III 

117TH CONGRESS 

2D SESSION S. RES. 518 

Expressing the sense of the Senate that in order to effectively address the 

high prevalence of individuals suffering from mental health conditions 

and substance use disorders, the United States needs to make historic 

financial investments into mental health and substance use disorder care 

and finally acknowledge such care as a priority in health care equal 

to physical health, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 17, 2022 

Mr. WARNOCK (for himself, Mr. PADILLA, Ms. STABENOW, and Mr. BOOKER) 

submitted the following resolution; which was referred to the Committee 

on Health, Education, Labor, and Pensions 

RESOLUTION 

Expressing the sense of the Senate that in order to effectively 

address the high prevalence of individuals suffering from 

mental health conditions and substance use disorders, 

the United States needs to make historic financial investments into mental health and substance use disorder 

care and finally acknowledge such care as a priority 

in health care equal to physical health, and for other 

purposes. 

Whereas there is an urgent need to improve our health care 

system to better integrate treatment of mental health and 

substance use disorders so they are no longer seen separately; 


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Whereas, according to the World Health Organization, mental illness is severely underdiagnosed, and less than half 

of individuals who meet diagnostic criteria are identified; 

Whereas there is a pressing need to provide a comprehensive 

solution to fix our health care system that incorporates 

the needs and expertise of all its stakeholders, especially 

individuals who have expertise in mental health and substance use disorders; 

Whereas it is essential to remove the misguided association 

between mental illness and violence, driven by fear and 

misunderstanding; 

Whereas mental illness and substance use disorders have 

been underresearched, undertreated, and overstigmatized; 

Whereas stigma, vilification, and dismissal of mental illness 

and substance use— 

(1) create a culture that— 

(A) discourages utilization of mental health and 

substance use disorder services; and 

(B) lacks acknowledgment that struggling with 

a mental health condition or substance use disorder 

is not something to be ashamed of; and 

(2) can vary in prominence in different cultures and 

communities, and are particularly high among communities of color and minority communities; 

Whereas men, in particular, face cultural and societal barriers to seeking treatment for mental health concerns and 

substance use disorders, which can contribute to concerning outcomes including suicide and aggressive behavior; 

Whereas the bulk of mental health and substance use disorder services are reactive instead of proactive, treating 


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patients when they are in crisis instead of incorporating 

services and screening earlier in an attempt to prevent 

such crises; 

Whereas there is a need to increase access to treatment, services, and social supports for everyone to proactively address the root causes of mental illness and substance use 

disorders; 

Whereas it is necessary to address the root causes of mental 

health concerns and substance use disorders; 

Whereas it is necessary to address suicide in a holistic manner and recognize and address suicidal ideation and not 

just the act of suicide in isolation; 

Whereas there is a need to address social determinants of 

health, which are conditions that directly and indirectly 

affect the health, health care, and wellness of individuals 

and communities, in order to effectively provide care for 

all individuals living with mental illness and substance 

use disorders; 

Whereas mental health impacts physical health, and physical 

health impacts mental health; 

Whereas the current health care system in the United States 

does not adequately incorporate mental health and substance use disorders into the assessment or delivery of 

care, as evidenced by the fact that all ‘‘vital signs’’ are 

currently for physical health alone and do not touch on 

mental health or substance use disorders; 

Whereas the lack of a united approach across the Federal 

Government to improve the care and related services for 

mental health and substance use disorders has left States 

and localities— 

(1) without adequate guidance or resources; 


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(2) unable to provide the mental health and substance use disorder services needed to adequately meet 

the needs of their populations; and 

(3) unable to effectively distribute services to adequately meet the needs of their populations; 

Whereas there is a need for greater collaboration across all 

Federal agencies that touch various aspects of the health 

care system in order to fully incorporate the needs and 

concerns of everyone involved in the treatment and prevention of mental health and substance use disorders; 

Whereas there is a need for greater collaboration between 

Federal, State, and local agencies that touch on various 

aspects of the health care system; 

Whereas there is a need for a centralized location within the 

Federal Government for good, reliable information on 

mental health and substance use disorders for providers, 

patients, and caregivers; 

Whereas there is a need for standardized definitions, standards of care, and metrics for mental health and substance 

use disorders across disciplines; 

Whereas there is a need to change incentives for providers to 

better ensure everyone with mental health and substance 

use disorders gets access to the necessary care and treatment; 

Whereas 13 years after the date of enactment of the Paul 

Wellstone and Pete Domenici Mental Health Parity and 

Addiction Equality Act of 2008 (subtitle B of title V of 

division C of Public Law 110–343), there is still a lack 

of compliance among insurers and failure to adequately 

cover mental health and substance use disorder services; 


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Whereas Medicaid is the single largest payer of mental health 

and substance use disorder services, and reimbursement 

is far from adequate; 

Whereas there is a need to incentivize payers to adequately 

cover mental health and substance use disorder services 

in the same manner in which all specialty services are 

covered; 

Whereas there is a need to increase the number of mental 

health and substance use disorder providers; 

Whereas 55 percent of counties in the United States do not 

have a single psychiatrist, psychologist, or social worker; 

Whereas only 10 percent of individuals in the United States 

suffering from a substance use disorder receive specialty 

treatment; 

Whereas there is a need to increase access to and utilization 

of telemedicine for mental health and substance use disorder services, both within States and across State lines; 

Whereas there is a need for a better way to share information 

among providers to better serve patient needs while still 

protecting patient privacy; 

Whereas there is a need for consistent care coordination and 

more effective transition services for patients moving between hospitals and the community; 

Whereas safe housing needs to be recognized as a basic requirement for successful treatment and needs to be better 

addressed in the transition of care; 

Whereas there is a need to improve social determinants of 

health, such as increased access to stable housing and 

jobs, for individuals suffering from mental illness and 

substance use disorders to have a sustained recovery; 


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Whereas there is a need to provide care in more appropriate 

and integrated settings for all patients, such as treating 

geriatric patients in their homes as opposed to nursing 

homes, when appropriate, and in compliance with the 

Americans with Disabilities Act of 1990 (42 U.S.C. 

12101 et seq.) and the decision of the Supreme Court of 

the United States in Olmstead v. L.C., 527 U.S. 581 

(1999); 

Whereas there is a need for greater focus on intensive outpatient, partial hospitalizations, residential programs, day 

programs, supported housing, assertive community treatment, mobile crisis services, peer support services, supported employment, and community-based services for 

adults with mental illness and substance use disorders; 

Whereas there is a need to ensure that services support individuals with mental health conditions and substance use 

disorders to participate fully in their communities and 

live and thrive independently; 

Whereas there is a need to address isolation issues geriatric 

patients face, which can negatively impact their mental 

health; 

Whereas 30 percent of first responders experience mental 

health conditions, such as depression and post-traumatic 

stress, and have higher rates of suicidal ideation and suicide attempt than the rest of the population; 

Whereas depression, anxiety, post-traumatic stress, and psychosis are some of the most common conditions women 

experience pre- and postpartum; 

Whereas unmet parental mental health and substance use 

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creased involvement with the child welfare system, which 

leads to preventable foster care placements, given that— 

(1) in 2018, 262,956 children entered foster care, 

with the leading reasons related to mental health and 

substance use disorder needs of the parents, with— 

(A) 36 percent of children entering care as a 

result of parental drug abuse; 

(B) 14 percent of children entering care as a 

result of the inability to cope of the caretaker; and 

(C) 5 percent of children entering care as a result of parental alcohol abuse; 

(2) even when necessary to ensure the safety of a 

child, foster care itself creates additional trauma for both 

the child and family; and 

(3) longstanding racial inequities in child welfare 

services create disproportionate child welfare involvement 

for Black, Native, and Latinx children and families, 

which exacerbates the experiences of trauma for those 

families and contributes to health disparities while not resulting in needed access to quality mental health and 

substance use disorder services; 

Whereas children and adolescents have unique needs when it 

comes to mental health and substance use disorders and 

the services provided, given that— 

(1) 45 percent of children have experienced adverse 

childhood experiences that have the potential to significantly impact the mental health of the children; 

(2) in the last 5 years, 49.4 percent of children who 

needed mental health services did not receive the necessary services, and there is a need for improved access 

to appropriate treatment services, which must focus on 

community-based supports and services available near 


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their home, in order to effectively prevent children from 

experiencing a mental health crisis; 

(3) many children suffering and struggling go 

undiagnosed and are not adequately supported, and there 

is a need to improve training and understanding of mental health and substance use disorders for educators since 

often there are barriers to mental health and substance 

use disorder treatment in a school setting; 

(4) 42 percent of school districts have reported using 

threat assessment and risk assessment teams, an approach created by the United States Secret Service that 

involves identifying, evaluating, and taking action on assumed current or potential threats, which— 

(A) can cause significant harm to the mental 

health and emotional well-being of children; 

(B) has compounded existent stigma for groups 

of students; 

(C) has had a disproportionate impact on students of color by initiating criminal justice involvement in lieu of more appropriate services; and 

(D) has had a disproportionate impact on students with disabilities; 

(5) families and caregivers need to be included when 

treating children suffering from mental illness and substance use disorders; and 

(6) when children turn 18 years old they are cut off 

from mental health and substance use disorder services, 

which impacts continuity of care; 

Whereas there is a growing need for mental health and substance use disorder services among young adults and college-aged adults, and between 2007 and 2017, for individuals aged 18 to 34, there was a— 

(1) 108 percent increase in drug-related deaths; 


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(2) 69 percent increase in alcohol-induced deaths; 

and 

(3) 35 percent increase in suicide deaths; 

Whereas, despite the rising need for mental health and substance use disorder treatment by young adults, there continues to be disparities in accessing care experienced by 

young adults of color; 

Whereas 5,500,000 veterans and servicemembers rely on the 

Department of Veterans Affairs for health services, and 

1,500,000 veterans have received a mental health diagnosis, and— 

(1) 1 in 4 active duty members shows signs of a 

mental health condition; 

(2) the rate of post-traumatic stress disorder (referred to in this preamble as PTSD) is 15 times higher 

in servicemembers than compared to civilians due to military combat and military sexual assault and trauma; 

(3) the rate of depression is 5 times higher in 

servicemembers as compared to civilians; 

(4) every day, 17 veterans die by suicide; 

(5) there is a fear of disclosing mental health conditions and substance use disorders and seeking treatment 

due to negative career implications; and 

(6) less than 50 percent of veterans receive the mental health treatment and services they need; 

Whereas 11 percent of individuals entering the Department 

of Veterans Affairs health system meet the criteria for a 

substance use disorder; 

Whereas veterans are more likely to have an alcohol use disorder than civilians; 


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Whereas 2 in 10 veterans with PTSD have a comorbid substance use disorder, and 1 in 3 veterans seeking services 

for a substance use disorder also has PTSD, showing the 

interconnectedness between these conditions; 

Whereas there is a need to better educate all individuals in 

the criminal justice system on the impact and needs of 

individuals with mental health conditions and substance 

use disorders; 

Whereas the United States criminal justice system is the 

largest provider of mental health services, and it was not 

built, nor intended to be used, for that purpose, and— 

(1) there are around 550,000 individuals incarcerated in the United States with serious mental illness; 

(2) 1 in 5 individuals incarcerated in the United 

States has a serious mental illness; and 

(3) of those incarcerated, 75 percent with a serious 

mental illness suffer from a co-occurring substance use 

disorder; 

Whereas there is a need for incentives to reduce inappropriate incarceration and detention for individuals with 

mental health and substance use disorder needs; 

Whereas one-third of individuals incarcerated in the United 

States receive treatment for mental illness, and many 

times treatment is inconsistent and inadequate, and there 

is a need for improved access to services and treatments 

that are also trauma-informed; 

Whereas there is a need to have mental health, substance use 

disorder, and diversion services available at all intercepts 

of the Sequential Intercept Model, a model developed to 

inform more appropriate community-based responses and 


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divert individuals with mental illness and substance use 

disorders; 

Whereas there is a need to improve levels of coordination, 

care management, and insurance coverage before, during, 

and after incarceration; 

Whereas post-release navigation is key to keeping individuals 

from reentering the criminal justice system; 

Whereas there is insufficient understanding of the mental 

health effects of incarceration; 

Whereas there is a need to redefine the juvenile justice system to account for age and development reflecting the 

most up-to-date scientific consensus on brain development and behavior and ensuring that there are developmental and age appropriate services; 

Whereas the juvenile justice system must fulfill its purpose 

of supporting, rehabilitating, and treating children in 

need rather than punishing them, given that— 

(1) studies have shown that 70 percent of youth in 

detention have a diagnosed mental illness, and 60 percent 

of those youths may also meet the criteria for a substance use disorder; 

(2) 90 percent of individuals in the juvenile justice 

system have been exposed to trauma or violence, which 

may increase the likelihood of juvenile justice involvement; 

(3) entry into the juvenile justice system may exacerbate the existing mental health and substance use disorder concerns of youths, particularly in the absence of 

consistent screening and treatment for these conditions; 

and 


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(4) an estimated 33 percent of children in long-term 

juvenile justice facilities have intellectual, developmental, 

and other disabilities and were receiving special education 

services, and therefore there is a need to have specific 

services and programs within the juvenile justice system 

with a focus on their needs; 

Whereas there is a need for services in the juvenile justice 

system to be trauma-informed and developed for highneed individuals; 

Whereas studies show that 41.2 percent of individuals who 

are diagnosed with a substance use disorder are also diagnosed with a mental illness, which is likely an underestimate in light of the current barriers to identifying 

and reporting mental health concerns; 

Whereas, given the high co-occurrence with mental illness, 

comprehensive care for substance use disorders should include access to psychopharmacology, psychotherapy, contingency management, recovery support, all evidencebased medication-assisted treatment, a multidisciplinary 

staff, and group therapy for adults, and— 

(1) addiction treatment centers should either offer 

or have available comprehensive care and support and 

have the ability to treat mental illness as well as substance use disorders; and 

(2) to allow for treatment flexibility to fit the needs 

of the patient, there is a need to increase access to all 

evidence-based medication-assisted treatment in prisons, 

jails, and all addiction treatment centers; 

Whereas there are inequities in access, availability, and quality for mental health and substance use disorder services 

for minority communities, and— 


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(1) there is greater stigma among racial and ethnic 

minority populations; 

(2) racial and ethnic minorities are disproportionately affected by disabilities that result from mental 

health conditions; and 

(3) only 31 percent of African Americans and Hispanics and 22 percent of Asians receive mental health 

care compared to 48 percent of Caucasians; 

Whereas lesbian, gay, bisexual, transgender, and queer (referred to in this preamble as LGBTQ) individuals are 

more than twice as likely to suffer from mental health 

conditions and substance use disorders than heterosexual 

individuals, and— 

(1) 29 percent of LGBTQ youths attempt suicide, 

which is almost 5 times more than heterosexual youths; 

(2) approximately 31 percent of LGBTQ older 

adults report symptoms of depression, and 39 percent report seriously thinking about suicide; 

(3) 30.8 percent of transgender individuals report 

considering suicide compared to 2.3 percent of heterosexual individuals; and 

(4) of the 4,890 transgender individuals incarcerated 

in State prisons, only 15 were confirmed as being housed 

according to their lived gender, while not being housed 

according to lived gender poses a significant threat to 

mental health; 

Whereas the COVID–19 pandemic has highlighted the gaps 

in our health system when it comes to mental health and 

substance use disorder services and shown how sheltering 

in place and isolating can impact mental health and substance use, specifically showing— 


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(1) that 47 percent of individuals in the United 

States report that the pandemic has negatively impacted 

their mental health, with 21 percent saying that it has 

had a major negative impact; 

(2) a significant increase in the number of calls to 

suicide prevention hotlines; 

(3) a 1,000 percent increase in texts to the mental 

health hotline of the Substance Abuse and Mental Health 

Services Administration to about 20,000 texts in April 

2020; 

(4) a 55 percent increase in alcohol sales; 

(5) a record high of more than 100,000 overdose fatalities between May 2020 and April 2021, driven by increased feelings of anxiety, depression, and use of substances; and 

(6) an increase in burnout and mental health conditions among healthcare providers, with 49 percent experiencing burnout and 38 percent experiencing anxiety or 

depression; and 

Whereas there is a need for a population health approach 

that examines the distribution of health across populations and focuses attention on the need to provide access to the best evidence-based treatment for individuals 

with mental health conditions and substance use disorders who need clinical intervention in order to effectively reduce or mitigate the impact of risk factors that 

lead to psychological distress among individuals in highrisk populations: Now, therefore, be it 

1 Resolved, That it is the sense of the Senate that in 

2 order to effectively address the high prevalence of individ3 uals suffering from mental health conditions and subVerDate Sep 11 2014 02:32 Feb 18, 2022 Jkt 029200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\SR518.IS SR518

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1 stance use disorders, the United States needs to make his2 toric financial investments into mental health and sub3 stance use disorder care and finally acknowledge such care 

4 as a priority in health care, equal to physical health, and 

5 recognize that— 

6 (1) mental health and physical health need to 

7 be treated together to treat the whole patient; 

8 (2) patient care needs to be patient-focused; 

9 (3) mental health and substance use disorder 

10 care needs to be proactive and treat individuals be11 fore they are in crisis; 

12 (4) any stigma associated with mental health 

13 and substance use disorders is completely unwar14 ranted and serves as a barrier to care; 

15 (5) the Federal Government needs to create a 

16 comprehensive approach to improving the health 

17 care system that incorporates mental health and 

18 substance use disorders and includes system reform 

19 that— 

20 (A) aims to break down silos across the 

21 Federal, State, local, and Tribal levels for im22 proved communication and care coordination; 

23 (B) provides a Federal framework to 

24 States, localities, and Indian Tribes that con25 nects agencies and services so they can have 


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1 guidance when working to address the mental 

2 health and substance use disorder needs of their 

3 communities; 

4 (C) incentivizes providers to see both more 

5 complex and less complex patients and to see 

6 patients in rural and underserved areas; 

7 (D) expects insurers to comply with parity 

8 laws and holds them accountable for not pro9 viding parity of mental health and substance 

10 use disorder services and treatments; and 

11 (E) requires both public and private payers 

12 to have higher reimbursement rates for mental 

13 health and substance use disorder services that 

14 are on par with medical and surgical services; 

15 (6) the Federal Government needs to create a 

16 comprehensive approach to improving the health 

17 care system that incorporates mental health and 

18 substance use disorders and that includes system im19 provements that— 

20 (A) focus on early screening, diagnosis, 

21 and intervention across the care continuum to 

22 prevent mental health crises; 

23 (B) improve the ability of families to ac24 cess timely, affordable, and high-quality treat25 ment and services; 


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1 (C) strengthen mental health and sub2 stance use disorder services in schools and en3 sure there is engagement from all stakeholders; 

4 (D) improve and expand community-based 

5 services so individuals have access to services 

6 locally; 

7 (E) improve care coordination across treat8 ment settings so patients have services when 

9 needed and do not have to navigate the system 

10 themselves; 

11 (F) promote a sustained recovery that in12 cludes social determinants of health, such as 

13 housing, jobs, and childcare; 

14 (G) can adjust to meet the needs of each 

15 individual to provide the best care for each indi16 vidual; 

17 (H) ensure seamless transitions in care 

18 when moving through steps or processes; 

19 (I) end the criminalization of mental illness 

20 and substance use disorders and increase pro21 grams for diversion that connect individuals to 

22 treatment, social supports, and social services; 

23 (J) provide access to high-quality and evi24 dence-based mental health and substance use 


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1 disorder care for individuals who are incarcer2 ated; 

3 (K) create young adult services and pro4 grams within the criminal justice system for in5 dividuals who are aged 18 to 25 to successfully 

6 reduce recidivism and that are informed by 

7 neuropsychological brain science; 

8 (L) incorporate apprenticeship or job 

9 training programs into the criminal justice sys10 tem, particularly for youth, to empower them 

11 and reduce recidivism; 

12 (M) ensure cultural congruence so every13 one in need of mental health and substance use 

14 disorder care has services that meet their needs; 

15 (N) adopt a population health approach as 

16 a tool to help address ongoing disparities in ac17 cess to mental health and substance use dis18 order care by youth and adults of color; 

19 (O) ensure that lesbian, gay, bisexual, 

20 transgender, and queer individuals, commu21 nities of color, and immigrants have access to 

22 mental health and substance use disorder serv23 ices that are culturally appropriate, are in the 

24 necessary language, and address any unique 

25 stigma from their communities; 


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1 (P) enable veterans to access timely mental 

2 health and substance use disorder care that en3 sures continuity and is free of any administra4 tive burdens; 

5 (Q) include training for educators, first re6 sponders, and clinicians to identify indicators of 

7 mental health conditions and substance use dis8 orders and to reduce stigma and bias related to 

9 these conditions so they can respond in a more 

10 productive way and connect individuals with 

11 more appropriate services; 

12 (R) support health care providers by ad13 dressing their mental health and substance use 

14 disorder needs to reduce burnout; 

15 (S) provide a process by which States can 

16 work with other States to reconcile licensure 

17 and certification for and reimbursement to 

18 mental health and substance use disorder pro19 viders across State lines for the purpose of tele20 medicine; 

21 (T) leverage the current mental health and 

22 substance use disorder workforce by reducing 

23 administrative burdens to allow mental health 

24 and substance use disorder providers to perform 


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1 to their highest level of licensure and certifi2 cation; and 

3 (U) expand training opportunities and 

4 grow the workforce by partnering with schools 

5 and programs to provide free education to indi6 viduals who work in rural or underserved areas; 

7 (7) expanded access to mental health and sub8 stance use disorder care is essential to improving 

9 health and well-being; 

10 (8) all individuals in the United States deserve 

11 access to mental health and substance use disorder 

12 care without any barriers, such as cost or location 

13 of services; and 

14 (9) the United States needs to comprehensively 

15 break down all barriers to receiving access to mental 

16 health and substance use disorder care, including fi17 nancial burdens and location hurdles. 

Æ 


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