Committee on Health, Education, Labor, and Pensions will please come to order. Let me just apologize. I'm smiling because um we're in a rental car. The young man driving me is in a rental, and he goes, "I'm pretty sure we have enough gas to get to Lelass."
And that's just before he's pulling off on the side of the road uh when clearly we did not have enough money enough gasoline to get to Llaus. But uh um thank you for for bearing the fact that we're late that I'm late. you if I'm in a crowd and I'm speaking
to whatever crowd I'm speaking to and I say everyone knows in their family or among their friends someone who's address who's having an issue of serious mental illness and people's face become faces becomes a person's face becomes
serious and they nod and it's not something we speak about generally but it's something that we all deal with personally and we're at a time when folks are more connected acted theoretically than ever and yet more isolated than ever. And
when you're more isolated, you tend to have less support, you tend to be more depressed. Suicide, one of the leading causes of death for teens and young adults. We had a committee hearing yesterday at LSU and the young lady who was >> recording in progress
>> for Tiger TV asked a really pertinent question about mental illness. And when I responded by saying, "In your age group, that's one of the leading causes of death." She nods her head. This is a reality. One in five adults experience
mental illness. Mo more than half don't get treatment. And of course, they're not this is these are not statistics. They are our family. They are our friends. Now, we've made progress. The landmark 21st Century Cures Act included
major mental health reforms that I champion. I say I because there was an input from our communities including some of those who are on the board here on the panel here. The legislation coordinated fragmented mental health resources across the federal government
providing resources to address serious mental illness, strengthen mental health parody, and provided support for mental health courts and crisis intervention teams. I I I led a bipartisan renewal effort of that law which supported the
uptake of evidence-based collaborative care models and crisis supports. Now, I practiced medicine for 25 years in the Louisiana Charity Hospital System, and I don't have to tell you that mental health and physical health is linked. If
someone feels good about themselves, they're more likely to be intentional in how they take care of their physical health. If the physical health deteriorates, it can lead to issues of depression and otherwise. Now, substance use disorders impact goes
well beyond the patient. Um, Tanja, I'm such an admire of her uh because she has walked the walk the talk in terms of how do you support a family, a community as they in turn interact with their workplace and society. The Support Act,
which was a bill that I helped author that President Trump recently signed into law, help helps curb the devastation by bolstering prevention, treatment, and recovery services. And I led the the laws reauthorization to build on those reforms. And it provides
guidance to the states about how to target block grant dollars to help those in most serious needs. Drug overdoses largely led by fentinyl and other synthetic opioids are the leading cause of death from uh for young
adults from 18 to 45. From 2022 to 2024, US Customs and Border Protection seized record amounts of fentinel, nearly 50,000 pounds, more than enough to produce two billion lethal doses. I
thank President Trump for signing my halt fentanel act which protects which gives law enforcement more tools to push against the cartels bringing in fentinel protecting Americans from fentanyl related substances. But it's not just about stopping the
drug dealers. It's about supporting people dealing with their illness and putting them on the road to recovery. So let's treat every wound both visible and invisible. I thank our witnesses for being here for their commitment to improving treatment for mental health and substance use disorders. And with
that, I'll introduce them to provide their testimony. First is Art Kleinmitt, a native New Orleian, formerly served as the acting assistant secretary for SAMA under President Trump 1. He has over two decades of experience providing direct
services for mental health, addiction, and co-occurring disorders. and he's also shared his personal recovery story. Dr. Kleinmitt holds an MBA and PhD and is a licensed professional counselor. And thank you, sir, for joining us. >> Thank you for having me. >> We turn I think you want to turn on your
microphone. >> Can you hear me? >> Gotcha. Well, good morning, uh, Chairman Cassidy. Uh, thank you for the opportunity to testify today on this very important topic. I also want to extend a special thank you for your support for SAMA's elimination of
hepatitis C pilot program. We are invited uh here today by the committee to to explore strategy and care models that effectively address mental health and substance use disorders. I am grateful that Senator Kennedy is shining a light on this topic. Despite our
progress, the latest provisional CDC overdose death numbers indicate that approximately 70,000 people died from a drug overdose in 2025. This equates more to more than 194 people dying from an overdose each day. In addition to drugs,
the CDC also reported that approximately 170,000 people die from excessive alcohol consumption annually. Put succinctly, addiction kills, which is why making effective models of care available to those struggling is critical. Through the grace of God and support of my family and others, I have
over 24 years of continuous sobriety. The last few years of my alcohol and drug use were actually the beginning of the opioid crisis as pill mills populated my hometown of New Orleans, Louisiana. I am also the former acting assistant secretary of SAMA, served on
the White House domestic domestic policy council as a subject matter expert on mental health and addiction and was appointed by President Trump as the deputy director of the White House Office of National Drug Control Policy in the last term. I'm also a licensed uh mental health professional with more
than 20 years of experience in working across all levels of care and throughout the socioeconomic spectrum. I'll focus my remarks on intervention and treatment strategies that work, but an equally important question is what hasn't worked. Harm reduction in the past has
been a valid component in addiction treatment, but this concept was subverted by the Biden administration. Their approach to addiction treatment under the guise of harm reduction included crack uh included taxpayer funded crack pipes, safe injection sites, and billboards telling people to
feel empowered they are using fentanyl safely. This only encouraged more self-destructive behavior. The Trump administration has worked hard to bring sobriety and the miracle of recovery to all Americans. As such, during my time at SAMA, we spearheaded the effort to
classify Nlloxxone as a life-saving intervention as opposed to just another tool of harm reduction. We also modified notice of funding opportunities to promote sobriety, recovery, and self-sufficiency. In my professional opinion, all individuals suffering with a severe
substance use disorder are confronted with a potentially fatal condition. As such, these people are in a c crisis situation. It is not enough for the federal government to continually discuss creating greater access to care. We need to adapt an intervention system
that moves people from active addiction and mental illness into treatment. Hepatitis C is a chronic and communical disease that adversely affects the homeless population and individuals with a substance use disorder. SAMA's hepatitis C initiative funded 19 treatment centers in 2025, including
Odyssey House in New Orleans to provide necessary medical treatment. The medical care for hepatitis C may bring a client to treatment which will encourage them to complete a continuum of care of addiction and mental illness treatment. Through my discussion with civic leaders from Baton Rouge, New Orleans, Los
Angeles, and Kending, Philadelphia, the message is clear. They are frustrated as the same people repeatedly receive crisis care and end up back on the streets. This is an example of insanity as we continue to do the same thing over and over and expect a different result. Kensington is one of America's hardest
hit neighborhoods by the scourge of drug addiction. I visited Kendon to work with uh civic leaders and community nonprofits. We established a certified community behavioral health center in the heart of this community that will treat a severely afflicted population.
It is my belief that we can fortify a link between CCBHC's and sober living residences to create a new model of care. Furthermore, we need to view law enforcement contact as another point of intervention for individuals. In addition to problem-solving courts like
drug courts and assist of outpatient treatment, peers can be very effective in bringing recovery to people in the criminal justice system. By training and pairing a peer or law enforcement agencies, you can ensure there is someone to encourage individuals at this crucial time to remain in an effective
treatment program. peers are also successful and utilized in street outreach programs, emergency rooms, and have a great commun utility to the community. Also, the Trump administration places a great emphasis on faith-based programs, which is something I fully support. Many
of my clients are plagued by their inability to delay gratification, which has caused numerous consequences in their lives. It is faith that allows somebody to replace instant gratification of drug and alcohol abuse with the belief that more meaningful goals are achievable and ultimately more
rewarding. Further, for 20 years, I have worked with many people who are robbed of basic life skills. Despite these hardships, people break free from the chains of addiction each day and learn to work one day at a time to create a whole new life for themselves, which includes the reparation of uh
relationships, the establishment of meaningful work and giving back through service. All of which form the foundation of spirituality. There is no quick fix for addiction and mental health disorders. panel like these and people like you who believe that making the miracle of recovery a
reality, we can recoup the opportunity cost caused by addiction and witness real people living fulfilling lives. Thank you for your time and I look forward to your questions. >> Thank you, sir. Next, we'll go to Lonni Grineer, um, policy and advocacy manager
for the Odyssey House Louisiana. He has supported the good work of Odyssey House providing mental health and substance use disorder treatment and related services. Mr. Graner has dedicated his work to reducing demand for elicit drugs while helping to expand access to treatment for folks here in Louisiana.
He's a graduate of LSU. Thank you, sir. >> Good morning. Thank you, Chairman Cassidy. Uh distinguished colleagues and friends, thank you for the opportunity to be here this morning and to speak about the importance of a full continuum of care in addressing substance use disorder, serious mental illness, and
co-occurring disorders. Uh, as mentioned, I represent Odyssey House Louisiana, which is a nonprofit health and human services provider with a comprehensive continuum of care that includes prevention, treatment, primary and behavioral health care, housing, homelessness response, and recovery
support services. For more than 50 years, we've served individuals across Louisiana with approximately 14,000 unduplicated individuals served each year across our continuum. I'm tremendously honored to be included on this panel. among such renowned experts
and leaders in the behavioral health field. And I appreciate the opportunity to offer perspective to the committee on such an important societal issue as building strong continuums of care supporting treatment and recovery. At its core, a continuum of care recognizes
a simple but critical truth. Recovery is not a single event. It is a process. It requires stabilization, treatment, and long-term reintegration in the community. And it requires that systems are built to support individuals at every stage of this process. A truly
robust continuum includes prevention, early intervention, overdose and infectious disease reduction, detox, residential and outpatient treatment, medication assisted treatment, primary and behavioral health care, recovery housing, vocational resources, and
long-term support. Not every individual will will need every level of care or piece of the service array, but every individual benefits from access to a coordinated system that can meet them where they are and adjust as their needs evolve. This is especially important for
individuals with co-occurring substance use and mental health conditions. When care is fragmented, people fall through the cracks, but when care is integrated, outcomes improve. An example of this is how Odyssey House Louisiana has innovatively crafted its continuum to
address whole person health. By evolving beyond our origins as a residential addiction treatment provider and establishing federally qualified health center locations on site with our residential programs, we're able to address individuals primary care, behavioral health, and MAT needs on-site
all in an integrated fashion. This model enhance is enhanced by Odyssey House's 340B pharmacy program which provides prescription medication to our client population at a deeply reduced rate. And as mentioned, OHL was one of only a few providers nationally recently awarded a
SAMA grant to test and treat hepatitis C amongst people with substance use disorders who are experiencing chronic homelessness. As we are also operators of the 296 bed low barrier homeless shelter funded by the city of New Orleans. OHL is eager and uniquely
equipped to leverage this grant funding to help better address whole person health needs of the individuals that we serve. Targeting an infectious disease which bears tremendous costs to our shared public health systems. Yet just as important as what occurs in
and around recovery environments is what happens beyond clinical treatment. Recovery is sustained not only by medical care but by stability, stable housing, employment, connection to care, and supportive community networks. When these elements are in place, we see
reductions in recidivism, fewer fewer emergency system encounters, and stronger learn long-term outcomes. In other words, a true continuum of care is grounded in whole person health. It recognizes that individuals often
present with complex medical needs such as chronic medical conditions, mental illness, housing instability, and justice system involvement, and that addressing substance use and isolation is not enough to produce lasting recovery. Emphasis on access and
retention are equally critical areas of focus in creating a strong continuum. We know that the window when someone is ready to seek treatment can be very narrow. If care is not available at that moment, the opportunity is often lost. That's why low barrier responsive models
of care are so important. Models that offer rapid access to treatment and minimize administrative hurdles and actively engage individuals where they are. But access alone is not enough. We must remember that retention in care is
what drives outcomes. Our strong belief is that the individual level of care should meet the individual level of need for as long as need be. And research consistently shows that longer treatment engagement leads to better results pertaining to long-term recovery. Yet
individuals often disengage due to competing survival needs, instability in housing, untreated mental health conditions, insufficient lengths of stay, or disruptions as they move between levels of care. That to address this, our systems must
prioritize creating long-term treatment environments within their own organizations, continuity by ensuring warm handoffs between providers, aligning services across sectors, and supporting individuals engagement through each transition in their recovery journey.
The stakes in this fight, Senator, are both economic and societal. Untreated substance use disorder and mental illness drive societal co significant costs across health care, criminal justice, and social service systems. The
US Surgeon General's landmark report on addiction found that every dollar invested in effective treatment yields approximately $11 in savings through reduced crime, lower incarceration costs, reduced hospitalizations, and increased employment earnings.
Similarly, a 2025 economic impact study capturing Odyssey houses's economic and societal impact underscores that for uh in our fiscal year 2024 budget, we generated 67.1 million in economic
impact and provided $341.2 million in cost savings associated with chronic addiction. Finally, none of this is possible without stable and and sustainable funding. Federal investments, particularly through Medicaid and
programs administered by SAMA, are foundational to maintaining the continuity of care. Uh when when funding is disrupted, even temporarily, it creates real consequences in service reductions, workforce instability, and
reduced access for individuals who need care most. Looking ahead, we would urge Congress and the Trump administration to prioritize continuity in funding, flexibility in how services are delivered, and policies that expand access, especially for individuals who
fall outside of traditional coverage systems. And this is particularly important amid the growing populations of under and uninsured individuals with states enacting the Medicaid provisions of HR1. We would also urge continued support for SAMA as its own single
entity as we are concerned that consolidation with other agencies uh with other focus areas could dilute our national response to public health crises of mental illness and addiction. In closing, thank you again, Senator, for your leadership and your commitment
to this issue. Uh, I look forward to continuing to work in partnership with you to strengthen uh to strengthen our behavioral health treatment systems and improve outcomes for the individuals in the communities that we collectively serve. Thank you.
>> Next, we're joined by Tonja Miles, CEO of Set Free Indeed Ministry, which takes a faithbased approach to addressing mental health and substance use disorders. She has testified before before Congress on mental health policy reform and has worked alongside federal
agencies to address the opioid crisis, has led national campaigns raising awareness about fentanyl overdoses, suicide prevention and crisis intervention. She's also a certified peer support specialist. Thank you for being here, Miss Miles. >> Thank you so much, Chairman Cassidy and
members of the committee. My name is Tan Jam Miles and I'm CEO of Set Free and Indeed Ministry based in Baton Rouge, Louisiana and senior advisor for awareness, partnerships, and community engagements for the Huntsman Mental Health Foundation based in Salt Lake City, Utah. I'm a certified peer support
specialist. I currently serve in the Louisiana National Guard and have served in the Louisiana Army National Guard for nine years as a military police. I am a licensed and ordained minister and pastor of subject matter expert in mental health, substance abuse, and suicide prevention. I have been in
recovery for over 36 years, and I'm a three-time suicide attempt survivor. Both my parents struggled with alcoholism and had 20 years of sobriety before they died. I have experienced the whole crisis continuum between myself and my immediate family members. I know
firsthand when crisis work and when it does not. In 1999, my husband and I started Sephri and Indeed Ministry, a faith-based nonprofit that help individuals and families who are struggling with addiction and destructive behavior. Our compassionate and supportive approach to addressing
addiction, including providing individual and group peer-led groups. We are also community- based outreach across East Bed Parish and has brought treatment and recovery resources to people across the city. Today we have a team of 14 peer support specialists,
mental health professionals uh addressing the fentanyl crisis in our community. Our efforts in East Badmish Parish led to the largest decrease in drug overdose deaths in the state. This reduction is among the best in the country. Thank you to uh Senator Cassidy
and President Trump for the halt fentanyl act and for the support act. They are indeed saving lives. I see it firsthand. I can't thank you enough. In 2004, I founded Free Indeed Treatment Center. It was Louisiana's first
licensed faith-based outpatient treatment center and the first of its kind in the nation. Free indeed provided intensive outpatient treatment support recovery service for individuals. The model moved many people to wellness and to recovery and helped to start faith-based treatments like free indeed
across the country. I worked alongside Dr. Jan Kasowski to bring Baton Rouge, Louisiana first stabilization center and was the founding board member of the Bridge Center for Hope in Baton Rouge, Louisiana. The Bridge Center for Hope provide compassionate immediate crisis
care for those experiencing mental health and a substance abuse crisis. No matter what the situation is, individuals will never be turned away. The Bridge Center for Hope is open 24 hours, seven days a week, serving individuals 18 and older from across East Bat Parish and beyond. In my role
as a senior adviser for the Huntsman Mental Health Foundation, I support their goals into uplifting individuals and families. The Huntsman Family has been advocates for both civic service and courageous philanthropy. The Huntsman Family Foundations was created
by the legacy of John and Karen Huntsman. The foundation focused primarily on study treatment and eradicating cancer as well as providing hope and healing to those suffering from mental health and substance abuse. They provide housing, uh, domestic violence
mitigation, scholarships, educations, and that is the priority of the foundation. Mental health and substance abuse challenges do not discriminate. From the curbside to the country club, it can affect anyone. Losing their sister Karen to a drug overdose after
years of suffering from depression, eating disorder, and substance use disorder motivate the Huntsman's siblings on mental health research, treatment, and policy innovation. This led to the creation of the Huntsman Mental Health Institute at the University of Utah and compliments the
groundbreaking Huntsman Cancer Institute. They have the whole crisis continuum. Together, these institutes strive for continuous breakthroughs and helping relieve humor and suffering. It is with the Huntsman's sole commitment to making an impact in the heart of
everyone who come through their doors. I am grateful to be a part of their organization. I and many other behavior health community specialists like here on this panel, we're grateful to you and we're grateful to President Trump for signing the National Hotline Designated Act in
2020, creating 988 suicide and crisis line. We are equally grateful to Congress for its continual bipartan support in advancing this critical work. Millions of Americans in America suffer from addiction and destructive behavior.
We heard that earlier. In 2020, SAMA under President Trump leadership worked in partnership with providers, peer support specialists, advocates, and people with lived experience like me to define the function of crisis systems that we're talking about today. It
should be someone to talk to, someone to respond, a safe place for help, and someone to follow up. This model already working in communities that has implemented it. The challenges before is is not whether what we know what to do.
The challenge is whether we have fully built to sustain it. As we move towards this vision, there is clear and acceptable actions that Congress can take to make this happen. Inclusion of crisis care centers and essential health benefits. Congress should require
Medicaid and Medicare and commercial health plans to recognize and cover core crisis care services as an essential health benefit. These services include crisis mobile teams, crisis receiving centers, crisis stabilization centers.
These service align directly with existing and essential health benefits cate uh c categories including emergency service, mental health and substance use disorder and hospitalization. Yet today coverage and reimbursements remain
inconsistent and inadequate. When crisis service are not covered, the cost does not disappear. It shifts. It shifts to state and local government, law enforcement and first responders, emergency departments, and ultimately to individuals and families who are
suffering. Most communities do not have the financial capacity to societies these services. As a result, taxpayers fund a most expensive and less effective system. Crisis care work. It reduces overall cost systems. These outcomes are
not only benefit for individuals. They are significantly more cost-effective than defaulting to hospitals or law enforcement response. Meaning people end up in our local jails. And local jails are not adequate to treat a lot of people who are suffering from mental
health and substance use disorder. Although SAMA has recently uh published models crisis uh service definition to guide both service and delivery reimbursement expectations, these standards have not yet re um translated into a consistent or adequate payment
structure. As a result, crisis providers are being asked to deliver 247 availability, rapid community-based response, clinically approach, and multid-disciplinary care. but or reimbursement at rates they fall below
the actual cost to deliver these service. In effect, we are asking crisis system to operate like emergency medical services and hospital departments without funding them like essential emergency care. Congress should direct the center for Medicare and Medicaid to
establish clear guidelines and benchmark that aligns reimbursement with the true cost of care. This include establishing sustainable reimbursement framework uh ensuring rates that are effective and efficient and also strategizing state
ownership of 988 crisis response. However, we know that there's a growing line between funds and the systems and who control it. In most states, these investments represent the vast majority of total crisis funding with federal contributions covering only a fraction of the cost. At the same time, the
current structure requires local centers to operate under direct uh contractual relationships with national administrative including operation and these do not align with the state funding systems prior to this requirement. Congress should authorize a
state optional model that allows state to assume a more direct leadership in the role of 988 implementation while maintaining national standards across quality and responses. In my closing, in crisis care, the difference between a call and a response can make the
difference between hope and harm. Thank you for this opportunity to testify. I look forward to working with this committee to advance these priorities and to meet this moment with urgencies and in uh demands. Thank you. >> Thank you for very uh thoughtful and
detailed testimony. Next is uh Nick Rishard, executive director of NAMI, the National Alliance on Mental Illness in Southeast Louisiana. And Mr. Rishard helps bridge the gaps between law enforcement, mental health providers, and community leaders to address the
mental health crisis. He helped found the 22nd Judicial District Behavioral Health Court and the crisis intervention team, um the CIT program within the St. Tamony Parish Sheriff's Office. He's a graduate of Huntington College and is
also a certified crisis intervention team coordinator. Thank you, Mr. Rishard. >> Thank you. Oh, am I on? Yeah, I'm on. There you go. I don't know who I uh got in trouble with to go after Tanja, but you know, next time I put me a different part of the lineup because uh I've I've
watched her speak quite a few times and I'm always impressed with everything you have to say. So, thank you uh chairman for allowing me to be here today and for uh allowing me to make some remarks. I'm here today to share the perspective of NAMI Southeast Louisiana along with the voices of the individuals and families
we serve every day. As stated, my name is Nick Reishard and I serve as the executive director of NAMI Southeast Louisiana. NAMI is the National Alliance uh on mental illness and it's the nation's largest grassroots mental health organization. NAMILA focuses on providing free education, peer support,
advocacy, direct services, and housing to individuals living with mental illness and their families across southeast Louisiana. We are on the front lines of a system that is both deeply committed and deeply strained. We see the successes. We see the progress, but we also see very clearly where the
system is falling short. I want to do something that we normally don't do when when we're advocating. I actually want to highlight the positives that we have here. And the first positive is and this is something that should be celebrated is we have the leading senator in healthcare from Louisiana. That is
something that we have not been able to say in this state uh in my lifetime. So I thank you Senator Cassidy for for leading and doing what you're doing. And also the honor of having a field hearing here is is something that I I know doesn't happen a lot and that is
something to be celebrated for the individuals who live in Louisiana. To have this committee here and to have this hearing here in our state is something that should be celebrated and that is a success and that is a win. So thank you for that. Louisiana has also made meaningful investments in community-based behavioral health over the past decade. We've expanded managed
care, strengthened community mental health centers, and increased the use of peer support. We've also seen growth in programs like behavioral health courts, drug courts, crisis intervention training that are making real difference. In many parishes, law enforcement officers are better equipped to respond to mental health crisis, and
we're seeing more individuals diverted away from jail and into care. Because of that, at NAMI, we see individuals stabilize, reconnect with their families, and begin recovery. We see it in our peer support groups, where someone with lived experience guides another person through their darkest moments. We see it in our
supportive housing where a person who was once cycling through emergency rooms and jails now has a stable plan. We see it in our transportation program where removing the barrier of a misride means someone actually makes it to their appointment. Those successes are real and they matter. But the reality on the ground tells us we have a long way to
go. As previously stated, in Louisiana, approximately one in five adults experience a mental health condition. Yet more than half do not receive treatment. Louisiana consistently ranks near the bottom nally in access to mental health care. We have fewer than half the psychiatrists per capita needed to meet demand, particularly in rural
and underserved areas. At the same time, the need continues to grow. Louisiana has historically had one of the highest overdose rates in the country and and through some of the work here I know that that is improving and suicide remains a leading cause of death in many of our age groups. But behind every one
of those numbers is a person and behind that person is a family. In my role, I've sat across from mothers and fathers who have lost their children. I've sat with individuals who've lost their spouses, their brothers, and their sisters. Those conversations stay with you. They're the reason we do this work
and they are the reason we do not stop. And they are the reason we continue to push for real change and true parity in how we treat mental health. Because for too long, mental health has not been treated the same as physical health. And people are paying for that with their lives. One of the most significant gaps
we see is access to timely, appropriate care. In many parts of southeast Louisiana and throughout the country, individuals in crisis still end up in emergency rooms or jails because there's nowhere else for them to go. Emergency departments are not designed for long-term psychiatric care. Yet, people
often wait hours, sometimes days for placement. At the same time, we do not have enough inpatient beds and more importantly, step down options to meet the demand. And when individuals are discharged, too many are released without stable housing. And I want to be real clear, supportive housing is
healthcare. At NAMI Southeast Louisiana, we operate supportive housing programs. We can tell you directly that when individuals have stable housing paired with services, case management, peer coaching, transportation appointments, connection to employment, hospitalizations go down, incarceration
goes down, and quality of life improves. But the demand for supportive housing far exceeds the supply. We continue to see individuals discharged from hospitals and correctional facilities back into homelessness, which almost guarantees they will cycle back through the system. This is not a failure of the
individual. This is a failure of the system. Workforce is another major challenge. We do not have enough psychiatrists, therapists, case managers, and peer support specialists to meet the need. Providers are stretched thin, and burnout is real. If we want a functioning system, we must invest in
the people delivering the care. We also need to be very intentional about how we respond to individuals with mental illness who intersect with the criminal justice system. Too often, individuals serious mental illness, particularly those experiencing homelessness, are drawn deeper into the system rather than diverted away from it. From our
perspective, expanding court involvement is not the solution. We know what works. When paired with proper services, diversion programs work, behavioral health courts work, crisis intervention training works, peer support works, and supportive housing models work. At NAMI
Southeast Louisiana, we're doing all of these right now in this region with results that we can show. We should be building on those strategies, not replacing them with more complex judicial processes. Finally, coordination remains one of our biggest opportunities. We have strong providers,
strong programs like many of the people here on this panel, and committed partners across Louisiana, but too often these systems operate in silos. Individuals and families are left trying to navigate health care, housing, and social services on their own, often during moments of crisis. We can do
better and we must do better. In closing, I'd like to offer a few priorities. Continue investing in a community-based mental health services, especially crisis response and outpatient care. Expand supportive housing and recognize it as a core part of treatment. Strengthen the behavioral
health workforce. Prioritize diversion and community- based solutions over deeper involvement in the criminal justice system. And finally, and most importantly, ensure true mental health parody. So mental health is treated with the same urgency and resources as physical health. At NAMI Southeast
Louisiana remain, we remain committed to this work every day through our peer support, our housing, our transportation, our education programs, and our diversion partnerships. We're showing what is possible when communities invest in real care. We carry the stories of the people and families we serve with us. We will
continue advocating until the system reflects the level of care, dignity, and urgency that they deserve. Remember, there is no health without mental health. Thank you for your time. I look forward to your questions. >> Thank you. Somehow, I think we're about to hear a little bit about the importance of parity and mental health
and physical health from and and each is built upon the other um each testimony. Uh, next is Stuart Archer, CEO of Oceans Healthcare, providing inpatient and outpatient mental health and substance use disorder treatment services across
Louisiana and eight other states. He has Mr. Archer has more than two decades of experience in the post-accute care and the behavioral health sectors. He's a graduate of Northwestern State University with an MBA from LSU. Thank you, Mr. Archer. >> Chairman Cassidy, thank you for the
opportunity to be here. Can you pull that microphone a little bit to you? >> Let's see. How's that? Can you guys hear me? May >> y Thank you. >> Uh, Chairman Cassidy, thank you for the opportunity to be here today and and lend our voice with our esteemed colleagues. As mentioned, uh, my name is Stuart Archer and I'm honored to serve
as the chief executive officer of Oceans Healthcare. Founded in rural Louisiana over 20 years ago, Oceans Today operates over 48 psychiatric hospitals and outpatient behavioral health locations across nine states, serving adolescence, adults, and older adults with serious
and complex psychiatric needs. Much of our work takes place in rural and underserved communities where we are often the only behavioral health provider available to these communities. Each year, our team of over 4,000 caregivers, support more than 57,000
patient admissions, provide approximately 450,000 patient days of care, and deliver over 700,000 therapeutic interventions. Many of our patients we serve rely on Medicare or Medicaid, coming to us through emergency departments, law enforcement, or court order commitments.
In many of these communities, expanding access requires partnership, often through innovative joint ventures with local nonprofit health systems such as Auctioner here in Louisiana to bring needed behavioral health capacity closer to patients. This is not theoretical for
us. It is what we see every day in our hospitals. OSHA's role is to provide clinically appropriate treatment and stabilization until patients are ready to safely step down into community-based outpatient care and continue their recovery as part of their everyday lives. You know, common sense tells us
that when medicine changes, policy needs to change with it. In behavioral health, unfortunately, that has not always happened as as many of my peers has shared as well. You know, over time, our understanding of mental illness has evolved, but policy has not always kept pace. This is due in part to the
complexity of psychiatric illness which does not fit neatly into the traditional health care structure. And unfortunately when something is uncomfortable, it can be easier for older policies to remain in place even as the system around them involves evolves. This is for instance what we're seeing with the Medicare
190day limit on inpatient psychiatric care. Imagine if Medicare placed a lifetime cap on hospital care for cancer or heart disease or diabetes. We would immediately recognize this as not only immoral, but is inconsistent with how
illness works. This arcane policy is one of many that date back to a time when behavioral health care was understood and delivered very differently. Today, we understand that severe mental illness can both be chronic and episodic. Patients may stabilize, return to their communities, and later may require acute
hospital level care. Again, that is the nature of illness, not a failure of a patient or a system or a caregiver. A lifetime cap does not reflect that reality. Instead, it places additional strain on communities and limits our ability to care for people when they need it most. MedPAC has found that at
any one given time, approximately 50,000 Medicare beneficiaries are at or near this limit. These are often the most vulnerable individuals in our health care system. And when that limit is reached, the need for care does not disappear. The illness is still there. The risk is still there. And the family
is still in need. But instead of being met in a psychiatric care setting, this need is often pushed somewhere else. It shows up in emergency departments. It shows up in law enforcement. It shows up in homes where families are trying to manage a crisis they can't safely
navigate many times themselves. This is not access. This is not care. This is a system waiting until crisis gets worse. Chairman Cassie, I want to thank you for your leadership on this issue. Oceanceans Healthcare strongly supports the important work you're doing to remove this limit to ensure that
individuals and their families can access the care they need for as long as they may need and just and not just for as long as a faceless system deems enough. When we deny the right setting for care, we should not be surprised when people end up in the wrong one. And this is not the only situation where
outdated policy creates barriers. In our facilities, we care for patients who come to us voluntarily, but many who do not. They arrive through emergency departments, law enforcement, and court-ordered commitments. These are individuals in acute crisis, often without the ability to advocate for
themselves. But yet, even in these situation, Medicare Advantage plans can impose higher cost sharing and more restrictive authorization requirements than traditional Medicare. This creates additional barriers for care for patients, families, and providers
working to deliver the basic necessary care. More broadly, we continue to operate as IMD hospitals under structural barriers that that include uneven parody enforcement and longstanding policies like the IMD exclusion that limit access to appropriate care. And I'd like to
highlight an issue directly and many of these policies, interestingly enough, date back to the Kennedy administration. Some before even someone landed on the moon. Um, so we're we're dealing with some of these policies that are just decades old. I I'd like to also
highlight an issue directly within the committee's jurisdiction. Today, private behavioral health providers like Oceans cannot work directly with SAMA to access mental health care block grants in underserved regions where Oceans may be the only behavioral health provider. That means federal dollars that could
make a meaningful difference can't be activated directly to support the families and patients who need care during a psychiatric crisis. Patients and families don't care about tax status. They need access to life-changing, life-saving care. This restriction was removed for private
substance abuse providers, but has yet to be addressed for behavioral health providers like Oceans. And and to be fair, our providers are not asking for any separate funding or special treatment. Simply for the ability to be considered for these funds alongside other providers. Allowing these
providers to compete directly for these funds would help expand capacity, improve access for patients who need it. Uh, Chairman Cassidy, your work on the 109 day limit reflects a broader opportunity to highlight how outdated parts of the regulatory framework are, many of which were enacted in previous
administrations and make little sense in today's world. We have the ability to take policies that were built for a different time and bring them into alignment with how care is actually delivered today. Eliminating the 109 day limit is an important step and improving access to resources that support care delivery is another. Thank you for the
opportunity to be here today and I look forward to your questions. Thank you all. Now, by the way, normally if we're in DC, you would be sitting down there and I'd be up here with the whole dis of fellow senators
prepared to ask questions. I actually like this because we're all up here. So when I'm through, I may ask you to ask questions of each other because what you're saying reinforces what the other is saying, but it also um um um
sometimes there's a little bit of a tension. I've got a fellow that used to work at at SAMA and a fellow is saying that SAMA regulations keep him from receiving the grants when he is the only mental health provider in a community. So, so that'll be kind of I'm going ask
you all to address that and if you will try and channel we are being um live streamed and there's people who cannot be here who have a personal connection to these issues and so again try and speak to not just the audience but the people in the live stream. Now we all
know what I'm about to say but in your answers I'm going to ask that you kind of parse it out. There is a difference between addiction. There's a difference between serious mental illness and sometimes there's not because someone is co-diagnosed. They have both addiction
and serious mental illness. So, as you speak to these issues and as you speak to the live stream and to the audience, make sure that you help us understand what you're speaking to because we're here for solutions.
Um, now I'm going to start with uh I can start with any of you. Um, >> Art >> Stuart says, let me No, let me start over. TJ, you mentioned that there's a problem with workforce. Nick mentioned that as well.
>> The rural areas being particularly poorly served. By the way, one reason my medical practice was in the charity hospital system with people who were uninsured and they would drive from across the state to come see me because I was the only liver doctor. Hepatitis C is a um you know a big thing I used to
address. One of the visions I had behind the infrastructure investment and jobs act which the Trump administration has just released $1.35 billion to make sure that everyone has access in our state to highspeed affordable internet is that
you could do telemental health. The VA is already doing this either through an iPad given to the vet when he or she is at home or they would go to a pharmacy and go into a room in the back and have the interview. Um, so to what degree,
I'll start with you Nick. To what degree can telemental health when truly everyone has access to highsp speeded affordable internet address the concern of a mom whose child has a has a has a mental health issue and the only
pediatric psychiatrist they only live in in Shreveport, Baton Rouge, Lafayette and New Orleans. How effectively can telemental health address these issues? >> Thank thank you senator for that question and I I I think the answer is
simpler than it needs to be. Right. So yeah, I do believe in integrating access to virtual mental health care but in coupled with that we need to bolster up our peer support specialists, our case managers and that's where I believe we're missing the boat. Um we have seen obviously through co a dramatic increase
in in uh teleaalth especially through psychiatric care. Um but again we we're human beings. We need people. Um so investing in in peer support specialists and investing in expanding case management in in those particular arenas
is going to get it because you know seeing a doctor is great, right? But what happens after that, right? What happens with all the other things? I take these phone calls from parents, the exact phone calls that you're talking about in rural areas where they have no help. And if I can get them a tellahalth appointment, that's great. But what
then? So we really need to uh in in invest into incentivizing individuals and really growing more of these programs that are not medical programs. Peer support again family support and case management is is really where the
answer is there. >> So so Tandra I don't know this I'm asking you uh for addiction services does tea addiction services work? Does the peer support have to be in person?
Uh can it be online? Um tell me tell me please. >> I I think it could be both. I mean >> please pull that microphone to you. >> I I think it can be both. Um because what has to happen is crisis need connections and you know like Nick
was saying there's a lot of people who just don't have access. Look, not just in rural areas, just in regular cities across the state, you know, don't have access to it. You know, they might live in a zip code where there's there's they can't get to another place. So, having
that in place would be something that was just so needed where they can go online, like you said, everyone has a phone and they can connect with a therapist, with a psychiatrist, but also with a peer support specialist. Again, we have to have these all things in
concert because I think a lot of times we think if we have this this this this is great, but if we're talking about crisis continuum, there's a continuation of that. And look, I can't stress enough enough. We talk about workforce. We know there's a workforce challenge in uh mental health and substance abuse and having certified peer support
specialists. That's why I think we should have a national uh certification for peer support specialist. And uh because we are just like any other profession. We just get to tell our lived experience. But there are 10 core functions that we have to adhere to just like any other mental health professional. And I think when we you
know make sure that teleaalth that people have that if they don't have access to transportation that that's ready available and also during those times when they're not in crisis because once a crisis happen there's a continuation continuation of things that need to happen so the crisis don't
happen again. So uh to your question I think that you know tella health is needed. We talk about rural areas, that's great. But just like in cities across the state, they're needed as well. And so when we do that with peer support, I think we would see the outcome for an individual and their
family that can help them get them to their on their worst day, get them to their best day. >> You know, you mentioned, I like how you put it. Um, our system has not been built up to support the people after the 988 call.
Now, on the other hand, I I also liked what Nick said. We can't just talk about the bad things. We have to talk about the good things. And it really sounds like Mr. Grineer, you guys have really thought strategically how to comprehensively
address everything people talked about, the community health center to treat the hepatitis C that Mr. Dr. Kleinit talked about and the housing and the 340B to help make your margins in order to do it.
Um, how replicable is your model? Well, >> thank you, Senator. I think uh I think it goes to uh two primary Sure. I think it goes to two primary focus areas that we have uh placing focus on access and retention. First with access, breaking down barriers to make sure that people
can get into treatment that they need. We know very few things about addiction and recovery, but two things that we do know for sure. Uh the first is that when an individual is seeking treatment, um the harder that we make it for them to get access to treatment, the more likely that they are going to disengage and not
want to go into treatment services. And so when they reach across and if we can get them in the door and we can get them into services, >> speaking about addiction specifically, if we can get them in the door, then we have a much greater chance of keeping them engaged in recovery. And then the second thing that we know is that the
longer people stay engaged in treatment services, the better the outcomes. And so because I like TA's question so much, I actually want to piggyback on something that she was talking about about tellaalth. Um I do think it uh I I agree with everything that you you stated. I think it's um it's
when the treatment matches the individual level of need, you're you're better set up for success. But um there are a lot of individuals who are not appropriate for uh for tellahalth for substance use disorder. um who uh who may not have uh financial wherewithal,
who might just be showing up with the clothes on their back, who might not have a phone, who might not have internet access, who might not be appropriate for those um outpatient group settings. So for for certain individuals, as has been mentioned, um you you definitely want to make sure that you get them the treatment services
to match their individual level of need. And it certainly is uh something that's scalable. I think that what Odyssey House has tried to do over the last 53 years is creatively identify where the gaps are, what is causing our individuals to not be successful in the long term and to try to address those
things comprehensively and in an integrated FA fashion. And I think that uh we do that pretty well. >> Bless you. >> Yeah, really do. >> Bless you. >> Oh, excuse me.
you do do it well and so thank you for that and it touches all of us. Again, Taja said this affects people from the curbside to the c to to the country club. um
art. Um there's a woman in New Orleans who cares deeply about our city and she will send pictures to me and others of the homeless passed out on a street literally on the curbside
with a leg dangling into the street knowing that they could be hit by a car. And we'll speak about fecal material being on this. So it degrades. So let's just let's just say okay first that person is a living tragedy.
The impact upon that person's family who doesn't know where they are is a source of grief but it impacts all of us. That's just the most visible. Um Greg Champan who is the sheriff of
St. Charles Parish says that he is the number one provider of mental health services in St. Charles Parish. And every sheriff I speak to says the same thing of his sheriff or her sher of of his parish or his county. There's an
occasional she. So I also want to include her parish or county. So you spoke of that surgeon general's report. every dollar invested in caring for patients in an effective way saves 11
throughout the system. Um could you elaborate on that? >> Uh yes sir. Thank you for the question. Uh I believe that uh somebody that you just described uh in the street like that we would have to kind of see how many times did that person actually cycle through the system and didn't
actually get their exact needs met until they recycle right back on the streets. uh if you look at prevention I think it's about $14 of prevention which uh you save uh $14 on prevention versus sort of treatment in situation where we
can intervene. So if if you address and I mentioned opportunity costs. So addiction drives up and serious mental illness drives up uh the opportunity cost of somebody to contribute and the more that that person goes through without getting uh the actual services
that they need, the more they keep taxing the system. So I've talked to stakeholders here in New Orleans. I've been to the CCBHC in my old uh neighborhood of Alier and I talked to those people and I've talked to the people in Mid City New Orleans as well uh about these people cycling through
the system and first of all that person that you described lying in the street is very much a redeemable person as long as we kind of get them the services they need. I also want to uh say that uh a lot is said about serious mental illness, but I I want to kind of
quantify that for people. What that really means, that's the government's way of saying psychotic disorders, right? So, not every mental illness is going to qualify as a serious mental illness. When I say psychotic disorders, that's going to be more your spectrum of schizophrenia and bipolar one with
psychotic features and that sort of a thing. Uh and if if you don't mind, I I was a rural provider uh and I've done a lot of teleaalth in my career. I started off as a peer uh prior to becoming like a psychologist delivering sort of services. Uh so with teleaalth to to
want to say yes, it's a very effective intervention. It works just to parallel off of what uh Mr. Gier said, uh it works really well with serious addiction once somebody's more in like an afterare type of setting. Uh I I've been the
provider of somebody at uh the Salvation Army where I did teleaalth and provided him with a clinical sort of psychotherapy. Uh where it's going to be a little bit of a struggle when somebody's still in active use to where it's it's hard to get to that person
through the screen to actually do something about themselves. Now I I actually unfortunately I lost a patient that way that was still using and getting that person to actually accept a higher level care was difficult. and I worked with his wife and family. So that was a very tragic sort of situation but
in in a large uh respect tellaalth could be very effective especially sort of with a lot of the uh mental illnesses that we sort of see. So I'm I'm an advocate for that but just like for all services there is you know a little bit of a gap in that but to bring it back I
want to say the person that you described in the street is a very redeemable person. We just got to address their needs in a more appropriate sort of fashion. And the the one thing I I was talking about is taking a CCBHC, a certified community behavioral health center, and and
establishing a link to sober residences. I think it's something that's replicable. We did that with the soy grant, the state opioid response, where we put money at SAMA to create that link for our our our guys really in need, the
19 to 24 sort of uh uh patient out there. So, I think that's something replicable and you know, we could all work on it, but I love what I'm hearing from all my colleagues today. >> Um Stuart, you had mentioned that
kind of a recurring theme is the difficulty in getting services to rural areas, but some of your facilities are in rural areas. First, how do you pull it off? And secondly, you're um for profit for for
profit, if you will, but you're going where there's no private, excuse me, where there's no public. >> Yeah. >> So, the public can't pull it off, but you're pulling it off as a for-profit. >> So, will you comment on that, please? >> Sure. Um, yeah, since since its founding 20 years ago, we have been focused on
the needs of underserved markets, underserved communities, and underserved patients. And and and I think you could sum up our mission is, you know, we go where where it's hard. I mean, we go where others haven't been. Half of the buildings we're in, at least one other company has failed or a larger company
said, "This is just too hard. We're leaving." Um and and so for us, you know, a couple ways that we do that is is and the biggest struggle we have is workforce. I mean, and I'm sure it's a theme you'll hear across this table. Uh I have a daughter, I have two daughters,
uh both uh one studying to be a speech therapist, the other um wants to go into medicine, wants to be a psychiatrist, and and we've had a long talk and and part of the conversation with her, unfortunately, is you know, when you graduate, you'll get paid twothirds your peers. when you graduate, you won't
always be treated like you're part of the varsity staff. And and and I think that is something that when we think about workforce in behavioral health, rural or urban, you know, we have to change the way we both fund that we support >> both addiction. You're speaking about
both addiction and yes, serious >> across both. And and I and I think so for us in rural workforce is one of the biggest issues that we struggle with. Um and and I and I think that for so many communities, they haven't had access in these communities. So I think supporting
rural caregivers is is so important. I would say we've talked a bit about technology. I want to continue to reiterate that. Look, I think for us it's an arrow in the quiver. It's a tool. It's an instrument. It's not an end all beall like we've talked before. Speaking with a physician, whether inpatient or outpatient, is really just
a part of a journey. We've got to support patients with a holistic um system of care. And I think so many times in medicine, you know, there's a lot of times we look at a cancer patient, we look other patients and we understand this is going to be a journey. This is going to be a long journey and we're going to support you
with with all the different tools and instruments that you need for that recovery. So often in behavioral health, we say, well, we did that one thing for you, right? You're happy now, right? Or we we funded this one grant, you're good now, right? Understanding that this is going to be a journey, a holistic journey for this patient and their
families. Um, you know, I would say lastly, we touched on this as well in rural areas and I and I can't, you know, this is one of those granular things is transportation. You know, we're an inpatient setting and an outpatient setting. And I and I think for many of our patients during COVID, for instance,
we pivoted to almost pure tele medicine. What we found was interesting was after the restrictions were lifted, the majority of our patients wanted to come back. They want to be with other people. Some chose to do their care at home or continue their care at home, but but transportation for behavioral health
patients is so important and it's so broken uh in many states. And you know, we can't help you unless we have an adequate way to get you to us if that's what your care needs. >> So, you know, you mentioned workforce and when I speak to any employer in any
industry, they have a problem with workforce. So, let me just put on my I'm a ruby red Republican hat. There's a fellow Kylie Sparks up in Livingston Parish blowing and going. He is collaborating with a faith faithbased
ministry called Lighthouse out of Church International that takes these men, I think typically men, but I'm sure sometimes women who have an problem with addiction. It'll give them the wraparound service that you're kind of speaking of, Lonnie. And it will and
among that wraparound service is the job training. So when they finish up, they have a way to support themselves uh and financially, but in the meantime, they're teaching them that delayed gratification that comes from every day
walking by faith. So that there's a power greater than you that helps you address these issues. and they are meeting their workforce demand in their growing business by these folks
coming to them through this ministry. >> So much so that I was visiting with the pastor, one of the some time ago graduates of their program wrote a check for $100,000 to the ministry to support
the ministry. That tells you so when Art you speak of the of that person is redeemable. There is a lot of potential in some of these folks. >> Uh there is the fellow that runs the uh Salvation Army in Monroe, Louisiana. And
he'll he'll tell me, "Man, those addicts come to me and they start the story and I end the story." I tell them, "I've been I've been where you are. Don't pass me the line because I can give you the line." He was a technician for a MercedesBenz dealership doing all that
kind of work on high-end automobiles uh and at some point fell into addiction. He says this publicly and now he's ministering to others. So there's absolute hope and I think that's where we need to go. You mentioned the role of faith-based. There's another faith base
I've been to called the Grove um which takes people co-diagnosed with serious mental illness and addiction and it's a live-in facility with peer support built within and they say I think 70 or 80% of their graduates are in longterm
um sobriety and control of their mental illness which is to say they're taking their medicines appropriately following up with their followup if you will and they're producing in So Art, you spoke of faith-based ministries. Um would you just comment uh
and Tanja did too and others would you just comment upon that? >> Uh yes sir. Thank you. Uh I believe faith is important. I I go with the higher power concept. Uh in a way to do that uh I'm not going to just say like 12step program but like there is like I
made a decision to turn my will and my life over to care of God as I understood him. Uh sometimes when somebody comes in with an addiction, they almost turn their care and their life over to the care of heroin or the care of alcohol. So what we're trying to do with faith
and enacting faith is a way to sort of see that there is something more than this actual instant gratification that been right there. And it takes faith to actually trust the process, trust in yourself, trust in others that if I keep
doing this next right thing, if I keep working towards my goal, good things are going to happen. Right? So, it's a sort of a belief that I can take and I believe nobody's come to this life empty-handed. Everybody's born with talents, ability, and resources. And addiction is like a thief. It steals
those things. But if we can kind of work and instill faith to kind of keep working, we'll start to recognize these talents and abilities that we have. Uh and also I want to say I want to parallel a little bit off what Mr. Archer said about people sticking
sticking around his treatment center. One of the things I really like to see when I visit treatment centers is do you have a pretty furbishing alumni community? because I believe a lot of the people in treatment are going to be like like I'm talking about one of the best resources that they have uh to
actually sort of build upon and use attraction and that's a why I actually are very fond of the peer uh aspect of this thing and working with Tanja and all that. So I believe some of the best resources are the alumni of people who sort of completed treatment and had
actually witnessed these things and can actually like you said uh walk the walk. So I appreciate that. >> Can I piggy back off what Dr. Art saying in your question? So it's funny you mentioned both those programs. So when I talked about in my opening statement uh other programs was able to uh other
programs are able to um look at the work we're doing and duplicate it or replicate it. So set free and indeed we have 24 across um the the country. Our biggest one is in Wasilla Alaska. >> Speak a little bit more slowly. >> Uh was Alaska the biggest is called set
free Alaska and uh they have the whole crisis continuum. People always ask where did you sell it as a franchise? No we didn't. We gave it away. Wish we would have but hey we did not. But uh you talk about um the lighthouse that was I remember having a conversation with pastor Mark Sturmer about when he
had a vision to do that and we had been doing that and just gave him that blueprint of what it should look like and now look what's you know he's doing amazing work um and also the executive director of the grove she came out of our program she talked about her story
that's where she began her clean time at free and treatment center so we know that faith-based organizations do work we know know that faith without works is dead. Uh when we started our faith-based program, we got a lot of push back because people thought that, you know, we were just going to be pushing faith
and prayer on people, which, you know, that was their option to do so. But we were also licensed. We had evidence-based practice. We had doctors and um psychiatrists and things of that nature. And you know, we need all of that together. A wise man once told me,
"Screw stigma. We do recover." And there are so many people across the country who experience sobriety and and recovery and those stories are why peer support specialists and you know the people that do this work you know when you talked about what's working there are a lot of people like us who do recover I mean I
had hopes to be sing on Broadway not to be a crackhead you know and I get to sit now you know in front of you and these amazing folks and so sharing that lived experience is vital and you know having that faith-based approach give that person that hope when nobody's not there
and they're by themsel that they know that they can reach out to God or whatever their faith is in those times where they can't get teleaalth where you know maybe they just need an extra push and their faith is what sustained them it's sustainability that's what faith is >> so a common theme here and I want people
to recognize this is that there is an approach which is replicable replicable that if you put it into place people who might currently be on the street with a foot hanging off onto off the curb can be restored to
wholeness and be a functioning member of society, not a drain upon society. Paying taxes, not consuming a tax, not consuming taxes. And because each of you have spoken of coordinating the physical, with the housing, with the
counseling, and getting the positive results. Um, Lana, you're leaning forward. It makes me think you have something to say. What is the success rate in your program of someone who's addicted of coming out of addiction into long-term sobriety and being a
contributing member of society? >> Well, thank you. I think it's important uh to to >> pull that microphone close to you, please. >> I think it's important to sort of figure out how uh how we view success with our efforts. Is it that we get people into
treatment? uh is it uh as um you know was I think it was Stuart who mentioned it before okay we took care of that grant need you got that money you're okay now it's uh it really is something where um you know as a as a professional I think two years uh in long-term
recovery is a is a good way to to measure successful outcomes um one thing that we know that's very important for someone is societal reintegration it's something that we are mindful of when we take someone into our care is that they
will leave our care hopefully prepared to take on the challenges associated with the world and to do so in a way uh that doesn't cause them to self-medicate. Um but that requires uh societal reintegration requires purpose.
It requires community. It requires accountability. Uh and those are things that take time. um 28 days uh in a short-term residential treatment program is uh is simply not enough. And so I think it it just goes back to the importance of this topic of this hearing
about a continuum of services because it is really fundamental that you are able to address the various aspects as you mentioned uh related to someone's instability in order to help them be stable and contributing functioning members of society in the future. and
kind of continue on the theme of if you do it, you can see results. Nick, you are involved with the crisis intervention team. Uh I've heard from um law enforcement that when they have their deputies or officers go through
this, they learn how to deescalate as opposed to escalate. That there is less, you know, le fewer shootings of people, which is traumatic for the officer if it comes to that point. um obviously not
good for the person receiving. Um there are fewer times when an officer is tied up for 12 hours in an emergency room waiting for somebody to come evaluate the patient because the patient is now being cared for by a professional mental health professional and the officer is back on the streets fighting crime. Uh
can you speak about u the improvements in recidivism and the number of violent uh encounters between law enforcement individuals with mental illness uh through the CIT you're involved with? >> Thank you for that question. CIT saves lives. The the the creation of
CIT was through a tragic incident in Tennessee where an individual with a serious mental illness uh was responded to by law enforcement. The family did in fact um you know say that there was a mental health condition. Unfortunately, that that individual um was um shot and
and killed. Uh from there um we have we have seen tremendous growth in CIT throughout Louisiana. As a matter of fact, we actually have the Louisiana CIT president um of a nonprofit. He is actually here today and I am actually the vice president of that organization. And our goal and our job is to work with
departments to show them the value. Law enforcement training um traditionally is is obviously meant to catch the bad guys, right? Um and and we know that that training and those tactics do not work in a mental health crisis. We know that that escalates that. So there's a
significant decrease not only in individuals being hurt, but also in in officers um obviously being hurt. Um so there there's a benefit all across the system. But there's another thing I want to touch on that that I don't know that we've hit today. And we've talked a lot about individuals with mental illness, a
lot about individuals with addictive disorders. We haven't talked about their families, which ties into CIT as well. Every single person in a crisis, it this is a ripple effect, they have family members that need support. They need education. They need to feel like they
know where to go. And one of the other aspects of CIT, and I I I I get to ride with CIT officers. So, I actually ride on the streets with some of these officers in real crisis. And the the comments from the family about law enforcement being the only lifeline is
is tremendous, but it's also troubling. the fact that mental illness is the only chronic illness where the first person you're probably going to see is someone with the badge is a problem. >> Um, but to your point, yes, I I definitely think and I commend all of our law enforcement agencies, especially locally here in Jefferson, Staint Tammy,
and the surrounding areas because they don't have to do this. They do it because it's the right thing to do and they see the results and it saves lives. >> Senator Cassie, can I say something about CIT? CIT saved my life and two other people in my family. The first time that law enforcement had to pick up
someone I love was my mom. And that was one of the most traumatic things that happened, but it was one of the best things because it end up, you know, that's how she entered sobriety number one. The second person was my uncle who was schizophrenia and bipolar. And I never forget when I was there. Matter of
fact, I think out of 11 times in one year, I saw it five times. And how deescalation and CIT training work. And the last time was myself. You know, life happens to all of us. In 2016, my husband and I was going through some things. And anyway, uh that was the
second time that I uh attempted suicide. And there was two officers that came on the scene. One was CIT trained and one wasn't. Matter of fact, the one who was engaging with me, I trained him. And one treated me like a criminal, the other one treated me like I was in crisis. And I'm here today because CIT training does
work. And like you were saying, you know, it's not just for the person, but it's for the family and it's also for the officers who are there because it's their job. They want to protect and serve and not and not do not do harm. But when we give them the tools they need, it works.
>> So, I'm going to spend a little time with you, Stuart. Um, a reality for many people is that their loved one, whether it's addiction or mental illness, is brought someplace. they're stabilized,
but then the provider is not allowed to tell the family when a follow-up visit is, not allowed to tell them key details about how to manage the disease. And the frustration I hear, maybe this has changed, but the frustration I hear from
families, I'm the one who cares for him. Who do you think is going to take him there? But you won't tell me. you won't tell me when he's supposed to be there, what medicines he's supposed to take, and when he's supposed to take them. Um, there's just this craziness about
it. Now, maybe it's changed since I had this conversation with my old high school buddy, but speak about that. And if you're watching, because when we had testimony in Congress, there was a family from New Orleans that spoke and they spoke about
how they could not be told by the provider and their son, if I recall, ended up committing suicide, but afterwards they found all sorts of terrible things in his room which indicated he was going to hurt other people. >> Yeah. >> So, please speak to this.
>> Sure. It's a it's a it's a great question and I and I would say we could spend probably all day talking about this topic. I mean, first of all, no one is working harder than a patient in a family in this crisis or someone in recovery to just get the life-saving
treatment that they need or have the ability to help their loved one in a in a time of crisis. Uh, I think sometimes our our lack of a national vision around mental health and substance abuse, we we end up burdening other parts of society, whether it be law enforcement, schools,
other settings, because we simply have not confronted, we've not funded really the things that we know as providers work every single day. You know, we get the question a lot, you know, do we know? We know the things that work. We know the evidence-based practices that'll get people back into their
community, that will get them back to work. We just simply have to have the courage to challenge. I think what are some longstanding rules, things that may sound good in academia, things that may sound good in a regulatory body, but families and providers know.
>> So, you're speaking specifically about rules restricting the ability of a provider to speak openly about someone's condition. >> Correct. By the way, as a physician who took care of patients with say cerosis from hepatitis C, I could say to the
family, listen, he needs to take this medicine three times a day. >> Yes. >> And if he ever gets confused, you need to call me, but in the meantime, start that medicine. >> Yes. >> Uh you we could have a frank conversation and yet that doesn't occur with mental illness. I'm not quite sure why not.
>> Yeah. You know, I I think there, you know, we we I think we still have a national um fear about, you know, where mental health was 50, 60, 70 years ago. I think there's a media perception of behavioral health that is really good to sell movies and books, but doesn't
reflect the actual reality of what we do every day. And I and I think some of these rules um you know, date back to a previous time in which abuses happened or information wasn't shared. But but but but chairman, you're exactly right. These rules that are in place today um
prohibit the adequate sharing of information with people that are going to be many times the the person caring for this person, the person helping them navigate these roles. And look, I think the balance between personal rights and the family's rights are delicate issues
and and they require I think a lot of thoughtful analysis. You know, we see this many times as states and the federal government struggles with what are the committal laws? What committal laws make sense today? And I would argue in many communities, uh, we need to
revisit that discussion. We're dooming people to lives that >> now, now for those who are not familiar with it, what do you mean by committ laws? So, so in its most simplistic fashion, when a person is in the throws of a severe mental illness or or an addiction disorder and they need to be
compelled to treatment, they need to be brought to treatment and they can't advocate for themselves, there is the ability, the court or law enforcement, not hospitals, but law enforcement court uh members of the court can compel a patient to treatment. Um, I think those
in previous generations, there's this image of patients would go to hospitals and they would never get out. Well, frankly, my biggest struggle is keeping your loved one long enough for even the medications to even get on board. Um, we've turned the committal laws, uh, I
would say so far one direction and on top of that, we've layered managed care on top of it. So, the combination of those two created an environment for our most severely mentally ill where we can barely keep you long enough to get to know you before you're being pushed out
of the door by many of these plans. So, I'm going to do now before I turn it over to you folks to ask each other's questions, I'm going to ask one more as a policy maker because I am chairman of the Health, Education, Labor, and Pensions Committee, but I'm also on the
Senate Finance Committee, the third person from Louisiana to serve. And that gives me a role in jurisdiction of Medicaid and Medicare. Okay. And so, Lonnie mentioned 28 days may not be long enough. you just mentioned it's hard to
keep someone in long enough uh and how there is a restriction of a total number of days on Medicare in terms of being treated. Now, I agree with you, but let's also admit that there's some that would abuse that.
They would keep people in when they don't need to be in to maximize profits. And I say that because I'm a fiscal conservative, but I'm also want to take care of patients and we know we get a great return on investment if we do it appropriately. But what we don't want is
to have somebody milking the system. Now there is a tension there and and I'm not sure that we have figured out how to have appropriateness of length of stay independently of saying you can only
stay so long. Now you're speaking to Bill Cassidy who's trying to make sure that we balance the budget but we are able to take care of the patients who need to be cared for. Lonnie, I'll start with you, then I'll go to you, Stuart.
>> You know, Senator, um Stuart mentioned the IMD exclusion, and I'm fairly certain that he >> So did Tanja. >> Yeah. And you you as well. I'm fairly certain that we're all going to be spending a lot of time. >> Now, explain what the IMD exclusion is for those who may not know. >> Well, as as Stuart mentioned, >> pull that microphone. I've had a hard
time getting that microphone up to your lip, brother. I need it right next to your mouth. You know what I'm saying? >> Um uh specifically, the IMD exclusion goes back to uh LBJ, even Kennedy days. So, u the implementing the so enacting the social security administration, but essentially what it did in in relation
to inpatient services is it limits the number of >> pull it a little bit closer. I cannot tell you if it's if it's more than an inch. >> You won't hear me back there. Uh it it limits the uh the number of days that an individual can receive inpatient services to 15 days and it limits the bed capacity that a provider can offer
services. So, we have a shortage of beds, but there's federal Medicaid rules which limit somebody providing care to only 15 beds. Correct. >> Yes. And those are long-standing rules. However, each state uh has the option to have a waiver around the IMD exclusion.
Louisiana is one of the uh the states that does have an a substance use disorder 11:15 waiver. So, it allows for our treatment providers to to help individuals past 15 days uh and and expand beyond 16 beds. However, we don't have uh 11:15 waiver for serious mental
illness. And so, that could potentially be something that could allow for uh individuals to receive inpatient psychiatric stabilization beyond 15 days. >> Okay, let me stop you. That's beyond 15 days just because you'd have more more beds by which to keep somebody in. Well,
just exactly. Exactly. Well, not not only that, but uh we need longer lengths of stay specifically for serious mental illness. >> So So help me out here. Going back to wearing my fiscal conservative hat with my we got to take care of patients hat because we got 11 to$14 return on
investment, >> right? >> How do you make sure that the increased length of stay is not being milked by bad actors, but rather is truly appropriate care? you you you with me? >> Absolutely. I would say that there's
that there certainly merit to that. Uh however, I would also submit that the um the the the the value of treating individuals and making sure that they get the individualized level of care that they need for as long as they need um may certainly outweigh any potential
fraud or mismanagement associated with that. Uh there uh there's also something something to consider where we might uniform um author prior authorization windows so that we're not peacemealing for a day here, 5 days here, but rather
maybe individuals could be authorized for 28 days at a time in treatment. Uh there are certainly, you know, different ways that we could go about it, but it is it's it's simply the case that minimum length of stay according to the American Society of Addiction Medicine
should be 90 days. Uh but but managed care as has been stated on once you start laying things together and trying to figure out what what you're going to pay for 28 days is where where we've landed. >> Stuart, >> yeah, I would say um look, a certain amount of friction in the system is
probably healthy. I'll acknowledge that between providers and payers. So I think that's healthy. I would say, you know, a couple things. As we embrace more outpatient care, we have to recognize who is an inpatient now in the hospitals. they're they're they're increasingly the more severely mentally ill. And then you you have this fentinel
crisis that we all know about and you now are facing um and we're seeing in our hospitals a more higher acuity behavioral health patient than we've really ever seen before. Patients um that are in more crisis that could be more violent that have a lot of issues.
And and so I I would say look I I think there is a certain amount of friction that's healthy. I would say your average behavioral health provider is is is not equipped to go to battle with these payers. Um you know these are multi-billion dollar organizations with
all kind of technology and and you have providers that you know for instance we'll admit a patient and we'll get a prior approval to admit the patient after 3 days every 24 hours the payer wants me to you know reertify why the patient has to be there. It's simply
harassment. And and so again, I think that the the you know, for us, we're we're arguing over keeping you long enough to hopefully keep you alive, much less transition you to outpatient treatment. Um so I look, I I I think that when you look at the margins of the
average providers in this state and you again, you look at the margins of the average payer, I think that tells you a lot of what you need to know. And I think our patients, frankly, and our families are easy to pick on. Um, when you're on the medicine side, you have a broken leg, you're on a ventilator. The first half of my career was on the
medical side in the severely mentally ill. I think on on ours, we are working with families. We're working with some things that the payers view is is subjective. They're not. And I think there's evidence-based criteria that proves out the treatments that all of us
engage in every day. That's not to say there aren't bad actors, but there's bad actors everywhere. I think you see them in every aspect of health care and they need to be pushed out of the program. Um, and so I I think look I I I do think that for behavioral health providers we
are uniquely vulnerable I think to some of the things that are that are in the industry today uh and and some of the challenges that our patients face. >> Art, you've been both a provider and a administrator through SAMA so I'm sure
you've thought about this. I'd like your perspective please. Uh, thank you. Yeah, I I uh believe in repealing the IMD. I just as a fiscal conservative, as you said, it's going to be very expensive. So, the one thing I'm looking at with the IMD and like your example with the
lady with the leg in the street, is that we could do that for people with like serious mental illness, people that are on the spec, way off on the psychotic sort of realm of the spectrum. we could expand the IMD to include more of them so they don't keep recycling back to the
street. Uh, and I I think that would be sort of an effective way to do this. Uh, I also sort of want to say that as a provider, I've worked in there and so I've seen it. Uh, basically when somebody comes in treatment, you do the assessment, right?
So since that's not 100% concrete as like you as a physician, there's a lot of gray area in there. So you could always put somebody in your treatment program if you want, but the the thing to do is to actually sort of have an honest assessment to where treatment
matches the needs of the individual. And that's the way you get the best success rate uh as as treatment matches their needs, addresses their their their liabilities as well as their strengths to get them back into being uh uh self-sufficient as quick as possible.
That's why I I like what Odyssey House is saying here about like stepping down levels of care. So, we could do this as a crisis intervention. We could stabilize people based on their need. Uh and you could stabilize people who are in a psychosis, get them the help they
need, and you could sort of step them down to where they're getting all their needs met at at the precise time of their recovery that they're working and getting them into self-sufficiency. And so that would actually justify a regular followup from the managed care provider, not the hassle, but to make
sure they're being appropriately stepped down. But the but what the insight you're giving is that if your initial diagnosis is correlated with the need for longer term care as opposed to someone with mild situational depression, right, who would be easy to
care for, but you certainly don't want them to stay in for 28 days. That would be milking the system. No, you want somebody who's schizophrenic. >> Correct. You would you want to address you would when with the IMD, you want to make sure we hit our most vulnerable people, our people in need, uh like the
lady that you described. So that's what we'd want to do with the sort of the IMD address that you can also like include severe substance use disorders where people don't understand how perilous close they are to fatality, right? So so many people, it might seem obvious to
the guy outside of them, but to them inside their bubble of addiction, they don't see how perilously close they are to sort of fatality. So I I think if we can kind of design the system to hit those really chronic severe people, we can address their needs without like you
said as a fiscal conservative without just opening the door for everybody like you said like somebody with like mild depression or something like that. And and to that end, I mean, what what we're seeing, I think more second after this, I'm going to ask you to ask questions of each other. So, just be thinking as
Lonnie speaks about what you would ask of each other because I'm going to learn or we will learn a lot from that. Please, please. >> Sure. I think I think to that end uh what we see in a treatment environment more than um the opportunity for uh for fraud and abuse is the managed care
organization simply not giving us the time and authorizing the time that we need with our with our clients. Uh a lot of times what we find is the uh the patient case reviewers are simply not qualified to be able to uh to to provide the the the the judgment that they are.
Uh especially considering uh when our clinicians are qualified, have are engaging with the client, um know them, can be able to to make a medical recommendation. Yet the managed care organizations because of cost containment are actually recommending
lower levels of care than what is being recommended by the provider. That's what we see far often than not is actually not being authorized the time that we need with the clients that we serve. Um, if you have on a later off off the record if you have a way that the government could regulate that because
I'm not quite sure how we'd regulate that because I hear that from doctors treating medical illnesses that the person who is reviewing the prior authorization is not competent to review. Now, that may be a perspective, but still you hear it and so Nick, why don't you start off our questions of one another
>> and it can be of me too, but I think you know whatever. >> Thank you. Um, so I don't know if it's a question so much as a a question to everyone on the panel and I I'm I'm going to oversimplify this whole conversation that we're having about inpatient care and about continuum of care. When I started in this industry,
obviously, you know, the medica as it pertains to serious mental illness, that's what I'm speaking to and not addictive disorders. As it pertains to serious mental illness, we've seen a dramatic increase in access to medications that allow people to lead lead fulfilled lives. We're seeing a lot of improvements. But what I see out of
the inpatient system, so this is a kind of a question definitely directed at you a little bit, but directed at everybody is the way that people navigate this system. Our inpatient and residential mental health facilities have become nothing more than we will stop you from
harming yourself or others. They're they're not set up and and it's not against them. It has to do with a lot of factors, but as I see it, they are just there to stop death. And philosophically as a society, is that really what we want that part of our health care system
to do? They once were there to actually treat. Yes, to stop harm and death, but also to get people into the path of recovery. At this point, because of how quickly people are discharged, our inpatient psychiatric facilities are simply there to stop an individual from harming themselves, from harming others,
and that is it. >> Stuart, >> so as a systematic problem, I I think that's an issue. I don't know that. >> Yeah, look, I I I would I would, you know, believe that our care is a lot more comprehensive than that, for sure. And I think um and we have an open formulary, right? So, whatever the doc
prescribes, the patient gets, but I I don't disagree with the fact that our biggest struggle is just I mean almost from day one, we're under attack by the payers. Um and and and and I think we're, you know, many times it takes us it may take us, you know, a few you
know, a bit of time just to ascertain what's going on with this patient. They have a very nebulous history. We're trying to navigate a family situation and by the time that's kind of becoming more clear, we have a payer banging on the door trying to get the patient out and many times maybe recommending a
level of care that they themselves don't fund afterwards. Uh that's another big issue that we have as we think about Medicaid in many states. uh you know we work very closely and we provide IOP and PHP services for for folks who these folks know it well. These are step down
levels of care. They're fundamental to what we do and and for what a lot of these providers do, but they're not always funded by Medicaid. Um those are not things that are uniformly funded in in different states. And so I think just as important about the length of stay and inatient is is to your point where
are you headed next is that funded. Art, you had something. >> Oh, yeah. I'd like to uh piggy back off Mr. Rishard there. Uh from my clinical experience when you're looking at serious mental illness and I worked at uh you know treatment centers with
severe overdoses multiple 10 in a lot of co-occurring. Uh but numerous times I would get somebody with the more acute problem is their serious mental illness. So you could stabilize them in treatment and kind of get them going. But what I've noticed is out out
there the gap uh that I see sort of like in the treatment community uh the continuum that is where do you place these people with serious mental illness post sort of that treatment stabilization period right so that's an area where the gap I think that would
actually we would sort of need to kind of close and like when I was at SAMA the idea that I was thinking because CCBHC's provide SUD and mental health and crisis care is a way to kind of have that to sort of fortify that with sort of like
with a recovery house uh uh situation to where they could receive services and have a maybe a step down level of care as they get more uh ingrained to go into society like uh Odyssey house uh Mr. Gier was talking about the resocialization of it all. So there is
that need for that piece for people with serious mental illness. Now, they will have places to place them, but it's kind of out of reach for people with third-party uh sort of payers, right? So, a lot of Medicaid and that uh is hard to find that uh funding for that
sort of level of care, but it is a gap that I I do feel like we need to sort of address here as a community. >> Does anyone else have a question for the others? >> I just wanted to I I know I already talked, but I just wanted to wholeheartedly agree with that. I've
spent a lot of my career time and energy creating housing programs for people with severe and persistent mental illness and the only way to leverage funding for that is generally local funding. Um this is not something and and it's one of the greatest needs that we have. So I I will tell you this if you have anybody in this region we do
actually house individuals great and are building a tiny home village actually in St. Tammy Parish right now specifically for people with serious mental illness. So if I were to be asked what my number one priority is 1, two, and three is for supportive housing for people with severe and persistent mental illness.
>> Yes. I agree with him. >> And you're specifically speaking of severe persistent mental illness. >> Yes, sir. >> Yeah. >> So I I guess I have a question for everyone and just a comment. So, we've talked a lot about, you know, uh, uh, folks with SMI and, you know, even, you know, those who are homeless, but I know
you're you're talking about the this being live stream and just if the average American is watching and listening, uh, crisis is not cookie cutter. It can happen to anyone. And I have been fortunate to work with people
who are broke or who have billions. And I know that one thing that happens when you're in crisis sometime none of that matters. So since we're talking about a crisis continuum here and so how do we address it as a whole for just the
average American who life is happening. They find themsel in a crisis. What do they need to do? Because I've had to navigate people who have insurance, who have means, and those who don't. And to be honest, the challenges are the same.
And so when we're talking about a robust crisis continuum, we have to make sure that we're talking about meeting the needs of Americans, no matter where they are, no matter what zip code or state that they live in, that they know that there's help and there's hope and that
crisis is real. And when we talk about that, first of all, thank you for having this because May is mental health awareness month. And you know, 988 was one of the best things in a long time. I never thought I'd live to see something like 988 in my life. And I think that when we talk about 988, we have to push
it more to let people know that anyone can call it 24 hours, 7 days a week. That also it's not just for a person because a lot of times people think it was for people who just have mental illness, but it's also for someone who's experiencing a substance abuse challenge. So, I guess my question to to
you guys is, you know, when we talk about the crisis continuum, how do we make sure that everybody, no matter who you are, if your crisis is serious mental illness or if it's just that you just got a divorce or you just found out someone died in your family and you find
yourself in a crisis, how do we make sure that we let the average American know that you matter, that what it is that they need to do, because we think people do and they don't know how to even enter a crisis continuum.
>> I'll just say making our society better is a team sport. The person that says my vote's only one vote, know that one vote can make a difference. And the person who says if I tell you 988 is a call you can make if you're having problems, the
one person you tell may be the person who tells many others or maybe the person who needs it. Just my perspective is do do whatever you can whenever you can as much as you can to help other people. Anyone else want to comment? >> No, I mean I would I would echo that sentiment and and look I would first say
Senator Cassidy how appreciative I am and I know my colleagues are to have this discussion with you in this forum. You know it's it's um it speaks a lot to to the dedication you've had to this space and and we just really appreciate the time you've given us to talk about
this. Um, look, I I am a little bit encouraged when I look at my kids. Um, I see an awareness in them. They talk about this at school. They their peers talk about this. I think they're more open in many ways to this. Um, I think it's maybe my generation and others that
still have the problem to talk about it or or have the um uh the fear of doing this. I think the more we can do to normalize this, the more we can share our own stories. Everybody that most people I've met in behavioral health or substance abuse have a personal journey. And certainly whether they're
comfortable sharing it or not, it's up to them. But I do think the more we can normalize this, the more we can share these stories that, hey, look, you're no different than me and that person's no different than us. Um I I think, you know, historically we wanted to marginalize, I think, many of these
communities or or walk past that person in the street, but that's our brother and our sister in many ways. And so I I think again in any way that we can share our stories and that we can make access easy. I think that's the final piece I would share is like many times because I
get those same phone calls as well like nobody's trying harder to get help than a patient in crisis and we've got to make these pathways easy and they don't always lead to a physician. you know, we've got to find ways um where we can arm primary care more and more and equip
them and reimburse them for the time they spend with patients and families. I think uh faith plays a huge role in many of our lives coming up with and equipping uh places of faith to have these conversations and and I think the concept it's get said many times of no
wrong door. We've got to have that mindset that folks can enter care and ask for help in in really many different ways and and they're all okay. Well, I thank I thank you all for participating. It's been a really good panel and uh I took
notes from things that um that I've learned. By the way, I've learned from each of you through the course of time. Uh I ran into your predecessor, I think his name was Ed, way back, went on an airplane and when I first became acquainted with the Odyssey House as an example, uh and y'all are obviously
doing a fantastic job. Uh I what am I taking from it? Mr. Rishard saying uh one, two, and three is housing and Dr. Kleinmid speaking about how maybe we could do some sort of limitation
fiscal conservative we got to take care of you by the initial screening of the diagnosis. Um, the fact that Stuart, your group has successfully brought programs into the rural areas, uh, tells me it can be done because you
also have workforce development in there, but payment policy is key. We got to get the payment policy right. uh Odyssey House putting successfully that wraparound set of services that then
give someone a trajectory to wholeness and Tanja you always through your personal testimony of your life but also of others reproducing what you are doing oh how did you do it we're going to do it and now one of their graduates has
given $100,000 back to the program to help others I mean I that reproducibility things work, you can put it in your community. Um, I think is one of the messages that each of you had and that we have to emphasize coming out of this.
So, thank you all for participating. Uh, I have some see if I get this right. Um, for anyone who wish any senator who wishes to submit a question for the record, you have up to 10 working days to do so. And with that, I um with that
I bring to an end this hearing. Thank you. Thank you.