November 30, 2016

ICYMI: Cassidy Speaks on Mental Health Reforms in 21st Century Cures Act of 2016

WASHINGTON—Today, US Senator Bill Cassidy, MD (R-LA) spoke on the US Senate floor to bring attention to the mental health reforms included in the 21st Century Cures Act. Many reforms from Dr. Cassidy and US Senator Chris Murphy’s (D-CT) Mental Health Reform Act were included in the 21st Century Cures Act. 

21st Century Cures Floor

Watch the speech here.

Find his full remarks below:

I thank Senator Alexander for yielding. I thank you for your leadership and Senator Murray’s leadership, and I thank Senator Murphy for his cooperation, collaboration in passing this. 


I will speak to mental health as a senator but also has a doctor, as a family member and friend of those with mental illness. And because of these different hats, passing comprehensive mental health reform has been a priority since day one. Senator Chris Murphy and I introduced the Mental Health Reform Act of 2015 shortly after arriving in the senate. Again, since then, Senators Alexander and Ranking Member Murray have made mental health reform a priority, and I thank them once more for their vital work to include the provisions the four of us introduced in the Mental Health Reform Act of 2016 into the 21st Century Cures Act. 


Everyone in some way is affected by serious mental illness. This is not a partisan issue. It crosses any division of age, gender, demographics and certainly of political party. If I go to a town hall meeting in Louisiana in an area not so wealthy and speak of the need to address mental health, heads nod yes. If I go to another town hall meeting in another area, very wealthy, and mention the need to address mental health, all heads nod yes. Everyone nods their head yes because mental health is an issue in the minds of everyone. I mentioned earlier everyone has a family member or friend who has a serious mental illness. Maybe not, but it might be that person you went to high school with, and her life turned out far differently. Her marriage broke up, her children in foster care, perhaps she homeless. If you think, not even hard, that person will come to your mind. 


The largest problem affecting Americans with serious mental illness is lack of access to care. Just a few weeks ago, I spoke to a neuropsychologist in Baton Rouge, Dr. Paul Dammers. He told me he sees 15-20 patients a day and is booked up to six months in advance. If your loved one is having a mental health crisis, they should not have to wait six months to receive treatment. He stressed the significance of the barrier to treatment posed by the shortage of mental health professionals. Thank God for Dr. Dammers, for all the work he and the other mental health specialists do to help those with mental illness return to wholeness, but they need help. Access delayed is access denied, and access is hampered by a shortage of mental health providers and too few beds for those with serious mental illness who need to be hospitalized. Patients too often cannot get the care they need and too often have a long delay between diagnosis and treatment. 


And without appropriate treatment options, prisons, jails and emergency rooms become the de facto mental health care facility. Sheriff Greg Champagne of St. Charles, Louisiana, a past president of the national sheriff’s association, quotes the statistic that sheriffs—sheriffs—are the number one provider of mental health services in any parish or county in the country. Incarceration has become our top mental health treatment strategy. More than three times as many mentally ill are housed at any one time in prisons and jails than being treated in hospitals. Now, it is clear. It is time to fix our broken mental health care system. The 21st Century Cures Act provides incentives to build an adequate and skilled mental health workforce to expand access to mental health care providing quick and effective diagnosis and treatment. Our goal is that that person who has their first psychotic episode when she is 18 will be restored to wholeness so that when she is 50, she looks back upon that as a distant memory, but not as a life-defining event. 


This bill also addresses privacy issues that keep some patients from receiving the best treatment possible. As an effect of the government regulation, HIPAA, an important law protecting patient privacy, nonetheless when it comes to a patient with mental illness as an adult, the doctor feels as if she or he is not allowed to share vital information for their care to a third party, even if that third party is their caregiver. A woman I went to high school with has an adult son with serious mental illness. She is the one who brings him to the doctor, gives him his medicines. Yet when he is discharged, she is not told what medicines he is taking and she is not told when to bring him to follow-up. Privacy is important, but when a government regulation gets between a doctor and a patient and the loved one caring for them, something needs to change. 


This legislation also offers incentivizes to build that skilled workforce, but also to train that workforce to better understand these rules of disclosing patient information. This allows doctors to better serve their patients and ensure they are getting the proper care they need.


 As a physician, this next provision just matters so much to me. It promotes access to services through the integration of primary and behavioral health. Now, right now, if someone with serious mental illness goes to see their psychiatrist and their hypertension is out of control and she wants to send the colleague to see her family practitioner, she refers him to the emergency room instead. Conversely, the family practitioner treating the hypertension notes that the patient is psychotic. They’re not allowed to send the patient down to the psychiatrist on the same day. In private insurance programs, this is not an issue. It’s only been an issue in Medicaid. This law begins to change that. And I will note that patients with psychiatric illness die 20 years younger than do patients that have a physical illness but do not have a psychiatric illness. We must do better. 


Another thing this bill does is establish a grant program focused on intensive early intervention for children who demonstrate first signs that may evolve into serious mental illness later in life. Dr. Howard Osofsky and his wife Dr. Joy Osofsky did research after Hurricane Katrina and found that you can detect from ages 0-3 evidence of a child who may have a problem with mental illness later in life. This bill provides grants for early intervention for the infants and children that will address the effects of trauma and the adverse experiences that children under the age of five have. A second grant program supports pediatricians consulting with mental health teams. This is modeled after a successful program in Massachusetts and Connecticut. 

This legislation does many important things to change how we treat mental illness by expanding access to mental health resources, clarifying the rules and disclosure of patient information with family caretakers, and integrating primary and behavioral health. The 21st Century Cures Act will begin to fix our broken mental health system and prevent more people affected by mental illness from being denied the care they need.