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Blunt, Stabenow Highlight Historic Step Forward for Mental Health Care in Bipartisan Safer Communities Act

Legislation Expands Successful Excellence in Mental Health Program Nationwide

June 23, 2022

WASHINGTON – U.S. Senators Roy Blunt (Mo.) and Debbie Stabenow (Mich.) spoke on the Senate floor today to highlight the significant mental and behavioral health provisions they worked to include in the Bipartisan Safer Communities Act.

The bill authorizes the nationwide expansion of the Blunt-Stabenow Excellence in Mental Health program. The Excellence in Mental Health Act was signed into law in 2014 and marked the most significant expansion of community mental health and addiction services in decades. It created Certified Community Behavioral Health Clinics (CCBHCs) that provide a wide range of services, including 24/7/365 crisis services, immediate screenings, risk assessments, and diagnoses.  Missouri and Michigan are two of the nine states currently participating in the Excellence in Mental Health pilot program, which has a proven track record of improving access to care, reducing hospital and ER visits, and providing mental and behavioral health support to local law enforcement.

The Bipartisan Safer Communities Act would give every state the opportunity to establish or expand community-based mental health clinics if they choose to do so.

Following Are Excerpts of Blunt’s Remarks:

“I would say the topic today, tragic in so many ways, but I think moving forward, and others, you know, last month, 19 kids were killed in their own school rooms, two teachers were killed at Uvalde, Texas. It was a horrific act, an agonizing thing for family, an agonizing thing for community. And I think, along with the Buffalo, New York event, an agonizing thing for our country.

“One thing that almost all these mass shootings have in common is a perpetrator who had a mental health issue that wasn't dealt with properly. And let me say, before Senator Stabenow and I talk anymore about mental health and I believe I'll repeat this again to be sure we know what we're talking about here. People with mental health conditions are not dangerous. Mental health is a health issue and we ought to treat it as a health issue. But, in rare and tragic occasions, people with a mental health issue undealt with can become dangerous. And that's what we've seen in this and other similar circumstances. And so one of the responses is always, well, it's 'we need to have a better mental health delivery system.' And that's true.

“But we should realize that, according to [the] National Institutes of Health, for at least a decade now, they've estimated that at least one in five Americans has a diagnosable and almost always treatable mental health or behavioral health issue. And, frankly, the pandemic made that even greater. A June 2020 survey by the Centers for Disease Control and Prevention found that 41% of adults in the United States said they'd had at least one symptom of a mental health condition in a recent time and 11% said they'd seriously considered suicide in the previous month. …

“Of course, we had even more alarming numbers with children and young adults during that lockdowns, months of virtual learning, time away from their friends, I'd argue too much time on screens. The effect of the pandemic on close family members had a staggering toll on the country. Children's hospitals saw mental health emergencies among 5- to 17-year-olds increase by 14% in the first half of 2021, compared to 2019, and a 45% increase in self-injury and suicide for children in that age group. Pediatric hospital needs, pediatric mental health care needs are greater than they've ever been.

“We need to be sure that everyone who has a mental health crisis or has an ongoing mental health problem has the help that they need when they need it. The bipartisan legislation we're debating today expands access to high-quality mental health and behavioral health through what Senator Stabenow and I will point out, we believe to be a truly proven model of community-based care. The Excellence in Mental Health Program, a program that we brought to the floor in 2013, and then got passed, signed into law in 2014. At the time, Senator Stabenow mentioned that that bill marked the most significant expansion of community mental health and addiction services in decades.

“When we pass this bill, it will be even more dramatic in its long-term impact. And we've worked on these issues together with pilot states, we’ve worked on these issues together that brought projects in individual states that weren't part of that eight state … and eventually nine state pilot. And, so today, we're able to come with five years of history in this program, a reimbursement model that matters, and results that we think make a big difference. And I'm glad to be here with my good friend from Michigan, and, we're going to kind of do this together for the next few minutes, talk about what can happen because of a critical piece of this community safety bill that is, in so many ways, a mental health and mental health delivery bill that we're going to see expanded in the country in unique ways. ….

“So Senator, and I think the point you're making here, too, are that these are, we now have five years of evidence in several states, multiple years in other states. So this isn't just assuming what will happen but looking at what we've carefully tried to keep track of what does happen. And, as you pointed out, that de facto mental health system, mental health delivery system of the emergency rooms and police, nobody was well served by that, certainly the police weren't well served, the emergency rooms weren't well served. And people [who] had many mental health challenges weren't served by that as well. And, you know, seeing those numbers go down dramatically of people having to go to the emergency room for mental health services or being kept in jail overnight or longer than overnight for mental health services. Nobody benefits from that system.

“And so we're seeing real numbers where the people that work at the emergency room, the people who are in the police department are among the biggest supporters of this system when it gets in place. And also the whole idea of crisis intervention, there are opportunities in this law for that to happen. And, in any of the new structures, whether that's drug court, or veterans’ court, or other places you'd go to try to be sure somebody is getting the help they need when they need it there’d also be due process involved in anything added that we use this bill to be added to the system. Due process where people have a right once -- now if there's an emergency moment, obviously, you've got to deal with it as an emergency moment -- but people then have a right to have their day in court as well, if they are not part of that crisis intervention moment, of seeing that happen. And, so that's important.

"But, you know, in Missouri, 150,000 people are now part of this Excellence in Mental Health effort, that's about a 40% increase on what some of the same facilities were doing before, but now they do it with more certainty that they're going to get their costs reimbursed. They do it with the right kind of staff, 365 days a year, 24 hours a day, seven days a week, they have to be available. And the new states that enter the program will go through that same type of competition to be among the 10 states every two years that could enter the program, and get us to all 50 states in that program, and have the kind of staff they need, the kind of accessibility they need. I think originally in our bill, which was eight years ago now, 2014, 24 states applied to be one of the first eight states in the pilot program. 19 of them went through the whole process and eight states were selected. But, in the other states, there are now 30 states that have big units that were able to qualify as individual demonstration grant units to show what they can do. And we really, I think, both believe that those units in those states will become both the models and the incentive to bring the whole state into that program now that that's possible.

“And seeing what we're seeing with results and also results in the non-mental health side. One of the unique things I think that this pilot did was part of the pilot was to see what happens of the other health care issues that people have who have mental health concerns. And what's happened is that they've seen those costs go dramatically down. If you've got a behavioral health problem that's being dealt with, you're much more likely to show up to your doctor's appointment, you're much more likely to show up to dialysis, you're much more likely to take the medicine that's been prescribed, whether it was for your mental health situation, and occasionally that's the best way to deal with mental health, or your other health situations. And so those costs go down and, even in the immediate health care space, Mr. President, we're seeing that states believe they're saving money in the immediate space of health care. There's never been any question that in the long run you'd save money if you treat mental health like all other health. …

“Just one final thought, Mr. President, we want to be sure that we're encouraging people to get the health care they need. You know, if this system works like it should work, you really never know what you're doing in terms of how you've changed people's lives in the future, or the lives of people they might impact. You know, we don't want to create any stigma here that a resilient, broad-based mental health system that's part of this bill means that you should be hesitant to seek mental health help.

“If you've got a mental health problem, you're more likely to be the victim of a crime than you are the perpetrator of a crime. But if those problems get out of control, often suicidal thoughts first before you have homicidal thoughts. But if this system works the way it should, who knows what good you've done by just letting people go through their normal lives as contributing citizens with treating their mental health, and talking about their mental health. As Senator Stabenow said, being able to talk about somebody in your family that has a mental health challenge as readily as you talk about somebody in your family that has a cancer challenge, or a dialysis trip that they have to make multiple times a week to go somewhere, or medicine that they take for something else.

“And talking about this, in the context of the good it does in making our society safer, should in no way be interpreted to mean that people with a mental health concern are unsafe. But if you don't deal with that problem in the right way at the right time, it has the potential to be unsafe. …

“Just like if your hearing is going bad, or your eyesight is going bad, people say, 'Let's get an appointment and go see what we need to do.' And anybody can be seen at these Certified Community Behavioral Health Centers. Anybody can be seen if you're covered by, it's very much based on the Federally Qualified Health Center model. If you have insurance that covers this, you can go there. If you have a government program that covers it, you can go there. If you need to pay cash, you can go there on a very affordable sliding scale. But people are seen, and, nobody in our state at least, I think this will be the case in all nine of the pilot states, nobody who needs to be seen that day is not seen that day. …

“It changes people's lives. It changes communities. It changes the way we talk about mental health. And, you know, we were, as Senator Stabenow said on the floor, the last 50 years after President Kennedy signed his last bill into law. Now here we are almost 60 years after that bill was signed into law, taking what would be, so far, the biggest step toward accomplishing what that Community Mental Health Act envisioned.”

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