Title: Expressing the sense of the House of Representatives that in order to effectively address the high prevalence of those 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.
Policy area: Health

Summary:
This resolution expresses the sense of the House of Representatives that investments in mental health care and substance use disorder care are necessary to address the high prevalence of those suffering from behavioral health conditions. It also recognizes the need for health care reform to integrate mental health care and substance use disorder treatment in the health care system.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 1057 Introduced in House (IH)]

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116th CONGRESS
  2d Session
H. RES. 1057

 Expressing the sense of the House of Representatives that in order to 
effectively address the high prevalence of those 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 HOUSE OF REPRESENTATIVES

                             July 21, 2020

Mr. Kennedy (for himself, Ms. Matsui, Mr. Tonko, Mr. Cardenas, and Mr. 
 Trone) submitted the following resolution; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                               RESOLUTION


 
 Expressing the sense of the House of Representatives that in order to 
effectively address the high prevalence of those 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 mental health and substance use disorders so they are no 
        longer seen separately;
Whereas according to the World Health Organization, mental illness is severely 
        underdiagnosed, and less than half of those who meet diagnostic criteria 
        are identified;
Whereas there is a pressing need to provide a comprehensive solution to fix our 
        health system that incorporates the needs and expertise of all its 
        stakeholders, especially those 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--

    G    (A) discourages utilization of mental health and substance use 
disorder services; and

    G    (B) lacks acknowledgment that struggling with mental health 
conditions 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 
        behaviors;
Whereas the bulk of our mental health and substance use disorder services are 
        reactive instead of proactive, treating patients when they are in crisis 
        instead of incorporating services and screenings earlier in an attempt 
        to prevent such crisis from occurring;
Whereas there is a need to increase access to treatment, services, and social 
        supports for everyone to proactively address 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 suicide ideation and not just the action 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 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 
        mental health and substance use disorders has left States and 
        localities--

    (1) without adequate guidance or resources;

    (2) without resources unable to provide the mental health and substance 
use disorder services needed to adequately meet the needs of their 
populations; and

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

Whereas there is a need for greater collaboration across all Federal departments 
        that touches various aspects of the health care system in order to fully 
        incorporate the needs and concerns of everyone involved in the mental 
        health and substance use disorder system;
Whereas there is a need for greater collaboration between Federal, State, and 
        local departments that touches on various aspects of the health care 
        system;
Whereas there is a need for one 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 needs gets 
        access to the necessary care and treatment;
Whereas the Mental Health Parity and Addiction Equality Act has been in effect 
        since 2008, and 12 years later there is still a lack of compliance among 
        insurers not adequately covering mental health and substance use 
        disorder services;
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 that 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 people suffering from a substance use disorder 
        receive specialty treatment;
Whereas there is a need to increase access and utilization to telemedicine for 
        mental health and substance use disorder services both within States and 
        across State lines;
Whereas patient privacy needs to be protected, but there needs to be a better 
        way to share information among providers to better serve the patient's 
        needs;
Whereas safe housing needs to be recognized as a basic requirement for treatment 
        to be successful and needs to be better addressed as people transition 
        care;
Whereas there is a need to improve social determinants of health, such as 
        increased access to stable housing and jobs, for those suffering from 
        mental illness and substance use disorders to have a sustained recovery;
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 (Public Law 101-336) 
        and the Supreme Court's Olmstead v. L.C. decision;
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 needs to be consistent care coordination and more effective 
        transition services for those moving between hospitals and the 
        community;
Whereas there is a need to address isolation issues geriatric patients face 
        which can negatively impact their mental health;
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 disorder treatment and 
        service needs contribute to increased 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--

    G    (A) 36 percent of children entering care as a result of parental 
drug abuse;

    G    (B) 14 percent of children entering care as a result of the 
caretaker's inability to cope; and

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

    (2) even when necessary to ensure a child's safety, 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 those families' experiences of 
trauma and contribute 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 which have the potential to significantly impact the mental 
health of children;

    (2) in the last 12 months, 49.4 percent of children who needed mental 
health services did not receive the necessary services, and there needs to 
be improved access to more appropriate treatment services, which must focus 
on community-based supports and services available near 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 disorder concerns 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 current or potential threats which--

    G    (A) can cause significant harm to the mental health and emotional 
well-being of children;

    G    (B) has compounded already existent stigma for groups of students;

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

    G    (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 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 amongst young adults and college-aged adults, and between 2007 
        and 2017, for those aged 18-34 there was a--

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

    (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 5.5 million veterans and servicemembers rely on the Department of 
        Veterans Affairs for health services, and 1.5 million veterans have 
        received a mental health diagnosis, and--

    (1) 1 in 4 active duty members shows signs of mental health conditions;

    (2) the rate of post-traumatic stress disorder (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 than 
compared to civilians;

    (4) every day, 22 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 those entering the 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;
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 have 
        PTSD, showing the interconnectedness between these conditions;
Whereas there is a need to better educate all those in the criminal justice 
        system on the impact and needs of those with mental health conditions 
        and substance use disorders;
Whereas the United States justice system is the largest provider of mental 
        health services, and it was not built, or intended to be used, for that 
        purpose, and--

    (1) there are 550,000 people currently incarcerated with mental 
illness;

    (2) 1 in 5 people incarcerated 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 those with mental health and substance use disorder needs;
Whereas one-third of people incarcerated receive treatment for mental illness, 
        and many times it 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 divert those with mental illness and substance use 
        disorder;
Whereas there is a need to improve levels of coordination, care management, and 
        insurance coverage before, during, and after incarceration;
Whereas postrelease navigation is key to keeping people from reentering the 
        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 include those 
        who are 25 years of age or younger in order to reflect the most up-to-
        date scientific consensus on brain development and behavior;
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 may also meet the 
criteria for a substance use disorder;

    (2) 90 percent of those 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

    (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; therefore there is a need to 
have specific services and programs within the juvenile justice system with 
a focus on their needs;

Whereas studies show that 41.2 percent of those 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 should include access to psychopharmacology, 
        psychotherapy, contingency management, recovery support, all evidence-
        based 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--

    (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 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 likely 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 of being housed according to their lived gender, 
which poses a significant threat to their 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 one's mental health and 
        substance use, specifically showing--

    (1) that 47 percent of people 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 number of calls to suicide prevention 
hotlines;

    (3) a 1,000-percent increase in texts to SAMHSA's mental health hotline 
to about 20,000 texts in April 2020;

    (4) a 55-percent increase in number of alcohol sales; and

    (5) an 11.4-percent increase in overdose fatalities in the first 
quarter of 2020 driven by increased feelings of anxiety, depression, and 
use of substances; 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 those 
        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 those 
        in high-risk populations: Now, therefore, be it
    Resolved, That it is the sense of the House of Representatives that 
in order to effectively address the high prevalence of those 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 recognize that--
            (1) mental health and physical health need to be treated 
        together to treat the whole patient;
            (2) patient care needs to be patient-focused;
            (3) mental health and substance use disorder care needs to 
        be proactive and treat people before they are in crisis;
            (4) any stigma associated with mental health and substance 
        use disorders is completely unwarranted and serves as a barrier 
        to care;
            (5) the Federal Government needs to create a comprehensive 
        approach to improving the health care system that incorporates 
        mental health and substance use disorders that includes system 
        reform that--
                    (A) aims to break down silos across the Federal, 
                State, local, and Tribal levels for improved 
                communication and care coordination;
                    (B) provides a Federal framework to States, 
                localities, and Tribes that connects agencies and 
                services so they can have guidance when working to 
                address the mental health and substance use disorder 
                needs of their communities;
                    (C) incentivizes providers to see both more complex 
                and less complex patients and to see patients in rural 
                and underserved areas;
                    (D) expects insurers to comply with parity laws and 
                holds them accountable for not providing parity of 
                mental health and substance use disorder services and 
                treatments; and
                    (E) requires both public and private payers to have 
                higher reimbursement rates for mental health and 
                substance use disorder services that are on par with 
                medical and surgical services;
            (6) the Federal Government needs to create a comprehensive 
        approach to improving the health care system that incorporates 
        mental health and substance use disorders that includes system 
        improvements that--
                    (A) focuses on early screenings, diagnosis, and 
                intervention across the care continuum to prevent those 
                from experiencing a mental health crisis;
                    (B) improves families' ability to access timely, 
                affordable, and high-quality treatment and services;
                    (C) strengthens mental health and substance use 
                disorder services in schools and ensures there is 
                engagement from all stakeholders;
                    (D) improves and expands community-based services 
                so people have access to services locally;
                    (E) improves care coordination across treatment 
                settings so patients have the services they need when 
                they need it and do not need to navigate the system 
                themselves;
                    (F) promotes a sustained recovery that includes 
                social determinants of health, such as housing, jobs, 
                and childcare;
                    (G) can adjust to meet the needs of each individual 
                to provide the best care for each person;
                    (H) ensures seamless transitions in care when 
                moving through steps or processes;
                    (I) ends the criminalization of mental illness and 
                substance use disorders and increases programs for 
                diversion that connects individuals to treatment, 
                social supports, and social services;
                    (J) provides access to high-quality and evidence-
                based mental health and substance use disorder care for 
                those who are incarcerated;
                    (K) creates young adult services and programs 
                within the justice system for those who are ages 18 to 
                25 to successfully reduce recidivism and that are 
                informed by neuropsychological brain science;
                    (L) incorporates apprenticeship or job training 
                programs into the justice system, particularly for 
                youth, to empower them and reduce recidivism;
                    (M) ensures cultural congruence so everyone in need 
                of mental health and substance use disorder care has 
                services that meet their needs;
                    (N) adopts a population health approach as a tool 
                to help address ongoing disparities in access to mental 
                health and substance use disorder care by youth and 
                adults of color;
                    (O) ensures that LGBTQ individuals, communities of 
                color, and immigrants have access to mental health and 
                substance use disorder services that are culturally 
                appropriate, are in the necessary language, and address 
                any unique stigma from their communities;
                    (P) enables veterans to access timely mental health 
                and substance use disorder care that ensures continuity 
                and is free of any administrative burdens;
                    (Q) includes training for educators, first 
                responders, and clinicians to identify indicators of 
                mental health conditions and substance use disorders 
                and to reduce stigma and bias related to these 
                conditions so they can respond in a more productive way 
                and connect people with more appropriate services;
                    (R) supports health care providers by addressing 
                their mental health and substance use disorder needs to 
                reduce burnout;
                    (S) provides a process in which States can work 
                with other States to reconcile licensure and 
                certification for and reimbursement to mental health 
                and substance use disorder providers across State lines 
                for the purpose of telemedicine;
                    (T) leverages the current mental health and 
                substance use disorder workforce by reducing 
                administrative burdens to allow mental health and 
                substance use disorder providers to perform to their 
                highest level of licensure and certification; and
                    (U) expands training opportunities and grows the 
                workforce by partnering with schools and programs to 
                provide free education to those who work in rural or 
                underserved areas;
            (7) expanded access to mental health and substance use 
        disorder care is essential to improving health and well-being;
            (8) all Americans deserve access to mental health and 
        substance use disorder care without any barriers, such as cost 
        or location of services; and
            (9) the United States needs to comprehensively break down 
        all barriers to receiving access to mental health and substance 
        use disorder care including financial burdens and location 
        hurdles.
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