Floor Statements

Paul, I thank the House and your leadership for moving so many bills dealing with the opioid

problem that are both life changing and life saving.

It is rare that so much is done in this Chamber, that to think about the 60-plus thousand, maybe 100,000 lives lost every year by this, it is clearly something that is going to save massive numbers of people.

Mr. Speaker, owing to a leave of absence for personal reasons, I was unable to cast votes on October 4th and 5th. Had I been present, I would have voted as follows:

On Roll Call No. 553, the Rep. Grijalva Progressive Caucus Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.''

On Roll Call No. 554, the Rep. Scott Congressional Black Caucus Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.''

On Roll Call No. 555, the Rep. McClintock Republican Study Committee Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.''

On Roll Call No. 556, Rep. Yarmuth Democratic Caucus Substitute Amendment to H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Nay.''

On Roll Call No. 557, Adoption of H. Con. Res. 71 (the FY' 2018 Budget Resolution), I would have voted ``Aye.''

On Roll Call No. 558, Approval of the Journal, I would have voted ``Aye.''

Mr. Speaker, I thank my friend from Arizona for her dedication to helping veterans.

It will be often cited that 20 veterans a day take their own lives. It is important that we take a deeper dive into why that is because, as a society, we want to know.

There will be upwards of 40-some thousand suicides this year in our Nation. Even one is too many. And I know that organizations that deal with suicide prevention want to see that drop considerably. But there is some understanding that is important for us to know what we can do and what stands in the way.

I want to note that those who serve in the military are about 1 percent of the population. Those who have served in World War II, Korea, and Vietnam are dying off fast from natural causes. But a great many of those veterans who do take an act of suicide are above age 50. Many of them have never served in combat.

Characteristic groups, such as the Army National Guard and reservists are among those who do have some

higher rates. It has been interpreted that perhaps one of the reasons for that is that they do not stay with their cohorts after combat. They go back home, come back on weekends, but don't have that same day-to- day support.

We also know the military, very much so after Vietnam, when you were done with your time, when you got your points, you were gone.

You could be in the middle of a battle, and you would be picked up by helicopter and taken home with encrusted blood still on your uniform from your friends, but you were sent back to the States--no chance to recover, no chance to develop from that, no chance to even get a checkup from the neck up, and, as a matter of fact, that was not even done. So for those who did serve in Vietnam and Korea and World War II, you just went back to life.

We have learned it is important to do more for people, and we do try and understand what is it, the characteristics among those who have taken their own lives, or tried to, that causes that to happen.

First of all, it is worth noting that about 70 percent of those who have taken their own lives who were veterans have not been involved with the VA hospital system. That is extremely important to know. They are not involved.

Now, that could be a number of reasons. It could be veterans who were not eligible for involvement at the VA. Many reservists and guards are not unless they served Active-Duty time, and even that is a limited timeframe. They also may have not been early identified when they came out of the military that would make them eligible for services. And, quite frankly, in many cases, it just is not near their home.

A study that was done with people at Fort Carson, Colorado, of 70- some folks who had attempted suicide, found that the number one reason that they gave, out of a list of 33 possibilities, was they wanted to end emotional distress. They simply wanted the pain to stop, and they ran out of ways to make it stop.

I reflect on the life of my father, who is now gone for other reasons, but one day when I was at home from college--and he himself was a World War II veteran--I heard his soft voice calling from the bathroom, and to see him there with a lot of blood on him, because he had just attempted to cut his arms and kill himself. Luckily, he did not. We got him care. But I believe for him, he certainly would have been in this category. He just wanted the pain to stop.

I don't think it was PTSD or his old signs of war. I think it was, perhaps, other distress as he dealt with his own alcoholism, or did not deal with it very well at that time, and the financial distresses of raising a family, and we just didn't have money, but it was enough to affect me--lifetime--in terms of trying to understand and dedicate my life to helping those in psychological need.

I should mention, on September 11, I got my honorable discharge, so I am no longer in the Navy. I miss it every day, because I loved that time working with servicemembers who had traumatic brain injuries and post-traumatic stress and a wide range of other problems, but here are a few things that I learned from them that are very important.

One is, if you want care in mental health, you just can't get it, not only because there may not be a VA near you, but even if there was, many persons who are dealing with panic and anxiety and depression don't want to leave the house; many with post-traumatic stress disorders do not want to go onto a bus or into traffic or into congested areas, because that can bring back some terrible memories for them. The very thing they need is to get treatment, but the very problems they have prevent them from getting treatment.

Now, we have passed legislation here that deals with choice to allow veterans to get that care closer to home. But can they get it? Well, tragically--not just sadly but tragically--in the area of mental health services, half the counties in America have no psychiatrist, they have no psychologist, they have no clinical social worker, they have no psychiatric nurse practitioner, and they have no licensed drug treatment counselor. In other words, it is not available.

If you just look at those, for example, with a substance abuse disorder, of the 22 million, about 75 to 80 percent of them also have a mental health problem and they are at higher risk for suicide. And certainly if we have a veteran who has substance abuse and depression, they are at higher risk.

But look at this group. For every 1,000 people with a substance abuse disorder--for every 1,000 people--900 do not seek treatment. Out of the 100 who do seek treatment, 37 have got nothing available to them. Of the 63 who have something available, only six get evidence-based care.

So it is no wonder when we talk to veterans, and they say, ``I tried getting help, but this person didn't understand. I couldn't get help. It was a problem that was ongoing,'' at some point they reach that point where they want to just end their emotional distress.

I remember visiting the house of a veteran. The mother had called me and said: ``Can you help him? He won't go to the VA. He won't get help.''

I made a house call. The VA doesn't do that, but I made a house call. And without revealing too much, I will just say that it was pretty clear he had a lot of medication around his house. His apartment was pretty unkempt, food lying around, bottles, dozens and dozens of bottles of medication unopened, each one from the VA, because probably each time he went to the VA, they said: ``How are you doing?''

``I am not doing well.''

``Here. We will just increase your dosage,'' or, ``We will give you a different medication,'' but the system was not set up to say, ``How are you doing? What else can we do to care for you?'' It simply was not set up to go to his home and help him out when he missed his appointments, when he was no longer employed, when he had isolated himself from society, when, like so many people, covered the windows of their bedroom with camouflage or some other dark thing so the light doesn't get in, don't watch TV, just stay away from the world, this shrinking world that constricts you like a snake around the throat until they see no more reason to live.

I remember going to the VA hospital and mentioning, ``You know, I know the Marines are famous for not leaving anyone in the field. What do you do about some of these other folks with mental health problems?''

They said, ``We don't go out to their homes.''

I said, ``Why not?''

``We just don't do that.''

``Why not?''

``We just don't.''

I agonize over that as being a Navy healthcare provider to know this doesn't sound like the Marines. The Marines don't leave someone out there.

Are we so constricted and tied up by rules that we can't even go and reach out to them? But that is part of the problem, that we need easier access to local care, we need care that reaches out to veterans, and not just say, ``Hey, listen, if you really want to get help, why don't you suck it up, pull up your bootstraps and go out and get help,'' because some of them are not able to do that yet.

Many of them feel, as a veteran, ``I have faced tougher battles. I can't let people know I am weak or I am struggling.''

Many of them have addiction disorders, and they don't want people to know that they are weak and they are struggling.

To those veterans, I say this is not a sign of failure. It is like if you are in the battle and bullets are coming at you and grenades are coming at you and incoming fire is coming at you, the last thing you want to do is deny it is happening. You have to acknowledge it is happening. What do you do? You get on the radio and you call for help. That is what we have to make sure veterans understand, that that is what this is about, depression and panic and anxiety as well.

We need more providers. I have had legislation on a mental health bill to get more providers. We recently voted on some things in amendment to the Labor-H bill here to get a little bit more, but we need thousands of more providers, psychiatrists, psychologists, social workers, licensed drug treatment counselors. We don't have that.

If Congress really wants to help, we have to do more of that, but part of the

problem is this, too: they oftentimes, in the field, have such massive student loans. And relative to other areas of medicine and healthcare, they get paid so little, they may choose not to go into these areas of mental health care. So for those who are the most vulnerable, we make it the most difficult for them to get care.

Add to that the idea of, who among those who are mental health providers actually have training and understanding of military healthcare, understanding military medicine, understanding military life?

I was commissioned 8 years ago, and I know that when I went on to officer school, and I went to training, you have got to learn a lot. The Marines say, ``I learned to shoot a gun, and I can polish my shoes better than anybody,'' but there is more to it than that. It is understanding the words, the acronyms, the lifestyle, what a person goes through.

We could certainly do much better, if not just saying let's hire people at the VA, but have a program for civilian mental health professionals, one, to recruit more; two, to pay for more reimbursed student loans to get them in the workforce; but also, quite frankly, to give them more regular orientation of what it is like to be a member of the military. Let them observe boot camp. Let them understand this.

I will give you an example. Once a soldier who I was treating, he said he had given up getting care for a while. He said the third time he had to explain to his therapist what an MRAP was, he said, ``Give it up.'' The MRAP is a military vehicle, commonly known vehicle.

Now, every branch of the military has their own acronyms, and I don't pretend to know them all, but if a person doesn't even know the basics, you lose that sort of connection with the patient, and they give up.

The other issue here is that we need to be able to have a system that monitors the medication closely. It is very common that if someone is on medication, they are a polypharmacy event; that is, they are taking so many medications, and then they will take other medications that counteract the effects of those medications, and then they will take other medications to deal with the side effects of those medications.

It was not uncommon for us at Walter Reed to have a patient on 8 or 10 or 15 or more meds that they were on. We found that we reduced them down to one or two.

But with medication comes weight gains, comes increase for diabetes, comes other problems, comes stresses in the family, comes situations where they are estranged from their spouse, difficulties with children, episodes with anger. These aren't bad people, but they see their life deteriorating, they see questions with regard to what is happening through their employer, they wonder about their future, they may have taken poor medication, but sometimes they just give up.

There is a quote by author Steve Goodyear, who had quite an inspirational quote. I hope, Mr. Speaker, if there are veterans listening tonight, they take this to heed.

Mr. Goodyear said: My scars remind me that I did indeed survive my deepest wounds. That in itself is an accomplishment. And they bring to mind something else too: they remind me that the damage life has inflicted on me has, in many places, left me stronger and more resilient. What hurt me in the past has actually made me better equipped to face the present.

That is a message I want veterans to hear, that having moments of depression or anxiety or worry are as normal as feeling tired or hungry, but we know when you get in a downward spiral, it gets worse.

I don't want veterans to give up. I don't want veterans or members of the military feeling that they have so much emotional distress, this is the only way to end it.

I understand the feeling, but I also know that, as members of the community and members who are veterans, we wrap our arms of hope around those veterans to say there is help out there, and we as Congress Members have an obligation to make sure we are providing those services.

It pains me when I think that sometimes we can come up with funding for all sorts of programs, but for this 1 percent who say, ``I am willing to take a bullet for you, I am willing to die to defend my country, its Constitution, and its flag,'' we as Congress ought to be able to say we are willing to put some money in to help you get more services.

Also some advice for those veterans who may be listening: It is extremely important to follow a few guidelines in your own life, too, besides not giving up, but physical fitness that you were forced to do in the military and boot camp, and all those pushups and sit-ups and running and pullups we did, they had a reason; because when you stay physically fit, it affects your brain functioning and it improves it, and it is one of the things that is used to fight off depression and other problems.

Two, you have to have an attitude that is focused on positive things. You can make it. Many times, part of that attitude, an essential part, is a strong faith in God, a strong belief there, which gives you that attitude to say, ``I can do it.'' Navy SEALs talk about the way you eat an elephant is one bite at a time; the way you temper steel is with fire; that pain is weakness leaving the body; that courage is something that is built through experience and focus. It is not something that just comes, but you build that attitude. So you have fitness, you have attitude.

Another part is sleep. Many studies I have seen--I think it was Dr. Germain at the University of Pittsburgh who did studies that said perhaps sleep is a greater factor with post-traumatic stress, anxiety, and depression than anything else, and a big part of this is just getting enough sleep.

Members of Congress, we deal with this a lot in terms of our own hectic lifestyle, and we know many constituents, because of their workload, their anxiety in the family, they don't get enough.

It is essential. It doesn't necessarily mean you are crazy, you have problems, but that is an important part.

Further, training, knowing what you can do, whether it is in the workplace or the military, we know it is essential.

Making sure one eats right. It sounds obvious. I don't want to make this in any way sound small, but making sure one is actually eating a healthy diet is an important part of fighting off suicide, fighting off depression.

Then making sure that people are paying attention to relax, to rehabilitate themselves, to do their own personal checkup from the neck up to make sure they are dealing with these things.

None of those things I just mentioned require help from a doctor. All of those things are essential to healing and getting better.

When one reaches the point where you say, ``You know what, I need a little help here; I need to call in support on the radio; I need a quick response team; I need to pop some smoke; get some help in here,'' that is okay. I want veterans to know not only is that okay, that is what we are supposed to do.

You call in help. We don't need dead heroes on the battlefield. We certainly don't need them in the streets or the homes. We need people who are saying: Understand, that even though it may be tough to get help, there is help out there. There is help out there. People want to facilitate and help you get better.

I don't want anybody to feel that this is the way to end emotional distress. It is a permanent solution to a temporary problem, and even if that problem seems to have been going on for years, I know people can and do get better. I have seen it time and time again. The soldier or veterans that thought: I can't go on; I have to give up. They can turn that life around and become a contributor.

One has a few choices. One can be a victim and say: You know what? I am under this giant boulder. I will never get better. The weight is too great. I am too weak. I cannot move on. There's no hope.

Or you can move on to another stage and say: I am going to be a survivor.

On the first part, you say: I am helpless because of what is happening. When you are a survivor, you say: You know what? I am going to move on despite what is happening. I will pray more. I will engage more. I will do

more. But every day I will wake up and commit more to get through that day to do something that is important and meaningful. I don't need to set up a goal of 10 years from now, but let me get through that day. Let me find some things I can do and focus. It is extremely important.

But beyond that, beyond being a victim or a survivor, is a third stage, and that is being a thriver, someone who says: I am going to make sense out of what I have done, and it is going to make me a stronger person.

What I said here in the quote from Steve Goodier where he says, ``What hurt me in the past has actually made me better equipped to face the present,'' if I am in a tough situation, if I am in a situation where I, myself, look at it and I have despair and I lack hope for my own future and I turn towards someone, give me someone who has been there before. Give me a veteran. Give me a soldier who understands boot camp and what is it like to be yelled at and lack sleep. Give me a veteran who has been on the battlefield. Give me someone who has been out to sea and understands what it is like to be months without seeing your family. Give me someone who has been there and says: I made it; so can you.

I want veterans to have that sort of hope. We have our obligations in Congress: get more providers, make sure the VA is responsible. But since most people aren't near a VA, we can do a lot to help them.

I hope that this Veterans Suicide Recognition Month is something that sometime in the future we can put behind us and make it a thing of the past. We can do that if veterans themselves make those decisions to get help, and if we as the Congress make some decisions to get them that help, and society itself says: Stop having pity on them. Give them help out of affection and love and respect.

And, by the way, that respect also includes a lot of people who play professional sports, who have no idea what it is like to have someone shoot at you and try to kill you. Stand up. Have a backbone instead of a wishbone. A lot of veterans don't really want to hear that life is tough for you when you make more money in 15 minutes than they will make in a lifetime. Show some respect for those folks.

And then as we as a society recognize what they have given to the last full measure, we will be able to provide the kind of things they need and save some lives.

Too many times I have gone to a ceremony. You fold a flag 13 times and hand it to a grieving widow or widower. How much worse it is when they take their own life, because the stigma among the family is there was nothing else you could do, and all of us feel helpless when that happens. Let us make sure we are not part of that problem and, instead, we are part of the solution to celebrate and help our veterans so these things don't continue to happen.

Mr. Chair, I have an amendment at the desk.

Mr. Chair, I want to speak on this amendment, which provides some additional funding for assisted outpatient treatment.

The underlying bill has in it $15 million, and we are asking for it to be raised to $20 million. First of all, I want to say where the money is coming from. This is within the budget of SAMHSA. This is not new spending. It is not additional spending. But over my years of investigating mental health in the United States and the conditions, and then led to my introduction of the Helping Families in Mental Health Crisis Act, which, by the way, this House passed 442-2, this level of funding was authorized in the bill. It is already authorized there. It is to come from the SAMHSA account, not new spending.

Let me describe what assisted outpatient treatment is. Understanding that there are about 60 million Americans with mental illness, and 10 million have severe mental illness, it is important to note that our prisons are filled with people who have mental illness. On some level, 60 to 80 percent of people in jail have a mental illness. That is no place to be treating someone. But, unfortunately, they may have a crime they committed, and in many cases it could simply be vagrancy, it could be other issues, too, where they may have become violent, they may have had other problems associated with that, but a person with mental illness is 10 times more likely to be in prison than to be in a hospital bed.

We don't have enough hospital beds. Ninety percent of the psychiatric hospital beds in this country have been closed down since the 1950s. Now we need 100,000 more, but instead what we do as a society, we throw them in prison.

A few years ago, when New York passed Kendra's Law, when a young woman was killed by a mentally ill person, they realized that had he been in treatment, it likely never would have happened.

So rather than having someone, if we can't put them in a hospital, can't get

them treatment, the idea of assisted outpatient treatment is, when a patient can be stabilized by remaining on their medication, by having their counseling, perhaps supportive housing, supportive education, supportive employment, their life can turn around.

So what happens is, a court, a judge, protecting this person's own rights, civil rights on every level, will say to this person: I am not going to involuntarily commit you to a hospital. Your crime doesn't rise to the level--it is not a felony or something like that--it doesn't rise to the level of prison, but what they say is: We are going to require, however, that you stay in treatment, require that you take your medication, that you stay in counseling, and you do other things as prescribed by the court.

Now, most States allow this, but here is the problem: in many counties in America, they don't have the ability to pay the administrative costs to handle this. So this amendment provides a mechanism whereby people can do this.

So understand, the assisted outpatient treatment is a civil-legal procedure whereby a judge can order an individual with a serious mental illness to follow a court ordered treatment plan in the community.

Here is another thing about this: Does it work? And the answer is yes. In a Duke University study of the New York AOT program, it said 90 percent of the people said that AOT made them more likely to keep appointments or to take medication; 88 percent said they and their case manager agreed on what is important for them to work on; 87 percent of them said they were competent in their case manager's ability to help them; 87 percent had fewer incarcerations; 83 percent had fewer experienced arrests--and the point is, they had an increased number of arrests prior to being in AOT, and then afterwards it declined precipitously.

Eighty-one percent said AOT helped them get and to stay well; 77 percent fewer experienced psychiatric hospitalizations; 75 percent reported that AOT helped them gain control of their life; 74 percent fewer experienced homelessness; 55 percent fewer experienced suicide attempts or physical harm to themselves; 49 percent fewer abused alcohol; 48 percent fewer abused drugs; 47 percent fewer physically harmed others; 46 percent fewer damaged and destroyed property; and costs were cut in half.

This small amount of money--and believe me, it would cost perhaps 10 or 20 times more to really do this thoroughly--is there to help people in mental health crisis. We could either continue to throw people in jail, continue to see crimes happen--and by the way, when a mentally ill person is in prison, 80 percent of them get no treatment. We put them back on the streets and the problems occur again.

The House passed this. It came out of committee unanimously. We need to do this for America. We don't want to read more statistics on a mentally ill person who harmed someone, primarily because they were not in treatment.

This is our opportunity to save lives. This is our opportunity to do something about this. And I do ask that the House pass this small amendment out of an existing budget, no new spending, to provide an additional $5 million for assisted outpatient treatment.

Madam Chair, I reserve the balance of my time.

Madam Chair, I reserve the balance of my time.

Madam Chair, I just want to say, investing in the AOT program, Congress says it is worth it to ensure the most vulnerable among us have the treatment they need, instead of being in ERs, or jails.

This pilot is extremely important. It saves money. It saves lives. And for Members to reflect back on this, I hope they would rather say: I helped fund a program known to save lives. SAMHSA has been reported many times by the GAO to waste a lot of money. This saves lives, and I urge people to vote for this amendment.

Madam Chair, I yield back the balance of my time.

Madam Chair, I demand a recorded vote.

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, this amendment is for infant and early childhood mental health promotion, intervention, and treatment. It provides $5 million in grants to develop, maintain, or enhance infant and early childhood mental health promotion, intervention, and treatment

programs, including programs for infants and children at significant risk of developing or showing early signs of or having been diagnosed with mental illness, including serious emotional disturbance. This was passed and authorized in the Helping Families in Mental Health Crisis Act last year in Congress in which it was passed 422-2--near unanimous.

The importance of this is that, across the United States, up to one in five children suffers from a mental disorder in a given year, according to the Centers for Disease Control and Prevention. This equates to more than 17 million young people who meet criteria for disorders that affect their ability to learn, behave, and express emotions. This small $5 million amount is about 29 cents per child, hardly enough to do much when distributed over that many, but it can do a great deal when distributed for a few.

If you follow the course of children with mental illness, untreated mental illness, of course, leads to very troubled adults and other problems. I might add that this is National Suicide Prevention Week, and among children, suicide rates are climbing. In fact, over the last 20 years, suicide rates have climbed overall in this country. But, tragically and alarmingly, they have grown a great deal among children.

How do we tell families of children who have completed a suicide or attempted a suicide that we couldn't come up with the money for this, and, instead, we thought other programs were more important?

This money comes from the existing programming budget. It does not take away from vital programs. But I want you to know that there has been a 54 percent increase of suicides among children under age 12. Thirty-seven percent of those child suicides are Black children. The rate among African-American children ages 5 to 11 has doubled over the last decade.

This provides critically important services for children. It appears that schools are the most important place where treatment can take place. Only 23 percent of prekindergarten programs have onsite or scheduled visits from psychiatrists and psychologists, according to the Child Mind Institute.

The current workforce consists of approximately 7,500 child and adolescent psychiatrists. We need 32,000. Eighty-five percent of all psychotropic medications for children are written by primary care practitioners, not psychiatrists, so we end up with serious problems here as suicides grow and as mental health problems grow. This small amount of money is taken from existing funds, not from any other programs, to make sure we are providing services for these children.

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, how much time do I have remaining?

Mr. Chairman, let me add to this. Yes, there was money in the Cures bill for opioid abuse for 59,000 people who had died from drug overdoses, but 350,000 people will die this year related to mental health problems.

I want to make sure that Congress is not, once again, in a situation where we are having another moment of silence for some suicide, for some child or young adult that got violent and shot someone or ran their car into a crowd, or something else. We have got to start putting money into these programs. Five million dollars barely scratches the surface, but it is like that old adage of the man who came across a child throwing a starfish back in the ocean. The person said: ``You can never take care of all of them.'' But the child said: ``It will make a difference for this one.''

This will make a difference to a few children.

How do we explain this to a parent whose child is suffering, who can't get services, that what we have is we couldn't transfer money within an existing account, it doesn't add any more, and it doesn't eradicate any programs, but it is something there especially at a time when this is so life threatening?

You can't explain that to a mom or a dad.

During all the time in the course of working this bill, we heard from thousands of people telling their horrific and sad stories. I spent the last 42 years of my life working as a psychologist. I have seen the faces of those who have gone to the funerals and seen those wasting away in prisons. I do ask that this amendment be adopted.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, this amendment increases access to pediatric mental healthcare by providing $9 million in grants to improve access to behavioral integration and pediatric primary care.

I thank the chairman of the Labor, Health and Human Services, Education, and Related Agencies Subcommittee for his agreement to our other amendment to boost the workforce. We have a massive workforce shortage in the field of mental health.

What good is it to have good wishes among Members of Congress for treatment, yet people can't get it?

There is a shortage of child and adolescent psychiatrists for the 17 million children with a mental health condition. We have 9,000. We need over 30,000. There is a shortage of psychologists, and 36 States have a shortage of psychiatric nurses. As a matter of fact, half of the counties in America have no psychiatrists, no psychologists, and no clinical social worker. So for children with primary mental health problems, it is a desert for treatment.

They sit on long waiting lists. Their symptoms worsen.

A study called the RAISE Program--Recovery After an Initial Schizophrenia Episode--found that if we provided treatment initially for those who show their initial psychotic episode, it improves their prognosis over their lifetime. But delaying treatment actually causes them harm.

When you have no care, you have that harm. For those few psychiatrists and psychologists out there, what are they told to do in rural areas?

Travel from one office to another to try and give them access, with valuable hours of time taken up. They can't provide that care.

This $9 million helps provide mechanisms by which pediatricians and family practices can have telemental health. We know that when a warm handoff occurs in the office--and that is when the family or the child at that point meets a psychiatrist or that psychologist--the actual follow-up rate is over 99 percent. A large number--over 80 percent-- continue follow-up right through treatment.

However, when they are given a referral, that actual follow-up is around 50 percent, and only 11 percent of people complete treatment. That is why you need to have some level of face to face.

This issue of at least providing telemental health gives people that face-to-face approach.

Since 50 percent of serious mental illness cases emerge by age 14, and 75 percent by age 24, this is the critical period in the life of someone who is developing serious mental illness to have care. We can no longer just say that we are going to let pediatricians be the primary providers for mental illness treatment when that is something that they do not have the specialty and training.

The number of psychiatrists there to treat children is declining relative to the needs. The problems among children, as I mentioned previously, continue to go up.

I might also add here that this does not reduce any spending among the critical funded and authorized programs within SAMHSA.

But let me say where some of the money goes in these SAMHSA programs. The GAO did a study and found that 80 percent of the grants are not using it for evidence-based care. SAMHSA, instead, spends their money on ridiculous, embarrassing programs: making fruit smoothies if you are stressed, $400,000 on a website for toddler sing-along songs, getting in touch with your inner animal workshops, making masks, making collages, a website and crisis hotline for people in the Boston area who had snow anxiety during a snowstorm, teaching people interpretative dancing, $25,000 for a painting of people sitting on a rock at SAMHSA headquarters, an alternative conference funded by SAMHSA at the luxurious Boston Park Plaza Hotel.

And we can't fund something that will save children's lives?

It makes no sense to me.

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, how much time do I have remaining?

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, let me say this: I have got to tell you that this is distressing to me. I know what my colleague meant by false crisis, but this is a crisis for children.

The children in America with mental health problems cannot get care. Members of Congress have an opportunity to put a small amount of money to make a big difference for children who cannot get that care.

What we can do and what my colleague from Oklahoma said is we need to cut some things. One of them is stop the ridiculous wasteful spending at SAMHSA. If they can fund $400,000 websites and going to luxurious hotels, they can certainly do something that actually puts providers there so children can change the trajectory of their lives.

I have just known too many families who suffer through this. I hope that as Members vote on this, they remember those families in their districts and decide this is a way to send a signal that we can make a big difference in the lives of many.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, I want to restate the problems that exist at SAMHSA.

The General Accounting Office, during the multiyear investigation of the subcommittee which I chair, the Oversight and Investigations of the Committee on Energy and Commerce, came back and said that 80 percent of the grants for SAMHSA are not evidence-based. There is a serious problem in that agency.

Instead, they funded absurd programs, such as making fruit smoothies; and a $400,000 website for toddlers to sing-along songs, which they told us was about prevention.

We asked: What are you preventing?

They said: We will get back to you on that.

They also had workshops on getting in touch with your inner animal, making masks and collages; interpretive dancing; a website and crisis line for people in the New England area when they had heavy a snowfall so they could call in.

They have workshops on how to tell people to get off their medications. They had a $25,000 oil painting for their office, which graces their hall, of people sitting on a rock, which gives them mental health awareness. I might add, the only thing I am aware of is a total waste of money. And, of course, an alternative conference, which continues this year as well, spending, I think, $150,000 or so to hold their conference at the luxurious Boston Park Plaza Hotel.

I don't want to hear from that agency that they don't have money. This particular program redirects them so they get reset in terms of evidence-based care. It forms a panel of people with expertise in medical psychiatric areas, including consumers.

It is there to provide direction and guidance for an agency that has been without direction and guidance. It is there to make sure that we redirect the way SAMHSA is going so that it gets in the area of really treating mental illness.

Let me say this--let me use the words of Dr. Elinore McCance-Katz, the current Assistant Secretary of Mental Health and, therefore, the de facto head of SAMHSA.

She said: ``. . . SAMHSA does not address the treatment needs of the most vulnerable in our society. Rather, the unit within SAMHSA charged with addressing these disorders, the Center for Mental Health Services, chooses to focus on its own definition of `recovery,' which generally ignores the treatment of mental disorders, and, as a major initiative under `recovery' services, focuses on the development of a `peer workforce.'

``There is a perceptible hostility toward psychiatric medicine: a resistance to addressing the treatment needs of those with serious mental illness and a questioning by some at SAMHSA as to whether mental disorders even exist.''

For example, they state that psychosis is just a different way of thinking for some experiencing stress. They also focus on activities that don't directly assist those who have serious mental illness.

She adds that: ``Significant dollars are spent on hotlines for callers who may be experiencing suicidal thinking. . . . ''

But I might add that during this whole time, while death rates decline for heart disease, lung disease, AIDS, and accidental deaths, et cetera, they went way up for suicide. They increased steadily for substance abuse.

It is a failed agency, along those lines.

She says that there are pressing needs, but nowhere in SAMHSA's strategic initiatives do they even address psychiatric treatment of mental illness as a priority.

I know we have to change this. I would like to ask of my dear friend, the chairman of the subcommittee, is there a way we can talk more about this and address this in the future to see that this is addressed adequately?

I yield to the gentleman from Oklahoma.

Reclaiming my time, knowing that when my friend says something, I consider that a bond.

Mr. Chairman, I yield back the balance of my time, and I withdraw my amendment.

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, this is the last of my amendments on this. Although this House overwhelmingly passed the authorization for these, as did the Senate, money was not allocated towards it.

While I understand there is a priority to treat substance abuse, but even with that, many times there is nowhere for someone to go.

Back in the 1950s, we had over half a million psychiatric hospital beds in this country. I think at the time the population of the United State was 150 million. Now, with a population close to 317 million to 318 million, we have about 40,000 hospital beds and a shortage of 100,000. The only State that actually has an adequate number of beds is Mississippi. All the rest are at a critical shortage.

So what happens when a person has a drug overdose and needs to get into treatment? What happens when a person has a psychiatric breakdown?

Well, generally what happens is the police arrive, not the paramedics. They arrest the person. Many States actually say: Let's put these people in a jail cell, because there is no bed.

Or, if they take them to the hospital, the hospital says: Let's just give them some medication to stabilize them and let them back out because we can't hold them. We have no place for them to go.

What happens, many times these people are boarded, that is, they remain in an emergency room bed, which is no place for someone with a psychiatric crisis. Sometimes they will be tied to their gurney; sometimes they are in the hallways; sometimes they are, for days or weeks or several weeks, waiting for a psychiatric bed and nothing opens up.

I thought when Dorothea Dix said let's close down the jail concept, that was prevalent in our country back then, let's have nice hospitals for them. Historically, they said that was a good move, but what happened is these psych beds closed down starting widely in the 1980s and continuing until now. There simply is no place for them to go.

Let's remember that President Kennedy's last bill he signed before his assassination was to begin this process of closing the beds but having community-based treatment, but America and Congress have not kept that promise.

There is a story of a Senator from Virginia by the name of Creigh Deeds. Some may remember in the news when his son Gus had a crisis and Senator Deeds took his son to a hospital. There they waited hour after hour after hour while the hospital tried to find a hospital bed available for him. Finally, he said they couldn't find any beds: Take young Gus home, and let's see what happens in the future.

When Senator Deeds took his son home, his son stabbed Senator Deeds, trying to kill him; and when Senator Deeds ran to get help, he survived, but his son did not because he shot himself with a bullet-- because there were no beds.

Now, this particular amendment doesn't create beds, but what happens is sometimes there are beds available in other communities; but short of a hospital calling hospital after hospital after hospital to find a bed for someone, which may be an hour or two drive away, there is no place for them.

Surely, we understand the idea: Do we continue to put these folks in hospitals and jail cells? Do we dump them back in the street and let them be the forgotten homeless whom we walk over? Do we send them back home and risk further harm to them? Do we have them tied to a gurney and given a chemical sedation, a chemical straightjacket to wait until something opens up?

What this amendment does is it is $10 million in grants to develop and maintain or enhance the database of inpatient psychiatric facilities and crisis stabilization units so we can begin to address this bed shortage. Rather than lead people away from care, this is a way of helping hospitals get that care and instill States to put together programs to speed this up.

We still have to work with CMS to create more beds and stop some of the ridiculous rules that they have in there, but what do we continue to tell the mentally ill? ``We will get around to it''? ``We couldn't do it this time''? ``Good luck''? ``I am sorry your son died''?

When does this end? Will we hear more excuses that we can't do anything about it because we had a $5 billion cut? What do we do with Americans who are dying from this over and over?

Thomas Jefferson once said: ``I tremble for my country when I reflect that God is just, that His justice cannot sleep forever.'' We have a chance to make a difference in the justice for the mentally ill, or will we once again turn a blind eye and say we can do nothing?

Mr. Chairman, I ask that Members vote for this amendment to try and save some lives.

Mr. Chairman, I yield back the balance of my time.

Mr. Chair, I was unavoidably detained. Had I been present, I would have voted ``yea'' on rollcall No. 416.

Amendment No. 5 Offered by Mr. Griffith

Mr. Speaker, tonight, I am joined by a number of Members here to talk about one of the most insidious problems our Nation has faced in a long time. It is the problem of opioid abuse. We are in a crisis mode.

We have now reached a point where we will have more deaths from drug overdoses this year than there are names on the Vietnam Veterans Memorial Wall in Washington. That is a frightening concept.

There is almost no county, no State in America, that is not affected by this. Some areas have much more. Places in eastern Kentucky, southern West Virginia and up the Ohio Valley, and places in New England and out West have seen this as a growing problem as death rates rise.

There are things we can do about this. But in order to have some discussion of what we can do about this, we are going to talk about how we got to this problem and then what we can do to go beyond that.

I want to start off by yielding to the gentleman from Oregon (Mr. Walden), the chairman of the Energy and Commerce Committee, to talk about what this means in one State alone, the State of Oregon.

I thank the chairman for his passion and hard work on the Energy and Commerce Committee. We know this is a life- and-death issue. This is one of those things where Members are coming together from both sides of the aisle to deal with.

Let me lay out the background here. How did we get here?

About 80 percent of addictions begin with a prescription. When we see what has happened here on this chart of heroin increased use and prescription opioids, there is something that occurred at the beginning of this millennium where things really began to take off.

On this next poster, seeing here how this is increasing at such a rate--about 9 or 10 percent--it is understandable you are looking at some of these rates increasing severalfold just in the last decade, with increasing jumps. As fentanyl has gotten here, it is even worse.

Back in 1980, Dr. Hershel Jick, a Boston doctor, wrote a letter in The New England Journal of Medicine, and he said this: ``Out of nearly 40,000 patients given powerful pain drugs in a Boston hospital, only four addictions were documented.'' Since he published that letter, it has been cited again about 600 times. Doctors, academics, pharmaceutical companies, and others use it as evidence of the unlikeliness of developing addiction.

But it has been criticized soundly, saying that never should have been said. In fact, The New England Journal of Medicine took the unusual step of posting a one-sentence warning over the so-called Porter and Jick letter to the editor that the Journal published in 1980, and it says: ``For reasons of public health, readers should be aware that this letter has been heavily and uncritically cited as evidence that addiction is rare with opioid therapy.''

Accompanying this note was an analysis from Canadian researchers exploring the frequency the letter had been cited, which was almost 600 times.

Here is the tragedy of this. Many physicians and many pharmaceutical companies said: See, prescribe these opioids; people will be okay. That was found not to be the case.

Jump ahead to 2001, when The Joint Commission released their pain management standards, and then shortly after that the American Medical Association said: let's make pain one of the

vital signs. The other vital signs being blood pressure, heart rate, respiratory rate, and temperature. But when pain was also made one of those as well, doctors began asking questions about that, and basically screening people along the lines of: On a scale of 1 to 10, what is your pain level?

Everything else is measured with an instrument objectively, but pain is subjective. In fact, it is so subjective that it was found that 51 percent of people who are on an opioid have a mood disorder, such as depression or anxiety. There is a huge amount there.

The thing about this, if a person fails to screen for presence of a mood disorder, along with other aspects, you really increase their risk for addiction.

About 50 million Americans, for example, have low back pain. Twenty- five million of those are on an opioid. Of that group, about 40 percent have been found to have depression. If you combine depression and opioid use, you could triple or quadruple your risk for misuse, abuse, and addiction. It would make sense that before a doctor prescribes in these cases, concurrently they would also be screening for mood disorders. That does not appear to be the case.

Here is another part of the problem. Under the Affordable Care Act, hospital payments are tied to patient pain satisfaction surveys, which reward hospitals financially when patients give them a high rating for managing pain. In turn, the hospitals get less money if the patient says: my pain was not handled.

That is actually question 14 of the Hospital Consumer Assessment of Healthcare Providers and Systems survey. It asks the question: How often did the hospital or provider do everything in their power to control your pain? Doctors feared negative responses, as did many hospitals, and it was found that probably had an impact on increasing prescriptions.

Another part of the problem is treatment access. Quite frankly, if you want to get help, you can't find it. Unfortunately, getting access to high-quality treatment is unlikely in the United States. Of the 27 million Americans suffering from addiction, less than 1 percent receive evidence-based treatment.

We have a shortage of trained providers, and half the counties in America have no psychologists, no psychiatrists, and no clinical social workers.

Let me add to this also that medication-assisted treatment is one of those things put up here as a treatment method. If I show you here, medication-assisted treatment is when a person is replacing their illegal drug with something like methadone or Suboxone, which Chairman Walden just referred to.

But here is part of the problem. It is supposed to be the doctor writing the prescription and then the patient is getting other treatment. But as is found with medication-assisted treatment, just in Pennsylvania alone, nearly 60 percent had no counseling in the year they received the buprenorphine. Forty percent were not drug-tested in the year they received the buprenorphine.

This is important because a person may receive a prescription but still remain on heroin or another drug. Thirty-three percent have between two to five different prescribers writing them a prescription for this. Where do all those prescriptions go?

This is one of the top diverted drugs. Many times, the patients simply take those drugs, sell them, and buy the street drugs. Twenty- four percent of those buprenorphine prescriptions didn't see a physician in the prior 30 days.

In other words, with medication-assisted treatment, we simply have a failure to provide other treatment and a low expectation for improvement, in many cases thinking we will replace one addiction with another.

Another part is in the area of hospital care. When treating opioid and heroin addiction, inpatient and residential treatment is crucial for full recovery, but there are simply not enough treatment centers and beds. Today, our Nation suffers a shortage of 100,000 inpatient treatment beds.

Further, we don't have enough providers. When we do have providers, many times they end up overprescribing.

There was a law in the United States back in the Nixon era called 42 C.F.R., consolidated federal registry. Basically, it made it so that physicians could not find out in the record if a patient was on other opioids, in treatment for that, or taking buprenorphine or methadone.

So what happened? Someone shows up in the emergency room, they are in pain, perhaps a doctor looks in the record and doesn't see anything there, and writes a prescription. If that person was in treatment and was recovering from an addiction, and at that point not taking other drugs, look at what just happened. The doctor may prescribe some opioids for that patient who was used to taking quite a few at any given time to have an effect. Now they have this, and they are no longer thinking: I will take just one or two. They may take more. So you risk overdose.

The second thing you do is risk a relapse. That person was perhaps clean for months or years. Now they have OxyContin or some other opioid, they take it, and they have a relapse.

But there is a third problem that goes with that, and that is the person may be on other drugs, such as benzodiazepines or other respiratory suppressants, and that becomes a problem because then the doctor doesn't know about drug interactions.

So we have this law in place which prohibits sharing of information about substance abuse treatment between doctors. Doctors unknowingly prescribe these for people. It causes more problems. We need to deal with this.

Another level here is fentanyl. Fentanyl is a synthetic opioid which is a staggering 50 times more potent than heroin and 100 times more potent than morphine. It has a high potential for abuse. A mere 2 milligrams is fatal. A single packet of sweetener for your coffee is 1,000 milligrams. Take two of those and that is enough to kill you.

Since last 2013, fentanyl has contributed to at least 5,000 overdose deaths in the U.S., and that is soaring. However, due to gaps in the data collections, it is likely the number of overdose deaths in the U.S. is actually much higher.

A low-cost, high-profit, hard-to-detect profile of fentanyl is increasingly more trafficked to traffickers and relatively easy to manufacture. China is a major part of this, in that the illegally manufactured fentanyl shipped to the U.S. via labs in Mexico, smuggled across the border, then hits our streets.

One other thing I want to point out here, in terms of this problem. If we look at what some have analyzed in terms of areas that are hotspots for substance abuse, you can see in here for persons on disability, look at the sections in Kentucky, West Virginia, Virginia, along the Mississippi Valley, up the Ohio Valley, and parts out West. This isn't the only causal factor. Many times you have people on disability and pain, and what happens is they may be prescribed opioids as part of that.

When you look here, where age-adjusted death rates occur for drug poisoning--those overdose deaths--look at the hotspots in America. It is just about the same out here in the Mississippi-Ohio Valley, portions out West, where you have these problems.

All of these come together in terms of crime, in terms of drug cartels, in terms of fentanyl, in terms of poor access to treatment.

I mentioned the hospital beds. By the way, over half the counties in America have no psychiatrist, no psychologist, no social worker, and no licensed drug treatment provider.

It is no wonder we are in this mess. We will talk more about some solutions here, but I wanted to recognize a number of Members who might want to talk about this.

Let me first go to the gentleman from Georgia (Mr. Carter). Representative Carter is also a pharmacist. Let's hear some of his perspective.

Mr. Speaker, I yield to the gentleman from Georgia (Mr. Carter).

As a pharmacist, when people come into the pharmacy, for example, if they want to get Sudafed, a cold medication, they have to go through some special process. It is behind counter. Is that right?

Now, what if they wanted to pick up an opioid prescription? Do they have to show an ID? Are they required by law to have the same kind of restrictions?

But as the gentleman knows, that is data within the State, but across State lines, that data is still not populated.

I appreciate that. That is a problem we are going to have to fix in our committee.

I want to call up the gentleman from Ohio (Mr. Johnson), eastern Ohio. Speaking of being able to jump across State lines and have prescriptions filled, minutes away from the Pennsylvania/West Virginia border, could travel down there, and also part of that deadly area along the Ohio Valley where so much of this is occurring.

Mr. Speaker, I yield to Mr. Johnson.

I thank the gentleman from Ohio.

I want to next recognize the gentleman from Indiana (Mr. Bucshon). Certainly he sees this issue, too. As I mentioned before, one of the problems physicians have, if they do not know what kind of prescriptions that person is on, for example, a medical record may show if a person has an allergy to penicillin or something, but you may have no idea that that patient may, for example, be taking buprenorphine or methadone unless they tell you or you test for it. And as a surgeon, what happens when they go to get anesthesia and the complications come from that, but it is part of the reasons why we have to make sure that you as a physician have access to these records, things we can clean up.

Mr. Speaker, I yield to the gentleman from Indiana (Mr. Bucshon).

I thank the gentleman for his impassioned words and dedication here.

I want to refer back to my map here a moment. Dr. Bucshon was referring to his district in southern Indiana here, which, on this 2014 map, was already showing high mortality rates for those who have drug overdoses.

Look here in the State of Washington, also an area that, on this 2014 map, showed a lot of problems, and now the problem is getting worse.

Mr. Speaker, I yield to the gentleman from Washington (Mr. Newhouse) to speak on this issue.

Mr. Speaker, I appreciate the gentleman's comments and his dedication to helping his State of Washington.

Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. Rothfus), whose district is just north of Pittsburgh, Pennsylvania, to talk about some of the problems, in his experience, and his thoughts about what we should be doing about substance abuse.

Mr. Speaker, I thank my colleague and friend for his dedication on this issue. And, yes, he is right: we have to cross party lines and work on this together.

Mr. Speaker, I yield to the gentleman from Ohio (Mr. Chabot), another friend, who has seen these problems, as well, in his district and knows full well how these problems have merged well into the Ohio area, as it is an insidious problem.

Mr. Speaker, I thank the gentleman from Ohio.

I point also on this map here to the Cincinnati area in southern Ohio, which is one of the hot spots in 2014 that has continued to grow as a problem. We recognize this is both a local problem and a nationwide problem.

I want to tell a story here.

Last December, when the President was signing into law the 21st Century Cures Act, which included my legislation, the Helping Families in Mental Health Crisis Act, a former State Senator from West Virginia took the stage to introduce it. David Grubb talked about his daughter, Jessie, who, herself, had been in rehab, in treatment, something like three or four times, had had several drug overdose instances and had been revived. But what happened to her also is part of what they called the loaded gun that never should have happened.

She went into the hospital for some surgery, but the doctors and nurses never told her discharging doctor that she was in recovery for heroin addiction. The point we made before about the NASPA list, or the other lists there, or the 42 C.F.R., blocks information from going into the medical record. So while someone was out to protect her privacy, they didn't protect her from death.

She was given a prescription of 50 opioid painkillers. Remember, I said before that when a person is given this prescription, they run the risk of relapse, overdose, or bad drug interactions. In her case, it was an overdose that finally took her life--another important reason why we have to deal with this 42 C.F.R. and get rid of that arcane and, quite frankly, deadly law.

Let me talk about some other recommendations of what I believe Congress can do to help.

The references made before by Dr. Bucshon and others about the prescription drug monitoring program--and also Buddy Carter of Georgia mentioned this, too--where a pharmacist or a physician can say, ``Is this person on other opioids? Have they jumped across the border? Have they seen four, five, or more physicians for some opiates?'' by having a better PDMP, prescription drug monitoring program, or National All Schedules Prescription Electronic Reporting program, we have to make sure that all States use the same system and that it collects data from across borders so doctors can easily see this.

But part of this, too, in dealing with the 42 C.F.R., is understanding Federal

law prohibits including buprenorphine and methadone in the PDMP. How absurd and how cruel that is that a doctor would not even be able to know that a patient is taking one of those prescriptions.

Also, some of these drugs can end up being a respiratory suppressant, and when the patient takes another drug such as benzodiazapine, it can add to that effect and add to further complications.

Another aspect, too, which we must be further engaged with is vigorous public education programs across all age groups, beginning with early elementary school.

When schools have some of these programs--and we will bring forth some models that talk about these programs in a future hearing I will be holding in the Oversight and Investigations Subcommittee--these are very, very important to help students, early on, understand the dangers of this.

This is not just recreation, but it is so easy to slip into addiction. Given that 80 percent of drug abuse begins with a prescription, whether it is a student, athlete, perhaps a football player who injures a leg or something and he is given some of these drugs, it is essential the whole family be counseled from the onset, understanding the concerns and dangers of continuing to take these drugs.

We also have to have drug take-back programs and public education programs stressing the importance of proper disposal of unused opiates and pain prescriptions to prevent them from being stolen or misused. For example, if a family is selling their home and they are having an open house and strangers come into the house and while they are there they say, ``Can I use your restroom?'' and the family lets them do that, don't be surprised if that person has no intention of buying a house but does have an intention of going into the bathrooms and checking the medicine cabinets and finding any medication and taking it.

Also, when teens come over to the house for parties or socializing, don't be surprised if they also go into medicine cabinets, look in drawers in the bathrooms or drawers in other places of the house looking for some of those drugs which they, themselves, will take or sell.

We have to make sure we have vigorous patient education programs about doctor-prescribed opioids to make sure people know about that before the addiction takes foot. And taking one of these prescriptions may only take 3 or 4 weeks before it begins to kick in and cause problems.

I know myself, back in 2005, I was in a rollover accident in Iraq with a couple of other Members of Congress. Our vehicle rolled, and as a result of that accident, I ended up having a mild concussion, snapping my neck, having some temporary paralysis, and a great deal of pain. Well, battlefield medicine is one that gets you out of the area, stops the bleeding, stops the pain, and ships you off to some other hospital, and that was the case for me.

But I know what happens. Everywhere I landed in a helicopter or an ambulance, appropriately so, the physicians would ask me a number of orienting questions, but also say: ``Are you in pain? On a scale of 1 to 10, how much pain are you in?'' And when I proceeded to say that number, immediately, as they would do for many other people in the battlefield, they would administer morphine or some other pain reliever and move you on from there.

What happened, though, returning to the United States, where pain continued for me, I was prescribed some pills for that pain, but I was also prescribed fentanyl. Never once was it ever described to me: ``Be careful with this. This is highly addictive. This is a problem.''

Now, after a few weeks on this and recognizing it was hard to even do my job because I couldn't keep my head clear, I just said: ``That it is. I am not taking this anymore.'' But at that point, my body had already begun to develop some tolerance for this, and when I stopped taking it, I had some reaction.

Granted, it was not as severe as some of those who have been taking these drugs at a higher dosage and longer, but I could feel myself actually saying I understand what people mean when they say their skin feels like it is peeling off of them and they feel a sense of nausea and other problems as well.

Now, I can't even imagine what it is like for someone who is taking higher doses for longer periods of time. But it is extremely important that, every time a prescription is written, pharmacists have an opportunity to counsel patients and doctors are also doing more than simply passing out a prescription.

Pharmacists should do what Buddy Carter was saying before: make sure they have the person showing a photo ID. Is this, indeed, a prescription they are picking up for themselves or claiming they have it for someone else? Perhaps that prescription was stolen from someone.

We have to make sure that we also understand, for those out there trying to legalize marijuana, I caution you, because the marijuana that is out there on the streets or presented in many areas can cause tremendous psychiatric problems for those who are already at risk. The longer you are on some of the types of marijuana, the greater risk you have for things like delusional behavior.

We have to make sure we also eliminate Medicaid payments for those question 14 responses I made reference to before when you are in the hospital to ask if the hospital adequately addressed your pain.

In the area of treatment and recovery, we have to expand the mental health workforce. As I said before, half the counties in America have no psychiatrists, no psychologists, no drug and alcohol counselors, and those who are out there likely have their schedule so filled, they don't even have room to treat someone. Not all of them even know how to treat addictive disorders.

The fact that a majority of people who may have an addiction disorder also have a concurrent mental health disorder is another reason why we have to increase this workforce by tens of thousands. Just for child and adolescent psychiatrists alone, we need another 21,000 of those.

We need tens of thousands more psychologists. It is important that the schools of medicine, schools of psychology, and schools of social work are graduating more people with these degrees and getting them into our workforce.

I have had legislation before, and we passed some things in the 21st Century Cures Act and in my Helping Families in Mental Health Crisis Act, to provide more funding so that more of these folks can continue with their education. It is essential. It is like trying to fight a war without soldiers, trying to fight this war, which is killing more people every year than the entire war in Vietnam, but we do not have the soldiers to fight this.

We also have to make sure that, with regard to the government- sponsored medication-assisted treatment which I referred to before, we cannot simply rely on synthetic opioid maintenance alone. We have to make sure there are requirements to have that person in counseling and treatment.

I have heard from some persons that go to those treatment programs that they have no counseling at all, and some have great counseling. In some cases, sitting in the waiting room, perhaps a nurse or someone simply checks up on them: ``What are you doing? How are you doing?'' That is considered and written down as group therapy. That is not acceptable in any way, shape, or form.

We need 100,000 more inpatient psychiatric beds, and we have to make sure insurance companies recognize that an addictive disorder is a chronic disorder. Simply giving someone a weekend or a few days for withdrawal and then putting them back on the street is not an answer.

That is why we have to encourage private insurance companies and Medicaid and Medicare. And I say Medicare because a large number of people who are having some of these problems are also the elderly.

We have to make sure that we increase the availability of fast-acting opiate blockers for first responders, such as Narcan. But let's keep this in mind: In some cases, we hear of some of those pushers of these drugs who also give an accompanying dosage of Narcan, recognizing that the drug will bring that person to a near-death experience.

We have heard from first responders and others, law enforcement, where someone may actually have a party where someone will remain there expecting that someone will actually have an overdose and die in order to bring them back to life. That is how some of these people are seeking some of those experiences.

We have to make sure that States review their laws, as some are doing, that if you take one of these opiates and you do have that near- death experience, perhaps that should be treated the same as a suicide attempt, that that person is in imminent danger of harming themselves or someone else and perhaps determine if they need an inpatient psychiatric stay.

We have to make sure we have support of employment for those in recovery to break the cycle of recovery and reexposure. Many times, persons who are trying to stay clean, they can't get a job because they can't pass the drug test, so they may be in a job and have exposure to other people who still end up with substance abuse.

We have to make sure they have higher standards and increased accountability for payment models that require evidence-based treatment in halfway houses, three-quarter houses, and residential treatment facilities.

We have to deploy certified addiction counselors to emergency rooms because we know that, when a person comes to an emergency room, if they see an addiction counselor there, they are not just simply given a business card and told, ``Call someone next week and we hope you get treatment''; but if they see an addiction counselor in the emergency room, they increase their chances of follow-up by 50 percent, according to a Michigan study.

We must make sure the FDA is working with companies to find alternatives to opioids and that, again, Medicaid and other physicians are educated on some of those aspects.

Physician training has to also be ramped up: require them to have training in opioid prescribing practices on risk for addiction and abuse and prescribing limited dosages. Instead of prescribing dosages for a month, perhaps just a couple of days. In many cases, they are not adequately trained in alternatives to opioids and the potential harm of overprescribing.

We have to increase training requirements for healthcare providers who deliver this medication-assisted treatment. Right now, in many cases, they only have a few hours of training, and then they can go and prescribe this and have very little, if any, training at all in drug addiction counseling. Before doctors write a prescription, we can make sure they are looking at the NASPER list or other lists as well.

In the area of law enforcement, it is critical that what is called the High Intensity Drug Trafficking Areas program is made more available, with greater access around the country.

Mr. Speaker, how much time do I have left in our segment here?

We have to make sure we have more border security so that we are intercepting these drugs as they come across the border.

We need funding for the post offices because, in many cases, unwittingly, the letter carriers are the ones who are delivering to people's homes fentanyl and other drugs.

In the incarceration system, we have to make sure we are testing inmates for the presence of drugs in their system during their incarceration. We can offer them medications which, upon discharge, actually block any effects of some of these drugs.

We need to also make sure that Medicaid and other insurance companies' payments resume immediately upon release from their incarceration to prevent them from relapsing or returning to the drug culture.

We also have to make sure we have solid data collection. In many cases, when we show the charts about death rates around the country, the charts may be grossly inaccurate. In many cases first responders, paramedics, and coroners do not keep accurate data on these rates. The persons themselves may not even be tested to see if they died from a drug overdose.

There are several items in here listing what we can be doing here as a nation, and there are many more. The point is we have fallen short and we have seen some problems with this. There is more that we can do and we must do in order to save lives.

I know I just have about 3 minutes left, Mr. Speaker, am I correct?

Mr. Speaker, I yield to the gentlewoman from Ohio (Ms. Kaptur) to talk about some of the issues dealing with substance abuse.

Mr. Speaker, I yield to the gentleman from Wisconsin (Mr. Gallagher).

I yield to the gentleman from Oregon (Mr. Blumenauer).

Mr. Speaker, I thank my friend from Oregon, and I thank all the Members speaking here tonight. I want to say, as you saw, this was a bipartisan coalition of Members. We are much better off working hand in hand to pass legislation that changes issues than standing next to each other as pallbearers for another 59,000 people in our Nation next week.

Mr. Speaker, with that and with some hope that we can pass this legislation and save some lives, I yield back the balance of my time.

Mr. Speaker, last week's shooting in Alexandria left our friend and colleague Mr. Steve Scalise badly wounded. Two brave U.S. Capitol Police officers and a young congressional staffer were also injured. We continue to pray for their quick and their full recovery.

I know that other Members, other staff members, their friends, their families have been affected by this, too. Too often, after a shooting or some other traumatic event, we focus on those injuries that are physical, the ones we can see, while forgetting about those injuries we can't see.

I continue to practice psychology in the Navy at Walter Reed Hospital in Bethesda, where I work with veterans who suffer from post-traumatic stress disorder, or PTSD, and traumatic brain injury. These veterans come back from witnessing traumatic events while in combat, and some have come close to committing suicide. These brave men and women fight every day against the horrific images that replay in their minds. The wound is invisible; the damage is often long term. They can and do recover with help.

Since last week, I have thought about other groups who witness trauma in their homes and in their neighborhoods. These are the forgotten ones: young kids in Chicago who have become desensitized to the sound of a gunshot or the sounds of police sirens throughout the night, victims of sexual assault on college campuses and elsewhere, children who witness domestic abuse, and youth in foster care.

Most youth in foster care have traumatic family histories and life experiences, including their removal from the birth family, resulting in an increased risk for mental health disorders. A recent study published in Pediatrics found that children placed in foster care were three to five times more likely to suffer from mental health problems such as depression and attention deficit disorder than children who were never in foster care.

Another study revealed that PTSD was diagnosed 60 percent of the time in sexually abused children and 42 percent of the time in physically abused children. A staggering 18 percent of foster children have never been the primary victim of abuse, yet they still suffer from PTSD probably because they witnessed domestic or community violence.

The American Academy of Pediatrics Healthy Foster Care America initiative identifies mental and behavioral health as the ``greatest unmet health need for children and teens in foster care.'' And since most of these kids are not receiving mental health treatment, their problems carry on into adulthood.

Adults who formerly were placed in foster care, known as foster care alumni, have disproportionately high rates of emotional and behavioral disorders; 21.5 percent of foster care alumni suffer from PTSD compared to just 4.5 percent of the general population.

Each year more than 20,000 young people age out of foster care without being ready to live independently. Discharged from care without social support or assistance, these youth are at higher risk for drug use and mental illness, depression, anxiety and post-traumatic stress, and others. Too often they experience higher rates of unemployment, homelessness, and dependence on public assistance programs.

A lack of a comprehensive mental health screening of all children entering out-of-home care and the need for more thorough identification of youth with emotional and behavioral disorders contribute to these dismal statistics. As well, insufficient youth access to high-quality mental health services highlights our Nation's shortage of providers, in that half the counties in America have no psychologists, no psychiatrists, no clinical social workers, or workers who are licensed as substance abuse providers.

Given the evidence from studies indicating that children in care have significant developmental, behavioral, and emotional problems, quality services for these children are an essential societal investment.

Mr. Speaker, I am proud that the House yesterday took up legislation to address this important issue. H.R. 2847, the Improving Services for Older Youth in Foster Care Act, expands and improves the John H. Chafee Independence Program, which helps current and former foster care youth achieve self-sufficiency. Specifically, the bill will widen the age range of foster youth who can receive assistance under the program.

I am proud to support this bill and will continue to shed light on those who suffer from trauma, who, as a consequence, suffer from either PTSD, depression, or other emotional sequelae. These bills we voted on will continue to give our foster children both help and hope.

Mr. Speaker, last November, Canonsburg, Pennsylvania, Police Officer Scott Bashioum was shot and killed as he and his partner responded to a domestic disturbance call. They were ambushed as they approached the home. Officer Bashioum was also a United

States Air Force veteran. He retired as a senior master sergeant with 29 years of service.

He will be remembered for his service both in the Canonsburg community as a police officer, and to the country as a veteran.

Mr. Speaker, when our brothers and sisters are killed in the line of duty, we can memorialize them by building monuments. We can remember them by renaming buildings. We can support them by raising funds to help their widows and their orphaned children.

But most importantly, we can make sure we do all we can so that they return home at the end of their watch and that we protect their right to raise their children and their children's right to be raised by them. The community needs to know that we do all we can to make sure that thin blue line does not break and that thin blue line does not bend. We need to work together as a nation to protect those who protect the safety of all of us.

Mr. Speaker, in my district over the time span since the Affordable Care Act, ObamaCare, was passed, I fielded many, many a call from persons who said they could not afford health care. In some of those instances, even though a person was able to afford the premium, they could not afford the deductible.

A gentleman aged 55 and his wife said they would have to pay $27,000 out of pocket between premium deductibles and copays before they could use their first benefits. He was one of the 19.2 million Americans who chose to pay the fine rather than get on the Affordable Care Act, ObamaCare. We suspect that many more will continue on with saying they would rather pay a fine or find a way out rather than continue to pay for it if this continues on as is.

In the past, we have been battling many things under this with regard to mental health care. The past administration attempted to strip the protected drug class status for lifesaving psychiatric medications. We fought back on that. We also worked together, however, in a bipartisan way to make sure we had assured things for mental health care.

This bill has several provisions which are extremely important. It has $100 billion which States may use to help in their stabilization fund to fund mental health care. There is another $15 billion focused on mental health care. There is $500 billion for substance abuse. Funding will be in there.

My hope is that States make a decision. It is in their hands with the passage of this bill so they can make the right choice to continue mental health care, and I trust they will do that.

Mr. Speaker, our Nation's HIPAA patient privacy laws should be improved to allow for compassionate communication between doctors, primary caregivers, families, and patients. Recently, the editorial board of the Observer-Reporter joined the conversation in support, citing a specific instance in Greene County, Pennsylvania. They wrote:

Christopher was arrested in early December and attacked

police officers at the scene. Witnessing his erratic

behavior, the officers decided to take him to a hospital for

a mental health evaluation.

Christopher was released from the hospital after there was

apparently no communication between the hospital's medical

staff and the arresting police officers.

Less than 4 weeks later, Christopher was shot to death by his brother, Ryan, in what Ryan and others described as self-defense.

If only the doctors were allowed to share limited, critically important information with the family, with law enforcement, and with supportive community specialists, this tragedy could have been avoided.

The leading predictor of success in treatment for a person with serious mental illness is family involvement. We must change Federal regulations to help, not block, treatment. Until then, there will be more sad stories like Christopher's every day.

Mr. Speaker, I was unavoidably detained. Had I been present, I would have voted ``yea'' on rollcall No. 54.

Mr. Speaker, today, four people were charged with a violent crime after a Facebook showed 30 minutes of horror. The criminal charges barely scratch the surface in describing the terror experienced by an 18-year-old boy who suffers from mental disabilities.

He was forced for 5 hours to cower in a corner scared, stunned, and powerless by people he thought were his friends. His mouth was duct taped shut. His hands and feet were tied. They cut his clothes, his hair, and scalp with a knife. He was burned, punched, and beaten. He was humiliated and berated. This was not just bullying, this was violent, perverse torture perpetrated by heartless young adults. His psychological trauma will haunt him for years.

He is not alone because children with disabilities are four times more likely to be assaulted than the general population.

We enacted major mental health reforms just a few weeks ago. Unfortunately, we cannot litigate compassion, mandate morality, nor legislate common decency for perpetrators who have no sense of shame. But today, as a Nation, we should all be ashamed and recommit to teach our children there is never any excuse to harm a disabled person. Never. I pray for the victim and his family.

Mr. Speaker, on rollcall No. 64 had I been present, I would have voted aye.

Stated against:

Mr. Speaker, last week, the wind chill in Buffalo, New York, was 20 below zero. Dead of hypothermia was Ronald Hunter. He was 21 and had untreated schizophrenia.

A third of the Nation's 750,000 homeless are so severely mentally ill that they cannot take care of themselves. They starve, they freeze, they live in their own squalor.

Had Ronald had some other brain disease like Alzheimer's, he might very well be alive today, but because he had a mental illness, the system refused to help.

Ronald's father told The Buffalo News:

``When he was living with us, I found him curled up in a ball in the corner of the bedroom,'' and I said, ``What is wrong, baby?''

He replied to his dad, ``I am hearing voices telling me to kill myself.''

Ronald's parents called Crisis Services, but as his stepmom said, ``Because he was 18, it was up to him if he wanted help.'' In other words, we let him die with his rights on.

Don't you understand, America, that this is a brain disease; it is not a choice?

I will soon be reintroducing the Helping Families in Mental Health Crisis

Act, and I invite all Members to join me in rebuilding our broken mental health system, so that we have treatment before there is tragedy.