A bill to amend title 38, United States Code, to establish epilepsy centers of excellence in the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes.

Mr. President, I rise today to urge swift Senate passage of S. 2162, the proposed Veterans' Mental Health and Other Care Improvements Act of 2008, as amended. This is an omnibus health care measure, which responds to the burgeoning mental health concerns of veterans and their families. The bill, as it comes before the Senate, is a compromise agreement developed with our counterparts on the House Committee on Veterans' Affairs. I thank Chairman Filner and Ranking Member Buyer of the House committee for their cooperation in this endeavor. I also thank my good friend, the committee's ranking member, Senator Burr, for his great energy and cooperation as we have developed this bill.

This compromise agreement is also focused on addressing homelessness among veterans, increasing VA's efforts on pain management, promoting excellence in VA's efforts relating to epilepsy, and improving access to care in rural areas. It also includes a series of necessary programmatic authorization extensions as well as major medical facility construction authorizations.

The framework for this bill is my legislation, S. 2162 as originally introduced. This bill represents a bipartisan approach and was cosponsored early on by the ranking member, Senator Burr, along with Senators Mikulski, Ensign, Rockefeller, Smith, Bingaman, Dole, Clinton, Collins, Sessions, and Stevens.

Mr. President, I want to share how we began this process. The legislation did not stem from a lobbyist or an interest group. It came about because of one letter--a letter to me from the parents of Justin Bailey--Mary Kaye and Tony Bailey.

Justin Bailey was a war veteran who survived Iraq only to die while receiving care from VA for PTSD and substance use disorder. A week after his death last year, Justin's parents were naturally heartbroken by the death of their only son, but even more than that, they were concerned that other veterans might share his fate if VA mental health care did not improve.

In their own words, they asked, ``Everyone talks about the costs of sending troops to Iraq--what about the cost of caring for their injuries, both physical and psychological, when they return?''

From this first letter, the Committee on Veterans' Affairs held various hearings on the mental health needs of veterans. The media carried so many stories of veterans who were suffering, and various studies showed how prevalent mental health difficulties are in those who return from duty in Iraq and Afghanistan.

We worked with experts in the mental health field and others who were advocating for veterans, including those at the Disabled American Veterans, to craft a bill that responded to the problem. This legislation responds to the concerns of the Baileys and many others who have come to the committee to tell their stories, and does so with the clear understanding that veterans care is a cost of war. If we neglect to pay these costs when the service members first return from deployment, we as a nation will suffer incalculable human costs that can never be repaid.

Provisions included in this compromise agreement are drawn from various bills which have all been reported favorably by the Senate Committee on Veterans' Affairs, including S. 1233 as ordered reported on August 29, 2007; S. 2004, S. 2142, S. 2160, S. 2162, as ordered reported on November 14, 2007; and S. 2969, as ordered reported on June 26, 2008.

I will briefly outline some of the key provisions in the compromise agreement.

This legislation would make comprehensive changes to VA mental health treatment and research. Most notably, it would ensure a minimum level of substance use disorder care for veterans who need such care. It would also require VA to improve treatment of veterans with PTSD co- occurring with substance use disorders. Additionally, in order to determine if VA's residential mental health facilities are appropriately staffed, this bill would mandate a review of such facilities. It would also create a vital research program on PTSD and substance use disorders, in cooperation with, and building on the work of, the National Center for PTSD.

It is not uncommon for veterans with physical and mental wounds to turn to drugs and alcohol to ease their pain. Many experts believe that stress is the primary cause of drug abuse and of relapse to drug abuse. Sixty to eighty percent of Vietnam veterans who have sought PTSD treatment have alcohol use disorders. VA has long dealt with substance abuse issues, but there is much more that can be done. This legislation would provide a number of solutions to enhance substance use disorder treatment, including an innovative approach to substance use treatment via Internet-based programs.

Furthermore, the inclusion of families in mental health and substance use disorder treatment is critical. To that end, the compromise agreement would fully authorize VA to provide mental health services to families of veterans and would set up a program to proactively help veterans and their families to transition from deployment to civilian life.

Beneficiary travel reimbursements are essential to improving access to VA health care for veterans in rural areas. This legislation would increase the beneficiary travel mileage reimbursement rate from 11 cents per mile to 28.5 cents per mile and permanently set the deductible to the 2007 amount of $3 each way. Senator Tester has been a leader on this issue, and I thank him for that.

Too often, veterans suffer from lack of care not only because they reside in rural areas but also because they are unaware of the services available to them. This legislation would enhance outreach and accessibility by creating a pilot program on the use of peers to help reach out to veterans. It would also encourage improved accessibility for mental health care in rural areas through coordination with community-based resources. Mental Health America and Iraq and Afghanistan Veterans of America brought to the committee the concept of using peers to help veterans, and I think it is a good one.

It is crucial that all veterans have access to emergency care. This bill would make corrections to the procedure used by VA to reimburse community hospitals for emergency care provided to eligible veterans to ensure that both veterans and community hospitals are not unduly burdened by emergency care costs. This provision is based on legislation introduced by Senator Brown in response to a situation in his own State of Ohio, where community hospitals were not being reimbursed timely from VA.

The compromise agreement also addresses homelessness among veterans, a far too prevalent problem. The bill would create targeted programs to provide assistance for low-income veteran families. It would also increase the total amount that VA is authorized to spend on its successful Grant and Per Diem Program, which assists community-based entities that serve homeless veterans. Finally, the bill would expand a program to help formerly incarcerated veterans reintegrate into life and ensure facilities are up to par for women veterans who are homeless.

Epilepsy is often associated with traumatic brain injury. This legislation would establish six VA epilepsy centers of excellence, focused on research, education, and clinical care activities in the diagnosis and treatment of epilepsy. These centers would restore VA to the position of leadership it once held in epilepsy research and treatment. Senators Murray and Craig worked together to bring this critical legislation to the forefront. I also add that the Epilepsy Foundation of America and the American Academy of Neurology were very helpful to the committee on this issue.

The medical community has made impressive advances in pain care and management, but VA has lagged behind in implementing a standardized policy. S. 2162 would establish a pain care program at all VA inpatient facilities, to prevent long-term chronic pain disability. It also provides for education for VA's health care workers on pain assessment and treatment and would require VA to expand research on pain care. We relied on the Pain Care Forum and their many organizations devoted to the relief of pain, and I thank them for their efforts on behalf of veterans.

Finally, S. 2162 contains extensions of authorities for VA to provide some essential services to veterans, such as both institutional and non-institutional long-term care and caregiver assistance. It would also authorize a series of major medical facility construction projects and clinic leases in California, Texas, Puerto Rico, Florida, Louisiana, Colorado, Nevada, Pennsylvania, Wisconsin, South Carolina, Ohio, Arizona, Georgia, and Illinois.

Mr. President, before I close, I recognize and thank the individuals involved in putting together this comprehensive measure. Specifically, I thank Cathy Wiblemo and Dolores Dunn from the House committee and Jon Towers from the minority on the Senate committee. I also thank my own staff who assisted me in forging this bill. Kim Lipsky and Alex Sardegna heard the needs of veterans, sought creative solutions to some very complex problems, and worked tirelessly to make this bill a reality.

In closing, I thank Mary Kaye and Tony Bailey, who set aside their own grief about Justin and fought for better mental health care for all veterans. We all owe the Baileys a debt of gratitude for so many reasons.

I urge all of my colleagues to support swift passage of S. 2162, as amended. It would bring relief, support, and needed services to so many veterans and their families across the country.

I ask unanimous consent to have the Joint Explanatory Statement printed in the Record.

Mr. President, I am pleased to express my strong support for S. 2162, the Veterans' Mental Health and Other Care Improvements Act of 2008, as amended. This bill includes provisions on mental health care, suicide prevention, care for substance use disorders, prevention of homelessness, pain and epilepsy care, and other health care matters. This comprehensive legislation addresses many critical issues facing our Nation's veterans.

Returning home from battle does not necessarily bring an end to conflict. Servicemembers return home, but the war often follows them in their hearts and minds. Their invisible wounds are

complicated and wide-ranging, and we must provide all possible assistance. I am working with VA Secretary James Peake to ensure that VA is forthright about the numbers of suicides and attempted suicides among veterans. Solid and reliable information is critical to our understanding of the issues. Prevention of suicide is a vitally important mission.

A growing number of veterans are in need of mental health care. VA's Special Committee on Post-Traumatic Stress Disorder advised in its 2006 formal report that virtually all returning servicemembers face readjustment issues. An assessment of mental health problems among returning soldiers, recently published in the Journal of the American Medical Association in November, 2007, found that 42.4 percent of National Guard and reservists screened by the Department of Defense required mental health treatment.

Additionally, a March 2007 study published in the Archives of Internal Medicine reported that more than one-third of war veterans who have served in either Iraq or Afghanistan suffer from various mental ailments, including post-traumatic stress disorder, anxiety, depression, substance use disorder and other problems. A RAND study released in April 2008, emphasized the high risks of PTSD and depression, especially among servicemembers sent on multiple deployments, and among National Guard and reservists.

Further, the RAND study found that the stigma associated with mental health care continues to prevent servicemembers and veterans from accessing care. VA and the Department of Defense must redouble their efforts to ensure that receiving mental health care does not harm one's career. No individual is immune to the risk of mental health problems, and all must have the opportunity to receive care.

On April 25, 2007, the Committee on Veterans' Affairs held a hearing on veterans' mental health concerns, and on VA's response. We heard heart-wrenching testimony from the witnesses.

The provisions of this bill are a direct outgrowth of that hearing and the testimony given by those who have suffered with mental health issues, and by their family members. Earlier versions of the provisions included in this bill were also discussed at a legislative hearing on October 24, 2007.

This bill represents a bi-partisan approach, and is cosponsored by Senators Burr, Rockefeller, Mikulski, Bingaman, Ensign, Smith, Collins, Clinton, Dole, and Sessions. It is a tribute to Justin Bailey, a veteran of Operation Iraqi Freedom, who died in a VA domiciliary facility while receiving care for PTSD and a substance use disorder. This was a tragedy that will live on with Justin's parents, who have so courageously advocated for improvements to VA mental health care.

Provisions included in this legislative package stem from bills which have all been reported favorably by the Senate Committee on Veterans' Affairs, including: S. 1233 as reported on August 29, 2007; and S. 2004, S. 2142, S. 2160, and S. 2162, as ordered reported on November 14, 2007.

I will briefly outline other provisions in S. 2162, as amended.

As I mentioned, the legislation would make sweeping changes to VA mental health treatment and research. Most notably, it would ensure a minimum level of substance use disorder care for veterans in need. It would also require VA to improve treatment of veterans with multiple disorders, such as PTSD and substance use disorder. To ascertain if VA's residential mental health facilities are appropriately staffed, this bill would mandate a review of such facilities. It would also create a vital research program on PTSD and Substance Use Disorders, in cooperation with, and building on the work of, the National Center for

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 632, S. 2162.

Mr. President, I ask unanimous consent that the committee substitute amendment be withdrawn, the Akaka-Burr substitute amendment which is at the desk be agreed to; the bill, as amended, be read a third time and passed; the motions to reconsider be laid upon the table, with no intervening action or debate, and any statements related to the bill be printed in the Record.