October 21, 2015

Cassidy Remarks on Mental Health

Mr. President, for 25 years I have worked in the Louisiana public hospital system, and you can’t help but notice when you work in a public hospital system, but also in private hospitals how often mental health issues are directly a part of a patient who comes to see you.  But it doesn’t just have to be a physician seeing patients in the emergency room, each of our families, mine included, has a family member or a friend who has serious mental illness.  It is non-partisan, it cuts across demographic lines, if I go before a group anywhere in my state, indeed anywhere in the nation, and bring up the need to address serious mental illness, all heads nod yes.  It is true of my family.  It is true of yours.  It is true of almost everybody watching today.

Now, I’m old enough to remember when people wouldn’t speak of cancer. There was a stigma associated with having cancer, that’s long gone, much to our advantage.  But for some reason there continues to be a stigma and a shame associated with mental illness.  And I would argue that that stigma and sense of shame has retarded what we can do.  This is something that we have to address, we have to discuss, we have to go forward.

Now, the discussion right now, frankly, is being driven by tragedy.  Lafayette, Louisiana, Newtown, Charleston, Oregon, Tennessee—we’ve heard stories, and they are beyond heartbreaking. But what’s not spoken of are the broken families, the parents that know that there is something wrong with their child, but don’t know where to go to receive that help, ending up in an overcrowded emergency room or their child in a jail or prison when a more appropriate setting would be elsewhere.

And it is in the midst of these terribly tragedies that at least we can hope that they can serve as a catalyst for society and Congress to begin to fix America’s broken mental health system, maybe something good can happen, even from tragedies as horrific as these. 

So the question is, if one of the roles of Congress is to respond to societal needs that justify federal involvement, shouldn’t we ask ourselves why has there been such a failure to address the issue of serious mental illness?

I’m pleased to say my colleague, Senator Chris Murphy and I wish to change that. We’ve introduced the bipartisan Mental Health Reform Act, which now has 10 sponsors, both Republican and Democrat.  Our bill begins to fix our mental health system and attempts to address the root cause of mass violence, which is recognized, but untreated mental illness.  

So how does our bill begin to do so?

First, patients too often cannot get the care they need and too often have a long delay between diagnosis and treatment. Access delayed is access denied.  Access is hampered by a shortage of mental health providers and too few beds for those with serious mental illness who truly need to be hospitalized. 

Related to this, right now, people with major mental illness tend to die from physical illness as much as 20 years younger as someone who does not have serious mental illness.  As a physician, I know if we treat the whole patient, if we integrate care, it is better.  Medicaid, though, by policy will not pay for a patient to see two physicians on the same day. 

So imagine this, a family practitioner sees a patient who clearly has major mental illness because the patient is right there, would like him to walk down the hallway to see her friend the psychiatrist to have both addressed immediately while the patient is there.  Medicaid will not pay the psychiatrist.  On the other hand, the patient might instead see the psychiatrist and has seriously high blood pressure or evidence for diabetes out of control, but the psychiatrist cannot say, “Wait a second, let me walk you down the hallway to see my colleague, the family practitioner,” because Medicaid will not pay for that.  By the way, private health insurance will, but this is a policy change we need for the public health insurance. Our bill would allow patients to use mental and physical health services on the same day.

Secondly- most people have their first episode of major mental illness between the ages of 15 and 25, starting down a path that ends with their life and their family’s lives tragically altered. This bill attempts to identify those young folks, stop that path from ever opening up and preventing the first episode of serious mental illness, or, if it does occur to lead them on a path of wholeness, a path towards wellness.

Another thing our bill does is establishes a grant program focused on intensive early intervention for children who demonstrate first signs that may evolve into serious mental illness that may only occur adolescence or adulthood. A second grant program supports pediatricians consulting with mental health teams.  This program has already been successful in states like Massachusetts and Connecticut.

Third- without appropriate treatment options, prisons, jails, and emergency rooms have become “defacto” mental health care providers. More than three times as many mentally ill are housed in prisons and jails than in hospitals according to the National Sheriff’s Association. Overcrowded U.S. emergency rooms have become the treatment source of last resort for psychiatric patients.  

We incentivize states to create alternatives where patients may be seen and treated in supervised outpatient settings, as opposed to being incarcerated. Our bill creates an undersecretary for mental health within the U.S. Department of Health and Human Services. This undersecretary’s responsibility to coordinate mental health services across the federal system to help identify and implement effective and promising models of care.

It reauthorizes successful programs, like the Community Mental Health Block Grants and state-based data collection. And the bill also increases funding for critical biomedical research on mental health.

On top of this, it strengthens the transparency and enforcement of mental health parity by requiring the U.S. Departments of Labor, Health and Human Services and Treasury to audit the implementation of the Mental Health Parity movement to determine the parity between mental and physical health services. 

Our bill does other things—but the most important thing it does is to help prevent tradgedies, help families and help those broken individuals affected by mental illness beome whole.

In 2006, William Bruce of Maine was a 24-year-old who needed help. He suffered with schizophrenia and had been hospitalized. Without contacting his parents, our broken health care system allowed William to be released—even though his doctors said he was “very dangerous indeed for release to the community.” Sadly, two months later he murdered his mother at home with a hatchet. This story is tragic and heart breaking and even worse, it could have possibly been prevented if we had worked then to fix our broken mental health system.  We with to fix it now so there is not another such episode in the future. 

The time for mental health reform is now.

If not now, when?

If not us, who?

If not now and not us, there will be more Lafayettes, more Newtowns, Charelstons, Tennessees, and Oregons, more broken families. This bill does not wave a magic wand, but it puts us on a path where we can say these things that once occurred, perhaps no longer will. 

Thank you.