MINDS Act

II 117TH CONGRESS 1ST SESSION S. 2105 To enhance mental health and psychosocial support within United States foreign assistance programs. IN THE SENATE OF THE UNITED STATES JUNE 17, 2021 Mr. CASEY introduced the following bill; which was read twice and referred to the Committee on Foreign Relations A BILL To enhance mental health and psychosocial support within United States foreign assistance programs. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLES. 3 This Act may be cited as the ‘‘Mental Health in 4 International Development and Humanitarian Settings 5 Act’’ or the ‘‘MINDS Act’’. 6 SEC. 2. FINDINGS; SENSE OF CONGRESS. 7 (a) FINDINGS.—Congress finds the following: 8 (1) According to the 2016 Global Burden of 9 Disease Study, an estimated 1,000,000,000 individ- 10 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 2 •S 2105 IS uals worldwide have a mental health or substance 1 use disorder. Mental disorders are major contribu- 2 tors to the global burden of disease, and depression 3 is among the primary causes of illness and disability 4 in adolescents. 5 (2) An individual’s mental health is a complex 6 interaction between genetic, neuropsychological, and 7 environmental factors, and environmental and social 8 factors, from the early years through childhood and 9 adolescence, can have long-term impacts on mental 10 health. 11 (3) According to a Lancet Commission report, 12 allocations for mental health have never risen above 13 1 percent of health-related global development as- 14 sistance. Estimates indicate that child and adoles- 15 cent mental health receives just 0.1 percent of 16 health-related global development assistance. 17 (4) The National Alliance on Mental Illness es- 18 timates that depression and anxiety disorders cost 19 the global economy $1,000,000,000,000 in lost pro- 20 ductivity each year. According to Lancet, mental 21 health disorders are projected to cost the global 22 economy $16,000,000,000,000 between 2010 and 23 2030, in part due to the early age of onset. 24 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 3 •S 2105 IS (5) According to the World Health Organiza- 1 tion (WHO), half of mental health disorders emerge 2 by age 14, and 14 percent of children and adoles- 3 cents worldwide experience mental health conditions, 4 the majority of whom do not seek care, receive care, 5 or have access to care. 6 (6) Exposure to violence and early childhood 7 adversity, including trauma, has been linked to neg- 8 ative, lasting effects on physical and mental health. 9 Early childhood adversity can impact brain develop- 10 ment, nervous and immune system functioning, the 11 onset of mental health conditions, and future behav- 12 iors. The United Nations asserts that widespread 13 school closures due to COVID–19, which have af- 14 fected roughly 1,500,000,000 school-aged children, 15 have placed many children at higher risk of exposure 16 to traumas, such as household violence, abuse, ne- 17 glect, and food insecurity. 18 (7) According to the United Nations, more than 19 1 out of every 5 individuals in conflict-affected areas 20 has a mental health disorder. Roughly 21 1,500,000,000, or 2 out of every 3 of the world’s 22 children under 18 years of age live in countries af- 23 fected by conflict, and more than 1 out of every 6 24 children live in conflict zones. A greater number of 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 4 •S 2105 IS children live in areas affected by armed conflict and 1 war now than at any other point this century. The 2 mental health burden in conflict-affected contexts is 3 twice the global average. 4 (8) Gender, age, disability status, race and eth- 5 nicity, and other identity characteristics contribute 6 to different risks and needs for mental health and 7 psychosocial support. Research has shown that 8 harmful gender norms contribute to higher preva- 9 lence of depression and anxiety disorders in women 10 and girls, while socialization of boys and men con- 11 tributes to higher prevalence of substance use dis- 12 orders. 13 (9) Risks and experiences of gender-based vio- 14 lence, particularly sexual violence, are a key driver 15 of mental health and psychosocial support needs for 16 children. Girls account for 98 percent of verified in- 17 cidents of conflict-related sexual violence. According 18 to the World Health Organization, 35 percent of 19 women globally ‘‘face sexual and/or intimate partner 20 violence in their lifetime’’ and these survivors can, 21 according to the Centers for Disease Control and 22 Prevention, ‘‘experience mental health problems such 23 as depression and posttraumatic stress disorder 24 (PTSD) symptoms’’, signifying the urgent need for 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 5 •S 2105 IS age and gender-responsive mental health and psy- 1 chosocial support services. 2 (10) According to the World Health Organiza- 3 tion, risk factors that increase susceptibility to men- 4 tal health disorders include poverty and hunger, 5 chronic health conditions, trauma or maltreatment, 6 social exclusion and discrimination, and exposure to 7 and displacement by war or conflict. These risk fac- 8 tors, along with demographic risk factors, manifest 9 at all stages in life. Preliminary research already il- 10 lustrates that the COVID–19 pandemic has in- 11 creased communities’, families’, and individuals’ risk 12 factors for multiple types of adversity and com- 13 pounded preexisting conditions and vulnerabilities. 14 (11) Crisis situations put parents and care- 15 givers under mental and psychosocial duress, which 16 can prevent them from providing the protection, sta- 17 bility and nurturing care their children need during 18 and after an emergency. The Lancet Commission es- 19 timates that between 15 and 23 percent of children 20 globally live with a parent with a mental disorder, 21 and parental ill health can impact the emotional and 22 physical development of children and predispose 23 these children to mental health problems. Numerous 24 and compounding stressors and uncertainty caused 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 6 •S 2105 IS by COVID–19 have exacerbated distress and further 1 impede caregivers’ ability to provide responsive care 2 to their children. 3 (12) Investments in the mental health, resil- 4 ience, and well-being of the children in a country to 5 ensure that they continue to thrive into adulthood 6 and contribute to their societies can help break cy- 7 cles of poverty, violence, and trauma and further the 8 country’s future potential. 9 (13) Investments in protecting and improving 10 mental health in a country across the life course 11 must take into account the need to target vulnerable 12 populations and address social, environmental, and 13 other risk factors in conjunction with other sectors 14 and local partners. 15 (b) SENSE OF CONGRESS.—It is the sense of Con- 16 gress that— 17 (1) ensuring that individuals have the oppor- 18 tunity to thrive and reach their fullest potential is 19 a critical component of sustainable international de- 20 velopment, and the global public good benefits from 21 investment in child and adolescent mental health; 22 (2) mental health is integral and essential to 23 overall health outcomes and other development ob- 24 jectives; 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 7 •S 2105 IS (3) mental health is an issue of critical and 1 growing importance for United States foreign assist- 2 ance that requires a coordinated strategy to ensure 3 that programming funded by the United States Gov- 4 ernment is evidence-based, culturally competent, and 5 trauma-informed; 6 (4) the United States Government foreign as- 7 sistance strategy should include a mental health and 8 psychosocial support component; 9 (5) the redesign of the United States Agency 10 for International Development (referred to in this 11 Act as ‘‘USAID’’) reflects the nexus between hu- 12 manitarian and development interventions and 13 should be applied to all mental health and psycho- 14 social support efforts of United States foreign assist- 15 ance programs; and 16 (6) ongoing efforts to improve social service 17 workforce development and local capacity building 18 are essential to expanding mental health and psycho- 19 social support activities across all United States for- 20 eign assistance programs. 21 SEC. 3. COORDINATOR FOR MENTAL HEALTH AND PSYCHO- 22 SOCIAL SUPPORT. 23 Section 135 of the Foreign Assistance Act of 1961 24 (22 U.S.C. 2152f) is amended— 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 8 •S 2105 IS (1) by redesignating subsection (f) as sub- 1 section (g); and 2 (2) by inserting after subsection (e) the fol- 3 lowing: 4 ‘‘(f) COORDINATOR FOR MENTAL HEALTH AND PSY- 5 CHOSOCIAL SUPPORT.— 6 ‘‘(1) APPOINTMENT.—The Administrator of the 7 United States Agency for International Develop- 8 ment, in consultation with the Secretary of State, is 9 authorized to appoint a Mental Health and Psycho- 10 social Support Coordinator (referred to in this sec- 11 tion as the ‘MHPSS Coordinator’). 12 ‘‘(2) SPECIFIC DUTIES.—The duties of the 13 MHPSS Coordinator shall include— 14 ‘‘(A) establishing and chairing the Mental 15 Health and Psychosocial Support Working 16 Group authorized under section 4 of the Mental 17 Health in International Development and Hu- 18 manitarian Settings Act; 19 ‘‘(B) guiding, overseeing, and directing 20 mental health and psychosocial support pro- 21 gramming and integration across United States 22 foreign assistance programming; 23 ‘‘(C) serving as the main point of contact 24 on mental health and psychosocial support in 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 9 •S 2105 IS the Bureau for Global Health, Bureau for Hu- 1 manitarian Assistance, regional bureaus, the 2 Office of Education, the Inclusive Development 3 Hub in the Bureau of Development, Democ- 4 racy, and Innovation, the President’s Emer- 5 gency Plan for AIDS Relief, and other inter- 6 agency or presidential initiatives; 7 ‘‘(D) promoting best practices, coordina- 8 tion and reporting in mental health and psycho- 9 social support programming across both devel- 10 opment and humanitarian foreign assistance 11 programs; 12 ‘‘(E) providing direction, guidance, and 13 oversight on the integration of mental health 14 and psychosocial support in both development 15 and humanitarian foreign assistance programs; 16 and 17 ‘‘(F) participating in the Advancing Pro- 18 tection and Care for Children in Adversity 19 Interagency Working Group. 20 ‘‘(3) FOCUS POPULATIONS.—Along with a gen- 21 eral focus on mental health and psychosocial sup- 22 port, the MHPSS Coordinator should pay special at- 23 tention to mental health and psychosocial support in 24 the context of family and children, including— 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 10 •S 2105 IS ‘‘(A) meeting the needs of adult caretakers 1 and children, including families and adults who 2 are long-term caretakers; 3 ‘‘(B) children and others who are sepa- 4 rated from a family unit; and 5 ‘‘(C) other specific populations in need of 6 mental health and psychosocial support, such as 7 crisis affected communities, displaced popu- 8 lations, gender-based violence survivors, and in- 9 dividuals and households coping with the con- 10 sequences of diseases, such as Ebola, HIV/ 11 AIDS, and COVID–19.’’. 12 SEC. 4. MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT 13 WORKING GROUP. 14 (a) ESTABLISHMENT.—The Administrator of the 15 United States Agency for International Development (re- 16 ferred to in this Act as the ‘‘USAID Administrator’’), in 17 cooperation with the Mental Health and Psychosocial Sup- 18 port Coordinator, shall establish the Mental Health and 19 Psychosocial Support Working Group, which shall include 20 representatives from every United States Agency for 21 International Development bureau and from the Depart- 22 ment of State, to ensure continuity and sustainability of 23 mental health and psychosocial support across foreign as- 24 sistance programs. 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 11 •S 2105 IS (b) REQUIREMENTS.—The Mental Health and Psy- 1 chosocial Support Working Group— 2 (1) should include representation at the Deputy 3 Assistant Administrator level from every United 4 States Agency for International Development bu- 5 reau; 6 (2) shall promote and encourage dialogue 7 across the interagency on mental health and psycho- 8 social support program development and best prac- 9 tices; 10 (3) shall coordinate the implementation and 11 continuity of mental health and psychosocial support 12 programs— 13 (A) within USAID; 14 (B) between the USAID and the Bureau 15 of Population, Refugees, and Migration of the 16 Department of State; and 17 (C) in consultation with the Centers for 18 Disease Control and Prevention and the Na- 19 tional Institutes of Mental Health, as appro- 20 priate. 21 SEC. 5. INTEGRATION OF MENTAL HEALTH AND PSYCHO- 22 SOCIAL SUPPORT. 23 (a) STATEMENT OF POLICY.—It is the policy of the 24 United States to integrate mental health and psychosocial 25 VerDate Sep 11 2014 05:22 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2105.IS S2105 kjohnson on DSK79L0C42PROD with BILLS 12 •S 2105 IS support across all foreign assistance programs funded by 1 the United States Government. 2 (b) IMPLEMENTATION OF POLICY.—The USAID Ad- 3 ministrator and the Secretary of State shall— 4 (1) require all USAID and Department of State 5 regional bureaus and missions to utilize such policy 6 for local capacity building, as appropriate, for men- 7 tal health and psychosocial support programming; 8 (2) ensure t [Text truncated for display. Full text available on Congress.gov.]