was an internal investigation in the army which isn't made up entirely of tortures and criminals. there are lots of people within the army that are appalled at what went on and they were investigating it. the idea that the press is the only route is not borne out. >> the situations are different. it's one thing where it occurs that most people in the system are unaware the crimes occurred and therefore what is needed to bring it to an investigator i view the snowden situation different that it was one that the situation veto was deemed as secret. you couldn't go to the congress and say i'm here. he couldn't go to the head of the agency and say i would like to report what you're doing without telling the american people what you're lighting about so there are situations

they don't think they are legitimate but to say that he should have gone to the caught chris when he is care was on fire and say i wish i could tell the american people this but i can't, that doesn't seem very plausible. >> i would like to end with a lightning round. we have been mostly talking about the cases that we love. we almost got the privilege. what do you think will go down? where do you think the current supreme court might deal with these questions and what they recommend likely rule in favor? >> no. [laughter] he is highly finale or with the supreme court. i think the recognition is less likely today than it was in

1973. and this i think the best thing for the press is to try to keep a decision away from this court. >> i think unfortunately at all of rises in the post-9/11 era that makes it more difficult than you will nee want to look e case that didn't involve the press versus the humanitarian project that involved material support to see that there can be the issues that you can see that they may not take that friendly of an approach to anything that a any way advances the cause of national security. >> this is a court he would want to keep the case away from but

what they recommended the amendment and the answer is probably no. whether you could convince them to recognize a common law privilege as the justice urged i think is an open question. i am not an optimist, but i think that you could make an argument to this court along the lines of if you don't recognize the privilege all that you are saying is that you have the power put in the hands of the executive control over the whole field of information and in our system of the government there is a role for the judges to play on these issues and therefore you should recognize the case-by-case privilege otherwise you have no role in the future and you might be able to get someone to coalesce around that. >> the only chance of getting the rule in here would be to appeal to the institutional judiciary and show the way that it ought to be set up in the

security state. during the arguments in the first case the justice asked is it your position they would have no jurisdiction if you were torturing prisoners in guantánamo and the government? we would never do that. and 6 16 minutes to broadcast te photographs from abu ghraib. last year in the challenge what we consider an unconstitutional surveillance program the government is actually said to the court to standing is based on speculations and the court and the decision said there are claims that are attenuated and they have no claim that they are subjected to this kind of surveillance and a few months later we have this revelation. so i do hope that the court will see that by deterring to the government with a national securities invoked the court is working itself out of the constitution. >> please join me in thanking the panel.

[applause] it was a great start. >> here is a look at the programs on the c-span networks.

we should have finished i'll qaeda in 2001. our general that was there but more than just a general i think all of us think back. we were attacked. 3,000 americans died. more than in pearl harbor. and we have al qaeda and we had osama bin laden trapped in tora bora. we didn't finish him off and then we lead in the scapegoat for the other side of the mountain because we said that his pakistani territory. think for a moment can you imagine during world war ii when he won the battle of midway he sailed across the international date line in the pacific and

attacked the japanese, destroy their fleet, 1942. he went across the international date line. suppose he turned back and said that's the international date that the international date line and japan said if we don't cross it we will take it a part of the pacific and we will live happily ever after. we get to these mountains in the middle of nowhere and we allow al qaeda to escape. it makes no sense. our entire country had become more legalistic. we should have finished it )-right-paren.

congressman tim murphy said it is inhumane and immoral and he spoke at the eric and enterprise institute in dc about a bill he introduced to improve access to mental health resources. the discussion is about an hour and a half. >> thank you everyone for coming today. i am a resident scholar here at aei and our discussion today is on the role of mental health, the role of the federal government and mental health policy.

we typically think of mental health as a state responsibility and to a large extent, it is, but the federal government has a very influential role in shaping services and policies for mentally ill patients. in the last few decades it hasn't used that very effectively. as everyone knows we have a chaotic patchwork of services and huge gaps through which mentally ill patients fall into the street and end up in jail. it is a completely heartbreaking situation. the -- so today we have that representative tim murphy at the legislation called helping families and mental health crisis act. it addresses persistent problems

and mental health care systems. among them the shortage of psychiatric beds. there was a hearing just a few days ago. the adequate implementation of evidence treatment, small but real problem of violence on the mentally ill are outdated in the voluntary commitment laws. the lead agency in the hhs that is responsible for funding the services for the nation's mentally ill. everyone on the panel that will respond are deeply dedicated to the patients and families. >> representative murphy actually i'm going to introduce everyone you have a folder biography at the desk so i'm going to be brief and then we

will begin. representative murphy is currently in his sixth term in congress representing the 18th district of pennsylvania. he's a former psychologist actually still psychologist. one always has his degree with three decades of experience. the chairman of the investigations subcommittee of the house and energy commerce committee, the cochair and a founding member of gop doctors caucus he authored the senior access to act which ended the practice of charging copayments to seniors on medicare and finally he introduced and passed the mental health security act for america's families and education which was instrumental in getting a college student to work suffering from depression or psychosis the help they need before tragedy strikes. next will be doctor jeffrey lieberman who is the chairman of psychiatry at columbia

university college of physicians. physicians and surgeons of the psychiatric institute and his research expertise has been on schizophrenia and psychopharmacology and this year he's the president of the american psychiatric associati association. next is the cofounder of one mind for research wizard 16 years in the house of representatives and was the author and sponsor of the mental health parity act of 2008. he's cosponsored bills to increase understanding of mental illness and treatment. finally the psychology professor at the services university health services and research specializing in schizophrenia and policy and infectious disease and schizophrenia which

is an interesting theory. he's the founder that the treatment advocacy center and executive director of the family medical research institute. he has co-authored numerous papers and books and that is the distinguished panel so we will start with mr. murphy. i don't know how to get the slides working. anybody know what we can do here good morning everyone. it's an honor to be a part of the panel and have so many distinguished colleagues in the audience. i wish i could see that yo say e getting continuing education credits for this. but i want to talk about is hr

3717 the bill introduced last december. it was for a very important reason. i connected to the parents from the sandy hook elementary that we would have this information. we have been rocked by the tragedies and although those with mental illness are not of the vast majority likely to be violent, nonetheless it is an area of grave concern they have been committed by untreated illness and that we need to deal with these things. let me give you some numbers

because without this nothing else is going to make sense. there are about 16 million americans in the 20% of the population or so with a degree of mental illness from the mild transient problem of anxiety or sadness to severe mental illness about 9.6 americans have a serious mental illness and about 3.6 million are without treatment. extremely important to understand what happens when someone is without a treatment because if someone to be violent in their tendency but when they are in treatment there is a 15 fold increase in the likelihood that they may become involved in violence. it's also important to note that some of the mental illness has about three to four times that there be victims of violence,

assault, robbery and this is where someone is in prison on the streets or at home independent. children who are mentally ill or three things are likely to be victims of sexual abuse. now those numbers are pretty staggering and should move towards action. they are misdirected and we are not getting the services to the people that need it. the federal government already spends about $125 billion towards mental illness. much of that is for payments for disability, medicaid, very little is for research, and very little is getting out in terms of early treatment access. while what seems to happen is where do these people go? twenty to 50% of people from the mentally ill if you move to the

next flight you will see that as we close the hospitals in the 1950s and 1960s we had 550,000 inpatient beds and for the population about 150 million. as they close down we have 45 hospital beds but where have the patience gone? we have filled our prisons so while the states budget are bursting at the seams and paying for the growth and expansion and over populations and a small prisons, is no wonder why it is not the crime that is so expanding in the nation but that we have treated the hospital bed for a prison cell. we've also treated at the hospital bed for a match race in a frat house and homeless shelter or blanket over a subway grate in the cities. it is inhumane, and moral and

puts us in a third world status. when you take action such as a typical situation when a mentally ill person having subacute breakdown or psychotic break the police are called and what happens? the ill staffed emergency rooms not designed to deal with a mentally ill patient is brought and what do they do? they tie them by their risks and legs to a gurney and often times too often they leave them in a hallway or in a room simply surrounded by a sheet or cover it if the person is out of control what could be more inhumane than putting someone in jail for leaving them on the street or chemically and physically handcuffing them to a bed and calling that treatment? it's wrong and it's time the nation woke up to understand the plight these patients face into the turmoil their families feel

about handling this has to change. so over the last year i held a series of hearings in the oversight investigation and here's what we learned that there is inadequate treatment options for simply not enough beds for those in the crisis. there is inadequate outpatient treatment options, too. the system is far away from helping people get better from a to recover, to get jobs again to be independent housing and we know that this can happen. a treatment has beethe treatment there. there's a number of medications, supportive services, there are community wraparound services, there are treatments out there but unfortunately there is not enough and in fact there is a huge shortage of psychiatrists overall and psychologists particularly those that treat serious mental illness. when you talk about 7,000 child

psychologists or 15 million children and we need 30,000 that is a serious problem. people cannot get help and when there is no hope there is no hope and when there is no hope people feel a stigma of going from place to place in the emergency room to police squad cars and it's no wonder they feel the stigma because we are a part of the society that doesn't treat those with mental illness. another problem is the whole venture and privacy act and also family education rights to privacy act are subject to a great deal of confusion. they are supposed to be there to protect confidentiality records to make sure doctors don't release records inappropriately, make sure the privacy act is there to make sure people are not getting school records and other records that don't need to be out there. they have become another barrier because people out of fear of releasing anything often times do nothing at all.

we've had many times people testified befortestify before te where parents are in the hospital trying to convince someone i need to tell you about the history of my son or daughter and people say we can't talk to you unless we have permission. you can't get permission for someone who doesn't know where they are ther they are severely involved in the psychosis and paranoid that they don't know who they are yet we are telling them until we get the information we can't tell you anything. that is a misinterpretation of the law. if you are in an auto accident or ar you have a stroke and your incoherent, no one says we have to wait until you get better before we make a decision to treat you. why do we do that with someone that's in the middle of a deep depression or bipolar disorder or psychosis? is wrong. we need to refine those otherwise you can't get the history. if you can't get the history you cannot diagnose and treat.

it is akin to telling an orthopedic surgeon we want you to diagnose whether this person has fractures in their bones that we won't let you look at the x-rays. we have to understand that we have to provide access to information and still protect confidentiality and follow all of the rules of the profession. we also founded as a standard that is quite frankly existed since the 17 hundreds and this is the standard that says the person has to be in imminent danger to themselves or someone else and then you can without their authority put them in the inpatient care against their will. again the standard is to this level but someone has to be basically slitting their risks overdosing on drugs and holding a gun or knife to someone's throat before we believe they need help. do we do that with any other medical illness? to we wait for someone to say i can't treat you until the cancer has advanced to stage four or a cat treat your chest pain until

you are unconscious for a heart attack or the with your cardiac problems until you have a stroke? no. but somehow we have this with psychiatric illnesses we have to wait until the person has deteriorated before we do something. we need to help them because that is more optimistic. it's also important that we have evidence-based treatments that really work. there are treatments out there but what happens as we see a lot of the federal dollars into state dollars going towards programs more along the lines of as many elected officials state don't just find this and put it away nobody wants to deal with this problem people don't want to talk about it. so we say let's just fund these programs and no one asks the question of all of these dollars does it work and in some cases quite frankly they do not work. some of the money is spent on silly things that would make your blood boil as a taxpayer. why is it that the federal

dollars coul go to pay for a conference where literally the top is such things as interpretive dancing, stopping taking your medication, making a collage getting in touch with your inner self. know you want to go to a weekend workshop pay for it out of your own pocket but when we see millions of dollars going towards those kind of things and telling people we don't have enough people to provide help for you, that is wrong and we aren't going to put up with it anymore. it goes to the point of the weak accountability for federal dollars. so what does this bill due? firsfirst plea and how are the parents and caregivers with making a definition for defining what the law is so the providers and family members clearly no it doesn't mean someone that has no relationship at all for a family member that has been distracted from the patient so they come in and get lots of information. we want them to be clearly defined so this is very important. we want them to have access when

they need it. we would also fix much of this shortage is in the inpatient beds. right now there is a rule don't know how that ever came about. how do we figure out we aren't going to reimburse if you have 17 or 18 dead when most states have a critical bed shortage this has to change so we boost the number of bids allowed in the medicaid payment. we also want to make sure that there's alternatives to the institutionalization. why should there be jailed homelessness or long-term inpatient facility? since it has been found to be effective in the states that do this a lot of states that very few states do it. new york is an example of doing it right where they have found instead of putting people in the procedures that we: pennsylvania basically an involuntary commitment in new york where things work with the family members or the district attorney they come up with an

agreement for the patient to stay on your medication and treatment but they found is that the cost for the related medical care and social service fell 46% overall but in many of those areas it is much higher quite frankly in some areas it is even easy percent or so for people going into jail or being homeless. the other issue is it encourages the states to adopt the need for the treatment standard instead of waiting until somebody is going to kill somebody else we look at the need of treatment as a standard. the next item it preaches patience beyond just the emergency room. they came up in a ruling that they were going to limit the type of medications available to someone with a psychiatric illness. we had a mother a few days ago on this where the representative was there to tell us they are going to limit the type of drugs available. i had been read out loud a statement from the psychiatric

association which clearly said that it distorts the analysis and you can have search and psychiatric drugs and in that one of the comments that was made was about ssri and i said can you tell me what that is and the response was i wasn't briefed on that. if you don't even know what you're talking about it is pretty clear that you were going to draw conclusions that it had nothing to do with reality, and i am understating my concern for the decision that was made. they have another standard that says if you are not hospitalized in seven days it's okay to change it then i'm not talking about generic drugs but they are eliminating the tougher drugs so severely that i thought it was going to end here the physician's ability to prescribe appropriate medication. added to this when you are over age 65 for example and receive a diagnosis of the comical honesty were twice as likely to face depression and those double your

healthcare costs for lots of different reasons of exacerbation and physical symptoms and less likelihood to comply with other treatments. so i reminded him that when seniors commit suicide, 20% of them do it the day of the doctor's visit. 40% the week of their dr.'s visit and 70% within a month of the last dr.'s visit. so recognizing that many of these drugs take two to six weeks to become effective, to say you can't use this drug and you've tried other ones that puts the patient's life at risk and i'm happy to say that a couple of weeks after or a few days after that hearing they reversed the decision but this s bill would say we aren't going to leave it up to whoever is sitting in that chair we are going to make it a part of the law. the same issue is also quite important that you can't have two doctors bills in the same

date. we know a family is most likely and person is most likely to go to a pediatrician, family physician or internist in the systems when they are beginning to exhibit serious mental illness. we know the average is 112 before a person has their first visit to treat mental illness. what happens is if a mother is bringing her teenage son 1 14 to 15-acre 25 is the age they begin to inhibit, bring their teenage son to a doctor and he says you know i'm very concerned about the things your son is saying and doing right now we need him to see a psychologist or psychiatrist now. doron medicaid. can you come back tomorrow? that is inhumane. in these cases it needs to be same-day billing. also more access to psychiatry where physicians can access a number or allow more psychiatrists as we have a shortage and we know it is an

effecte mechanism to do this to have a mental health professional able to talk on a video screen but it is the barriers we have to eliminate. we know medical research is important so we authorize the initiative extremely important for the nih to involve research on the brain that is from the human body and the initiative to response after the initial schizophrenic episode. very effective for the early intervention for these problems. we also want to integrate mental health and primary care for the reasons i said before about that's where the first to point friendpoint andtend to take plaf this is the bill that senator stabenow and want to put it in yesterday and also put in some funding which was approved in the house bill and i'm sure the senate will do that, too. ..

so physicians can work as a team another part of this bill is through our community health centers, to allow mental health professionals and positions to volunteer. here is another think that only the federal government could come up with. if you work and community health center, and these are marvelous places to buy low-cost services to underserved areas are rural and urban. if you work and one of these places malpractice insurance is low and they can provide a lot of integrated care. the nice thing about this, positions and podiatrists and

dentists and nurses and nurse practitioners and psychologists, social workers all working together, great. that's what you want, to provide team access. unfortunately one a lot of them are understaffed. if you are employed you're covered. if you're at a free clinic and you volunteered there you are covered by the federal humpbacked. but been a community health center, and you volunteer, you are not covered. a free clinic and you are paid, you are not coverage. there have been a number of studies that say that people will give out their time. an afternoon a week, a day a month can be very, very valuable in providing some assisted care. so allow people to be lean the good samaritan, help out, give of their time. and quite frankly, this is probably going to be about a billion dollars worth of free care every year in this country. next, a department of justice

reforms, when i described before, unfortunately a lot of those estimates been. still, we don't know all of what happens. who want to know that treatment for serious mental illness, disjointed model. they may have to have a different kind of care in jail. we don't know if they have followed care. you want to make sure we are tracking that. the teen behavior health awareness and bear, educated and understand. what the symptoms are and how they can receive treatment. and mental health, this is extremely important. of all the money the federal government spends, there is nobody who looks after what happens to that part of the fence, the department of veterans affairs, the department of justice, department of education, health and human services, and maybe even department of labor and transportation. a lot of money is spent on

prevention and treatment services. as i said, a lot of it is care. the department of defense has done marvelous things. but throughout the military and we have done a number of tremendous initiatives to try and create more care for our active duty and service and guardsmen here. the disjointed between that and if veterans, someone in viejo saw a study about 20 percent of people who contacted the viejo, 20 percent of proper health. 20 percent. waiting lists initial treatment, group therapy, given medication spirited comeback in a couple of months. we won an assistant secretary of mental health specifically designed as a physician psychiatrists, clinical psychologist to said this person's job is to go through every nook and cranny of the federal government, find every

dollar. evidence based care, does it make sense? is there a scientific standards? if not, eliminated. it is duplicative, birgit. if it's great, expanded. gather information. incredible things. how we can -- hits in essential part of what the secretary can be doing to move forward. this is what this bill does. it is very comprehensive, not something akin just explain. but quite frankly there are three things that have happened in the last 50-60 years in this nation to change mental health. one is that change that president kennedy made with regard to how we need to close down our assignments and stop warehousing people and move toward a real change. some of those things have withered away. two, things that far congressman patrick kennedy did in office to

make sure we have mental health parity. three, these other reforms are starting to happen. this is a headline that should be in newspapers. the federal government finally stood up and made some reforms and changes. i don't want to see anymore had lines of another tragedy, victimization or violence committed by personal manson on this. bring this issue out of the shadows and make some significant changes and help our country before it. thank you very much. [applause] >> thank you very much. did -- take you very much. in conclusion i would like to thank. i have spent my career -- most

of my career really being a pointy headed scientist and a laboratory during research. i always am acting as a clinician treating patients as well. then in the past, the decades, the largest and helped to fund health care provider. president of the apa and got drawn into the legislative political dimension. and it has been an interesting but sobering experience. when i was called to participate in this event i noted that it was smack in the middle of a vacation to go to a key biscayne, florida, and watch the sunday tennis open. and i said after thinking about it and him who is going to be here and particularly the legislative initiatives of gained momentum.

i'm going to come. i messed roger farah plan yesterday. but it was for good reason because this is an opportunity in a time that can really be -- i know it's a cliche, but a tipping point or a turning point. we are here today on an issue that has been in front of us for decades, if not more. many people have been talking about it, in derailing about it including my good friend and colleague. it did not resonate this fully. we are here today because an individual like congressman murphy has stepped forward to assume all greuel which is really doing something important and meaningful. and he is not alone in doing this. there have been champions for mental health in congress previously.

patrick kennedy and his colleague jim branstad and his father's, edward kennedy, but as time goes on day move on and we are not sure who is going to sort of follow in their place. congressman murphy a step toward to do so along with other individuals who are so gratefully sort of working in this way such as senators have been no and your cochairperson. well, then neuroscience caucus and so forth. so when you really have a chance to do something now given the fact that an individual who has a vision and courage and a position, platform is stepping

forward to do so. as a researcher you can't talk about having slides into long. i put those up to so you could follow along. it is not going to be easy. the reason is because -- the reason is because our system of care which is admittedly fragmented, inefficient, and expensive really is trying to address at least three distinct populations or populations defined by illness, type of illness, severity, and treatment. the one we hear most about and is, indeed, probably the most urgent priority rv serious and persistently mentally ill, people with schizophrenia, bipolar disorder, major psychotic depression. they are treated largely in

mental health care facilities outside of medical facilities. then we have the people who are receiving medical and surgical services who have, orbitz psychiatric illnesses. and this proportion of the health care population is one of the biggest cost drives. then we have a third group which is individuals who have milder forms of mental illness cannot award well for working addictions that i treated in clinics, practice settings and so forth. so we have three distinct groups. we talk about mental health care, mental illness. were all talking about 70 different emphases on these different populations or settings where people are receiving care. now, we have -- there is an obvious need to address the

needs of these populations. one of them which is become the new buzzword is collaborative or integrated care. what that means simply this psychiatry, mental health care needs to be embedded in the primary care system. separate places, it has to be embedded just like journalists go to war and get embedded. mantle of care providers need to be embedded. primary care providers -- psychiatrists don't take on general medical care as a new part of their responsibility. primary-care doctors need to be -- primary care professionals need to be embedded in the clinics the as bmi populations. that's a no-brainer. huge benefits. the second, if we really want to get serious with this, the next thing that we will try and push congressman murphy on, need of public health initiative for mental health care.

hypertension screening, diabetes screening. the move out of clinical settings into the community, primary care, the educational system, the workplace, faith based organizations. that is where mental health care needs to move also. sort of a new frontier. now as starkly this has been a stepchild of medicine and health care. there are reasons for at, but apart from those for the time being it's something that has been seen fit to need to step in and do something about. people with mental illness were not taking care of an ordinary ways in which people had their out taking care of. the government had to step in. luckily has fallen to the state

or local government, state mental health systems. you don't have a state health system. you have a state mental health. no one else is providing the software. it fell to the state and local government. the federal government initiative came. is book american psychosis brilliantly depicts this shameful trajectory of the federal government's effort to try and take on mental health care. but when it began in post-world war two is started, had a vision with president kennedy's mental health act and then failed miserably. the recognition and mental health was somewhat different for a variety of reasons in need of some kind of special attention, and that is still the case.

one way, it gets the most attention, but it is the jails, 30 or 40 percent, the homeless that the 34%. the cost of care that is driving out the percentage of gdp that is banned in health care that is, in part, driven by this. but we have opportunities here, and these are not just sort of more of the same. we have a convergence of things going on. the truth be told, one of the reasons that people have a stigma with the system into a lesson psychiatry is because -- it can basically be be constructed to discrimination and mistrust or suspicion. and that there is a reason. we did not have that much to offer. now we do.

our evidence based treatment, the science of the brain is the new science. and it has given mental health psychiatry attraction that they never have before. combined with this is the legislative initiatives that are really being pushed forward, and also even though it's not perfect the increase social awareness. we have a real opportunity here that historical has not occurred , and need to take full of advantage of it. finally, let me say that as we move on i think what will happen is that as someone is really passionate about this, people who are involved in mental healthcare, the provider side, on the policy side, and even on the stakeholder consumer advocacy side the need to put aside the parochial interests and realize that this is not

anybody's -- we are not competing for market share. and not competing. we get the largest proportion and the other group doesn't. what is the optimal model to deliver care? what are their roles that the people at different levels of training should play in? county reconfigure in the context of services that are distributed into different venues are settings. had we concentrate? what are their reimbursement schemes? these are noble things. we don't have to find the gene or given experiment have a bright regard to a huge impact. and this is the way it can be orchestrated. i'm feeling -- and i'm usually not sort of a rosy, pink glasses type of guy. i'm feeling that even though the challenges are significant their is a historic opportunity. no matter how much we know what degree can do we can orchestrate

the political process. >> i've gotten all little weary of not having to turn on microphones for three years since i've been out of congress. excuse me for being a lure rusty i really am honored to be here with you. i am so thrilled that your amassing the kind of energy that needs to be placed in this area and to try to get the federal government to pay attention to how we move for effectively. i just want to say to all of you, i'm honored to be here with all of you. it is they a ei -- and i'm a liberal democrat. mental health knows no partisanship. as has been stated before, my dad and i were the principal

sponsors of mental health parity . in 2008 george w. bush signed it into law, and it could not have been done without many view. we are polarized by ideology. this is one area where we can put our ideology aside and understand that there are still going to be those with ideology on either side, both large majority can work together to find common ground. so i will use kind of a metaphor to explain what jaffa's been trying to explain in is academic in monroe -- medical lingo. talked about the tip of the iceberg. we have the titanic. we are taking on water. now we're trying to think, how do we avoid hitting the aspirin again? well, we could build more lifeboats to take care of all the people that in going to be

displaced because of this disastrous system that we have in place, we could steer clear of the expert. what a font. in other words, the answer in my view to the severe and persistently mentally ill is not only to treat them but to prevent people from becoming severe and persistently mentally ill. to liken it to diabetes, we are all about discussing how to conduct more amputations. as opposed to getting people the kind of primary care that will catch there being, you know, early candid it's for diabetes and trading them aggressively early on so that they never have to develop those symptoms that necessitate such draconian responses so i appreciate the

fact of so many people after the lack of follow through on president kennedy's, i think, correct vision. prevention is what he talked about. you talked about doing more research so we can come up with better therapies, and he talked to the community-based care because at the end of the people want to live with their families and in their community cannot and institutions. but to get their whenever, as in washington that favored term of the money. the money never went from the institutions to provide the needed care in the community. so if you look at the most successful experiment in the country in new york what makes it so successful is that they're on the funding mechanisms to support people in their community. and so in other words there is no kind of quick fix here.

and we need a comprehensive approach. what we ultimately need to do is tell the american people were talking about. we are not talking about middle of. we're talking about treating every american the way we would treat them if they had cancer, diabetes, cardiovascular disease , asthma, any other illness. if we truly change our minds as a nation and think about this and the same way that we would any other health care, a lot of these problems go away. why? because we will start paying for them. i'm on let the door. i've been on the power for 15 years. wind and it worried about me having a stroke in my 60's? i was in my 30's when i was first put on it. why are we taking that same mentality and terms mental of? you look at my face in the norm -- skin cancer because of

already had it. so they say, when have you been to the dermatologist? of perry. you got me. most talking about screening. i got a check up on the neck up. why don't we have every physicians visit included check out. you talk about changing perceptions and ideas. mental health is not something you have to go down all to drink from the colored water fountain. no one wants that separate but not so equal system of care. that's what mental office today. it's the separate but unequal system. we want mental health as part of overall health care. and a lasting alsace, i think the way for us to achieve this, as tim has been doing in trying to put together this bill is to monitor the federal government's implementation of the mental health parity addiction equity

act such that centers of medicare and medicaid are going to have more say on where the dollars and a job by going to go. i would like to see them follow the federal law. imagine the federal government having to follow their own long? to, if the department of labor's could oversee because over half the health care in this country is being delivered in the private sector, why not have up better monitoring or clarity in ensuring that, you know, they treat the invisible ones of war of are returning soldiers the same way we would treat their visible ones. because both are killing them. quite frankly today the invisible ones are costing more soldiers' lives than a visible ones. some my view is, this is all about framing the issue. i appreciate the work that

everyone is doing in this field to try to do that, and i think, as jim has pointed out, this is a very important time in the history of this movement to get it right. because they're is a long line. on the list of witches are returning heroes who are not only going to use the public system but there will also be employees in our fortune 10500 small business companies all across this country. so we better get it right. not only for those of us who have a mental illness like myself for an addiction like myself, but for our returning hearings. so i am glad to be here and look forward to the discussion. >> dr. fuller. >> thank you very much. thank-you to the eye for sponsoring. i can honestly say it's an honor to be here and support representative murphy on his bill.

i been following this for over 40 years. during that time the problems of gotten progressively worse. it is an equal opportunity disaster since 1963, the passage of the cme to see bill. we have had the five republican, five democrat presidents, no president has understood the problem. these are brain disease we're talking about, and so really nothing has been done. we had to presidential commissions. we've had at any given time 15 to 25 members of congress who have severely mentally ill people in the family. we have had things like the insurance parity, as representative kennedy mentioned perry did a lot for a lot of people but very little for people with severe mental onuses representative murphy is the first member of congress and the 44 years i follow this to take on serious mental illness and

try to propose serious solutions i think we are obligated to and from an. but is it a difficult problem? you what it will be. there's a three and a half million i'm treated people with severe mental illness today. that is the same as the population of san francisco and oakland put together, the same as the population of minneapolis and st. paul. these are not just numbers. these are people. there is an acute shortage of psychiatric beds. none of us are saying we need to go back to where we were in 1958. we now have a 11 beds, public psychiatric beds. we have effectively closed 1 million public psychiatric beds. if you project on the same number of people per population as we had. there's 1 million people who one year ago -- i'm sorry, half a

century ago would have been in psychiatric hospitals. where are they now? come tuesday we will be releasing a number of mentally ill people in jails and prisons, state prisons. the number, as best we can tell, and i think it's conservative, about 350,000. what we have left in the state hospital is 35,000. we now have ten times more people with severe mental illness in our prisons and jails and we have in a mental hospital homeless, at least 200,000 homeless which is a conservative number. so you have 350,000 people who are in jails and prisons, to under thousand homeless. representative murphy at home some -- hearings on wednesday. asking where have all these people gone? well, 600,000 are right there. that's where they are. i think it's important. these are not just numbers. these are people who have mothers and fathers and brothers

and sisters and. i get a printout every day of the reports from around the united states on was going on. last week set where was on. thirty-six year-old college graduate, homeless, refused to take his medicine, probably unaware of his illness. he sometimes slips in trash bins he was found dead, compacted in a trash bin. these are tragedies that happen every day. we have about 10 percent of our 13,000 homicides a year that are committed by people with severe on treatment aloneness. about 50 percent of the mass killings, tucson, war, committed by people with severe mental illness or untraded. emergency rooms are now overrun in terms of where those of the four and a thousand people or, most for an emergency rooms awaiting.

it is a huge problem, and it's getting worse. every time -- last year in anderson, south carolina, a man with severe mental ellis was stuck in the emergency room for 36 days waiting for bed. now, until recently we about 36 hours long time to wait. are now on to 36 days. are we going to go to 36 months? of what point will we start to try and turn this around? i think that's what the representative wants to do. the sheriffs and police are overwhelmed with the number of severely mentally ill increasing the number of what we call justifiable homicides to be a report we issued last year suggests that the data, about half of the people who are killed by shearson police are severely mentally ill. summer suicide by cop. this is also bidding wars. it to cover many of the public spaces, parks, playgrounds commercials, bus stations.

we did a survey of librarians a few years ago. 28 percent -- 48% of the libraries, a staff member who had been insulted. many of the public libraries to become day programs. the other thing that has amazed me over the years because i kind of fall the politics, this is a hugely expensive problem. i don't always expects to pay too much attention, but i do expect conservatives. and almost no one suspected of. the federal medicaid and medicare ssin t in are among the most rapidly growing segments of the federal budget. for medicaid, for example, people with mental illness or 11% of the beneficiaries but represent 30 percent of the cost for sdi, as sdi tripled between 1980 and 2010.

28 percent have a psychiatric diagnosis as a recent publication said, the largest and fastest-growing group of as sdi beneficiaries. the problem is huge. it is costly both in terms of human lives and in terms of dollars. i think what representative murphy has proposed is a good start. it will solve everything obviously, but it's a good start many different areas. the need for treatment, the demonstration funds, those of us who don't know what peyote is, assistant outpatient treatment. that means you can live in the community as long as you take your medicine because we now you have -- and you don't know the your sake. about 50% of schizophrenic and bipolar with psychotic features. when you know you have been dangerous to be let me stress that only a small number of people need to be on a of tea, probably about 1 percent of the severely mentally ill to be those in need to be on it really need to be on it, and it is

hemophilus reflection. five states have shown that it decreases hospital admissions. studies in new york and north carolina have shown that it decreased arrests and incarceration, homelessness, episodes of violence, and it decreases costs. a study coming out for psychiatric services this month showed that when you keep people on medication a decrease the cost. are not talking about a large number of people, but this is one of the most important things that representative murphy hands, demonstration projects. i think it's going to become very clear how important this has been on it. refocusing samson, probably a least functional government agency in washington which is saying a lot. been around for 40 years and then constantly amazed at how dysfunctional some of the federal agencies are. i think.

this bill attempts to bring them into the 21st century. whether a worker not, not sure, but it's worth a try. finally, it increases. one of the few people in washington you really understand this problem and is put the best leader forward we have had today. anything we can do to give him more involved. finally, let me thank representative murphy for taking this on. we are obligated to. what he's doing is important and deserves our support. [applause] >> okay. now we have a good amount of time. we have two folks going around with microphones. one thing i will mention, mr. murphy just went through that toward the force of this bill, but one of the many

important elements is also the provision that works -- that would work with the criminal justice system to educate law enforcement and shares about mental illness and how-to manage these folks into the treatment system and not into the criminal justice system. too often these and other front-line professionals. in the case of the washington navy yard shooting, in retrospect everything was 2020, but the fatal difference in his case. it did not quite manage as well as they might have. anyway, it's very important as an aspect of the bill. i'm sorry, there were hands? update. the gentleman in the red tide. >> mr. kennedy, i share your illness. i too am a democrat. >> your name and affiliation.

>> d.j. jaffe with mental illness. among hard-core democrat, but i have found on the issues of the seriously mentally ill that the republican party is a lot better my own party is willing to throw money and mental health but is unwilling to admit the politically incorrect things that need to be done to help the most seriously ill. in your presentation, you talked about prevention. there is no way to prevent schizophrenia or bipolar. we don't know how to do that. you talked about early intervention. we don't know how to identify someone with schizophrenia before they come up with the symptoms. working on it, but we don't know how. you talked about her research, and talked -- count on one hand the number of people with schizophrenia who have not subsidized employment outside the mental health or arts field. what is it about serious mental illness that my own party will

address? >> well, again, not to get polarizing. the one thing we cannot afford to do in our field is to not work together when we have more in common than we have the separates us. i think we absolutely need to do more which is why i've been talking to tim on this legislation. i think identifying the real elephant in the room of the facts that there is problem every institutionalize asian, as tom pointed out, in our emergency rooms and in our prisons. but i think for us to retreat from the notion that the race program which i salute for highlighting in his legislation, i think has fuller talked about,

the work on the naples project, the notion that we can't too early intervention, if you intervene on first instance of psychosis you can dramatically reduce the pathology of that illness if you intervene early. everybody knows that. so to say that we are not going to put in place a system of care that responds to you with mental illness the same way we would, like i pointed out with diabetes the way we treat mental illness today is wait until you have to get the imputation. we do not pay. we say, if you have cancer we would not imagine saying to someone, come back when you have stage for cancer. that is how we reimbursements and wellness. i'm saying, we are in the historic time of three incentivizing a payment. so if we start paying for these

primary and secondary levels of care, my contention is you are not going to have as many tertiary levels of care. so i -- and what i want to say about this politically is, i don't think we are irreconcilable. we have to deal with the severe and persistent mentally ill but we have to reorient the system so we don't create some many. i think in this day and age we are at a moment in time to change the system so that while we are treating those people who are so sick we are also preventing others from in and out in a situation. i agree with you. is there a vacuum? you bet. but that is what we're here to discuss, what to do about putting that back in washington on these issues. >> let me comment first. thank you so much for your support of this bill. ronald reagan, not sure what he

was referring to. this is not an issue of the left or right. that's where it really comes down. i have not seen any division among my colleagues on either side of the aisle on dealing with these issues. i think it's been a common desire to do something, but they're is a divide on a couple of issues. you probably know this better than i, but back in the 60's reagan was the governor of california in the 70's. there was a move at that time to close hospitals in california. one group said, well, we can have these hospitals because that would be like the russian gallants or we put people we don't want. i was coming from one. another was saying were putting people there against their will and not allowing them to have their rights. so here you have an imperfect storm. california shut the hospital

system's down. and what remains are some groups that talk about the rights of patients. i think people have a right to give well. this is where this sketch grossly misinterpreted from people who will say, this person should have the ability to refuse treatment. i understand the sometimes people are there with late stage cancer and say, it's time. when someone is not even while and can't even make a decision, they don't know what planet their honor who they are, how we suddenly say they're going to make decisions? we have them die with them writes on. during our hearing this week we have the impassioned comments. most of the homeless in deals with have no idea they have mental illness. haags so we have to talk about the people on the right hitting better. they can go ahead and refuse

treatment. i want them to get better. the stigma that comes with mental violence is the idea that it can't be treated. they think that we showed them ink blots, give them charge and then sit on the couch and talk about the relationship with the mother. well we do is really get the treatment and help make them better. that is red and we can have people talk about the right to go back to work among the right to live independently, the right to say hello to policeman instead of hearing a policeman said you're under arrest. we can do this early. we don't have to wait. that's the thing that really for people were consumers really. >> and not going to need the

same levels because in not going to wait for the homeless to apologize. in not calling them to tell them to the court order. a guard to have to live and understand it's well within their ability to integrate. there will have much better results this government micromanage. >> thank you question dr. murphy . massive numbers, guard and reserve units. would you address please the necessity for more varied and

out of the box effective treatments but also our cultural imperative to eliminate stigma that can be attached to posttraumatic stress disorder as we have these units coming back on and is there going to need to decompress and reintegrate into civilian society to do exactly what your colleague was saying, treated early and effectively so that these folks don't wind up going full blown and the system. helps our economy, helps the entire society. >> thank you. yes, sir. >> putting my navy and non, i am not authorized to make statements on behalf of the department of defense. let me describe what i see here. there has been a stigma on my arm services numbers. they signed a something that would lead to lots of parenchyma opportunities to grow sometimes

discharges. so there were free. it's not that the noncommissioned and commission officers would not put them into battle or give them and write ups. what we have found is with ptsd, posttraumatic stress disorder and posttraumatic stress and other anxiety related it is identifiable. but we have to remove that internal stigma. many generals and animal served on a lot of work on this up when the people understand, but a lot of this is to go to levels of noncommissioned officers -- officers. the best thing i heard from a patient was seen at walter reed hospital, marine, i was asking him about some of the symptoms after he had been a hospital. dealing with some of the mental aspects of this. and he said the fascinating thing. dennis sergeant had told -- would tell them almost every day, if you have a twisted ankle

undergoing outside and you don't tell us as low as tonya going to get somebody killed. similarly if you have a twisted brain at de ghandi is somebody killed, speak up. you worry both of them text in the pack up there. that is the kind of attitude we need. what happens is to announce think there are enough providers within the department of defense david l. degree of and a provider still have more experience. medical school and residencies. they're great providers. incredibly dedicated people there's not enough years of experience behind them. he liked to find out to it that. but when it comes down to as making sure there is also a transition between when they leave the service and get into the viejo system or another part, huge campus for reservists and guardsmen. when there with the unit they go back to the fort.

the come back to the come no united states. they have those groups that go with them. when they go back to the reserve base is the unit is dispersed. they don't have that. they will require a lot more work, turning civilians. but one of the things i tell them, people have a choice with this this is a choice. the person who is experiencing severe combat, i can't even imagine. they have a choice. they can be a victim the rest of their life because there will always be an innate this bull that holds them back from doing anything. quite frankly it's sad to see many of them living in a mother's basement playing video games, subduing themselves with vodka or whiskey all day. the second choices they can be a survivor. you know what, despite what happened to me and moving forward. going to have these got some times. i have to get back to work, get

moving poleward and you can despite what happened. the third choice, they can become a driver cannot turn this into a source of strength. because they have been through what they've been through their starter, faster, better, smarter. they can teach other people have a handle it. this is the source to make me a better person. over the years there have been millions of people who have been traumatized by combat fatigue commercial shock. but it is only within the last decade or so that we have really begin to address that. this is part of what i see our assistance secretary working with. they don't have to reinvent the wheel. the veterans affairs can get up to snuff. the program with hhs can do what they are supposed to do, and we don't have to have everyone do it on their own. just like everyone else, every branch of the service and hhs and every community doesn't treat diabetes differently, cancer, they don't deliver babies differently.

why don't we do the same thing with mental health? >> i just want to make to follow-up comments. one to vigilance question and congressman murphy's comments or response. coming back to patrick's question about prevention. the first thing is is that the military has taken, what, civil war, world war one, world war ii, korea, vietnam, afghanistan, a few wars to finally realize that there are psychological consequences to war, not just physical consequences. everything congressman murphy said is true, but we need to also be honest or candid at least. our understanding of ptsd and al experiential stress affects the brain, you have to be relatively normal and in the span of whether it is in ied explosion or repeated tours of duty, the

irrevocably changed. that is what happens, but we don't know the underlying pathology or what all the genetic and constitutional vulnerabilities to that are. truth be told, our treatments are effective, better than nothing but far from optimal. and so a lot more has to go into understanding. and also something that general peter corelli and then nothing about mental health and cover religion as a result can appreciate. i want to see a diagnosis, a way of diagnosing this because they're is suspicion that people do milling gear. i think that's a very unkind thing to say, but that is a reality of this. they're needs to be a better understanding as well as addressing what is obvious. in terms of deejays question, the point that was being made, prevention comes in many forms,

not just primary prevention. we know someone is at risk for heart disease and get treatment. the mentally ill, tuberculosis. we support people. we're not going to have these needs for these programs for people who have progress that far into the illness if we do things like rican. the other side of that coin is the interdiction of people with respect to their checkup from the neck of when they're giving their primary care whether not psychiatric care. for that we need this integrated care model, this distributor of care model. psychiatry, rejoining madison. next friday by happenstance we are having -- the apa is holding the forum with the national

press club on integrated care where a very comprehensive report on the model of care, the economic consequences, the expected effects on the outcomes will occur with an integrated care model. so as i was saying before, they're different populations that need mental health care. they are seen at different places and different sort of clinical the news. a need to be thinking or having approaches to deal with them and all these respects. the military is another one which is a specialized venue and population with the same body of knowledge of requires slightly adapted set of services. >> thank you. other questions there's a gentleman in the corner.

>> a question for the congressman. you have in this new law, people who run through our so-called justice system and when the judge orders competence checkup and when they're put through that test when they're under arrest that can turn them crazy. i don't know as a doctor you may know the procedure. it seems our justice system is turning a lot of people crazy. so given that is there any way you can address that? >> by the time a person is involved of major crime such as a felony assault or murder it's too late to do something. what happens in some states with

the justice system changing, this week we also, the share from runs a cook county jail in chicago, the second-largest psychiatric facility in the nation, the first largest is a jail. what happens in some cases, some divine chicago or in some other states, but someone picked for shoplifting. someone stole $20 with the sheets. he did even know where you once. prosecution. he's added jail for a while running of the total cost of $16,000 until it finally came before a judge. back on the street. no one provided in the treatment this happens all the time. it case of air and alexis, this was talked about before. several times the can before the police. no, no.

kaj accidently discharged my weapon. some women on an airplane was harassing him. but as mike was talking them. switching from three until rooms. i don't know this but i would guess they did not know what to do. complaining he could not sleep. they gave him some sleeping pills. i don't know if he ever saw a psychiatrist psychologist. i don't know. but what i see here is that it's a long list of failures of the system. i was disappointed and the only thing the department of defense concluded if they've done a better job. they should have done a better job identifying when he was in the navy and other places. don't give him an honorable discharge. let's really work through these issues. so what happens, the hub of

mental health. it will work with the system to get that person into treatment. assisted outpatient treatment. her from the chief of police, we don't even want these people to go to jail she wanted to press charges. again, severely mentally ill. just wandered into a home thinking it was is. it took a lot of convincing. he needs to be in treatment committed medication, see a therapist, be followed by people, have wraparound services, much better off and putting him in jail. happens in some jails to and this is where it gets really third world, some of these patients are victims of assaults from other prisoners, can be more combative and aggressive and deal with it by giving more sedation, putting in an isolation. working in billion solitary confinement. and makes it even worse. now we're trying to address these by ramping up awareness of

police and how to handle that and having more things and getting to early treatment. i do want to say for the audience, the health subcommittee has announced that they're going to do a hearing on this bill, helping families in this coming thursday at 1030 in the morning. very important. hope america is also watching. become a co-sponsor. i'm showing you -- i'm saying that because there's a major issue. we like an immense. that's moving forward. >> on sorry. one last question? sure. >> peter cars and.

curious how you feel the increase in medicaid coverage for individuals with a positive impact if at all it will have on treatments for severely mentally ill. >> let me hand than one. exploratory. no, okay. it's up. >> let me describe that. japan's. it is not enough to say we're going to cover more people medicaid. will there be parity? a lot of it varies by state. either people -- you can just say you have insurance coverage if there is no psychiatrist, psychologist, or clinical social worker to see them. he heard of children have been tied to a bed for several days. medicaid is not just the answer. have to make sure there's treatment, make sure there's a lot of support services available.

i'm amazed that the volunteers then the work with people many places they found it, using recovery model people who love actually recovered from the mountainous cannot be in great support for someone those are fundamental changes we need to make. far from being adequate. one reason is medicaid reimbursements, at the low level of the reimbursement spectrum in terms of a third-party payment. in addition medicaid was really managed through the states. each state is determining how it's going to medicare and medicaid had been in new york state largely at least for mental health care fee-for-service. ..

erode ode over the last two to three decades. so the infrastructure is not really adequate. there needs to be abhor -- the financing process needs to be a reconfigureation of the mental healthcare delivery system. >> i want to thank all the

people who are providing help. often times they're underpaid and undervalued. it is the people's military who is just phenomenal in what they give as providers. it's the people in the civilian seguement and the veteransed a administration, the many volunteers and i'd like to allow more of this, but what stands out there is the many people still suffering as family members, as patients, who are looking for a way out and a way for hope. that can be done. it will take a united courage. >> i am for the expansion of the imd exclusion in your legislation going back to where we can find common ground. now, here's the thing. it's all because it's a violation of parity. medicare and medicaid da not hear parity. what i want to find is the nexus point for us to take this whole issue to the next level, and the

parity things becomes like common law -- we don't have common law what constitutes mental health. and we need to have a process that shares best practices amongst states, like tim sets up in his legs so people will pay for something that can be demonstrated to be effective. as fuller says, he wonders why republicans don't get this. this is a deliverable. we need to make sure those become standardized forms of care and that it's not a -- you don't have to have a million conferences before you nail down the sweet spot in terms of therapy. and i think we can accelerate this through cms, huge oversight in enemy health delivery, as well as through, back to plans overseen by the department of labor. the private sector has shunted off everybody that is high cost on the medicaid system. so if we can figure out a way to

show them it's a value add for them to provide these services early, you get much more cost-sharing and savings sharing, which i like and well resonate here at aei. >> thank you. we thank all of you for coming and for an excellent panel. i'm optimistic with the passion in this group and the growing on the hill that things may get better for the mentally ill. thank you very much. [applause] [inaudible conversations]

>> start with the basics, which is everybody acknowledges that consumers have the right to an antenna. everybody acknowledges a consumer has a rug -- macon tent themselves. everyone acknowledges there's nothing wrong with a combination of an antenna and, back then, vcr, now a dvr. the debate seems to be about where the equipment is located because nobody appeals the finding of fact, which is that each individual consumer controls their own an ten na. the antenna is deading in the consumer logs in and instructs the an ten na to tune to a particular frequency. each consumer makes their own copy, never mingled, and transmits it to themselves. none of those facts have been appealed or disputed. so it comes down to we as a country, and as a system, do we permit this idea of private

conduct? which the courts have consistently found, yes, we do, and congress has been encouraging the idea of consumption of local broadcast television. so the idea that a new way of capturing this signal by an individual should somehow be prohibited is just absolutely incorrect, wrong, incorrect policy, and devastating blow to innovation in the next step of our industry, which is movement of all of these technologies away from the consumer's home, into the cloud. >> tuesday, the supreme court will take up whether aereo is violating copyright law by transmilting products of the internet without permission. tonight at 8:00 p.m. eastern on c-span2. >> we should have finished al qaeda in 2001. our general, who was there, put

more than just the general. all of us think back, we were attacked on 9/11. 3,000 americans died. more americans than died at pearl harbor. and we had al qaeda and we had osama bin laden trapped in some mountains called tora bora. we didn't finish them off. then we let them escape over the other side of the mountain because we said, that's pakistani territory. oh, wait. think for a moment. can you imagine during world war ii, when we -- win the battle of midway, which changed the entire war against japan. sailed across the international dateline in the pacific and attacked the japanese. destroyed their fleet. 1942. he went across the international dateline. supposing he turned back and said, that's the international dateline and japan has said, if we don't cross the international

dateline, we'll take this part of the pacific, you take that, and we'll live happily ever after. we get to the mountains in the middle of nowhere and allow al qaeda to escape? makes no sense. our entire country had become more legalistic. we should have gone and finished it right then. >> this month, booktv's book club swings is bing west's "the wrong war." read the book and join in the discussion on booktv.org, and live, sunday may 4th, our next in-depth guest, luis rodriguez, former gang member turned author and poet. find booktv every weekend on c-span2. >> next, a conversation about legal issues facing documented and undocumented immigrants.

a panel of hispanic legal advocates participated at this event hosted by american university's washington college of law last week. >> good afternoon, everyone. thank you for coming. dean grossman, thank you for this great conference, and i would like to thank the panelists and everyone who puts this conference together for giving so wonderfully of their time. i'm the president of the hispanic bar association of the district of columbia. and we are in our 37th year. we love to partner with american university that every year supports a very significant cohort of the latino law student community here in the district of columbia. we do this because it's the right thing to do. and we do this because we're here to support those of you who are law students now to become lawyers, successful, and those in the audience who are actually practicing lawyers as well. so, my bit of the infomercial is

hbadc.org. and all the benefits including an annual convention we'll be putting on with the hispanic national bar association in september. so we urge you to take advantage of those opportunities we provide for the organization, and one of the focuses we offer is a focus on serving the community. as justice sonia sotomayor recently said, ours is really the only profession where helping others is part of our credo or training. we may not have an actual requirement to provide pro-bono service but we have a duty to serve the community because being a latino lawyer, you have an amazing amount of power.

had latino lawyers bring their families out of poverty. and those who are in law school are getting your aunts and uncles coming to you and asking you questions, the answers you don't know. you haven't probably taken those classes. but so and so is in law school or a lawyer, you know the answer to everything. they wield power and it's important to wield that power for the benefit of the community. you'll hear today in this conference one aspect of public service, which is protecting the small and vulnerable community from those practitioners who, shall we say, are somewhat lacking in their ethical duties. so ethics, i think win i was in law school you had to take one class, one credit. it's interesting how you just

need a very small amount or at least i did in law school, but it impacts everything you do. and as a lawyer, you have to think ethically every minute of the day, and you also have to do that with respect to legal services that you provide, whether paid or not. you have the same standard of ethical conduct, no matter if your client is paying you money or we're rendering that service for free. so, this is really an important aspect, and i'd like us to at least pay close attention to make sure that we understand the importance of serving the community and the importance of understanding that you are pair gones -- paragons of the latino community along with your family, and we're here, the hispanic bar associations here and national to ensure you have the resources you need to be the

best that you can be in the profession. thank you so much for your time, and i look forward to speaking with you all later in the conference. i'll be around for the dinner as well. thank you. [applause] >> we're honored to have -- who served as president of the virginia hispanic bar association. correct? that's right. >> boundary i am the current president of the virginia hispanic bar association for the commonwealth of virginia. that is our official name. the next group of panelists with talk about fraud. those of us who practice in virginia have known long too

well the problems in the commonwealth, and i'm proud of the fact that within the last year, hispanic bar association in virginia has combated it in our state. we assisted senators evans and wexton to combat fraud and other organizations in the commonwealth of virginia and have written a letter to governor mcauliffe, awaying him to sign legs which would penalize those who exceed their authority and provide services they're not allowed to do so. it's my understanding the governor has signed the legislation and it will take effect on july 1st of this year, and impose civil sanctions on anyone who is a notary who

practices law or dispenses legal advice. i'm also proud of the fact that some of our members assisted local prosecutors within the past year to go after notaries. our members interviewed potential victims. they were able to compile affidavits which they gave the prosecutors and detectives, which were then idea to prosecute individuals and one well-known individual in virginia, a gentleman by the name of luis ramirez, actually received a two-year prison sentence for what he did as a notary and the fraud he committed. now, briefly, i'd like to talk about mr. ameer because our panelists may touch upon this in our discussion of notary fraud. the reason i want to bring this up to you, those of you who are attorneys and who will become attorneys, as you know, our profession is a self-regulating one. we police ourselves.

but we should also police those who dabble in the legal profession, and by dabble i mean those who are not trained as lawyers, but who we know are out there giving legal advice, taking money from members of our community, and more on than not causing more taj -- more damage than good. i'll quickly highlight mr. ramirez and what he did in our community. mr. ramirez was not a lawyer. he never went to law school. mr. ramirez submitted an application to virginia, paid five dollars, and became a notary public, which under virginia law means he was only able to attest to signatures on documents. mr. ramirez was a con man, and he was a savvy business marketer. he was able to convince a radio station in virginia to give him a one-hour program where he dispensed legal advice on the air, and of course, gave out his telephone number, his address,

for people to come see him if they had any issue or legal issues they wanted addressed. mr. ramirez was also able to convince spanish print mia to write puff pieces on him. i were i had an overhead projector because i have some pieces but one -- i'll highlight two that are interesting and entertaining. in one, he had a newspaper write an article about him that the democrats were considering running him for u.s. senate, and that the internal democratic polls show that if he ran with -- against former governor allen and also former -- governor allen was also former u.s. senator -- that he would win that race. he also had a piece written

about him, after he pled guilty and was awaiting sentencing, that the puerto rican government just awarded him the title, chief lobbyist for the puerto rican government, and that they paid him $11 million to lobby state and congressmen and senators to pass statehood on behalf of the puerto rican commonwealth. all that was done in order to gain credibility within latino community, and what was interesting about this gentleman was, not only did he charge as much as attorneys did, in most cases he charged even more. and in most cases he took clients away from individuals that had very good attorneys, convinced those individuals that he was better, that he had the political connections, he would show them the newspaper articles, and again, they would

hire him, they would pay him their life savings, he would then take the cases, and more likely than not, people went to jail because of his lack of representation, and people were deported because he was not an immigration attorney, even though he said he was. now, what you're going to hear from our panelists is information that i hope for those of you, even if you don't practice immigration, well take to heart. i said in the beginning, we are self-policing profession, and i ask those of you who have significant contact or will have significant contact within the latino hispanic community, to not only watch what attorneys are doing to our community but watch what others are doing to our community as well. thank you. [applause]

>> good afternoon, thank you. i'm orye ya and it's my honor to moderate this very distinguished panel. everybody is in for an exceptional gathering of attorneys that truly are specialized in this area and not just in the policy and political debate that we hear so often about, but in addition, with such pragmatic and such day-to-day real life and very rich experiences, i'll briefly introduce the subject we'll talk about and introduce our panelists in general we're going to talk about this case -- you might have heard so much about, for those who might not know details on the case, in 2010, this case was essentially decided and it versed largely on the role of criminal defense

representation related to counseling clients who also have certain immigration status issues about the broader consequences of criminal convictions on their other potential civil or immigration situations. so, essentially, the panel is here today are going to talk not not just the role that defense attorneys in criminal cases have with their clientses and the duties and ethics behind the roles in defend thing client and making sure the client understands the consequences of criminal convictions, our panelists will discuss broader civic implications, broader benefits and other ways in which the different civil and criminal trials can affect any one individual in a way that makes their representation constitutionally deficient as stated in the barea case. what we want to ensure, we want

to ensure that everyone has fair representation, has representation that meets their constitutional rights, and that is what i think you'll hear largely about, and what is being done, what needs to be done, and the experiences of these practitioners day-to-day. so, first we have calderon who is founding partner at the immigration firm in arlington, virginia. she keeps a diverse practice, including family, naturalization, business, and asylum cases. concentrates on federal matters also. she is also in her personal capacity been a great supporter of immigration reform and is frequently spoken to neighborhood associations on the rights of noncitizens in the u.s., and presented before judges and other political and to authoritative issues, she is a

member of the bar of commonwealth of virginia and the district of columbia admitted to practice in a number of district courts in the dmv, as well as courts of appeals for the fourth circuit. she is currently serves as president of the hispanic bar association -- sorry -- immediate past. now manuel is the current president -- while maintaining membership with ala, the american immigration lawyers association, a well as a number of other coalitions and organizations dedicated to providing services to particularly immigrant clients. she has also served as the d.c. chapter chair of the liaison committee to the executive office of immigration review in arlington, virginia, through her work with aila and other organizations for five years. she has been constantly a speaker and panelists at national conferences on the

immigration -- on immigration issues, web seminars, and at the national immigration project in the fall of 2005 in portland, oregon. she contributes her time to the board of immigration appeals pro bone know screening project as well. a graduate of the university of maryland, with a bachelors degree in political science, and she received her law degree from the university of san francisco school of law. and next to her -- thank you for being here -- next is matthew handley, the director of litigation at the washington lawyers committee for civil rights and urban affairs. his practice focuses on representing victims of civil rights abuses, with a particular focus on employment discrimination, wage theft, and public accommodations discrimination. he is a long-time advocate for the rights of ims and workers who suffer from discrimination treatment in their day-to-day work. prior to joining the committee, mr. handley was partner at a law

firm, where he represented mainly foreign workers who had been trafficked and otherwise abusessed. while employed here in the u.s. or by u.s. companies. also, advocating on issues of disability rights, accessible housing, and for detainees as well. before joining the law firm, he was an attorney at covington and burling and was a law clerk to a u.s. district judge for the western distribution of texas. he was a peace corps worker in nepal where he work as a rural construction engineer and has been recognized as a rising star, graduated in hi j.d. with high honors from the university of texas school of law, and earned his bachelor's from princeton. welcome, matthew.

next to matthew is jonathan green from the green law firm. admitted to practice before the maryland couples of appeals, u.s. struggle court for maryland, the u.s. court of appeals for the fourth exhibiter the supreme court. also ans a junction professor on immigration law and earned his bachelor degree from university of maryland and his jd. only attorney to have served as both the chair of the maryland state bar association's immigration law section and the aila, d.c., maryland and virginia chapter. mr. green has serve as a member of the aila national board of governors and the nominating committee. jonathan hases a crow indicated for years before the maryland general assembly on immigration and currently serves on ail as conference committee and served on other panels and as i.c.e.

lee asewn and also lee a son for -- liaison on distance learning help was written for the cardoza school of law and the maryland journal of contemporary legal issues. also published a handbook released by me then bar association commission on domestic violence. mr. green has represented pro-bono clients on the behalf of the maryland volunteers lawyers society, catholic charities, and kids in need of defense, as k.i.n.d. also a guest lecturer on immigration law at new york city law school, and he frequently served as an expert witness in consulting attorney on immigration matters. and last we have certainly not least, though, anne. she is a staff attorney with a project end, eradicating defeat,

a new initiative dedicated to provide direct representation to victims of fraud in d.c. matters. a 2013 graduate of american university washington college of law where she was student attorney with the justice clinic, and while in law school, ann was a summer hpadc fellow where she researched the scope of notary fraud in the d.c. metro area. michelle has also been a dean's fellow for the international human rights law clinic, and a law clerk, attending to unacandidate independent children at pro bar in south texas, and prior to law school, aberdeen was a fulbright fellow, researching effect of deportation, and is on the aba commission on immigration. thank you all for being here, and essentially to walk you through the panel, we'll start with an overview by the -- on

the implications on responsibilities for attorneys and then expand a bit to the civil areas i mentioned that are also touched by this decision, and implicate other responsibilities of anyone representing an immigrant client. so'll start with you, ophelia. can you give us an overview as to what exactly are the duties that -- can you give us a brief context what led to this ruling. >> okay. at the time of the issuance in 2010, he had been a permanent resident of the united states for more than 40 years. in -- i should point out he lived in the united states, ties in the u.s., had served in the vietnam war, in the armed forces, really been a part of this community.

in 2001, for whatever reason, he was charged with -- he was arrested, driving a tractor-trailer with 1,000 pounds of marijuana, and in the end he had multiple charges, i think it was like -- i want to say two misdemeanor trafficking or felony trafficking,'s of paraphernalia and then a weight issue on his tractor. he pleaded guilty to three counts of -- i'm sorry -- in any event pleading guilty to the distribution of the marijuana, which under immigration laws is considered an aggravated felony, was considered an aggravated felony, now potentially as well, some he was rendered removable from the united states at that moment. so the deal was he had a criminal attorney, obviously, defending him in the criminal court, and he was advised by his criminal attorney that these would not -- that pleading guilty to these offenses would

not be a problem for his immigration status because he had been here a long time. he was wrong. affirmatively wrong. and so obviously deportation proceedings were initiated against him, or removal, as it's called now, and that is the position that mr. barea found himself in. he actually started his case in '04 on a pro se motion, which i think is very interesting. in the context both of talking about what our responsibilities are as lawyers, and then also talking about why people go to notaries versus why they don't or that sort of thing in any event, he started this journey in 2010. the supreme court said -- granted his case and they essentially -- for the first time the supreme court said that immigration consequences of a criminal conviction are not merely collateral. prior to barea, the conte