I 117th CONGRESS 2d Session H. R. 7483 IN THE HOUSE OF REPRESENTATIVES April 7, 2022 Mr. Reschenthaler (for himself and Mr. Trone ) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To direct the Secretary of Health and Human Services to conduct a study on the direct and indirect costs of serious mental illness for nongovernmental entities, the Federal Government, and State, local, and Tribal governments, and for other purposes.

1. Short title This Act may be cited as Cost of Mental Illness Act of 2022 . 2. Study on the costs of serious mental illness (a) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services, in consultation with the Assistant Secretary for Planning and Evaluation, the Attorney General of the United States, the Secretary of Labor, and the Secretary of Housing and Urban Development, shall conduct a study on the direct and indirect costs of serious mental illness with respect to— (1) nongovernmental entities; and (2) the Federal Government and State, local, and Tribal governments. (b) Content The study under subsection (a) shall consider each of the following: (1) The costs of the health care system for all facilities and health services, including— (A) public and private inpatient hospitals, outpatient health care, and home health care; (B) office-based physician visits; (C) prescription drugs and digital therapeutics; (D) emergency room visits; (E) substance use treatment; (F) skilled nursing and long-term care facilities for residential, custodial, and general health care; (G) with respect to the costs described in subparagraphs (A) through (F), out-of-pocket costs and costs for different types of behavioral health and psychiatric illness; and (H) other professional health services. (2) The costs of homelessness, including— (A) homeless shelters; (B) street outreach activities; (C) crisis response center visits; and (D) other supportive services. (3) The costs of structured residential facilities and other supportive housing for residential and custodial care services. (4) The costs of law enforcement encounters and encounters with the criminal justice system, including— (A) encounters that do and do not result in an arrest; (B) investigating a crime and judicial proceedings, including the process of sentencing; (C) services provided by police officers, sheriff deputies, police departments and sheriff offices, and judicial staff (including public defenders, prosecutors, and private attorneys); (D) services provided by public institutions (including local and county jails, State prisons, and paid legal guardians); (E) public safety costs to transport an individual with a serious mental illness to receive mental health or substance use treatment services or be incarcerated (including vehicle miles and personnel expenses); (F) with respect to inmates with a serious mental illness, incarceration costs in Federal prison, State prison, and local jails (including residential, custodial, and on-site and off-site health care); and (G) solitary confinement, security, and other similar costs. (5) The costs of addressing serious mental illness as a disability in the workplace, including— (A) reduced wages for individuals with a serious mental illness who are employed; and (B) the estimated costs attributable to— (i) the nationwide unemployment rate for individuals with a serious mental illness; (ii) benefits payable on the basis of disability to individuals with a serious mental illness— (I) under title II or XVI of the Social Security Act ( 42 U.S.C. 401 et seq. , 1381 et seq.); or (II) from a State or other governmental entity; or (iii) to the extent feasible, lost lifetime productivity due to disability. (6) With respect to family members and caregivers, the costs of caring for an individual with a serious mental illness, including— (A) the cost of unpaid labor; (B) additional health care costs associated with providing ongoing care for an individual with a serious mental illness, including higher health care costs resulting from stress and anxiety; (C) taking leave from work; and (D) out-of-pocket costs incurred while caring for such individual. (7) Costs with respect to funding for grants or cooperative agreements for programs or services for basic, translational, and applied research for individuals with a serious mental illness. (8) The costs of workforce development and training for personnel that interact with individuals with a serious mental illness, and insurance for such development and training, including health care workers, social service employees, law enforcement, and first responders. (9) Other costs for programs and services administered by the Federal Government or State, Tribal, or local governments. (c) Data disaggregation In conducting the study under subsection (a), the Secretary shall (to the extent feasible)— (1) disaggregate data by— (A) costs to nongovernmental entities, the Federal Government, and State, local, and Tribal governments; (B) types of serious mental illnesses and medical chronic diseases common in patients with a serious mental illness; and (C) demographic characteristics, including race, ethnicity, sex, age (including pediatric subgroups), and other characteristics determined by the Secretary; and (2) include an estimate of— (A) the total number of individuals with a serious mental illness in the United States, including in traditional and nontraditional housing; and (B) taking into account the information collected pursuant to section 3(b)(3), the percentage of such individuals in— (i) homeless shelters; (ii) penal facilities, including Federal prisons, State prisons, and county and municipal jails; and (iii) nursing facilities. (d) Report Not later than 2 years after the date of the enactment of this Act, the Secretary shall— (1) submit to the Congress a report containing the results of the study conducted under this section; and (2) make such report publicly available. (e) Definitions In this section: (1) Secretary The term Secretary means the Secretary of Health and Human Services. (2) Serious mental illness The term serious mental illness means a mental, behavioral, or emotional disorder resulting in a serious functional impairment that substantially interferes with or limits one or more major life activities, including the following: (A) Schizophrenia, including schizoaffective disorder and other related psychosis. (B) Schizoaffective disorder. (C) Persistent mood disorder, including bipolar disorder I and II. (D) Major depressive disorder. (E) Any other such mental, behavioral, or emotional disorder, as determined by the Secretary. (f) Authorization of appropriations There is authorized to be appropriated to the Secretary to carry out this section $3,500,000 for each of fiscal years 2023 and 2024. 3. Schizophrenia surveillance survey (a) In general The Secretary of Health and Human Services (in this section referred to as the Secretary ), acting through the Assistant Secretary for Mental Health and Substance Use, and in coordination with the Director of the Centers for Disease Control and Prevention and the Director of the National Institute of Mental Health, shall— (1) conduct a surveillance survey to collect the information described in subsection (b) about individuals with schizophrenia in the United States; and (2) not less than every 5 years, update such survey. (b) Content In carrying out subsection (a), the Secretary shall collect— (1) to the extent practicable, information relating to individuals with schizophrenia, such as— (A) demographics, such as age, race, ethnicity, sex, geographic location, family history, and other information as appropriate; (B) risk factors that may be associated with schizophrenia such as environmental risk factors and other information as appropriate; and (C) average age at the time of initial diagnosis and time lapses, if any, between the initial diagnosis and the initiation of mental health care; (2) to the extent practicable, information on the health status of individuals with schizophrenia, including— (A) mortality and morbidity rates; (B) incidences of comorbid chronic diseases, including diabetes, cardiac conditions, emphysema, cirrhosis, HIV/AIDS, and hepatitis C; and (C) the frequency of hospital emergency department utilization; and (3) the percentage of individuals with schizophrenia in— (A) homeless shelters; (B) penal facilities, including Federal prisons, State prisons, and county and municipal jails; (C) nursing facilities; and (D) inpatient hospitals. (c) Consultation In carrying out this section, the Secretary shall consult with individuals with appropriate expertise, which may include— (1) epidemiologists with experience in mental health conditions surveillance; and (2) representatives of national voluntary health association and nonprofit citizens organizations that— (A) focus on schizophrenia and related psychotic conditions; and (B) have experience in research, care, and patient services. (d) Coordination In carrying out this section, the Secretary shall— (1) coordinate with the National Neurological Conditions Surveillance System under section 399S–1 of the Public Health Service Act ( 42 U.S.C. 280g–7a ) to determine any overlap between— (A) individuals with schizophrenia counted for purposes of the survey under this section; and (B) individuals with neurological conditions identified by the Director of the Centers for Disease Control and Prevention for purposes of the National Neurological Conditions Surveillance System; and (2) coordinate with other Federal agencies, including the Social Security Administration, the Department of the Treasury, and the Department of Labor, to use administrative data, to the extent feasible, to provide information for the survey authorized by subsection (a). (e) Grants The Secretary may award grants to, or enter into contracts or cooperative agreements with, public or private nonprofit entities to carry out activities in furtherance of the surveillance survey under this section, including the convening of stakeholder meetings. (f) Reporting (1) In general The Secretary shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate— (A) not later than 2 years after the date of enactment of this Act, a report containing findings of the surveillance survey under this section, including aggregate information collected and epidemiological analyses, as appropriate; and (B) not less than every 5 years when an updated survey is conducted pursuant to subsection (a)(2), an updated report. (2) Posting The Secretary shall post the report under paragraph (1) and each update under paragraph (2) on the public website of the Department of Health and Human Services. (g) Authorization of appropriations To carry out this section, there is authorized to be appropriated $50,000,000 for the period of fiscal years 2023 through 2027.