I 
110TH CONGRESS 
1ST SESSION H. R. 4053 
To improve the treatment and services provided by the Department of Vet-
erans Affairs to veterans with post-traumatic stress disorder and sub-
stance use disorders, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 1, 2007 
Ms. BERKLEY (for herself, Ms. CORRINE BROWN of Florida, Mr. DELAHUNT, 
Mr. FILNER, Ms. WATSON, Mrs. NAPOLITANO, Mr. FALEOMAVAEGA, Mr. 
HALL of New York, Mr. HARE, Mr. BACA, Mr. MCNERNEY, and Mr. 
KAGEN) introduced the following bill; which was referred to the Com-
mittee on Veterans’ Affairs 
A BILL 
To improve the treatment and services provided by the De-
partment of Veterans Affairs to veterans with post-trau-
matic stress disorder and substance use disorders, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Mental Health Improvements Act of 2007’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
TITLE I—SUBSTANCE USE DISORDERS AND MENTAL HEALTH 
CARE 
Sec. 101. Findings on substance use disorders and mental health. 
Sec. 102. Expansion of substance use disorder treatment services at Depart-
ment of Veterans Affairs Medical Centers. 
Sec. 103. Care for veterans with mental health and substance use disorders by 
clinician teams. 
Sec. 104. Program for enhanced treatment of substance use disorders and post- 
traumatic stress disorder in veterans. 
Sec. 105. National centers of excellence on post-traumatic stress disorder and 
substance use disorders. 
Sec. 106. Report on residential mental health care facilities of the Veterans 
Health Administration. 
Sec. 107. Tribute to Justin Bailey. 
TITLE II—MENTAL HEALTH ACCESSIBILITY ENHANCEMENTS 
Sec. 201. Pilot program on peer outreach and support for veterans and use of 
community mental health centers and Indian Health Service 
facilities. 
TITLE III—RESEARCH 
Sec. 301. Research program on comorbid post-traumatic stress disorder and 
substance use disorders. 
Sec. 302. Extension of authorization for Special Committee on Post-Traumatic 
Stress Disorder. 
TITLE IV—ASSISTANCE FOR FAMILIES OF VETERANS 
Sec. 401. Clarification of authority of Secretary of Veterans Affairs to provide 
mental health services to families of veterans. 
Sec. 402. Pilot program on provision of readjustment and transition assistance 
to veterans and their families in cooperation with Vet Centers. 
TITLE I—SUBSTANCE USE DIS-
ORDERS 
AND 
MENTAL 
HEALTH CARE 
SEC. 101. FINDINGS ON SUBSTANCE USE DISORDERS AND 
MENTAL HEALTH. 
Congress makes the following findings: 
(1) More than 1,500,000 members of the 
Armed Forces have been deployed in Operation Iraqi 
Freedom and Operation Enduring Freedom. The 
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2005 Department of Defense Survey of Health Re-
lated Behaviors Among Active Duty Personnel re-
ports that 23 percent of members of the Armed 
Forces on active duty acknowledge a significant 
problem with alcohol use, with similar rates of ac-
knowledged problems with alcohol use among mem-
bers of the National Guard. 
(2) The effects of substance abuse are wide 
ranging, including significantly increased risk of sui-
cide, exacerbation of mental and physical health dis-
orders, breakdown of family support, and increased 
risk of unemployment and homelessness. 
(3) While veterans suffering from mental health 
conditions, chronic physical illness, and polytrauma 
may be at increased risk for development of a sub-
stance use disorder, treatment for these veterans is 
complicated by the need to address adequately the 
physical and mental symptoms associated with these 
conditions through appropriate medical intervention. 
(4) While the Veterans Health Administration 
has dramatically increased health services for vet-
erans from 1996 through 2006, the number of vet-
erans receiving specialized substance abuse treat-
ment services decreased 18 percent during that time. 
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No comparable decrease in the national rate of sub-
stance abuse has been observed during that time. 
(5) While some facilities of the Veterans Health 
Administration provide exemplary substance use dis-
order treatment services, the availability of such 
treatment services throughout the health care sys-
tem of the Veterans Health Administration is incon-
sistent. 
(6) According to the Government Accountability 
Office, the Department of Veterans Affairs signifi-
cantly reduced its substance use disorder treatment 
and rehabilitation services between 1996 and 2006, 
and has made little progress since in restoring these 
services to their pre-1996 levels. 
SEC. 102. EXPANSION OF SUBSTANCE USE DISORDER 
TREATMENT SERVICES AT DEPARTMENT OF 
VETERANS AFFAIRS MEDICAL CENTERS. 
(a) PROVISION
OF
SUBSTANCE
USE
DISORDER 
TREATMENT SERVICES.—The Secretary of Veterans Af-
fairs shall ensure the provision, at each Department of 
Veterans Affairs medical center and community based out-
patient clinic, of the following services and treatments 
with respect to substance use disorder for veterans: 
(1) Short term motivational counseling services. 
(2) Intensive outpatient care services. 
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(3) Relapse prevention services. 
(4) Ongoing aftercare and outpatient counseling 
services. 
(5) Opiate substitution therapy services. 
(6) Pharmacological treatments aimed at reduc-
ing craving for drugs and alcohol. 
(7) Detoxification and stabilization services. 
(8) Such other services as the Secretary con-
siders appropriate. 
(b) EXEMPTIONS.— 
(1) IN GENERAL.—The Secretary may exempt 
an individual medical center or community based 
outpatient clinic from providing all of the services 
otherwise required by subsection (a). 
(2) ANNUAL
REPORT.—Each year, the Sec-
retary shall submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Vet-
erans’ Affairs of the House of Representatives a re-
port setting forth the exemptions made under para-
graph (1) as of the date of the report and the rea-
sons therefor. 
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SEC. 103. CARE FOR VETERANS WITH MENTAL HEALTH AND 
SUBSTANCE USE DISORDERS BY CLINICIAN 
TEAMS. 
(a) IN GENERAL.—In the event the Secretary of Vet-
erans Affairs provides a veteran inpatient or outpatient 
care for a substance use disorder and a comorbid mental 
health disorder, the Secretary shall ensure that treatment 
for such disorders is provided concurrently by a team of 
clinicians with appropriate expertise. 
(b) TEAM OF CLINICIANS WITH APPROPRIATE EX-
PERTISE DEFINED.—In this section, the term ‘‘team of 
clinicians with appropriate expertise’’ means a team con-
sisting of the following: 
(1) Clinicians and health professionals with ex-
pertise in treatment of substance use disorders and 
mental health disorders. 
(2) Such other professionals as the Secretary 
considers appropriate for the provision of treatment 
to veterans for substance use and mental health dis-
orders. 
SEC. 104. PROGRAM FOR ENHANCED TREATMENT OF SUB-
STANCE USE DISORDERS AND POST-TRAU-
MATIC STRESS DISORDER IN VETERANS. 
(a) IN GENERAL.—The Secretary of Veterans Affairs 
shall carry out a program for the purpose of enhancing 
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(2) MINIMUM FUNDING.—In allocating amounts 
under paragraph (1), the Secretary shall ensure 
that, after funds are allocated under this section for 
a fiscal year, the total expenditure for programs of 
the Department relating to the treatment of post- 
traumatic stress disorder and substance use dis-
orders is not less than $50,000,000 in excess of the 
baseline amount in that fiscal year. 
(3) BASELINE.—For purposes of paragraph 
(2), the baseline amount is the amount of the total 
expenditures on programs of the Department relat-
ing to the treatment of post-traumatic stress dis-
order and substance use disorders for the most re-
cent fiscal year for which final expenditure amounts 
are known (except for amounts made available to 
carry out this section), adjusted to reflect any subse-
quent increase in applicable costs to deliver such 
programs. 
SEC. 105. NATIONAL CENTERS OF EXCELLENCE ON POST- 
TRAUMATIC STRESS DISORDER AND SUB-
STANCE USE DISORDERS. 
(a) IN GENERAL.—Subchapter II of chapter 73 of 
title 38, United States Code, is amended by adding at the 
end the following new section: 
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‘‘§ 7330A. National centers of excellence on post-trau-
matic stress disorder and substance use 
disorders 
‘‘(a) ESTABLISHMENT OF CENTERS.—(1) The Sec-
retary shall establish not less than six national centers of 
excellence on post-traumatic stress disorder and substance 
use disorders. 
‘‘(2) The purpose of the centers established under 
this section is to serve as Department facilities that pro-
vide comprehensive inpatient treatment and recovery serv-
ices for veterans newly diagnosed with both post-traumatic 
stress disorder and a substance use disorder. 
‘‘(b) LOCATION.—Each center established in accord-
ance with subsection (a) shall be located at a medical cen-
ter of the Department that— 
‘‘(1) provides inpatient care; 
‘‘(2) is geographically situated in an area with 
a high number of veterans that have been diagnosed 
with both post-traumatic stress disorder and sub-
stance use disorder; and 
‘‘(3) is capable of treating post-traumatic stress 
disorder and substance use disorders. 
‘‘(c) PROCESS OF REFERRAL AND TRANSITION TO 
STEP DOWN DIAGNOSIS REHABILITATION TREATMENT 
PROGRAMS.—The Secretary shall establish a process to 
refer and aid the transition of veterans from the national 
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centers of excellence on post-traumatic stress disorder and 
substance use disorders established pursuant to subsection 
(a) to programs that provide step down rehabilitation 
treatment for individuals with post-traumatic stress dis-
order and substance use disorders.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 73 of such title is amended 
by inserting after the item relating to section 7330 the 
following new item: 
‘‘7330A. National centers of excellence on post-traumatic stress disorder and 
substance use disorders.’’. 
SEC. 106. REPORT ON RESIDENTIAL MENTAL HEALTH CARE 
FACILITIES OF THE VETERANS HEALTH AD-
MINISTRATION. 
(a) IN GENERAL.—Not later than six months after 
the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall, acting through the Office of the 
Medical Inspector of the Department of Veterans Af-
fairs— 
(1) conduct a review of all residential mental 
health care facilities, including domiciliary facilities, 
of the Veterans Health Administration; and 
(2) submit to the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Veterans’ 
Affairs of the House of Representatives a report on 
the review. 
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(b) ELEMENTS.—The report required by subsection 
(a)(2) shall include the following: 
(1) A description of the availability of care in 
residential mental health care facilities in each Vet-
erans Integrated Service Network (VISN). 
(2) An assessment of the supervision and sup-
port provided in the residential mental health care 
facilities of the Veterans Health Administration. 
(3) The ratio of staff members at each residen-
tial mental health care facility to patients at such fa-
cility. 
(4) An assessment of the appropriateness of 
rules and procedures for the prescription and admin-
istration of medications to patients in such residen-
tial mental health care facilities. 
(5) A description of the protocols at each resi-
dential mental health care facility for handling 
missed appointments. 
(6) Any recommendations the Secretary con-
siders appropriate for improvements to such residen-
tial mental health care facilities and the care pro-
vided in such facilities. 
SEC. 107. TRIBUTE TO JUSTIN BAILEY. 
This title is enacted in tribute to Justin Bailey, who, 
after returning to the United States from service as a 
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member of the Armed Forces in Operation Iraqi Freedom, 
died in a domiciliary facility of the Department of Vet-
erans Affairs while receiving care for post-traumatic stress 
disorder and a substance use disorder. 
TITLE II—MENTAL HEALTH 
ACCESSIBILITY ENHANCEMENTS 
SEC. 201. PILOT PROGRAM ON PEER OUTREACH AND SUP-
PORT FOR VETERANS AND USE OF COMMU-
NITY MENTAL HEALTH CENTERS AND INDIAN 
HEALTH SERVICE FACILITIES. 
(a) PILOT PROGRAM REQUIRED.—Commencing not 
later than 180 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall carry out 
a pilot program to assess the feasability and advisability 
of providing to veterans of Operation Iraqi Freedom and 
Operation Enduring Freedom, and, in particular, veterans 
who served in such operations as a member of the Na-
tional Guard or Reserve, the following: 
(1) Peer outreach services. 
(2) Peer support services. 
(3) Readjustment counseling services described 
in section 1712A of title 38, United States Code. 
(4) Other Mental health services. 
(b) PROVISION OF CERTAIN SERVICES.—In providing 
services described in paragraphs (3) and (4) of subsection 
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(a) under the pilot program to veterans who reside in rural 
areas and do not have adequate access through the De-
partment of Veterans Affairs to the services described in 
such paragraphs, the Secretary shall, acting through the 
Office of Rural Health, provide such services as follows: 
(1) Through community health centers under 
contracts or other agreements for the provision of 
such services that are entered into for purposes of 
the pilot program. 
(2) Through the Indian Health Service pursu-
ant to a memorandum of understanding entered into 
by the Secretary of Veterans Affairs and the Sec-
retary of Health and Human Services for purposes 
of the pilot program. 
(c) DURATION.—The pilot program shall be carried 
out during the three-year period beginning on the date of 
the commencement of the pilot program. 
(d) PROGRAM LOCATIONS.— 
(1) IN GENERAL.—The pilot program shall be 
carried out in at least two Veterans Integrated Serv-
ice Networks (VISN) selected by the Secretary for 
purposes of the pilot program. 
(2) RURAL GEOGRAPHIC LOCATIONS.—At least 
two of the locations selected shall be in rural geo-
graphic locations that lack access to comprehensive 
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pilot program under subsection (b) shall partici-
pate in the training program conducted pursu-
ant to subparagraph (A). 
(i) ANNUAL REPORTS.—Each community mental 
health center or facility of the Indian Health Service par-
ticipating in the pilot program under subsection (b) shall 
submit to the Secretary on an annual basis a report con-
taining, with respect to the provision of services under 
subsection (b) and for the last full calendar year ending 
before the submission of such report— 
(1) the number of— 
(A) veterans served; and 
(B) courses of treatment provided; and 
(2) demographic information for such services, 
diagnoses, and courses of treatment. 
(j) DEFINITIONS.—In this section: 
(1) The term ‘‘community mental health cen-
ter’’ has the meaning given such term in section 
410.2 of title 42, Code of Federal Regulations (as 
in effect on the day before the date of the enactment 
of this Act). 
(2) The term ‘‘eligible veteran’’ means a vet-
eran in need of mental health services who— 
(A) is enrolled in the Department of Vet-
erans Affairs health care system; and 
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(B) has received a referral from a health 
professional of the Veterans Health Administra-
tion to a community mental health center or to 
a facility of the Indian Health Service for pur-
poses of the pilot program. 
(3) The term ‘‘Indian Health Service’’ means 
the organization established by section 601(a) of the 
Indian Health Care Improvement Act (25 U.S.C. 
1661(a)). 
(k) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated such sums as may be nec-
essary to carry out the provisions of this section. 
TITLE III—RESEARCH 
SEC. 301. RESEARCH PROGRAM ON COMORBID POST-TRAU-
MATIC STRESS DISORDER AND SUBSTANCE 
USE DISORDERS. 
(a) PROGRAM REQUIRED.—The Secretary of Vet-
erans Affairs shall carry out a program of research into 
comorbid post-traumatic stress disorder (PTSD) and sub-
stance use disorder. 
(b) DISCHARGE THROUGH NATIONAL CENTER FOR 
POSTTRAUMATIC STRESS DISORDER.—The research pro-
gram required by subsection (a) shall be carried out and 
overseen by the National Center for Posttraumatic Stress 
Disorder. In carrying out the program, the Center shall— 
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(1) develop protocols and goals with respect to 
research under the program; and 
(2) coordinate research, data collection, and 
data dissemination under the program. 
(c) RESEARCH.—The program of research required 
by subsection (a) shall address the following: 
(1) Comorbid post-traumatic stress disorder 
and substance use disorder. 
(2) The systematic integration of treatment for 
post-traumatic stress disorder with treatment for 
substance use disorder. 
(3) The development of protocols to evaluate 
care of veterans with comorbid post-traumatic stress 
disorder and substance use disorder and to facilitate 
cumulative clinical progress of such veterans over 
time. 
(d) FUNDING.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated for the De-
partment of Veterans Affairs for each of fiscal years 
2008 through 2011, $2,000,000 to carry out this 
section. 
(2) AVAILABILITY.—Amounts authorized to be 
appropriated by paragraph (1) shall be made avail-
able to the National Center on Posttraumatic Stress 
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Disorder for the purpose specified in that para-
graph. 
(3) 
SUPPLEMENT
NOT
SUPPLANT.—Any 
amount made available to the National Center on 
Posttraumatic Stress Disorder for a fiscal year 
under paragraph (2) is in addition to any other 
amounts made available to the National Center on 
Posttraumatic Stress Disorder for such year under 
any other provision of law. 
SEC. 302. EXTENSION OF AUTHORIZATION FOR SPECIAL 
COMMITTEE ON POST-TRAUMATIC STRESS 
DISORDER. 
Section 110(e)(2) of the Veterans’ Health Care Act 
of 1984 (38 U.S.C. 1712A note) is amended by striking 
‘‘through 2008’’ and inserting ‘‘through 2012’’. 
TITLE IV—ASSISTANCE FOR 
FAMILIES OF VETERANS 
SEC. 401. CLARIFICATION OF AUTHORITY OF SECRETARY 
OF VETERANS AFFAIRS TO PROVIDE MENTAL 
HEALTH SERVICES TO FAMILIES OF VET-
ERANS. 
(a) IN GENERAL.—Section 1701(5)(B) of title 38, 
United States Code, is amended— 
(1) by inserting ‘‘marriage and family coun-
seling,’’ after ‘‘professional counseling,’’; and 
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(2) by striking ‘‘as may be essential to’’ and in-
serting ‘‘as the Secretary considers appropriate for’’. 
(b) LOCATION.—Paragraph (5) of section 1701 of 
title 38, United States Code, shall not be construed to pre-
vent the Secretary of Veterans Affairs from providing 
services described in subparagraph (B) of such paragraph 
to individuals described in such subparagraph in Readjust-
ment Counseling Centers, Department of Veterans Affairs 
medical centers, community-based outpatient clinics, or in 
such other facilities of the Department of Veterans Affairs 
as the Secretary considers necessary. 
SEC. 402. PILOT PROGRAM ON PROVISION OF READJUST-
MENT AND TRANSITION ASSISTANCE TO VET-
ERANS AND THEIR FAMILIES IN COOPERA-
TION WITH VET CENTERS. 
(a) PILOT PROGRAM.—The Secretary of Veterans Af-
fairs shall carry out, through a non-Department of Vet-
erans Affairs entity, a pilot program to assess the 
feasability and advisability of providing readjustment and 
transition assistance described in subsection (b) to vet-
erans and their families in cooperation with centers under 
section 1712A of title 38, United States Code (commonly 
referred to as ‘‘Vet Centers’’). 
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