I 
111TH CONGRESS 
1ST SESSION H. R. 2691 
To provide assistance to adolescents and young adults with serious mental 
health disorders as they transition to adulthood. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 3, 2009 
Mr. STARK (for himself, Mr. CAMP, and Mrs. BONO MACK) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To provide assistance to adolescents and young adults with 
serious mental health disorders as they transition to 
adulthood. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Healthy Transition 
Act of 2009’’. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) According to a June 2008 Government Ac-
countability Office (GAO) report to Congress there 
were at least 2,400,000 young adults aged 18 to 26 
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with a serious mental illness (SMI) in 2006, and an 
additional 9.3 million who experienced mild or mod-
erate mental illness. GAO also found that in 2006— 
(A) 46 percent to 63 percent of homeless 
young adults experienced mental health prob-
lems; 
(B) 63 percent to 71 percent of incarcer-
ated young adults experienced mental health 
problems; and 
(C) close to 32 percent of young adults 
with SMI had a co-occurring diagnosis of alco-
hol or drug abuse or dependence along with at 
least one other mental disorder. 
(2) A July 2008 American Psychological Asso-
ciation (APA) report found that more than 60 per-
cent of transition youth with SMI do not complete 
high school, leaving many of these young adults un-
employed, unable to benefit from continuing edu-
cation (32 percent rate of postsecondary continu-
ation versus 51 percent for youth without mental ill-
ness), and without the skills needed to live independ-
ently. 
(3) The 2003 President’s New Freedom Com-
mission on Mental Health found that only 1 in 3 
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persons with a disability resulting from mental ill-
ness is employed— 
(A) about 186,000 young adults with SMI 
received disability benefits in 2006 because 
their illness was severe enough to prevent sus-
tainable employment; and 
(B) youth centers often lack the expertise 
to find employment for young adults because 
they do not generally have the capacity to suit 
individual mental health needs. 
(4) The Substance Abuse and Mental Health 
Services Administration (SAMHSA) recommends 
supportive housing—which would include job train-
ing and mental health services—to young adults 
with SMI. State officials, however, cite a lack of 
availability of such housing and the Department of 
Housing and Urban Development (HUD) reports 
that the median age of HUD supportive housing re-
cipients is 47 years old. 
(5) During the transition to adulthood, youth 
with SMI are also at risk of losing free or low-cost 
services they received as children, but may not qual-
ify for as adults. The difference in eligibility criteria 
between child and adult benefits from the Social Se-
curity Administration (SSA) can result in a loss of 
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benefits during the redetermination stage at age 18. 
For example, Medicaid income requirements are 
more stringent for an adult, even though an appli-
cant may have received benefits as a child. 
(6) GAO found critical gaps in mental health 
and housing services for foster youth— 
(A) the report found that States were serv-
ing less than half of their eligible foster care 
population through existing programs such as 
Chafee Foster Care Independence and Med-
icaid; and 
(B) a separate national survey from 2006 
found that foster youth were 4 times more like-
ly to have attempted suicide in the preceding 
year when compared to those never placed in 
foster care. 
(7) Public service provision for young adults 
with SMI is fragmented and these individuals can 
struggle to locate services that aid in their transition 
to adulthood— 
(A) GAO found that there are currently no 
Federal programs to specifically target this 
population; 
(B) directors of programs providing serv-
ices to youth aged 14 to 21 have difficulty find-
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ing adequate age-appropriate mental health 
services for their clients partly due to lack of 
proper training; and 
(C) group therapy in mental health serv-
ices is often not age appropriate and as a re-
sult, SAMHSA reported in 2007 that young 
adults with SMI have the lowest ‘‘help-seeking 
behavior’’ of any age group. 
SEC. 3. HEALTHY TRANSITIONING FOR YOUTH. 
Subpart 3 of part B of title V of the Public Health 
Service Act (42 U.S.C. 290bb–31 et seq.) is amended by 
adding at the end the following: 
‘‘SEC. 520K. HEALTHY TRANSITIONING FOR YOUTH. 
‘‘(a) PLANNING GRANTS.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the agencies described in subsection (c)(3), 
shall award grants or cooperative agreements to 
States to develop plans for the statewide coordina-
tion of services to assist adolescents and young 
adults with a serious mental health disorder in ac-
quiring the skills, knowledge, and resources nec-
essary to ensure their healthy transition to success-
ful adult roles and responsibilities. 
‘‘(2) APPLICATION.—To be eligible for a grant 
or cooperative agreement under this subsection, a 
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State shall submit to the Secretary an application, 
at such time, in such manner, and containing such 
information as the Secretary may require. 
‘‘(3) PLAN.—Not later than 18 months after 
the receipt of a grant or cooperative agreement 
under this subsection, a State shall submit to the 
Secretary a State plan that shall include— 
‘‘(A) reliable estimates on the number of 
adolescents and young adults with serious men-
tal health disorders in the State; 
‘‘(B) information on the youth targeted 
under this Act, including— 
‘‘(i) the number of adolescents and 
young adults with serious mental health 
disorders in the State and the number of 
such individuals who are currently being 
served in the State; 
‘‘(ii) the number of such individuals 
who are receiving mental health services 
provided by State agencies other than the 
agency responsible for mental health serv-
ices in the State; 
‘‘(iii) the number of youth with seri-
ous mental health disorders who are in-
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volved in the juvenile justice system in the 
State; 
‘‘(iv) the number of youth with seri-
ous mental health disorders who are in-
volved in the child protection system in the 
State; 
‘‘(v) the number of youth with serious 
mental health disorders who have plans in 
effect under the Individuals with Disabil-
ities Education Act in the State; 
‘‘(vi) the number of youth with seri-
ous mental health disorders who are in-
volved in vocational rehabilitation in the 
State; 
‘‘(vii) the range of ages served by the 
programs described in clauses (i) through 
(vi); and 
‘‘(viii) a description of the overall 
transition coordination that is currently 
provided by the State or local authorities 
and programs in the State; 
‘‘(C) an identification of the skills, knowl-
edge, and resources that adolescents and young 
adults with serious mental health disorders in 
the State will need to ensure their successful 
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and healthy transition into adult roles and re-
sponsibilities; 
‘‘(D) an identification of the obstacles that 
adolescents and young adults with serious men-
tal health disorders in the State encounter while 
transitioning into adult roles and responsibil-
ities, including breaks in service or programs 
caused by eligibility and program criteria dif-
ferences between the child and adult mental 
health systems, the lack of culturally and lin-
guistically appropriate mental and behavioral 
health and transition services, and the lack of 
local access to mental health and transition 
services; 
‘‘(E) an identification of the current level, 
type, quality, effectiveness, and availability of 
services, including evidence-based practices, 
available in the State that are uniquely de-
signed for adolescents and young adults with a 
serious mental health disorder to ensure a 
healthy transition to successful adult roles and 
responsibilities; 
‘‘(F) an identification of adolescents and 
young adults with a serious emotional disorder 
who have a low likelihood of a healthy and suc-
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cessful transition due to the severity of their ill-
ness, and an identification of how the State will 
provide treatment and other support services to 
this population; 
‘‘(G) an analyses of the strengths, weak-
nesses, and gaps of the current system in the 
State, including the availability of lack of men-
tal and behavioral health professionals trained 
to treat adolescents and young adults with a se-
rious mental health disorder, as well as bar-
riers, to address the needs of adolescents and 
young adults with a serious mental health dis-
order with an appropriate array of effective 
services and supports; 
‘‘(H) a description of how the State will 
improve the system of care to ensure successful 
and healthy transitions; 
‘‘(I) a description of how the State will en-
sure that services and systems of care are cul-
turally and linguistically competent; 
‘‘(J) a description of how the State will co-
ordinate the services of State and non-State 
agencies that serve adolescents and young 
adults with a serious mental health disorder; 
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‘‘(K) a description of how the State will 
provide a system of coordinated service delivery 
under the grant or cooperative agreement that 
will address the effective services, supports, and 
unique needs of adolescents and young adults 
with a serious mental disorder, including those 
who have been placed in out of home settings 
such as the juvenile justice system or those who 
are or were involved in the child protection sys-
tems; 
‘‘(L) a description of how the State will co-
ordinate efforts under the grant or cooperative 
agreement with existing services and systems in 
the State that focus on life skills necessary for 
a healthy transition including health, employ-
ment and pre-employment training, transpor-
tation, housing, recreation, mental health serv-
ices, substance use, vocational rehabilitation 
services for persons with disabilities, and train-
ing for adolescents, young adults and adults, 
consumers and their families; 
‘‘(M) a description of how the State will 
work to build workforce capacity to serve the 
population described in subparagraph (J); 
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funds provided under the grant or coopera-
tive agreement; and 
‘‘(iv) for any fifth such fiscal year, is 
not less than $2 for each $1 of Federal 
funds provided under the grant or coopera-
tive agreement. 
‘‘(B) DETERMINATION
OF
AMOUNT
CON-
TRIBUTED.— 
‘‘(i) IN GENERAL.—Non-Federal con-
tributions required under subparagraph 
(A) may be in cash or in kind, fairly evalu-
ated, including plant, equipment, or serv-
ices. Amounts provided by the Federal 
Government, or services assisted or sub-
sidized to any significant extent by the 
Federal Government, may not be included 
in determining the amount of such non- 
Federal contributions. 
‘‘(ii) 
NON-FEDERAL
CONTRIBU-
TIONS.—In making a determination of the 
amount of non-Federal contributions for 
purposes of clause (i), the Secretary may 
include only non-Federal contributions in 
excess of the average amount of non-Fed-
eral contributions made by the State in-
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