental health 

25 care providers; 
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1 (C) family and spousal education to assist 

2 family members of veterans and servicemembers 

3 to recognize and deal with signs of potential re4 adjustment issues or other mental health dis5 orders; and 

6 (D) seamless transition of servicemembers 

7 who have been diagnosed with mental health 

8 disorders from active duty to veteran status (in 

9 consultation with the Seamless Transition Task 

10 Force and other entities assisting in this ef11 fort). 

12 (3) REPORT.—Not later than June 30, 2007, 

13 the Secretary of Defense and the Secretary of Vet14 erans Affairs shall submit a report to Congress con15 taining the findings and recommendations of the 

16 workgroup established under this subsection. 

17 SEC. 5. PRIMARY CARE CONSULTATIONS FOR MENTAL 

18 HEALTH. 

19 (a) GUIDELINES.—The Under Secretary for Health, 

20 Veterans Health Administration, shall establish system21 wide guidelines for screening primary care patients for 

22 mental health disorders and illnesses. 

23 (b) TRAINING.—Based upon the guidelines estab24 lished under subsection (a), the Under Secretary for 

25 Health, Veterans Health Administration, shall conduct ap-
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1 propriate training for clinicians of the Department of Vet2 erans Affairs to carry out mental health consultations. 

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