Transcripts For CSPAN2 House Hearing On COVID-19 Impact On M

To eliminate background noise. Members and witnesses, you are going have to unmute your microphone each time you wish to speak. So i just say that as a reminder and a little housekeeping issue, but please remember to do that. Documents for the record can be sent to megan bolin 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. Lets see, where is the clock on the screen . There it is. Okay. In any given year, one in five adults experience a Mental Illness such as depression, anxiety, or bipolar disorder. But 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 the coronavirus. One can only imagine the middle of impacts on the American Families who are grieving the loss of their loved ones to this virus. The economic downturn is also taking a mental toll on our fellow americans. Studies found for every 1 increase in the unemployment rate, the suicide rate increases by 1 to 1. 6 . Despite the frequency of Mental Illness, too many suffer in silence. Mental health is a neglected part of our Health Care System, with less than 40 of people with Mental Illness receiving any treatment. This is because of the high cost 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 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 was the author of the 2008 Mental Health parity and addiction equity act, which promised to require Health Insurers to treat Mental Health care the same as physical health care. Unfortunately, years after its passage Health Insurers still deny too Many Americans coverage because they dont follow the letter and spirit of the law. The good news is there are many strong bills to address these issues. Today were considering 22 bills. There is clearly bipartisan demand to address this crisis. The legislation were considering cover the recent increase in suicides, Racial Disparities in Mental Health outcomes, telehealth, coverage parity, and access to Mental Health services in schools. A 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 caregivers to deal with the crisis. Mental Health Programs are struggling to treat an influx of patients while awaiting funding that congress appropriated, but hhs has been slow to release. Our health as a nation, both physical and mental, will be tested in the months ahead. Aristotle said, even calamities have a soul and can teach us a wise life. I view this calamity is teaching us the importance of correcting the wrongs in our society and hope for recovery for all. I yield the remainder of my time to representative joe kennedy who has been a leader on this issue. Madam chair, thank you. Grateful for your leadership and yielding this moment, and obviously great to see my cousin patrick again here before the committee grateful for all of his work. The Mental Health shared system is broken. Our Addiction Treatment system is broken. All of us here today bring stories of constituents and loved ones who fell through the gaps that were wide and only widening. This pandemic did not create these gaps. Italy highlighted them and to show what many of us have already knew. That our Mental Health system is underfunded, under prioritized and over stigmatized. We are beyond the point of cosmetic fixes and incremental change. We need substantive systemic reform. We need legal Mental Health parity like what mike cousin patrick has envisioned. We need to put teeth behind the hold insurers accountable for the violations they commit on a daily basis. This hearing is another critical step forward but this hearing alone will not protect those who need of protection most. Only action and true reform will do that. I look for to what with all of my colleagues to call bush that the weeks ahead. Anxious so much, madam chair, and thanks to all of our college for addressing this critical issue. Yield back. Thank you, congressman kennedy. Yield back. The chair now recognizes dr. Burgess, the Ranking Member of our subcommittee for five minutes for his Opening Statement. Please remember to unmute. Maybe i have. So i think the chair and i think your willingness to work on productive bipartisan agenda for the subcommittee and i respect and and i am grateful for your respecting my request that we have a hearing on Mental Health with the coronavirus figure was a topic we were slated to talk about prior to the outbreak but now that the outbreak has occurred it has become even more serious. The human laws, job loss, the isolation that 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 bills before us today in many of these have bipartisan consensus. I appreciate you have included the bills that are mentioned in my letter, specifically h. R. 3539, the Behavior Interventions guidelines act which i worked on with dr. Drew ferguson of georgia. We had successful behavioral intervention programs in schools at her states, and that inspired us to work together. For me it was hearing from leadership at Texas Tech University Health Science centers and their program to provide 24 Behavioral Health intervention, and tell the behavioral Health Services at schools in rural west texas. School age children are primates identified and treat behavioral Health Issues before they worsen. I i believe this bill is even me important now. Students have been away from school and friends during a difficult time and some may be getting with the loss of loved ones or being home with family, a difficult family situation. I hope we will advance this bill toward markup. Other bills cover a wide range of important issues issue from approving the National Suicide prevention hotline to extending the authorization for two Movie Services block. This bill will ensure stable high Quality Resources for those in need. One issue not addressed it is a Mental Health of the Frontline Healthcare worker. This is especially important now, and i believe this has long been a serious issue our Healthcare System but has taken on added importance with the additional stress that caring for the serious ill coronavirus patient entails. I unfortunately the to devote some time to process. There is a strong bipartisan commitment to improve our nations Mental Health so im frustrated by majorities willingness to make even small changes some of the bills to accommodate some concerns prior to this hearing. When compromise was clearly possible, we didnt. Majority staff acknowledged the changes would make some of these bills easier to enact. Still what were introduced were bipartisan bills instead of what we have been working to secure republican support. Unfortunately this has become all too predictable in the Public Health space in this congress which is sad because historically it is the Public Health space where this subcommittee comes together to legislate the most. It also concerns me that we are considering bills as introduced rather than the language negotiated as part of the bipartisan effort and this is that first time that majority minority have had agreement oldest of the majority move the goal post. Makes it difficult for members on the side of the dice to trust you and the agreements that are made. Ignoring our requests, reasonable request, actively harms the legacy of this committee. And it did not need to happen. I am puzzled why did. You should fully expect members to file a nimitz should bills be brought up to markup that you were unwilling to engage with us or our staff and did refuse to acknowledge our proactive outreach and ignored our flag concerns. My. My expectation for supposedly noncontroversial market 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 muchneeded resources to individuals who are struggling with Mental Health issues and i will yield back. Gentleman yields back. Everyone was not on when i said this earlier, but we expect most between 11 15 and 11 30. When i go into recess since will be voting in shifts. So the full committee chairman, mr. Pallone, has agreed to chair the hearing when i go over to the capital 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. And remember to unmute, please. Thank you, chairwoman eshoo for convening todays legislative hearing on 22 bills to improve both quality and access to Mental Health care in america. Of course want i want to wee back our former colleague Patrick Kennedy. Everyone knows now is if you dont i will telecom is the new jersey resident actually a resident in jersey shore which on particularly fond of. I understand coming from the ocean state to the jersey shore, so youve been there for a few years now, so i really shouldnt be welcoming you, but 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 systemic racism. All three of these crises are understandably triggering distress for millions of people and it is compounded by the fact that many people are isolated from family and friends. It is no wonder that nearly half of americans are reporting that their Mental Health has been negatively impacted due to worry and stress in recent months. Mental health is an essential part of our Overall Health and wellbeing. Thanks to this committees work, we have made progress to better incorporate comprehensive Mental Health care into our Health Care System. We have improved Insurance Coverage for Mental Health services though the Mental Health parity act of 1996 and the Paul Wellstone and Pete Domenici Mental Health parity and addiction equity act of 2008. Thanks to the Affordable Care act millions of americans now have access to comprehensive Health Insurance plans that include Mental Health care services. The aca dramatically improved access to Mental Health and Substance Use disorder benefits by requiring individual and Small Group Insurance plans to cover these benefits. As a result, millions of americans can now access Mental Health services and Substance Use Disorder Treatment without fear of exorbitant outofpocket costs that all too often deter people from seeking treatment. The aca also applied Mental Health parity requirements to individual market plans. We continued 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 for children through medicaid, improved coordination between primary care and behavioral Health Services, and reauthorized Important Programs including those focused on Suicide Prevention. Again, thank you congresswoman degette at upton for the role on that. Taken together, these legislative changes have made a true difference in americans lives, but there is more work that must 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 more than 11 million who had a serious Mental Illness. Research estimates that more than 7 million American Children have a Mental Health disorder. Tragically, far too many of these conditions in children go unidentified and untreated, and research has found large disparities in access to Mental Health services among black and latino children. We also know that people experiencing Mental Illness are at a higher risk of developing Substance Use disorder. According to surveys, roughly half of individuals experiencing Mental Illness will also experience a cooccurring Substance Use disorder. This underscores the importance of expanding access to both Mental Health and Substance Use Disorder Treatment. 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 use. Unfortunately, suicide has also been on the rise. In 2018, more than 10 million americans seriously contemplated suicide and 1. 4 Million People made nonfatal attempts. Suicide is now one of the top ten leading causes of death in the United States and is the second leading cause of death among young people ages 10 to 34. Today, less than half of those with Mental Health conditions get treatment with many citing the inability to pay for services as their primary reason for not seeking treatment. Individuals in need of care also often cite stigma and fear of discrimination as reasons for not seeking treatment and many others report difficulty gaining access to providers due to workforce shortages. All of this speaks to the urgent need for additional action to help those in need. That is why we are considering a variety of policies, including proposals to improve teleMental Health, Mental Health parity, Opening Statement<\/a>. Lets see, where is the clock on the screen . There it is. Okay. In any given year, one in five adults experience a Mental Illness<\/a> such as depression, anxiety, or bipolar disorder. But 2020 has been a year like no other. In a recent poll, half of adults report that their Mental Health<\/a> has been negatively impacted due to the coronavirus. One can only imagine the middle of impacts on the American Families<\/a> who are grieving the loss of their loved ones to this virus. The economic downturn is also taking a mental toll on our fellow americans. Studies found for every 1 increase in the unemployment rate, the suicide rate increases by 1 to 1. 6 . Despite the frequency of Mental Illness<\/a>, too many suffer in silence. Mental health is a neglected part of our Health Care System<\/a>, with less than 40 of people with Mental Illness<\/a> receiving any treatment. This is because of the high cost of care, insufficient Insurance Coverage<\/a>, 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 former congressman Patrick Kennedy<\/a> as a witness today. He has led the way in attacking the stigma of Mental Health<\/a> by being open about his own journey and advocating for transformational changes to our Mental Health<\/a> system. He was the author of the 2008 Mental Health<\/a> parity and addiction equity act, which promised to require Health Insurers<\/a> to treat Mental Health<\/a> care the same as physical health care. Unfortunately, years after its passage Health Insurers<\/a> still deny too Many Americans<\/a> coverage because they dont follow the letter and spirit of the law. The good news is there are many strong bills to address these issues. Today were considering 22 bills. There is clearly bipartisan demand to address this crisis. The legislation were considering cover the recent increase in suicides, Racial Disparities<\/a> in Mental Health<\/a> outcomes, telehealth, coverage parity, and access to Mental Health<\/a> services in schools. A very, very important one. Several bills also address the Mental Health<\/a> issues caused by covid19. The pandemic is fueling Mental Health<\/a> problems while also hurting the ability of caregivers to deal with the crisis. Mental Health Programs<\/a> are struggling to treat an influx of patients while awaiting funding that congress appropriated, but hhs has been slow to release. Our health as a nation, both physical and mental, will be tested in the months ahead. Aristotle said, even calamities have a soul and can teach us a wise life. I view this calamity is teaching us the importance of correcting the wrongs in our society and hope for recovery for all. I yield the remainder of my time to representative joe kennedy who has been a leader on this issue. Madam chair, thank you. Grateful for your leadership and yielding this moment, and obviously great to see my cousin patrick again here before the committee grateful for all of his work. The Mental Health<\/a> shared system is broken. Our Addiction Treatment<\/a> system is broken. All of us here today bring stories of constituents and loved ones who fell through the gaps that were wide and only widening. This pandemic did not create these gaps. Italy highlighted them and to show what many of us have already knew. That our Mental Health<\/a> system is underfunded, under prioritized and over stigmatized. We are beyond the point of cosmetic fixes and incremental change. We need substantive systemic reform. We need legal Mental Health<\/a> parity like what mike cousin patrick has envisioned. We need to put teeth behind the hold insurers accountable for the violations they commit on a daily basis. This hearing is another critical step forward but this hearing alone will not protect those who need of protection most. Only action and true reform will do that. I look for to what with all of my colleagues to call bush that the weeks ahead. Anxious so much, madam chair, and thanks to all of our college for addressing this critical issue. Yield back. Thank you, congressman kennedy. Yield back. The chair now recognizes dr. Burgess, the Ranking Member<\/a> of our subcommittee for five minutes for his Opening Statement<\/a>. Please remember to unmute. Maybe i have. So i think the chair and i think your willingness to work on productive bipartisan agenda for the subcommittee and i respect and and i am grateful for your respecting my request that we have a hearing on Mental Health<\/a> with the coronavirus figure was a topic we were slated to talk about prior to the outbreak but now that the outbreak has occurred it has become even more serious. The human laws, job loss, the isolation that americans have faced due to this pandemic make it an even more critical topic. At the very beginning of this crisis the American Psychiatric<\/a> Association Found<\/a> that onethird of americans felt it seriously affected their Mental Health<\/a>. That reality compounded with the existing prevalence of Mental Health<\/a> and Substance Use<\/a> disorders make this issue urgent. According to the National Institute<\/a> of Mental Health<\/a>, nearly one in five adults lives with a Mental Illness<\/a>, ensuring proper supports are in place for families to manage and treat these illnesses should be a priority. So there are 22 bills before us today in many of these have bipartisan consensus. I appreciate you have included the bills that are mentioned in my letter, specifically h. R. 3539, the Behavior Interventions<\/a> guidelines act which i worked on with dr. Drew ferguson of georgia. We had successful behavioral intervention programs in schools at her states, and that inspired us to work together. For me it was hearing from leadership at Texas Tech University<\/a> Health Science<\/a> centers and their program to provide 24 Behavioral Health<\/a> intervention, and tell the behavioral Health Services<\/a> at schools in rural west texas. School age children are primates identified and treat behavioral Health Issues<\/a> before they worsen. I i believe this bill is even me important now. Students have been away from school and friends during a difficult time and some may be getting with the loss of loved ones or being home with family, a difficult family situation. I hope we will advance this bill toward markup. Other bills cover a wide range of important issues issue from approving the National Suicide<\/a> prevention hotline to extending the authorization for two Movie Services<\/a> block. This bill will ensure stable high Quality Resources<\/a> for those in need. One issue not addressed it is a Mental Health<\/a> of the Frontline Health<\/a>care worker. This is especially important now, and i believe this has long been a serious issue our Healthcare System<\/a> but has taken on added importance with the additional stress that caring for the serious ill coronavirus patient entails. I unfortunately the to devote some time to process. There is a strong bipartisan commitment to improve our nations Mental Health<\/a> so im frustrated by majorities willingness to make even small changes some of the bills to accommodate some concerns prior to this hearing. When compromise was clearly possible, we didnt. Majority staff acknowledged the changes would make some of these bills easier to enact. Still what were introduced were bipartisan bills instead of what we have been working to secure republican support. Unfortunately this has become all too predictable in the Public Health<\/a> space in this congress which is sad because historically it is the Public Health<\/a> space where this subcommittee comes together to legislate the most. It also concerns me that we are considering bills as introduced rather than the language negotiated as part of the bipartisan effort and this is that first time that majority minority have had agreement oldest of the majority move the goal post. Makes it difficult for members on the side of the dice to trust you and the agreements that are made. Ignoring our requests, reasonable request, actively harms the legacy of this committee. And it did not need to happen. I am puzzled why did. You should fully expect members to file a nimitz should bills be brought up to markup that you were unwilling to engage with us or our staff and did refuse to acknowledge our proactive outreach and ignored our flag concerns. My. My expectation for supposedly noncontroversial market is that you will not notice these bills but the ones where the general agreement had occurred. Many issues but especially Mental Health<\/a> should rise above partisan politics. We should come together to change the landscape and provide the muchneeded resources to individuals who are struggling with Mental Health<\/a> issues and i will yield back. Gentleman yields back. Everyone was not on when i said this earlier, but we expect most between 11 15 and 11 30. When i go into recess since will be voting in shifts. So the full committee chairman, mr. Pallone, has agreed to chair the hearing when i go over to the capital 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<\/a>. And remember to unmute, please. Thank you, chairwoman eshoo for convening todays legislative hearing on 22 bills to improve both quality and access to Mental Health<\/a> care in america. Of course want i want to wee back our former colleague Patrick Kennedy<\/a>. Everyone knows now is if you dont i will telecom is the new jersey resident actually a resident in jersey shore which on particularly fond of. I understand coming from the ocean state to the jersey shore, so youve been there for a few years now, so i really shouldnt be welcoming you, but thank you. Good to see you, patrick. This hearing is particularly timely as our nation is simultaneously confronting a Global Health<\/a> crisis, a severe economic downturn, and centuries of systemic racism. All three of these crises are understandably triggering distress for millions of people and it is compounded by the fact that many people are isolated from family and friends. It is no wonder that nearly half of americans are reporting that their Mental Health<\/a> has been negatively impacted due to worry and stress in recent months. Mental health is an essential part of our Overall Health<\/a> and wellbeing. Thanks to this committees work, we have made progress to better incorporate comprehensive Mental Health<\/a> care into our Health Care System<\/a>. We have improved Insurance Coverage<\/a> for Mental Health<\/a> services though the Mental Health<\/a> parity act of 1996 and the Paul Wellstone<\/a> and Pete Domenici<\/a> Mental Health<\/a> parity and addiction equity act of 2008. Thanks to the Affordable Care<\/a> act millions of americans now have access to comprehensive Health Insurance<\/a> plans that include Mental Health<\/a> care services. The aca dramatically improved access to Mental Health<\/a> and Substance Use<\/a> disorder benefits by requiring individual and Small Group Insurance<\/a> plans to cover these benefits. As a result, millions of americans can now access Mental Health<\/a> services and Substance Use<\/a> Disorder Treatment<\/a> without fear of exorbitant outofpocket costs that all too often deter people from seeking treatment. The aca also applied Mental Health<\/a> parity requirements to individual market plans. We continued to build on this progress in 2016 when president obama signed the 21st century cures act into law. It expanded access to Mental Health<\/a> services for children through medicaid, improved coordination between primary care and behavioral Health Services<\/a>, and reauthorized Important Program<\/a>s including those focused on Suicide Prevention<\/a>. Again, thank you congresswoman degette at upton for the role on that. Taken together, these legislative changes have made a true difference in americans lives, but there is more work that must be done to help people in need. In 2018, more than 47 million americans said they suffered from a Mental Illness<\/a> over the past year, including more than 11 million who had a serious Mental Illness<\/a>. Research estimates that more than 7 million American Children<\/a> have a Mental Health<\/a> disorder. Tragically, far too many of these conditions in children go unidentified and untreated, and research has found large disparities in access to Mental Health<\/a> services among black and latino children. We also know that people experiencing Mental Illness<\/a> are at a higher risk of developing Substance Use<\/a> disorder. According to surveys, roughly half of individuals experiencing Mental Illness<\/a> will also experience a cooccurring Substance Use<\/a> disorder. This underscores the importance of expanding access to both Mental Health<\/a> and Substance Use<\/a> Disorder Treatment<\/a>. This is particularly important as we continue to respond to the Opioid Epidemic<\/a> that claims 130 lives every day, as well as emerging epidemics involving cocaine and methamphetamine use. Unfortunately, suicide has also been on the rise. In 2018, more than 10 million americans seriously contemplated suicide and 1. 4 Million People<\/a> made nonfatal attempts. Suicide is now one of the top ten leading causes of death in the United States<\/a> and is the second leading cause of death among young people ages 10 to 34. Today, less than half of those with Mental Health<\/a> conditions get treatment with many citing the inability to pay for services as their primary reason for not seeking treatment. Individuals in need of care also often cite stigma and fear of discrimination as reasons for not seeking treatment and many others report difficulty gaining access to providers due to workforce shortages. All of this speaks to the urgent need for additional action to help those in need. That is why we are considering a variety of policies, including proposals to improve teleMental Health<\/a>, Mental Health<\/a> parity, Mental Health<\/a> services for students and in the emergency room, and Suicide Prevention<\/a> programs. Taken together, these proposals are focused on improving our nations wellbeing. I want to thank our witnesses this is a bipartisan issue. Many people have spoken out oute people have told their individual stories which is often difficult but i but i ade those who do that and again thank you chairwoman eshoo. This is really important legislative hearing. And as you mentioned we do intend to move bills. Thank you again. We thank the chairman of the committee and he yields back. Its now a pleasure to recognize the Ranking Member<\/a> of the full committee, mr. Walden of oregon for his five minutes of questions, for opening saving. Good morning, madam chair. Thank you very much, good morning. Madam chair, and i thank you for holding the string. I think its important hearing and one that we have a lot of work to do one. I which are some frustration at the outset about the bills and the liner. Im hopeful that we can work through as dr. Burgess at some of these legislative initiatives where we already found some agreement but we are hearing the underlying bill that has been agreed to. As chairman pallone said this is always been bipartisan work, Mental Health<\/a> issues, do not pick us by our Voter Registration<\/a> and theres a lot of bipartisan work being done here. I also must express all the frustration. I had trouble getting on so maybe thats where my frustration starts this morning, but were going to roll through with the votes because the way we are voting in the elongated voting and all, i know some of our members are concerned about missing out on some of the presentation that is in the q a with the hearing going on. I think for a future time we should have a discussion about how we do that. Too many of us have lost loved ones because a suicide. Like my friend conformed oregon u. S. Senator gordon smith who tragically lost his son Garrett Lee Smith<\/a> one day before his 22nd birthday. I worked with sender to spit on the original Garrett Lee Smith<\/a> morrill act which provides information training for Suicide Prevention<\/a>, surveillance and Innovation Strategies<\/a> for all ages. I was proud to see this Important Program<\/a> we authorized and expanded interiors. Many of the bills before city will further improve crisis intervention and Suicide Prevention<\/a>. Im looking for tips for 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 all know covid19 and resulting economic downturn hase impacted the Mental Health<\/a> and wellbeing of all americans. A recently released report by wellbeing trust of the American Academy<\/a> of Family Physicians<\/a> predicted that an additional 150,000 americans to die because of suicide or drug and alcohol misuse as a result of the pandemic. These deaths from despair as theyre called will likely increase as continued lockdowns further isolation and even the economic downturn. States will need resources to help prevent them. I am concerned one of the bills would make states ineligible for Mental Health<\/a> and Substance Use<\/a> disorder grants if they cannot meet the bills mandate. Under this bill certain states would be stripped of all samsung funding including Substance Abuse<\/a> prevention, treatment and come and help block grants to my friends of madrid may not have considered that these mandates are logistically impossible to meet as many states do not have yearround legislatures. Furthermore, kiting states critical funding at a time when theyre needed the most is not acceptable by which the majority the time to work with us on consensus limit of some the bills today that weve covered and look forward to working with you as we go forward. With that i will yield back knowing we have votes coming up. Tank the gentleman. He yields back. I met would like to introduce our witnesses for today. First, the honorable Patrick Kennedy<\/a>. He is the fount of the Kennedy Forum<\/a> as well as founder beloved former colleague of the house of representatives and a representative, where he represented Rhode Islands<\/a> 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, chief executive officer of the American Psychological<\/a> association. Welcome to you, and we thank you for being with us. Dr. Jeffrey geller is the president of the American Psychiatric<\/a> association and the director of Public Sector<\/a> psychiatry at the university of massachusetts medical school. Thank you, dr. Geller. Ms. Arianna gross is a National Youth<\/a> Advisory Board<\/a> member of the Sandy Hook Promise<\/a> students against violence everywhere, called save, promise club. Welcome to you and take you for being with us. We are so pleased, we really are. Its an honor. So former congressman Patrick Kennedy<\/a>, you are recognized for five minutes, please remember to unmute. We dont want to lose one word what you have to offer to us. Thank you. Thank you, madam chairwoman, and its so great to see 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 i tell them to do on Mental Health<\/a>. Im so honored that hes a member of this committee, which as such important jurisdiction over this critical issue to our nations health, here at it want to thank chairman pallone for his leadership, chairman burgess and chairman walden for the opportunity to address all of you and, of course, as i look in the screen i see some of my former colleagues, and im so grateful for the opportunity to see your faces, some of whom are covered by face masks, kudos to you are setting a standard and a model. So 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<\/a> parity and addiction equity act, republican jim branstad, come t appreciate this is a bipartisan process, special on Mental Health<\/a> which affects every family. We can go around saying it is one in four or its 50 , we all know in our own lives, its every family. And jim always used to say, patrick has got the same kind of profile in courage as his uncle president kennedy, and always would stop in and say i didnt have any courage about coming forward because what happened to me was a guy that i was in drug rehab with at 17 wrote about being in drug rehab with me in the National Enquirer<\/a> and he sold a story to the National Enquirer<\/a>. So basically i had no out. I want to keep the fact that i i suffered from addiction from an early age private. I do want anyone to know, and what ended up happening was i had no choice in the matter. I came from public family and, unfortunately, like Everything Else<\/a> it always is made public. I would say that was probably the best thing that ever happened to me in my life in the sense that for one thing, as a congressman i didnt have any fear for being outspoken proponent for Mental Health<\/a> and it was because i connect to worry about the press reporting about what i was a supporter of Mental Health<\/a>, because they somehow had the goods on me, you know, that they could hold it against me that i would disclose this private factor in my life. And it also help address the main point, and that is that we keep these illnesses secret, and these illnesses being secret of the reason why they are exacerbated. So let me just say, in recovery we say we are only as sick as our secrets. And i would say even though we have made great progress on Mental Health<\/a>, we are still very sick as as a nation because wep these things secret. I also think in recovery we have these phrases like, you know, you have got to walk the walk, not talk the talk. In our country we have really just talked the talk. We have never walked the walk on including Mental Health<\/a> and Addiction Treatment<\/a> in our country on par as we would cancer, cardiovascular disease, or any form of treatment that we would expect from our medical system. And then finally i would say that denial is the big issue here. And we all know growing up in families where there is alcoholism and addiction and or Mental Illness<\/a> that we dont like to talk about these things. And i frankly think the reason we as a nation have not addressed this issue is because we are still in deep denial about these illnesses and their pervasiveness. And the evidence in exhibit a of that is a fact that congress and the country has really never appropriated the necessary resources for this crisis to the chair womans point earlier. They never enforce the parity act and which is a sick and was a that simply says treat these illnesses like other chronic illnesses. And until there is that same urgency towards enforcing and until theres that same money backing up our words that these are really equal illnesses, we are really still in denial as a nation. And i look forward to hearing my other counterparts testify and 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 doctor evans. You are recognized for five minutes, and please remember to unmute, doctor. And thank you again for being with us. We so appreciate it. Thank you. Chairwoman eshoo, Ranking Member<\/a> burgess and members of the subcommittee, thank you for this opportunity to testify today. The American Psychological<\/a> association, its a leading scientific and professional organization representing psychology in the United States<\/a> more than 121,000 researchers, educators, clinicians, consultants and students as its members. Even before covid, our Mental Health<\/a> system was facing severe challenges. Less than half of the individuals with a Mental Health<\/a> disorder receives treatment and only about one in nine individuals with Substance Abuse<\/a> disorder receive treatment. The tragic result is that we have multiple crises happening simultaneously. We have pandemic that is creating a number of psychological challenges for individuals. We have on top of that and economic crisis that is also 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 has on many of our fellow americans. All of this results in data that shows consistently across a number of different sources that we are seeing increases in anxiety, depression, posttraumatic stress disorder and eating disorders. This is having a disproportionate impact on marginalized communities. The Public Health<\/a> term for this is systemic, and packing those at high risk for poor health, to address this we need a populationbased approach that targets appropriate interventions across a population including addressing social determinants of health. Example of the power of addressing social determinants like housing, when it looked as commissioner for Behavioral Health<\/a> in a city of philadelphia. My Agency Working<\/a> with the Housing Agency<\/a> leverage section eight housing funding with medicaid funding for Mental Health<\/a> services to address homelessness. As a result of this we were able to improve Mental Health<\/a> outcomes, able to get over 800 people off of the streets of philadelphia and we save literally hundreds of thousands of dollars. A winwinwin. We need improvement on a number of fronts. As would be addressed by the array of bills before you today. This include stronger parity enforcement, enactment of the parity and addiction equality act of 2008 was a major step forward and my fellow panelist and good friend congressman kennedy, we will forever come will ever deserve our thanks and gratitude for leading this fight which were proud to be a part of along with our friends and many other groups. Unfortunately, parity has not reached its sole potential and we need support for the parity bill before the committee to strengthen existing law. We also need to give patients that access to Mental Health<\/a> and Substance Use<\/a> providers. One of the bills before you, h. R. 884, the medicare Mental Health<\/a> access act, would incentivize Mental Health<\/a> Service Delivery<\/a> in rural and underserved areas by making psychologist eligible for Mental Health<\/a> shortage area bonus payment. I want to thank the bills longtime champion, congresswoman schakowsky, congresswoman mullen and cosponsors congressman forte, congressman lee han and congressman long for their support. I would also like to highlight congresswoman matsui extension act of telehealth expansion act cms has taken some Great Strides<\/a> in expanding telehealth across Mental Health<\/a> 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 the telehealth provisions permanent. In addition to the bills i have already mentioned, we support many others before you today, including the Behavioral Health<\/a> coverage Transparency Act<\/a> and the Mental Health<\/a> parity compliance act, the Mental Health<\/a> services for students act, the pursuing equity and Mental Health<\/a> act, and h. R. 6645 to provide additional funds to the National Institute<\/a> of Mental Health<\/a> for Research Related<\/a> to the Mental Health<\/a> effects of covid. Finally, i commend the leadership on the range of Suicide Prevention<\/a> bills before you today. Notably, by the cochairs of the Suicide Prevention<\/a> task force, and members of the committee. I am grateful for this opportunity to testify today and i look forward to working with you to advance these important pieces of Mental Health<\/a> legislation, and im happy to address any of the questions that you might have for us today. Thank you very much, doctor evans, for your important testimony. The chair is now pleased to recognize dr. Geller. You are recognized for five minutes for your statement, and please unmute. Welcome to you. Thank you very much. Chairwoman eshoo, Ranking Member<\/a> burgess, and distinguished members of the energy and commerce h. E. L. P. Subcommittee, thank you for all i need the opportunity to testify before you today. My name is dr. Jeffrey geller and im prefers of psychiatry at university of massachusetts medical school. I testify today as president of the American Psychiatric<\/a> association. Throughout the covid pandemic i work on site daily to treat civilly mental ill patient and icy outpatients through telepsychiatry. Also a parent. One of my sons whose intellectual disabilities supposed work daily where he delivers medical supplies throughout the hospital. I have been much more concerned about his wellbeing and have about my own. Covid19 crisis is exacerbatingg and anxiety depression and other Mental Health<\/a> and Substance Use<\/a> conditions. This disparity in inequity and were pleased to see this as part of todays focus. What highlight a few areas in my written testimony. First, the covid crisis is made the value of your actions to facilitate telehealth clear. Access to video and audio only telehealth has enabled large numbers of patients including vulnerable urban and rural as residents to receive care but also minimizing the risks of contracting or spreading covid19. Telehealth is popular with patient under members come as reduced noshow rates dramatically, and it has been quite effective. It is essential that cant telehealth authorization not end prematurely. The apa is active in working with psychology and others to ensure continued access to telehealth for our patience beyond the current emergency. We strongly encourage h. R. 5201 introduced by which would normally exempt Mental Health<\/a> services from medicares geographic site of service restrictions. Second, the only bill before the committee apa opposes is h. R. 884 which would define psychologist as physicians under medicated psychiatrist, psychologist and other team members like nurses, physician assistants, social workers and care managers help patients by each contributing and her own area of expertise. The goal of h. R. 884 is unclear and italy recognize that allows psychologist abroad services are trained to perform and to practice independently in appropriate settings. The psychologists are not physicians. Psychologists do not have medical training. The psychiatrists treat patients with Mental Illness<\/a> and comorbid medical patients. The psychiatrists has to recognize medical disorders, masquerading as psychiatric disorders. You cannot be equipped to do this without a medical school background. Cms emphasizes medicare patients and partial hospitalization programs require comprehensive structured multimodal treatment requiring medical supervision and coordination. We know high quality care is best provided by a team working together to provide coordinated services. But this legislation would do the opposite come from the fragment and create unnecessary and dangerous silos. Existing guardrails are there for a reason. Administrative hurdles can be addressed without going to the extreme, like inappropriate defining psychologists as physicians under medicare. We suggest the subcommittee focused its attention on the oppressive array of proposals before you i which there is broad agreement, and little controversy. Finally, theres Mental Health<\/a> parity. Both apa, i fellow panelist Patrick Kennedy<\/a>, and unified Mental Health<\/a> and Substance Use<\/a> Disorder Community<\/a> champion parity law in 2008. But has failed to in discriminatory Health Insurance<\/a> 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 of the bill proposed by representative porter and bilirakis can help improve reporting of health plans medical Management Practices<\/a> and thereby enhance compliance. We support both bills and recommend the important 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 American Psychiatric<\/a> association. We look forward to working with you to improve the availability, accessibility, and affordability of quality Mental Health<\/a> care across our nation. Thank you. Thank you very much, dr. Geller. We have 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. Arianna gross. You are recognized for five minutes, and please unmute. Welcome to you. Thank you. Good morning, faq to the committee chairwoman, Ranking Member<\/a>, and all the neighbors of this committee on this before im here today. A 15yearold rising junior in covington, georgia. Im in my second serving as one of the only Advisory Board<\/a> members on Sandy Hook Promise<\/a> is students against violence february often promised club. It was formed in 1989 as the result of 17yearold who died from gun violence. Today there are over 3500 clubs across the nation in all 50 states. They say promised club in my community admits to use and as to protect our friends come schools and community from all forms of violence including suicide. We do this by promoting Student Health<\/a> and Mental Health<\/a>. For example, in response to fight in a School Record<\/a> at the bowling projects with Students League<\/a> policy messages about themselves and each other put them on a wall around the school. It provides opportunity for substantive about themselves and appears. Because of covid our project is holding weekly calls with the primary folks supporting the Mental Health<\/a> of our streets. We open this up to the command of large because Everyone Needs<\/a> help. As a student i know that Mental Health<\/a> and wellbeing are more important now than ever before. Suicide is the second leading cause of death for students and for black boys, the rates are on the rise. Unlike other tragedies their actions this one is preventable. 75 persisted to die by suicide will show a warning sign or tell a friend. Covid is only making this worse. For some students home isnt the safest place and with no place to go and know when to go to from our schools, it has become very stressful, lonely and even dangerous for some students. I have seen firsthand the need for support for student Mental Health<\/a>. In our school a year doesnt go by without a student dying by suicide. Ive even known an elementary kid who died by suicide. I am concerned Youth Suicide<\/a> has become so, that my School Community<\/a> and our nation is that in the pattern of mourning and accepting these death is something that is normal instancing dennis preventable and tragic. As stewards we see everything in class come in the neighborhood, and on social media. We see way more than our parents, teachers and other adults that we are not given the tools to help our friends struggle with Mental Health<\/a> or speaking about suicide. We need the tools to save lives. Trust me, we have seen and been through way more than you realize and we can and want to help. Our say from scope teaches how to spot a friend who is struggling Mental Health<\/a>. I briefly had a friend who is struggling and didnt feel comfortable talking to a parent or a teacher. Finding and affording care can be challenging. When i had to see a therapist i had to travel two hours from my home. This shouldnt be the case in order to get help at school. Unfortunately when i go to school theyre only supporting ones for academics and not qualified Mental Health<\/a> professionals. Because of that, many students dont talk about how theyre feeling and we need for our minds and our academics. We need your help in creating a system of support in our schools. Allow us to be the eyes and ears of our peers. Give us the tools and training to know when their friends or ourselves may be struggling so we can speak up and prevent suicide. Once we speak up, for those who are struggling. The bipartisan act of 2020 and the Mental Health<\/a> act for students. These bills will help support Mental Health<\/a> and wellness to train students on Suicide Prevention<\/a>. You have the power to help and i ask that you act now to prevent another one of my friends from dying from suicide. Thank you. Thank you very much for your excellent testimony. We now we have completed the testimony of our witnesses and well move to member questions and i recognize myself for five minutes for questions. First to patrick. Patrick, you wrote the Mental Health<\/a> parity 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<\/a> systems 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 it because its missing money or did we miss something in the legislation . So thats my question to you. Thank you. And 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<\/a> gets. 04 of the cares act funding, it says a lot where Mental Health<\/a> is in this country and when you see how many routine violations by Insurance Companies<\/a> 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 originally in their brain as opposed to another organ in their body and thats widely accepted and 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<\/a>. I mean, it is weve been at it for a long time, accepting it as a moral failing and not a medical failing and so at that kind of grows on you. Gets to make you think, you know, someones 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 their housing or that they alienate their friends or family members is all part of what someone voluntarily chooses to do in any given day which of course, we know is not the casement so, why cant our country get over the fact that these are by logically based disorders and behaviors, but a symptom of them, thats what the neuro scientists at nih tell us. So i would say if we can understand that as the premise, then why wouldnt the payment models, which by the way, reimburse for all kind of Health Benefits<\/a> rather than sick benefits for, you know, cardiovascular disease. I mean, ive been on lipitor for 20 years, right . Apparently our Health Care System<\/a> thinks its best if i dont die from a stroke or a heart attack in 10 more years and theyve invested much in me, but when it comes to Mental Health<\/a>, theyre just missing in action. And so, yet, we allow that as a society. We dont enforce parity laws both at the state or federal levels. There are now some states that are doing a terrific job in stepping towards that, but 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. But thats what i would say in a long winded way to your question. Sorry for taking up too much time. No, i hang on every word that you say. Just very quickly, dr. Evans and dr. Geller, 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 . So i could respond to that. I think that Patrick Kennedy<\/a> is exactly right. In the entire history of our country weve always tied together any reform in Mental Health<\/a>care with saving money. Doroth dorothea dix traveled around the country and testified on two things, we can save money and do whats right. To actually address this problem, we need to say we need to do whats right and its going to cost us some money. We go in for surgery for can, no one asks how much money is that going to save. For cancer. 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, the Ranking Member<\/a> of our subcommittee for his five minutes to ask questions. Sure and thank you. I thank the chair. Dr. Geller, i want to thank you for raising the concerns you did about hr84, seems like too often in this subcommittee we dismiss or ignore or devalue the benefits 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 Opening Statement<\/a> 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<\/a> care providers. When suicide was a problem among our colleagues prior to the onset of this coronavirus epidemic and i know it is more pronounced now. So, do you have any recommendations for us for us on this subcommittee. Well be working through these things and well have a full markup perhaps the catco legislation, perhaps some other legislation where you would see it, where we could modify it to more properly attempt for and perhaps impact positively our Front Line Health Care<\/a> personnel . Personnel . I can tell you that besides prejudice and discrimination in relationship to preventing with a Mental Illness<\/a>, a major problem for 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 Mental Illness<\/a>. When i applied for a license and renewal every three years, generally im asked the 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 that it would make Frontline Health<\/a> care workers more willing to seek treatment. The second is, we need to do a Massive Campaign<\/a> to educate the population about what Mental Illness<\/a> is. We are familiar with a very ineffective Massive Campaign<\/a> currently in terms of how to protect oneself from covid and to remove the prejudice and discrimination against homosexuals in the time of the aide crisis and weve dramatically turned that around and in the 1940s and 50s we did the same thing with breast cancer. Nobody would say the word cancer. So we know how to do it and thats what we need to do. I thank you for those observations. Mr. Kennedy, i wanted to ask you, representative ferguson introduced a bill 3539 and i think i see in your written testimony, you talk about social and Emotional Learning<\/a> and as our last witness testified, often times amongst the student population, they can quickly 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 that trouble all the time. Thank you, dr. Burgess for prioritizing that. You know, its shocking. Literally, as shocking as it is that we dont address Mental Health<\/a> in our Health Care System<\/a>, we dont address Mental Health<\/a> in our Health Care System<\/a> because how are children supposed to learn when their migdulas are on fire and theres no adequate coping skills to develop. Theres no problem solving skills, no socialEmotional Learning<\/a> skills developed. I think that you are absolutely on point that this needs to be a priority and it will be an enormous protective factor for especially since were seeing suicide rates skyrocket. This will help kids learn 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. And on fire i ask you, you said in your testimony, the largest facility 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 . No, you know, im familiar you should also ask judge lightsman who has successfully turned around a major bond for an additional jail down in florida and he took that money and he put it into Supportive Housing<\/a> for those with severe Mental Illness<\/a> for the predominantly schizophrenia diagnosis, bipolar 1. What he ended up doing, reducing 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 and you know, charges, loitering, all kinds of what they call nonviolent offenses. That could be better picked up by a Mental Health<\/a> system frankly as were talking about today is nonexistent. So our criminal Justice System<\/a> has become a default mode, in fact, we dont have a Mental Health<\/a> 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<\/a> by providing those services which arthur evans and others have spent their lives providing, that Supportive Housing<\/a> that he talked about in his Opening Statement<\/a>, thats the solution that we need. Thank you for that. Redirecting is, of course, a part of that process, not just eliminating. I thank you for your input. Youve raised some interesting points that i want to discuss with you. Of course. The gentlemans time is expired. I cant help, patrick, but think of our good friend and his wife, but norman and judy warrenstein who have done extraordinary work in this area and the example that you used from florida relative to the criminal Justice System<\/a> and bringing justice to those that have the Mental Health<\/a> issues and using the dollars in a very, very smart and effective way. Now, mr. Polan is voting. Mr. Butterfield is not there. I believe miss matsui is recognized now for her five minutes of questions. Thank you very much, madam chair. I appreciate you calling this hearing today. Its such an important subject because theres such an impact on many of our own lives. Before i get to my questions, i do want to acknowledge that tremendous pressure our Community Behavior<\/a> Health Centers<\/a> are facing to meet this crisis. Given that theyre completely unacceptable, and largely Covid Relief Fund<\/a> made available by hhs. I work in this committee to finding a solution that would guarantee adequate aid to those providers to avoid permanent losses to the Behavioral Health<\/a> infrastructure. Prior to this pandemic. My colleague johnson and i introduced the teleMental Health<\/a> extension act to expand access for medicare, for restrictions for teleMental Health<\/a> services in the urban areas and at the patients homes. In sacramento, theyve been using teleMental Health<\/a>. Theyve seen overall encounters and patient visits increase by almost 50 . Conducting 80 of Behavior Health<\/a> via telehealth. Remarkably the telehealth have a noshow rate of 10 compared to 40 for facetoface visits. With that in mind, i want to ask about this new reality of widespread virtual care. Dr. Geller, can you expand on how lifting certain restrictions on Mental Health<\/a> via telehealth has been during the pandemic . Its had a remarkable effect. Weve shifted, previously, the psychiatrists approximately 65 had in the previously used telehealth and now about 85 are using telehealth for about three quarters of their patients. Okay. Many patients have difficulties getting to appointments, particularly in the period of social distancing, they actually have no way to get to appointments. Its either no Public Transportation<\/a> or transportation that anybody would use because of infection rates. Sure. So 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<\/a> available a huge percentage of the population that didnt previously have available services. Right. So the combination of allowing for visual as well as telephone only services is very important as we have many patients who have no idea how to use any electronic equipment whatsoever. Exactly. That is very important. Mr. Kennedy, my former colleague, at the outset of the pandemic, made certain that all connected Health Services<\/a> would be reimbursed at the same rate as inearn about service. Why is payment critical to sustaining the use of telehealth . Well, its obvious that a key driver in terms of ability to provide the service is necessary because while there is a suspension now and people are using it, thats not going to continue unless the biggest payer of all cms steps up and starts paying for it and by parity, meaning it is deemed equally effective, especially in addiction medicine. Exactly. To inperson. Why we wouldnt pay the same is beyond me and you guys need to really set on cms to do that and you also, to your point, congresswoman matsui, like you said, make sure the money you already appropriated for Health Care Relief<\/a> goes to Mental Health<\/a> providers. Theyre the ones getting the shortest of the short end of the stick in terms of money because it went through medicare as a mechanism not through medicaid as a mechanism of payment. Just as a highlight for your colleagues who dont know why their Behavioral Health<\/a> providers are barely hanging on, if at all in their districts. Thank you very much. I want to thank you for your advocacy. Its been unbelievable. And the access to treatment for Mental Health<\/a>, i encourage teleMental Health<\/a> and broader teleHealth Services<\/a>. And i see my time is gone so i yield back. Thank you. The gentle woman yields back and were very grateful to you, congresswoman matsui for your special leadership. This is not only a Public Health<\/a> issue for congresswoman matsui, its highly personal. As patrick said in his Opening Statement<\/a>, we have family members. We have family members so we carry those experiences and those wounds with us and we certainly have and thats why your advocacy and your work is so important. The chair would now like to recognize with pleasure the Ranking Member<\/a> of the full committee, mr. Wall walden for his five minutes of questions. Mr. Walden with us . Then well go to mr. Upton. Well, 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 in the Mental Health<\/a> charity a long time ago, but obviously we still need to step up and we need to do more and his friend and his advocacy with his key players and certainly in our Committee Really<\/a> makes a difference. I think the point that he made early on where one in four families, lets say every family, mine, too, directly impacted by suicide and things that we know we can do to really make a difference to begin this, the turn around to turn that around and Everything Else<\/a>. Ive got a couple of questions and i want to follow up with what, i guess, what doris was talking a little 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 really key and of course, we know 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 active in introducing legislation, i think well see additional legislation well introduce literally in the next couple of days, that would require the action to auction off some of that spectrum. For states like mine underserved. Michigan is going to get a billion dollars, 108 million in the next ten years. Ive got districts in my area, without a four lane road and broadband. And kids going back to school extremely limited without that access, but 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 2. 0. Weve had good conversations how we might expand telehealth and also a look at cms to make sure they impact those services, but i might ask both dr. Geller and evans, what additional things can we do as it relates to telehealth for Mental Health<\/a> services . Well, congressman, i would say a couple of things, one is that in addition to supporting the principle of telehealth, as you noted it helps with access and for a variety of people not only in rural areas, but in urban areas. When i was a commissioner for Mental Health<\/a>, we had immigrant communities in our city that had fairly large immigrant populations that didnt have Mental Health<\/a> professionals who spoke their language in the city. 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 for cms and fortunately we were able to get that. Its not just having video conferences ability which many communities dont have, but its also being able to do telephone 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, 201 2019 nihfunded study for deliberate harm had a rate after discharge. How important is it to screen for suicide risk in Emergency Departments<\/a> 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<\/a> within the last year and theres a High Percentage<\/a> of people who die by suicide who had a mnl Emergency Department<\/a> visit relatively short time to their suicide. So doing universal screening in the Emergency Department<\/a> is important. Having surveillance mechanism, but i can tell you as someone who is overseeing Mental Health<\/a> systems, one of the most important aspects of this is to to have connection, between Emergency Departments<\/a> and the local Mental Health<\/a> 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<\/a>. Thank you, my time is expired. The clock goes way too fast. We all have i have 20 questions ive got 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<\/a> and a 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. And 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 Patrick Kennedy<\/a>, all the members on both sides of the aisle have said nice things about you and i want you to know that theyre all deserving. We miss you here in the congress and thank you for the incredible work youre doing all across the country. Patrick, while we have made progress in normalizing conversations and stigma and youve made it abundantly clear and we have a long way to go, youve noted that the promise of Mental Health<\/a> care and equity act have not been realized. And manier encountering when speaking Mental Health<\/a>. Im sure that some give up after receiving denials or limited benefits, can close the window of opportunity for the individual that they could get harm, harm to the individuals. And you look at economic losses to our community, our country as we all know it, experiencing crisis on so many different fronts, from covid to the epidemic of police violence, against africanamericans. Now, more than ever, the process to seek help should not be a barrier to receiving help. Question, what should we do . What should we do to enforce the Behavioral Health<\/a> standards and regulations to ensure that beneficiaries are not encountering needless road blocks to receiving the care that they need when they need it . I thank you so much. Gk, obviously youve got before your committee a couple of different bills, both of way are very, very important to help bring Greater Transparency<\/a> to really what Insurance Companies<\/a> deliberately obfuscate. 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 parity act and so i would basically encourage you to pass those parity bills that you have before you because as you said, gk, what its really about is Insurance Companies<\/a> know that its going to take forever for you to appeal their denial. Counting on it is the cost of doing business. So many people who are in a Mental Health<\/a> crisis, families in a Mental Health<\/a> crisis, they have nowhere near the wherewithal to challenge a major payer, a thats what the Insurance Companies<\/a> count on. And reduces the total liability to provide care because they basically deny care and yet, if you looked at the comparable between the percentage of care they deny thats Mental Health<\/a> and addiction related versus medical and surgical related you would see a huge disparity and what your bills before your committee do is, that they will require that to be opened up for the light of day, so that theres transparency and i think of transparency, Insurance Industry<\/a> will be loathe to put together any plan that when evaluated will clearly illustrate that theyre discriminating because as you know, gk, through your long work and behalf of civil rights, 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. So, thank you for that question. Thanks for your service and your friendship. 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 told who it is right now. It looks like its mr. John simpkins. Youre recognized for five minutes. Thank you, mr. Butterfield and congressman kennedy, good to see you. I was looked at the exchange of dr. Evans and mr. Upton. I represent 102 counties in illinois, i represent 33 of them and so what covid has caused to happen, which is kind of a side benefit, its forced us to ease some of the regulatory burdens on telehealth. And so, i know, dr. Geller, in your testimony you talk about te te telepsychiatry. And if someone is working when this covid crisis fails i mean, when it ends, we dont want some of the reforms created for emergency purposes, wed like to see them continue. I just think thats helpful. Everybody understands theres unserved, underserved areas and money is going in, whether for us the sec, even some of the states are starting to put more money to broadband deployment and laying fiber. So, first of all, let me go to dr. Geller. I think ive heard requests from 22 month extensions and or more, and i guess what well be asked is not because of 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. Geller . So, yes, we do. The an extension that should allow for study and we could look at various outcomes in terms of access and we could also look at something i mentioned before, but its unfortunately incredibly important and that is cost. While its going to cost more upfront because people have more Services Available<\/a> and access more services is a high likelihood theres going to be significant downside, downstream savings, not having people go to emergency rooms, not having people leave inpatient admissions. And we look at clinical variables and economic vartables 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. Yeah, what would you think would be a time frame that we would need to gather this data . With em well, thats an excellent question because we expect even after the infectious aspect of this pam is over that were going to have a Mental Health<\/a> pam that could go on for quite some time. But we dont really know how long thats going to be. The ap doesnt have any official position on how long that should be. If you were asking me, i dont think we could know that the answer in less than five years. Yeah, i think thats important for us to hear because i am, again, this is in such a great opportunity to exercise and show the benefits of telehealth in the medical practice field for underserved, unserved communities in rural areas. Dr. Evans, do you want to add anything on this debate, period of time, our push to keep this when they ease the regulatory burdens, we want to make sure we dont replace them once someone thinks this thing is over . Sure, well, i think its important to keep it and to recognize that telehealth is only a means to an end. Its a mechanism to provide services that we know work for people and dr. Geller referenced in his point. One of the things we know is that there are significant offsets on the physical health side when people have access to meant health care. So, i would expect that not only will people be able to address their meant 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<\/a>. We have relationships with farm aid and the farm bureau and were currently working with a program to train individuals to work with people in Rural Communities<\/a> and one of the things thats really clear, we can do our part as an association to train people and to encourage people, but we need to have the infrastructure available so that people can get those services delivered. So i appreciate your question. My time has expired, thank you, gk, ill yield back. Thank you, the chair recognizes the chairman of the full committee for five minutes. Please remember to unmute, frank. Thank you, gk. Patrick, i wanted to go back, i know everyone keeps asking you about the promise of the federal parity law which you sponsored and you know, what more needs to be done and you talked a little you certainly talked 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<\/a> parity laws and increase transparency regarding how the Health Insurance<\/a> plans to comply with the law. I want to ask you about both of those things. Looking back at the implementation of the federal parity law over the past decade, can you discuss the challenges associated with the enforcement and oversight, you know, basically transparency . I know you dont think its been fully realized, but you know, what remains to be done to deal to achieve parity looking at the enforcement and the transparency, if you would . In a little more detail. Well, for one thing, having one inspector for over 1500 plans, obviously lets the you know, 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<\/a> of the way insurers make these medical assessment determinations wan we need to before the bills before the Committee Really<\/a> demonstrate how that all works and you know, thats the process of evaluating whats known as nonquantitative treatment limits, a medically necessary criteria, all which are crucial to peoples ability to get the care that they need in a timely manner and i know that dr. Evans, as well as dr. Geller, 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 you need more staff is what your there isnt a call by the whole community for 20 million would dramatically improve department of labors. We have nearly 80 of people in our country are covered by arissa plans so the oversight is obviously by department of labor. Most people dont know that, but so i would encourage all of you, in your jobs as federal members, this is in exactly your purview, you need to have your department of labor step up its game. Its absolutely unbelievable in the time where were losing more people to suicide and overdose and alcoholic deaths than they are covid, more than cov covid. And what do we spend . We cant even get 20 million even. By the way, for my republican friends, enforcing parity means that making sure that Insurance Companies<\/a> dont give the heisman to Mental Health<\/a> and addiction such that our taxpayers have to pay the difference here because thats ultimately what happens is because payers never really fully adhere to this federal parity 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 disproportionate sides gobbled up by people who are homeless, 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 our the Richest Companies<\/a> in our country, the health care Insurance Companies<\/a> who, by the way, are sitting on a boat load of cash because they havent paid bills for the last five months and theyre denying Mental Health<\/a> still, you cant even make this up, and who is paying for this . The hard strapped taxpayer is paying for it in innumbererable ways including through medicaid and also through their local property tax base. So if i were both a liberal or a conservative, parity would be a big issue for me. Thank you, patrick and thanks for all of your work over the years. Thank you. Gk or i see shes back as well. I went as fast as i could and i want to thank 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. Griffiths for your five minutes of questions. Thank you, madam chair. Can you hear me . Yes. All right, i appreciate it. I have submitted for the record a letter from jennifer feist. Many of you may have heard of her sister who was at the Allen Hospital<\/a> in new york city. Dr. Breen endured stress as she helped covid19 patients and battled the virus herself. Eventually the responsibility for human life, lack of sleep, unknowns of this virus became no burdensome, dr. Breen 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<\/a> was at risk and her career could be over. Approximately two weeks later she took her own life. And the bills in force today address many important issues, but none would have alleviated dr. Breens concern. We must consider the Mental Health<\/a> of the providers on the front lines of had a pandemic. I dare say very few individuals could have endured struggles dr. Breen endured without help. I was on the way to vote, i was listening even though i was going over to vote, but for dr. Evans and dr. Geller, do you believe that doctors should be an i believe to seek Mental Health<\/a> without risking licensure. I am familiar with the dr. Breen case. The answer to that is absolutely. One of the question is, should states be able to ask the question on your license application, and most states in fact ask the question. We have got to start a Major Campaign<\/a> to address prejudice and discrimination. We use the word stigma, but its an unfortunate word. If we use the word prejudice and discrimination. We would understand its the same prejudice and discrimination against minorities. Its prejudice and discrimination to think that if a person has a Mental Illness<\/a> theyre not capable of functioning. Patrick kennedy who addresses that throughout his life and hes actually 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 interductry remarks, i have a son with pretty significant intellectual disabilities who keeps people every day with medical supplies. Yes, emphatically, we need help from congress to remove prejudice and discrimination and treat it. Congressman, if i could add something. Yes, sir. Your point is a really good one and one of the big challenges of the way that we deal with Mental Health<\/a> and patrick references, is almost entirely reactive and we wait for people to have a diagnosis before we intervene. One of the things that we have to start doing and 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<\/a> association is doing is developing information for elk Health Care Workers<\/a> as one of the groups to tell people how they can manage and mitigate their stress and to do selfcare that would reduce the likelihood that their psychological one more quick question before i run out of time. I run in a district where health care is limited. As much as wed like psychiatrists there we dont have them. Do you believe hr will help the Rural Communities<\/a> . Absolutely, absolutely. I can tell you i spent a good amount of time last year in a Southern State<\/a> and the major reason that people missed their followup appointments they didnt have money to put gas in the car. And the other is, one of the reasons weve affected attendance at followup visits is that its the doctor who initiates the contact. So i can tell you in my own experience ive had lots of telepsychiatry contacts where the person says, oh, i forgot about my appointment. Lo and behold we had the appointment anyway and i contacted them, so, yes, it makes huge difference in rural areas. Telemed, but im talking about expanding the ability of a number of people to provide help that arent currently licensed to do so. I think that thats an important one of the things thats happening in global Mental Health<\/a> is the notion of tax shifting. Not all of the functions that Mental Health<\/a> professionals do needily need to be done by a highly trained Mental Health<\/a> 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<\/a> 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<\/a> recently ran a piece written by an emergency physician in arizona titled i am a Health Care Worker<\/a>, 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 physician makes clear the impact of responding and treating high numbers of Covid Patients<\/a> or obviously more than physical. This is true in new york city, other hardhit medical communities that lacked the personal protective equipment and resters. And our colleague has had a bill that would provide the state and communities for Frontline Health<\/a> care workers, work force training. Paul conoco has a bill to study the impact of covid19 on the Mental Health<\/a> of americans, including Health Care Workers<\/a>, and i think both of these have been included in a modified fashion in the heroes act. I want to speak a little, its been touched on in response to questions from congressman burgess. But maybe dr. Evans and dr. Geller, the best way for Mental Health<\/a> support and counseling for Health Care Workers<\/a>, because obviously one avenue avenue for this is through the institutions, the hospitals. The Community Health<\/a> 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<\/a> program and other measures to help the Health Care Workers<\/a> that are on the front line, what would that look like . And ill start with dr. Geller and then dr. Evans if you have any thoughts as well. Three components. The first is that you have to have the services on site and immediately available. For those of us in health care that are terrible at saying no. Were not going to leave at the end end of their shift, its the end of their shift where people are dying. So you have to have services immediately available. Second is the advantages again of telehealth. Youre much more likely to have a Health Care Worker<\/a> who has gotten home and can call in to somebody than somebody after working 16 hours and asking them to go to somebodys office. And the third, which dr. Evans alluded to previously, is proactive Wellness Programs<\/a> that are available right on site. So if im in the emergency room, i could take a half hour and go to a yoga glass. All right. Dr. Evans. I would add is peer support is extremely important, that often people in the medical and nursing professions dont want to reach out for help and so what weve 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, of the kind of selfcare information that weve provided for Health Care Workers<\/a>, its really important because what we do, we talk about, mere is an exercise that you can do when youre extremely stressed and then we give people the Science Behind<\/a> that works and why thats an effective strategy. So, i think it really is a combination of making sure that people have access to care or that there is peer support, that there are options to help people understand things that they can do themselves and ultimately ensuring that people can have access to care when they need it. Thanks. Thats already in place, as you know for oncologists, particularly pediatric oncologists and others, they have the support systems. The mayrroyo mayo clinic where frankly a lot of recovery for people with addiction were for people with doctors who were experiencing enormous stress in their jobs and needed ways to learn how to manage their own stress and feelings. Thanks very much, patrick. And as i close. Thank you for your leadership and advocacy in this area. Two things im coming away with from this call that youve emphasized. Weve got to address the stigma and put resources behind the efforts. Thank you, madam chair, i yield back. 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. Yes, nice to see you. I am here. Dr. Geller, would you describe the benefits youve received for patients receiving care for Mental Health<\/a> services via telehealth during covid19. If your opinion has the flexibility provided by congress and the Trump Administration<\/a> facilitated needed access to Mental Health<\/a> and substance Disorder Services<\/a> during this pandemic . The greater flexibility and access to telehealth, i think, has made a tremendous difference. The inclusion of the ability to have telephone appointments has made a tremendous difference. People have referred several times for people who dont have broadband access, but its greater, and i have a gentleman who hasnt bought a piece of electronic equipment since the Johnson Administration<\/a> and his favorite activity is listening at home to records on his record player and for 25 years, he only talks to his brother and me, the only two people that he talks to in his adult lifetime. 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 disorganize, i initiate the contact, often by phone so i can 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. Geller. Mental health in missouri, a year, year and a half ago, more recently during the pandemic, but i know that they take advantage of the Mental Health<\/a>, telehealth thing a lot and its very, very vital. Very, very important and they also were 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 shortage of Mental Health<\/a>, Behavioral Health<\/a>. What will it take to attract more students into this field . There are several things. One is we need a program, much expanded program on loan forgiveness. People can get out of their training with half a Million Dollars<\/a> in debt. Thats going to direct them to high paying specialties, not to low paying specialties, so we need people in primary care, we need people in psychiatry and pediatrics. And so loan forgiveness would make a big difference. And medicare funded residency slots directing those slots to underserved areas. Fellowships and those shortly directed to specialties that are underrepresented like psychiatry. Those are all 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 miss gross next if i can. Thank you for being here, miss gross, and speaking about what youre doing in your community to promote Student Health<\/a> and wellness. You say as students you see more parents, teachers and other adults live now to the floor of the u. S. Senate for what is expected to be a brief pro forma session. The presiding officer the senate will come to order. The parliamentarian will read a communication to the senate. The clerk washington, d. C. , august 14, 2020. To the senate under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable tom cotto, a senator from the state of arkansas, to perform the duties of the chair. Signed chuck grassley, president pro tempore. The presiding officer under the previous order, the Senate Stands<\/a> adjourned until","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia601905.us.archive.org\/25\/items\/CSPAN2_20200814_121700_House_Hearing_on_COVID-19_Impact_on_Mental_Health\/CSPAN2_20200814_121700_House_Hearing_on_COVID-19_Impact_on_Mental_Health.thumbs\/CSPAN2_20200814_121700_House_Hearing_on_COVID-19_Impact_on_Mental_Health_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240716T12:35:10+00:00"}