Transcripts For CSPAN3 House Hearing On COVID-19 Impact On Mental Health 20240712

Restricting the number of hours a baker could work each week. Watch landmark cases tonight on cspan 3. And any time on cspan. Org. Now a hearing on the impact of the coronavirus on Mental Health. The house energy and commerce subcommittee on health discusses the benefits telehealth has provided americans and the need to continue after the pandemic ends. This is just over four hours 15 minutes. The subcommittee on health will now come to order. Due to covid19, todays hearing obviously is being held remotely. All members and witnesses will participate via Video Conferencing. As part of our hearing, microphones will be set on mute to eliminate background noise. Members and witnesses, youre going to have to unmute your microphone each time you wish to speak. I just say that as a reminder and a little housekeeping issue. Please remember to do that. Documents for the record can be sent to megan mullin at the email address we provided to your staff. All documents will be entered into the record at the conclusion of the hearing. The chair now recognizes herself for five minutes for an Opening Statement. Where is the clock on the screen . There it is. Okay. In any given year 1 in 5 adults experience a Mental Health illness such as depression, anxiety, or bipolar disorder. 2020 has been a year like no other. In a recent poll, half of adults report that their Mental Health has been negatively impacted due to coronavirus. One can only imagine the mental impacts on the American Families who are grieving the loss of their loved ones due to the virus. The economic downturn is also taking a Mental Health toll on our fellow americans. Studies have found that for every 1 increase in the Unemployment Rate the suicide rate increases 1 to 1. 6 . Despite the frequency of Mental Illness, too many suffer in silence. Mental health is the neglected part of our Health Care System with less than 40 of people with Mental Health illness receiving any treatment whatsoever. This is because of the huigh cot of care, insufficient insurance coverage, limited options due to poor provider reimbursement, and an antiquated system that too often relies on prisons, jails, and shelters. Were so fortunate to have our colleague former congressman Patrick Kennedy as a witness today. He has led the way in attacking the stigma of Mental Health by being open about his own journey and advocating for transformational changes to our Mental Health system. He authored the 2008 Mental Health and addiction equity act which required Health Insurers to treat Mental Health care the same as physical health care. But, unfortunately, years after its passage, Health Insurers still deny too Many Americans coverage because they dont follow the letter and the spuirt of that law. The good news is there are many strong bills to address these issues. Today we are considering 22 bills. There is clearly bipartisan demand to address this crisis. The legislation were considering cover the recent increase in suicides, Racial Disparities, Mental Health outcomes, telehealth, coverage parity, and access to Mental Health services in schools. Very, very important one. Several bills also address the Mental Health issues caused by covid19. The pandemic is fueling Mental Health problems while also hurting the ability of care givers to deal with the crisis. Mental Health Programs are struggling to treat an influx of patients while awaiting funding that congress did appropriate. Very importantly and in very large sums. But hhs has been slow to release them. Our health as a nation both physical and mental wul ill be tested in the days and months ahead. Aristotle said even calamaties have a soul and can teach us a wise life. I view this calamety as an opportunity to correct the wrongs in our society and create hope for recovery for all. Now i yield the remainder of my time to representative joe kennedy who has been a leader on this issue. Thank you. Grateful for your leadership and yielding this moment and great to see my cousin patrick again and grateful for all of his work. The Mental Health care system is broken. Our Addiction Treatment system is broken. All of us bring stories of constituents and loved ones who fell through the gaps that are wide and only widening. This pandemic did not create the gaps. It only hewletted them and has highlighted them and has shown us what we already knew that the Mental Health system is under funded, under prioritized, and over stigmatized. We are beyond the point of cosmetic fixes and incremental change. We need substancive, systemic reform. We need legal Mental Health parity like what my cousin patrick envisioned with teeth behind it that holds insurers accountable for violations they commit on a daily basis. This hearing is another critical step forward but wont protect those who need our protection most. Only action and true reform will do that. I look forward to working with my colleagues to accomplish that in the weeks ahead. Thank you so much madame chair and to all of our colleagues for addressing this critical issue. Thank you, congressman kennedy. Yields back. The chair now recognizes dr. Burgess the Ranking Member of our subkmcommittee for five minutes for his Opening Statement. Please remember to unmute. So i thank the chair and i thank your willingness to work on productive, bipartisan agenda for this subcommittee. I respect and am grateful for your respecting my request that we have a hearing on Mental Health and the coronavirus. It was a topic that we were slated to talk about prior to the outbreak but now it has become even more serious. The human loss, the job loss, the isolation americans have faced due to this pandemic make it an even more critical topic. At the very beginning of this crisis, the American Psychiatric Association Found that onethird of americans felt it seriously affected their Mental Health. That reality compounded with the existing prevalence of Mental Health and Substance Use disorders make this issue urgent. According to the National Institute of Mental Health nearly one in five adults lives with a Mental Illness ensuring proper supports are in place for families to manage and treat these illnesses should be a priority. So there are 22 bulills before today and many have a bipartisan consensus. I appreciate you have included the bills that i mentioned in my letter specifically hr3539. The Behavior Interventions guidelines act. Which i worked on with dr. Drew ferguson of georgia. We had successful behavioral intervention programs in schools in our states and that inspired us to Work Together. For me, it was hearing from the leadership at Texas Tech University Health Science centers and their program to provide training for Behavioral Health intervention and telebehavioral Health Services at schools in rural west texas. School age children are a prime age to identify and treat behavioral Health Issues before they worsen. I believe this bill is even more important now. Students have been away from school and friends during a difficult time and some may be dealing with the loss of loved ones or being home with family, a difficult family situation. I hope that we will advance this bull toward mark up. Other bills o cover a wide range of important issues from improving the National Suicide prevention hotline to extending the authorization for Community Prevention hotline. These bills will ensure, stable, highquality resources for those in need. One issue not addressed today is the Mental Health of the Frontline Health care worker. This is especially important now and i believe this has long been a serious issue in our Health Care System but has taken on added importance with the additional stress that caring for the seriously ill coronavirus patient entails. I do have concerns about the medicare bills. I oppose opening medicares definition of what is a physician. I support telemedicine. Its been critical during the coronavirus, but we must make sure that important guardrails are in place because we dont want it to be used inappropriately as been noted by the Government Accountability office and the inspector general. We must also seriously evaluate on if resources are better used to get psychologists in underserved areas. I need to devote some time to process. Theres a strong bipartisan commitment to improve our nations Mental Health. Im frustrated by the majority trying to accommodate concerns prior to this hearing. You know when compromise was clearly possible, we didnt. Majority staff acknowledged that changes would make some of these bills easier to enact. Still, what were introduced were very partisan bills instead of what weve been working onto secure republican support. This has become all too predictable in the Public Health space in this congress which is sad because historically its the Public Health space where this subcommittee comes together to legislate the most. It concerns me considering bills introduced rather as negotiated and this is not the first time that the majority has majorityminority have had an agreement and to have the majority to move the goalpost. It makes us difficult to trust you and the agreements that are made. Ignoring our requests actively harms the legacy of this committee. It did not need to happen. Im puzzled why it did. You should expect members to file amendments should bills be brought up to markup that you were unwilling to engage with us or our staff and refuse to acknowledge our proactive outreach and ignored our flag concerns. My expectation for a supposedly noncontroversial markup is that you will not notice these bills, but the ones where the general agreement had occurred. Many issues but especially Mental Health should rise above partisan politics. We should come together to change the landscape and provide the much needed resources to individuals who are struggling with Mental Health issues. And i yield back. The gentleman yields back. I just everyone was not on when i said this earlier, but we expect votes between 11 15 and 11 30. Were not going to recess since well be voting in shifts. So the full Committee Chairman has agreed to chair the hearing when i go over to the capitol to vote. So thank you for that. The chair now recognizes the chairman of the full committee, mr. Pallone, for five minutes for his Opening Statement. Remember to unmute, please. Thank you, chairwoman for convening the hearing today on 22 bills to improve both quality and access to Mental Health care in our country. And of course i want to welcome back our former colleague, Patrick Kennedy who i have to everyone knows now, if you dont, ill tell you, is a new jersey resident, a resident of the jersey shore which im particularly fond of. I understand coming from the ocean state to the jersey shore. Youve been there for a few years now. Thank you. Good to see you, patrick. This hearing is particularly timely as our nation is simultaneously confronting a Global Health crisis, a severe economic downturn and centuries of systematic racism. All three of these crises are triggering distress for millions of people and compounded by the fact that many people are isolated from family and friends. Its no wonder that nearly half of americans are reporting that their Mental Health has been negatively impacted. Mental health is an essential part of our Overall Health and wellbeing. Weve made progress to better Corporate Health care into our system, which i think patrick was involved with. And the Mental Health parity act of 2008. Thanks to the Affordable Care act, millions of americans have access to plans that include Mental Health services. The aca improved access by requiring individuals to cover these benefits. As a result millions of americans can now access Mental Health services and Substance Use Disorder Treatment without fear of out of pocket costs that deter people from seeking treatment. And the aca applied parity to markup plans. We continue to build on this progress in 2016 when president obama signed the 21st century cures act into law. It expanded access to Mental Health services, and reauthorized important programs including those focused on Suicide Prevention. Again, thank you, congresswoman, for their role in that. And taken together, all of these changes have made a true difference in american lives. Theres a lot that has to be done to help people in need. In 2018, more than 47 million americans said they suffered from a Mental Illness over the past year, including 11 million who had a seriously Mental Illness. Research estimates that more than 7 million American Children have a Mental Health disorder and too many of these conditions in children go unidentified and untreated and research has found large disparities in the services with black and latino children. According to surveys roughly half of individuals experiencing Mental Illness will experience a cooccurring balance order. This is particularly important as we continue to respond to the Opioid Epidemic that claims 130 lives every day as well as emerging epidemics involving cocaine and methamphetamine. Unfortunately, suicide has been on the rise. In 2018, more than 10 million americans seriously contemplated suicide and 1. 4 Million People made nonfatal attempts. Suicide is one of the top ten leading deaths in the u. S. And the second leading cause of death among young people ages 10 to 34. Less than half of those get treatment citing payment for services for not seeking treatment and stigma and fear of discrimination as reason for not seeking treatment. Many others report difficulty getting access to providers. And this speaks to the urgent need for additional action for those in need. Were considering a variety of policies to improve telehealth and in the emergency room and Suicide Prevention programs. Taken together, these proposals are focused on improving our nations wellbeing. I want to thank our witnesses. Thank everyone. This has always been as has been mentioned, a bipartisan issue for our committee. Many people have spoken out. Many people have told their individual stories which is often difficult but i admire those who do that. And, again, thank you, chairwoman, this is a important hearing. We do intend to move bills. Thank you, again. We thank the chairman of the committee and he yields back. Its a pleasure to recognize the Ranking Member of the full committee, mr. Walden of oregon for his five minutes for Opening Statement. Good morning, madam chair. Thank you very much. Good morning. And i thank you for holding this hearing. I think its really important and one that we have a lot of work to do on. I would share some frustration at the outset about the bills and the lineup. Im hopeful that we can work through some of these legislative initiatives where we found some agreement but hearing the underlying bill. As the chairman said, this has always been bipartisan work, Mental Health issues do not pick us by our Voter Registration and theres a lot of bipartisan work done here. I must express a little frustration. I had trouble getting on, maybe thats where my frustration starts this morning. But were going to role through with the votes because the way were voting in the elongated voting and all, i know some of our members are a little concerned about missing out on some of the presentation and the q a with the hearing going on and i think for a future period, we should have a discussion about how we do that. Too many of us have lost loved ones because of suicide. Like my friend, former oregon u. S. Senator who lost his son Garrett Lee Smith one day before his 22nd birthday. I worked with senator smith on the original Garrett Lee Smith act which provides information and training for Suicide Prevention, surveillance and intervention strategies for all ages. I was proud to see this program reauthorized and expanded in cures. Many of the bills will further improve crisis intervention and Suicide Prevention. Im looking forward to working with our colleagues in the majority to move these bills through the legislative process. Consideration could not come at a more pressing time as we know, covid19 and resulting economic downturn have impacted the Mental Health and wellbeing of all americans. A recently released report by wellbeing trust predicted that an additional 150,000 americans could die because of suicide or drug and alcohol misuse as a result of a the pandemic. These deaths from despair, as theyre called, will likely increase as continued lockdowns further isolation and deepen the economic downturn. States will need resources to help prevent them. Im concerned that one of the bills would make states ineligible for Mental Health and Substance Use disorder grants if they cannot meet the bills mandates. Certain states would be stripped of all funding including Substance Abuse prevention and treatment and community Mental Health Services Block grants. My friends may not have considered that these mandates are impossible to meet a many states do not have yearround legislatures. It could cut funding when its needed at the most. Its not acceptable. I wish the majority would take the time to work with us on consensus language on some of the bills today. But we covered that and well look forward to working with you as we go forward. With that, i will yield back knowing we have votes coming up. Thank the gentleman and he yields back. I now would like to introduce our witnesses for today. First, the honorable Patrick Kennedy. Hes the founder of the Kennedy Forum as well as as we all know, a beloved former colleague of the house of representatives and a representative where he represented Rhode Islands first congressional district. Welcome to you, dear patrick. Thank you for being with us. It means everything to us to have you here with us. Dr. Arthur evans jr. The chief executive officer of the American Psychological association. Dr. Jeffrey geller is the president of the American Psychiatric association and the director of Public Sector psychiatry at the university of massachusetts school. We have the National Youth Advisory Board member of the Sandy Hook Promise students against violence everywhere, called s. A. V. E. Welcome to you. And thank you for being with us. Were so pleased. We really are. Its an honor. Former congressman Patrick Kennedy, you are recognized for five minutes and please remember to unmute. We dont want to lose one word you have offered to us. Thank you. Thank you, madam chairwoman. Its great to see you always, your family. And i just want to say, in addition to your being family, its nice that you shared your opening remarks with family, my cousin joe, who does everything i tell him to do on Mental Health and im so honored that hes a member of this committee which has such important jurisdiction over this important critical issue to our nations health. And i want to thank chairman pallone for his leadership, chairmfor the opportunity to address all of you. I see so many of my former colleagues and im so grateful for the opportunity to see your face as some of whom are covered by face masks. Kudos to you for setting a standard and a model. You know, i get acknowledged for having some great courage on this and it often was the case with my great colleague and coauthor of the Mental Health parity act, republican jim ramstad. We can say its one in four or 50 , but we all know in our own lives, its every family. And jim always used to say, patricks got the same kind of profile in courage as his uncle president kennedy and i would stop and say, i didnt have any courage in coming forward. What happened to me was the guy that i was a drug rehab with at 17 wrote about being in drug rehab with me in the National Enquirer and sold his story to the National Enquirer. I had no out. It was i wanted to keep the fact that i had suffered from addiction from an early age private. I didnt want anyone to know. And what ended up happening was, i had no choice in the matter. I came from a public family. And unfortunately, like everything else, it always made public. I would say that was probably the best thing that ever happened to my in my life. In the sense that for one thing as a congressman, i didnt have any fear for being an outspoken proponent for Mental Health. And it was because i didnt have to worry about the press reporting about why i was a supporter of Mental Health because they somehow had the goods on me. That they could hold it against me that i would disclose this private factor in my life. And it also helped address the main point and that is that we keep these illnesses secret and these illnesses being secret are the reason why they are exacerbated. Let me just say, in recovery we say were only as sick as our secrets. And i would say even though weve made great progress on Mental Health, were nation becp these things secret. I think in recovery, we have phrases like, you know, you got to walk the walk, not talk the talk. In our country we have really just talked the talked. Weve never walked the walked in our country on par as we would cancer, cardiovascular disease or any form of treatnt that we would expect from our medical system. Finally i would say that denial is the big issue here. We all know growing up in families where theres alcoholism and addiction or Mental Illness that we dont like to talk about these things. I think the reason that weve not addressed this issue is because were still in deep denial about these illnesses and their pervasiveness. And the evidence in exhibit a in that is the fact that congress and the country has really never appropriated the necessary resources for this crisis to the chairwomans point earlier. And theyve never enforced the parity act, which as i said, was a bipartisan bill that says treat these illnesses like other chronic illnesses. And until theres that same urgency towards enforcing and until theres that same money backing up our words that these are really equal illnesses, were really still in denial as a nation. And i look forward to hearing my other counterparts to testify and to answering any of your questions and my time is up. Thank you for letting me share. Thank you, and we need to heed your words, patrick. Thank you very much. Now, i would like to recognize dr. Evans. Youre recognized for five minutes and please remember to unmute, doctor. Thank you, again, for being with us. We so appreciate it. Thank you. Chairwoman eshoo, thank you for this opportunity to testify today. The American Psychological association, its a leading scientific and professional organization representing psychology in the United States with more than 121,000 researchers, educators, clinicians, consultants and students as its members. Even before covid, our Mental Health system was facing severe challenges. Less than half of the individuals with the Mental Health disorder received treatment and only about one in nine individuals with Substance Abuse disorders received treatment. The tragic result is that we have multiple crises happening simultaneously. We have a pandemic that is creating a number of psychological challenges for individuals. We have on top of that an economic crisis that is always contributing to the psychological distress of americans, and then on top of that, more recently, we have been dealing with systemic racism and the impact that that has on many of our fellow americans. All of this results in data that show consistently across a number of different sources that we are seeing increases in anxiety, depression, post Traumatic Stress disorder and eating disorders. This is having a disproportionate impact on marginalized communities. The Public Health term for this sysdemic. It impacts those already at higher risk for poor health. To address this, we need a populationbased approach that targets appropriate interventions across a population including addressing social determnance of health. When i worked as commissioner for Behavioral Health in the city of philadelphia, my Agency Working with the Housing Agency leveraged section 8 housing funding with medicaid funding for Mental Health services to address homelessness. As a result of this, we were able to improve Mental Health outcomes, we were able to get over 800 people off of the streets of philadelphia, and we saved literally hundreds of thousands of dollars. A winwinwin. We need improvements on a number of fronts as would be addressed by the array of bills before you today. This includes stronger parity enforcement, enactment of the equality act of 2008 was a major step forward and my fellow panelists and good friend, congressman kennedy, we will forever deserve our thanks and our gratitude for leading this fight which apa was proud to be a part of along with our colleagues at the American Psychiatric association and many other groups. Unfortunately, parity has not reached its full potential. And we need support for the bills before the committee to strengthen existing law. We also need to give patients better access to Mental Health and Substance Use providers. One of the bills before you, the medicare Mental Health access act, would incentivize it in rural and underserved areas. I want to thank the bills longtime champion, congressman mullen and cosponsors, congressman leon and congressman long for their support. I would also like to highlight congresswomans expansion act. Tms has taken some Great Strides in expanding telehealth across Mental Health treatment which has been critically important in helping patients get the help that they need during covid. Ultimately, cms and congress should make most of these telehealth provisions permanent. In addition to the bills ive already mentioned, we support many others before you today, including the Behavioral Health coverage Transparency Act and the Mental Health parity compliance act, the Mental Health services for students act, the pursuing equity and Mental Health act, and hr6645 to provide additional funds to the National Institute of Mental Health for Research Related to the Mental Health effects of covid. Finally, i commend the leadership on the range of Suicide Prevention bills before you today. Notably, by the cochairs of the Suicide Prevention task force. And members of the committee, im greatly im grateful for this opportunity to testify today and i look forward to working with you to advance these important pieces of Mental Health legislation and i am happy to address any of the questions that you might have for us today. Thank you very much, dr. Evans for your important testimony. The chair is now pleased to recognize dr. Geller. Youre recognized for five minutes for your statement and please unmute. Welcome to you. Thank you very much. Chairwoman, Ranking Member, and distinguished members of the energy and Commerce Health subcommittee, thank you for allowing me the opportunity to testify before you today. My name is dr. Jeffrey geller. Im professor of psychiatry at the university of massachusetts medical school. I testify today as president of the American Psychiatric association. Throughout the covid pandemic, i work on site daily to treat severely mentally ill patients and i see outpatients through telepsychiatry. Im also a parent. One of my sons who has intellectual disabilities goes to work daily where he delivers medical supplies in the hospital. Ive been more concerned about his wellbeing than my own. The covid crisis is exacerbating conditions. Its unmasked clear Racial Disparities and inequity and is were pleased to see these are part of todays focus. Im going to highlight a few areas in my written testimony. First the covid crisis has made the value of your actions clear. Access to video and audio only te telehealth has enabled large numbers of patients to receive care but also minimizing their risks of contracting or spreading covid19. Telehealth is popular with patients and our members, has reduced noshow rates dramatically, and has been quite effective. It is essential that current telehealth authorization not end prematurely. The apa has been working with psychology and others to ensure continued access to telehealth for our patients beyond the current emergency. We encourage the bill which would exempt Mental Health services from site of service restrictions. Second, the only bill before the committee apa opposes is hr884 which would define psychologists as physicians. Psychiatrists, psychologists and other team members like nurses, physician assistants help patients by each contributing in our own area of expertise. The goal of hr884 is unclear since medicare already recognizes and allows psychologists to provide services and practice independently in medicare and appropriate settings. The psychologists are not physicians. They treat patients with Mental Illnesses in inpatient and partial hospital settings. The psychiatrists has to recognize medical disorders. You cannot be equipped to do this without a medical school background. Medicare patients and partial hospitalization programs to require treatment requiring medical supervision and coordination. We know highquality care is best provided by a team working together to provide coordinated services. This legislation would do the opposite. Further fragment and create unnecessary and dangerous silos. Existing guardrails are there for a reason. Hurdles can be addressed without going to the extreme like inappropriately defining psychologists as physicians under medicare. We suggest the subcommittee focus its attention on the oppressive array of proposals before you on which theres broad agreement and little controversy. Finally, theres Mental Health parity. Both apas, my fellow panel lists Patrick Kennedy, and unified Mental Health and Substance Use Disorder Community champion of the law in 2008. Failed to end discriminatory Health Insurance practices. Numerous investigations by state regulators and the department of labor have revealed systematic parity violations again and again. The proposal introduced by representative kennedy and the bill proposed by representative porter can each help improve reporting of health plans medical Management Practices and thereby enhance compliance. We support both bills and recommend the language because it mirrors the language many states have applied to state regulated plans. I appreciate the opportunity to testify today on behalf of the america psychiatric association. We look forward to working with you to improve the availability, accessibility, and affordability of quality Mental Health care across our nation. Thank you. Thank you very much dr. Geller. Weve learned a lot from your testimony and look forward to asking you questions and so appreciate the role that you play in todays hearing. I now have the pleasure of recognizing ms. Gras. Youre recognized for five minutes and please unmute. Welcome to you. Thank you. Good morning and thank you to the committee chairwoman, Ranking Member and all the members on the subcommittee for having me here today. Im a 15yearold rising junior in georgia. Im in my second year serving as one of the only Advisory Board members on Sandy Hook Promises club. It was formed in 1989. Today there are over 3,500 clubs across the nation in all 50 states. They empower us to protect our friends, schools and community from all forms of violence, including suicide. We train students to recognize warning signs of violence and how to seek help. For example, in response to fighting at our school, we created an antibullying campaign. It provided an opportunity to reframe students thinking about themselves and peers. Because of covid, our club is holding calls with a primary focus of supporting the Mental Health of your students. Weve opened this up to the community at large because Everyone Needs help. As a student, i know that Mental Health and wellbeing are more important now than ever before. Suicide is a second leading cause of deaths for students and for black boys, the rates are on the rise. This one is preventable. 70 of students who die by suicide will show a warning sign or tell a friend. Covid is only making this worse. Some students, home isnt the safest place. With no place to go and no one to go to from our schools, its become very stressful, lonely and even dangerous for some students. I have seen firsthand the need for support for student Mental Health. In our school, a year doesnt go by without a student dying by suicide. Im concerned that Youth Suicide has become so common that my School Community and our nation is stuck in a pattern of mourning in accepting these deaths as being thats normal instead of seeing them as preventable and tragic. As students, we see everything, in class, in the neighborhood, and on social media. Were on social media sites that you probably havent heard of. We see more than our parents, teachers and other adults but we arent given the tools to help our friends struggling with Mental Health or speaking about suicide. We need those tools to save lives. Weve seen and been through more than you realize and we can and want to help. Our promise club teaches us how to spot a friend who might be struggling, reach out and help and talk to an adult. I had a friend who was struggling and didnt feel comfortable talking to her teachers our parents. He felt comfortable talking to me. I knew how to have a conversation with her and make sure she was supported. Mental Health Challenges go beyond school walls. As part of the black community in the south, theres a lot of stigma on Mental Health issues. Affording that care can be challenging. When i needed to see a therapist, i had to travel two hours to talk to someone. This shouldnt be the case. Unfortunately, where i go to school, the counselors are only there to support within with academics and are not qualified Mental Health professionals. Many students dont have somebody to talk to. We need counselors for our minds and academics. We need your help in creating of support in your schools. Allow us to be the eyes and ears of our peers. Give us the tools and training we need to know when our friends may be struggling so we can speak up and prevent suicide and once we do speak up, give us Mental Health professionals in our school. I ask the committee to vote in favor of the bipartisan standup act of 2020. These bills will support Mental Health and wellness by encouraging more schools to adopt policies to train students and provide more Mental Health professionals in schools. The effects of covid are happening in our homes now, whether we talk about it or not. You have the power to help and i ask that you act now to prevent another one of my friends from dying by suicide. Thank you. Thank you very much for your excellent testimony. We now weve completed the testimony of our witnesses and ill well move to member questions and i recognize myself for five minutes for questions. First to patrick, patrick, you wrote the Mental Health parity and addiction equality act. You have referenced it. Others have. Its not working. Thats what you essentially have said. So, as we move forward we have 22 bills. What im interested in mostly as we weave different bills together, what are the major pillars of reform to our entire Mental Health system in the country as your cousin joe said, we have a lot of broken pieces. So what are the major pillars that you would advise us that need to be reformed including getting your legislation to finally have teeth in it . Is because its missing money or did we miss something in the legislation . Thats my question to you. Thank you, anna. I would say it all revolves around the money. And, you know, as we know, you see whats important based upon what you spend your money on. And clearly when Mental Health gets 0. 4 of the c. A. R. E. S. Act funding, it says a lot about where Mental Health is in this country. When you see how many routine violations by Insurance Companies there are of i should say discriminatory practices against people who live in your districts and are family members and friends, just because their illnesses happen to originate in their brain as opposed to another organ in their body, and thats widely accepted. Unfortunately as were learning with black lives matter, so many things that we have come to take for granted are just routinely accepted. And i think we are in denial as a nation about Mental Health. It is weve been at it a long time, accepting it as a moral failing and not a medical failing. That kind of grows on you. It gets to make you think that, you know, someone is to blame as if they get up in a given day and think that, you know, trying to lose their job if they have one or sacrifice their housing because they jeopardize the rules of the housing or that they piss off or alienate their friends or family members is all a part of what someone voluntary chooses to do in any given day which of course we know is not the case. So why cant our country get over the fact that these are biologically based disorders and behaviors but a symptom of them. Thats what the neuroscientists at nih tell us. I would say if we can understand that as the premise, then why wouldnt the models which were, by the way reimbursed for all kinds of Health Benefits rather than sick benefits for cardiovascular disease. Ive been on lipitor for 20 years. Our Health Care System thinks its best if i dont die from a stroke or a heart attack in ten more years. They invested that much in me. But when it comes to Mental Health, theyre missing in action. And so and yet we allow that as a society. We dont enforce parity laws both at the state or federal level. There are now some state that is are doing a terrific job and stepping towards that. But the as far as youre concerned, our department of labor, i know which is regulated by one of your colleagues committees, needs to step up and pass an enforcement action so that we hold these insurers accountable. Thats what i would say in a longwinded answer to your question. I hang on every word that you say. Just very quickly, i only have a minute left. But would either one of you like to weigh in about major pillars and how you would reform the system . I could respond to that. I think Patrick Kennedy is exactly right. In the entire history of your country, weve always tied together any reform in Mental Health care with saving money. Traveled around this country and testified before the house and senate said two things in every one of her messages, we can save money and we can do whats right. If were going to address this problem, we have to say we need to do whats right and its going to cost us some money. If you go in for a surgery for cancer, no one asks, how many money is that going to save . I think my time thank you very much, doctor. I think my time has expired. And so i now will call on, recognize dr. Burgess for his five minutes to ask questions. I thank the chair. Dr. Geller, i want to thank you for raising the concerns you did about hr884. It seems like too often in this subcommittee we dismisses or ignore or devalue the benefit that a medical curriculum can actually bring to a persons background and i appreciate you for highlighting that. One of the other things that i mentioned in my hoping statement is my concern about i dont think we have a bill in front of us today that is specifically looking at helping our Frontline Health care providers. We knew that suicide was a problem amongst our colleagues prior to the on set of this coronavirus epidemic and i know its more pronounced now. So do you have any recommendations for us on this subcommittee who are going to be working through these things. Well have a full Committee Markup at some point. Perhaps the legislation, some other legislation where you would see it where we could modify it to more properly account for and perhaps impact positively our Frontline Health care personnel . I can tell you that besides prejudice and discrimination in relationship to presenting with a Mental Illness, a major problem for the physicians and nurses and other licensed personnel is the fear that they will lose their license to practice if they report that theyve had treatment for a Mental Illness. When i applied for a license and renewal every three years, generally im asked a question in almost every state, have i sought psychiatric treatment and am i mentally impaired or do i believe im mentally impaired. If congress could address that problem, i think it could make frontline workers more willing to seek treatment. The second is, we need to do a Massive Campaign to educate the population about what Mental Illness is. Were familiar with a very ineffective Massive Campaign currently in terms of how to protect one self from covid, but we experienced a very Successful Campaign to remove the prejudice and discrimination against homosexuals in the time of the aids crisis, we dramatically turned that around. In the 1940s and 1950s, we did the same thing with breast cancer. Nobody would say the word cancer. We know how to do it and thats what we need to do. Thank you for those observations. I do mr. Kennedy, i wanted to ask you, representative ferguson and i have introduced a bill and i think i see in your written testimony you talk about schools who embed social and Emotional Learning and as our last witness testified oftentimes amongst the student population, they can identify for you who perhaps is having trouble. So do you have any thoughts have you had an opportunity to look at 3539. Is there any advice you would give us for perfecting that . Patrick, you need to unmute. I have the trouble all the time. Im sorry. Thank you, doctor, for prioritizing that. Its shocking as it is that we dont address Mental Health in our Health Care System, is that we dont address Mental Health in our education system. Because how are children supposed to learn when they cant have their prefrontal cortex operate because theres no coping mechanisms developed. Theres no problemsolving skills developed. Theres no socialEmotional Learning skills developed. So i think that you are absolutely on point that this needs to be a priority and it will be an enormous protective factory for kids, especially since were seeing suicide rates skyrocket. This will help kids learn how to mediate their impulses, which, of course, this is the key factor in helping to do that. So thank you very much our time is always limited here. Thank you. I do want to ask you, though, you reference in your testimony that probably the largest Mental Health Treatment Facility in all of our districts is our county jail. And were looking now at people who are asking for reduction in funding for Law Enforcement, do you see a problem developing here . Im familiar you should also ask the judge who was successfully turned around a major bond for an additional jail down in florida and he took that money and he put into Supportive Housing for those with severe Mental Illness predominantly schizophrenia diagnoses bipolar 1. And he reduced the total docket in his jurisdiction dramatically, such that they didnt have to build a new jail to house all of the people because a good 30 of them were people who were being arrested for routine, you know, charges, loitering, all kinds of what they call nonviolent offenses that would be better picked up by a Mental Health system that frankly as were all talking about today, is nonexistent. So our criminal Justice System has become the default mode for in fact, we dont have a Mental Health system. All i would say to you is that, its not necessarily the case that less is less. If it can be redirected towards what we know is more, which is reducing the total number of people in our criminal Justice System by providing those services which others have spent their lives providing. The Supportive Housing that he talked about in the Opening Statement, thats the solution we need. Thank you for that. Redirecting is, of course, part of that process, not just eliminating. Thank you for your input. Thank you. Im going to follow up with you offline because youve raised interesting points. Look forward to that. Thank you. The gentlemans time is expired. I cant help, patrick, but think of our good friend and his wife norm and judy who have done extraordinary work in this area and the example that you used from florida relative to the criminal Justice System and bringing justice to those who have the Mental Health issues and using the dollars in a very, very smart and effective way. Mr. Pallone is voting. Mr. Butterfield is not there. I believe. Thank you very much. And i appreciate you calling this hearing today. Its an important subject. Theres such a a subject that has impacted many of our own lives. Before i get to my questions, i want to acknowledge that tremendous pressure of our community Behavioral Health centers are facing to meet the demands of this crisis. Theyve been largely excluded from covid19 funds made available by hhs. I urge the committee to commit to working on finding a solution that will guarantee adequate aid for those providers to avoid permanent losses. Prior to this pandemic, my colleague representative johnson and i introduced the teleMental Health act. It removes restrictions. In sacramento, our community Health Centers have been using telehealth to help patients get regular treatment. A local fqac has seen encounters in patient visits increase by 50 . Theyre conducting 80 of Behavior Health visits via telehealth. These visits have a noshow rate of just 10 compared to 40 for facetoface visits. With that in mind, i want to ask about the new reality of widespread virtual care. Dr. Geller, can you expand on how lifting certain restrictions on Mental Health services via telehealth has changed Patient Access during the pandemic . It does have a remarkable effect. First of all, we have shifted the previous psychiatrists in a poll that approximately 60 had not used telehealth and now 85 are using telehealth for about three quarters of their patients. Many patients have difficulties getting to appointments, particularly in the period of social distancing, they have no way to get to appointments. Theres no Public Transportation that somebody would use because of infection rates. They cant physically get to an appointment. There are people across the country that are in rural areas that had difficulty before covid and now its close to impossible. Telehealth actually makes Psychiatric Services available to a huge percentage of the population that didnt previously have available services. Right. The combination of allowing visual or telephoneonly servic services is very important. Because we have many patients who dont know how to use that. At the outset of the pandemic, cms made certain that all connected Health Services would be rebimbursed at the sam rate as inperson service. Why is that critical to sustaining the use of telehealth. Its the key driver in terms of ability to provide the Services Necessary because while theres a suspension now, people are using it, thats not going to continue unless the biggest payer of all steps up and pays for it. Its deemed equally effective to inperson. Why we wouldnt pay the same is beyond me me. You guys need to really sit on cms to do that. And have you also, to your point, congresswoman, you have to do, like you said, make sure the money you already appropriated for Health Care Relief goes to Mental Health providers. Theyre the ones who are getting the shortest of the short end of the stick in terms of the money. It went through medicare as a mechanism, not through medicaid just as a highlight for your colleagues who dont know why their Behavioral Health providers are barely hanging on, if at all, in their districts. I really want to thank you, patrick for your advocacy. Its been unbelievable. Medicare beneficiaries access to telehealth treatment for Mental Health services regardless of where theyre located, i encourage my leagues to support this as we look ahead to support similar services. And i see that my time is already gone. I yield back. Thank you. The gentlewoman yields back and were all very grateful to you, congresswoman matsui, for your special leadership. Its highly personal. As patrick said in his Opening Statement, we have family members. We have family members. And so we carry those experiences and those wounds with us and you certainly have and thats why your advocacy and work is so important. The chair would now like to recognize with pleasure the Ranking Member of the full committee, mr. Walden, for his five minutes of questions. Mr. Walden with us . Well go to mr. Upton. Thank you, madam chair. I really appreciate this hearing. Its really terrific to see my ill say old friend. Patrick and i go back a long way. I was one of the team with him that looked at Mental Health parity a long time ago but obviously we still need to step up. We need to do more and his friendship, his advocacy, with other key players, certainly in our committee, really makes a difference. And i think the point that he made early on where one in four families directly, but lets face it, every family, directly impacted by suicide and things that we know we can do to really make a difference to begin to turn that around. Ive got a couple of questions and i want to follow up with what doris was talking a little bit about earlier and that is the impact of telehealth. You know, we hear so many cases of folks, patients not showing up at doctors offices. Telehealth is a real key and of course we know that there are so many areas around the country that are underserved, that dont have access to broadband. I know that mr. Clyburn and i have been very active in introducing some legislation i think youll see some additional legislation that were going to introduce literally in the next couple of days that would require actually to auction off some of that spectrum and for states like mine, underserved, michigan is going to get about a billion dollars in the next ten years. 108 million each year for the next ten years. And i have areas that in my district without a fourlane road and without broadband. Kids go back to school this fall, their access to e learning is obviously extremely limited. As we look at the benefits of what we can do, not only working with cms, but also working to make sure that patients have access to that i look at what we might be doing with 21st century cures 2. 0. Weve had good conversations on how we might be able to expand telehealth and also look at cms to make sure theyre using those services. I might ask both dr. Geller and evans, what additional things can we dos it relates to telehealth for Mental Health services . Congressman, i would say a couple of things. One is that in addition to supporting the principle of telehealth, it helped with access for a variety of people, not only in rural areas but in urban areas. When i was a commissioner for Mental Health, we had immigrant communities in our city that had fairly large immigrant populations that didnt have Mental Health professionals who spoke their language in the city. And so telehealth was a mechanism that we could use to reach those communities that even in urban areas can be a challenge in serving. There are a couple of things. One of them is to understand that for many people who dont have broadband, having telephonic access for telehealth is extremely important. We fought very hard for that provision with cms and unfortunately we were able to get that. But its not just having Video Conferencing ability, which many communities dont have, but its also being able to do telephonic care as well which is very important. So i think making a longterm commitment to this is going to be very important for continued access. I might just add this, 2019 nihfunded study, found that patients who were admitted to Emergency Departments due to selfharm had a higher decide rate following their discharge. How important is it to screen for suicide risk in Emergency Departments and followup care . Its extremely important. One of the things we know is that for people who die by suicide, most of them, the majority have visited a Health Care Practitioner within the last year. And theres a health care Pr Practitioner in the last year. A high number of people die by suicide who had an emergency room visit in a relatively short time around their suicide. Doing screenings in Emergency Departments is very important, having surveillance mechanisms. I can tell you as someone whos overseen Mental Health systems, one of the most important aspects of this is to have connections between Emergency Departments and the local Mental Health system. Too often people are evaluated. If theyre not meeting criteria for involuntary commitment, theyre discharged without a good connection. And thats where you see a lot of the problems with people who die by suicide who have had recent visits to Emergency Departments. Thank you. My time has expired. The clock goes way too fast. It really does. We all have i have 27 questions i want to ask, but i cant. The gentleman yields back, and thank him for his questions. The chair would now like to recognize the gentleman from north carolina. And the gentleman he is, mr. Butterfield. And mr. Butterfield, i want to ask you to i have to vacate the chair to go over to vote, so i ask you to fill the chair and be recognized for your five minutes of questions. And thank you. Thank you to the chair. I just left the floor a few moments ago, and they are, indeed, waiting for you. So, thank you for allowing me to sit in your chair for just a few minutes. The chair will now recognize himself for five minutes. Let me just start with our dear friend Patrick Kennedy. Patrick, all the members on both sides of the aisle have said such nice things about you, and i just want you to know that they are all deserving. We appreciate you. We miss your service here in the congress. Thank you for the incredible work youre doing all across the country. Patrick, while we have made progress in normalizing conversations and reducing stigma about Mental Illness, it is clear it is so clear, and youve made that abundantly clear in your Opening Statement we have such a long way to go. You note in your testimony that the promise of the Mental Health parody and addition equity act has not been realized and that Many Americans are encountering variance when seeking professional help. Im sure that many individuals give up and just absolutely give up after receiving denials and limited benefits. Areas to care can close a window for opportunity for an individual to get the help they need results in serious harm to the individual. As you pointed out in your testimony, societal and economic losses in your country is experiencing crises on so many different fronts from covid to the epidemic of Police Violence against africanamericans. Now more than ever, the process to seek health should not be a barrier to receiving help. Question. What should we do . What should we do to enforce Behavioral Health standards and regulations to ensure that beneficiaries are not encountering needless road blocks to receiving the care that they need when they need it . Thank you so much, g. K. Obviously youve got before your committee a couple of different bills, both of which are very, very important to help bring Greater Transparency to really what Insurance Companies deliberately on on fus kate which is they hide behind this seeming confusion as to how they determine someones medical necessity. Well, we have in the federal law very clear guidelines that are now being adopted by all of your respective states to bring absolute clarity based upon the administrative rule to enforce the federal parody act. So, i would basically encourage you to pass those parody bills that you have before you because, as you said, g. K. , whats its really about is Insurance Companies know that its going to take forever for you to appeal their denial. Counting on it is a cost of doing business. So, so many people just who are in a Mental Health crisis, families in Mental Health crisis, they have nowhere near the wherewithal to challenge a major payer, a major Insurance Industry, so they give up. Thats what the Insurance Industry counts on. As a result the Insurance Industry reduces liability to provide care because they basically deny care. And yet, if you looked at a comparable between the percentage of care they denied thats Mental Health and addiction related versus the amount of care they denied thats medical and surgical related, you would see a huge disparity. And what your bills before your committee do is they will require that to be opened up for the light of day so that theres transparency. And i think if theres transparency, Insurance Industry will be loathed to put together any plan that, when evaluated, will clearly illustrate that theyre discriminating because, as you know, g. K. , through your long work on behalf of civil rights, you know, the more you bring transparency and open it up, the less people have the opportunity to discriminate because ultimately people dont want to be caught discriminating. Or they shouldnt want to be caught discriminating, i should say. So, thank you for that question. Thanks for your service and your friendship. Well, thank you. Thank you as well. I have one other question for dr. Evans, but it looks like the gentleman is running out of time. So, im going to yield back the balance of my time and recognize the next republican. Im being told who that is right now. Looks like its our friend john. Thank you. Its good to see you. I was interested in production and dr. Evans. Thats kind of gone my line. I represent theres 102 countys in illinois. I represent 33 of them. So, what covid has caused to happen, which is, i mean, kind of a side benefit, is it as forced us to ease some of the regulatory burdens on the telehealth stuff. And so i know, doctor, in your testimony, you talk about telepsychiatry. And then we go into this i think a lot of our concern is if somethings working, when this covid crisis fails i mean, when it ends, we dont want these reforms that were created for emergency purposes, we would like to see them continue because i just think thats helpful. Everybody understands theres underserved areas. Moneys going in whether its for us as usda rule development, the fcc. Even some individual states are now starting to put more money to broad band deployment and laying fiber. First of all, let me go to dr. Gellar. I think ive heard requests from 22month extension or more, and i guess what will be asked is why not just because in my perception thats a huge benefit. But do we need time to extend this program now to gather data . And how long should that be . And what kind of data are we looking at, dr. Gellar . Yes, so yes, we do. The an extension should allow for study, and we can look at various outcomes in terms of access. And we could also look at something i mentioned before, but its unfortunately of incredible worth. And that is cost. Because while its going to cost more up front if people have more Services Available and access more services, theres a high likelihood theres going to be a significant downstream savings, not having people go to Emergency Rooms, not having people leave inpatient admissions. We need to look at clinical variables and economic variables to see how this is working. We also need to include the capacity for physicians to work with each other through telehealth so that we have a coordinated care across the board. And that should address lots of the problems in Rural Counties like youre talking about. Yeah, if what would you think would be a time frame that we would need to gather this data . Well, thats an excellent question because we expect that even after the infectious aspect of this pandemic is over that were going to have a Mental Health pandemic that could go on for quite some time. We dont really know how long thats going to be. The apa doesnt have any official position on how long that should be. If you were asking me, i dont think we could know the answer in less than five years. Yeah, i think thats important for us to hear because i am again, this has been such a great touopportunity to exercise and show the benefit of telehealth in your world and also just in the medical practice field for underserved unserved communities in rural areas. Dr. Evans, do you want to add anything to this debate on period of time and our push to keep this when they ease regulatory burdens, we want to make sure we dont replace them once someone thinks this things over. Sure. Well, i think that its important to keep it to recognize that telehealth is only a means to an end. It is a mechanism to provide services that we know work for people. And as dr. Gellar referenced in his point, one of the things we know is that there are significant cost off sets on the physical health side when people have access to Mental Health care. So, i would expect not only will people be able to address their Mental Health challenges, but were going to see savings on the physical health care side. I think this is really critical. Our organization has been working on getting access to members of the Rural Communities. We have relationships with farm aid and the farm bureau, and were currently working with samhsa on a program to train individuals to work with people in Rural Communities. And one of the things that is really clear, we can do our part as an association to train people and encourage people, but we need to have the infrastructure available so people can get those services delivered. So, i appreciate your question. My time has expired. Thank you, g. K. , and ill yield back. Thank you. The chair now recognizes the chairman of the full committee, mr. Pallone for five minutes. Please remember to unmute, frank. Thank you, g. K. Patrick, i wanted to go back i know everyone keeps asking you about the promise of the federal parody law which you sponsored and what more needs to be done. And you certainly talk a lot about it. But i want to kind of drill down again. We have these two important bills introduced by your cousin, representative joe kennedy and representative porter that would strengthen the enforcement of Mental Health parody laws and increase transparency in how the Health Insurances companies are complying with the law. I wanted to ask you about both of those things. Looking back at the implementation of the federal parody law over the past decade, can you discuss the challenges associated with the enforcement and oversight, basically transparency . I know you dont think its been fully realized, but, you know, what remains to be done to deal to achieve parody looking at the enforcement and the transparency, if you would in a little more detail . Well, for one thing, having one inspector for over 1,500 plants obviously lets the whole process go to pieces because how are we going to have any accountability if theres no oversight . Two, what we need to do is really strengthen the requirements that theres kind of a Forensic Audit of the way insurers make these medical necessity determinations. And they need to know under the pills that are proposed before the Committee Really demonstrate how that all works. And, you know, thats a process of evaluating whats known as the nonquantitative treatment limits, a medical necessity criteria. All of which are very crucial to peoples ability to get the care they need in a timely manner. And i know that dr. Evans as well as dr. Gellar, their professions know full well how they get micromanaged well beyond what they ever would expect if they were any other area of health care delivery. And i mean, from the enforcement perspective, obviously just need more staff. Thats what youre there is a call by the whole community for 20 million, would dramatically improve department of labors. I mean, we have nearly 80 of all people in our country are covered under a plan so that oversight is by obviously department of labor. Most people dont know that. But as i would encourage all of you in your jobs as federal members, this is exactly your purview. You need to have your department of labor step up its game. Its absolutely unbelievable. And the time where were losing more people to suicide and overdose and alcoholic death than we are covid more than covid and what do we spend . We cant even get 20 million to even and by the way, for my republican friends, enforcing parody means making sure Insurance Companies dont give the heisman to Mental Health and addiction so that our taxpayers have to pay the difference here. Thats ultimately what happens here is because payers never really fully adhere to this federal parody law, what they end up doing is pushing the cases down, down, out, out, out the door while they dont assume any accountability. And then who pays . The taxpayer pays through our corrections system, through our policing system, through our firefighters and all of their disproportion of time gobbled up by trying to pick up people who are homeless, who are on the streets all because early on, you know, payers tried to save money and they pushed it on to the taxpayers. And really in essence this is corporate welfare of the first order. We are allowing the Richest Companies in our country, the health care Insurance Companies, who by the way are sitting on a boatload of cash because theyve never had to pay any bills for the last five months. And theyre denied Mental Health still. And you cant even make this up. And whos paying for this . The hard strapped taxpayer is paying for it in innumerable ways including through medicaid and also through their local property tax base. So, if i were both a liberal or a conservative, parody would be a big issue for me. Thank you, patrick. And thanks for all your work over the years. Thank you. I see annas back as well. Anna is back. I went as fast as i could. And i want to thank you mr. Butterfield for stepping into the chair. I believe that mr. Walden is the next to question. Is he there . Going, going, gone. Not so, well return to him. Its a pleasure to recognize the gentleman from virginia, mr. Griffith for your five minutes of thank you, madam chair, can you hear me . Yes. All right. I appreciate it. I have submitted a letter for the record from jennifer heist. You heard from her sister, head of the Emergency Department of presbyterian Allen Hospital in new york city. She endured weeks of stress as she worked around the clock to help covid19 patients and battled the virus herself. Eventually the responsibility for human life, lack of sleep, and unknowns of this virus became so burdensome that she became physically unable to continue and sought help for a weekend mental state. She told her family as a result she believed her license to Practice Medicine was at risk and her career could be over. Approximately two weeks later, she took her own life. Today address many important issues, but none would have alleviated dr. Breens concerns. We must consider the Mental Health of the providers on the front lines of a pandemic. I dare say very few individuals could endure the struggles dr. Breen faced without help. I know somebody talked about it earlier why. I was on my way over to vote. I was listening even though i was going over to vote. For dr. Evans or dr. Gellar, do you think doctors should be able to seek help for Mental Health without fear of losing licensure. I spoke about this earlier. Im quite familiar with that case. The answer to that is absolutely. One of the questions is should states even be able to ask the question on your license application. And most states, in fact, cask the question. We have got to start a Major Campaign to address prejudice and discrimination. We use the word stigma, but i think its an unfortunate word. If we used the word prejudice and discrimination, we would understand that its the same prejudice and discrimination against minorities. It is prejudice and discrimination to think that if a person has a Mental Illness, theyre not capable of functioning. You have a panel member right here who addresses that throughout his life. And he is one of millions of examples. We have clubhouses that help people go back to work. We have all sorts of interventions. And i mentioned in my introductory remarks, i have a son with a pretty significant intellectual disabilities who keeps people alive every day in his job by delivering medical supplies that are necessary to the functioning of that hospital. So, yes, emphatically, we need the help from congress to remove prejudice and discrimination and treat it just like all other forms of prejudice and discrimination. Congressman, if i could add something. Absolutely, yes, sir. Your point is a really good one, and one of the big challenges of the way we deal with Mental Health in this country and patrick references is almost entirely reactive. We wait for people to have a diagnosis before we intervene. One of the things we have to start doing is start working upstream. Start providing services to people before they need before theyre in crisis, before they have a diagnosis. One of the things that the American Psychological association is doing is developing information for Health Care Workers and one of the groups thats based on psychological science that tells people how they can help to manage and mitigate their stress and to do selfcare that will reduce the likelihood that their psychological distress is going to lead to one more quick question before i run out of time. I respect a district where access to care is limited and as much as we would like to have si psychiatris psychiatrists everywhere, we dont have them. Do you think hr 945 would help Rural Communities . Absolutely. Absolutely. I can tell you that i spent a good amount of time last year in a southern state, and the major reason that people missed their follow up appointments is they didnt have money to put gas in the car. So and the other is one of the reasons that we have affected attendance at followup visit is that its the doctor who initiates the contact. So, i can tell you in my own experience, ive had lots of telepsychiatry contacts with people that said, i forgot about the appointment. Lo and behold, we had the meeting anyway because i called them. Im talking about expanding the ability of a number of people to be able to provide help to people who arent currently licensed to do so. I think thats important one of the things thats happening in global Mental Health is the notion of task shifting. Not all of the functions that Mental Health professionals do necessarily need to be done by a highly trained Mental Health professional. Many of those things can be other people can be trained to do. In addition to that, peer support is extremely important. And both in terms of engaging people who were otherwise not being engaged, keeping people retained in treatment, and otherwise supporting people in longterm recovery. So, it absolutely is something thats important, another important element to a wellrounded Mental Health system. Thank you very much. I yield back. The gentleman yields back. Its a pleasure to recognize our colleague from maryland, mr. Sarbanes, for his five minutes of question. Thank you very much, madam chair. Can you hear me okay . Yes, very well. Thank you. Thanks for this hearing. To patrick, its great to see you. And to all of the other panelists, thanks for your testimony today. The New York Times recently plan a piece written by an emergency physician in arizona titled i am a Health Care Worker, you need to know how close i am to breaking. Arizona is among the states experiencing some spikes in the covid19 cases right now. This position makes clear the impacts of responding and treating high numbers of the Covid Patients are obviously more than physical. This was true in new york city, other hardhit medical communities that lack the adequate personal protective equipment and testing and respirators and so forth. So, we know the stress of this is like nothing weve seen before. Its taking a huge toll on our Health Care Work force. There are bills under consideration. Katie porter, our colleague, has a bill that would provide support to states and communities for Frontline Health care workers. Paul tonko has a bill to study the impact of covid19 on the Mental Health of americans including Health Care Workers. And i think both of these have been included in a modified fashion in the h. E. R. O. S act. I want to speak a little bit on its been touched on in response to questions from congressman burgess. But maybe dr. Gellar and dr. Evans, you could share your perspective on the best way to deploy the support the Mental Health support and counseling for Health Care Workers because obviously one avenue for this is through the institutions, the hospitals, the Community Health care clinics where they work. But is there also a role to play for, sort of, a separate resource to be brought to bear that comes from outside the four walls of a hospital, for example . So, if you could speak to if you could design the best program through, you know, Employee Assistance programs and other measures to help the Health Care Workers that are on the front line, what would that look like . And ill start with dr. Gellar and then dr. Evans, if you have any thoughts as well. Three components. First is that you have to have the services on site and immediately available. Those of us in health care are terrible at saying no. Were not going to leave at the end of their shift because its the end of their shift when they have people that are dying. So, you have to have services immediately available. Second is the advantages, again, of telehealth. You are much more likely to have a Health Care Worker who has gotten home and can call in to somebody than somebody after working 16 hours and asking to go to somebodys office. And the third, which dr. Evans alluded to previously, is proactive programs right on site. So, if im in the emergency room, i can take half an hour and go to a yoga class. Sure. What i would add to that is peer support is extremely important as dr. Gellar mentioned earlier in his testimony that often people in the medical and nursing professions dont want to reach out for help. So, what we found in working with over 65 nursing associations, how important it was to have peer support groups on floors that people can access, have access to immediately. In addition to that, the kind of selfcare information that weve provided for Health Care Workers is really important because what we do is we talk about heres an exercise that you can do when youre extremely stressed. And then we give people the Science Behind why that works and why thats an effective strategy. So, i think it really is a combination of making sure people have access to care, there is peer support, that there are options to help people understand things they can do themselves, and ultimately ensuring people can have access to care when they need it. This bill is already in place. As you know, for on kolgss, particularly pediatric on kolgss and others, they have the support systems. Mayo clinic where i went to drug rehab, i learned all about this because they incorporated a lot of the same recovery they had for people with addiction were for people with doctors who were experiencing stress in their jobs and needed ways to learn how to manage their own stress and feelings. Thanks very much, patrick. As i close, thank you for your leadership and advocacy in this area. Two things im coming away with from this call, that you emphasize. Weve got to address the stigma and put the efforts in. Thank you, i yield back. We thank the gentleman for his excellent questions, and he yields back. Has mr. Walden come back . I can recognize him. If not, then the chair will recognize mr. Bilirakis for his five minutes of questions. Is he on board . Not now . Then the chair will recognize mr. Long for his five minutes of questions. Thank you madam chairwoman. Nice to see you. I am here. Dr. Gellar, can you describe to me the benefits youve received from patients receiving care for Mental Health services via telehealth during covid19 . And in your opinion, have the flexibilities provided by congress and the Trump Administration facilitated access the needed Mental Health and Substance Abuse Disorder Services during this pandemic . The greater flexibility and access to telehealth i think has made a tremendous difference. The inclusion of the ability to have appointments has made a tremendous difference. The population is much greater. I have a gentleman who hasnt bought a new electronic piece of equipment since the johnson administration. His favorite activity is to sit at home listening to his records on his record player. Before covid, met every month for 25 years. He only talks to his brother and to me, the only two people he talks to in his adult lifetime. And he and i have a telephone contact every week, every month. And if we didnt have that ability, he would be without services and probably be hospitalized. So, it has made huge differences. And also as i indicated previously, particularly for people who have trouble keeping track of appointments or have some disorganization, i initiate the contact, often by phone, so that i can actually track them down and they actually have an appointment. I think its making a world of difference. And congress should be taking movements to extend this far beyond the infectious pandemic. Okay. Ill stay with you dr. Gellar. Mental health in springfield, missouri, i chaired it about a year, year and a half ago. I also toured it more recently during the pandemic. I know they take advantage of the Mental Health telehealth thing a lot, and very, very vital, very, very important. They also were just issued a large grant which we were happy to see. But i know how important telehealth is, and i appreciate your comments. The u. S. Is facing a serious short fall of Mental Health Behavioral Health officials, as you know. And what will it take to attract more students into this field . There are several things. One is we need a program, a muchexpanded program on loan forgiveness. People can get out of the end of their training with a half a Million Dollars in debt. Thats going to direct them to highpaying specialties, not to lowpaying specialties. So, we need people in primary care. We need people in sipsychiatry d pediatrics. Those are lowpaying specialties, so loan forgiveness would make a big difference. Increase in gme slots, that is medicare funded residency slots, directing those slots to underserved areas. Third is fellowships and those should all be directed by specialties that are underrepresented by psychiatry. Those are efforts that are within the purview of some of the bills that you face that will make a big difference to the work force. Okay. Thank you. Im going to go to ms. Gross next, if i can. Thank you for being here ms. Gross and speaking to us about what youre doing in your community to promote Student Health and wellness. You say that students you see way more than parents and adults. But you arent given the tools needed. Can you tell us about your experiences and what tools would be beneficial for you to help a friend struggling with Mental Health and for creating a system of support for students in your school . Yes, thank you for that question. So, one thing that it has taught me is being able first you have to learn how to communicate with people. Thats one thing we focus on, reaching out to the community. We go out to different schools and build communities where people feel comfortable with each other, where somebody feels safe enough to speak about this kind of thing. We have trusted adult training. So, we train people to bring their communities together by being there for students because students, we go through a lot. And i think that at least in my perspective, thats why we need we need our peers as well as help within our schools because we dont have a lot of that around us. And so it has allowed me to learn how to do that so that i can help my peers, so i know how to explain how to help them. Thats one reason im here today. Im here today to get this message out and let people know that there is help beyond just being in a state where you dont feel comfortable. So, just offering that. They taught me how to communicate and how to build communities so that people feel comfortable. Very good. Thank you again very much for being here today. And thank you to all our Witnesses Today for participating. Madam chairwoman, i yield back. Thank you. The gentleman yields back and i thank him especially for the question that he asked of the witness because the student population is just so important and we really need to address that and make sure that they get exactly what they need. The chair would like to recognize the gentleman from oregon, mr. Schrader. Is he available . Not seeing or hearing him. The chair recognizes mr. Kennedy. Mr. Kennedy available . Not in his chair. Then the chair will recognize the gentlewoman from New Hampshire, ms. Kuster for her five minutes of questions. You need to unmute. Thank you. Thank you very much. Thank you, madam chair. I appreciate this hearing. And i appreciate the opportunity to address you on this important issue. Here in New Hampshire, weve had a dramatic increase of depression, anxiety, trauma and grief as a result of covid, and we are struggling as well with changes to the Economic Impact on our Health Care Providers, particularly Mental Health providers. 83 of small and large group Substance Abuse disorder providers have experienced what they would describe as a significant Financial Hardship as a result of covid. And 48 of those survivors have had to cancel incomegenerating events while several incurred events including ppe. Across the board weve experienced loss revenue of 23,000 per organization in just the first three months. So, i wanted to focus my questions on some of the conversations that weve been having today including the impact on Substance Use disorder. The Opioid Epidemic has taken a big toll here in New Hampshire. We have increase in deaths from opioid overdose as well as focusing in on trauma. We had some conversation. I think it was mr. Burgess talking about Mental Health and Substance Abuse Disorder Treatment in prisons and jails. And i wanted to direct my questions to dr. Gellar. You had mentioned this in your written testimony. I have legislation, the Humane Correctional Health Care act, which would repeal the medicaid inmate exclusion and allow health care to follow an individual through the Justice System so that they could access Mental Health and Substance Abuse Disorder Treatment while incarcerated. Could you comment on that, dr. Gellar . And how that could make a difference in terms of the outcomes . And i think there was also comment about how people are being incarcerated for their Mental Health challenges. I think representative kennedy talked about that. So, i think that your state motto, live free or die, now has another meaning. It means that im going to leave free of services, and im going to die. So, it is extremely important. Im personally delighted by the notion of removing the medicaid exemption. I thought for a very long time we would never solve this problem. If people cant get services when they get incarcerated when many times they get incarcerated because they had a psychological problem. I think that can make a huge difference. In term of you also mentioned small providers. And that is something that Congress Needs to attend to because they are really the bedrock, the Public Sector Substance Abuse programs, community Health Centers are really taking care of the disenfranchised population and having tremendous problems currently because they are not beneficiaries of most of the covid funding thats been coming from the federal government. I wanted to also ask i recently was visiting with our excuse me, my time is getting short. I also was visiting with our state prison recently, and i was told that 100 of the women in the state prison are survivors of trauma, sexual assault, Domestic Violence, abuse and neglect as children. We im very concerned during covid. I chair a task force to end sexual violence. Its a Bipartisan Task force. We recently had a round table about the increased incidence of sexual assault, and during the stayathome order children that are at home with their perpetrator, predator. Do you have any concerns or how could we go about this as we reopen . And again, my time is short. Just one really quickly one of the problems weve had its circular. Ive had patients who when they get released from jail and fall into the serious trauma category commit crimes to go back to jail because its the only place they have where they can feel any safety or comfort. Thats a huge problem in our society. New problem with Domestic Abuse is a significant problem. We have people staying at home together, people who are afraid to report, people are afraid to leave home to report. We have to be cognizant of that phenomenon and specifically address it. It has not been talked about a great deal. Well, i thank you. Madam chair, i yield back. I very much appreciate this hearing, and i think these are critically important issues for us to address, especially now during the covid. Thank you, i yield back. The gentlewoman yields back. We thank her for her excellent questions. I see the Ranking Member of the full committee has returned, just took his mask off. The chair recognizes my good friend from oregon, mr. Walden for his five minutes of question. Thank you, madam chair. I appreciate it. I appreciate this hearing and our witnesses and the work they do in the communities or in their schools. Thank you for what you do. Its good to see our former colleague here on the screen as well. And sure appreciate youre continued speaking out on these so important issues. Were getting there but not fast enough. Theres more to be done. Thats part of the question i want to direct to you patrick. What is it when you look at these bills and there are obviously some. What are the gaps . What are we missing here, especially when it comes to day that that could better inform us on things to do . I know money is an issue. Mental Health Resources are always an issue. We tried to increase funding in communities like we did with the opioid legislation. As you look at these and know the realities of washington, what are we missing . Thank you. I would say that if i had a magic wand, i would fully fund the Nurse Family Partnership in this country which would ensure that every atrisk mom would be able to get the wrap around services. The pay off of that is so wellestablished, but the problem in our Health Insurance system as in our society is that we dont often measure the longterm pay off. If its not a quarterly pay off or an annual pay off, we really dont see the real Value Investing in Mental Health early to the previous question about trauma and really doing the kind of systemic things in society that could mitigate the impact of trauma. So, in terms of, you know, obviously the parody laws that you to enhance. I could answer more there, but let me go to you. What it could particularly be helpful with in addition to that. I would do first instance of schizophrenia. If i had a magic wand, i would not only do nursefamily partnership. I would say every first instance of schizophrenia in this country, we provide coordinated rapid response. If you did that, you would change the trajectory of long term comorbidities and illness due to Mental Illness in a dramatic way. And i see this every day. And for the life of me, i dont know why as a nation we do not make that a done deal on a bipartisan basis. You would automatically reduce number of people in jail, in prison n our country overnight. I dont know why our General Accounting Office if i were you, a chairman, i would find a way to have gao or omb come up with some kind of accounting because you all know. You dont spend anything that you cant find off sets for. Thats part of the big problem here. We all know this stuff works, but you have to find a way of justifying to spend money on those things because invariably it will come out in other programs that you think are equally worth while but frankly may not have the pounds per square inch of a solution that these do. Yeah, its really good counsel. I did a town meeting several years ago, one part of my district, and i remember we were doing the opioids issues and Mental Health issues and i remember one of the Law Enforcement people kind of made that case. He said, look, we get somebody in we pick them up because theyre off their meds. We get them into in this case a county jail setting. We get them back on their meds. Theyre stable. And we know once theyre released were going to pick them up again. And this seems to be a huge gap, still, in the country, trying to get that help to people. Were part of a pilot. And it may be going on in New Hampshire as well where we have Mental Health people that interseed before the arrest occurs. Theyre there 24 7 on site and theyve been able to do diversions and keep people out of jail, get them the help that really they need. I think thats the focus that seems to work. Ms. Gross, thank you for speaking up. Thank you for the leadership that youve provided. When it comes to kids, what are we, quote unquote old people missing here . What can we do more . We know were missing a lot, so ill just stipulate that. But from your perspective. I think a lot of what we need is just people to listen. I think a lot of times what we think and feel are down played because, you know, theyre just kids. They dont know what theyre feeling. But i think thats why from my perspective coming around and allowing our peers to be there for us with the stand up act or having them to act professional to know what were going through and know that kids can go through these kinds of things is really important. And giving to have that voice and be listened to because we have concerns and we go through a lot. So, just being able to have people who listen and care is really important. I appreciate that. Thanks for your work. Madam chair, thanks again for this hearing, and i yield back. The gentleman yields back. And thank him for his excellent questions. Its a pleasure to recognize the gentleman from massachusetts, mr. Joseph kennedy, for five minutes. Excuse me. Madam chair, thank you, and thank you for calling this incredibly important hearing. So, patrick, ill start with you, my friend. So, you mentioned in your Opening Statement in written part, but i want to have you have the opportunity to remind us how long ago that you were able to get the Mental Health parody and Addiction Treatment act enacted. Ten years. Over ten years. Yeah. 11 and change i think. Time flies. Thats why youre in congress, im not. Time flies. There we go. So, almost 12 years later though, there are still insurers that are not compliant with the federal law, right . Exactly. So, to highlight the department of labor conducted 187 investigations in fiscal year 2017 and found that 92, almost 50 of those surveyed, were not compliant. In december, gao came out with reports saying the department of labor and health and Human Services commonly found violations of parody requirements and recommended evaluating whether or not targeted auditing is an effective method for mental Degree Health care parody. Youre familiar with those courts . Yes. So, one of the things that Mental Health parody and Addiction Treatment acts along with subsequent parody laws did was ensure plans provide definition on how theyre making decisions. After almost 12 years, all plans, all plans should be doing this and have that information already readily available. For this one i want to turn to dr. Gellar. Doctor, because insurers should be collecting and reporting this information already, should it be difficult for them to make that Information Available immediately . It should not. They should be required to do so. So, knowing that youre not an insurer but a provider, would it surprise you if an Insurance Company were to make alterations and give false impression of compliance with those parody laws . Im sorry to say it would not surprise me. Yeah. So, doctor, if a health plan is not compliant in providing Mental Health services, do you think that should be Public Knowledge . Absolutely. Do you think that it should be proactively publicized in some capacity to protect current and future enrollees . Absolutely because the enrollees have no capacity to do this on their own. Do you know how many health plans are in the department of labor alone, dr. Gellar . Im sorry. I do not. 2. 2 million roughly. So, 2. 2 million different plans covered by dul alone. So, i believe because of the wide number of plans and the fact these plans have not yet come close to earning our trust or their patients trust, we not only need to have random, robust and immediate audits but also approximate Public Disclosures of parody compliance to hold them responsible for parody violations. The point is to force us to have teeth behind those requirements to allow for that investment to be made up front and to talk about the partnership of nurses. One of the challenges we have is we dont actually have those incentives put in place to require or incentivize that investment up front to provide access to patients and care for patients which is why the largest providers of Mental Health behavior in this country are the jails in l. A. And chicago. You talk to the sheriffs in my home state in massachusetts, 98 of people that have access to health care i would say 98 of people that have health care coverage, you talk to the sheriffs, those the folks at massachusetts run our jails, between 80 and 90 of incarcerated individuals on any given night are suffering from Substance Abuse disorder, Mental Illness or both. In a state with 98 coverage. We are so failing people with mental behavior illness. So, i just want to come back to the fact that patrick has worked on this for a long time, many of us have on this committee. But the behavioral act Transparency Act would increase authority, increase transparency and make it available to the public. That public piece i think is so critical because as you said, doctor, theres no way that patients would be able to get access to this particularly if plans arent making that Information Available. So, how do we possibly hold people accountable if theres no remedy for it . If i can say, sir, right on. And i think if Congress Responds by actually saying youre not allowed to sell your Health Insurance product anywhere else in our market if you dont adhere to our laws. I mean, imagine a Health Insurer comes a coming and saying i want to sell into your market. Its a lucrative thing to sell in the Insurance Market in a given state. Why doesnt the state put up a big barrier and say youre not allowed to sell in our state if you discriminate against the most important set of illnesses affecting our people. What your bill is calling for is the ability for that to be transparent, to get out so that state legislatures can start to enact similar laws like that to help provide some accountability. And to your point on the numbers, its hard to believe, but in your colleagues committee oversees dol appropriations, that its only one inspector i should correct myself from earlier. 2,500 plans. That one inspector have to oversee 2,500 plans from one inspector. So, you need to pass your bill. You need to have greater money to support enforcement overall, and you need to give these states more authority to invoke their own accountability measure by making this more public like your legislation calls for. Thank you, cousin. Great. Im great to see your flexibility. Good to see you again. Thanks for joining us. I yield back. The gentleman yields back, and we look forward to your legislation becoming law, mr. Kennedy. And thank you, patrick, for your for all of your responses. Were just learning so much from you about what we actually need to do. The chair would now like to recognize the gentleman from florida, mr. Bilirakis for his five minutes of questions. Thank you, madam chair. I appreciate it very much. Again, lets see. Im especially appreciative, to me consideration a few of my priorities. Hr 4861, hr 7293, hr 3165. I also want to flag a bill i introduced with congressman soto, the enhanced access to support essential behavioral Health Services act which builds upon the support for patients and communities act to allow medicare and medicaid to reimburse for behavioral Health Services delivered through telehealth. I hope we can consider this great bill in the future, madam chair. And i also want to say hello to my former colleague, Patrick Kennedy, who always did a great job on these issues. Thanks for being here, patrick, and giving us all your great advice. Dr. Gellar, this question is for you. Our nation is in the midst of we have an audio problem. Yeah, were going to im going to give him my computer to work off of. Thank you. Make a little adjustment for that time, mr. Bilirakis. Madam chair . Yes. Okay. We wont penalize you for the timeout. Okay. Very good. Thank you. Okay. Thank you. I appreciate it very much. Ill start with dr. Gellar again. Our nation is in the midst of a suicide crisis, as you know. Over the past several decades, suicide rate has risen sharply, increased 31 since 2001. At the same time, Emergency Departments which are often placed within our Health Care Systems to provide care for people who are at risk for suicide have inconsistent protocols for screening and treating highrisk patients. For this reason i introduced hr 4861 the effective suicide screening and assessment in the Emergency Department act. This bill will assist hospital Emergency Departments and improving their ability to identify and treat those who may be suicidal. What is the potential impact of covid19 on the risk for suicides, and what role can Emergency Departments play in identifying and treats individuals who are at risk for suicide . Dr. Gellar, please, thank you. The effect of covid on suicide is a substantial and actually multifactorial. One is the response to an individual in the stress of the potential for infection. Another is grief, loss and significant depression from people who are losing family members to covid19. And the third, which is probably the newest information, is that we are seeing recent data from the United Kingdom that theres a direct neurocognitive effect on some patients from the covid. That is it affects their brain. Theres an increase risk of strokes, and theres all sorts of other psychiatric presentations. So, we have three rather distinct ways that covid is significantly affecting suicide. Were not doing something right in this country. Of all the developed countries in the world, we are the only one, the United States, who is seeing increased rate of suicide while the other countries are seeing decreased rate of suicide. I think your bill is extremely important. Not only should we be doing suicide screening for people who show up for psychiatric problems, we should have a high index of suspicion of people who show up for other reasons, just like we have a high suspicion when a kid shows up with a bunch of broken bones that maybe is parental abuse, we need people who when they are doing is evaluation for whatever reason are paying attention to a suicide risk. We then need continuous follow up so people dont get lost the day or minute they walk out of the emergency room. Thank you very much. Ms. Gross, thank you for your testimony again today. Ive seen firsthand the promised work and promised plugs in Harvard University high school. My kids go in my district last fall. I agree with you students are equipped and available to prevent all forms of violence. Officer peters and i with the recent induction of suicide training and awareness nationally develop for universal prevention which encourages states and schools to trade utilizing samhsa providing best practices, training and Technical Assistance. You mentioned that to Save Promise Club trained you on how to notice the signs and talk to your classmates who may be struggling. And youve done that. And we appreciate it so much. If students like you werent trained in your school in your d there werent safe promise clouds, what do you think you and your classmates would do if they were struggling with Mental Health . If you can answer that question, id appreciate it. Yes. First of all, thank you so much for that question. Thank you for supporting this act. I think its so important one. In my mind, or in my perspective, have kids begin to start showing signs kids would show signs that they are going through something but they wouldnt be able to express because a lot of things dont feel comfortable in doing that. There might be a lot of kids getting in a fight, it might be the only way they can get this out because it wouldnt have anyone who was like them like another pure or student thats going through the same thing to talk to. They wouldnt have someone to relay that on so you kids with the greats dropping. For running their future really because, you know, colleges and all that stress been put on you, whats a culture in danger to their lives. Thats why i think, in my perspective, its important because it allows to save lives by being there for people who are like us and allows students to step in and help and give another hand to something that is so important. Thank you so very much. Madam chair for, i dont my time was. Look, we always have more time has. The gentleman yields back and i thank him for his excellent questions. Thank you so much. I would like to recognize the gentleman from new york, mr. Angle for his five minutes of question. Thank you madam chair and thank you chairman pallone for holding todays important hearing on legislation addressed ongoing Mental Health crisis in the United States. My district in new york, which includes the bronx and west chester, has been at the epicenter of the nations coronavirus outbreak. This pandemic is taking on total physical, emotional toll on my constituents. All Health Officials have reported a surge in covid19 related mental and was behavioural problems. As doctor evans noted and written testimony, Text Messages as that this dress hotline are 1000 percent in the month of april. It was also a growing concern about a rise in suicide as it was before, which before the pandemic, had increased by nearly 30 in new york state since 2000 and nationally attempt leading cause of death. Doctor geller, id like to ask you, can you please explain why the coronavirus pandemic has exacerbated the suicide epidemic . Wow there are several reasons congressman. First is a reaction to a pandemic where people are required to quarantine. People are spending much more time without social supports and for people with depression, that increases depressive symptoms. Second, we have a feeling of helplessness and the feeling of helplessness is already a key component of depression so we increase depressive symptoms. People dont have contact with family that they have used for support. People are losing family members and they cant even attend a ceremony like a funeral and that is exacerbating depression. So we have people who have depression, who symptoms are much worse and we have people who are developing symptoms who didnt previously have it. As i mentioned in my testimony before, the newest information is, we are actually getting direct effects of the covid19 on the brain itself which is affecting peoples functioning and also increasing rates of suicide. Well the help reduce rates of suicide in the United States i offered the effective suicide screening and assessment in the Emergency Department act with congressman so its bipartisan. Studies show that as many as 11 of all patients visiting the hospital Emergency Department are at risk for suicide and only a fraction of that risk patients are identified. This Bipartisan Legislation would provide 100 Million Dollars over five years to help Emergency Departments improve the identification assessment and treatment of patients at risk of suicide. Madam chairwoman, i ask for unanimous consent but and submitted to the record, a lettered of support in support of our legislation. I thank the gentleman for written request. We will take up all of your consent request at the end of todays hearing. Thank you. Doctor evans, in your written testimony you call the nations rising rate of suicide iv pandemic. Since the nations Emergency Department, counting close to 50 of all Patients Health care visits each year, do you support a more focused approach on identifying and treating patients at risk in suicide or are they still in the Emergency Department such as the approach provided in hr 4861. I do. I know is very important. I know a High Percentage people who died of suicide had a visit in emergency within the last year. When we dont screen people for suicide, we are missing an opportunity to intervene. I do think though its really important to look at this issue as a systemic issue. When design our intervention for suicide we have to do the kind of clinical interventions that you are talking about that our oneonone but we also have to think about the network of resources that are available to people. I mentioned earlier the importance of having a connection between the Mental Health system and Emergency Department but its also important to have prices Intervention Services that dont require people to actually need to be hospitalized or need to be admitted to a service before they can intervene. Those are the things that people have the level of support when they leave an Emergency Department but they can be followed reducing the likelihood that they are going to get into crisis without having a connection to a Mental Health professional. Thank you. Thank you madam chairwoman. Thank you. The gentleman yields back. The chair would now like to recognize doctor busan from indiana. Its he available . If hes not then we will go to mr. Carter of georgia. You are recognized for five minutes for your questions. Are you there . Mics not work. Are you on muted . I am on muted now. Thanks to the Ranking Member who is holding my hand making sure i do everything correctly. And i appreciate him very much. Thank you madam chair and thank all of the panelists here. This is certainly a very extremely important subject but i certainly support the legislation that we are discussing today. I do feel like we need more time to work on some seaming issues and to come to a mutually agreeable place. This, you know, ive been a practicing pharmacist for many years and i know firsthand through personal experiences as well but also through professional experience that Mental Health is not a partisan issue. Mental health is a very personal issue in a very serious issue that we need to not only Mental Health but addiction. Its extremely important and we have to address this in a partisan fashion, in a bipartisan fashion excuse me, and make sure that we are getting everything right. You know i really do, i feel like the administration has done a fantastic job during the pandemic especially expanding tally health. Its been said that kelly health has had ten years of expansion in one week and i think thats true. Before this started there was almost 11,000 telly Health Visits a week, now its only 1 million per week. Telly health is here to stay and something we will work on. I want to ask doctor geller and doctor evans if i could, both about your testimony that congress in the administration can do more to build upon the rapid success of telly health. What can specifically we do to expand telly health and the patient usage of this service as well . I will start with dr. Geller. One is that we can ensure that telly health includes telephonic services, thats the use of a telephone as i described before. The second is that we can ensure that i believe it has been mentioned previously, parity reimbursement, that there should be no difference if a person comes to an appointment or if a person is seen through telly health. Third, we should be putting in components to allow for collaborative care through telephonic and other electronic means that is for example, this coordinating care and thats available service. All of those things would make quite significant differences as compared to what we had before covid19. Doctor evans, if i could ask you, you know, one of the things about that we have come to notice during this and come to realize is the lack of Health Services and a rule in minority communities. How can telly health help us in that respect . Well it can provide services to people who would otherwise not receive them. I think one of the other issues when you talk about telly health, one of the things that we have to fix or to work on is the issue of providing those services across state lines. Right now telly health is limited and regulated by the law within the state. There are a few exceptions to that. When you think about areas of the country where there are not enough practitioners and other areas of the country where they have an abundance of practitioners, one of the ways to solving the problem in rural and frontier parts of the country is to allow providers who are licensed to work across the state lines. Its something we are working at the American Psychological association and its really essential for this to address some of the disparities that we see. Thank you doctor evans. Congressman kennedy, i want to ask you, as i said earlier, as a practicing pharmacist and also as a pharmacist legislator in the Georgia State senate in 2009, i sponsored a legislation that created Prescription Drug Monitoring Program so im very concerned about opioid use. I think weve done a very good job of managing the prescription for patients but the lasting effects are still there. What weve seen is just recently in the last year weve had Overdose Deaths in 11 . Theyve gone up 11 with everything weve done in the way of addiction and thats something that is very concerning to me. I want to ask you, how do you think we can utilize telly health to help us with to treat this and to treat addiction . How can we encourage providers and patients to speak seek treatment . Thank you so much for your question, congressman. As you know, as a pharmacist, addiction is addiction is addiction, it could be opioids today but it could be pencils i as a pm tomorrow and as you know, one of the real impacts that weve never talked about in this hearing so far is bends oh prescriptions have gone up since 30 covid hit. 30 . Not only has Alcohol Consumption far surpassed even very high rates but now we have this so as a pharmacist, you are seeing the full scope of what people are prescribed. Thats crucial data. So we narrowed it down to opioid because it was the quote, Opioid Crisis, but as we know, its really an addiction crisis were opioids are one thing but it could also include any number of other drugs that could also get people in trouble. So thank you so much, congressman, its great you are serving as someone with the experience that you are bringing to this effort in keep asking these important questions. Telly health can definitely help in a number of ways and thank you. Thank you and thank you all and thank you madam chair, i yield back. The gentleman yields back. Its a pleasure to recognize our colleague from california, one for his five minutes a question. Thank you very much for and also Ranking Member bridges and all to the witnesses, thank you for your testimony, your expertise and your Practical Knowledge that you are sharing with us. We are going through a pandemic and lets pray for all those foundlings who have been affected and for all the loved ones who lost family members. Im glad to see us discussing the legislative movement for Mental Health today. I have expressed concerns about our disjointed Mental Health system and the historic wave of Mental Health problems that expert warns are approaching. As mr. Kennedy mentioned, there are no help without Mental Health. Support for schools is very important. All of our witnesses identified schools as an important piece of the puzzle as i was especially glad to hear our student perspective. Miss cross, thank you so much for being with us today and thank you for sharing your experiences today. Mr. Kennedy, in your testimony you mentioned goals around social and Emotional Learning in addressing the student trauma. How could the federal government best support schools with these goals and Mental Health for all . Thank you congressman. Well at first i would overall the way we think of education so that we understand that there is no education without Mental Health just like we say theres no help with Mental Health because how can the body learn new mercy, literacy when the mine can absorb information because of what we understand narrow biologically that there are prefrontal core tex is inhibited by the domain of dr. Geller but i will let him talk about that. The bottom line is we need to give our kids the ability to modulate their emotions and just like they work out and learn other skills, they have to practice the skills and those are problem solving skills, coping mechanism skills. And if they learned these they built resilience and frankly, unfortunately, for too many of us, we learn all the skills after the fact. It would be so much better for all of us if i were kids have the skills as early in life as possible and that would be able to stick with them throughout their education. Doctor evans, in your written testimony you mentioned some challenges schools are facing. Some of my colleagues and i are working on a Technical Assistance and training support from a Substance Abuse and Mental Health administration. What type of support would be most beneficial for schools in School Systems right now . Well i think its important to look at schools. In my role as a commissioner i work closely with the school and the system that i was commissioner for. One of the things is to help teachers have the skill set one children and youth are having Mental Health problems and challenges. Its a big issue. I also think that implementing evidence based approaches like School Climate programs which have been shown to reduce not only violence but to improve School Climate is important. The kind of services that you heard on this talk about, by the way, im a former connecticut im really proud of her to be able to articulate some of the needs of students. You know not every child needs to see a Mental Health counselor or to get into a Mental Health program. Having people, whether they are youth and peers, or even councillors who are simply giving an opportunity for children to talk to them is also very important and then finally having connections to Mental Health services. In my system, we actually embedded those Services Within schools so that children got highlevel Mental Health services there. So its really a range of things ranking from education teachers all the way to having services that meet the needs of children who have higher needs. Thank you and what i dont have time on this discussion to discuss the lack of diversity when it comes to Service Providers in the field in general, whether its Mental Health or physical health, and hopefully we can figure out ways in which, in this country, we can actually encourage and get young people to get into the mental and physical health space so that they can be more of the doctors who look like the patients they are serving. Miss cross, when it comes to education, dont you think its just as important that students identify within each other, not just the parent, excuse me, not just to teachers that identify when a student is having a crisis but the students if we gave them the knowledge and experience to identify, dont you think that would be a good way for us to one investigate the incident on School Campuses . Yes. Thank you for the question. Thats definitely important because, think about it, teachers spend 45 minutes to an hour with a stone every day in class. We get that time on projects and being with our friends to spending that time. So we follow them on social media, these are people that have Constant Contact with. So what we see is very important in fighting this caused. Thank you very much. My time is expired. I yield back. Thank you madam. The gentleman was has completed his questions is dr. John available . I dont see him. Yes, i am coming. Okay. I am starting my day, madam chair woman, as we speak. The gentleman is where recognized for his five minutes of questions. Glad you are there. Thank you. I have another briefing that i had to deal with. First of all, i want to thank you for holding this important hearing. This is the work we need to be focused on i think very challenging times in this pandemic and i think Mental Health gets overlooked. During the midst of covid19, i have spoken directly to Mental Health facilities across my district and the increase and challenges, and honestly, the increasing calls to their health lines, has been dramatic during the pandemic. Youd be surprised. One center i talked to one form receiving two to three cause a week on their suicide hotline for upwards of 20 or more calls every week. And one part of my district, talking to First Responders that normally go out on a suicide call once or twice every two or three months, its once or twice every two to three weeks during the pandemic. I mean its created a pretty substantial toll on the Mental Health of our society. We also spoke to universities who have now left time to figure out how to provide continuing therapy for their out of state students. I wasnt aware of this until i talk to one of my president s in one of my universities and, you know, theres a lot more College Students that are getting therapy on campus i think that people understand. They are shouldve shared to me the differences of therapy has on their students and its troubling they can continue to provide that continued care to their students in many cases because now students are all over the country. This particular university has many people states and foreign countries. I mean the issues of course of reimbursement, liability and sometimes technology. As was pointed on the testimony, they continue to work our past the first visit is really important. Therefore, as we look at Mental Health and tell a health, this is an issue i hope we could address. Doctor evans, do you have any comments may be on what is happening to universities and the Counseling Services that universities provide for their students is and the challenges we might be facing during this pandemic . Sure. We have been seeing a growing trend on College Campus in the rival country of Mental Health need and increase students in our prices on campuses. I think the good news is that i think a lot of College Campuses around the country are starting to pay more attention to this. They are building services. They are building in peer services, which is actually a really effective way to reach students. I think its also important for us to not only make sure that there are services on campuses but there are active efforts to reduce stigma so that people will reach out for help. One of the things that we do a survey each year looking at some of these issues and one of the things that weve noticed is the Younger Generation is much more likely to reach out for and be open to receiving Mental Health services. So thats a good thing but we didnt know that we still have more work to do there in terms of continuing to reduce the stigma so people will retail for help. What can we do in congress to help facilitate this type of activity . Well i think its continuing to support efforts to embed Mental Health services along College Campuses. Its also encouraging Innovative Strategies. For example, in philadelphia, where i was out, we started to do Mental Health screenings and make them available in the community, but then took those same screening tools and put them in a kiosk in which students could walk up in the student center, take a tenminute screening which would not do a diagnosis but it would tell the student whether or not they were exhibiting symptoms that were consistent with depression or anxiety. And then it gave them information on how to connect to those Mental Health services. So for a millennial population that is really accustomed to using technology, using these kinds of Innovative Strategies is an effective way of reaching students who would otherwise not get that help. Excellent. Thank you. Doctor geller, can you talk briefly, because my time is running out, about the complexity of managing both mental and physical health of patients and what the challenges are there because its usually more complex than we think . Its generally much more complex than we think. As i mentioned briefly before, lots of medical illnesses present with the psychiatric presentation and we have to have the ability to do a work up to differentiate. We have a clear example of that now as a integrated with the presentation, so somebody shows up with a psychosis and they are covid positive. The mistake is to send them home for 14 days because a psychosis might be a direct effect of the coat and are literally hundreds of examples of medical presentations that look like psychiatric disorders. Thank you. Just briefly, madam chairwoman, i was a physician before i was in congress for the witnesses, and the complexity of dealing with both physical and Mental Health problems at one time is becoming more and more, i think, prominent in the medical community realizing that you have to deal with the medical issues and with these patients that have Mental Illness or you are not going to support them. Thank you with that and i yield back. The gentleman yields back and i would just say that you are a doctor for life, doctor bucshon. We are blessed to have you as part. Think. You the chair now will now recognize the gentleman from vermont for his five minutes of question. Thank you very much. I want to start with the telehealth. My friend mr. Carter would say, telehealth, its been terrific in vermont and i do think the congress and the president has done a good job in taking advantage of it. Doctor geller, you talked a lot about ive had a lot of feedback from practitioners that contrary to what i expected, the interruptions are oftentimes not only easier but more intimate. One practitioner told me about being able to go on a virtual walk with a client who was in a very rural part of vermont and also how at times it will be relative for other members of family to participate in the call. Can you comment on that, the effectiveness from establishing that intimate relationship and trusted relationship is so essential for the person seeking help and the provider giving help . Sure. It works in both directions. This is something we said for being in the same room but ive had a lot of experiences with patience intel isa kai a tree where not only are they more willing to speak but you have opportunities for in the moment experiences that you can then bring it to therapy so i have a woman who was a simple mom with four kids and sometimes the kids run in and interactions take place and we can actually talk about what just a place. So you are in the moment with patients and that could make a huge difference. Thank you. Another question i have about Mental Health is this one, there will probably get this wrong but there are some conditions like bipolar, schizophrenia, that are chronic with acute episodes required medication, concentrate meant. So much of Mental Health seems to be in that circle of loneliness, depression, the russian of community stability, lack of job, communities getting hollowed out. One of the challenges we face in congress, with our bipartisan commitment to addressing opioids, is that it really doesnt its after the fact, its not providing that underpinning of some security. Folks need stability in relationships, stability in social networks. How much of the explosion in Mental Health situations that we have here do you see as having a connection to the erosion of those communities of jobs, support structures and so on . Because so much that you indicated of the suicide level in europe was significantly low here. Maybe i will start with you doctor evans. Sure. Well what you are referring to we know that there are certain things that we experience that can lead to challenges for us physically and mentally and as you noted things like losing your job, being under life stress, being homeless, all of those things are stress that can lead to Mental Health challenges. Our field has not done a good job of understanding or at least incorporating into our clinical approaches and understanding of those social determinants and using that information to actually help people. I mentioned in the testimony, my regional testimony, the importance of addressing issues like homelessness as a way of actually improving peoples Mental Health. Let me interrupt you there. With respect to that, we followed the activity we are seeing, the activism of black lives matter, are we, in many cases, focusing too much on will ease as the First Responders of first resort rather than the First Response team that dr. Kennedy said we need when it comes to Mental Health issue . Patrick, maybe you could address that . Thank you so much was. I think obviously when you look at the fact that so many of our jails are filled with people with Mental Illness and addiction that clearly a better response than Occupying Police time would be to make sure that proper First Responder teams are in place to Mental Health, first aid responders and the like. Obviously i hope that spin your number of things that you can consider today and it would certainly be a terrific allocation of resources or if you will, reallocation because i think any firefighter would tell you, these days, especially this, spend more other time trying to do First Response to overdoses and Mental Health crisis than they do putting out fires and the same with Police Officers. Most of the cases they get called to may present as a criminal justice issue, but clearly have a Mental Health at the root cause. Thank you very much. I yield back but i do want to say thank you to ariana crossed for her testimony. Thank you madam chair. The gentleman yields back and thank him for his excellent questions. The chair is pleased to now recognize the gentleman from oklahoma, mr. Mullin for his five minutes of question. Thank you madam chair. I appreciate you and holding this hearing because it is an important issue. Something that i have been working on for quite some Time Starting with the 42 sfr part two which i was glad to see was in line and put in with the cares act. Mr. Kennedy, this is a question for you. I know our offices have spoke multiple times about this. I appreciate your insight and the feedback while we were taking this fight on for 42 cfr part two. Your feedback was instrumental and you provided some influence in there that i think really helped with the colleagues on the other side of the aisle, which was a bipartisan approach in this committee. How does this important measure help in the times that we find ourselves especially when we see an increase in Mental Health crisis going on because of the pandemic . Thank you mr. Mullin and thank you for your leadership on this. I appreciate very much. I think, as we just heard doctor geller talk about the occurring in a psychiatric symptom with physical symptoms and conditions. And the bottom line is, when we go into the er, if im going in with covid or Something Else and they dont understand about my underlying psychiatric issues or in the case of addiction, they do not know that i am someone who suffered from the chronic addiction which has a better chance of killing me than any other illness that i face and nothing as critical as the life or death issue of having to fight addiction as a disease, which by the way, when i go to my doctor, my doctor doesnt ask me about my addiction. Because its not in my Electronic Medical record and my doctor has a pen, an electronic pen these days, to prescribe anything that they want and if they do not know that i have the disease of addiction, they are practicing medicine without a license. And thats why i thank you for the 42 cfr because there are hundreds of thousands of my fellows in america who are dying because their medical system does not know they have an underlying addiction because it doesnt show in the mri that theyve been treated for addiction. So i just assume if you are protecting my privacy with respect to anything else that super sensitive, and if if sexually transmitted diseases are protected, then i think Mental Health should be protected by could be protected by hipaa as well. So i think this is about protecting Patients Health, thats why important to have 42 cfr fixed. Thanks. Well patrick, you have been very passionate about this and it was something that affects all of us. I think in your previous statement you said this. Every family is affected by this, my family is no different. In oklahoma we have been affected by Mental Illness in the opioid and Mental Health issue. They are trying to self medicate and all the families have been devastated by this and so i just want to tell you again, i really appreciate it and thank you for your insight and import on that to. Doctor evans, real quick, there has been an increase of almost 900 of Mental Health crisis hotlines, causing hotline this year, now more than ever. Do you think its more appropriate to remove some of the barriers that are prohibiting some of the treatments that could take place for people that are some freeing from Mental Illness . Absolutely. I appreciate that question congressman because, as you know, you are a supporter of aid for which removes barriers in the Medicare Program for a psychologist. It is a travesty that in 2020 we have administrative barriers that prevent people from getting the care that they need. That legislation would allow two things. One is to ensure that seniors who right now are experiencing Mental Health crises of our lifetime have access to psychological care and then the second thing is to make sure that psychologists are eligible for reimbursement, for the incentive payment to work in some of the rural areas and adversaries that we talked a lot about in this hearing. Our seniors have significant Mental Health needs normally. They have exorbitant Mental Health needs under this Current Crisis and it is just not right. It is not right to deny them that care when there are ways to remove and misstated barriers. Let me just say that the barriers that we are talking about have been a moved for podiatrist, they have been removed for optometrists, for chiropractors, for a lot of other doctor really trained professionals and the administrative barriers that we are talking about are only in the Medicare Program. They are not in the va, they are knit not and try care, they are not in private insurance. It is only the Medicare Program where we have the most Vulnerable People in our society and i really appreciate your support and other members of congress so we could remove that barrier and really focused on making sure that everyone gets the care that they need. Thank you doctor evans and madam chair, sorry about going over there but i appreciate the indulgence and i will yield back. Thank you. Well thank you for your good work, mr. Mullin. The gentleman yields back. Pleasure to recognize doctor ruins from california for his five minutes of question. Thank you, thank you very much. We are very happy to have this hearing today on such a critical issue. This is especially important in this very time that we are seeing Anxiety Stress levels go up during this pandemic. This march, for example, the disaster distress how blinds supported by the Substance Abuse and Mental Health Service Administration saw an 891 increase in calls compared to march of last year. The Mental Health system and our country was already strained prior to the Public Health crisis which is why it is more important now than ever to look at ways to expand access to Mental Health for all americans. It is worth noting that if the aca were to be overturned, Health Insurance plan would no longer have to cover Mental Health and Substance Use Disorder Services including behavioural help treatment as an essential health benefit. Having spent my career prior to coming to congress as an Emergency Department physician, i can tell you from firsthand experience, some of the access issues that individuals face. Oftentimes individuals with an acute Mental Health episode end up in the Emergency Department sometimes because there is literally nowhere else to go. Then the emergency physician needs to make a decision either they hold them for a psychiatric to develop evaluation or they hold them because they could not find any transfer man, and the Mental Hospital methods or they just charge them and are unable to start treatments or get them the care that they need because there is not enough primary care practicing psychiatrist on the community or other Mental Health professionals. The biggest concern is lost to follow up, thats a term that we use when you discharge somebody knowing that they need to follow on care but unfortunately because of the system, systematic problems, they are lost to follow up. The Emergency Physicians want to find appropriate care for their patients before releasing them. They want to have them and be able to hand them off to the next provider knowing full well that once the patient walks out the door that they will not take this next step or that it drops dramatically. Emergency departments have implemented innovative approaches to securing on follow on care for patients, like Transportation Systems to get their patients to the hospital to the rehubs, coordinating with area Mental Health providers in a Team Community approach, but they dont always have the resources or capacity to do as much as they want to do. That is why i introduced hr 20 5 19, the Mental Health access which created a grand program for Emergency Departments to transition their patients to a more appoint create care for better treatment. Can you talk a little bit about the specific barriers that Emergency Departments have to be able to give their patients a handoff to their followon care . Sure. As you have indicated most Emergency Departments operate like silos. They have no relationship to the services that follow, unless those services happen to be within the same hospital. So your bill is making huge steps forward in that regard. The second piece of this is we dont have enough beds. So people sit in Emergency Rooms where they dont belong for length of time weve had people sit in Emergency Rooms for up to 30 days looking for a bed. Why cant we find a bed . Because we have people in hospitals but not enough beds, some people in general hospitals that can wait six months to get transferred in some states to the Public Sector. We also have jails and prisons filled with individuals because we have the not enough beds. Your bill does an excellent job with that. It needs to be coordinated with an adequate number of psychiatric. What are some of the barriers the patients face when theyre discharge for follow on care . The ones that go beyond the lack of beds or locations . How can the grant help . The grant can help because we are asking people who are in distress and may have their diagnosis and problems with social skills an organization. We are saying here, heres a phone number, you follow up. They called out for number and they get a recording. This bill would actually create steps to facilitate the emergency room to make sure there is a warm handoff. There is nothing more important and warm handoff. Thank you very much. Your time has expired. The pressure recognizes the gentleman from montana for his five minutes of questions. Thank you chairwoman. I appreciate the hearing today to discuss legislation to improve our Mental Health care system. I appreciate our legislation that i introduced was my friend from virginia and that was included in this hearing. Our bill the campaign to prevent suicide act, our legislation would direct the cdc to conduct a National Suicide education program. This includes advertising for the new nine eight eight number for the National Suicide prevention lifeline. It would also encourage individuals to engage with people showing signs of suicidal behavior instead of ignoring them. We introduce this legislation to compliment the efforts of mr. Stewarts efforts as the suicide hotline, and to ensure funding to implement the designation. To battery spawn to those in crisis we need to have a shorter number. People need to know about it and it needs to be resourced so that those on crisis are not put on hold. This legislation has already been voted out of the communication subcommittee. I hope our bills can join it in a bipartisan markup in full committee soon. These bills were needed before the nation entered this Unprecedented Health and economic crisis. With hundreds of millions of americans worried about their health and millions out of work, henry strict it from social interactions, it is important more now than ever. I support the legislation that is included in the far bill, to prevent farm suicides and the need to address this in all walks of life is only growing. People are hurting in montana and across our nation. We should be able to Work Together and help make a suicide hotline work in this crisis. Madam chair i ask for unanimous consent to enter into the record letters for Suicide Prevention and the Mental Health liaison group. I want the gentleman to note that im going to take up the race quest at the end of todays hearing. So thank you. Thank you madam chair. I also appreciate legislation to expand the use of telephones for Mental Services. I want to go back to the topic of teller health. My home state of montana frequently ranks among one of the worst states for suicides in our country we have a population that is mostly rule, it is very hard to find Mental Health providers for these communities. Can you talk specifically about how telehealth for Mental Services help fill this gap in Rural America . Absolutely. It can make all the difference. I have been to montana and i know how long it took me to get from one farm to the next. It makes Services Accessible to anybody no matter where they are. And if we include the telephone component it doesnt matter if you have access electronically, if you use a telephone. It also means in terms of both of the issues that youve talked about, with the crisis number, we know that a significant number of successful suicide are impulsive acts. If a person has the ability to dial three digits, he can get immediate attention, and that can interrupt that impulsive act. Between that and the ability to access a professional, no matter where they are in montana or anywhere else in the United States, i think we can make a significant in wrote and as a footnote, every major state should have whether it is a billboard that says what numbered is and what it isis. Thank you. Doctor evans mentioned earlier practicing across state lines, but what additional steps do we need to make sure that we can get quality Mental Health services to rule america . I think the legislation that i mentioned earlier, eight eight four which is allows psychologist to practice to the full extent of their license is one example of that. It is clear that we need Technological Solutions and telehealth does that. We need policy Solutions Like interstate contacts that allow people to get a hold of, and we need to make sure the providers are there to provide those services and the legislation that you are supporting 884 does that and we appreciate that. Could dr. Geller comment briefly on that . I think we have to have more opportunities for medical education and more attention to employing people to underserved areas, like an underserved area in montana. And if i can respectively disagree, i do not believe that psychologist being turned into positions is going to increase access, there are some ways it is potentially dangerous like psychologist running a partial hospital program. I think that is dangerous. Thank you madam chair, i yield back. It thank you for your excellent questions. The gentlewoman from michigan is recognized for her five minutes. I want to thank all the members for their patients. We are living in a new era, everything takes more time, i cant help but think that todays hearing is some of the best time spent, but it still takes patience on the part of members. I think all of you. The gentleman is recognized for five minutes of questions. Thank you. Patient is also observed by the witnesses for staying so long for answers. We think you. And i think this is a subject that is very important to me like many others here. I think the fact that the committee is chosen to highlight this issue is really important because quite frankly, during normal times Mental Health is a significant challenge. I can sit here and listen to patrick talking about, he and i have been friends and we have talked a lot about this, one of the law things that we havent talked about is eliminating the stigma. It is still a reality. There are too many people who are afraid to acknowledge that there is a problem. Like him, my father was a drug addict, no one ever talked about it. There is a number of pretty horrific situations. My sister ultimately died. I tried for years to get her in and out of the system. I have learned a lot. Ive had too many people that are still afraid to acknowledge they have a problem. It is in every family. Yes, that jails kept people in them that should be getting help. People that need Mental Health treatment, they dont need to beat a prism. But there are a lot of people that are set to get their homes or jobs that need help that wont extra knowledge that they have a problem. Because they are afraid of what some people say. Covid has made it worse. Some people said that they have already made the decision that if they get covid they will die because they feel disposable. I deal with a lot of Domestic Violence cases, and my Law Enforcement have been doing wellness checks this entire period. We need to be talking about this. Our Mental Health systems need it. I hate talking about money because when you were talking earlier, i or we all dont have enough psychiatrist going into the psychiatric field. We had a unfortunate incident with a College Student who knew he needed help, who went to the hospital, there was no doctor available to take care of him, they called his parents to come and get him. When his parents came, his father was the sheriff and he took his fathers gun and shot and killed his two parents because there is nobody to help him. And there was no bed available. And then i learned, that only one person had gone into their psychiatric residency from that school. We have to incentivize this. That is something i want to talk about down the road. Mr. Kennedy, thank you for your longstanding and everything that you have done and we have talked specifically about non medicaid states and Addiction Services face if we dont provide help in the next few weeks . Thank you. By the way, my book, the dean of the house is right next to my bed. I am so grateful for that book. Nice words that your husband mentioned, i loved him. And i loved being scolded by him when i wasnt following the pauper rules of the house. I know how proud he is in heaven that you are caring on that tremendous legacy and public service. Sorry for wasting all that time. Just wanted to say that you are a great person i am so glad that you were there. The Mental Health budget is about the first thing to go. The reason it is is because there arent a lot of people raising their hands saying that they are consumer unlike if you had cancer or heart disease. You dont have a big Cancer Society or american heart associations. They will be the first to remind everyone that they are very woefully under funded as an advocacy group. So you are either in jail, in an institution, or you are in a 12 step meeting and you are supposed to remain anonymous. Which means there is no public advocacy going on there, unfortunately. Im just trying to go through all of your will put comments. This is the first area of government that they are going to see is being able to be disposed of because you are not going to hear the human cry that you will get if you try to cut other areas of state and county funding. Thank you, madam chair. Im already out of time. Thank you. The gentlewoman yields back. It is a pleasure to recognize my good friend from illinois, congresswoman brooks for her five minutes of questions. Thank you madam chairwoman, i apologize that im having some technical difficulties with my wifi here in my office. I just want to thank the chair for having this hearing. I know you in the Ranking Member have requested as well, that is a very important that we focus on Mental Health. Especially during this time with covid. I really appreciated all of the panelists who are here and providing us expertise. Last year, or the last congress, i lead in additional log forsman and mental toll healthiness act, and we got that signed into law. Providing more resources for those frontline workers. I want to talk a little bit more and go back to providing more resources for those frontline workers, particularly the Health Care Workers and what they are experiencing, firefighters, First Responders who are First Responders who are going to homes and helping people who may be very ill with covid. Particularly those Health Care Workers. I think doctor evans, maybe it was doctor geller who talked about the stigma of those providers seeking help because of their license. I would like to talk about that a little bit further. Doctor geller, what is it that you believe we should do because i am an attorney, often with licenses you have to indicate you have sought psychiatric help. Is it your position that we should no longer be having that on applications . Whether youre going to be a Police Officer . A lawyer . A doctor . A teacher . How is it that we address that . I do agree that i think it keeps people from accessing and it does build on the stigma of accessing the services. So, two parts to that answer. We have had an explosion of attention to Health Inequities for black people. But wed have these for 300 years. We need an explosion of attention to the discrimination and gives people of Mental Illness. What is the purpose of that question . What is the relevance on my license application or your license application as an attorney as to whether or not, we have ever sought psychiatric treatment. They dont ask me if i want to dermatologist. If there is some concern about impairment then the question ought to be about impairment. Because i could be impaired because ive medical disorder that is just as easy as a psychiatric disorder. I think the question should be changed if we are concerned about impairment. That should be the same across the spectrum. I saw psychiatrist and that should not preclude me from being a doctor, or an attorney, or a school janitor, or anything else. Thank you very much. I would like to ask, thank you so much for sharing, one of my high schools in the Fifth District in indiana created a stigma free club created by young man whose mother very much suffered from Mental Illness. It was all about pure education. How do we educate people young people around the country . Or increasing the number of peer educators and pure councillors to get involved in that High School Level and maybe into college . What do you think we should do . I think that, the beginning of this year we should put aside time for orientation, for fitting into the school. Maybe do some career training. I feel like we could use that time to put in place a little bit of learning so that people can understand how to help their peers. In my perspective that is so important. In order to be a good student you have to have a great Mental Health, and we dont we could be easily filling our students in that regard. The Mental Health and wellbeing of our students is so important to how well they end up doing. As you said before, getting that little bit of time, it doesnt have to be a lot of time, but lets make sure they have the information they need. The amount of time it takes them to teach them about what their classes are going to be, or what they white want to do in the future, take that bit of time that will impact their future. Thank you for your leadership. I yield back, congresswoman. The gentlewoman yields back. It is now a pleasure to recognize the gentlewoman from illinois, miss kelly for her five minutes of questions. Thank you, madam chair. Thanks for bringing us together to discuss these issues. I think all four witnesses for willing to testify today. In 2003 National Academic study found that even with controlling various cares minority patients have worse Health Outcomes than white patients. The report found it both explicit and implicit racial bias that contributed to these outcomes. As we all have heard by now, minority communities show disproportionate amount of covid19 cases and deaths. This is compounded by a pandemic related shutdowns and layoffs that are hitting minority communities. These parallel economic and medical crises are recipe for stress anxiety and grief within the community, yet to often the same communities lack access to care and Mental Health services. Doctor evans, how can we address disparities and access to Mental Health treatments in communities of color . What we have to do or number of things. One of the things in my role as commissioner in two different states, it is really clear that while we need to make sure that the services are funded we also need to make sure that we work on communities that have understanding of Mental Health. The biggest mistake with how we deal with Mental Health is to move from thinking about Mental Health is about them to thinking about Mental Health about us. That means all of us. Our Mental Health is as important as our physical health, and yet all of us have some Mental Health issues going on at some point in our lives. It reduces the stigma and makes it easier for people to reach out for help. We will have to make sure that we have policies that are directed at communities that are affected. When i was a commissioner i made sure that they immigrant communities, particularly small communities that didnt have a loud voice, cut funding. Or areas of the community that are deserts in terms of Health Care Providers that they have services. There is no way around making sure that the resources are in places and directed to the people that need them. Thank you. I wanted to ask, the pursuant equity and Mental Health act for undisturbed communities, and would also help students of color to enter the Mental Health workforce. Your organization has a task force to address racism within psychiatry, what are some of the barriers the task force has fan and what are you doing to address the issues . The task force has just begun its work. I cant answer to that. What i can answer in terms of the ap. We have a very Long Health Care inequities and disparities. We have all sorts of educational material that is directly related to that subject matter. We are working on deploying personal outside of traditional offices. Besides having financial resources, you have to send services to where people are going to get them. In order to meet the needs of the black man you have to somebody sitting in the barbershop. Definitely. Despite the pandemic and filings continues to play a role, the bipartisan solution to cyclical violence acts of 2020, can you discuss how cycles of violence for the Mental Health for trauma victims . And can violence prevention programs helped assist . I am again i am not against guns but we have such easy access that that has to contribute to suicide levels also. Sure. Let me commend you for your leadership around the cdc, that is really critical piece in producing these disparities. It is really important to have interrupters to interrupt violence and communities. But it is also important to connect those efforts with addressing trauma. One of the things that happens, that we talk about with my work, hurt people hurt people. When people are traumatized they are much more likely to continue that pattern of traumatizing others. A big part of addressing Community Trauma and violence helps to reduce both of those. Thank you so much, i am out of time. Take care. I yield back. The gentlewoman yields back. A pleasure to recognize the gentleman from ohio for his five minutes of questions. It is nice to see you. You need to unmute. You need to unmute. Are you muted . The gentleman needs to unmute. We cannot hear you. We cant hear you. Mister louder we cant hear you. How do we reach him . Madam chair . There you are. Can you hear me now . We can hear you now, thank you. We are having a little technical difficulty. The gentleman is recognized for five menaced. Thank you and before i begin if i could ask consent to submit some letters to the record. The chair announced earlier that by unanimous consent will be at the end of the hearing. Thank you very much, madam chair. Today we are signing a light on improving Mental Health in our country. I would like to thank you for being on the subcommittee. Before i asked my questions i would like to highlight how cool the high 19 has taken its toll on every aspect of our lives. The Mental Health tradition, Substance Abuse, suicide and drugs have all increased drastically over the last few months. The White House Drug Policy Office has released a troubling statistic, they share that Drug Overdose have increased 11. 4 in the first four months of 2020 compared to the same period last year. Theres social repercussions of covid19 have caused stressed, exile the in our communities that is going to need care. Thats why our office is creating resources to improve situations. The crisis act would direct states to utilize funds from the Mental Health bloc for Crisis Services and improved care to those experiencing a psychiatric episode. I want to thank our witnesses for their attendance, if i may begin with dr. Geller. Doctor geller your testimony says that Mental Health Crisis Services can help those with Mental Illness by limiting their contact with the Justice System and reducing visits to the er. I have introduced slow legislation for the Mental Health block grant to enhance their services. What is special about this services and how would the Community Benefit from having them . Crisis services take many forms, they can be freestanding mobile intervention, they can ride with Police Officers, they can be within the courts, Crisis Services we have no one will divert people from higher levels of care and diverting people from higher care will allow those levels of care to be available for people who absolutely need them. Not only is the individual beneficiary aiding, this system is a beneficiary or because it is targeting people with higher levels of care. That piece of legislation is very important. Wouldnt it also decrease cost . You are not having those folks at the er because i know in my practice i have had a lot of the sheriffs tell me that theres is the first place that they bring care, on the psychiatric side. But they can provide those services. That is a double edged sword. It may decrease costs because it will have people not a places they are not needed. But it will still do case findings thats gonna find people that need services that wouldve otherwise gotten those. Lets say this cost neutral, and we have given a whole lot more people the services that they need. That is the bottom line. We will serve more people more effectively without spending more money. Thank you very much. Tour for colleague, mr. Kennedy, suicide and Drug Overdose and alcohol use killed more than hundred 80,000 americans in 2018, how is covid 19 increased depression for these americans . Thank you. Again the numbers are startling. We are counting all the time the number of americans who are dying as a result of covid, things that we are losing just as much if not more to these illnesses and we are not hearing a word about it. The silence in this is deafening. Covid forces people to stay isolated, removed, disconnected. People who have addiction, Mental Illness, those people like to isolate. This adds gasoline to the fire. Isolation is not good for your Mental Health. It is a coping mechanism for people who do have addiction and Mental Illness. It is reinforced by the messages we are getting society now which says that we should not talk or connect with each other. It could obviously, as we have seen from the science, really add enormous amount of tragedies. Thank you for having me here, i yield back. You are always welcome. Thank you. Pleasure to recognize fellow californian, gentlewoman from california. Five minutes of questions. Thank you madam chairwoman for having this. Just a moment please. You need to hit mute please. I think he is good now. The gentlewoman can proceeds. We will add another ten seconds on so that you wont lose any time. Thank you for holding this important hearing today to address Mental Health crisis facing the country. Doctor evans, you have mentioned many things that i have been talking about and can relate with, oftentimes i am somebody who says we all have Mental Health issues. The question is to what degree. And so to hear you say that today, that reaffirms my experience throughout my life. And across the board. Youve also talked about the importance of looking at the social determinants of health. That is so critical. I represent a district that includes compton, we have children who worry about getting shot as opposed to worried about the next School Report that is due. The impact that has on their Mental Health, those factors have on a child and the importance of us looking at that. I have introduced a bill to address those social determinants of how to create program specifically at the cdc to address these social determinants of health and create partnerships with local Public Health agencies. I think this hearing is great, i think we need to have more of them on Mental Health. It touches every single part of our lives whether it is kamala violence, homelessness, covid19, addiction. We all have family members who have experience with addiction and it goes across the board that we hear it day in and day out. Mr. Kennedy, i want to follow up with you on a topic that my colleague brought up on the applications. I want to share a personal story. When i was in college, i was applying to be an intern at the white house, and i remember seeing the application asking if i had ever seen a Mental Health professional. My father had been terminally ill the last ten years, it was the ten years of his life which was meeting in college. And i remember thinking to myself, as i leave and i end up getting the job at the white house, if i leave and cannot see a Mental Health expert maybe i cant work in government. Having that thoughts had me second guessing if i should ever see any Mental Health services. We heard doctor geller talk about his belief that we should change the question, do you think we should eliminate the question . Or if we do change it how should it be changed . Thank you. I will just add that the green berets, which no one would think would have any Mental Health problems, they are the best of the best of our military, they are afforded and take advantage of more Mental Health than any other branch of the service. Now why would the green berets, the best of the best, have so much Mental Health provided . Because our nations military has figured out that in order to have the best of the best, all of those that they have invested so much and is far as training, they have to be on their game. They have to be able to minimize intrusive thoughts, anything that might compromise their ultimate ability to meet the task of their mission. Why as a nation do we not take that same attitude that the u. S. Military is taken . That chairman of the joints chief of staff have taken . Seeking Mental Health makes you mentally healthier, we should be encouraging people in this country to seek Mental Health. That should not be a disqualifying factor in anything. It should be a rewarding factor to folks. For the same reason that i am eliminating checking the box for those who have been in our criminal Justice System who say that, after theyve already paid their dues to society, totally hinders their ability to move on in their life. It is the same thing with this. We need to illuminate this check the box as well. I think that the job you are going for, there should be criteria and whether youre able to meet that criteria, not some question about whether youve ever sought Mental Health. That should not be disqualifying criteria. Thank you so much for letting me eat up all your time with that answer. Thank, you mr. Kennedy. I will follow up with some of our other witnesses. My time has expired. Thank you madam chairwoman, i think we need to have more on this critical issue. I think we do also, thank you to you. It is now who is next . The chair now recognizes a wonderful addition to our committee, the gentlewoman from delaware. Five minutes of your questions. Thank you madam chairwoman. And a special thank you to the Witnesses Today, as has been said this is crucial hearing. Not only are our Mental Health issues a crisis in her country, we couple that with an economic crisis. I come from a state that has a Farming Community and we have seen suicides rise in the firming community. You add on to that covid19, think about essential workers and frontline workers. The stresses there. And more recently, the Racial Injustice issues that we have been facing as a country. You know that this is an important time to be having this conversation and to be dealing with it. For communities of color, there are persistent disparities and Mental Health, in 2018 16 of African American adults reported having a Mental Illness, in 2017 suicide was the second leading cause of death for African Americans aged 15 to 24. In fact, suicide death rate among black youth has been increasing faster than any other racial or ethnic group. I actually have legislation that im working on, it is taking a look at the issues of trauma and policing in the African American community and access to Mental Health. I want to address the question to miss gross, and congratulations on your leadership. And your focus on the arts as well. I do think theres a connection between Mental Health and the arts. You wrote, trust me we have seen and been through more than we realize. We can and want to help. And thats what you said of your generation. I was wondering if you could talk about two things. One, if you feel that when we talk about the stigma associated with Mental Health and the shame, do you feel that your generation is more focused on getting the help then on the stigma or shame . Or do you feel that it is still a problem . And how to social media and internet contribute to this . Thank you for that awesome question. I definitely do believe that students today, i am sorry could you just say that again . Do you think that there is still the stigma attached to it and how the social media be better . Do students want help . Or is that stigma still there . I see both. Students today we have tried to push away the stigma, but sometimes older generations are still saying, you are young i dont know how you feel. So we feel like we wont be understood, our problems wont be hurt because we have grown up in a unique set of times. The way that we understand is much different. My perception is that having our peers help us during this time is really important. Social media is both good and bad. I see that it is a place that a lot of kids feel comfortable talking to other kids, all those people that understand their issues. That is one thing that is so great about the generation is that we have a very Strong Community which we can rely on. There are so many people that ive been able to call on and who have supported me when i needed it. In my perspective,. How could expanding access to competent care, how would that help reduce the systematic barriers . And what else do you recommend that congress do to do redress this . I think that any attempt to create services is going to help people feel like the person that is all the other side of the door is going to be responsive. One of the things i think congress should consider, increasing the Mental Health brand. That is because you have much more flexibility in the block round that you do the medicaid which is the other major funder. And so, the block grant gives each state the ability to have Flexible Services that are geared towards the unique Cultural Roots within their states. Thank you. Dr. Geller, ive run out of time. I will yield back to the chairwoman. I think the gentleman, shields back. Pleasure to recognize the gentleman from ohio, mr. Johnson for his five minutes of questions. Thank you madam chairwoman. Especially for giving me the opportunity to weigh in today and speak unfavorable edges sleigh shun for our Health Subcommittee that is considering. You are always welcome. Thank you very much. I appreciate it. I know my friends work very closely together on issues that are important to the Health Subcommittee. I am proud that we are going to be talking about one of those. Even in normal times, without a Global Pandemic raging many of our fellow americans suffer from severe anxiety, depression, and Substance Use disorders. Unfortunately, we have heard mid testimony today that all the evidence is pointing to the fact that covid19 is severely exasperating these problems. I think the experts here would agree, to fight this problem effectively, it is imperative that patients keep their regular Mental Health treatment schedule. Fortunately Congress Gave the Trump Administration temporary authority to waive some restrictions on accessing Mental Health from the safety of their home. Mental health has proven to be convenient and Popular Technology with the American People. The covid19 pandemic will end at some point. When it does, what we will do with telehealth, that is still a big question. Patients and providers are now taking advantage of this new service and will they be left in the lurch . You all might remember last congress the passage of the support act, wide rated legislation for americas Opioid Crisis. Many of us work closely on this. And it included provisions to wave restrictions for medicare beneficiaries, and coal occurring Mental Health needs. If we all can all support telehealth for those with Substance Abuse problems and psychological issues along with the Substance Abuse, there is no logical reason why we cant finish what we started and make this care available to those who is standalone Mental Health needs as well. This is why it is time to pass the teleMental Health expansion act, which i introduced,. ,. In your experience, and the experience of your members can you quickly walk us through the consequences of someone who is suffering from Mental Health issues or Substance Use disorder, undergoing regular visits and then stop showing up . Do these individuals requests from the progress that theyve made . Absolutely. That is a high risk. Other risks that go along with that regression are people with medications, if they abruptly stopped those medications, there can be dire consequences, lifethreatening, and also goes along with an increased rate of suicide. As ive said before, i support your bill. One thing nobody has mentioned is that many of you come from states where in the winter you cant get there from here. This then doesnt mean people miss their appointments because it doesnt depend on using transportation to get their. The difference spoken by or members who as ive said before, 64 have never used telehealth since before covid19. There is very little negative. As i mentioned, we have made some progress but it is wellknown that Mental Health programs and drug addiction can be related, especially during this dress during a Global Pandemic. If an individual in the need of Psychiatric Care can get access to access, could telehealth help them from getting problems with Substance Abuse . Absolutely. It can prevent them from self medicating. For increased Substance Abuse, i cant get the services i need so i resort to drugs and alcohol. It also can affect people who are being treated for Substance Abuse in terms of increasing their use of substances in spite of the treatment. So for both of those groups it is extremely important. I have exceeded my time, i yield back. Thank you mr. Johnson. The gentleman yields back. Pleasure to recognize the gentleman from illinois, mr. Rush for your five minutes of questions. Thank you madam chair. This has been a very important and powerful hearing. Something of this is personal with me in a number of different ways, i have my own grandson right now who is in the hospital for Mental Health and psychiatric evaluation. I am praying for that that he can get the help that he desperately needs. Even as we speak. You have all of our prayers, certainly mine. Madam chair, from the legislative approach, i need to ask, let me ask you, when you look at micro aggressions. Micro greszler societally through racism, untreated Mental Health status in these communities and in this nation and if he would also include your views on how why superiority complex contribute to ptsd of gender and other minorities in the u. S. Are you addressing this in our nation right now . Our nation right now is tiptoeing of the subject of racism and how it is completely almost unbearable for a significant amount of our society. And it is an issue that we cant ignore. One of these issues that are front and center. Could you address your views on my questions . Sure, i think youre framing is exactly right. We cannot, we can no longer ignore that racism has an effect of Mental Health. One of the things that has been hopeful about the recent guidelines is that we dont have to continue to make the case that racism has psychological impact. There are a number of scholars and psychologists who have documented what is called race based Traumatic Stress. That is the daily stressors that happened to African American and other people of color based on the race. I want to give you a quick antidote, recently after the protests, i casually mentions that i have been stopped by police, pat it down, my car has been searched, i have been followed. And my colleagues were surprised by that. They had no idea that any African American man of my ages had that experience. Yet it is a universal experience. Those daily kinds of experiences that people face have a cost. That cost is in terms of stress. We do an annual survey and our survey indicated that in one month alone we saw a 15 increase in the stress that African Americans were experiencing. This was right before the George Floyds death. It was really important that as we are looking at the broader social issues around racism, that we understand that there is a psychological and physical impact that we also have to realize. Could i address that quickly . Racism is a Mental Health problem for everybody. Its not just black folks. And if we are going to change that, white folks have to understand that it has negative consequences to their Mental Health and they need to do something about that. I absolutely agree. Stress is pandemic especially in African American communities. White folks have to understand that their privilege and the maintenance of their privilege and status carries with it an enormous amount of respect. The fact that they can look and see other american citizens who are denied the opportunity for justice inequality and that that also bring stress in the white communities. Madam chairman, i think my time might be up. But if i have time for one final question i would like to add, i am familiar with the writings of psychiatrists. And i dont know whether or not this methodology or his muse or pertinent to psychosis and racial issues in america. All right either of you familiar with his writings . Do you know any of his work . This is a discussion for today in contemporary america . The chair would just ask that you be very assessing to because a minute and a half past the gentlemans time. Please answer. He had a significant effect on chester pierce who was a psychiatrist who came up with the concept of micro aggression. So he lives on today. Thank you. Thank you madam chair. I yield back. The gentleman yields back. The chair is pleased to welcome back to our subcommittee, from illinois. You are recognized for five minutes. Thank you so much madam chair for allowing me to participate today. I wanted to first give a big shout out to my dear friend catherine kennedy. I think that, are you still there patrick . I am here. Its good to see you too. I just want to acknowledge the fact that you have had such an important role, not only in conveying proper information but eliminating stigma which is still the curse of Mental Health in many ways. And because of that, thank you for saving lives. I know that there are thousands of people who are willing to accept and feel good about getting the help they need. Let me move on. By 2030 the number of psychiatrists in the u. S. Is projected to decline by 20 , from 2017 levels. And thats why i first introduce the medicare, Mental Health access act in in the 100th and the 11th congress that will allow psychologist to utilize the full scrub of practice. And now we are cosponsoring hr 884, which would do just that, for Older Americans who have a higher rate of psychotropic drug use, they are also less likely to receive care from a psychiatrist. In my district, i want to give a shutout to doctor kenneth, he is a psychologist from my home town of chicago who runs a Group Practice that provide Psychological Services to residents of nursing homes. It is so much needed now. Doctor evans, i want to ask you this. Do you believe that expanding medicares statutory definition of physicians and psychologists would enhance the availability of help for patients that need it . Yes i do. I am so appreciative of your legislation. I want to address some misinformation that we heard here today. The legislation does not try to redefine psychologists as physicians. Psychologists are not interested in that. Psychologists are interested in being able to practice to the fullest extent of their training and their license are. Without administrative barriers. I find it ironic that at this hearing where we have talked about needless administrative burdens requiring people to jump through hoops Ticket Services that we would have this as an issue. The reality is that the Medicare Program is the only pair that does this. Not medicaid, not try care, not the va, not any private. Requiring psychologist to have to go through a psychiatrist to provide services, that is just unconscionable at a time when our seniors are isolated, they are experiencing anxiety. They need direct services. I will just leave you with this, i had correspondent from psychologist who have experienced those barriers where it physician told a psychologist who was waiting to be able to provide services, waiting for an order from a physician, he was told to his face that he, i dont believe in psycho therapy. Im not going to provide that order. That is unconscionable. We cannot allow those kind of barriers in 2020 to continue to exist. We should not discriminate against seniors and the Medicare Program, we should get the Services Just like they would if theyre a private insurance. I couldnt agree with you more, especially at a time where we beat more, not fewer providers. Particularly for seniors, but everyone. All psychologist should be able to practice to the full scope of their licensing. And finally, let me say. I ask for unanimous consent to enter a letter into the record from a well respected Health Provider serving my district that is unfortunately looking at laying off staff and closing programs. We need to help organizations like this. We need to allow psychologists to be able to do the qualified work that they do. With that i yield back. Thank you. Thank you, and your unanimous consent request, the chair announced earlier that all of the requests will be taken up at the end of the hearing. I think we have at least 70. Yours will be included in that. Now it is a pleasure to recognize another wonderful and important member from the committee who is waving on today. Gentleman from new york and a good friend and an important legislator. You are recognized for five minutes. You need to unmute. Can you hear me . Yes. Thank you madam chair. Thank you for allowing me to wave back as youre hosting this important discussion. Thank you to all of our witnesses that have joined us today, it is always good to have our friends from the Mental Health Community Joining us. And to my former colleague and friend Patrick Kennedy, welcome home. With covid19 crisis and the associated economic downturn, we are really facing enormous challenges, when it comes to our nations Mental Health. The threat of coronavirus has still threatened so many of us in unprecedented feelings of fear and exciting, for those living with a Mental Illness, this stress must be magnified. We also know that social isolation or key risk factors for Substance Use, despite the heroic efforts of those in treatment and recovery communities, we know that many will become disconnected from their support systems and those who help them stay on the path of recovery. Will we work to tackle these crises, we must ensure that we have a Knowledge Base needed to understand the scope of this challenge before us which is why authored the covid19 Mental Health research act. This legislation would authorize 100 Million Dollars annually over the next five years for the National Institute of Mental Health, study the impact of covid19 pandemic and the impact that it has had on the Mental Health of americans and in particular front line Health Care Providers. Can you speak to why covid19 pandemic presents unique Mental Health challenges . And my research would be useful in how to calibrate a response . It is unique because we have not an infectious pandemic only, but a Mental Health pandemic. You cant fix a problem if you dont know what the problem is. The research that you are proposing to be funded, which i would highly support, would answer such questions as, we know there is a disproportionate amount of covid19 in African Americans, and hispanics, but we also know there is a disproportionate covid in poor people. We need research to figure out what degrees is poverty an issue or what degrees at African Americans have sickle cell anemia accounting for this. If we are going to fix the problem we have to understand the problem. Your bill will help us understand the problem. It specifically requires Mental Health institutes to study the covid19 impact to minorities, can you speak specifically why this is important topic to study . Ive been doing research for 30 years and trained in psychology, i will tell you that one of the big challenges for a lot of research is that you dont generalize populations for what you have not done the research. The problem that we have in our country is that we dont always have robust samples that include the populations that we are talking about that are at greater risk for some of these conditions. That is number one. It is also important to have researchers who are from the communities who are doing the researchers and ultimately understand how to design studies that are going to be more accurate and so that they can do the proper interpretation of that data. And finally i just want to say and give props to your group because they are doing this type of group. One thing that i would add that they are doing, the Clinical Services research, implementation research, it is closer to we really need our studies, real world studies that are understanding some of the implementation issues and understanding to take the science that we have spent money on and accurately translate it. Thank you. The Census Bureau reported that americans are Self Reporting signs of anxiety and depression, jumping a huge amount, what do these figures mean to you . And what consequences do you think we will see it americans aside a in the years to come . Thank you for your leadership. I cant help but think, a huge uptick in the prescribing of ben so diaz opinions, coupled with a huge increase in Alcohol Consumption and then of course coupled with a new commercialization of marijuana that we dont have a kind of major tsunami of addiction that we are creating right now that is not going to be fully realized for another few years. We are still reeling from the Opioid Crisis which we never quite got our arms around, and then we are just now adding fuel to the fire. We should be very mindful of the fact that this is going to get, as we are discussing, a bigger Mental Health crisis. Thank you. Thank you madam chair for your leadership. I yield back. We would like to recognize the gentleman from california, mr. Peters. Welcome, you are part of that committee. It is wonderful to have you with us today. Five minutes for your questions. Thank you very much. Today i am considering critical bills, it is so important as other members have mentioned because of coronavirus that is taking a toll on every single american. I am thankful and grateful that are bar protestant bill that brings awareness. And that it is included in todays hearing. Thank you for introducing this bill with me to help combat suicide. Since 2010, suicide has been the second leading cause of death between youth in black people between ages of ten and 24. A study published in 2019 from the adolescents who side rates for young people aged 12 to 19 had increased by 87 from 2007 to 2017. Thats in one decade. This rise in suicide and other senseless deaths like shootings and active violence in schools points to a serious Mental Health epidemic. There is no question that covid19 has influenced the Mental Health of our nation. Students have been separated from friends. Classes are moving online. Futures are uncertain. Those turbulent circumstance are stressors that contain adolescent suicide and violence against others is preventable. 70 of people who die by suicide tell somebody their plans or demonstrate warning signs. 80 of School Shooters tell someone before their actions. However, we need to understand the warning signs and know how we can intervene. Tradings help educate to know the signs of suicide and violence and connect them to the care that they need. The standup act would do just that, supported by Sandy Hook Promise, this bill would need states Public Schools to have common sense evidence based policies to prevent suicide. These grants would promote we have to prioritize early prevention, key warning zions and give educators and tools to stop violence. This displayed how the standup act and why it is so important to have it in the schools to help fears that maybe struggling. In addition the standup back is backed by 50 organizations. I would add a letter of record and support to these administrations, from these administrations, and a list of things for the record to be considered later. And it will be with the other unanimous consent request. I want to thank my fellow committee matter bursts,. ,. Does your school prevent any type of Suicide Prevention, is it to all students outside of the club. If not, how do you think your school could benefit from . This thank you, and i do want to thank you for the standup act. So, my school does not have any programs that focus on our wellbeing or offer students any help outside. That leaves a lot of students to have to go out on their own and seek help. That could be hard for a lot of people. Especially when it can take hours to go seek help. But i think what we could do is simply do this is take a little bit of time at the beginning of the school year, the same thing with career training, introduction to your class and just take a little bit of that time and teach people how to help others. I think that would be maine. You mentioned that students are struggling during covid. Could you talk about what its like to be a student and the challenges that youve seen with your classmates struggle with during covid . I do not have very much time. For me, i have trouble focusing outside of a classroom, that is typically hard for seniors. They dont get a prom. They dont get to graduate. Theyve spent school all four years and that is something that they are missing out on. I think the standup act and focusing on the Mental Health, and give them access to what they need, that will most definitely allow kids to help cope with these hard times. Thank you very much. Thank you for being here. Thank you very much for your leadership. The gentlemans time has expired and i think we are nearing the end of her hearing, last but not least the very gentle man from arizona. Thank you for joining us today. You have five minutes. Thank you, madam chair. I appreciate the opportunity to waive on to the committee. On this critical issue, i worked on parity when i was in the legislator for years, and i am still sad to see that it is stopped being addressed in the appropriate way. We can change that. Covid19 has exposed something to people who have been living in Rural America that have known, we have a shortage of psychiatrists, therapist nadler Mental Health officials. Tell a health can help, but broadband speeds are still too slow in many parts of my district and in many places cannot fully replace for patients to see a physician with their provider. According to the rule Health Information hub, supported by hhs, 14 of the 15 counties in arizona are designated a shortage area of Mental Health providers. This is not a new issue. The shortages, despite rule america having a higher prevalence of Mental Health issues including Substance Abuse, they are high levels of high poverty, overtime people suffer in silence and lack of providers makes Early Intervention and peoples Mental Health more challenging. This pandemic is going to leave a footprint into the future. The issues on tribal lands are even more tough. For young americans, indian and alaskan people, ages 15 to 34, the Youth Suicide rate is 1. 5 times higher than the national average. There are tribal communities where that is ten times the national average. For this reason, i helped lead a chair the native americans Suicide Prevention act, this bill ensures that the states would work with tribes and native americans and organizations to ensure that statewide Suicide Prevention programs are actually culturally sensitive and effective. This legislation i had hoped, the Committee Considers in the future. As i mentioned earlier, rural areas have higher rates of suicide, Mental Health issues, and Substance Abuse. Dr. Evans and dr. Geller, we have talked about these problems in the hearing throat decades. In your opinion, how do we best ensure providers in these rules and tribal areas . What can congress, administration, or the Community Help to do to solve these problems . I think there are a few things. One is, we are partnering with groups to train providers on unique issues of people in Rural Communities. Just like different ethnic groups have a culture, there is a cultural perspective for people that live in those areas, Mental Health professionals need no need to know how to work with those communities. I spent some time with fire made and one of the things that many people dont recognize is that farmers are experiencing a significant crisis. Unlike a crisis that they have ever seen. They have a much higher suicide rates. I think we have to Pay Attention to that legislation. We also have to remove administrative barrios that make it hard for practitioners to practice in those areas. We have to make sure that people have the incentives of financial, that is one of the reasons we are supportive for hr884, that provides financial incentives to afford psychologist to work in some of these areas. Thank you very much. Im going to send your questions. Madam chair, i yield. The gentleman yields back, we thank you for joining us. Are there any other members that have joined us who were not recognized earlier . Who are not seeing . We are not hearing anyone . For the benefit of the members, i want to remind them that pursuing to committee rules, each member has ten Business Days to submit additional questions for the record to be answered by the witnesses, to the witnesses i ask that you respond as promptly as possible to any questions that are submitted to you. I want to thank each one of the witnesses. Let me start with the youngest. You have hit the ball out of the park. You have really explain to us exactly the way it is on the ground in your time, in your life and that of your peers. We have learned a great deal from you. We are going to build on it and use your testimony to improve the system for young people across our country. Dear patrick, i dont know if you can see behind me, but that is the portrait right here behind me. He is with me every day and i think hes always been proud of you. But today he is exceedingly proud of you. You have given as testimony from the outside, understanding how the inside works. What you have said, what you have shared with us is invaluable. Thank you for raising the point about the green berets. Very few people think that the green berets would ever need or have any issues relative to Mental Health. This expands across humanity, across humanity. A friend of mine just alerted needed something last evening, and that is that theres going to be a powerful and revealing documentary on hbo entitled, the weight of gold, and that documentary is going to explore the Mental Health challenges with deeply personal details about olympic sports figures. Now who wouldve thought of that . But when you mention the green berets, i thought of this that i just learned about. I want to acknowledge, that one of the secular of directors reminded me of that. We are going to take what you have given to us and really bless you for spending over four hours with you. This is one of the longest hearings the subcommittee has ever had. At least since i have been chair. Every second, every second has been an 18karat gold piece. We have learned from you and we are going to build on it. Patrick, you are always welcome to be with us and we are especially grateful to you today. To both of the doctors, you have given us magnificent testimony, not only years of experience, which is on full display but also your depth and breadth of knowledge. Because you Practice Medicine. So you see it, and you feel it and you treat it firsthand. To dr. Evans, thank you for going even layers steeper to demonstrate the curse of racism and the toll it takes on the entire human being. We will certainly be taking all that into consideration with the bills that have been written by members. To the four witnesses, you have broadened and enhanced are thinking. I think youve been highly instructive to the American People today. To all those that have listened and watched, and i would ask that you will keep you yourselves available so that in the interim period as we are looking to mark these bills up that any additional advice that members may have, that they be able to access that from you because you have been so outstanding. If i will just end on this note, it was one of the things that i said in my Opening Statement, that with the enormous challenges, just extraordinary, breathtaking challenges, our country has today, i think we need to view them as opportunities. That we can right the wrongs in our society, that we can address full health for all americans, and then when we do that that we are saying that there really is justice for all. And finally, i think that when we are called and judged, we will be judged on how we cared for each other. I think more than anything else thats what the hearing was about today. I think each one of you. I would like to thank the Ranking Member if he will join a unanimous consent request, we have 69 documents. And i dont think you want to hear you want to go through every single one of them. They are all important, every member has put this together and feels very strongly about them. We want this to be part of the records. Will you join me in a unanimous consent request to approve what has been entered for all the documents that have been entered into the record . Yes, maam. That is wonderful. I have to buy a nice ice cream sundae. Thank you to all the witnesses, bless you, thank you to the members, the excellent questions, all the time that you gave us today. And with that, the Health Subcommittee and the health of representatives did you need to add something . No, i just wanted to say goodbye to patrick. I thought i might have done something wrong. I think that congresswoman from rochester still with us, everyone is waving in saying thank you. It is a clean slate. This is wonderful, wonderful to be together. Godless all of us. Godless our country. May we do the right thing for it. Goodbye everyone. Thank you. Thank you. The meeting is now adjourned. 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