II 

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. 

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 TITLES. 

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

5 International Development and Humanitarian Settings 

6 Act’’ or the ‘‘MINDS Act’’. 

7 SEC. 2. FINDINGS; SENSE OF CONGRESS. 

8 (a) FINDINGS.—Congress finds the following: 

9 (1) According to the 2016 Global Burden of 

10 Disease Study, an estimated 1,000,000,000 individVerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105

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1 uals worldwide have a mental health or substance 

2 use disorder. Mental disorders are major contribu3 tors to the global burden of disease, and depression 

4 is among the primary causes of illness and disability 

5 in adolescents. 

6 (2) An individual’s mental health is a complex 

7 interaction between genetic, neuropsychological, and 

8 environmental factors, and environmental and social 

9 factors, from the early years through childhood and 

10 adolescence, can have long-term impacts on mental 

11 health. 

12 (3) According to a Lancet Commission report, 

13 allocations for mental health have never risen above 

14 1 percent of health-related global development as15 sistance. Estimates indicate that child and adoles16 cent mental health receives just 0.1 percent of 

17 health-related global development assistance. 

18 (4) The National Alliance on Mental Illness es19 timates that depression and anxiety disorders cost 

20 the global economy $1,000,000,000,000 in lost pro21 ductivity each year. According to Lancet, mental 

22 health disorders are projected to cost the global 

23 economy $16,000,000,000,000 between 2010 and 

24 2030, in part due to the early age of onset. 


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1 (5) According to the World Health Organiza2 tion (WHO), half of mental health disorders emerge 

3 by age 14, and 14 percent of children and adoles4 cents worldwide experience mental health conditions, 

5 the majority of whom do not seek care, receive care, 

6 or have access to care. 

7 (6) Exposure to violence and early childhood 

8 adversity, including trauma, has been linked to neg9 ative, lasting effects on physical and mental health. 

10 Early childhood adversity can impact brain develop11 ment, nervous and immune system functioning, the 

12 onset of mental health conditions, and future behav13 iors. The United Nations asserts that widespread 

14 school closures due to COVID–19, which have af15 fected roughly 1,500,000,000 school-aged children, 

16 have placed many children at higher risk of exposure 

17 to traumas, such as household violence, abuse, ne18 glect, and food insecurity. 

19 (7) According to the United Nations, more than 

20 1 out of every 5 individuals in conflict-affected areas 

21 has a mental health disorder. Roughly 

22 1,500,000,000, or 2 out of every 3 of the world’s 

23 children under 18 years of age live in countries af24 fected by conflict, and more than 1 out of every 6 

25 children live in conflict zones. A greater number of 


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1 children live in areas affected by armed conflict and 

2 war now than at any other point this century. The 

3 mental health burden in conflict-affected contexts is 

4 twice the global average. 

5 (8) Gender, age, disability status, race and eth6 nicity, and other identity characteristics contribute 

7 to different risks and needs for mental health and 

8 psychosocial support. Research has shown that 

9 harmful gender norms contribute to higher preva10 lence of depression and anxiety disorders in women 

11 and girls, while socialization of boys and men con12 tributes to higher prevalence of substance use dis13 orders. 

14 (9) Risks and experiences of gender-based vio15 lence, particularly sexual violence, are a key driver 

16 of mental health and psychosocial support needs for 

17 children. Girls account for 98 percent of verified in18 cidents of conflict-related sexual violence. According 

19 to the World Health Organization, 35 percent of 

20 women globally ‘‘face sexual and/or intimate partner 

21 violence in their lifetime’’ and these survivors can, 

22 according to the Centers for Disease Control and 

23 Prevention, ‘‘experience mental health problems such 

24 as depression and posttraumatic stress disorder 

25 (PTSD) symptoms’’, signifying the urgent need for 


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1 age and gender-responsive mental health and psy2 chosocial support services. 

3 (10) According to the World Health Organiza4 tion, risk factors that increase susceptibility to men5 tal health disorders include poverty and hunger, 

6 chronic health conditions, trauma or maltreatment, 

7 social exclusion and discrimination, and exposure to 

8 and displacement by war or conflict. These risk fac9 tors, along with demographic risk factors, manifest 

10 at all stages in life. Preliminary research already il11 lustrates that the COVID–19 pandemic has in12 creased communities’, families’, and individuals’ risk 

13 factors for multiple types of adversity and com14 pounded preexisting conditions and vulnerabilities. 

15 (11) Crisis situations put parents and care16 givers under mental and psychosocial duress, which 

17 can prevent them from providing the protection, sta18 bility and nurturing care their children need during 

19 and after an emergency. The Lancet Commission es20 timates that between 15 and 23 percent of children 

21 globally live with a parent with a mental disorder, 

22 and parental ill health can impact the emotional and 

23 physical development of children and predispose 

24 these children to mental health problems. Numerous 

25 and compounding stressors and uncertainty caused 


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1 by COVID–19 have exacerbated distress and further 

2 impede caregivers’ ability to provide responsive care 

3 to their children. 

4 (12) Investments in the mental health, resil5 ience, and well-being of the children in a country to 

6 ensure that they continue to thrive into adulthood 

7 and contribute to their societies can help break cy8 cles of poverty, violence, and trauma and further the 

9 country’s future potential. 

10 (13) Investments in protecting and improving 

11 mental health in a country across the life course 

12 must take into account the need to target vulnerable 

13 populations and address social, environmental, and 

14 other risk factors in conjunction with other sectors 

15 and local partners. 

16 (b) SENSE OF CONGRESS.—It is the sense of Con17 gress that— 

18 (1) ensuring that individuals have the oppor19 tunity to thrive and reach their fullest potential is 

20 a critical component of sustainable international de21 velopment, and the global public good benefits from 

22 investment in child and adolescent mental health; 

23 (2) mental health is integral and essential to 

24 overall health outcomes and other development ob25 jectives; 


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1 (3) mental health is an issue of critical and 

2 growing importance for United States foreign assist3 ance that requires a coordinated strategy to ensure 

4 that programming funded by the United States Gov5 ernment is evidence-based, culturally competent, and 

6 trauma-informed; 

7 (4) the United States Government foreign as8 sistance strategy should include a mental health and 

9 psychosocial support component; 

10 (5) the redesign of the United States Agency 

11 for International Development (referred to in this 

12 Act as ‘‘USAID’’) reflects the nexus between hu13 manitarian and development interventions and 

14 should be applied to all mental health and psycho15 social support efforts of United States foreign assist16 ance programs; and 

17 (6) ongoing efforts to improve social service 

18 workforce development and local capacity building 

19 are essential to expanding mental health and psycho20 social support activities across all United States for21 eign assistance programs. 

22 SEC. 3. COORDINATOR FOR MENTAL HEALTH AND PSYCHO23 SOCIAL SUPPORT. 

24 Section 135 of the Foreign Assistance Act of 1961 

25 (22 U.S.C. 2152f) is amended— 


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1 (1) by redesignating subsection (f) as sub2 section (g); and 

3 (2) by inserting after subsection (e) the fol4 lowing: 

5 ‘‘(f) COORDINATOR FOR MENTAL HEALTH AND PSY6 CHOSOCIAL SUPPORT.— 

7 ‘‘(1) APPOINTMENT.—The Administrator of the 

8 United States Agency for International Develop9 ment, in consultation with the Secretary of State, is 

10 authorized to appoint a Mental Health and Psycho11 social Support Coordinator (referred to in this sec12 tion as the ‘MHPSS Coordinator’). 

13 ‘‘(2) SPECIFIC DUTIES.—The duties of the 

14 MHPSS Coordinator shall include— 

15 ‘‘(A) establishing and chairing the Mental 

16 Health and Psychosocial Support Working 

17 Group authorized under section 4 of the Mental 

18 Health in International Development and Hu19 manitarian Settings Act; 

20 ‘‘(B) guiding, overseeing, and directing 

21 mental health and psychosocial support pro22 gramming and integration across United States 

23 foreign assistance programming; 

24 ‘‘(C) serving as the main point of contact 

25 on mental health and psychosocial support in 


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1 the Bureau for Global Health, Bureau for Hu2 manitarian Assistance, regional bureaus, the 

3 Office of Education, the Inclusive Development 

4 Hub in the Bureau of Development, Democ5 racy, and Innovation, the President’s Emer6 gency Plan for AIDS Relief, and other inter7 agency or presidential initiatives; 

8 ‘‘(D) promoting best practices, coordina9 tion and reporting in mental health and psycho10 social support programming across both devel11 opment and humanitarian foreign assistance 

12 programs; 

13 ‘‘(E) providing direction, guidance, and 

14 oversight on the integration of mental health 

15 and psychosocial support in both development 

16 and humanitarian foreign assistance programs; 

17 and 

18 ‘‘(F) participating in the Advancing Pro19 tection and Care for Children in Adversity 

20 Interagency Working Group. 

21 ‘‘(3) FOCUS POPULATIONS.—Along with a gen22 eral focus on mental health and psychosocial sup23 port, the MHPSS Coordinator should pay special at24 tention to mental health and psychosocial support in 

25 the context of family and children, including— 


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1 ‘‘(A) meeting the needs of adult caretakers 

2 and children, including families and adults who 

3 are long-term caretakers; 

4 ‘‘(B) children and others who are sepa5 rated from a family unit; and 

6 ‘‘(C) other specific populations in need of 

7 mental health and psychosocial support, such as 

8 crisis affected communities, displaced popu9 lations, gender-based violence survivors, and in10 dividuals and households coping with the con11 sequences of diseases, such as Ebola, HIV/ 

12 AIDS, and COVID–19.’’. 

13 SEC. 4. MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT 

14 WORKING GROUP. 

15 (a) ESTABLISHMENT.—The Administrator of the 

16 United States Agency for International Development (re17 ferred to in this Act as the ‘‘USAID Administrator’’), in 

18 cooperation with the Mental Health and Psychosocial Sup19 port Coordinator, shall establish the Mental Health and 

20 Psychosocial Support Working Group, which shall include 

21 representatives from every United States Agency for 

22 International Development bureau and from the Depart23 ment of State, to ensure continuity and sustainability of 

24 mental health and psychosocial support across foreign as25 sistance programs. 


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1 (b) REQUIREMENTS.—The Mental Health and Psy2 chosocial Support Working Group— 

3 (1) should include representation at the Deputy 

4 Assistant Administrator level from every United 

5 States Agency for International Development bu6 reau; 

7 (2) shall promote and encourage dialogue 

8 across the interagency on mental health and psycho9 social support program development and best prac10 tices; 

11 (3) shall coordinate the implementation and 

12 continuity of mental health and psychosocial support 

13 programs— 

14 (A) within USAID; 

15 (B) between the USAID and the Bureau 

16 of Population, Refugees, and Migration of the 

17 Department of State; and 

18 (C) in consultation with the Centers for 

19 Disease Control and Prevention and the Na20 tional Institutes of Mental Health, as appro21 priate. 

22 SEC. 5. INTEGRATION OF MENTAL HEALTH AND PSYCHO23 SOCIAL SUPPORT. 

24 (a) STATEMENT OF POLICY.—It is the policy of the 

25 United States to integrate mental health and psychosocial 


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1 support across all foreign assistance programs funded by 

2 the United States Government. 

3 (b) IMPLEMENTATION OF POLICY.—The USAID Ad4 ministrator and the Secretary of State shall— 

5 (1) require all USAID and Department of State 

6 regional bureaus and missions to utilize such policy 

7 for local capacity building, as appropriate, for men8 tal health and psychosocial support programming; 

9 (2) ensure that all USAID and Department of 

10 State mental health and psychosocial support pro11 gramming— 

12 (A) is evidence-based and culturally com13 petent; 

14 (B) responds to all types of childhood ad15 versity; and 

16 (C) includes trauma-specific interventions 

17 in accordance with the recognized principles of 

18 a trauma-informed approach, whenever applica19 ble; and 

20 (3) integrate the Advancing Protection and 

21 Care for Children in Adversity Strategy into its offi22 cial policy. 

23 SEC. 6. BRIEFING REQUIREMENTS. 

24 (a) USAID BRIEFING.—Not later than 180 days 

25 after the date of the enactment of this Act, the USAID 


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1 Administrator and the Secretary of State shall brief the 

2 Committee on Foreign Relations of the Senate and the 

3 Committee on Foreign Affairs of the House of Representa4 tives regarding— 

5 (1) the progress made in carrying out section 

6 5(b); and 

7 (2) any barriers preventing the full integration 

8 of the strategy referred to in section 5(b)(3). 

9 (b) BRIEFING ON SPENDING.—The USAID Adminis10 trator, in consultation with the Director of the Office of 

11 Management and Budget, as necessary and appropriate, 

12 shall annually brief the Committee on Appropriations of 

13 the Senate and the Committee on Appropriations of the 

14 House of Representatives during each of the fiscal years 

15 2022 through 2026 regarding the amount of United 

16 States foreign assistance spent during the most recently 

17 concluded fiscal year on child mental health and psycho18 social support programming. 

19 (c) USAID AND DEPARTMENT OF STATE BRIEF20 INGS.—Not later than 180 days after the date of the en21 actment of this Act, annually thereafter for the following 

22 5 fiscal years, and subsequently, as requested, the USAID 

23 Administrator and the Secretary of State, in consultation 

24 with the Mental Health and Psychosocial Support Coordi25 nator appointed pursuant to section 135(f) of the Foreign 


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1 Assistance Act of 1961, as added by section 3, shall brief 

2 the Committee on Foreign Relations of the Senate and 

3 the Committee on Foreign Affairs of the House of Rep4 resentatives regarding— 

5 (1) how USAID and the Department of State 

6 have integrated mental health and psychosocial pro7 gramming, including child-specific programming, 

8 into their development and humanitarian assistance 

9 programs across health, education, nutrition, and 

10 child protection sectors; 

11 (2) the metrics of success of the Advancing 

12 Protection and Care for Children in Adversity Strat13 egy; 

14 (3) the mental health outcomes pertaining to 

15 the evidence-based strategic objectives upon which 

16 such strategy is built; 

17 (4) where trauma-specific strategies are being 

18 implemented, and how best practices for trauma-in19 formed programming are being shared across pro20 grams; 

21 (5) barriers preventing full integration of child 

22 mental health and psychosocial support into pro23 grams for children and youth and recommendations 

24 for its expansion; 


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1 (6) any unique barriers to the expansion of 

2 mental health and psychosocial support program3 ming in conflict and humanitarian settings and how 

4 such barriers are being addressed; 

5 (7) the impact of the COVID–19 pandemic on 

6 mental health and psychosocial support program7 ming; and 

8 (8) funding data, including a list of programs 

9 to which USAID and the Department of State have 

10 obligated funds during the most recently concluded 

11 fiscal year to improve access to, and the quality of, 

12 mental health and psychosocial support program13 ming in development and humanitarian contexts. 

Æ 


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