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>> that's why we have a british history lesson that school to bring different people together. that is right. our way, the conservative way. [applause] >> if you believe in strong defense and few others -- to

understand the that is possible if you believe we could become the enterprise capital of the world. if you want us to be the generation is never too late. this is possibly my last election labor is a gate i am 100% for a united kingdom.

[applause] i believe we can make this era a defining decade for our country one that people will look back to say when people no longer felt the current we can be that great britain. nothing is written repros that in school end said the problems of our society that we have to read highlife a struggle. that means go out to do the same thing all over the weekend to be treated differently.

but we need to have millions of these individual success stories. in great britain they are raised expectations employees because of employers. eva with a bigger e. connor with extremism a greater britain no longer are they held back. or the noses of the children pressed to the window as the world moves ahead. and to reach new heights. but greater chances and greater security. we will make it happen. [applause]

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>> [inaudible] >> let's be very clear. that was created for one purpose of a truth of behalf of four dead americans. period. the only reason that committee was created the integrity of the work that has been done never to come into question and it never should be. >> i could have been more clear in my description of what was going forward civic

there is only one reason the committee was created. >> majority leader mccarthy and florida congressmen webster are looking to replace speaker boehner. >> good morning.

to improve access to care in incarceration at this time silents yourself over leave them now because we and courage during social immediate use the #mental health. there are record runs around the room. if you have a question you to also submit my question anytime and use the #. if you haven't already we encourage you to download the national altered alive with the events schedule as well as today's speaker and underwriter in the woods above to have you fill that out.

>> we will have a robust discussion of mental health reform and is to be suffering from serious mental illness that results in homelessness homelessness ad in homelessness and incarceration at the state and federal level recognition that effective meant when dash mental health care is a cost driver. but our conversation will focus on what policy changes are needed for the access to mental health services. >> bay was a dove for a moderated discussion with "the national journal" staff correspondent. >> but now i would like to invite the vice president for global health policy to the podium.

>> dam policies to the society at large. they're proud to underwrite this event from stakeholders across the policy and criminal-justice communities. we set the bar to go. costing wording cancer and diabetes combined. of all the efforts are under way of local level. we should set the bar higher. in reducing the

inefficiencies of the recidivism opportunities exist to reform the criminal justice system and the support programs to assist in transitions of care. with the individuals for whom it is appropriate to the criminal justice system that better connect individuals to committed the resources. thank you for joining as we are pleased that you were here and the you are part of this important discussion and the topic that affects us all. >> co-chair of the mental health caucus. [applause]

>> hq on this critical importance to our nation was night eyeleted the beautiful sun set in the "twilight" sky the clouds are crimson and gold against the sky darkening than i see the hot - - the house office building and the flags or at half staff. i was reminded why with the mental illness treatment week that once again we are mourning the loss of so many citizens of the deaf that did not have to happen. this is been a bloody summer of 2015. when many high-profile events occurred in dallas and houston and virginia and the list goes on and on.

those get the headlines is a tiny fraction of what has occurred with of mental illness and treated. we actually make it the most difficult for those who have the most difficulty that it is un treated a and under treated or mistreated. back in the 1950's with half a million hospital beds now we have 40,000 we need to close those asylums we were supposed to have providers to have a change in the mental health system in america that here is have a century later and i believe things have gotten worse despite the knowledge to

identify the genetic markers of schizophrenia and bipolar to have psychotherapy treatments despite breakthroughs of medication rehab federal policy that our abusive ad neglected towards people's mental illness psychiatry and psychology in patient and family. what is worse? it is made the most powerful force minorities of low-income. when we close those asylums we ended up reducing the number of hospital beds but where did they go? some got better with treatment and industrial lending committee service that is good to lead productive lives but for so many they treated the hospital bade one dash bed for a prison cell.

the home the shelter. your emergency room. and the morgue. we'll have between 12 and 1500 homicides for serious illness untraded we will have thousands and thousands more their victims of crime and rape and assault. we will have 41,000 deaths by suicide 1.2 million attempts that were bad enough for medical help of a drug overdose and the list goes on and on. but those that tell us what we need to do. we have addressed these directly incomprehensibly first to deal with serious mental illness in america because it administration has been neglecting it they

have taken millions of dollars of taxpayer money to do frivolous, silly and abusive grants. yes they have the fun things of 400,000 already site singalong sells for children , recommend drink a fruit smithy -- smoothy and though workshop to get off of their vacation last winter they told people in boston how to deal with snow anxiety and two days ago "the washington post" released a story they have sent money to an agency to tell reporters they will give $175 to the charity of their choice of their right a nice story if they are reduced to that bribery of the media to say please tell a nice story because to reports said it is not doing its job there is 112 federal

agencies that are supposed to be services for the serious mentally ill. the gao report said they have not even met since 2008 despite the director she said we will start meeting now. when we asked about the web site for children sing-along we will look into that but we're still waiting to see the results provided to spend $22,058 on a painting in your office? it was for mental health awareness. it is a waste of money that is the way the country operates that is why the agency must change. now we will elevate this to have an assistant secretary no more fruitless workshops don't take your medication or they march in a circle singing songs. and $80,000. no more imagine what

communities could have done if they had this money. in a 40,000 word statement they don't even mention the word schizophrenia or bipolar didn't even have despite - - ecologist on staff. they quit their more concerned about the right to refuse them the right to be well. win i hear the judge is simply is officer said cannot do anything i say what about their right to be treated? if somebody walked the streets with alzheimer's and delusional you would not say she has the right to have alzheimer's or if someone had a stroke and not aware we would say nothing you can do about if they were passed on the street from a heart attack you wouldn't say they have a right but that is precisely what we do with mental health in america. the politics are abusive and neglectful particularly minorities and the port.

and medicaid has a rule you cannot see to doctors in the same day that is neglectful toward the port with as a policy cannot have more than 16 hospital beds that is neglectful to the port we need to address the needs to get them to see the people they need to see if we have a shortage of child and adolescent psychologist when mental illness emerges we don't have enough canadian incentive to get more we need more peer support counselors who have been through this to have like a little help america we will work on people getting the training that they need to be out there. agency after agency have to struggle to get dollars to make sure they have the wraparound services every

taxpayer in america should be disgusted with bases someone go off to jail and see what our government spends money on people should be outraged and i am. once again we will have moments of silence in congress as we mourn the death of these people that should not have died because someone should have been in treatment. congress wake-up lead moments of action not silence the shouting about it enough is enough. here is a brain illness not a difference of attitude hallucinations and dilution are not simply not consensus reality is a brain disease and must be treated as such we will organize these agencies to weed out those who are not doing a good job elevate those that are.

to make sure we allows states to combine the dollars for mental health and substance abuse because the majority of each why would we isolate them if we need more hospital beds will allow the same day dr. rule. we make sure for people in the revolving door of a prison system with mental illness to have a wraparound services for them. this is the time we have to stop wasting our time on morning to put under a sharp microscope treat mental illness or get out of the way to deploy the best and brightest of the consumers of peer support, providers and families and allow them to be a part of this. we are going to stop being kicked out but some interesting we blame

families why didn't the parents know? because the laws to not allow them to participate they have a much higher risk of chronic illness part merely because of poor nutrition or because of the medication they take with higher risk of diabetes and cardiovascular disease we do not tell family members their treatment planner the next appointment then we blame the parents. so we have millions of americans that are not treated on that slow motion road to death. that is embarrassing the only person in congress in mental-health provider currently, i am determined to change the system to wake up congress and say there are answers to this and not continuing to do what we do

begin rally have the "twilight" of 17 setting the way we treat serious mental illness now by one to look forward to that bright new dawn effectively with the evidence based care to make the difference in their lives. today is helping families of mental health crisis stay where hundreds of families will talk to congress him this week people are speaking a to the members of congress over 40 newspapers have published supports with wonder 43 co-sponsors now they need to call this up for a vote but congress vote on this to provide hope for those people who were suffering in silence. thank you very much.

[applause] >> staff correspondent for national journal. ♪ >> i want to start off because he mentioned your the only current mental health provider in congress when did you for start realize there were gaps and issues with getting your clients the help they need? >> my first internship in the '70s when community help centers were beginning to re-emerge i found the things i was trained on but was not allowed to urdu the law does not allow you to do that so it was a matter to recognize even then but it got even worse as chairman of the oversight subcommittee after

the shootings at sandy hook we heard family after family in providers talk about the difficulty of getting care that is when it became very clear much of the policies were in the way. >> want to talk about this in the context of shooting and gun dash talked-about does after a tragedy can you address why they interlinked is that a mistake? >> they do because those are the cases that get people's attention but we have to pay attention to what is in their mind and not the other hand if we miss that we will fail to address the mental-health treatment no other area of medicine is controlled by lawyers in congress the way mental-health is it is restricted air prevents people from getting the care they need. when we book that suicide

than the tens of thousands of people that die from jumping in front of a car or poisoning themselves or a drug overdose we understand that is not what we need to do and to diminish our focus on people with serious mental illness we have set those people inside to ignore them and treat them with denial and diversion of the mental-health provider i cannot let that happen. it is critically important to have the right services for them to get better. >> you think this discussion helps to give your build more momentum? maybe not if on guns but mental health. >> i hope so. most people with mental illness are not violent we

all experience some level of transient concerns and we get better. but what happens is if we recognize people with serious mental illness not getting treatment for 50 more likely - - time is likely to be violent in intent times more likely to be in jail than a hospital getting services for them is extremely difficult. that is why hopes it provokes a discussion not all violence will go away it won't but among this group we know ignoring it is a harmful process if anything meaningful can come out of this for those families who lost a loved one the this will motivate congress to do something. >> i want to talk about the families of those who try to get their family members help there is the shortage of hospital beds.

how does sure bill address that? to use the a promise? >> we left the cap to say as long as the average length of stay is 30 days or less it can save money because it covers 90 percent of people in the bucket the difference between psychiatric hospitals or general bed without full services there they may spend twice as much time with fewer services and in many cases the average wage of state is under a week because they can target right away but there must be a reference service after words medicaid does pay for 70 is is extremely helpful they make sure they have those services secured, housing, job placement, make sure they have counseling but involved

the families because many times parents for generic -- genetic reasons we have ric -- genetic reasons we have to stop telling family members you are cut out of the equation. >> your bill makes those 20 -- changes to make sure families can be more involved. >> one is already permitted to get doctors can talked with them remember the lawyers say they don't because they will get trouble but that only works if someone says he is my friend were my son here is his psychiatrist here is the medication don't try this medication and has been harmful before so that information is vital for a mental-health professional history is vital it is like an x-ray to the orthopedic

surgeon. we would never do that not look at the mri for a tumor but it is a narrow keyhole but where the consumer has diminished capacity can be gravely disabled then have other complications the doctor will make a decision to a trusted caregiver, not a stranger they can get out vital information to the diagnosis and treatment plan the doctor's name it is also forbidden to give any therapy information that at least if they will assist the person that will help and save a lot of lives otherwise you end up with a continuing issue that people

with mental illness died 25 years sooner. >> talk about criminal-justice roughly 20 percent of individuals serving have some kind of mental illness how do we know that jails are not receptacles? what can we do to expand there? >> some estimates put that much higher state penitentiaries are pretty high benefit is the major contributor if you have prevention and early on to make a world of difference not like happy sing-along songs but targeting as a second prevention you can use programs that is authorized in my bill after

a schizophrenic episode but you do these early on in major you have enough providers but if someone is caught up in a cycle we want to have wraparound of services. 46 states have been on the books but they don't always use it if you have a history of violence and you're not engaging in treatment than the judge can order year to outpatient care to stay on medication and treatment. this is very important. bayesian not do involuntary of any kind but to them i say you are wrong. because some people are not even aware they have a problem or that those hallucinations are not in existence so they say i don't need help in a survey has been targeted one to get

help but if the state mandates and they provide that. we one service to be flexible i will tell neil tardive. ed gentleman last week was arrested for $5 worth of theft he went to jail because there is no room in the hospital and stayed there 70 days and treated a and he died and starved. there is no way he should ever should have been put in a jail we should of had services to get him in treatment to work with the state of virginia you need places to treat people change your rules so someone like this was a minority and impoverished it is those services that our vital. >> are there mental-health

services is in jail to prevent that individual to be more traumatized? >> there is but they are weak some try to save money by not giving medication or by shutting down institutions and the money isn't where it needs to be. there was an article in "the new york times" on rikers island people with serious mental illness get in fights with new charges from a minor offense became elevated put in solitary confinement you should never do that to someone with mental illness that with a person with mental illness the same crime the person will serve the term four times longer that is the shame of the system would

agencies to anyone to address it and waste money on bribing reporters to tell my stories it is the shameful story what we need to do instead of saying you have to criminalize it before you get help horsey will kill yourself why deal with them a stage for? we need to save lives them be more compassionate. >> is there a local or state program to get in at the ground level? >> i mentioned the response program that is targeted science evidence based the traumatic stress network at adolescents or adults that have been traumatized one of the reports from the gao said they don't follow through or have standards or have reports that come out

this is into the it is gao seven recasts the director how would you score yourself? she said 10 out of ted this shows how out of touch they cannot even be humble enough to say we need to change. so we will change for them so they elected us because agencies will want there are some excellent programs with on a 20 homeless programs we need better continuity between the department of defense is on the veterans administration i worked at walter reed with ptsd patients there is continuity between the army and of the a otherwise we would see them end up in jail or homeless. >> tell us about working across the aisle on this issue and if you feel confident this time has come

>> it has not necessarily from the political insight because people want to protect their turf but it is a grassroots movement across america of those people there are dynamic leaders you have a wide range of people who were outspoken on this issue we have vocal supporters of both sides but it will take american people to pick up a pen or a phone or computer to contact congress to move this bill we cannot risk again 90,000 people per year die within treated illness or mental health. >> went to give the audience an opportunity we will start questions in five minutes so you can start lining up. i also want to talk about

the language that we use that stigmatizes is the issue to make it difficult for people who don't have loveland's how they perceive it is there a better way to you discuss this issue? >> we do with a couple of ways to develop a stigma by not having services available if you don't have places for people to go, a peer support psychiatrist or psychologist or nurse practitioners, we don't have enough of any of those. it would be easier to get help if you look at of breast cancer treatment center in a beautiful building in mental-health clinic is hidden away not well funding and struggling

bin part of it as you look at breast cancer runs nfl wears pink even rougher rearrest plans -- recipients in the fountain in pittsburgh that is great awareness it is important to me personally my sister died of breast kinzer last year then if you wear green shoelaces to bring awareness to bipolar he is fine for a rebirth in recovery that is why i wear a green tie talking about mental-health after things are sprouting new in the spring and one people to have that kind of pope also family members speaking and people in recovery you have to have the help. >> you have made a few

changes to your bill since introducing it one was to give the incentive to ruth states that assist the outpatient rather than penalize states that do night how you find that right balance to make sure people get the help that they need the civil liberties are not infringed upon? the wreckage is to make sure they have a right to get well we have gone down the road but they should be allowed to be set to be homeless and die. how cool and heartless is that when judges say he has the right to be crazy we would not see have the right to have a heart attack but we is a line that label to people with this is an outpatient treatment states have been on the books but when the york did this the money they were saving they put back into the system so that was good but they found

the reduced incarceration by 80 percent and we hospitalization in homelessness by 70 percent consumer satisfaction above 90% and they cut costs in half a duke university study if they do this that it is more compassionate to help people who are in the revolving door we don't want to read more stories of people with mental illness that involved with a police altercation but to say we will get you help. >> '01 to end on the question of how officers could be trained better to interact with individuals of mental illness because those that are killed by police officers have their mental illness so how could those pds belated? garett we do have the

escalation crisis training for police officers to identify the situation. many times you can tell how they behave or how they dress that they have a different point of view or even in a threatening posture how to talk calmly project the officer and safety if if they're threatening but in many cases if it is verbally hostile or scared or paranoia or hallucinating the one the police to get the extra training so they're not in the unsafe position but also to be treated like a human being so they can be safer and recover. >> now let's move onto the audience questions.

>> i heard about this late last night so i have not done my background information but word is that your bill is highly threatening with a psychiatric diagnosis that more controls are put in place. >> where did you hear that? >> several people. >> organizations get funding like stanford because they find these organizations to make sure that you speak out because he may lose our funding we're not taking refunding we're protecting their right to be well. what happens people have the

right to get better nothing in our bill takes that away to mandate involuntary commitment one organization to hold their audience that if a police officer stops you for a traffic accident can force you to take medications they are creating lies. that is not true we want more providers were places of treatment we want accountability and innovation in grants would with the funding in washington we want to see the effectiveness so understand there is a lot of people in the system that don't want to see the change but while nih has worked so hard with federal dollars we have seen a decrease of death rates for heart disease, cancer, auto accidents, is declining at the same time we see the increase the suicide death going up overdose goes up.

crimes were people in prison and homeless those statistics tell us the system is failing those they are supposed to help. so while it is not people's rights by understand people don't want to change. the current system is failing. go to the parents whose children died at sandy hook i have the parents those in my office where is there rights where is the right of the students you just died where is there right to have a hopeful future? i was with the police officer in houston texas done down from someone with a serious mental illness that was not treated case after case where is the right of those 41,000 that died of suicide? for we to say if you are crazy it is okay? any organization that wants

to create an atmosphere of lies. no and they prey upon those with mental illness by giving them a falsehood. that is unethical so whenever information you have i would be glad to show you but you show me the word for the line in our bill and i will change a but they cannot do that because it is not there. >> a kiss so much. >> -- they accuse so much. >> i am from los angeles i travelled over here read i just to be here to represent over 1500 families globally on this very issue housebroken mental health system has destroyed our family is, our children are dying our kids are incarcerated after incarceration put in state mental hospitals to be taken away from this.

but how many of us in here have had an experience of mental illness with your family? raise your hands. reconsider your part of our family as well. a couple months ago we were invited by congress to speak our voices our story can now in the "l.a. times" to be hospitalized eight times on the ninth time the day before we beg them to take our son and 89 s and left him there the next day he will up and he stabbed to kill his mother and father and also killed our dog. now he is faced with double attempted murder and cruelty to animals now serving a

life sentence in san bernardino only 20 years old. my baby. >> along those lines with a question we have what rights does he have in jail? committee doesn't have any rights. >> that is what i mean the most compassionate thing to do is get people help you were aware there was the case in maine with the gentleman was asked if he would harm himself the advocacy person said make sure that you say no and he said no and they released him and he went home hallucinating thinking his mother was part of al qaeda he chopped her to pieces he had the right to get better for better treatment and thank god you lived and there to help your son in the future i hope things turn around. >> but now he has a

psychologist a psychiatrist and a social worker altered his disposal this is what he needed to have on the outside but he had to break the law to get what he has now so this bill that the doctor is trying to pass we sit here every day waiting to hear congress move forward with this necessity and the rest of the world is watching us to take leadership as we do with other things to fix our problems it is such an old ancient problem it is time the movement of this year. the movement is your purpose we're 1500's strong and growing. not until this bill is passed. >> and want to take a question from twitter. for the american health system what barriers are

there how to read better bridge disparity? >> you cannot see to doctors the same dared not enough beds or services for minorities are limited we don't have enough and to make sure the minority fellowship is authorized so they have access to treatment and the issue of minorities they get their services in present generation after generation are in jail we need to have easy access. >> representative murphy with the national program health directors we will let express our appreciation to you and for all the work all if you are doing on the

mental health issue. the administrator that responded with the score 10 of 10 has been gone for about two months per or understand you have had an opportunity to sit down with the eric minister with your concerns and she has told to about the things they have done to strengthen the system. >> when did that meeting happen? when is that going to happen? we ask for a document we are still waiting months later to tell us about what they have never but to have an open conversation but they have got to change they cannot continue to have this belief mental illness does not exist with frivolous prevention programs to spend whatever they want that passed to fundamentally change i welcome conversation with any federal agencies the

american people are demanding that this insensitivity has to change among providers like you and others the most compassionate and caring people i have ever met let's face separate probe to love the people were working with that type of altruism is valuable. >> we have one minute left. >>. >> it is a town twister. how does your bill insurer culturally competent care with the linguistic standards of legislation?

>> so that it is already required? >> different states. >> you say that is already required? >> i think eight states? thirteen on the table and a couple have vetoed. >> white states to individually is up to them that we recognize that are you saying it is a federal regulation? >> i am sure of the process i am just learning because to that extent we try to pick up the slack i think it is extremely valuable to major there is more access for providers to be part of the communities. and we will work on other things we recognize today that cross-cultural

sensitivity so help us with that. >> we appreciate you for being here. >> i hope america will speak out. [applause] ♪ number of u.s. senate committee on health.

>>

>> of how to talk about mental health with the mass shootings. this was a crisis for a very long time. for those who had dead dealing with a long time as well. in for many of the rest of us it is personal for close their members to navigate system that simply does not work. to have the long proud history of mental illness i say that because we talk about it. because of the bruises and scrapes and a broken bones we talk about the fact we

have a history of behavioral health in our family and we are lucky enough to have the resources to navigate through that system and that is what this piece of legislation is about to hit a brick wall after a brick wall. with this signature piece of legislation and that was it was the effort with the insane asylum of mental illness and into the community but over the intervening 50 years we have encountered two major

problems that we never properly resource for the care necessary for those that left these institutions but those that were really institutionalized we just did not keep that promise as we say end connecticut's. . .

and as we increasingly understand by treating this with a wholly different space bar reimbursement system, we really perpetuate that stigma. the legislation that we have introduced myself and senator cassidy in the senate and tim murphy and eddie bernice johnson and others certainly is about building new capacity. we have some major medicaid reforms here which will attack the diminution of 4,000 inpatient mental health that since 2007 which will allow for more people to be able to see primary care and behavioral health clinicians on the same day. but it is also about trying to bring these two systems

together. i am particularly proud of the program in our bill that would provide grants to states to stretch a break down the existing regulatory barriers to the coordination of physical and mental health. in connecticut community mental health clinics and community primary care clinics want to collaborate, but because states regulate them they have aa hard time working together and a harder time co- locating. our legislation is designed not only to have capacity but to try to get these two systems working together. and we hope that by doing that we are attacking the stigma, not just making the system work better but bringing the system together as well. but we also hope that there are other parts of our bill that attack a stigma. we take the next step in parity by forcing insurance companies to disclose what all of their bureaucratic hurdles are to the guarantee

of parity that we passed several years ago. we give the administration knew enforcement powers to make real that guarantee which has been illusory for far too many. we attack the discriminatory treatment in the way that research is done by setting up a new research organization that will specifically focus on best practices for the delivery of mental health and challenge our colleagues to put money into that kind of research just like we do other types of research, and i tell you, we are hopeful that there are serious amounts of momentum behind this bill in the senate. already we have five republican cosponsors and five democratic cosponsors this week. we just added our new pair. next week we will likely announce another pair. we are actually had aa

longer line of republicans than democrats waiting to get on this legislation which is wonderful to have is a problem. and we feel like with the hearings scheduled in the health committee later this month the 1st hearing in the health committee on mental health in three years -- and that is amazing to think about -- that we are poised to move this bill. as my time is up, let me spend two minutes talking about the context of messaging here. i no we are talking about this in a more robust way, but i went to the floor yesterday to challenge my colleagues and understand the mental and behavioral health system has to be fixed because is broken. and we should not fool ourselves that we are going to cure the nations epidemic of gun violence by fixing a

broken mental health system. why? the us has a gun violence rate that is 20 times that of all of our other competitor oecd nations, and there is no evidence we are spending less money on behavioral health or have any greater rate of mental illness. there is something different that is not necessarily an hour behavioral health system. if you fix some of the gaps it will have a downward pressure on violence, but we must be careful over the coming weeks and months of debate are falling into the trap which tries to define america's growing gun violence epidemic as one that is rooted in a behavioral health system. i do not mind conflating the two because i think that it will ultimately help to make our behavioral health system better. if this is our opportunity and moment, we would be

fools not to take it.it. ultimately, we will not fix the gun violence epidemic in this country if we do not get serious about what differentiates our software other countries. this is not a forum to talk about that, but it is not necessarily a question surrounding our behavioral health system and how we fix it. thank you very much for having me. i look forward to the debate. [applause] >> please welcome back lauren fox, staff correspondent and national journal. >> thank you so much for joining us today. i wanted to start out with the bipartisan nature of this bill, a rarity in washington dc. pickpickup behind-the-scenes of how this issue became so bipartisan and what it has been like to work with congressman murphy and others?

>> i give a lot of credit to ten, good friend. he really set a precedent for bipartisan cooperation in the house by building this robust group of republican and democratic cosponsors. when. when i decided to really dive into this issue at a new level i decided that the most likely vehicle that was ultimately to become a law was going to be the one that had the biggest amount of bipartisan support in the house. i said, i don't know that i agree with everything or that i can guarantee i will introduce a carbon copy, but let's try to do companion bills that have the same foundation with different branches that come off of them. bill cassidy was very involved in tim's bill in the house, and someone said to merely on, you should go talk to bill about this because he would walk into

tim murphy's hearings with a dogeared copy of the book crazy, which many of you have read and is a guidepost for a lot of us who care about this issue. and so i approached him, and he immediately said he wanted to diving along with me. we have some things that are different. i have been pleasantly surprised at how fast the colleagues of signed on. they have done the most work on mental health. him, sandra collins, senator better, and then we have added since then senator it on their side and senator murkowski. we will have more quickly, and what this will become is a bill that has bipartisan support, the cross-section

of ideologies within each carcass which is important as well. it is really progressives, moderates,progressives, moderates, conservatives altogether which will be a pretty important signal to leadership. >> i want to give you an opportunity. you address this at the end of your speech just now. we have often talked about mental health legislation in the context of the gun debate, and there always seems to be more discussion momentum after a tragedy occurs. does that stigmatize mental illness? >> this is an incredibly important topic, and, and i have talked openly with my colleagues about how we talk about this. what we know is that there is no inherent connection between mental illness and violence, the people with mental illness are ten and 20 times more likely to be the victims of violence and the perpetrators of it, and we do risk perpetuating the stigma, and we see it play

out in really disturbingly open and blatant ways. the german wings plane that went down in your openly playing out that someone with a history of depression shouldn't be allowed to fly a plane is somehow is a connection between depression and desire to take down a plane in an act of mass murder? is ridiculous garbage shows how easy people make this connection between mental illness and the predilection of violence. it is why yesterday i went down to the floor and give a specific speech calling out my colleagues and saying that if you want to take on gun violence you have to take on the celebratory

culture of guns in this country, acceptcountry, accept the fact that what makes us different from other nations is not the amount of money we spend on behavioral health. we can do better. what makes what makes us different is when people have a dispute in this nation, when people are dealing with internal demons, they go reach for a shotgun to try to settle there disputes. that is not what happens in other countries. i think thati think that it is important to have some lines of clear distinction as this debate goes forward. >> i want to talk a little bit about your bill and what it does to help identify and help young people who are diagnosed with mental illness, obviously getting to individuals earlier can be helpful in their treatment long-term. >> we have a very specific program in this bill which would engage and invest in early intervention. our bill starts the program at three years of age but we have had a lot of feedback.

early intervention programs that identified individuals who are showing those warning signs of mental illness, serious mental illness and get the resources and the parents resources upfront. early identification so that we can find the kids and get them in the treatment. and then it is a matter of building capacity. one of the most important things in this bill is the ability to see a primary care provider the logistics will get too big for

families that have economic and social challenges. symbolically what is that say about how it changes americans view of mental health issues and also logistically, what does the new role do, create organization or are there fears that it could create more bureaucracy? >> we keep them intact in our bill. we certainly think there are ways that we can reform it. we don't think it is productive.

we do. his bills by setting up as new assistant secretary. here is where is coming from. most all of the serious conversation debate is happening within samson is controlling a tiny portion of the federal government's students on mental health, behavior health, and substance abuse. there is no one sitting next to the secretary who is thinking creatively about how you use medicare and medicaid in order to advance new treatment models and behavioral health. the new comparative research center set up under the health care law is actually doing more work and behavioral health research than they are on any other

sector of research, and it was unexpected that they just found this making sure it is infused into my medicare medicaid work. you have to have someone overseeing the big mental health stent, not just the targeted dollars. >> how do we ensure that insurers are following through with the changes made. >> we hear on a daily basis that they had taken this guarantee. either you have a technically cover behavioral health like physical health and direct so many barriers

to getting that behavioral health benefits that it just becomes meaningless often, and the stories are heartbreaking. when you walk through an emergency room and have a broken leg or a bleeding ulcer, you get treatment immediately. but if you walk in with a complex behavioral health issue at night. nobody touches you, treats you, evaluates you because they won't touch you until they know that they can get someone on the phone at an insurance company to give you the prior authorization for treatment and so they were house you overnight.

but we need to do is what this bill does which sheds light on the processes that these insurance companies use to try to deny treatment and then give new enforcement mechanisms to the federal government to go after companies that are violating law by essentially doing an end around with these bureaucratic hurdles. >> i want to give the audience a chance to line up for questions. both are bills are infused with work that we have learned from state governments, programming specifically designed to do early interventions on schizophrenia, for instance,

say programs that are now funded in this bill, wonderful, simple program in connecticut that invest in telemedicine that allows for primary care physicians who encounter a patient with a complex behavioral health diagnosis to call up immediately a behavioral health clinician who will do an immediate in person phone consult while the patient is in the office. rather than have to send them across town you can get an immediate conversation on the phone. we are doing that in connecticut to rave reviews and good outcomes. we pilot program that in the legislation as well. you know, we really do believe a lot of the innovation starts at the state level in the house and senate and both involve a number of programs that come from the grassroots.

>> even though one in five adults is diagnosed with some kind of mental illness each year the number of psychiatric beds has decreased dramatically. do you view that as one of the biggest barriers on care? where you rank that in ensuring that people get the care that they need? >> that is at the top of the list. i guess i have not gone through the trouble of ranking all the terrible problems we have in our behavioral health system. far too depressing. but that is at the top the list. what is happening is that people are just sitting in emergency rooms for days and days and days, but they are also creating pressure on the backend whereby the people who are in the institutions are being pushed out before they are ready command we just here that story over and over again in connecticut.

a story about her son who committed suicide the day after discharge from the hospital, and she begged for him to stay. not clear whether it was the hospital pushing him out to make room for the insurance company, but his mother knew he was not ready to come home, not stabilized. when you've lost 4,000 bed since 2007 there are only so many places that you can go. this is going to be the challenge. two major changes. they get rid of the exclusions. you cannot fix this problem

you have to make some serious investments. but we are committed to it. >> i think we just need to make sure that there are knew voices in the discussion. >> you cut me off before i could ask my question. >> very briefly kenny asked a question. >> in looking at the very 1st line of murphy's law proposal you started talking about stigma as well. he quoted violence, 10 percent of untreated psychiatric disorders result in some sort of violence, and you are concerned about stigma.

here i quote the very 1st line. >> ask your question. >> untreated serious mental illness and recent acts of mass violence. the very 1st line of that immediately connects violence with those who have aa psychiatric diagnosis. >> i think that i spoke to this very intentionally. i think that this is amongst the most important questions we have come how to acknowledge that we are talking about behavioral health reform in part because of these episodes of mass violence without perpetuating in creating this stigma. again, i have been very outspoken on this matter. we should fix our behavioral health system because it is broken. it doesit does not mean that we should forsake the opportunity to fix the behavioral health system, but it is dangerous.

>> go ahead. >> can you hear me? my name is jennifer off. here from orange county california, family member. as a member of the 4 percent are voices are not generally shared because our family members are too sick to speak up for themselves. they arethey are not well enough to find their way to a meeting here today to advocate against civil commitment reform,reform, fear mongering is they think they will get locked up because there homeless under a bridge. they are too sick to advocate for themselves, so we have to come here to advocate for them. my question would be, what are you doing to address the needs of the 4 percent,

those who lack insight like my son who was institutionalized from ages 12 to 18 because he did not respond to the current medical treatment. therethere was no brick wall for our family financially, nor in our rolodex, but unfortunately it was not brick walls with cracks in the system by design without restructuring samsara, eliminating and dissolving, but restructuring families like us do not see the money being spent differently. not necessarily mean funding in that direction. families are not represented in data pools. you will not find my son as a failure on anyone's pretty pie chart. my son has found his group now because that is where they all end up in they turn 18, graduate from the facility, get a plane ticket

and the shoelaces and go back home to our communities about which they're are no wraparound services for people like my son. >> the question is, is your bill going to address the needs of the population upon which we do not even no how many exist because no one is tracking them until they wind up incarcerated. he is serving 14 years in state prison. he does not have beds. it is a known population. how are we addressing those voices, and looking out for the families of the monster. >> that's a big question.

>> basically these tragedies are not a surprise from our vantage. we are not trying to connect violence to all mental illness. i have been screaming for 17 years for help. you have to empower parents to be more involved. both of our bills include changes to laws to allow parents to be more involved. for the complex behavioral kids, who is in charge?

the community health physician is in charge. we have got to answer that question. my belief come as you build these coordinated systems and change the way that you pay for healthcare so you are requiring systems to coordinate across each other and to get paid based upon how healthy they keep people rather than how sick they keep people, they will solve some of those questions of leadership. and soand so listen, i -- the reason tim and i are doing this is for the people like your son. the people we decided to dedicate our legislative lives to trying to fix, and i am sure we do not have all of the answers, probably not even 25 percent, but we are trying. >> thank you so much. >> another question? >> senator murphy, my question is, if the imd

exclusion is lifted or partially lifted, probably completely lifted and the money, some of the money will go to state psychiatric hospitals, but there is -- is there a requirement that the states that the endeavor their medicaid match to help pay for that hospitalization maintained funding for medicaid services and community mental health system? the state funding for mental health is back to where it was before the recession. >> most all of these expansions of the federal dollars i will double check on that. my intent is to make sure you're not robbing peter in order to pay paul. >> glad to take a look at the follow-up.

>> more questions on either side? >> no. just one more for you, senator. i want to talk a little more when you are talking about the issue of mental health there are a lot of stories and people who are passionate about this. do you find in your conversations with us in ensuring thatensuring that you can go to leadership and say i think this is getting for time and are you optimistic that this bill will move forward out of committee? ..

>> >> if you have a broken make you really can put a cast on it and it will be better but if you have a complicated behavioral health bill this it may not be that you just need to treat that individually but also the

support system and reach out to the parents of the child or to the siblings or the issues that have compounded the issue with surrounding trauma. and 16 kids that day how many also have page from the history? he said all 16 have a troubled history. so it certainly inspires me to do better but it makes me understand the you have to approach this system we are building and a slightly different way than the primary care to have the resources to reach out to

treat those around the individual not just target the individual. >> is the white house engaged on this issue? have you been talking about the prospect of a mental health bill? >> i would love for them to be more engaged frankly. so we're working with hhs and not sure yet who will testify later this month at our hearing by a magic in the administration will be there. secretary for well is serious about this issue it is very bold in her reform proposals and to build this new model to reward outcome

the also do that for the behavioral health system that frankly there is a greater connection between the volume and other parts of the health care system one of the things we are lacking is the volume is enough visits or enough beds to make sure this reform is thinking about the ubique of the behavioral health system. >> the queue for all of your time. it has been a very productive conversation. [applause] ♪

♪ ♪ [applause] >> good morning. thanks for joining us today i hope we have a lively and exciting discussion here on stage i hope you interact with each other i do have a couple of questions free each individually and as we talk about this are a lot of perspective of this we want to make sure they're all represented. address the issue of parity it has come up a couple of

times with the senator and the congressmen and what du view is it fair the way they treat mental illness compared to a physical illness? >> parity is the of law by now but unfortunately it isn't always the case and with that better enforcement of parity that problem is that people who were not getting parity opted for those who cannot advocate for themselves and one of the things the american psychiatric association is doing is to develop materials to ask every psychiatrist and every clinic to have this poster up and it says you are

entitled to coverage for mental health care in the same way you're entitled for physical care if you're not getting that then this is the number to call and take care of it. we need to let people know what they can do with it don't have parity is a backlash to recast the members to they were experiencing and they found denial's for mental health was twice as much as physical health care and it was completely inadequate if they could not get access to care in the big concern about medications so we found a lot of problems when we talk to members. >> obviously there already dealing with mental illness to report these issues that

our difficult to get through >> the organization advocacy center focuses on eliminating barriers what d.c. as the biggest obstacle to get the care that they need? >> the idea that we have not kept treatment laws up with science we have a situation whereby realizes if you were in treatment you're no more likely to be dangerous to anyone else but you cannot get help unless you are a danger to yourself or someone else so if you are ill and need care you are left to your own devices that is how we treat any other elvis so we're taking

steps to say we are changing best. >> is there a way to intervene earlier? >> there are any number of ways we see working in the state's they allow states to step bin to make sure they get the care they need before they are in danger. the reality shows before this level of crisis it is cheaper and people to recover. >> coming from the medicaid perspective working on integration and behavioral health one of the opportunities is to find

people before they are in a crisis to have sources of care but to better spot issues and to think about bill whole person better at spotting things early behavior health when you're in that office to see those individual providers. >> early intervention is very important those that baby developing science us to the freddie as the adolescent who thinks they

are off maybe they have unusual ideas so they can be brought to a psychiatrist who will do a comprehensive evaluation to try to determine if these are early signs of psychosis and if they are, as there are very effective programs to get the young adults treatment very, very quickly to prevent full blown schizophrenia. there are also programs in schools to identify children who have early programs which also that targets teachers were the first to notice so the teacher will wonder is this typical behavior of the adolescent or early sign of problems? they're not supposed to do

the evaluation they are not qualified but they identified then they can refer the young person to a mental health professional or a psychiatrist to do the detailed evaluation and maybe hopefully we could prevent future problems. >> i fully support the notion of prevention with the community mental health systems we cannot always predict when the individual does have a crisis it is incumbent on all committees to have a diverging care crisis capacity that those people in need in the middle of the nature of the weekend can easily access care to address their significant mental health symptoms at that time. far too often without the alternatives we see the path of least resistance to take

that individual to a local county jail that is not the place where people should be. >> you have to be situations right now and in many communities to say he will not hurt anybody tonight so we will send him home for some the that is more ill that is a terrible way to treat people and it is a terrible way to do things hoping they're not the next headline. >> with those in the criminal-justice system what can local law enforcement do better to preemptively work

with them once people are in the system to create programs to make it easier to be less traumatizing? >> that nexus is really important just as i applauded the of bipartisan approach they're taking to the mental health reform issue we also a collaboration between the spectrum and with regards to law-enforcement, we have almost 2 million people each year with illness mentally in jails and prisons that pose no risk to public safety but we see law-enforcement with specialized police responses with crisis intervention where there are about mental illness and how it judy escalate situations in the field that are given

alternatives to incarceration for those individuals it is an important component of the overall strategy to reduce the prevalence of mental illness in our jails that are filled with individuals with eight times the rate of general population every county is struggling with this natural of the initiative called stepping up the american psychiatric association and foundation and other groups to say a status quo is not acceptable there are interventions that work we need to drive that prevalence down. >> there has been a lot of programs that you advocate for do you find they have access or the even have knowledge that did exist?

could there more be done to expose those programs that are out there? is that a barrier to care? directory take thousands of calls every year. people don't know where to go for help they often have no idea of their services in their communities most often they think they have to choose between the police and no care so it is an issue of knowledge but then there isn't sufficient service there i cannot tell you how may times i have tried to help families find help it isn't there or not covered by insurance it isn't available, no where for people to go and knowledge and also the access problem we want people to have early easy effective access to care suppliers to get care and no evidence it will help you but we go well works but people cannot get it.

>> addressing the issue of rural communities purses the urban centers where there are more resources available what about those individuals that don't live within a couple of hours from mental health care centers. >> in the medicaid space there used to be a bias face-to-face with so important deal the way to deliver these services in physical and behavioral space but now we're using maurer technologies of now using telepsychiatry that they are trying tear tap into to care for people in their communities that is the most important aspect that we have been to continue your care if you're committed a. so telepsychiatry not just

the individual but the providers to not have the expertise so we have a couple of examples of states to try a to use a model where there is a center of excellence they treat people in crisis and handed to intervention but then when that individual returns to the committee and the providers that care for them to maintain their continuity is important. >> what d.c. as the shortcoming to help the legislation expand coverage? >> i will set aside the issue of access a but isn't there then they are struggling but the one that

comes up the most frequently as a barrier is the exclusion but the issue that it leaves for us to have individuals what is called an institution for a short period of time that we drop the matter of the system of medicaid with the i am d exclusion may cannot keep them in the continuity of care so we have to figure out a way to include the i am d in the system of care but we're not looking to warehouse people so if that

is the challenge that is the biggest barrier with a stronger system. >>. >> weigh in on if they are at a larger scale to be more effective. >> that the person who has committed a crime and a mental illness goes to the public defender who says you have a choice. i and your defense attorney i will defend you but we

know you will stay in jail or go to prison but you have an opportunity i can go to the d.a. to make your case you need mental-health services but you have to participate in the half to go to the judge to say this is appropriate in those services and golf medication, to see a therapist, a substance abuse treatment or maybe housing and if you are willing we can keep you out of jail and you will no longer be a defendant we will change your title to a client. it is very effective. i have done a couple of studies in san francisco and it shows people that participate in mental-health court said behavioral courts if you follow them and compare them to similar

people who committed this same sorts of crimes of the state mental illness and do not participate, there is a decrease incident of violent crimes and a decrease of jail time. that is the effective way to get people out of the criminal-justice system and into treatment. >> certainly i support the mental health courts if they have the tools in the toolbox and we appreciate that. it is the case they are small in scope and the of -- those that participate are relatively small but those that can get connected to care to move for recovery it is also an opportunity for the judiciary to learn about the needs of defendants with mental illness.

they are dependent on the effective robust accessible mental-health system so at the very core is to improve the behavioral health responses to a variety of mechanisms that are well articulated can work. >> just to pick up on that we have to recognize the existence of mental health courts is a recognition and the system has failed mental-health system fails of we have progressed to them to get treatment so assisted outpatient treatment that we talked about earlier is a mental health court without having to be arrested and states not using it having on the books but not doing the work they need to implement and that is a systematic failure

that the congressman touched on for too long we have allowed the system to say you are difficult he will be expensive the jails will take care of him. >> we have to of minutes to questions feel free to wind up to discuss these issues. i want to talk about not just access to care but are there enough doctors are trained professionals to deal with clients? that is part of the barrier to care. >> as a psychiatrist there are not enough. there is a workforce issue especially talking about child and adolescence. in the bills introduced to congress that the american

psychiatric association supports it is absolutely necessary we may never have been half and that is where we get into the programs such as telepsychiatry although they may not be available in that community you can see them and do the evaluation over long distances to integrated care clinics for patients who are disabled or elderly and cannot come to the psychiatrist of the. >> were the biggest challenges for medicaid to there is a shortage have the hardest time to compete for those providers we don't pay as much and we have people who could be considered as more difficult to deal with because they don't come is we have a very hard time to

double down on those that need the services the most so even if one is available free have a hard time for the patience to see them. >> recall that the license to hunt. >> reimbursement for medicaid is very low. in my community i practice in san francisco the psychiatrist say for a patient of medicated cost more to provide the service than reimbursement. we have to do something if we expect providers to take medicaid patients. >> we will start questions on the left. >> i work for the house majority whip who is a

co-sponsor of mr. murphy's bill. we are very excited about that. we feel it helps on the front end to get people into care so they don't commit crimes but the criminal justice reform that is going on right now the discussion has a great opportunity for us to do something having reviewed a number of the bills' head of think we are doing enough. like steadies' that would encourage more courts i am not sure there is a biggie nastic to address what happened last week with a young man in virginia. do you have ideas with federalism to do better than we are with some of the proposals of how we can

encourage states to prioritize making sure they don't end up in jail? >> a very important topic. thank you for your work. this is an area where there is bipartisan conversation going on right now. it is hard to see those as you think of the jail and prison system with the role they play to keep the community save but i would highlight a bill which does fund along a continuum of services and integration dissociated assisting individuals with mental illness to stay out that is also bipartisan senator frank introduced the bill that is an important

incentive to develop these effective responses. >> i am a psychiatrist and medical director of a large psychiatric hospital. thinking about the two speakers we've heard earlier in the panel looking at federal legislation from mental health professionals you have some very important areas of crisis intervention teams mental health services and whether the attention to federal legislation accelerates the

implementation in a way that could prolong that i wonder if how those bureaucratic boxes are structured is where efforts should be spent or somewhere else i've interested in your thoughts if you find that federal legislation helpful or a diversion in some ways. >> i can tell you pretty clearly not only having a senator to know what i amd stands for but talk about onstage is amazing having him go county to county to fix the health system is amazing. we have never had as exciting time the momentum to reform if this is up

problem above to have more of that. >> i think the efforts are complementary but we also worked at the state level it only complements what we a try to do that the state level to provide resources so those efforts is complementary but to talk about that effort i think is complementary. >> but those that come from the state level is an innovation. and to reinvest the dollars