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[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 2105 Introduced in Senate (IS)]

<DOC>

117th CONGRESS
  1st Session
                                S. 2105

To enhance mental health and psychosocial support within United States 
                      foreign assistance programs.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             June 17, 2021

   Mr. Casey introduced the following bill; which was read twice and 
             referred to the Committee on Foreign Relations

_______________________________________________________________________

                                 A BILL

 
To enhance mental health and psychosocial support within United States 
                      foreign assistance programs.

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

SECTION 1. SHORT TITLES.

    This Act may be cited as the ``Mental Health in International 
Development and Humanitarian Settings Act'' or the ``MINDS Act''.

SEC. 2. FINDINGS; SENSE OF CONGRESS.

    (a) Findings.--Congress finds the following:
            (1) According to the 2016 Global Burden of Disease Study, 
        an estimated 1,000,000,000 individuals worldwide have a mental 
        health or substance use disorder. Mental disorders are major 
        contributors to the global burden of disease, and depression is 
        among the primary causes of illness and disability in 
        adolescents.
            (2) An individual's mental health is a complex interaction 
        between genetic, neuropsychological, and environmental factors, 
        and environmental and social factors, from the early years 
        through childhood and adolescence, can have long-term impacts 
        on mental health.
            (3) According to a Lancet Commission report, allocations 
        for mental health have never risen above 1 percent of health-
        related global development assistance. Estimates indicate that 
        child and adolescent mental health receives just 0.1 percent of 
        health-related global development assistance.
            (4) The National Alliance on Mental Illness estimates that 
        depression and anxiety disorders cost the global economy 
        $1,000,000,000,000 in lost productivity each year. According to 
        Lancet, mental health disorders are projected to cost the 
        global economy $16,000,000,000,000 between 2010 and 2030, in 
        part due to the early age of onset.
            (5) According to the World Health Organization (WHO), half 
        of mental health disorders emerge by age 14, and 14 percent of 
        children and adolescents worldwide experience mental health 
        conditions, the majority of whom do not seek care, receive 
        care, or have access to care.
            (6) Exposure to violence and early childhood adversity, 
        including trauma, has been linked to negative, lasting effects 
        on physical and mental health. Early childhood adversity can 
        impact brain development, nervous and immune system 
        functioning, the onset of mental health conditions, and future 
        behaviors. The United Nations asserts that widespread school 
        closures due to COVID-19, which have affected roughly 
        1,500,000,000 school-aged children, have placed many children 
        at higher risk of exposure to traumas, such as household 
        violence, abuse, neglect, and food insecurity.
            (7) According to the United Nations, more than 1 out of 
        every 5 individuals in conflict-affected areas has a mental 
        health disorder. Roughly 1,500,000,000, or 2 out of every 3 of 
        the world's children under 18 years of age live in countries 
        affected by conflict, and more than 1 out of every 6 children 
        live in conflict zones. A greater number of children live in 
        areas affected by armed conflict and war now than at any other 
        point this century. The mental health burden in conflict-
        affected contexts is twice the global average.
            (8) Gender, age, disability status, race and ethnicity, and 
        other identity characteristics contribute to different risks 
        and needs for mental health and psychosocial support. Research 
        has shown that harmful gender norms contribute to higher 
        prevalence of depression and anxiety disorders in women and 
        girls, while socialization of boys and men contributes to 
        higher prevalence of substance use disorders.
            (9) Risks and experiences of gender-based violence, 
        particularly sexual violence, are a key driver of mental health 
        and psychosocial support needs for children. Girls account for 
        98 percent of verified incidents of conflict-related sexual 
        violence. According to the World Health Organization, 35 
        percent of women globally ``face sexual and/or intimate partner 
        violence in their lifetime'' and these survivors can, according 
        to the Centers for Disease Control and Prevention, ``experience 
        mental health problems such as depression and posttraumatic 
        stress disorder (PTSD) symptoms'', signifying the urgent need 
        for age and gender-responsive mental health and psychosocial 
        support services.
            (10) According to the World Health Organization, risk 
        factors that increase susceptibility to mental health disorders 
        include poverty and hunger, chronic health conditions, trauma 
        or maltreatment, social exclusion and discrimination, and 
        exposure to and displacement by war or conflict. These risk 
        factors, along with demographic risk factors, manifest at all 
        stages in life. Preliminary research already illustrates that 
        the COVID-19 pandemic has increased communities', families', 
        and individuals' risk factors for multiple types of adversity 
        and compounded preexisting conditions and vulnerabilities.
            (11) Crisis situations put parents and caregivers under 
        mental and psychosocial duress, which can prevent them from 
        providing the protection, stability and nurturing care their 
        children need during and after an emergency. The Lancet 
        Commission estimates that between 15 and 23 percent of children 
        globally live with a parent with a mental disorder, and 
        parental ill health can impact the emotional and physical 
        development of children and predispose these children to mental 
        health problems. Numerous and compounding stressors and 
        uncertainty caused by COVID-19 have exacerbated distress and 
        further impede caregivers' ability to provide responsive care 
        to their children.
            (12) Investments in the mental health, resilience, and 
        well-being of the children in a country to ensure that they 
        continue to thrive into adulthood and contribute to their 
        societies can help break cycles of poverty, violence, and 
        trauma and further the country's future potential.
            (13) Investments in protecting and improving mental health 
        in a country across the life course must take into account the 
        need to target vulnerable populations and address social, 
        environmental, and other risk factors in conjunction with other 
        sectors and local partners.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) ensuring that individuals have the opportunity to 
        thrive and reach their fullest potential is a critical 
        component of sustainable international development, and the 
        global public good benefits from investment in child and 
        adolescent mental health;
            (2) mental health is integral and essential to overall 
        health outcomes and other development objectives;
            (3) mental health is an issue of critical and growing 
        importance for United States foreign assistance that requires a 
        coordinated strategy to ensure that programming funded by the 
        United States Government is evidence-based, culturally 
        competent, and trauma-informed;
            (4) the United States Government foreign assistance 
        strategy should include a mental health and psychosocial 
        support component;
            (5) the redesign of the United States Agency for 
        International Development (referred to in this Act as 
        ``USAID'') reflects the nexus between humanitarian and 
        development interventions and should be applied to all mental 
        health and psychosocial support efforts of United States 
        foreign assistance programs; and
            (6) ongoing efforts to improve social service workforce 
        development and local capacity building are essential to 
        expanding mental health and psychosocial support activities 
        across all United States foreign assistance programs.

SEC. 3. COORDINATOR FOR MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT.

    Section 135 of the Foreign Assistance Act of 1961 (22 U.S.C. 2152f) 
is amended--
            (1) by redesignating subsection (f) as subsection (g); and
            (2) by inserting after subsection (e) the following:
    ``(f) Coordinator for Mental Health and Psychosocial Support.--
            ``(1) Appointment.--The Administrator of the United States 
        Agency for International Development, in consultation with the 
        Secretary of State, is authorized to appoint a Mental Health 
        and Psychosocial Support Coordinator (referred to in this 
        section as the `MHPSS Coordinator').
            ``(2) Specific duties.--The duties of the MHPSS Coordinator 
        shall include--
                    ``(A) establishing and chairing the Mental Health 
                and Psychosocial Support Working Group authorized under 
                section 4 of the Mental Health in International 
                Development and Humanitarian Settings Act;
                    ``(B) guiding, overseeing, and directing mental 
                health and psychosocial support programming and 
                integration across United States foreign assistance 
                programming;
                    ``(C) serving as the main point of contact on 
                mental health and psychosocial support in the Bureau 
                for Global Health, Bureau for Humanitarian Assistance, 
                regional bureaus, the Office of Education, the 
                Inclusive Development Hub in the Bureau of Development, 
                Democracy, and Innovation, the President's Emergency 
                Plan for AIDS Relief, and other interagency or 
                presidential initiatives;
                    ``(D) promoting best practices, coordination and 
                reporting in mental health and psychosocial support 
                programming across both development and humanitarian 
                foreign assistance programs;
                    ``(E) providing direction, guidance, and oversight 
                on the integration of mental health and psychosocial 
                support in both development and humanitarian foreign 
                assistance programs; and
                    ``(F) participating in the Advancing Protection and 
                Care for Children in Adversity Interagency Working 
                Group.
            ``(3) Focus populations.--Along with a general focus on 
        mental health and psychosocial support, the MHPSS Coordinator 
        should pay special attention to mental health and psychosocial 
        support in the context of family and children, including--
                    ``(A) meeting the needs of adult caretakers and 
                children, including families and adults who are long-
                term caretakers;
                    ``(B) children and others who are separated from a 
                family unit; and
                    ``(C) other specific populations in need of mental 
                health and psychosocial support, such as crisis 
                affected communities, displaced populations, gender-
                based violence survivors, and individuals and 
                households coping with the consequences of diseases, 
                such as Ebola, HIV/AIDS, and COVID-19.''.

SEC. 4. MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT WORKING GROUP.

    (a) Establishment.--The Administrator of the United States Agency 
for International Development (referred to in this Act as the ``USAID 
Administrator''), in cooperation with the Mental Health and 
Psychosocial Support Coordinator, shall establish the Mental Health and 
Psychosocial Support Working Group, which shall include representatives 
from every United States Agency for International Development bureau 
and from the Department of State, to ensure continuity and 
sustainability of mental health and psychosocial support across foreign 
assistance programs.
    (b) Requirements.--The Mental Health and Psychosocial Support 
Working Group--
            (1) should include representation at the Deputy Assistant 
        Administrator level from every United States Agency for 
        International Development bureau;
            (2) shall promote and encourage dialogue across the 
        interagency on mental health and psychosocial support program 
        development and best practices;
            (3) shall coordinate the implementation and continuity of 
        mental health and psychosocial support programs--
                    (A) within USAID;
                    (B) between the USAID and the Bureau of Population, 
                Refugees, and Migration of the Department of State; and
                    (C) in consultation with the Centers for Disease 
                Control and Prevention and the National Institutes of 
                Mental Health, as appropriate.

SEC. 5. INTEGRATION OF MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT.

    (a) Statement of Policy.--It is the policy of the United States to 
integrate mental health and psychosocial support across all foreign 
assistance programs funded by the United States Government.
    (b) Implementation of Policy.--The USAID Administrator and the 
Secretary of State shall--
            (1) require all USAID and Department of State regional 
        bureaus and missions to utilize such policy for local capacity 
        building, as appropriate, for mental health and psychosocial 
        support programming;
            (2) ensure that all USAID and Department of State mental 
        health and psychosocial support programming--
                    (A) is evidence-based and culturally competent;
                    (B) responds to all types of childhood adversity; 
                and
                    (C) includes trauma-specific interventions in 
                accordance with the recognized principles of a trauma-
                informed approach, whenever applicable; and
            (3) integrate the Advancing Protection and Care for 
        Children in Adversity Strategy into its official policy.

SEC. 6. BRIEFING REQUIREMENTS.

    (a) USAID Briefing.--Not later than 180 days after the date of the 
enactment of this Act, the USAID Administrator and the Secretary of 
State shall brief the Committee on Foreign Relations of the Senate and 
the Committee on Foreign Affairs of the House of Representatives 
regarding--
            (1) the progress made in carrying out section 5(b); and
            (2) any barriers preventing the full integration of the 
        strategy referred to in section 5(b)(3).
    (b) Briefing on Spending.--The USAID Administrator, in consultation 
with the Director of the Office of Management and Budget, as necessary 
and appropriate, shall annually brief the Committee on Appropriations 
of the Senate and the Committee on Appropriations of the House of 
Representatives during each of the fiscal years 2022 through 2026 
regarding the amount of United States foreign assistance spent during 
the most recently concluded fiscal year on child mental health and 
psychosocial support programming.
    (c) USAID and Department of State Briefings.--Not later than 180 
days after the date of the enactment of this Act, annually thereafter 
for the following 5 fiscal years, and subsequently, as requested, the 
USAID Administrator and the Secretary of State, in consultation with 
the Mental Health and Psychosocial Support Coordinator appointed 
pursuant to section 135(f) of the Foreign Assistance Act of 1961, as 
added by section 3, shall brief the Committee on Foreign Relations of 
the Senate and the Committee on Foreign Affairs of the House of 
Representatives regarding--
            (1) how USAID and the Department of State have integrated 
        mental health and psychosocial programming, including child-
        specific programming, into their development and humanitarian 
        assistance programs across health, education, nutrition, and 
        child protection sectors;
            (2) the metrics of success of the Advancing Protection and 
        Care for Children in Adversity Strategy;
            (3) the mental health outcomes pertaining to the evidence-
        based strategic objectives upon which such strategy is built;
            (4) where trauma-specific strategies are being implemented, 
        and how best practices for trauma-informed programming are 
        being shared across programs;
            (5) barriers preventing full integration of child mental 
        health and psychosocial support into programs for children and 
        youth and recommendations for its expansion;
            (6) any unique barriers to the expansion of mental health 
        and psychosocial support programming in conflict and 
        humanitarian settings and how such barriers are being 
        addressed;
            (7) the impact of the COVID-19 pandemic on mental health 
        and psychosocial support programming; and
            (8) funding data, including a list of programs to which 
        USAID and the Department of State have obligated funds during 
        the most recently concluded fiscal year to improve access to, 
        and the quality of, mental health and psychosocial support 
        programming in development and humanitarian contexts.
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