about immigration and with our system is broken, and if so, how we might resul resolve it. based on some the things that you mentioned in your oral as was in your written testimony, we've got about 11.4 million undocumented individuals in this country right now, is that figure about correct? >> yes, that's what i understand the estimate to be. i've seen 11.5, 11.4, somewhere in there. >> what is the likelihood that these individuals in any significant number will self deport? >> i think the likelihood is next to zero, that they will all self deport. i think we are to be realistic about the situation. they are not going away. >> what's the feasibility that we as a united states government, homeland security, any apparatus that we have available can't engage in mass deportation of such a significant number?

>> with any realistic -- it can't be done. we have to accept the fact that we have an 11.5 million undocumented immigrants in this country. we have to deal with them. i don't think we should allow them to continue to exist in a state of legal ambiguity, or in a dark hole. i think from my homeland secured a perspective i would rather deal with this population, encourage them to be held accountable, encourage them to pay taxes, get on the books and get on an armed path to citizenship so that they go through the necessary background checks, they're in a position where they can work legally, and we reckon with this problem which is why i'm a strong supporter of immigration reform. i think that we have to be realistic about the place we are in with respect to these 11.5 million people.

there are states know where they're permitted to have drivers licenses. california supreme court says that an undocumented immigrant in this country can practice law. so they are not going away. they will not self deport. i would rather see us reckon with this population than continue in the state of legal ambiguity we are in right now. >> i certainly take that position. i think most reasonable people would conclude based on the fact that self deportation is in practical, unlikely to occur and as deportation is impractical in terms of any execution. we've got 11.4 million plus undocumented individuals we need to do with, and appropriately, but we need to address that situation. so i appreciate those observations. you expressed concern earlier today and in your testimony that there's been a substantial increase in the number of unaccompanied minors who have been entering into this country. it's my understanding that that

phenomenon really began to occur sometime in the fall of 2011, and we've seen a significant increase in and around that moment. what are some of the factors, if any, that are leading to this substantial increase in those central american countries that we have experienced? >> i think that phenomenon is driven largely by the circumstances in those countries, and those central american countries. the levels of violence, the levels of poverty, because when you look at, when i see these children and ask at mcallen station where you from, they tell us honduras, el salvador, guatemala. and you just look at the situation in those countries and you have a readily available answer to your question here and

so i want to try to work with these governments to stem this tide and to see what we can do to add to their own border security and deal with some of the underlying problems that are causing this phenomenon. but i think the principal reasons we are seeing this is because of what's happening in the source countries. >> what can we do proactively to address not just the underlying violence which seems to be a problem, as it relates to some of the drug cartels essential being pushed out of mexico into honduras, guatemala, el salvador, in a manner that those countries were prepared to address creating a chaotic situation, but also there appears to be in absence of any meaningful child protective system in those countries and in the athens of border security, i mean, is there opportunity here for us through your leadership,

through the leadership of others, for the united states, for congress to potentially get behind assisting a central american countries to our southern border beyond mexico in a manner that could alleviate what i think is a humanitarian crisis that we have to deal with for those who actually make it to? >> i think first of all it requires a whole of government approach by our government, executive branch and congress, dhs and other agencies of our government here and this is something i've had conversations about with my cabinet counterparts who all recognize and appreciate the problem. i think requires a whole of government approach in homeland security, national security and law enforcement. and if it requires an indication with the government of mexico, because this problem is also their problem. people who migrate from central

america to the united states migrate through mexico, and many of them stop there. and so i've had this conversation with the government of mexico about doing more. and i believe that there is a recognition of the problem in our partnership with their government, and i believe that there is the mood and climate to address the problem. i've had that conversation with a senior most members of the mexican government. and i think that they want to help and i think, i think, my sense is that we are in a position right now to make some progress with the mexican government on that issue. >> thank you. my time is up. >> the gentleman's time has expired. i want to say that i've had the same opportunities to speak with senior mexican officials who said the same thing, which is a change in the attitude toward their southern border in any assistance the u.s. gives to them, to help secure the border with guatemala. i think it will pay dividends

for both mexico and the united states. so i would certainly encourage you. the chair recognizes the gentleman from georgia for five minutes. >> thank you, mr. chairman. i wasn't, mr. secretary, i was going to go on here but i said and a listener either the questions i'm going to get to, but we just spoke to my good friend from new york, brought this up, that their 11.4, 11.5 i think think it's high, lawyer tomatoes america but these 11.4 million our income will use the words undocumented. they are not here -- they're not here in a lawful status, correct? >> for the most part that's correct. >> no, no. are the here in a lawful status or not? >> for the most part that's correct. some of them -- >> no, no, no. reclaiming my time. either -- you can't have it both ways. if they are here in a legal status and then they're not undocumented and not here, they are here legally. if some form of legal status. when you say, and i think this is the problem of a political

agenda or a want to our a feeling, it's not legal ambiguity if you are here and would talk about a group of people that are undocumented and not to properly. that's not a legal ambiguity. so it concerns me that we take this conversation, and like i said, you've answered a lot of questions on both sides, very concerned about that we can't define a secure border. that's a different issue. i will be submitting questions for the record it to you on the. but just a moment ago, we would not be having this discussion in a large since it these 11-point whatever million were here and there was legal ambiguity on their status. there's no legal ambiguity. one side wants to different. another side which we think, work toward resolving this issue. i want to go do something else, but i just don't think it's been very honest with the committee to say that there's legal ambiguity here. if there were this would be a

whole different discussion. >> there is legal ambiguity in that they're here undocumented there are states that permit them to driver's licenses. i consider that and ambiguous legal state, and we have to fix it. the system is broken. we are not going to deport 11.5 million undocumented immigrants in this country. you and i both know that. we've got to deal with it. >> reclaiming my time. have you heard me say, have you heard me say that? >> we have to deal with -- >> have you heard me say that i would deport 11.4 million people? have you heard me -- >> not going away. >> mr. secretary, i'm not asking you to give a roundabout and. have you heard congressman doug collins said that we need to deport 11.4 million people? >> no, i have not. >> i want to move onto something else because we are obviously not going to see eye to eye on this one because a duplicate needs to be a fix but if we can't even agree on the fact that there's not legal ambiguity

here there's a problem. one of the things i think we're making progress on is in the effort of the border protection and also homeland security in dealing with intellectual property issues coming across the border and patent infringing goods making its way into the us. could you provide me with a brief update on the border patrol's efforts to develop a process which we can expect over the month to work on this issue of patent infringing products, across the border and areas that this has been discussed is because i'm happy to have that discussion and engage in a conversation with you, or any other member about border security, yes, sir. >> okay. i just asked the question. the question is, can you briefly on the update of dealing with patent infringing products of the things dealing with the ip intellectual property issues come across our border, just update me or giving an update if you can, if not, can you supply it and ride on the issues that

are going on? >> guess i can. i will. >> supply in writing, okay. favorite of this year, -- stated that i.c.e. is working closely with the border patrol to adopt best practices to ensure their limited resources are focused on finding the most egregious violators as relates to ip theft, is this correct? >> i believe so. >> could you share with some of the best practices are? >> i could do that in writing, scheuer. >> okay. in looking further, i've also been concerned, and i would just sort of come back and to finish up here, been concerned with the releases and detentions that we discussed. that's been discussed as not being -- ad nauseam. are you willing to ride with a different information regarding any, and released in georgia since 2012 so i confide appropriate oversight on path of the citizens of my district? >> i believe we're in a position to do that and i will do that. >> again, mr. secretary, i do

appreciate your work. and the very concerned with the answers, especially the first part of our discussion because some of these things are not legal ambiguity. the things they need to be fixed. if they are not then we wouldn't be looking at it from the perspective we are and that is why there's such conversation on this. >> would the gentleman yield? >> i would just add to your concern that the real idea which deals with making sure that driver's licenses other forms of identification help convince the -- type of tragedy occurred on nine 9/11, 2000 with the that makes it clear on some who is not lawfully present in the united states does not anyway and for a legal status on that individual whose presence is here. >> you are correct and that's why they're still not legal ambiguity. there's a problem with a law that -- >> would the gentleman yield?

>> is the chairman's time. >> i will yield an additional minute to the gentleman from georgia so he can yield to the gentlelady. >> i yield to the gentlelady. >> i think him and appreciate the gentleman yielding, that there are certainly instances and i'm sure mr. labrador is also run into this in his practice with someone doesn't have documents but they are, in fact, legally present in the united states. it's not all that rare, surprisingly enough. i would just add that into -- >> and reclaiming my time and i do agree with the gentlelady that we agree on many different things but i think in this instance though i think when you discuss the 11.4 million the application was there all her under legal entity and that is not the case. >> i am not suggesting that. >> i yield back. >> the chair thanks the gentleman and recognizes the very patient gentleman from idaho, mr. labrador, for his questions. >> thank you, mr. chairman. thank you, mr. secretary for

being here with us today. i want to start with something good because we're going to get to some issue that will disagree on but i admire your answers to mr. dutch. i don't know if your memory the exchange that you have just a few minutes ago about an hour ago about the number of beds. i want to make sure your answer is really clear. there is nothing in the law that is me giving you to put 34,000 people on these beds, is that correct? >> i don't read the law that way. it doesn't read that way. >> it doesn't be that way and they keep hearing -- that's what i read as well and i commend you for your answer. i was actually confused thinking maybe that was the interpretation of the administration and i appreciate that you clarified that. i don't read the law that way either. i do believe a critical part of immigration reform is a robust ad and non-ag work, guest worker program to do you agree that such a program is important? >> yes. >> i think that the evidence at least in my mind is prickly or

that a guest worker program can end illegal immigration. for example, the program did in the 1960s, in my opinion. the congressional research service found that the program only works when combined with greatly increased law enforcement efforts. so here's the problem. employers in my district are telling me that legal workers, people who are coming to the united states legally, are absconding to work in the black market and they are being told that they won't be removed from the united states by i.c.e. agents or others to be agree that i.c.e.'s priorities are maybe undermined one of our legal programs that is actually meant to deter illegal immigration? >> that sounds like a problem, yes. >> we are hearing again and again in our districts that people are leaving, for example, the sheepherding program and moving on to other industries, and that the i.c.e. agents don't have the resources or are being

told not to pick up these, and i'm concerned about the. your testimony, there's no way that illegal aliens will depart. in fact, you just stated a few minutes ago that the likelihood is nearly zero. let me tell you that i disagree with you vehemently. in fact, my experience is totally different. some actually spent with immigration lawyer has been totally different from what your testimony is today to in my experience, many did leave prior to the bars banning illegal aliens from returning a decade or more. you're familiar with the three and 1 10 year bars and permits are? >> with what? >> are you the money with the bars that are in the lot right now where if you're here illegally in the united states, you must return to your home country before you can return to the united states legally? >> yes, yes. to be clear what i said, congressman jeffries asked me what is the likelihood that those 11.5 million people will also deport? and i said the likelihood of

that happening with regard to 11.5 million people is near zero. >> that's what i wanted to clarify. >> do people self deport? >> people will do it, if we have the incentive in the law. do you agree with that? >> i agree that there should be disincentives to engage in illegal migration. >> correct. for example, if we moved the three and 10 year bars, if we repeal those bars that are in the law, don't you think many people would deport him a self deport so they can reapply legally to the united states? >> i don't have any -- i don't have any empirical evidence one way or another to be able to answer that question stink you should look into that because i did that with many of my clients when i was an immigration lawyer but even when the bars were in place, if there was a high likelihood they could return, even in spite of the bars they would actually go back to the home country and return to the united states. don't you think it would be positive if we actually --

>> intuition says if there's a shorter period of time that you have to go back and wait, you're more likely to go back. >> so right now the waiting period is three to 10 years. if we remove those bars and they know that they can return legally, for example, a u.s. citizen's spouse knows that they can go back to the home country and they can return legally within a matter of months instead of three to 10 years, don't you think they would probably more likely be willing to do that? >> intuition says that if the wait period is shorter people are more likely to go back. >> don't you think it would be a good first step to start with something like that where we could make a small change in the law and encouraged a lot of people, in my estimation and others, is about 25% of the people who are here illegally who qualify for some legal status, but for the bar. don't you think that would be a good first step? >> well, it's hard to comment on

that proposal in isolation to the exclusion of everything else that's in the works in comprehensive immigration reform. >> so you would rather have nothing than at least have one area where we can fix the status of people that are here illegally by having them go back to the home country and returned in a legal status? >> there are many things about our immigration system that needs to be fixed. i hope this congress will act on. >> and you don't want to pick one of them. you want an all or nothing approach of? >> i think that we have an opportunity on a cover his bases, either in one bill or several bills, to fix a whole multitude of problems that i think every member of this committee realizes exist. >> so your answer is if we don't do it comprehensively in we should fix nothing about the current system? >> i won't be categorical in that way. i am saying that it would encourage the congress to think about immigration reform in a

whole variety of areas. >> we can do that and i agree with you, but if we can fix something today, if tomorrow we could get something passed that gets rid of the bars so we could help a group of people that are here illegally, return legally after the return to the home country, you would be opposed to that? >> i would encourage you to think about the whole range of -- >> so you don't want to answer that question. again, your answer is you want all or nothing. that's -- >> i didn't say that. i am encouraging the congress -- >> i know -- >> comprehensive solution to this problem. >> would the gentleman yield asked if i may, the -- >> my time at -- >> the gentleman's time has expired. , but that you would recognize the gentleman for an additional minute to yield. >> i just note that really it's up to the congress to decide what to legislate and the secretary doesn't get to decide. >> i yield back. and every clean my time and i agree with that, but the position of the said administration as has been demonstrated by the secretary

and has been construed by a lot of the comments that anybody other side and by the president is that they want an all or nothing approach. i think that's rather unfortunate because we -- >> i don't think that's what the secretary said. >> i have not said that spin but you won't answer the question. you won't answer the question if it would be okay for us to fix one portion of the immigration system that i think is actually preventing people from returning to their home country and come back legally. >> if the gentleman would for the yield, i would encourage them to bring that and many other items up to the floor for a vote. >> we will. >> the chair thanks the gentleman, and the chair and special effects the secretary. you've been very generous with your time, and i believe by my count you've taken questions from a 32 of the 39 members of this committee, and we know that there were some questions asked that you are not prepared to answer, wanted to do some research on. and if you would respond to

those questions in writing as well as any other questions that members of the committee may propound to you in writing, we would very much welcome the. also want to take note of one other issue that was raised by the gentleman from georgia, and the gentleman from california, and thank you for this, and that is with regard to the real id. as you know, the real id act allows states to issue drivers licenses to illegal immigrants as long as the licenses are real id compliant. something by the way that i have not, i am not in favor of having states issue license if you're not lawfully here. but lawfully here. but be that as it may, realize being complied notes the driver's license cannot be used for federal purposes and that the markings that clearly make it different from regular driver's licenses. at the beginning of may, your department rejected california's illegal immigrant license designed pursuant to the real id, and i thank you for that. i think was absolutely correct

decision. that decision was made because it did not have markings that made it clearly different from normal licenses. that was a great decision, and i want you to know the number of members of congress who supported that decision and thank you for having made it. >> doing my best to comply with the law, congressman. >> thank you, mr. secretary. 's concludes today's hearing. we thank you, secretary, for joining us. without objection all members let five legislative days to submit additional questions for the witness or additional materials for the record. and with that the hearing is adjourned. [inaudible conversations]

>> [inaudible conversations] [inaudible conversations]

>> on the next washington journal we will talk about the department of veterans affairs. also, the release of the latest agriculture center. washington journal begins live at 7:00 a.m. eastern time on c-span.

>> solis in the results when you have this classic cold out. hold out? they're starting to block traffic on internet service for customers. wonder why your cable bill keeps going up? one big reason is that the the fccon of these -- is really hamstrung by the rules and the ways that are interpreted to get involved here, the easy result is these parties eventually agree to deal , which gives consumers lots of channel sedona actually want care that is what i'm afraid of. i think to say that interconnection happens in a private way is great, and i think there definitely should be

way for private deals, but if we think yout point, i would be a real tragic outcome. >> this weekend on c-span, saturday morning at 10 a clock a.m. eastern. real america features u.s. government films made during world war ii by academy award-winning director frank capra third sunday afternoon at 4:00. c-span's new book, sundays at eight. any of the problems that we at thethe end, begin very beginning. i spoke about the intent to control all institutions and control all parts of the economy and political and social life. and you do that, when you try to

control everything, then you create opposition and potential dissidents everywhere. if you tell all artists they have to paint the same way and one artist is no, i don't to paint that way, what to paint another way, you have just made him into a political dissident from someone who may have otherwise been a political. be youngs have to pioneers, which is what happened in a number of countries. thatroup to sizes are like and so they form a secret underground boy scout troop, which absolutely happens. underground scouts were very important in poland through the comments. period. >> read more in sundays at eight, now available for a father's day gift that c-span.org.

>> you cannot take c-span with you wherever you go with our free c-span radio app for your smart phone or tablet could listen to all three c-span tv anytime or c-span radio . there's a schedule of each of our networks so you can tune in whenever you want, play podcast of recent shows from our signature programs, like .fterwards take c-span with you wherever you go. download your free up online for your iphone, android or blackberry. a news briefing yesterday, he'll speaker john boehner and other republican leaders discuss and as a leaker edward snowden and wait times at veterans affairs medical centers. several members of congress have ofled for the resignation the a secretary shinseki. this is about 15 minutes.

>> there are 150 open jobs in the small community of hartford city. thisve a skills gap in country. we have too many people that don't have the skills for the jobs that are open. we have too many young people that don't have the skills you can coming out of college. our work force training system is supposed to help fill that gap, but it is a bureaucratic maze. it is very difficult, if you're unemployed, to even get through those workforce training systems. that is why the skills gap is an important step forward. it will give people direct access to in demand jobs. when you show up at a training center and city want a job and you have an idea, you can move faster to get into the right workforce training. it is going to help employers

make sure that they can provide those workforce training centers job opportunities at our unemployed need. it is going to take a lot of flexibility to fund the programs to make a difference. we can work together. this is important that the house and senate work together and that we passed the skills act. we are working on it, there is positive momentum. we can get this done, and it will make a difference for those 4 million job openings. there are bipartisan solutions the house has put up third when need the senate to work with us, and we need to build those 4 million job openings in this country. thank you. >> the american people continue to struggle under presidents weak economy. families are paying more every day for items like ask, groceries, and their health insurance. and while, their incomes under have done nothing but fall.

there are nearly 40 jobs bills in the united states senate. fortunately, senate democrats -- unfortunately senate democrats continue to block those bills. tiredthe same antibusiness policies that don't work. i am wondering when are senate democrats here in washington going to listen to the american people and focus on creating jobs, not destroying jobs? >> good morning, there was recent news out this morning about first quarter gdp numbers. think that that announcement continues to create doubt in the minds of the american people, not only about where this economy is heading, but it inroads again the trust they wee in their government very have come here week in and week out and said that the house is

working. we're trying to focus on getting people back to work. we are trying to focus on an america that works with solutions. over 200 bills still sitting in the senate, many of them are bipartisan bills. some of them have democratic leads sponsored. but harry reid in a democratically controlled senate refuse to take this up. they refused to help us do constructive things to help get america working again. susan brooks just talked about the skills act. this is one bright exception. we should be able to take that act, let's see the senate we will be ready to act in the house. this bill is squarely aimed at helping those who are chronically unemployed access cisco sues -- accessed the skills they need to get employed. these join us, and the president, please join us in helping america work again.

>> members, we are back home on memorial weekend. we continue to you the report. the president was just now finding out about it. once again, the house has not been sitting back in in 2011, i heard from my veterans. myself and another of other members asked for a gao study on the weights time of these veterans. your know we cannot? exactly what we know today. chairmany of 2013, miller and myself wrote a letter , to look directly at the gao report and the wait time for. january 2013. the president is claiming that he just now knows about? the request to implement the gao report, the request to make the

recommendations. they have known about this. there've ignored it, just as they ignored our jobs sitting over in the senate and is a candidate for one to his right, how would you veterans is in direct correlation to a think as americans. to defend our freedom and this is a way you treated? to the acid question is saying you're just finding out about it? the house republicans have sent you a letter to change it. we have been ignored. >> today, i want you to remember and reflect on the america that you grew up in. for me, it was an america in which anyone, i was a farm kid who worked my way through college, spent some time working at the drive-through and

mcdonald's, clean rooms, which i don't ever want to do again, so that i could achieve better things. it was an america that was the most innovative, competitive country in the world, and one where hard work was rewarded with the promise of a better life. for my kids and euros, that is the america that we want to move forward. we have seen the numbers, 800,000 americans dropped out of the workforce last month alone. nearly 4 million americans continue to be on unemployment, long-term unemployment. it is a current path and it is clearly not working. in the last five years, we have learned one thing, it is that an increased tax burden and more debt leads to fewer jobs and less opportunity. we have seen it in our own eyes, and people back home that are discouraged because they can't find a job. moms and dads who are struggling to support their kids. millions of americans are worried they will be able to pay their bills at the end of the

month. we can do better. we owe it to our kids to do better. that is why the republicans continue to work on this legislation, on dozens of bills. we ask the senate to join us, join us in supporting the skills act. join us in supporting other legislation that dozens of bills over in the senate that are waiting for action. let's leave our kids a better america. one in which every single person in this country has the opportunity to succeed. >> hard-working americans continue to suffer under the obama economy. the costs for everything continue to rise well household incomes remained stagnant. it is not surprising that a majority of americans think our economy is on decline. the president wants to double down on his agenda by adding more taxes, more red tape.

the house is committed to solutions that get government out of the way, and we are championing policies that give the middle class opportunity to bounce back hurt americans are fed up with the new normal. we are paying more for everything while taking home less. , itead of campaign rhetoric has become standard for this administration. i heard the president -- i urge the president to call on the senate to act. the accountability act. the save american workers act. americans needed plan, and we have one. >> last week you said you're getting closer to calling for shinseki's resignation. >> i'm going to continue reserving judgment on general shinseki.

is, isstion i ask myself his resigning going to get us to the bottom of the problem? is it going to help us find out what is really going on? the answer i keep adding is no. the real issue here is that the president is the one who should be held accountable. as kevin pointed out, we sent a letter going back to early 2013 talking about the gao report and asking for his recommendations to be implemented. for the president to say he did know anything about it is rather shocking. so, the president is going to need to step up here and show ome real leadership. it is pretty clear that he will resign at some point. what type of person do you think theeeded to restore

reputation? >> first we have to figure out how to get to the bottom of all the problems at the v.a.. this is more than just about phony waiting list. this is also about the quality of care that we provide for our veterans. there is a serious problem here, and we need to get to the bottom of it before we begin to prescribe what the diagnosis is for treatment to fix a problem. [indiscernible] >> edward snowden is a traitor to our country. he is damaged our ability to keep americans safe here and abroad. there is no other word that should describe him other than a traitor. [indiscernible]

let's listen, i am not qualified to debate the science over climate change, but i am amazed -- astute enough to understand that every proposal that is come out of this administration to do with climate change involves hurting our economy and killing american jobs. that can't be the prescription of dealing with changes in our climate. next. thanks. [indiscernible] so, my son paul was in the hospital at children's national. we were waiting to have his open-heart surgery. withd been diagnosed general heart defects and had to

have the surgery otherwise you would die. while we were waiting for the surgeon to come back from overseas, eating in the hospital , realizing always of the families were there. you are in the trenches with them. this family, maggie's family, maggie had been through nine surgeries in nine months, various different problems. as daunting as our situation was, we were really feeling for them. we were in the waiting room every day, walked past maggie's bed on the way to paul's bassinet. the day of all surgery, we came in and maggie's family wasn't there. she had asked away the night before. hard that the family had spent so much time waiting for to get out of the hospital and she did not make it. ,e went into surgery that day and eight hours surgery, his first open-heart surgery of three. as we were sitting in the

cardiac intensive care unit watching through a clear plastic bandage, my son's heart beating, which was a moment in and of itself. the nurse comes over and says you have a phone call. they brought me a phone, and it was maggie's mom, checking on paul's surgery. the strength and the grace and the fortitude it took for a mother who had lost her child the night before to call and check on our child, i think was a moment that i will always remember. anchor readchannel baier, sunday night at 8:00 on c-span's q and a. affairsn brings public events from washington directly to you, putting you directly in the room at congressional hearings, white house events,

briefings and conferences, and offering complete gavel-to-gavel coverage of the u.s. house, all as a public service of private industry. we are c-span, created by the cable tv industry 35 years ago and brought to you as a public service by your local cable or satellite provider. watch us in hd, like us on facebook and follow us on twitter. jim murphy held a briefing yesterday to discuss ways to better treat mental illness. congressman murphy is a clinical psychologist. he is joined by forensic psychiatrist and a man whose son has its a friend you. this is an hour and 15 minutes.

>> last weekend, a man known to be mentally ill killed himself and others. tucson, new town, aurora colorado. there were many victims. young man who the is a mental health crisis but was denied extended patient care before he killed himself and

stabbed his father, a virginia state senator. all had untreated or undertreated illness. all spiraled out of control within a system that lacks a basic mistake -- mechanism to help. many had parents who were pleading for more help. among persons with mental illness is extraordinarily rare and is far more likely to be self-directed. there were 40,000 suicides in this country last year, almost one million attempts. the mentally ill, sadly, are more likely to be the victims of violence, robberies, beatings, rapes and other crimes. the mentally ill are also 10 times more likely to be in the hospital. is because he seriously mentally ill and counter law enforcement after they are refused medical care. what makes it painful episodes so compounding and a reality that so many tragedies involving a person with a mental illness are entirely preventable.

elliott rodgers family would've been able to ask the courts to order an emergency psychiatric evaluation. in california, the law says they cannot. the families know, when a loved one is in a mental health crisis and the condition is gravely deteriorating, but, as my subcommittee to scribe, families are shut out for being part of the care delivery team. as a road in the post-gazette just two weeks after the newtown, the lesson is that we better take off our blinders and deal with such illnesses or we are sure to face the same problem again. it is not only what is in the person's hand that makes a person of ireland, is what is in the person's mind. how many must die before we finally deal with our broken mental health system? in that nearly year and a half since i've been investigating america's broken mental health system is a chairman of the congress that congressional

subcommittee, even with my 30 year background in clinical psychology, i have been shocked to learn just how much our country has failed those with serious and persistent mental illness. the report reveals that the current mental health system does not respond. we do not empower parents, patients, clinicians, law enforcement and others to stop this from happening. even in the face of these tragedies, we have been too uncomfortable to knowledge this sobering fact, because the last bastion of stigma in mental health concerns those with serious mental illness. between january, 2013 in march this year, an investigation held a dozen public forums, and expended considerable hours determining how mental illness is being prioritized. the committee focused on three areas of critical public policy oferest rate one, the scope society's problem that is unseeded mental illness.

mental health situations third three, how federal resources are being spent. we have heard from the director of the national institute for paatal health, experts on hi the roots of the failures of the current mental health system and begin to identify legislative path to reinvigorate and rebuilt the system. reef we come here are our main findings. first, families have been shut out from the treatment team. the inability of an individual experiencing a serious mental illness to recognize that they have an illness, a neurological condition, elevates importance that the individual family helps that patient get the treatment. persons with serious mental illness like schizophrenia or

bipolar disorder. health care providers often misinterpret the information, portability and accountability aa privacy rule. in some cases heard by the committees, the lack of understanding of the privacy rule was so persuasive, the film is rector told they could not even give information to the doctor. three, there is a critical shortage of psychiatric beds, shortage of providers and shortage of out nation treatment options for patients dealing with a psychiatric crisis. not go backd will to the 19th century. for those who need acute, intensive therapy, there are not enough places, none of doctors and not enough community to help them. a person with mental illness must be homicide death must be homicidal or suicidal before we

can give them treatment. it is like denying a patient care until after they have a heart attack. number five, federal resources are not targeted toward serious mental illness like schizophrenia, bipolar disorder and major clinical depression. they're often at the end of the line when it comes to receiving effective help across a spectrum of services. anti-psychiatrist activists have used federal resources to block care for the hardest to reach patients. we know that proper intervention can be very effective in providing health to those with serious mental illness to get in back towards being independent, holding jobs and recovering. our report provides a legislative to rebuilding our mental health system and finally taking it out of the shadows and into right hope and recovery. where there is no help there is no. , -- thishat end

afternoon we're joined by federal experts who should be familiar to those who attended or follow this committee's work on serious mental illness over the past year. he is an advocate for mental health reform. his everest to maintain the best possible treatment was repeatedly stymied in no small part to misinterpretations of aa. mr. jaffe is a founder and director of the policy organization. the firstecame sister-in-law who had schizophrenia. he's a clinical and forensic psychiatrist whom courts have invited to examine many of the most complex cases and notorious killers in america. dr. welner has been a leading edge of limiting mass killings

for the last decade. i thank all of them for being with us today. i would like to welcome a couple of my colleagues. a doctor from the city of georgia, i welcome you, and a dash and an attorney from the state of virginia. some people want to grab a seat, they're welcome here. i want to leave a couple of center seats for members of congress. those standing in the back can,. we're going to ask person and maybe talk for five minutes. just make sure your button is on. >> thank you, congressman. a few housekeeping items. my name is ed kelly and i am the parent of three children, one of

which is paranoid schizophrenia. we have been going through virtual madness for 15 years. importantly, this is different than in the past. there are more cameras. on the off chance my son sees this, i want to tell him i love him and i am doing this for him. that is a risk we take when we do this. our resume as a family covers 15 years of dealing with our son descending into a madness that is impossible to describe. those 15 years include over 30 hospitalizations and seven different hospitals in four counties in the city. door,rs of the revolving trouble with the law, dealing with the courts, dealing with the state's attorneys, dealing with hospitals and social workers and everybody here a gatekeeper somehow the mental system -- mental health care system, years of judges

ridiculing us and saying we are not going to warehouse your child to make your life easier, your zip or services, good people who want to provide great services to our son. their sand because what they're educated and trained and committed to do you not allowed to. are committed to this battle, we are committed to this battle. i'm about to tell you about an army that is committed with us. more importantly, our son refuses our help. his illness refuses our help. as a result, we have watched for , we have watched the laws support his delusions instead of our needs. my wife teaches family support groups. i will tell you, and all due respect to mental health america, the reason she went there is because she was shocked and angered by how she was -- how she would refuse to believe that not everyone will volunteer.

it is an impairment of the brain that causes you to refuse treatment. you're willing to do about anything. i've seen him think he was cia, a u.s. marshall, veteran of both gulf wars, did not believe we were his parents for three years. he has lived under bridges, boarded up our wouldn't -- our windows from inside and done things i can't even tell you. he is been beaten, robbed, at hishim up in shelters own intentions. if you think that is someone, after 15 years, that is voluntarily looking for treatment, i ask you how many years is enough. i have spoken in front of federal and state hearings. last year had the pleasure and privilege of being part of the state of maryland's department of mental health hygiene's continuity of care program, which is a five month exercise. i want to ask for forgiveness for what i'm about to say.

five months we focused on one topic, how do we deal with the most years the mentally ill are 18 and older? after these hearings and after that continuity of care, there is one painful fact that has emerged that i must share. that is that the opposition groups do not care but my family, they do not care what my care about my son. only care about their own needs. treat the seriously mentally ill who don't believe their ill in a manner that you think they will seek treatment, because they will not. you're putting at risk, you're putting my wife it at risk. you are putting my neighbors at risk. these reached out to groups.

there is not movement in support to try to make something happen together. ridiculed, told my testimony is saying him lying. -- i'm lying. is doing something different this time. it is not the tragedies of columbine and virginia tech and everything else. families did not want to do what i was doing when i first started testifying. you are pouring your heart and soul out to complete strangers. we are letting you into our lives. i have seen people crumple and fall to their knees and cry trying to get out their story. that is why you did not have people doing this. there are 7 million families who share our plight. if you don't think that is a large number, we did around mass. 19 immediate family members. 30 close friends.

it is about easily 50 people time 7 million people. then you take the people who are handcuffed and cannot provide treatment. it is unimaginable. times are changing. i want to tell you the pain of standing here and talking to each of you is far less than accepting the pain that it will never change. hipaa needs to change. our family has not known where our son was. hipaa cannot tell us he has been released. --gine you cannot tell us find out whether your son has been released. he has no transition of medical records. every time he goes to a hospital, he is a guinea pig. sometimes the only force the doctors listen to is psychosis and delusions. when he gets released, we are

not involved with that. anyou don't make aot alternative, the only choice is in hospitals. we prayed and waited for the laws to except that we were right. every time we do that, we are a risk. if he does not get into the hospital and he does not have aot, i want to tell you what happened. signs of serious mental illness when you are in the downward slide of very subtle at first. the families see it first. but we are not listened to. the poor family that heard on the radio about the shooting. i cannot imagine. we're are the first ones to know. we can tell when the delusions and voices are taking over. we can see his personal hygiene declining. the next thing you know, he disappears.

no baths, no showers, no shaving, no haircut, tattered clothes. in about two months, he is this person. , can't imagine what he smells like, hair down to hear, beard down to here. he looks like he is lost about 40 pounds, sleeping under bridges. at his own choice. then he walks through our neighborhoods and shopping centers and talks to himself and scares the hell out of people. you want to talk stigma? that is were stigma comes from. that is what hollywood portrays. that is what happens to someone who is not treated. then what happens? the support network starts to pull back. usually it is too painful to watch. that person becomes isolated. they become frustrated and angry. then you have psychosis, loneliness, isolation, anger, and then they self medicate. and you wonder why things in california happen?

beckett acknowledged in a hundred 20 page document how i still waited and frustrated he was -- isolated and frustrated he was. you sit those parents down here and they could have predicted this long ago. our system refuses to accept that families can play a major gatekeeping role in safeguarding role for all of you out there. when lawmakers are making decisions, they need to make incisions without fearing the wrong things. don't fear the threats of unconstitutionality. don't fear the threats of lawsuits. those groups don't care. you need to care. this could happen to your child, or your child's child. try that one. someone is try to help their child help their child. to make it publicly to senator mikulski. get the appropriation money in place for this part of the bill to pass. it has been made law, it just needs to be funded for an aot

grant program. you did it for alzheimer's. thecan deal -- do it for rest of the mentally ill population. for the lawmakers, when you put your hat on the pillow tonight, ask yourself how important this law would be to you if one of the members of your family had this going on or your next-door neighbor. you could be the next family. it is growing like crazy. i don't have an explanation for it. i am asking you to care. too much of the families. if the families ever give up, you are in deep trouble. thank you. >> we appreciate that. >> wow. point, both gerald lochner and james holmes were identified by the mental health system is needing treatment. aa kept their parents in the

dark before the tragedy. what he is talking about israel. -- is real. i want to think the congressman and mr. murphy, congressman murphy. what you are seeing is something different going on. we have had tons of mental health bills. this is the first one that focuses on the elephant in the room, which is how do we get people known to have serious mental illness and particular adults -- adults known to have serious mental illness to go untreated? doesis the first bill that that. we agree with the majority report. we are not advocates for mental health. we are not advocates for improving the mental health of all americans. we are advocates for the most seriously mentally ill. not all mental illness is serious. have theirlts can

mental health improved. 20% of adults have a diagnosable mental illness. that is people in this room and your coworkers on prozac or zoloft to were doing quite well. only 4% have severe mental illness. we have to stop ignoring the most seriously ill. we cannot go on pretending that they do not exist. until the 1960's, virtually all mental health expenditures were spent on the most seriously ill because the expenditures went to state psychiatric hospitals. after that, at the request of the mental health industry, the funds are now spent on all others. as a result of this shift from

focusing on the seriously mentally ill to try to improve the mental health of all others, 164,000 are homeless and 300,000 incarcerated. a disproportionate number of them are people of color who cannot get treatment. i get calls from people all the time. they beg and plead for treatment for their adult children known to have serious mental illness and the mental health system turns them away. they fund everything else. the mostw how to treat seriously mentally ill to see that the gain, to see that they get treatment. we have to prioritize spending. this is one of those issues where it may not be that we are not spending enough. we spent $130 billion. what we have to do is start sending the seriously ill to the head of the line. we have to replace mission creep with mission control.

if we do that, we can start to address the problems we see. hipaa. talked about i there are some seriously mentally ill people who need to be in hospitals. we do not have enough hospitals for them. we need more hospital beds. does not ignore that. it recognizes it and starts to fix it. if we can only do one thing, i want to cut spending. stop samsa from funding anti-treatment advocacy and stop empowering that. you can see a lot of information on our website how they do that. samsa is the biggest problem we have. we have to recognize that some people are so sick they do not know they are sick. when you see somebody going down the street screaming and voices only they can hear, yelling that

they are the messiah, it is not because they think they are the messiah. they know they are the messiah. the illness tells them they are the messiah. as the messiah, they are never going to volunteer for treatment. we have to recognize this reality. most importantly, we have to expand the use of assisted outpatient treatment for a very small group of people -- the most seriously ill. earlier, i talked about 4% or 5% being mentally ill. there is a small subset of that group who do not recognize their ability to get their need for treatment, who already have multiple arrests, multiple incarcerations, multiple instances of homelessness all associated with going off all

and terry treatment -- voluntary treatment that was made available to them. what aot does, after folder process, for this tiny group of people, and including a lawyer, it allows judges to order them into six months of mandated and monitored treatment in the community. in the community. it has been proven to reduce violence 66%. arrest,omelessness, hospitalization, incarceration 74% each. peer support and trauma informed care do not do that. spirit, aotith the prevents us from needing expensive, inhumane inpatient commitment, incarceration, or hospitalization. it allows people to live in the community. it is the most humane thing we

can do. it is an off ramp before jail. it is like putting a fence at the edge of the cliff, rather than an ambulance at the bottom. from policee heard chiefs, sheriffs, judges, homeless advocates, parents, and children of the seriously mentally ill in support of aot. the only opposition comes from funded mental health industry. that is the only opposition. they are basing their opposition based on stuff that is not fact. it does not force -- it does not drive people from care. wellaid it helped them get and stay well.

one police chief said it best when he told the committee we have two mental health systems today serving two mutually exclusive populations. community programs serve those who voluntarily accept and seek treatment. those who refuse or are too sick to seek treatment following terribly become law enforcement responsibility. mental health officials, semenally samhsa, responsible to take responsibility for the second group. this puts the public at risk. i think representative mercy -- murphy, i think the congressman who support it, and i support my fellow democrats. i am about as liberal as you can get. for too long, we democrats have failed to ignite unpleasant truths, like not everyone recovers. sometimes hospitals are needed.

left untreated, there is a small group of the seriously mentally ill who do become violent. hrt i say is we have to pass 3717. we have to move from a system that requires tragedy to one that prevents it. attachedbsite, i have my statement and you can find more information. >> dr. wilner. >> thank you. we really appreciate hearing from you, learning from you, and we want to thank the members for coming. certainly those of you who are here today, we appreciate you taking the time, taking it seriously. denialomes a time when is no longer possible. we have reached that time. many of us and perhaps most of us are here now because of that denial. thick about it.

-- think about it. because we have denied that serious mental illness unmanaged can go away just because you will it to, what do you think happens to serious mental illness? what is the difference between serious mental illness and just mental illness? well it is serious enough to warrant treatment and it does not just go away because we deny it exists and we avert our gaze. we are here because we are in denial that serious mental illness does not just go away because hospitals close, so the people in the hospitals get discharged. where do they go? we are in denial because the biggest institutions of the world in america are now prisons. congratulations. you have the right to remain silent. feel better now? you are not in an institution

which could benefit from modern medicine. forget the sanitariums. a reasonmore than just of regulation and accountability that congressman murphy speaks to for why we are not going to go but -- back to the psychiatry of old. this is why psychiatry does not step up to the plate. this is not a form of psychiatry. we have better treatments and more accurate treatments and more precise treatments, more humane treatments, more researched treatments, we spend on thelion dollars decade of the brain and we have something to show for it. when you contrast that with the money we spend on wars. we have a windfall from the decade of the brain which could be treating people who need serious treatment for their serious mental illness. it is there. it is humane. it is digestible. it is palatable. it is not savagery. in "one flew over the cuckoo's nest" is about as outdated as shirley temple.

it is time to get past that thinking. it is quite antiquated. we are in denial. not just about serious mental illness, but about crisis mental health. which is what brings us here today. we have heard about schizophrenia and bipolar illness. i am here to tell you, as a frantic psychiatrist, and i have interviewed mass killers who have spoken to length and i have talked to people who have carried out crimes that we think are unthinkable and sometimes they are psychotic and sometimes they are not, as much as we hate to admit it. one thing they all have in tom and is that they are in crisis. we are here because we are in denial. but if someone gets discharge from an emergency room or hospital, the crisis goes away. magically. we are here because we are in denial that if someone decides if someone is not dangerous enough to be hospitalized, well, that means the crisis will go away.

we are here because we deny -- forget that you -- how many of you in this room know someone who has committed suicide? who has made that choice? who has made that choice thinking about? not delusional. people make permanent choices because they want things to be dramatically different and they may be in crisis and the world may be black and that is a blackness that they cannot endure. you know and i know, as people who are still here and grieving them, that if they just got the right care and the right intervention at the right time from the right people they would be here with us today. do we feel so much better that they have the rights six feet under at room temperature? does that make us feel better? does that make us a better society? i will let you answer it. i will at the members answer it. this is a crisis mental health

bill. it does not direct itself that every single person who has ever had a diagnosis. it does not direct itself in an intrusive way. it directs itself to the individual who was in a place at a moment in time who lacks the insight to recognize that they are in a place where they are about to make a catastrophic choice. you cannot let the crisis run the situation. this is why one has leadership. members of the house of representatives are leaders chosen by the people to lead, not to placate. doctors are chosen, doctors are trained to make choices that may be difficult, and sometimes, and i can tell you this as a clinician who started my career treating the violent -- imagine if you will, close your eyes and imagine this scenario of someone i knew to be violent as an on armed person not owning a gun.

let's put the gun thing aside for a moment. this person was on the cusp of being violent. should i commit him or should i not? the repercussions might be that he would be so angry and feel so betrayed that his next violence victim would be me. no decision that a clinician makes to commit someone forcibly is made without great ambivalence because we are on the frontlines. i live in new york city, were any of you who follow the news know about a psychologist who was knifed by a patient. we have our own safety issues. we don't see patients behind bars. we see them in private rooms. you are exposed. i have had patients in my office get violent. i had one guy beat the hell out of his father. i had to drag them both down to the street because i did not want them to mess the office up anymore. i had to hold one down while i call the ambulance to come. when you have those kinds of

experiences, he recognized that you are. but that you also have to preserve and protect the alliance with the patient. of course we try to negotiate a voluntary resolution. sometimes it is not possible. especially with a person in crisis, who denies that there is something wrong. point wherech a denial is no longer possible. isn't that why we are all here? with this isla vista thing? what it has blown the doors off of is the denial that when someone carries out a mass not, that they snap. i think you made it quite clear that he was contemplating and at least before he bought his first gun, way back in 2012. can we now dispel the idea that all we have to do is get these people help? let's just get him help and this will never happen. he was in help, he was getting

therapy. he was getting therapy from before woody allen was getting therapy and he was still in therapy. and guess what happened? investedkiller is so in the life choice -- we may think it is irrational -- but that is our world -- a person who makes an unacceptable choice to him and his world, he is so invested in it, that he will pull it together in such a way that police, who may be very and sit and can count down and say, nice boy, have a good day, you take care. the parents know. right? the families know. sometimes the relationship is afraid. -- frayed. as a doctor, you draw history from those folks.

as a physician with a person who is in crisis and i feel that i can help the person in my office, but the crisis is not resolved -- what happens when the person goes out the door and the family can be an auxiliary safety net? aa says i cannot talk to the family because the patient is not imminently dangerous. the family has no idea what is happening. it is a betrayal. this is a law that is a betrayal of a sacred relationship of intimacy of a family that would do anything for loved one, more than a doctor would. it is not fair. it is not right. i am plenty confident in my ability to assess a person in an emergency room about whether they are a danger to themselves or others. you and you know you do not want to come in the hospital. you do not want treatment.

you are looking at the world the way you want to look at the world and we are going to agree to disagree and you know that you have to tell me, no, doctor, no, we just had a misunderstanding. i just had a little bit too much to drink, but i am ok now. i was just crashing from the cocaine, but i feel better now. i will get into detox. and you give me the card for a referral? but the family that i'm not allowed to talk to can say, she is going down the drain. somebody do something. this country is full of people who have thought in their head, somebody do something please. somebody do something place. before the suicide. before the self injury. before the homelessness. before the child under the bridge. before the loved one gets the tar beat out of them. before the next beating from the abusive husband. before the next father who was

abusive within the home because his seven-year-old is to a mature to articulate. somebody do something. hipaa is a law that stands in the way of crisis situations. i want to underline this just to dispense with the political distortion. we are talking about crisis situations, where the doctor can make a collective decision. this person is going to walk out of my office. i am not going to commit them. this is a precarious situation. i need help. hipaa will not let me help my patients. i have better care that i want to combine with a better love. in a humanistic profession. that law will not allow me as a psychiatrist to be human. i don't know any psychiatrist who does not go through that experience and who would not feel that they trust themselves with the latitude to make a decision when something is a crisis.

if you don't have that confidence in your doctor, go pick another doctor. it is a free country. you know? but if you trust your doctor, you trust them to make that appraisal. ofwe come to appreciate it denial brought us to this situation. all of these police officers who went to check out this one individual who did a disgusting thing in california, let's call it for what it is -- that is a familiar pattern. family expresses concerns, family smells it, authority looks into it, person in a mental health crisis does not want help, or lacks the insight or is invested in a bad outcome -- let's stop for a minute here. people who carry out mass killings, these are long, premeditated crimes, they are

invested in making it happen. they will pull it together and they will do everything they can to protect their agenda. you have someone who cannot hold down a job, who cannot keep himself in school, who could not be unselfish enough to maintain a personal relationship, but what he could do is write and rewrite and stage manage a production for youtube. you think he really looked like that? that was a best possible camera angle that he could ever summon from the director's son. that is not saying anything flippant about the family. it is the same thing as the silly gunplay over to abc. you think you look so tough in real life? that is how we get there in the first place. he is invested in becoming a different person. thatse of that, because of we have to appreciate that if somebody smells trouble and the

danger is so catastrophic, we have to trust families. we have to trust families to know there is trouble ahead. we are not giving families the wherewithal to be involved. i respect psychiatry's capabilities. i believe that families need to be directly involved. we have court systems. we have the ability for judges to sorted out. we also have a revolving door of commitment here the people are familiar with. how does that go when somebody is actually able to get care? and the family input is not disregarded? well, the person goes into the hospital, where they are greeted with a strong incentive to discharge them as quickly as possible because there are not enough beds. as congressman murphy has so properly and courageously pointed out. the person in crisis wants out

also. they know exactly what to say. if they do not know what to say, they asked the other patients. just say this, just say this, and then you will get discharged. they get discharged. to go right back to the family with no owners manual. what happens to the family? confidence ines psychiatry. it happens enough times, the family is going to say, what's the point? andfamily loses confidence mental health, the person in serious crisis is lost to treatment and then there is a bad outcome. i want to give everybody opportunity for asking questions. i'm going to make a couple of very quick points and then open the floor and allow everybody to get involved. there is a certain amount of talk about stigma. let's take to hypothetical people that are walking down the street. let's take a bully who looks for the week person to prey upon.

folks are identical twins. they both have a serious mental illness. one takes his medicine and one does not. the person who was taking his antipsychotics is not experiencing side effects because these medicines are easy to take. the person not taking his medicines is experiencing florid symptoms. which one do you think is going to get stigmatized? let's put both of those folks as job applicants. which one do you think is going to get hired? which one do you think is going to build to pass a class or be thought of as more intellectually capable and to have more ability? illness thatial of is responsible for stigma. treatmentdenial of that is responsible for stigma. it is a disrespect for psychiatry and what it has accomplished that enables

stigma. no medical specialty has to encounter the adversity that psychiatry has. you have pediatricians who promote vaccination and they are never stigmatized for causing a public health problem. who treatsychiatrists with medications and have to contend with a budget, a budget that is controlled by folks who are anti-psychiatry. i respect holistic medicine is much as the next person. you should see the diet my wife has me on. be that as it may, we would not have holistic medicine control the budget of medicine in surgery. competing perspectives. nothing against the organizations involved. with that said, i realize the members have a difficult choice. i also realize we have a full room. we have the nation watching. for that reason, i want to underscore -- you think you are

tired of it? you think you are tired of the adam lanza's? tired of thisre clown in california looking for his 15 minutes of everybody's going to see him at different way? so are we. people are doing something about this. if it matters to you, we have an election coming up in november. ask yourself. you are going to go into the ballot box, you're going to make a choice. would you vote for somebody who ran on a record that said that he would not change commitment laws to make sure that adam lanza's mother could get him treatment in a community? would you vote for a person like that? would you want him to run on a record saying that you support laws that keep the parents from knowing they were going down the drain of virginia tech? is that the person you want to

be representing her interest in the community? would you vote for somebody who would run on a record saying jerodyour lawn or -- gera launer on personal? if we are in denial, we can always say the illness happens to somebody else in someone else's family, but when you have a mass shooting. i don't think abby giffords anticipated that she would be shot. i don't think anybody it would happen to them in california. i don't think anybody forgets that russell west tried to get into the capital and got into tom delay's office shooting before he was subdued. let me tell you, i did not forget.

it was a physician that saved his life who was in the u.s. senate. doctors are trying to solve this problem. we are blessed that a psychologist has devoted his energies the way congressman murphy has to this. i would encourage you to have a dialogue with your congressman and to tell them that you feel it is important, imperative for us to change commitment laws to enable people who need help, who are in crisis, to get help, before they are dangerous. so that families can be involved in a way. families know and families love and families can keep us safe. thank you for coming. >> thank you, dr.. recognize marsha blackburn of tennessee, bill johnson of ohio. we have a few minutes. i want to see if any of my colleagues want to make any

comments or questions regarding anything that has come up. anything anybody wants to say? >> i appreciate what you are doing, tim. we need to move forward on this legislation. this is very important. thank you to the panel. this is such an important issue. it is timely. we have to prevent these things from happening. ablenly thing that we are to do is help empower families and patients in mental health. >> thank you. >> i want to make one question of the panel. one thing that comes up is the question of denial. there is an urological basis for denial. some people call it a non-consensus reality. as aere such a thing neurological basis for denial? >> we are still learning a lot about it. the physiological appreciation

is that when a person suffers a stroke on the right side of the brain, the neglect an entire side of their body. that that from one single event, that one can actually be of the belief that partisan does not even exist. there is a physiological basis for denial of illness. that is where it originates. there is a lot of thinking within psychiatry that for those who are irrational to the degree that they are psychotic, that there is something going on with them physiologically that resembles anna cigna shthis. everybody in this room has denial of something. the question is, at what point are we talking about the physiology of a psychological to an actualposed

physiology of illness? it may be specific to the diagnosis. some folks who have chronic mental illness who are young men deny illnesses such as schizophrenia because they have been exposed to too much stigma, saying they have no hope. we can promote public health that encourages people that if you get treatment early and appropriate, that you have avenues of accomplishment open to you and that will have an impact on denial. the answer is both. >> thank you. i am going to see if other -- if members staff who have questions . clarifying questions on the hearing or anything like that. i know some of us have to run to the floor. if the press has questions you want to ask of the panel, you can stick around, if that is ok. i'm from laszlo congressional bureau. >> i want to have staff first.

>> ok. sounds good. >> i want to make sure we are going to run and make our votes on the floor. no other questions from members? this is a briefing on our findings. this panel has been involved and has participated in the hearings. please feel free to ask clarifying questions. if one of my staff could moderate. dr., did you have any questions? you are ok? thanks. chair ofss is the vice the health committee. the welcome member of the committee. you can continue here if you would. thank you very much. thatart of this bill

representative murphy has put forward six to immigrate behavioral health in primary -- seeks to integrate behavioral health and primary care. you have said that you would not have much trouble in er settings telling if someone had trouble and warning signs? mr. rogers manifesto seems to suggest a than an aggressive and violent incident that he admitted he instigated brought him to the er and that was the final straw for him. there is the suggestion of telemedicine as a way of keeping mental health professionals in the loop with er care. however, there is a competing thator maybe another bill representative barbers put forward strengthening mental health in our communities act.

it has 40 cosponsors. foreeks hhs awards co-locating behavioral health services in primary care settings. i was wondering how you think that plays with telemedicine. is it better? can telemedicine work as well? i appreciate your input. >> i think both bills have telemedicine in them. somebody who thinks their messiah is not going to go to their messiah is not any more likely to go to a psychiatrist. testimony --ed my there is a comparison of the bill barber proposed with the byl that is being proposed 86 cosponsors, including democrats and republicans. i think those supporting the barber bill have been misled by

the mental health industry. again, i am a uber liberal democrat. but when nancy pelosi told roll call that she wants a bill that was supported by the mental health industry, the barber bill got it. it gives the mental health industry more money without requiring them to serve the seriously mentally ill. we cannot pretend they do not exist. telemedicine is related more to takers inimary care rural areas access to psychiatrists who do not live in those areas for consultation. >> i want to take -- i want to add to the response. i have mixed feelings about telemedicine. i think what congressman murphy has been attempting to underscore that has not come across more clearly -- i want to underline it. there is a serious shortage of

mental health per for -- professionals. above all, a serious shortage of needed specialist. what do you do? you want to make an immediate fix to people who have mental health needs in non-served areas, let alone underserved areas. you can use technology to ramp up a solution. i view telemedicine as a bridge. i don't view it as a long-term solution. but we have a problem that needs immediate resolution. i think the solution is on a national level we have got to turn the behavioral sciences into a growth industry. spend a bazillion dollars getting people to like obamacare -- and i am not telling you my position about it -- but considering the amount of promoting went into obamacare so that people would experience it as warm and fuzzy, forget your feelings about it. i'm just talking about the promotional level. if we spent a fraction of that

budget on promoting the behavioral sciences for how wonderful it is, i could tell you this as a psychiatrist. it would give someone their life back, their outlook that, their soulback, to restore their , to give them some sense of future. what an amazing gift. i went to medical school. i picked psychiatry. i made that call. the reason others do not make that call is because psychiatry should be promoted the way obamacare gets promoted. i should have people saying, want to be a psychiatrist. i want to make sick people well. i want to be a crisis psychiatrist. it is the mental health equivalent of the navy seals. if we look at people in crisis and recognize how meaningful it is too broader society to take someone who is fragile and help carry them through to a place where they have strength, we are making an enormous societal contribution. can invest in making

obamacare and other national imperatives attractive, you can make mental health attractive and you can make the doctor-patient relationship attractive. if patients come to appreciate the potential of mental health care, that will have as big an impact on denial is anything. maybe they can help me. so much of what the pharmaceutical industry invests in is just demystifying their treatments. and they say, ask your doctor. ask your doctor. maybe the solutions exist. i think part of the solution is if you want mental health to solve these problems, you have to invest in mental health. you have to invest and promote it. otherwise, you have a mental health system that does not even believe in itself. we will have 10 or 15 more minutes of questions. that.l wrap up after

welner, this question "of trapdoors. -- opened up all sorts of trapdoors. we will certainly try to get everybody in. >> the elephant in the room. there are two of them. everybody is afraid of severe mental illness. i can look in your eyes and i could probably pick out three quarters of this room who fear severe mental illness. it is scary. a few have ever been two feet away from psychosis, it will blow you away. my son is six foot to and was 240 pounds. isn he is psychotic, there no reality there. fear of mental illness is big. have goneood movies to great lengths to make sure we stay afraid.

is that welephant are saying if we did the right thing, we do not have the money, so why bother? at the state and federal level, that is what is going on. we know what is needed behind closed doors. we do not have the money. why even bother? is you gething burnout in the mental health care industry let you cannot believe. i know social workers who just gave up. i know emergency room physicians who got overwhelmed trying to make a three-minute decision without having the ability to consult with the family who just give up. i have a good friend -- she is going to testify next year. she is going to make a lot of heads swivel off their shoulders. the things she has seen and the things they do to release patients prematurely in the way we treat the seriously mentally ill, she can say whatever she wants to say now that she is retired. issueink the va hospital

is big? i think this is just as big. >> other questions. your name and where you are from. >> i am with "the voice of america." for the question father. i just want to make sure i'm understanding correctly that you feel that your son needs to be hospitalized to protect himself, but you have not been able to accomplish that. in five minutes come you cannot tell the story. what a thing people need to know -- whether it is schizophrenia or bipolar -- there are different things -- you are not that way all the time. you go through spikes of up-and-down. what you try to do is catch the downward fall. get them under control. there used to be medicines, we had to get our son to take a

pill in the morning in the afternoon. he did not want to take that. he would stick them under the cushions and we would find them in the toilet. then they invented the dissolvable tablet. once that came out, he said, i am not taking that everyday. i am not ill come i don't need the medicine. the longer he went without the medicine, the more his psychosis deteriorated. that is when you need to get them into the hospital. that is when they are a danger to themselves. the laws and the standards of what gets you into the hospital are too high. you go past the moment of safety and i you are just clinging. you try to get him into care. you cannot started early. he does not want the care. you try the care. fail, you fail and you finally get him in. he succeeded. he get's to care. he is safe. he gets treatment and then sometimes he gets released prematurely end the cycle starts all over. sometimes not. he gets out.

and then the whole cycle starts again. you want to get him into care when he needs to care. i don't want them in the hospital all the time. he was kept in one hospital for one year because the hospital refused to give him medications. i ask you, which is worse? that he went into the hospital and did not take the medicine or the fact that he had to stay in the hospital for over a year? that is on public record. >> other questions. i am the mother of a daughter with a serious mental health condition. i am a sister of a brother who died by suicide. i know where you are coming from . i have been there. i have done it. the systems are really broken. that is why i have the career where i have where i try very to get find solutions learning to come up with programs that engage people. i encourage representative

murphy -- i commend representative murphy for being involved in this. what i am asking is how do we work together to bring the knowledge of connecting people who really want to change the systems? is hidden behind is part of it. i knew better. i would say, you can listen to me. people who don't know that, don't know how to do that. changing the laws does not change the culture. programsot fund the and the outreach. i have designed lots of programs to do outreach to people who have been on the streets for a long time. unless we are working together to get that money, no matter how we change commitment laws or are still notwe there. how do we get the money to get the services and really change the culture? i want to have you hit it

second. i want dj to speak. you are with mental health america, correct? >> i want to get people like your son and my daughter and my brother to treatment. that suicidal intention and he kept it and he is dead. >> my question to you is do you believe that everyone will eventually seek treatment voluntarily? that is the mantra of mental health america. >> it is not. but i do not want to get into a debate with you. sometimes, i myself have committed people, including my brother, including people i worked with.

i submit to you that that is an incorrect -- >> i will set aside a guestroom and you can state your health -- stay at my house for a year. >> we need to join together. >> if i can talk about suicide. i just got word that the webcast is not hearing the questions. repeat theo question. the question was, you have different perspectives that are offered in legislation. how can people necessarily work together to get more moneys available to solve these problems? >> what i would say is that money is great, but we also have to prioritize the most seriously ill. you talked about suicide. most of the money that goes to suicide prevention is going to advertising and public relations. there is zero evidence that advertising not to commit suicide is effective.

most of the money is going to colleges. college-age students who are in college are least likely to commit suicide. to usewant evidence-based practices, suicide is most common in first degree relatives of people with mental illness and those who have previously attempted suicide. andould use science-based start getting treatment based on science, rather than what feels good, which is doing the advertising. likewise, we are funding an awful lot of sideshows. i congratulate you for doing outreach. but if you want to do outreach to find the seriously mentally shelter,d outside a stand outside the jail, stand outside a hospital, and you will find everybody you need. the idea that we are funding talks to ptas and going in schools and telling people how to identify people who need parents beg for

treatment. people known to be seriously mentally ill. we need to prioritize. that means cutting programs. that is where the objection to the bill proposed by murphy comes from. it cuts non-evidence-based programs and uses the funds for evidence-based programs. there is an entrenched group that wants to prevent that. for instance, there are groups who are getting money to prevent mental illness. we do not know how to prevent schizophrenia or bipolar disorder. if anyone knows that to prevent those disorders, they deserve a nobel these prize. the government is funding prevention. i would argue it is prioritizing and getting rid of bad spending, that is what the murphy bill does. that is what is engendering opposition to it. >> i will briefly add and i want to differ to the expertise. i want to add something that has not been set. i buried a sister.

from a numbert of levels and i want you to know and i hope that god comforts you in your morning. -- mopurning. on a daily basis, as a forensic psychiatrist, i am not only dealing with death, but i'm also dealing with people left behind and all of the shards of glass from a shattered story that cannot be reassembled. i have learned a lot. in practicing for 20 odd years with responsibilities on my shoulders. i have worked on more death penalty cases than anybody will meet. i say that to say that i don't understand. i'm saying this because it informs my perspective. i have had more than my fair share of gun violence. i'm not saying that guns are

irrelevant to this discussion. i do think that a lot of the focus on guns versus mental health is inappropriate and it is politically driven. we will work together when people recognize that they are not fooling anybody by saying it is either/or or saying that there are certain cases that would be prevented by resolution of certain gun laws. there are certain instances that nakedly exposed problems in crisis mental health, such as the california case, which is what brought everybody here. one cannot deny the obvious and other elements of a gap in the system. i think that is one way for us to work together. if we experience tragedy on a national level as something that ought to transcend who takes credit for the bill that passes, will then we will all get our act together and everybody jump in the pool and resolve the problem. aa andreciation for hip commitment not only comes as a

forensic psychiatrist who visited the five cases -- identified cases, but i lived it is a family member. i lived it in the worst way you want. of being able to survive someone you say that if commitment laws were different, that family was saying somebody help me. it is not why went into psychiatry, but when you have proximity to it, you feel like you're living or worse nightmare. you say, i have a psychiatrist, shouldn't i have some authority? nobody is immune. just like gabby giffords was not immune. it can touch any of us. god bless that any of you should never have to go through any of this. any other questions. , i think theint mistake we are making is a political the polarization is just out there

and it infuriates me. we are saying, it has got to be either this or other that. having community-based treatment and the right continuity of care for the mainstream mentally ill, absolutely on target, should continue. carveout.d a and that carveout has to be the seriously mentally ill. that is what we are talking about. change the rules. just like you don't treat cancer and the common cold the same. >> other questions. ok. i feel like i'm at the antiques auction. going once, going twice, i believe we will adjourn. thank you for coming and for your attention. i guess my colleagues will stay appear for those who want to speak to us privately. thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014]

>> today on c-span, washington journal is next with your phone calls. then, live coverage of the u.s. house. they are scheduled to work on the intelligence authorization bill. tonight, some college commencement speeches. hour, we willan talk about the department of veterans affairs and calls for secretary eric shinseki's resignation. the release of the latest agriculture census. we will talk to hubert hamer. ♪ host: good morning worried in 90

minutes come in the veterans affairs secretary will be addressing the issue of homeless veterans at a conference here in washington. secretary shinseki is scheduled to meet with president at the white house. his development scum is more than 100 members of congress -- this development comes as more than 100 members of congress are calling on him to step down. senate democratic leader harry reid is offering new legislation and more funding for the department. a former be a