Calendar No. 388

103D CONGRESS

2D SESSION S. 1512

[Report No. 103–237]

A BILL

To amend title 38, United States Code, to require

clinical centers, and for other purposes.Affairs of mental illness research, education, andthe establishment in the Department of Veterans

MARCH 17 (legislative day, FEBRUARY 22), 1994

Reported with an amendment
II

Calendar No. 388

103D CONGRESS

2D SESSION S. 1512

[Report No. 103–237]

To amend title 38, United States Code, to require the establishment in

the Department of Veterans Affairs of mental illness research, education,

and clinical centers, and for other purposes.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 30 (legislative day, SEPTEMBER 27), 1993

Mr. ROCKEFELLER (for himself, Mr. AKAKA, Mr. CAMPBELL, and Mr.

WELLSTONE) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs

MARCH 17 (legislative day, FEBRUARY 22), 1994

Reported by Mr. ROCKEFELLER, with an amendment

[Strike out all after the enacting clause and insert the part printed in italic]

A BILL

To amend title 38, United States Code, to require the establishment in the Department of Veterans Affairs of mental illness research, education, and clinical centers, and

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. MENTAL ILLNESS RESEARCH, EDUCATION, AND

2 CLINICAL CENTERS.

3 (a) IN GENERAL.—Subchapter II of chapter 73 of

4 title 38, United States Code, is amended by adding at the

5 end the following:

6 ‘‘§ 7319. Mental illness research, education, and clini7 cal centers

8 ‘‘(a) The purpose of this section is to improve the

9 provision of health-care services and related counseling

10 services to eligible veterans suffering from mental illness,

11 especially mental illness related to service-related condi12 tions, through research, the education and training of per13 sonnel, and the development of improved models for fur14 nishing clinical services.

15 ‘‘(b)(1) In order to carry out the purpose of this sec16 tion, the Secretary, upon the recommendation of the

17 Under Secretary for Health and pursuant to the provi18 sions of this subsection, shall—

19 ‘‘(A) designate not more than five health-care

20 facilities of the Department as the locations for a

21 center of mental illness research, education and

22 training, and clinical activities; and

23 ‘‘(B) subject to the appropriation of funds for

24 such purpose, establish and operate such centers at

25 such locations in accordance with this section.
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1 ‘‘(2) The Secretary shall designate at least one facil2 ity under paragraph (1) not later than January 1, 1994.

3 ‘‘(3) The Secretary, upon the recommendation of the

4 Under Secretary for Health, shall ensure that the facilities

5 designated for centers under paragraph (1) are located in

6 various geographic regions.

7 ‘‘(4) The Secretary may not designate any health8 care facility as a location for a center under paragraph

9 (1) unless the Secretary, upon the recommendation of the

10 Under Secretary for Health, determines that the facility

11 has developed (or may reasonably be anticipated to de12 velop)—

13 ‘‘(A) an arrangement with an accredited medi14 cal school which provides education and training in

15 psychiatry and with which the facility is affiliated

16 under which arrangement residents receive education

17 and training in psychiatry through regular rotation

18 through the facility so as to provide such residents

19 with training in the diagnosis and treatment of men20 tal illness;

21 ‘‘(B) an arrangement with an accredited grad22 uate school of psychology which provides education

23 and training in clinical or counseling psychology, or

24 both, and with which the facility is affiliated under

25 which arrangement students receive education and
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1 training in clinical or counseling psychology, or both,

2 through regular rotation through the facility so as to

3 provide such students with training in the diagnosis

4 and treatment of mental illness;

5 ‘‘(C) an arrangement under which nursing, so6 cial work, or other allied health personnel receive

7 training and education in mental health care

8 through regular rotation through the facility;

9 ‘‘(D) the ability to attract scientists who have

10 demonstrated creativity and achievement in research

11 into the causes, treatment, and prevention of mental

12 illness and into models for furnishing care and treat13 ment to veterans suffering from mental illness;

14 ‘‘(E) a policymaking advisory committee com15 posed of appropriate mental health-care and re16 search personnel of the facility and of the affiliated

17 school or schools to advise the directors of the facil18 ity and the center on policy matters pertaining to

19 the activities of the center during the period of the

20 operation of the center; and

21 ‘‘(F) the capability to conduct effectively eval22 uations of the activities of the center.

23 ‘‘(c) Clinical and scientific investigation activities at

24 each center may compete for the award of funding from

25 amounts appropriated for the Department of Veterans Af-
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1 fairs medical and prosthetics research account and shall

2 receive priority in the award of funding from such account

3 insofar as funds are awarded to projects and activities re4 lating mental illness.

5 ‘‘(d) The Under Secretary for Health shall ensure

6 that research activities carried out through centers estab7 lished under subsection (b)(1) include an appropriate em8 phasis on the psychosocial dimension of mental illness and

9 on proposals of means of furnishing care and treatment

10 to veterans suffering from mental illness.

11 ‘‘(e) The Under Secretary for Health shall ensure

12 that useful information produced by the research, edu13 cation and training, and clinical activities of the centers

14 established under subsection (b)(1) is disseminated

15 throughout the Veterans Health Administration through

16 the development of programs of continuing medical and

17 related education provided through regional medical edu18 cation centers under subchapter VI of chapter 74 of this

19 title and through other means.

20 ‘‘(f) The official within the Central Office of the Vet21 erans Health Administration responsible for mental health

22 and behavioral sciences matters shall be responsible for

23 supervising the operation of the centers established pursu24 ant to subsection (b)(1).
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1 ‘‘(g)(1) There are authorized to be appropriated for

2 the Department of Veterans Affairs for the basic support

3 of the research and education and training activities of

4 the centers established pursuant to subsection (b)(1) the

5 following:

6 ‘‘(A) $3,125,000 for fiscal year 1994.

7 ‘‘(B) $6,250,000 for each of fiscal years 1995

8 through 1997.

9 ‘‘(2) In addition to the funds available under the au10 thorization of appropriations in paragraph (1), the Under

11 Secretary for Health shall allocate to such centers from

12 other funds appropriated generally for the Department of

13 Veterans Affairs medical care account and the Depart14 ment of Veterans Affairs medical and prosthetics research

15 account such amounts as the Under Secretary for Health

16 determines appropriate in order to carry out the purposes

17 of this section.’’.

18 (b) CLERICAL AMENDMENT.—The table of sections

19 at the beginning of chapter 73 of such title is amended

20 by adding at the end of the matter relating to subchapter

21 II the following:

‘‘7319. Mental illness research, education, and clinical centers.’’.

22 (c) REPORTS.—Not later than February 1 of each of

23 1995, 1996, and 1997, the Secretary of Veterans Affairs

24 shall submit to the Committees on Veterans’ Affairs of

25 the Senate and House of Representatives a report on the
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1 status and activities during the previous fiscal year of the

2 mental illness, research, education, and clinical centers es3 tablished pursuant to section 7319 of title 38, United

4 States Code (as added by subsection (a)). Each such re5 port shall contain the following:

6 (1) A description of—

7 (A) the activities carried out at each center

8 and the funding provided for such activities;

9 (B) the advances made at each center in

10 research, education and training, and clinical

11 activities relating to mental illness in veterans;

12 and

13 (C) the actions taken by the Under Sec14 retary for Health pursuant to subsection (d) of

15 such section (as so added) to disseminate useful

16 information derived from such activities

17 throughout the Veterans Health Administra18 tion.

19 (2) The Secretary’s evaluations of the effective20 ness of the centers in fulfilling the purposes of the

21 centers.
8

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1 SECTION 1. MENTAL ILLNESS RESEARCH, EDUCATION, AND

2 CLINICAL CENTERS.

3 (a) IN GENERAL.—Subchapter II of chapter 73 of title

4 38, United States Code, is amended by adding at the end

5 the following:

6 ‘‘§ 7319. Mental illness research, education, and clini7 cal centers

8 ‘‘(a) The purpose of this section is to improve the pro9 vision of health-care services and related counseling services

10 to eligible veterans suffering from mental illness, especially

11 mental illness related to service-related conditions, through

12 research (including research on improving mental health

13 service facilities of the Department and on improving the

14 delivery of mental health services by the Department), edu15 cation and training of personnel, and the development of

16 improved models and systems for the furnishing of mental

17 health services by the Department.

18 ‘‘(b)(1) In order to carry out the purpose of this sec19 tion, the Secretary, upon the recommendation of the Under

20 Secretary for Health and pursuant to the provisions of this

21 subsection, shall—

22 ‘‘(A) designate not more than five health-care fa23 cilities of the Department as the locations for a center

24 of research on mental health services, on the use by

25 the Department of specific models for furnishing such

26 services, on education and training, and on the devel-
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1 opment and implementation of innovative clinical ac2 tivities and systems of care with respect to the deliv3 ery of such services by the Department; and

4 ‘‘(B) subject to the appropriation of funds for

5 such purpose, establish and operate such centers at

6 such locations in accordance with this section.

7 ‘‘(2) The Secretary shall designate at least one facility

8 under paragraph (1) not later than January 1, 1994.

9 ‘‘(3) The Secretary shall, upon the recommendation of

10 the Under Secretary for Health, ensure that the facilities

11 designated for centers under paragraph (1) are located in

12 various geographic regions.

13 ‘‘(4) The Secretary may not designate any health-care

14 facility as a location for a center under paragraph (1) un15 less—

16 ‘‘(A) the peer review panel established under

17 paragraph (5) has determined under that paragraph

18 that the proposal submitted by such facility as a loca19 tion for a new center under this subsection is among

20 those proposals which have met the highest competi21 tive standards of scientific and clinical merit; and

22 ‘‘(B) the Secretary, upon the recommendation of

23 the Under Secretary for Health, determines that the

24 facility has developed (or may reasonably be antici25 pated to develop)—
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1 ‘‘(i) an arrangement with an accredited

2 medical school which provides education and

3 training in psychiatry and with which the facil4 ity is affiliated under which arrangement resi5 dents receive education and training in psychia6 try through regular rotation through the facility

7 so as to provide such residents with training in

8 the diagnosis and treatment of mental illness;

9 ‘‘(ii) an arrangement with an accredited

10 graduate school of psychology under which ar11 rangement students receive education and train12 ing in clinical, counseling, or professional psy13 chology through regular rotation through the fa14 cility so as to provide such students with train15 ing in the diagnosis and treatment of mental ill16 ness;

17 ‘‘(iii) an arrangement under which nursing,

18 social work, or allied health personnel receive

19 training and education in mental health care

20 through regular rotation through the facility;

21 ‘‘(iv) the ability to attract scientists who

22 have demonstrated creativity and achievement in

23 research—
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1 ‘‘(I) into the evaluation of innovative

2 approaches to the design of mental health

3 services; or

4 ‘‘(II) into the causes, prevention, and

5 treatment of mental illness;

6 ‘‘(v) a policymaking advisory committee

7 composed of appropriate mental health-care and

8 research personnel of the facility and of the af9 filiated school or schools to advise the directors

10 of the facility and the center on policy matters

11 pertaining to the activities of the center during

12 the period of the operation of the center; and

13 ‘‘(vi) the capability to evaluate effectively

14 the activities of the center, including activities

15 relating to the evaluation of specific efforts to

16 improve the quality and effectiveness of mental

17 health services provided by the Department at or

18 through individual facilities.

19 ‘‘(5)(A) In order to provide advice to assist the Under

20 Secretary for Health and the Secretary to carry out their

21 responsibilities under this section, the official within the

22 Central Office of the Veterans Health Administration re23 sponsible for mental health and behavioral sciences matters

24 shall establish a panel to assess the scientific and clinical
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1 merit of proposals that are submitted to the Secretary for

2 the establishment of new centers under this subsection.

3 ‘‘(B) The membership of the panel shall consist of ex4 perts in the fields of mental health research, education and

5 training, and clinical care. Members of the panel shall serve

6 as consultants to the Department for a period of no longer

7 than six months.

8 ‘‘(C) The panel shall review each proposal submitted

9 to the panel by the official referred to in subparagraph (A)

10 and shall submit its views on the relative scientific and

11 clinical merit of each such proposal to that official.

12 ‘‘(D) The panel shall not be subject to the Federal Ad13 visory Committee Act (5 U.S.C. App.).

14 ‘‘(c) Clinical and scientific investigation activities at

15 each center may compete for the award of funding from

16 amounts appropriated for the Department of Veterans Af17 fairs medical and prosthetics research account and shall re18 ceive priority in the award of funding from such account

19 insofar as funds are awarded to projects and activities re20 lating to mental illness.

21 ‘‘(d) The Under Secretary for Health shall ensure that

22 at least three centers designated under subsection (b)(1)(A)

23 emphasize research into means of improving the quality of

24 care for veterans suffering from mental illness through the
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1 development of community-based alternatives to institu2 tional treatment for such illness.

3 ‘‘(e) The Under Secretary for Health shall ensure that

4 useful information produced by the research, education and

5 training, and clinical activities of the centers established

6 under subsection (b)(1) is disseminated throughout the Vet7 erans Health Administration through publications and

8 through programs of continuing medical and related edu9 cation provided through regional medical education centers

10 under subchapter VI of chapter 74 of this title and through

11 other means.

12 ‘‘(f) The official within the Central Office of the Veter13 ans Health Administration responsible for mental health

14 and behavioral sciences matters shall be responsible for su15 pervising the operation of the centers established pursuant

16 to subsection (b)(1).

17 ‘‘(g)(1) There are authorized to be appropriated for the

18 Department of Veterans Affairs for the basic support of the

19 research and education and training activities of the centers

20 established pursuant to subsection (b)(1) the following:

21 ‘‘(A) $3,125,000 for fiscal year 1994.

22 ‘‘(B) $6,250,000 for each of fiscal years 1995

23 through 1997.

24 ‘‘(2) In addition to the funds available under the au25 thorization of appropriations in paragraph (1), the Under
14

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1 Secretary for Health shall allocate to such centers from

2 other funds appropriated generally for the Department of

3 Veterans Affairs medical care account and the Department

4 of Veterans Affairs medical and prosthetics research account

5 such amounts as the Under Secretary for Health determines

6 appropriate in order to carry out the purposes of this sec7 tion.’’.

8 (b) CLERICAL AMENDMENT.—The table of sections at

9 the beginning of chapter 73 of such title is amended by add10 ing at the end of the matter relating to subchapter II the

11 following:

‘‘7319. Mental illness research, education, and clinical centers.’’.

12 (c) REPORTS.—Not later than February 1 of each of

13 1995, 1996, and 1997, the Secretary of Veterans Affairs

14 shall submit to the Committees on Veterans’ Affairs of the

15 Senate and House of Representatives a report on the status

16 and activities during the previous fiscal year of the mental

17 illness, research, education, and clinical centers established

18 pursuant to section 7319 of title 38, United States Code

19 (as added by subsection (a)). Each such report shall contain

20 the following:

21 (1) A description of—

22 (A) the activities carried out at each center

23 and the funding provided for such activities;

24 (B) the advances made at each center in re25 search, education and training, and clinical ac-
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1 tivities relating to mental illness in veterans;

2 and

3 (C) the actions taken by the Under Sec4 retary for Health pursuant to subsection (d) of

5 such section (as so added) to disseminate useful

6 information derived from such activities through7 out the Veterans Health Administration.

8 (2) The Secretary’s evaluations of the effective9 ness of the centers in fulfilling the purposes of the cen10 ters.

11 (d) TECHNICAL AMENDMENT.—Section 7314(d)(1) of

12 such title is amended by striking out ‘‘the Chief Medical

13 Director’’ and inserting in lieu thereof ‘‘the Under Sec14 retary for Health’’.