Skip to main content

tv   Experts Testify on Veteran Suicide Prevention  CSPAN  January 18, 2022 4:47pm-8:17pm EST

4:47 pm
at or on our app c-span now. american history tv saturdays on c-span2, exploring the people and events that tell the american story. watch an event marking the 30th anniversary of justice thomas' confirmation to the u.s. supreme court. justice thomas is joined by senate minority leader mitch mcconnell reflecting on his time on the court. and at 2:00 p.m. eastern on the presidency, a look at the herbert hoover presidential library and museum with allan hoover iii. he talks about how the presidential library will evolve in coming years. exploring the american story. watch american history tv saturday on c-span2 and find a full schedule in your program guide or watch online anytime at
4:48 pm
government officials and experts testified on veteran suicide prevention before the house veterans' affairs committee, the impact of the afghanistan withdrawal on veterans, access to mental health care, and reducing stigma to receiving care. this runs 3 1/2 hours. i will now recognize myself for opening statement. today we come together as we do every september to explicitly shine a spotlight on the prevention of veteran suicide. it is work that requires the collective commitment of us all. va, vsos, policymakers, advocates, families, caregivers, survivors, and loved ones. the work we all do every day all year long to prevent veteran suicide is vital. we talk a lot about systems of care for those in crisis, the veterans crisis line and, for
4:49 pm
example, a key part of my compact act which would ensure any veteran at imminent risk for harm to self or others can receive free stabilization care at or paid for by va. i want to make sure all of you, veterans, family members, caregivers, friends and colleagues, answer the veterans crisis line into your phones in case you or someone you care about needs it. the number is 1-800-273-8255. that's 1-800-273-8255. i would enter it into my own phone but i don't want to take up that time right now, but i will. i do carry the card with me. i think it's a good thing if all of us, as members of congress,
4:50 pm
we have it into our phones if we're at a town hall or at a place where we address this topic. it's always great to be able to know you have it with you. but we also know you. we also know that a true public health model prevention is the most comprehensive holistic approach to suicide prevention. everything we do upstream is also suicide prevention. education and employment with a living wage are suicide prevention. preventing and treating the effects of trauma including sexual assault is suicide prevention. addressing social isolation and
4:51 pm
loneliness is suicide prevention. especially by getting everyone to store their firearms and ammunition safely is suicide prevention. and treating all veterans with respect inclusive of their gender, race, ethnicity and sexual orientation is suicide prevention. now, we will hear this morning about va's ongoing and new suicide research studies on how science and innovation both drive the broad and targeted efforts to prevent suicide. we want to know what works and what looks promising. and i'm also eager to hear about
4:52 pm
va is tailored and expanded its mental health support and suicide prevention outreach in the wake of the ongoing pandemic and the recent u.s. withdrawal from afghanistan. now, this hearing was planned long before the most recent events in afghanistan. but i've asked va, bsos and veterans witnesses to share what they have been doing for outreach and support for veteran who are struggling. my staff has been in daily contact with organizes this past month. i thank you for keeping them briefed on your needs and efforts. veterans are not a monolithic group. and though all have served this country they all have unique backgrounds, experiences and strengths and challenge to their service and next phases of their lives. this means just as there is no single cause of suicide, there is no single approach to
4:53 pm
preventing suicide. with this goal in mind i've directed my staff to put together a legislative package of mental health and suicide prevention bills we can move with the urgency we all agree is warranted. and they have invited republican staff to provide input as well. this new mental health and suicide prevention website package will include how va trains its community mental health providers, increase the number of peer specialists in va medical centers, expand va, auto enroll service members suffering from active duty in va databases during the transition process, strengthen and add more
4:54 pm
resources for the veterans crisis line, increase the number of vet centers around the country and inensure suicide prevention outreach and care reaches traditionally underserved veteran communities. on that note, i've just introduced a bill with congresswomen porter and slotkin. i know we were all really pleased with 2019 the most recent year which the cdc have the most reliable suicide death
4:55 pm
data the rate of all suicide especially veterans went down. the number among veterans decreased for the first time in many, many years. while this is wonderful news, all of us know that it doesn't pause our commitment and our work for even one second. one veteran dying by suicide is a heart breaking event. with that i look forward to hearing from the witnesses on both of our panels. ranking member, i now recognize you for five minutes for your opening remarks. >> thank you, mr. chairman. i appreciate the opportunity today to discuss the tragedy of veteran suicide and how to prevent it once and for all. you know, september is gnash suicide awareness month. and this september there's cause for celebration and caution. two weeks ago va released 2021 veteran suicide data report. for the first time in a long time as the chairman said, the
4:56 pm
report contained good news. it showed a 7.2% decrease from 2019. the most recent year of which we have data and that's available. according to va that doesn't hurt progress, but as we all know the last two years have brought unheard of challenges as well. those challenges include covid-19 crisis and more recently the crisis caused by the biden administration's failure to withdraw from afghanistan properly. veterans who serve in afghanistan and even those who serve elsewhere have been under immense stress watching the tragic events of the last several weeks unfold, and i've felt that same stress as well. and according to the va compared to the same time period in 2020 from august 13th to september 15th the veterans line experienced a 6% increase in
4:57 pm
calls and a 71% increase in texts. those increases are a direct result of the crisis in afghanistan. they paint a stark picture of the pain many veterans are experiencing at this moment. it is our responsibility as members of this committee to do everything in our power to support those veterans and make sure that we have what they need to heal and move forward. that's why my fellow republicans and i have been calling on the chairman to schedule the oversight hearing the address the impact of the afghanistan crisis it is having on our veterans communities. this is not that hearing. our calls have gone unanswered, but we must use this opportunity nevertheless to shine a light on those in need. that is why i'm honored to have nick here to testify as a
4:58 pm
minority witness today. nick is an army veteran who has served three combat tours in afghanistan. he transitioned out of the military eight years ago in 2013. he has been frank about the battles he's faced since then and his own mental health issues he's dealt with. he will be frank today about just how devastating the last several weeks have been for him and for many other veterans. and nick, we thank you. we thank you for your service in uniform, and we thank you for your service you're doing here today. your pain is not just your own. it is shared by many of your brothers and sisters in arms across this country. by giving voice to your experience you are powerfully showing that veterans, that they are not alone and that there is strength and hope on the other
4:59 pm
side of every struggle. it is -- it really is okay to not be okay. if you're a veteran watching this right now who needs help please know help is available to you any time. and i know that the chairman mentioned this, but i think it's important if you're listening here today and we do mention this, you could receive help by calling 180027382 # # 5 and pressing 1. or you can text 838255 or you can visit the for help as well. mr. chairman, with that i yield back. >> i want to thank the ranking
5:00 pm
member what if we also mention how fast can get help, so ranking member it was a pleasure to spend time with you and i want to say how much i appreciate the relationship we're developing. we don't agree on many things but we agree on other things. and i think that simplifies the membership of our committee. we're very passionate about our points of view, but i think we share a very common passion for those who serve our nation. so i want to express what an honor it is to always serve with actually not only the ranking member but someone who comes from a great military family who was a marine himself. >> thank you. >> i'll now call up and recognize our first witness
5:01 pm
panel from vha. dr. cameron matthews, assistant under secretary for health and clinical services accompanied by dr. matthew miller, executive director of the suicide prevention program. dr. lisa brenner, dr. of vha's rocky mountain mental health illness research, education center for suicide prevention. thank you all for being here, and i'll remind our witnesses to pause for 2 to 3 seconds before speaking and answering questions. dr. matthews, you're recognized for five minutes to present va's testimony. >> thank you very much, sir. good morning, chairman takano, ranking member and distinguished members of the committee. my colleagues and i appreciate the opportunity to talk about the great things va has done and will continue to do related to suicide prevention. i'm accompanied today by dr.
5:02 pm
matthew miller and lisa brenner. we would like to express our gratitude to each of you for joint efforts with us in ensuring veterans are aware of resources of support including the veterans crisis line in response to recent events in afghanistan and for all your commitment to veteran suicide prevention across many levels. i want specifically to thank the house for passing a strong military construction veterans affairs and related agencies funding bill. of note the bill includes robust funding for mental health and 5 # 9 million requested specifically for suicide prevention activities. in 2019 45,861 adult americans died by suicide. of those 6,261 were veterans. they reflect individual lives
5:03 pm
and with each loss for each family we continue to rededicate with each of you a commitment to the mission to address suicide as a national public health concern. suicide has no single cause and no one set solution. our work continues now in partnership with each of you to operationallize the public health approach in the national strategy for preventing veteran suicide providing community and clinical strategies to reach all veterans. the strategic plan is being actively implemented through deployment of the suicide prevention 2.0 initiative. the suicide prevention now initiative, the president's road map to empower veterans and end the national tragedy of suicide and 988 and the expansion as well as the implementation and their translation into practice. in addition to these initiatives our efforts are now further fueled by the commander by and
5:04 pm
the treatment act of 2020. the act will provide critical health resources and evaluate alternative or supportive treatments to clinical care as well as provide financial assistance to eligible entities through the award of grants of such entities to provide or to eligible individuals and their families. the compact act authorizes va to implement programs, policies and reports related to transitioning service members, suicide prevention and crisis services, mental health education and treatment and improvement for services for women. section 201 specifically on the compact act requires va to furnish care, pay for or reimburse an individual for emergeant suicide care provided
5:05 pm
to the eligible individual at a nondepartmental facility. and va is working rapidly to develop a process of community care is notified whenever dispatch or facility transport plan results in a veteran receiving care at a community facility. additionally, the veterans benefits administration provides a variety of benefits and services upstream which can reduce and eliminate risk factors associated with suicide and protective factors. disability compensation, pension veteran readiness assists veteranwise transiging to civilian life connecting with benefits and supporting financial well-being. finally va's community growth to inform and advance our knowledge base. and the office of mental health and suicide prevention work together to ensure requirements
5:06 pm
and funding are synchronized with operational priorities aligned with the national strategy of preventing veteran suicide. anchored in hope we hold to our core tenants. number one, suicide is preventable. number two, suicide prevention requires a public health approach, and number three, everyone has a role to play in suicide prevention. suicide prevention will take all of us including all of you and all of our communities across the nation. we appreciate the committee's continued support and encouragement as we identify challenges in finding ways to care for veterans. this concludes my testimony. my colleagues and are prepared to respond to any questions you may have. >> thank you, dr. matthews. i now recognize myself for five minutes for questions. dr. matthews, i'm impressed with how va immediately provided resources for veterans in the wake of the u.s. withdrawal in
5:07 pm
afghanistan. this is a paramount importance to me and this committeesuch is there more you want to share about va's efforts? >> thank you so much for the acknowledgment, sir, for the question, really. we were quite interested to really having a multipronged approach to ensure veterans impacted by the events in afghanistan knew they were not alone. that was consistent messaging we shared through a multitude of different resources, through different blogs, daily outlets through our veterans news and different media interviews, even our facilities holding town halls, observance events, support groups. there's a multitude of different resources we have purposefully made widely available with just acknowledging we need to talk about it. in fact, that's our tag line.
5:08 pm
let's talk about it. they are not alone. that was emphasized time and time again. and really the concept that va is here for them, that we are regularly available through a multitude of resources whether it's through the vcl, online opportunities and chat events or directly at a facility where they can sit face-to-face with our provider, with a support team, these are numerous examples that we hope veterans really have been benefitting from. we've been getting that feedback ourselves. even the proactive outreach we've done just through e-mails alone and the response we get has been really telling, and we will continue these efforts as much as needed to make sure, again, that they realize va is here for each and every one of them. >> well, thank you, dr. matthews. before i turn to dr. miller, i'll really glad va is going to have conversations about their
5:09 pm
firearms. >> thank you for the question and for the spotlight focus on lethal means, safety and in particular firearm related lethal means safety. you in your introductory statement accurately asserted that there is no one single explanation for suicide, and there is no one solution. it involves as you highlighted maximizing protective factors, minimizing risk factors and those risk and protective factors have to be explored and enacted across clinical and
5:10 pm
community based settings. now, take the facts we have just talked about with regard to multiple reasons, multiple causes and think of it in terms of the following. all of those multiple causes, all of those multiple factors, 70% of the time come down to one lethal means. and that's firearms for veterans. so as our clinical practice guidelines demonstrate demonstrate one of the most important things we can do in suicide prevention is, yes, explore risks, explore preventive factors. explore policy and interventions that can address those. but as we're exploring the whys,
5:11 pm
if you will, of suicide, don't forget the how. and when the how is explained 70% of the time by one thing, a firearm, that suggests it's a very important area to focus upon. therefore in this year we are addressing the issue aggressively through our legal means safety campaign. >> i want to get to the doctor. can you say more about what va has learned about suicide from the genome sequencing and the veterans project and what it hopes to learn from the ascent study? >> i think as dr. miller highlighted what we're trying to do is understand how to put different risk and protective
5:12 pm
factors together and in doing so do a better job at predicting suicide. both the mvp project with genetics and the ascent project can be combined to look at predictive models and identify those who may not always know they're at risk at this point. >> thank you so much. i now want to yield back and call on the ranking member for five minutes. >> thank you, mr. chairman. dr. matthews, you kind of went into where we're dealing with the afghanistan situation with what we're doing passively, and i'm glad to hear we're talking to them. i was alarmed to hear that they
5:13 pm
never made a national outreach effort. we know many veterans are suffering because of this fatal withdrawal and the problems that came out of it. so what is the va's responsibility in reaching out and making -- you know, and supporting them and as we see the uptick as i talked about in my opening statement, why has there been no national outreach effort that's been done by the va? >> thank you for the questions, sir. there actually has been a considerable amount of proactive outreach through even our vcl line, through our office of social work, through our post-9/11 case management program and individuals are reaching out to those at high risk for suicide. there's been a considerable
5:14 pm
amount of engage proactively. i don't know if there's additional information you can share from your perspective. >> considering this from a public health perspective means that we engage outreach at least three target populations. universal which means outreach to everyone in the population, selected which means those at elevated risk and indicated those at the highest risk. our paid media has been structured to outreach and specifically target each segments of those populations. within the present month we've engaged too radio media tours into 50 plus markets to talk specifically about resources available to veterans including post-9/11 veterans and to offer
5:15 pm
follow-up resources and ways to connect. taken in total looking at 1.2 billion for our paid media websites 3.3 million website visits and 400 million video views and 94,000 resource engagements which means the veterans are diving deeper into links and resources that are provided. >> dr. matthews, also on our next panel he's going to testify that regular hearings from the veterans who cannot gain -- he's hearing from veterans who cannot gain access to be in mental health care or do not trust it. and i just need to find out some veterans experience wait times up to ten weeks and are not being given the option to seek care in the community despite
5:16 pm
being eligible for it under the mission act. those are various charges that are going to be out there that -- that will come up in the next hearing. so can i have your response to that now? i wish we could put both of them together so we could actually have that talk. >> really as you know with my history this is by all means unacceptable through va. we would certainly like to address any individual concerns of veterans that are having those issues, please share that information. i'd be happy to work with the zwraem on next panel. we are in every way looking to increase availability and capacity of mental health services within va but are in every way supportive of ensuring
5:17 pm
veterans that need and have eligibility for community care are also receiving those services in the community. >> so what should they do in a real short period of time? if they're seeking an appointment or they told they had a long wait time or are not being the opportunity for community care, how do they reach out? >> yeah, they can certainly work with their patient advocate at the facility. >> i appreciate that and all the -- >> thank you, mr. chairman and thank the panelists for being here. my first question to dr.
5:18 pm
matthews and you stated in your testimony that there's been a 13% decrease in the number of women veterans who die by suicide. can you talk a bit about what va is doing very specifically to address the unique mental health needs of our women veterans? >> thank you so much, councilwoman. this, of course is, of paramount importance as we do, of course do and strongly value our women veterans. we offer a full continuum of gender sensitive and most importantly evidence informed mental health services to meet women veterans needs through either a mental health providers more than half of which are female themselves but also through our womens mental health champions designated at every facility to truly support them. we're also concerned about
5:19 pm
reproductive mental health needs, so our consultation program was focused on eating disorder and another more specific disease states. we acknowledge the clinical complexity around women veterans being over 40% of women veterans actually have been diagnosed with at least one mental health condition. so the need for this kind of targeted services is readily paramount. our training initiatives, you're aware of our residencies, increasing mental health training, so we'll continue to expand and most importantly recruit providers with a focus on women's mental health. >> i think in the bill there was a piece around making the pilot program a permanent program in the va for retreat settings for women that have been deemed successful mental health-wise.
5:20 pm
is that happening? >> i'd have to get back with you and conifer with dr. hayes just about the current progress of that. but we are certainly committed to implementing the entirety of the sampson act. >> thank you. and dr. renner i was excited to hear about the ongoing research you and your team were doing on suicide prevention, so what are -- from your vantage point what are the biggest challenges doing your research, and how can congress be supportive of your efforts? >> well, i have to say that i have the opportunity to do research in a number of different settings, and i really appreciate your question, congresswoman, because va is such an amazing setting to actually do research in. and part of that is because the veterans are so willing to participate, and for example, on your last question about women veterans we know not only do
5:21 pm
women veterans need services but services that meet specific needs and need to do things in different settings looking at how can we possibly use reproductive care settings with our partner -- how could we bring suicide prevention into reproductive care settings where patients really trust their providers and really match those two things? i think continuing to have access to the resources that we have and some of it very specific to technology, but va is a place to do research. >> great. so this question is -- i thank dr. matthews and dr. brenner both. one of the things he talks about the need for more current data.
5:22 pm
and in the va that data lags usually by a two-year period. what can va do to have more current data so they're actually dealing with real data, timely data in terms of responding to programatic needs within the organization? >> i'm happy to respond to that, dr. matthews. so some of the challenges are related to the data we received from cdc. and so the lag is a little bit kind of outside our control in terms of death data. one thing leadership has done is funded this project. and with the assent project let's us collect data in more realtime around factors living
5:23 pm
in perhaps rural areas, women veterans, veterans we've had trouble reaching in the past so we can have realtime data about things that drive risk and things that are protected. not only can we do this in realtime, but we can also change questions in realtime. so just recently we added a number of questions about covid and the impact of covid on suicide risks, and this lets us respond more quickly to current crises. >> thank you so much. and i yield back, mr. chairman. >> thank you, chair woman brownley. section 2 establishes a grant program in support services to at risk veterans and their families. as a veteran and someone who's
5:24 pm
spent a fair amount of time over the last several weeks talking to veterans in my district and elsewhere, i can tell you that veterans are struggling right now. the failure in afghanistan has caused a lot of painful memories to resurface. i worry we'll be grappling with the impact of that for a long time to come. that makes the act much more important than ever before. what actions are you taking to expedite the implementation of the improve act, and how soon will va be able to deliver grants through the improve act? >> thank you so much. we could not agree more this level of emergent suicide care and its coverage is critical. we are working on our existing processes. as you're aware with the mission act we really were able to add a lot of efficiencies to how we move forward with paying for that care in the community. we definitely want to and have
5:25 pm
quality oversight over a lot of this good care, that we are making sure that we are appropriately also, unfortunately, administratively, making sure they're not facing bills for this care when actually they're seen in emergency rooms around the country, and we're even paying directly for that claim or reimbursing for it. as you remember well with our claims backlog in the past that was a huge disservice to veterans that was the case, so we want to make sure we do this right and that the regulations are appropriately affecting how these claims will be built. it's really that and an issue about where they'll be receiving this care but more so how can we assure it's being structured appropriately. there's the additional expansion as well, too, which we are equally as committed to. this actually expanded the eligibility of individuals
5:26 pm
including those who are not enrolled in va. if we do not structure this appropriately the processes of how this care can be awarded they might as well be billed and that is equally unacceptable. and we look forward to some time in 2020. do we need anything specifically from congress? i'm sorry, you broke up there. at this point we are moving forward at a steady clip. no further assistance is needed. we're looking forward to its implement. >> how much time do i have left on the clock?
5:27 pm
>> a minute and 45 seconds. >> i thinkther task force did excellent lifesaving work for veterans under under the trump administration. and part of that was due to the role it had outside of the va where it was leverage an all of government approach to suicide prevention. that is critical because as you have admitted this morning preventing suicide requires everyone to play a role not just those within the va health care system. given that, ranking member and i wrote to the va earlier this congress to express our concerns about the events moving inside the va allegedly because there was not -- >> before i defer to dr. miller who's actually serving in the current role of executive director i would definitely
5:28 pm
state we've had no hesitation whatsoever in the forward motion of achieving goals on the road map, our lethal means safety campaign has moved forward quite steadily as dr. miller referred to earlier, so i see really no pause in those efforts at all. dr. miller, do you have an additional opponent. >> 100% correct, dr. matthews. we're in the implementation phase of the firearm lethal means safety outreach, which is directly tied to and a reflection of road map recommendations 1 and 8 and are graded together and fy 22 we'll be moving forward with that and expanding across at least three tracks addressing lethal means safety, a track specifically for veterans, one for family, loved ones and community members and one for health care systems. we're also working from an
5:29 pm
interagency perspective in the government where lethal means safety is one of four primary goals and domains for interagency collaboration. >> thank you. i'm sure my time has passed. i yield back. >> thank you, general. i now recognize representative lamb for five minutes. >> thank you, mr. chairman. and thank you for the panelists joining us. good news on 2019, of course, my strong suspicion is that the 2020 numbers may be tougher to take once they come in given the type of year it was. we know particularly with respect to drug overdoses in our country it was the worst year ever, and i'm sure the veterans population was affected as well. i wanted to ask dr. matthews a bit about the peer support outreach program and the peer
5:30 pm
support specialists. i know actually somebody i served with who works in that capacity already who received excellent care and treatment over a long period of time outside of pittsburgh now able to give back to other veterans. i was hoping you could delineate for us how that program is operating every day particularly in the participation in it who suffered mental health conditions, nonsubstance related and those that are substances related. are those types of veterans sort of targeting their own kind, or is everybody kind of working in it together? and is this a program you could see us growing over time? obviously we're going to have a lot of veterans suffer from these conditions, and do you think there's promise in bringing more veterans into the fold to kind of help their peers along the way? >> such an important question. i'm going to defer to matt.
5:31 pm
>> that's fine. >> i think one important area we're very excited to share in terms of our peer support and expanding peer support services is the fact this year the veterans crisis initiated a peer support outreach call center. and that was developed with the mission to provide support, hope, recovery oriented services to veterans who were identified as high risk. but then from a beyond the call perspective it's having veterans who are peer support specialists reaching out to those vcl callers and offering follow-up contacts, follow through with regard to access to services. that initiated earlier this year. we're very excited about it and
5:32 pm
hearing great feedback from veteran vcl callers who have appreciated this extension of peer support services. >> it's great work. and it provides a very concrete and tangible future i think that people who are are going through recovery in the va system this is an area they can work afterward and put their skills and knowledge to work. is there any kind of formal evaluation or data collection or research being done on the program to help us understand? i think sometimes we feel like we're throwing a lot of different things at the wall on mental health as we should. but would you say va is evaluating this program as we go with an eye toward expanding it if that is warranted? >> dr. matthews, if you would prefer for me to address that, i would be happy to -- >> please, matt, jump in. >> program evaluation, sir, is a critical component of any program that we initiate within
5:33 pm
suicide prevention, within mental health as a whole. we have program evaluation tied to our beyond the call efforts which includes the peer support outreach center and includes the care and contacts we have initiated to veterans. that is also a peer to peer based format. we have program evaluation built in for and will expect a report upon sp 2.5 in the both the critical and clinical domains. together with the veterans program and the progress that's being made with that because that is a peer to peer based program within the community. >> thank you. i think there's a lot of promise in this idea, and i think because especially i've seen it up close, and just while you're
5:34 pm
serving that kind of looking out for the person to your right and left i think has a lot of promise. so please share those evaluations and data with us as they come in. we're always looking for places to invest so i thank you for your service and, mr. chairman, i yield back. >> thank you for those questions. i too have seen some of the results of this up close. i know we've had bipartisan legislation on the peer support specialist, but i am watching what is going on in this program. and i want to encourage our republican members to also -- this is an area that i think we could build consensus around and ramp up our work force more quickly or expand our work force more quickly and have it be more diverse so we have relatable -- relatable folks within our
5:35 pm
mental health work force. that's one of the complaints i'm hearing. representative banks i recognize you for five minutes. >> the legislation required the government accountability office to conduct an assessment of responsibilities, workload and vacancy rates of va suicide prevention coordinators. in many instances suicide prevention coordinators reported being overworked and unable to keep up with many of their responsibilities. some medical centers didn't even have an spc staff. as a follow-up the ranking member and i cointroduced the access to suicide prevention
5:36 pm
act. this important legislation required the va to employ at least one spc at each va medical facility across the country within one year and required the va to implement the findings of the gao report on spcs. dr. matthews, can you give an update to the committee on whether the va has or is close to implementing the spc staffing requirements or the findings of the gao report? >> sir, yes. we are moving forward with not only some internal staffing assessments but the broader evaluation that was prescribed as you described. >> do we have an spc on site at each medical facility in the country today? >> matt, can you confirm that at this point? >> yes. out of 140 facilities as of this day right now and the information that we have
5:37 pm
available, we have 135 or 140 with one suicide prevention coordinator at least. we have zero with no suicide prevention coordinator or suicide prevention care manager. we have five, which accounts for the difference, i'm sure you've calculated in your head that are below 1.0 right now, and we continue to work with those five facilities as well as facilities as a whole with their spc staffing. >> great. an april 2021 report found that the vha has, quote, not conducted a comprehensive evaluation of local suicide prevention teams including an assessment of any challenges teams face in implementing vha policies and the effects of program growth on workload, end quote. the report goes onto say, quote,
5:38 pm
without an evaluation vha does not have a good understanding of how its various activities and initiatives are affecting teams including any effects on the care teams provide veterans who may be at risk for suicide, end quote. dr. mill, does vha plan to conduct a comprehensive evaluation of suicide prevention teams to help address the challenges they face and ensure our nation's heroes are receiving the best front line care as possible? >> yes, sir. it's in process. we have two actually, broad initiatives that are in process in response to this. first you mentioned and thank you for bringing it up section 506 of the hannen act with regard to section 506 of the hannen act we are pursuing a formal exploration, and it's engaged with a contractor to assist in terms of what is the best alignment national to local
5:39 pm
with regard to spcs to make sure they are adequately and fully supported administratively and clinically. we've also initiated a suicide prevention coordinator staffing model. the review is completed in a preliminary format. is a productivity based model. it's similar to the caregiving staffing model. and that is then in motion as well. >> appreciate those updates very much. thank you, mr. chairman. i yield back. >> thank you, representative banks. i now recognize representative levine, chair of our subcommittee for five minutes. >> thank you, mr. chairman. dr. matthews, i appreciated your testimony about the steps the veterans crisis line is taking to meet the needs of veterans who might be struggling with recent events in afghanistan.
5:40 pm
can you describe the resources vcl collected from other agencies and disseminated to the call center staff? >> i'm sorry, you broke up there. i think you were asking about information collected by the vcl from other agencies. i think i heard that part correct, right? >> that is correct. >> okay, great. yes, i'll defer on some details but i am aware that the vcl not only is -- is being quite proactive and making sure we are appropriately staffed throughout all shifts. this is a 24/7 process here, that we're disseminating resources not only from other agencies like samsha where and those resources are being disseminated and we're also providing a significant amount of support for the staff
5:41 pm
themselves, many of whom are actually veterans, many of whom are feeling what we call somewhat the vicarious trauma of really working with others in these really touching moments. anything that you would add to that? >> i think you covered it very nicely, dr. matthews. i think just my summary response would be dr. lisa and the vcl team have responded rapidly in at least five key areas in response to the afghanistan situation. number one, partner engagement. number two, dissemination of resources internally and externally for federal working government groups. number three, identifying supports for vcl staff as they were engaged in their front line
5:42 pm
work. four, appropriate appropriation for increased volume addressing capacity visa vi demand and finally enhance data monitoring which allowed us to quickly better understand what we were seeing in terms of demand. for example, quickly. >> let me get to my other questions if i might, dr. miller. but i appreciate that response. and perhaps my next question will allow you to continue your answer. i understand you've seen a surge in call, chat and texts in the last several weeks. so first i'm curious what trends you're seeing with regard to the number of calls that relate to the events in afghanistan. and then, secondly, vcl is a vital resource for veterans in crisis i think we have to work with and connect with veterans before they reach that point. earlier this month i led several colleagues in writing a bipartisan let to develop a comprehensive post 9/11 outreach
5:43 pm
plan. what is the va doing to contact these veterans especially those who served in afghanistan and to connect them with local resources? >> great. so the first part of your comments and questions gets exactly where i was heading. you asked about themes and trends we were seeing in the vcl. because of the data monitoring and the changes that were put in place we can see that about 2% of the total incoming demand for the vcl during this time has been directly atranscriptable to afghanistan as stated by the responder who's working the situation. about 5 to 6% of the time on average afghanistan is noted within the documentation but is not necessarily cited as the primary reason for calling. so 2%, 5%, important to
5:44 pm
understand contex wale in light of the recent surge of demand. in terms of that which we are engaging for outreach to all veterans this is where our reach out campaign comes into place which is partnership between suicide prevention and prevents. and as i mentioned we've been hitting the radio media tour heavily this month to talk about the reach out campaign to direct individuals to the landing page. and the map provides direct resources including local resources. >> dr. miller, i appreciate all of that and everything you are doing. i would just encourage you to continue to be proactive in outreach to veterans going through these challenges. so thank you, and thank dr.
5:45 pm
matthews as well. i yield back. >> i now recognize dr. murphy for five minutes. >> thank you, mr. chairman, members of the committee. and i want to thank the guests especially today for testifying. you know, as a practicing physician of 30 years i'm terribly alarmed at the continued high rate of suicide that affects our veterans. i recently received the latest dod statistics on total suicides for the active component, reserved component for the national guard and they're very alarming. and mr. chairman, i request to enter this data into the hearing record. >> without objection so ordered. >> as we all know stutties have shown post traumatic stress dorder and brain injury could play a major factor.
5:46 pm
most recent reports have indicated as many as 850,000 veterans have returned since 2001. although service members may have survived the terror of battle, all too often they don't survive the torment of their own injuries, memories, thoughts at home and tragically to take their own lives. this oftentimes has a tremendous destructive effect on relationship with spouses, children, family, friends and coworkers. unfortunately, we are faced a regrettable reality. there isn't a cure in the government's current arsenal for ptsd or tbi which needs to be
5:47 pm
expanded in my opinion to include therapies that i have worked with for over five years. as a physician i found that hbot has been successful in treating many vet rps where no other source was treatment was rendering good results suffering from these combat wounds especially the debilitating symptoms on the brain. hbot is conducted by placing a patient by delivering pure oxygen under pressure. their blood levels for oxygen effectively deliver grating levels to help heal other organs including vital organs. i've used it for the treatment of wounds, and i believe these wounds to the brain are something worthy of investigating hyperbaric oxygen therapy. peer reviewed double blind studies have verified the
5:48 pm
effectiveness of treating ptsd and tbi. the majority of combat veterans who have used this therapy have helped it restore their executive function and feeling of well-being. perhaps most important is the return of hope, hope they had lost that is responsible for the elimination of the suicidal ideation. i'm not here to infer it will help anyone, but it does help a statistically significant population suffering from injuries to the brain that cause acute or chronic inflammatory indications and where other treatments simply do not help. our veterans who have valiantly served our country and sacrificed so much deserve every remedy possible and i believe that every veteran if needed should be afforded the opportunity to give hyperbaric oxygen therapy to them. that's why i've introduced the national -- the veterans national traumatic injury act, hr 1rks o 1rks 4rks.
5:49 pm
if passed my legislation would direct the secretary of the va to create a pilot program for veterans suffering from tbi or ptsd. it's already bipartisan and we're working with senator tupperville on the other side. he's submitted similar legislation in the senate and the bill is actively endorsed by the organization of military veterans. i provided therapy also for folks in north carolina where i serve. the third district in north carolina has over 89,000 veterans and i'm working to make this potentially lifesaving therapy to all veterans. it's congress' duty to restore hope to each and every war fighter so we can start to see a reverse trend of these suicides. the background reference of this study i would ask, mr. chairman, we place this into the record
5:50 pm
also. >> without objection so ordered. >> mr. chairman, i just have one minute. if i would just ask one question to our committee to our committee members members. what is their particular opinion, where do they believe the use of off-label is available to our receipt vans? >> i'll allow 30 seconds. >> thank you, sir. >> i'm not sure i would be able to speak to any research done in this area. we have partnerships we've been exploring this therapy. so thank you for the question. >> i've been quite involved with research in this area and i think we continue to want to provide the best care with the best evidence, and i think we do have evidence-based treatments for ptsd and for tbi and we want to continue to reduce systems and use the best science to explore new interventions and the findings have been mixed.
5:51 pm
i know the va is still working diligently to try to provide it to veterans and explore different ways that it may be used as part of a whole toolbox of interventions for veterans. >> thank you, dr. murphy. i'll recognize representative pappas. >> thank you, chairman takano for recognizing me. i want to thank the panelists for their work and commitment to this issue. we know one veteran suicide is too many, but we continue to see a crisis. it's been interesting to hear about some of the latest legislative efforts, how those are helping to move us in the right direction, but we know barriers continue to exist to access care and services and supports at va. so i want to zero in on one particular group that does experience barriers to get the
5:52 pm
help that they need and the support they have earned through their service, and that's the lgbtq+ community. on monday we marked ten years since the don't ask, don't tell policy was repealed. estimates say that more than 13,000 service members were discharged under this policy, many receiving other than honorable discharges or entry-level separations. so it's clear across the board that those who are connected to services, supports, to care at va have lower risk for suicide. and as we kind of continue the legacy of don't ask, don't tell, i'm wondering if you could offer comments on the directive issued on monday which seeks to remove this barrier. there's startling statistics that i've seen about lgbtq+ veterans, people who were not
5:53 pm
able to serve openly in the military, experiencing suicide at a much higher rate, 15% of all lgbtq+ veterans attempt suicide, according to one study, compared to less than 1% for the entire veteran population. i've got legislation i've introduced on this topic, which reflects the priorities that were outlined in the directive, but i'm wondering if you could reflect on the experience of this particular group, what va needs to continue to do to make sure we're removing barriers and whether legislation will be needed to help support the direction that the administration wants to move in. >> i'm so glad, sir, for this question, just because you are hitting the nail on the head as far as really a targeted population that we need to bring some attention to. our directive really was seeking to emphasize our current benefits policy, that this sort of exclusion is unacceptable.
5:54 pm
we really are charging our adjudicators to assure that any separations due to sexual orientation, gender identity or hiv status are classified as eligible. that is affirming our policy. we're also implementing a second look policy so we can assure any veterans that might not have been provided benefits are actually having their actions reconsidered. so there's increased oversight and guidance through this directive. we firmly agree with ensuring that all of our lgbtq+ veterans are receiving services they need. of course you're aware we're also moving forward with gender-affirming surgery coverage as a benefit, which was excluded as well, too. so we're actively looking to assure that this population of veterans receives the services they need. >> well, thank you for that. and i'm wondering if you'll commit to working with my subcommittee, with my office on the serve act and other
5:55 pm
legislation that is going to be needed to make permanent the expanded access to benefits and services for lgbtq+ veterans. >> definitely, sir, va is committed. >> thanks for that. in the remaining i have, i wanted to also ask about va police. this has been an issue that this committee has looked at, the compact act included requirements for improved training for va police to ensure appropriate response to mental health incidents at our hospitals involving those who are in crisis. as we know, va police are often the first on the scene during one of these incidents. so i understand that each facility's police force is required to have a new curriculum as part of this annual refresher training and that this curriculum will be developed in partnership with law enforcement training organizations and the facility's own va mental health staff. so i'm wondering if you can tell us how far along the police forces are in implementing this requirement. >> sir, this is so important,
5:56 pm
and actually all va police officers do receive suicide training, and of course initiation as a requirement of their training, but also annually. so this is really affirming for us and we're re-committing and trying to establish stronger community partnerships so that there's even a local, really a contingent there to ensure that our crisis intervention concepts are further engaged. this is about partnership, this is about training, this is about comfort level, so it's been a bit slower with expanding those partnerships, unfortunately due to covid restrictions, that's unfortunately been the case. but that in no way takes away from the fact that this training is in place and we are reiterating it every moment possibly. >> my time is up, but maybe we can connect about the implementation and how it's moving forward. with that, i yield back, mr. chair.
5:57 pm
>> thank you. i now recognize representative meeks for five minutes. >> thank you, chair takano. i greatly appreciate it and i appreciate this testimony and hearing. dr. matthews, i know that all of us were thrilled to learn that 399 fewer veterans died by suicide in 2019 compared to 2018. that was much-needed progress after many years of stagnation. what specifically do you think led to that improvement and how can it be replicated moving forward? and do you also have data and information on what conflict or war, times of service and the age range for the majority of suicide or suicide attempts that occurred? >> ma'am, if you don't mind, i'm going to defer to dr. miller. i don't want to speculate on causes. do we have any information as to
5:58 pm
how those numbers decreased, dr. miller? >> i think as we've mentioned, the 2019 data reflects unprecedented levels of progress. that said, again, as we've all said, within the context of the critical number zero versus one, and one is too high. with that in mind, i think what we learned thus far from the data is 2019 represented the full start, if you will, of sp 2.0 and our public health approach, the implementation of a clinically based plan and a community based plan. it also represented the initiation of what we call sp now, which was designed to focus on five target areas, where we
5:59 pm
believe as a team across the va, if we make significant, meaningful changes, we would lower the suicide rate by 7%, and that's exactly what we saw occur within that. so i think it's an affirmation of the public health approach that espouses the importance of data, following good data, and building strategy, policy and interventions that are based on a public health approach, combining clinical and community emphasis. what do we know in terms of the numbers and risks? we know that the highest count for suicide in veterans occurs in the age group 55 and older. we know that the highest rate occurs in individuals age 18 to 34. in both age groups, white males
6:00 pm
are the predominant highest risk and firearms are the most significantly employed lethal means. therefore, that's where our firearm lethal means safety campaign comes in that is addressing both age groups and demographics within the campaign. >> thank you, dr. miller. the reason for my question was because the veterans that i encounter, and i'm a 24-year military veteran, the withdrawal from afghanistan has been extraordinarily problematic for them and has led to increased mental health issues. so, dr. matthews, on our second panel, the wounded warrior project, there will be testimony about substance abuse, mental health treatment and how it appears that the va does not combine these treatments or have
6:01 pm
a comorbidity treatment plan. if that's the case, what can the va do to provide greater access to these programs? i have limited time, so if you could be brief, i would appreciate it. >> i'll defer to dr. miller again. >> that's all right, mr. miller. what lessons do you think the va could learn from the success of operation resiliency? >> so the success with operation resiliency, there's many. i've personally been privy to one myself with bravo company infantry regimen and i've seen, firsthand, the impact that it has on the overall population. >> excuse me, you'll be testifying and answering questions on the second panel. >> okay. >> but dr. miller -- >> thank you very much, i yield back my time. >> thank you.
6:02 pm
i now recognize the representative who chairs our modernization subcommittee for five minutes. >> thank you, chairman takano. dr. matthews, as kparm of the subcommittee, i'm using this hearing to gain a better understanding of the ways the electronic health record modernization program may be leveraged to help the suicide prevention efforts. do you believe that the program will assist clinicians in preventing suicides among their patients? and additionally we've talked several times about the function of the suicide notification risk flags and va challenges to get
6:03 pm
them working properly. and i have appreciated your forthrightness in those conversations. what is the current status of suicide risk flags, and can you assure me that they are now fully functional and that all appropriate personnel can see them? >> thank you for the question. and you're right, it's a critical connection, but really our ability as teams, care teams, to prevent suicide is not hinging on an electronic medical record. that's a tool. so those flags, those tools are quite critical, they are in place. there were some initial, i would call them glitches in the programming that have since been clarified, that have been cleaned up. particularly the suicide prevention coordinator have also been more fully refined so they have access to different parts of the record. so, yes, that's been clarified.
6:04 pm
it's a critical tool, but, of course, the true action that's taken is through our care team and the staff there are the ones that caught these issues and, therefore, allowed us to make the improvements that were needed from that baseline. so i have full security in the fact that we'll be able to continue with the strong work that we do as care teams with the new system as well. >> thank you, dr. matthews. secondly, dr. miller, the 2008 national strategy for preventing veteran suicide contained important insight that not all veterans have the same risk. specifically the strategy identified women as a subgroup with potential higher risk for suicide behaviors. are these specific resources available to women veteran survivors of military sexual trauma, including during the mst claims process? if so, what are these
6:05 pm
interventions and have they been effective? >> you're on mute. try again, mr. miller. >> it was with regard to the 2018 national report, you mentioned, and it was specific to what population, sir? >> are there specific suicide prevention resources available to women veteran survivors of military sexual trauma, including during the mst claim process, claims process? if so, what are these interventions and have they been effective? >> yes, there are specific interventions and programs that are available for women veterans, particularly women veterans who have experienced or are engaged in the mst
6:06 pm
evaluation process. i believe that you're seeing from our 2019 data solid indications that the programming that's been engaged by the va for women veterans is heading in a positive direction, and that's indicated by the 13% reduction in women veteran suicide rate in 2019. that took it to a level that it has not been at since 2002. >> can i just jump in there, too, dr. miller? i want to highlight that we've talked a lot about populations and we've talked a lot about context. and i think beginning to understand the context of these women's lives, many of these women actually have experienced interpersonal violence before they come into the military, may
6:07 pm
experience interpersonal violence after the military, and how do we create treatment settings, resources, materials that will fit for them so that they can benefit from our evidence-based treatments that we have at the va. >> thank you. thank you, mr. miller, and i yield back my time. >> thank you. i now recognize representative rosendale for five minutes. representative? >> thank you, mr. chair. good to be with everybody today. thank you all for participating in this critically important issue. i attended a veterans suicide prevention program about a week ago in boseman, montana, and it included a presentation from the overwatch project that featured a bunch of what i consider valuable online resources where we as the general public could
6:08 pm
access that, veterans could access that so that we all could do our part in supporting veterans, and quite frankly, how they could help each other as well. and while i really recognize that this is a real problem, the access to firearms and the amount of times that veterans are, obviously, using firearms to take their own lives, and that we need to put time and distance between veterans and their guns during a crisis period. it sounds like there's a ten-minute period between when they decide that they're going to take their life and they actually do it. if we could get time and distance between them and their firearms, that's going to be a good thing. what i also recognize is that mandated removal or restrictions on veterans on firearms who sought help would be very counterproductive, and quite frankly, would be completely unacceptable to many members of this committee.
6:09 pm
and so while chairman takano was speaking with you, dr. miller, it sounded like you were getting close to discussing your recommendations with him about what you would recommend, and i wanted to hear those recommendations to make sure where we were headed in order to address this problem without infringing on the rights of our veterans. >> so i think that there's two really important words to ensure that i'm communicating the distinction between and where we land with regard to firearms and safety. the two words are restriction and safety. we are not gearering any campaign or messaging toward restriction. we are gearing our messaging and campaign toward safety.
6:10 pm
safety, in this context, is defined exactly as you said, as time and space between person, firearm and ammunition, three parts of the triangle, during critical points in time that may be described as dark or crisis. so that's why you'll see in our lethal means safety campaign that it puts together depictions of veterans experiencing particular risk factors, and in that context, with access to a firearm, engaging time and space mechanisms. and you're 100% correct, that 60-minute window is critically important, and within that 60-minute window, 10 to 20 minutes can be life-saving in and of itself. so that's our recommendation and point of emphasis, sir.
6:11 pm
>> i appreciate that. that makes me feel a lot more comfortable. because, again, i just can't stress enough that the mandated restrictions or control over veterans firearms would be very problematic. dr. matthews, the crisis in afghanistan has led to significant increases in the utilization of the veterans crisis line over the last month. how is the vcl adapting to those increases, ensuring that the veterans continue to be well and promptly served? >> great question, sir. just to reiterate, we are definitely assuring that our staff has appropriate resources about the withdrawal, knowing how to interact with veterans. we're making sure the staff is adequately supported through different wellness programs. we're anticipating the increased volume, so making sure that we're appropriately staffing shifts or having backup plans in order to take care of that volume. every call must be answered and
6:12 pm
every call, text message or even chat, must receive the attention that it needs. and, of course, we're monitoring appropriately so that we can make sure that we continue this effort. but the vcl has really truly responded appropriately, the team is providing the support that's necessary. >> thank you so much. mr. chair, i'm right down to it, so i would yield back. thank you very much. >> thank you, mr. rosendale. i do appreciate your very responsible comments and understanding of the time and space campaign, and i think -- i appreciate that language that we can come together on, a very sensitive topic. so i just want to express my appreciation for that. i do want to now recognize our
6:13 pm
representative communicating to us at an ungodly hour in a very godly place on the planet. >> thank you, thank you, chairman, takano, for holding this important hearing on veteran suicide prevention. i also want to thank the witnesses who are with us today. chairman takano, it is so good to be here in dc and join all of you, on the west we would have started the meeting at midnight for me. it's 11:00 in the morning for me. i want to bring out a happy story, a story with a rather happy ending. there was a soldier who grew up across the street from our family home and who got out of the service in 2011, if i have
6:14 pm
it correctly, and i know, because we tried to help this soldier and his mother in the first two years, after he got out of the service, he was truly a broken man. but last week he came to visit me and i was just so happy with who i was talking to face to face, after the issues he went through and having to recover, and the fact that it took him several years to come home, because he can't get the services he needs at home. but this is a soldier with five purple hearts, three bronze stars with valor, and very highly decorated military man.
6:15 pm
dr. matthews, let me ask, since generally veterans from the district do not get access to the same services and benefits the va offers across the nation, i would very much like to know whether veterans are benefiting from the suicide prevention. >> unfortunately, sir, i can't speak directly to veterans there. i can definitely take that for the record to get you specific information. they do, of course, have access to the vcl and can readily use a lot of our online resources as well as chat functions, if, indeed, that's necessary. but i think, unless dr. miller, you have some specific data around the island. i'll have to get back to you with some data there. >> i'll just add that a focus of our governors challenge for this upcoming fiscal year is u.s. territories, and we're looking
6:16 pm
forward to the opportunity to learn ways that we can improve access to services for veterans in u.s. territories, and further the suicide prevention mission in those areas. so i'm looking forward to fy-22, sir. >> thank you. and so, again, and maybe this is you will be able to look at, without breaching confidentiality, of course, can you also look at, since i don't think you can tell me today, can you also look at how many veterans in have been able to support -- have support offered by the suicide prevention 2.0 initiative, and of course the prevents program, and what is the va doing to make sure veterans know about the programs, and how this congressional office could help.
6:17 pm
again, i look forward to you looking at those and providing us with information. again, dr. matthews, you stated in your testimony that most veterans who die by suicide are not receiving va health care at the time of their death. as i mentioned, there are any number of veterans, va health care programs and services that are simply not available there, and coming from a population of 55,000, one death is a death in the community, by suicide, it really makes a profound impact on our community. and i know that we have, and there may be more, but we have have two deaths by suicide, so if you would agree to providing interest with the same level of
6:18 pm
care available in most of the united states so that it would reduce the risk of suicide. and finally, in february of this year, my office was briefed on the va's plan to hire a primary care doctor or advanced practitioner who would travel to see veterans and build up and strengthen telehealth services in those areas. so right now we do, finally, after years, we have a licensed social worker. i would like to know whether this social worker is able to meet with veterans and help them to get a primary care provider or doctor for the veterans on this island as well. >> sir, i'll get some information back about that social worker. i'm glad to hear that person is there. i'm not familiar with what sort of interaction they're having,
6:19 pm
but we can definitely take that further. >> thank you. my time has expired. go ahead, no, please. >> can i jump in also? because i think there's a new exciting program that we are just getting started with trying to understand individuals living in different parts and the territories, to understand better how we can provide care to people, pacific islanders, asian-american veterans, understanding the context in which they live, and we'll be doing key interviews and looking at analyses, data, so that we can do even better to understand individual drivers, contextual drivers that really do contribute to risk in your community and other people's communities. so i hope you stay tuned for i think this new important program that we are just getting under way. >> thank you, again. you guys really do some wonderful work and this soldier who returned home to retire,
6:20 pm
we're helping him get all of his records -- >> representative -- >> from the medical center. chairman, i am way over time. i appreciate your patience. >> yes, you are. representative, i just want you to know that the mental health package, i am planning to include a bill to get the marianas a vet center. >> thank you, mr. chairman, for your support. i appreciate it. >> thank you. >> i yield. >> representative, you are recognized and welcome to your first full commit hearing. >> thank you, mr. chairman, thank you, channelists. it's a pleasure to be here, especially for this important topic. i don't attend to ask my questions. as a veteran who retired in 2012, first of all, you are the 911 for veterans.
6:21 pm
you have a thankless, stressful and very difficult job to deal with the end result of how veterans handle their time in the military, and for every veteran, whether they see combat or not, any deployments, they come back a little bit different. and you're on the receiving end of that and i would like to thank you for all your hard work and i would also like to point out those on the veterans care line have a stressful job, indeed. that is like being a dispatcher for police departments, except you're trying to save a life yourself. and i hope they're adequately taken care of with that stressful job, too. we have the most well-trained military on the planet and you are trained in everything you do from how to fold a t-shirt to how to eat to fire your weapon. we're asking the people who walk the old ladies across the church and care for their country, to
6:22 pm
do the worst thing a human being can do, and that's deliver coordinates on target, usually resulting in a loss of life. that's a very stressful thing and every veteran deals with it differently. no matter how long you serve, whether it's two years, five years, 20 years, the transition to being a veteran is nonexistent. the military does a great job of training us to do everything that we need to do. and then we'll probably have a two-day transition at the assistance program class and they say thank you very much for your service, godspeed, that door is the va and go find it. that's a daunting task for people who have been taken care of, the military has become their family for so long and they are left without any training. we have the best trained military on the planet, but the transition from service member to veteran does not exist, so you don't have well-trained veterans. and i would like to see greater collaboration in the future between the department of defense before a service member is released, both on health
6:23 pm
checkups, mental, psychological, and health-wise so they have every tool in their toolkit necessary to make the transition to a life that's now foreign to them, and that is civilian life. so i appreciate everything that you do. god bless you all for what you do. it's a privilege to be on here. mr. chairman, thanks for recognizing me and i yield back my time. >> thank you for that, representative. i invite you to take a look at the bills that we have so far included in the mental health package. they address many of the things that you just talked about. and of course i welcome the minority to also continue to contribute what we can contribute to the mental health package and suicide prevention bill that we're try to go put forward. thank you very much. i agree with much of what -- actually, i don't think i disagree with anything you said with regard to the transition and the ways we can improve it.
6:24 pm
there's been tremendous bipartisan cooperation in terms of the topics you addressed, so thank you. representative underwood, i now recognize you for five minutes. >> thank you, mr. chairman. i join my colleagues on this committee and americans across the country in grieving the deaths of the u.s. service members who were killed during the august 26th terror attack in kabul. the va has responded swiftly to the surge in demand for mental health and crisis resources and i urge the department to continue to take every available step to ensure that veterans suffering from new or worsened mental health conditions have access to the care and to the support that they need. now, there have been reports of significant increases in outreach to the veterans crisis line in recent weeks, including a 98% increase in text messages to the hotline between august 14th and 29th. now, the va must continue to ex stand evidence-based practices to prevent veteran suicide,
6:25 pm
including lethal means safety training. given the proven effectiveness of lethal means safety training in reducing suicide rates, the va requires all vha clinical health care providers to take the department's lethal means safety training. as a result of this requirement, compliance is already above 90% among newly mandated vha providers. however, the lethal means safety training course remains optional for other va staff who regularly interact with veterans, as well as community providers and caregivers. my lethal means safety training act would expand the required training courses to ensure that anyone who regularly interacts with veterans in their work is prepared to have a conversation, a conversation that could save a veteran's life. so, dr. miller, in response to a letter that i sent to secretary mcdonough in february, va staff
6:26 pm
noted that only 30 community providers have completed the optional course since october 2020. that's 30 providers across the country. unacceptable. the secretary's response stated without a national mandate or incentive for non-va community providers to take this course, va will likely continue to face notable challenges advancing the mission of increasing the competency of the community, and community-based health care providers to better identify, assess, intervene and treat veterans at risk of suicide, end quote. now, during the committee's hearing with secretary mcdonough in march, i asked about opportunities for the secretary to use his own existing authorities to further expand mandatory lethal means safety trainings, and i was encouraged by his commitment to looking into this critical issue. so, dr. miller, my question is, can you provide an update on any steps the va has taken in the last six months or other actions
6:27 pm
that might be planned to expand lethal means safety trains for va staff, community care providers and caregivers? >> thank you. this is an important issue. we share the perspective that this is critically important to suicide prevention on a whole, and accounts for 70% of veteran suicides with firearms alone. more broadly, with lethal means safety training, since that point in time with the secretary's support, and at his behest, we have moved to officially integrating lethal means safety training as an agency priority goal for fy-22, which includes training for community care providers who are working with veterans. >> excuse me.
6:28 pm
so you said a goal. what does that mean? >> it means that we have put in writing that it is officially an agency goal to increase and enhance training, not just for va and vha providers and teams, but for community care providers as well. the first step of that is to take a look at ways that we can create a preferred provider system and network where community care providers who are working with veterans are incentivized to engage in the same training that vha clinicians are engaged in, and in turn becoming, then, a preferred provider within the network for veterans based upon their increased awareness and accumen with lethal means
6:29 pm
safety. >> is this the only to obtain the preferred provider status? >> this is the only criteria that i am aware of, because i am in on the discussions with regard to lethal means safety. i don't know if there are discussions outside of lethal means safety training and applied to preferred provider. >> as we close, do you know if this goal and the requirements will be complete by september 30th, which would be the end of this current fiscal year ahead of october 1st, the beginning of fiscal '22? >> they would be complete by the conclusion of fy-22, which would be next september. >> if you all could get back to the committee and my office about the current status of this goal-setting process and the preferred provider program, including the criteria, i think this is a little bit askew from the mandate that we are looking for to ensure that any provider who is regularly interacting
6:30 pm
with a veteran, whether within the community or va, is prepared to have a life-saving conversation. thank you to the witnesses for your time. thank you, mr. chairman, for your indulgence. i yield back. >> thank you. you're always welcome to our hearings and holding to account our administration folks. so thank you. representative allred, you are recognized. >> thank you for sharing your research, obviously preventing suicide and ensuring access to resources and mental health is one of our top goals, and we're committed on this committee to working with you all to do that. i wanted to ask about the use of mdna and psychedelic drugs to combat pts and where the va is in terms of studying this.
6:31 pm
there was a recent "new york times" article discussing a study of 90 people that seemed to show some pretty good results from this and in my conversations with some of my constituents, veterans, some of them have sought this treatment out even outside of the country. anecdotally they found it to be effective for them. i wanted to ask whether or not this is something the va is looking into, whether we have anything along these lines, and if we don't, whether we're covering it. >> i'm happy to respond, thank you, congressman, for the question. we're also watching very, very closely, both clinicians, researchers and the office of research is watching closely, not only that we do have researchers connected to the va that are working on these projects with their affiliates. so we are tracking very closely.
6:32 pm
there are currently some trials under way as you highlighted and we're eagerly anticipating the results from those well-designed trials. and once we are able to see the results from those well-designed trial, then we'll be able to think about what would be the next steps in terms of any modifications necessary or what the next steps will be. along with you, we will continue to watch closely. >> so would you need any additional authorization frs the congress to pursue that or is that something that you could do if those studies proved to be efficacious, that you can do it on your own authority? >> this is a complicated issue because of the specific intervention and i will take it for the record, but i know we're watching closely and we will get back with you, particularly once we find out what the results of the trial are. >> okay. so generally the approach is to see how the outside trials function? because obviously i know one of your missions is research and i know we do some of the best
6:33 pm
research in the world in the va. but in this case, the approach would be to see how the outside trials -- what their results are, and then proceed from there, is that the understanding? okay. >> yes, that's correct. and the trials, i'm very happy to say, we've looked closely at them and they're well designed and we're trying to benefit from the work that's being done and then using that resource to help us guide next steps. >> okay. i mean, obviously this is your area of expertise and not mine, but anecdotally, positive results, and also from the early trials it seems like it could be a real breakthrough. so i hope we'll continue to pursue that. if my office can help you with anything, please let us know. i wanted to quickly turn, dr. matthews, to your testimony regarding covid and the study that found that veterans with covid were more than twice as likely to report suicidal
6:34 pm
ideation. did the study identify causes for this and does the va have any indicators of why that is? >> sir, i'm not familiar of, unfortunately, any information that we have as of yet. i think, purely conjecture, i think that kind of comes along with the pandemic, including probably a lot of the risk factors of how the veterans actually got covid in the first place are probably just as indicative of causing increasing mental health concerns. so i think we need to get back to you about any real evidence. i'm purely speculating at this point. but it's something we're definitely tracking, unless, dr. miller, you know of something more. but i haven't necessarily seen any evidence of the exact reasons why. >> so there was a published study, jama psychiatry, probably three or four weeks ago, it hit
6:35 pm
the presses and it was specific to the veteran population and covid. and it found that overall, suicide behaviors, as evidenced by suicide ideation, had not increased in the veteran population during covid, except for those veterans who manifested what we might call pre-existing risk factors, in particular substance use disorders, social disconnection, and some other mental health issues or disorders. >> well, thank you. should you find that this is an ongoing problem, i think we should consider tying covid testing and diagnosis to our mental health resources immediately, if that's not something we're already doing. >> we are doing that, yep. covid diagnosis, plus high risk
6:36 pm
flag comes together, and an outreach kicks in immediately through the local facility. >> okay, great. well, thank you all for the work you do and i'll yield back, mr. chairman. >> thank you. representative, i recognize you for five minutes. >> thank you, chairman, and ranking member for the hearing today. as the chairman and ranking member know, my office focuses heavily on addiction and mental health, so this discussion today is really meaningful and i really appreciate the chairman and the ranking member bringing this forward. last monday i toured maryland's 6th district with secretary mcdonough, and we stopped by gaithersburg and had a roundtable discussion on mental health, suicide, and substance use disorder. during the roundtable, dr. neptune, the mental health
6:37 pm
expert, shared with us what she tells a patient that is skeptical about asking for help. she says, quote, you're doing something wise, not weak. i think that's especially meaningful, because the mental health stigma still exists so much in our community, especially with our vets. so we're lucky to have folks like dr. neptune combat stigma. the committee recently passed a bill to provide $18 billion for va physical and human infrastructure, and most importantly for me, $375 million in residency slots, which will help the va train and retain excellent mental health professionals like dr. neptune. so to better understand the population of veterans seeking health care, dr. matthews, if you could, for a second, if we compare the population of
6:38 pm
veterans seeking mental health today versus our vets ten years ago, what is different? the availability of services, and the acuity of conditions, or maybe something else? >> i think we have a great deal of difference, both in how veterans are seeking out services, as well as our awareness of how to offer those services, and most importantly screen and evaluate those services. matt, do you want to go into greater detail there? >> we have, i think, a significant difference, ten years ago to now, with regard to access. we now are able to offer same-day access to mental health care, as well as primary care, at every local va facility. and, by the way, when we were discussing the question of what should a veteran ask for, have them get on the phone and call their local facility and say,
6:39 pm
i'm interested in same-day access for mental health at this facility, tell me what i need to do, where i need to go, and how we need to kick that in. and they should have an sop and an answer for that. if they don't, we want to be the first to know that that is or has occurred. so you're also going to see increased access to the veterans crisis line. ten years ago versus now, you're going to see text and chat, and we were phone-based before. you're going to see press seven on the phone to any forward-facing vha number. that wasn't in place with the veterans crisis line prior. finally, you're going to see increased access options that aren't just limited to geographic related variables. for example, if i am interested in an evidence-based treatment
6:40 pm
for suicide prevention, but i am in saginaw, michigan, and the saginaw va is not able to provide that, i can connect to the resources for that and receive those services through my phone, through my computer. so i think that those are some notable examples. >> i would also highlight that the va has taken on the largest in the u.s., for sure, and maybe the largest known universal screening program and health care system for suicide risk. and we have been able to screen millions of veterans for suicide and doing this in a universal manner, a, decreases stigma, we ask everybody, and identifies individuals who may not be prepared to talk about it unless they're asked. and i think this new practice that we've been rolling out in the va and we're rolling it out, studying it and looking at
6:41 pm
outcomes, i've been on several calls with other agencies, other health care systems, and this is being seen as something that could be adopted by other systems. so i think that is a completely different way of doing business. >> well, thank you. mr. trone, your time is expired. you're on mute, mr. trone. >> i'm fine. i yield back, mr. chairman. >> thank you. ms. captor, i recognize you for five minutes. >> thank you, mr. chairman, for this excellent hearing, and also ranking member trone and all of the members who have participated fully and we want to thank those who are dedicating their lives to health care for our veterans. thank you all so much. as we can tell today, all of us are very concerned about the
6:42 pm
brain conditions that onset during or as a result of military service, and ms. brenner, i was very happy to hear you talk about the recruitment phase, because we need to understand who is coming into the military with conditions that actually were created before they came to the military. we know pts onsets faster in those who have experienced pre-enlistment violence, and that is certainly true across the country. one of my goals is to improve the number of health care providers, doctors, advanced practice nurses, who specialize in the psychiatric and mental psychiatric arena, and that is a long battle, but one that i would welcome all your recommendations for as we move this particular bill forward. but i am interested in proving,
6:43 pm
as well, that diagnostic capabilities to identify brain related functions, particularly through high frequency imaging, to pinpoint where underlying conditions present that -- and maybe we have markers in the biochemical interaction in the central nervous system, of brain function, where we could predict better what can happen. and to that end, i wanted to just mention this to you. i've worked as a member of the defense committee for a number of years to work with the ohio national guard and case western university in ohio for our enliftees to provide dna samples
6:44 pm
to understand why some people get pts and others not. i'll just inform you, the results of that study, that all of the dna samples are now located at the veterans education and research association of michigan, at the university of michigan. they call it vram. i believe the datasets have not been fully probed and i think more research can be done there and we've spent literally millions of dollars, along with the ohio guard, trying to understand these conditions. so i just wanted to let you know that those exist. and i think we should continue the high science and the va's budget is much smaller than the department of defense or the department of energy, for example, in terms of developing a research protocol for high frequency imaging, and for the
6:45 pm
careful assessment of biochemical imbalances in the central nervous system that result in nerve disorders. i'm just one member out here trying to help, but i think we can make scientific progress in our lifetime because of super-computing now and i really would love to talk to you more, along with our colleagues, our chairman and ranking member, about some research protocols we could work across government on that might be able to move us into this era where we could understand so much better how to treat -- first how to diagnose and then how to treat these conditions, the stress receptors in the brain and so forth. i think there's a lot we could do together. so i just wanted to put that on the record. if you want to give reaction, you certainly can. but as others have stated, we are so grateful for your service to those who have served for the cause of liberty around the world and for our country. thank you.
6:46 pm
>> there's no response. thank you, representative captor, for sharing that information and i know your passion for the research in this area. >> thank you, mr. chairman, very much. and i hope that those who didn't have any reaction at all, i hope that we might be able to have a further conversation on this and how to move additional research forward in this very important arena of understanding how stress and certain concussions and brain conditions contribute to these illnesses, and so we're not just treating symptoms, but we're actually going right to where the premarkers exist. >> i am excited to hear more. i want you to know that i hear you and i'm with you.
6:47 pm
>> thank you. >> thank you, ms. brenner. and also know that we have a veterans project that is sequencing the genomic sequencing that's going on, it's hundreds of thousands of samples in our austin depository. so some more work could be done with that database as well. i see that we have mr. hawthorne who has joined us. you're recognized for five minutes. >> thank you, chairman. and as always, ranking member, thank you very much for your leadership. i'm sure all of us on this committee have done the challenge where you've done 25 pushups, every single day, symbolizing that we are losing 23 to 25 veterans every single day. this is something i take seriously. and when you're doing the pushup challenge, it's okay to say i've
6:48 pm
done my 23 and move on. but when you really sit down and think about it, when you sit back to really believe that these heroes who wear bullet proof vests, who go in and fight for our freedoms, to make sure no attacks happen on our homeland, defend liberty, are committing suicide once they come home, the idea that they are at a higher chance of dying once they return home than many of them are in active battle zones, it really hits home with you. it truly makes you feel that our country is failing them, that us as a va are conducting an abject failure to allow this many service members' mental illnesses go unanswered. i do have some questions for our esteemed panel here. ms. hetrick, what do you believe the catastrophic --
6:49 pm
>> mr. hawthorne, mrs. hetrick is part of the next panel. we are limiting our questions to the representatives on this panel. >> i apologize, sir. i will hold my remarks for the next panel. with that, i yield back. >> thank you. >> you're recognized for five minutes. >> thank you, chairman. >> veterans' ability to receive care and ensure mental health they need, my bill passed as part of the isaacson act and the federal government owes native veterans health care. many veterans suffer a disproportionate rate of pstd. as such, can you share what progress the va has made in implementing this provision and what is the timeline for full implementation?
6:50 pm
>> thank you. yes, this out of the isaacson rowe bill is drafted and moving forward in the conversations now. there were some nuances, just so you're aware, about the definition of urban indian, just because that's not necessarily a term and so we've been working with the indian health services, as well as human health services, as well as other tribal organizations to ensure we get the language correct and that we're referring to the right population. but other than that, the regulation is moving forward. it, unfortunately, is not on time. i was told it won't make the january timeline, closer to middle of 2022 calendar year. but it is moving forward. >> great. and, dr. matthews, if you do need any more assistance on that, especially with the definition, we would love to be helpful on that. i worked on the research
6:51 pm
committee. and i want to make sure this is fully implemented. this is a general question for whoever can answer. earlier this year kelly and i sent a letter to the va in response to findings that the phoenix va had made critical errors in taking care of a patient. we want to make sure that veterans aren't falling through the cracks nationwide. in response to that letter, the va shared it was in the process of a site to increase oversight of suicide prevention programs, prevent errors before they occur and improve best practices. can you share any update on that pilot program? and this is open to anybody in the va. >> dr. miller, you can speak to that. >> yes, happy to say that the pilot program is in motion. we have our first selected for engagement in the site visit process, and we will be engaging
6:52 pm
the actual site visit within the next 30 to 45 days. the leadership has concurred with the process and are looking forward to participating. it will be within '22, which includes the phoenix va. >> anybody else have anything else to add? perfect. let me move on, too, then, because you know keeping veterans housed is one of the surest ways to prevent suicide. in phoenix i'm working with organizations like u.s. vets and community project with housing and you know how hard the pandemic has been on veterans. does the va have updated data on how the pandemic has impacted veteran homelessness rates and suicide rates? >> great question, sir. this is really getting to an important point about really the connection of these risk factors, risks for homelessness,
6:53 pm
risks for suicide, that homelessness prevention is suicide prevention. i unfortunately don't have data. you know, we rest a lot on our pit counts, of course, and unfortunately that hasn't necessarily been updated. what i can say is, thanks to your support, we've of course been provided significant funding to our ssvf grantees for more non congregate housing to keep our veterans safe, and in more motels and hotels over the last year or so during the pandemic, that's much safer than the shelter congregate settings. we'll continue to promote with our ssvf grantees that they are actually taking part in our suicide prevention efforts, so they're looking for risk factors, even improving their policies about how to connect veterans back to care, and really being players, being our partners in suicide prevention strategies. so those are active, really
6:54 pm
changes, updates with the support of this body, that we've been able to provide during the pandemic. >> do we have -- do we have any data on how our housing efforts are helping lower the suicide rate or how the money is being spent anecdotally so far? >> i'm going to have to take that for the record, just about the actual impact. >> all right. thank you, mr. chairman, i yield back. >> thank you, mr. gallego, for your amazing questions. i want to now say that the questioning for the first panel is now complete. i want to thank our va witnesses for appearing today and we'll now move to our second panel, doctors matthews, miller and brennan, you are now welcome to stay on the zoom and listen to the testimony of our second panel of witnesses, which i think will be very important.
6:55 pm
i'll now call up and recognize our second panel. with us, the first western i want to introduce is the deputy legislative director of the veterans of foreign wars. second, affairs associate with the iraq and afghanistan veterans of america, and chief program officer at the wounded warrior project, chairman of the national indian health board, and army veteran, and co-director of rand epstein research institute and senior behavioral scientist with the rand corporation. thank you all for being here.
6:56 pm
i'll remind our witnesses to pause two to three seconds before speaking and answering questions. mrs. bartlett, you're recognized for five minutes. >> chairman takano and members of the committee, thank you for the opportunity to present how the vfw is spreading awareness for suicide prevention. veterans suicide prevention requires a multi-facetted approach, looking at group causes and protective factors before mental health reaches a breaking point. the social ecological model brings together the individuals, family and friends, and communities to create connectiveness, strengthen life, coping skills, empower purpose and address social determinants of health to improve outcomes and reduce the risk of suicide. one of the vfw's prominent resolutions is to end suicide.
6:57 pm
we have multiple programs and opportunities to engage suicide prevention awareness. i touch on these programs in my written testimony, but i will take this time to highlight a few. whether it's in response to a worldwide pandemic or a natural disaster, vfw posts are still serving their communities by opening food pantries, doing buddy checks, and rallying around other organizations for a common cause, thereby strengthen mental well-being and staying engaged and driving a sense of purpose. as the world watched the u.s. troops withdrawal from afghanistan, the collapse of the afghan government and the return of the taliban rule, some vet vans questioned the worth of the work they had done. several vfw posts channelled this energy and took action to check in and found ways to help those who helped them in the past. vfw 2974 and 5130, collected
6:58 pm
items of clothing, shoes and various hygiene projects and raised over $7,000 to donate to organizations assisting afghan refugees. the post collaborated with the georgetown university student veterans association, va, and the afghan youth relief foundation on september 11th, patriot day and national day of service and reppance to sort through the organized donations. from the national level to the post level, the vfw continues to do more for veterans, to include support and suicide intervention. they post 11453 raises funds through the poppy donation and presents the money to a local nonprofit providing education for gun laws. vet centers are an excellent tool for veterans seeking mental health care. the vfw urges congress to assess
6:59 pm
vet centers and expand eligibility to include certain veterans use education benefits. as eligibility increases, we must provide an increase in resources for this vital program. earlier this month va published it's 2021 suicide prevention annual report. this report acknowledged progress. but the vfw remains concerned that we do not have the complete picture on how this change occurred. we believe that vba has access to information that can inform decisionmaking on programs like disability compensation, gi bill or home loan guarantee, which are facets of critical social determinants of health. this data should be easily cross-referenced with data already in vha and now the national cemetery administration, to produce the suicide report. the vfw has asked these questions for years but va has
7:00 pm
chosen not to elevate it or does not want to share it. if va is serious about understanding and preventing suicide, then we must demand a more thorough evaluation of all va programs. this is why the vfw calls on congress to direct va to include relevant vba data in the annual report for all va programs and their impact on veteran suicide. . eliminating suicide among our nation's veterans will continue to be a top priority for nations veterans t will continue to be a top priority for the vfw. veteran suicide awareness is not just a va, congressional or veteran organizational issue. it's an everyone issue. i close my testimony and i'm prepared to answer any questions you and members may have. >> thank you, for your testimony, ms. barlet, i now recognize ms. hetrick for her testimony. >> chair takano, ranking member
7:01 pm
bost and members of the committee, on behalf of our members and iva i thank you for the opportunity to testify. mental health care and suicide prevention. september 11th, 2000, one -- before this monumental anniversary, president biden announced that american troops withdraw from afghanistan by august 31st, 2021, following a previous commitment to withdraw by president trump. this effectively ended the two decade-long war ended early august, the world watched as the taliban swiftly made their way through the country of afghanistan and seize control. many veterans watched as their former bases were taken over by the end of may that they selflessly fought alongside afghan forces to defeat. feelings of anger, sadness and
7:02 pm
despair filled the hearts of our nations veterans and families. for some, the trigger of these events was unexplainable pain and change the way they viewed the war. iva regularly surveys our members to determine what issues are important to them. our most recent survey open on september 8th, just over a week following the withdrawal of troops from afghanistan. preliminary data shows that 52% of our members feel our engagement in afghanistan was worth it, a decrease from 2020. the data also shows that although 63% agree with the need to withdraw troops, only 22% of respondents approve of the way that president biden withdrew. respondents also agree that moore should have been done to protect afghan allies. or affects each veteran
7:03 pm
differently and the circumstances over the last month and a half of no doubt caused a lasting effect. iva has a concierge program helping veterans and families navigate a complex roadmap of services and saw an 80% increase in mental health inquiries compared to 2020. the va must continue to push out support and mental health resources, both within and outside of the va. preliminary data also shows that almost 43% of participants have considered taking their own life. and only 10% considered it before. two thirds of those participating also said that they know personally someone who has died by suicide and another percentage also said that they are not seeking service for a mental health injury. they cite that the negative
7:04 pm
stigma around mental health care is too great, a common issue heard from both active duty members and veterans. the issue of domestic violence has long been ignored when it comes to the military and following separation. a recent investigation found 100,000 incidents of domestic abuse have been reported to the military since 2015. according to data released in 2019, by d.o.d., incidents of spousal abuse in the military or more than twice that of the national population. iva's preliminary data shows that 51% feel this is a serious issue in the military and 32% are unsure. this is a testament to the severe lack of attention that domestic violence receives. our survey also shows that approximately 38% of those experiencing domestic violence experience it both within the
7:05 pm
military and after separation. stress exacerbates domestic violence and the last year and a half has been extremely stressful for the veteran community. even with this increased stress, messaging around intimate partner violence from the d.o.d. and va has continued to be almost nonexistent. veterans are resilient, but the weight of a pandemic and the feelings of our military withdrawal from afghanistan can be a lot to bear. we must ensure that we are doing everything we can to help veterans through this difficult time. members of the committee, i thank you again for the opportunity to share iva's perspective on these issues. i look forward to answering questions and working with the committee in future. >> thank you, liz hetrick, i appreciate hearing from iva because your organization serves the cohort of veterans
7:06 pm
who have served in iraq and afghanistan. ms. silva, i recognize you for five minutes for your testimony. >> chair takano, ranking member bost, and distinguished members, thank you for inviting me to testify on today's hearing on veterans suicide prevention. this is a central part of our mission here at the wounded warrior project. sometimes it comes as intervention during crisis but most time it is an intervention upstream to improve healthy habits or connect with communities or encourage a mental health appointment. while veterans aside is -- has recently been heightened by the covid-19 pandemic. during this time, we have proactively engaged to address these challenges and gain insight into how we can help
7:07 pm
affected warriors. we saw a 38% increase in referrals to our mental health program and learned that most warriors were feeling disconnected and isolated. we made over 40,000 outreach calls. that effort led to more than 50,000 hours of clinical care and conducting more than 7000 hours of emotional support engagement. the largest volume of referral was from connections of veterans, their families and the wounded warrior project. -- after more than 15,000 calls from warriors, we see that mental health programming is now the leading request. from a public policy standpoint, it is important to recognize your committee's commitment to improving mental health situations. this impacts on -- most notably those to accelerate bio markers for ptsd
7:08 pm
and traumatic brain injury. to understand treatment options and a new community grant program new alignment -- working tirelessly veteran suicide. [inaudible] i am pleased to hear that these programs will help guide our community forward after losing more veterans and helping those veterans -- first, we must continue to find innovative ways to remove barriers to care. two key barriers occur with substance use disorder or traumatic brain injury. treating these concurrently, without a gap and treatment, can be life-saving. we are expanding intensive outpatient services for both of these co-occurring challenges to our academic medical partners and our warrior care network. we believe that this care can be provided through va. second, we must continue to
7:09 pm
recognize and invest in the power of peer support. as a collective, we must create an environment where there is no -- around help. this includes training in suicide intervention for peers and the clinicians they're likely to interact with. these techniques have saved lived. as the va extends its network, we believe the same approach will save more lives. we must continue to embrace and expand telehealth, however. we saw a great increase in our interactions of veterans and veterans in rural areas. we believe that using this telehealth mental health practice over state lines will be crucial to addressing health provider shortages and connecting those who may not use va hospitals or resources. lastly, are written statement
7:10 pm
highlights the impact of both sleep and physical pain pain on mental health. poor sleep and chronic plain pain is higher among those who have served than those who have not served. we believe that the va can do more around alternative and complementary programming in clinical work. this will address warriors whole health. the wounded warrior project thanks the committee on veterans affairs and the contributions of their perspective and policy recommendations for reducing veteran suicide. we share a special obligation to serving our nations veterans. i am thankful today for the invitation to testify and i'm happy to answer questions. >> thank you, ms. silva, i want to just point out how pleased i am today with the panels for both the va and the -- in which women are well
7:11 pm
represented, as they should be. now, chief smith, you are recognized for five minutes for your testimony. >> good morning, chair takano and ranking member bost, members of the house veterans affairs committee. on behalf of the national health, board thank you for the invitation to testify on veterans suicide prevention. my name is chief william smith and i am chair of the national indian health board. i am a vietnam that. as an alaskan native and veteran, i can speak firsthand about the challenges facing native vets, especially during this pandemic. native veterans continue to have among the greatest challenges in behavioural valves health than any other veterans. one is due to our service to the nation's armed forces and our status as a last get neat of people.
7:12 pm
we have served in each conflict in the last 200 years. we have -- in 2019, the va determined that there was over 217,000 -- that use the va for their health care. about 2.5% of all the eight users. many native veterans receive care from both the indian health service and the va. for example, i have -- the primary care for the indian health service and -- the va. to give you a better picture, let me tell you about my experience. as a vietnam that, we returned home to a country that did not think us for our service. we were not provided care for our wounded physical and mental health care or the care that we are. and this was on top of policies from the federal government to try to take our culture aware from us away. --
7:13 pm
difficult situations and native veterans struggle and unfortunately i've seen too many brothers and sisters in arms take their lives. people -- are people are two times more likely to suffer from post-traumatic stress disorder. 84% of native women experience violence in their lifetime. these are just some of the challenges that tribal communities continue to face. across the board, native veterans reported higher issues around quality care and leave veterans vulnerable. destruction of federal indian policies and irresponsible human services systems have lefties veterans with historical trauma, affecting generations. the suicide rate among veterans
7:14 pm
recently increased by 62%. native veterans suffer a higher rate of mental health disorders. it is essential that we work with indian tribes and organizations to create resources. our priority will be to increase wellness and stamina and prevent suicide. it is essential that we continue to consult on activities. building compassion is a first step. it improves the likelihood of that a native veteran will seek care and as a tribal veteran representative i have seen the need to speak to native veterans and connect them with their deserved va health benefits. for help they need and
7:15 pm
deserve, and we must reach them. it should include a traditional approach, medicine and method that have been practiced in traditional healing, as a different technique. including physical, mental, and [inaudible] their path that might be different from one aegean trip to another. culture and -- also includes the need to understand and acknowledge the patient's that grant and recognize the history of trauma affected by native veterans. this background should inform treatment pollen and health care reforms and improvement. without recognizing the importance of culture and -- care, we will miss some other native veterans that need help and will benefit in court and important culture practice. it is very important that congress established parity between the va and the indian health services, especially for the mental and -- health care. without parity, the quality of
7:16 pm
care for native veterans will continue to suffer and health outcomes will remain worse. thank you -- for holding this important hearing and for the -- we have a long way to go to improve care for the native veterans. we will serve in this way as well. thank you. i yield back time. >> thank you, chief smith. as you know, i've made it a priority for this committee to infuse all of our work with an emphasis on equity. and this includes not only access to care for all veterans sitting at the table for -- testifying on behalf of the traditionally underserved -- they represent. your testimony, in many ways, was heartbreaking, but so necessary for us to hear. so i'm so glad that you're with us today, sir. mr. armendariz, you are recognized for five minutes for your testimony. >> yes, sir. excuse me, thank you, chairman
7:17 pm
mcconnell, recommended boss, and members of the committee. thank you for your candidate formation in invitation to testify. my personal experience but as an afghan -- veteran with before and after i became an employee mirror the concerns raised by the chairman about recent events in afghanistan. in september 2006, i enlisted in the u.s. army, during my time on active duty, i was honored to serve three combat tours in afghanistan, including some of the deadliest fighting in the afghan war. while all three deployments of saw heavy fighting and significant casualties, during my deployment with profit company second battalion five right infantry regiment where we lost 51 fellow comrades enemy inaction and 200 wounded, many severely. one of those, sergeant mike borough, of the u.s. army, retried now, it's the husband of the independence, -- funds ceos are brought in, for whom she has his hair care giving. i have seen the impact of the trauma itself did this come that diplomats both within
7:18 pm
myself and with my fellow soldiers. for example, what the losses of bravo company sustained income that were significant, since that deployment, i know of countless suicide attempts and four men with whom i served were lost to suicide. i left active duty soon after my third deployment to afghanistan, and find myself feeling isolated and struggling with many of the same issues arising out of my post so dramatic to stress that to combat experiences that many of my fellow soldiers above the country company struggled with today. my case i hung up by -- lost my 20, my family, and my job. i was lost and a whole i could not climb out. some of the mistakes about unfortunately put me in a bind illegally and mentally. mistakes that ultimately put me in a position of which i didn't feel as though i wanted to be here any longer and considered an alternative the more -- path. i was lucky in individual district attorney -- so i needed a different tire of help. personally interviewed and recommended that recommended to veterans treatment. not because of that i got a second chance that they'll
7:19 pm
never take for granted. my situation emphasizes the importance with which community organizations play in federal mental health and suicide prevention. the va -- and the crew knew -- this committee passed last year. veteran mental health is also impacted by recent events in afghanistan. the va saw a significant uptick in august inventors engaging in va mental health resources. the independent fun saw this as well, so much so that we cofounded a new coalition aims to save our allies, to evacuate americans and afghans to aid both the afghan refugee refugees in the ended states and to support u.s. veterans are struggling to make sense of recent events. unfortunately, one of your referred veterans to the va, we found many of them do not trust either because of perceived poor prior treatment or because of the stigma law enforcement affairs outline in the national academy of sciences report. in the coming weeks, the independence fund will roll out the independence a line of professionally manned called center and hotline where both u.s. veterans seeking mental health care and afghans seeking refugee of assistance can call
7:20 pm
and get assistance. one thing that must be discussed is the role combat deployments may place on veterans suicide risk. for the u.s. army combat units operate at an incredibly brutal on -- the committee deployments every other year. in my case, 45% of the second i have years i spent an active duty were deployed to afghanistan, engaged in direct combat actions. the previous 2016 annual veterans suicide report was the only report i could find where the va is still reported on combat veterans suicides. well i detail these numbers in my written testimony, the data indicates that 18 to 24-year-old male cub deployed veteran suicide rates is two to three times higher than the overall veteran suicide rate and 67 times higher than the nonfederal overall suicide rates. similarly, i describe the same increase in all of our veterans suicides in the last 20 years in my report were 18 to 34-year-old veterans make up 77% increase in veterans suicides but represent only 9% of the veteran population. our community needs to analyze
7:21 pm
this data and study the risk factors, combat deployments concrete agreed to veterans or size. today the department of veteran affairs has not provided the public withdraws suicide data used in these reports. only age cohorts which are too broad to allow for useful analysis. this limits the ability of all approved to test to -- conduct a regional research journalist research on protective factors involved in such a source. that encourage this committee direct the department to release such information and resume reporting on suicides by combat veterans. chairman turner, ranking member boss, members of the committee, i thank you again for allowing me to testify and i stand ready for your questions. i look forward to working with you but that's the main federal recommend -- to work with this committee on these crucial issues. >> thank you. thank you, mister armendariz. i know i speak for all of us today in thanking you for the tremendous service you provided
7:22 pm
to our country in uniform, and also, thank you for continuing to serve in the work you continue to do for the independence fund. it is very clear to me that you have endured great sacrifice continuing to face the effects of your service today. we owe you and every one of your brothers and sisters in arms support now as long as you need it and as long as they needed. mr. ranch on, you are recognized for five minutes for your testimony. >> good afternoon chairman took on, a record number, boston members of the community. thanks for the opportunity to to testify this evening. my name is rajeev and i'm a senior scientist at the nonpartisan rand corporation, where i also direct the rant epstein family veteran policy institute. in my testimony today, i am
7:23 pm
going to address for strategies critical for preventing veterans suicide. one, improve the national mortality data infrastructure. to, use data to better understand the veterans health care experiences outside of the. three, reflect better and more comprehensive data on veteran firearm ownership and storage. and for, incentivize researchers to collect data on suicide when testing novel and promising mental health treatments. first, the national mortality data infrastructure needs to be improved. the v8 just released data on veterans suicide from 2019, we need that our data is over 20 months delayed. where the impact of covid-19 or the withdrawal of u.s. troops from afghanistan have led to increased suicide rates among veterans, are questions that are currently unanswerable, due to the lack of --
7:24 pm
timely data on suicide. to have mortality data on veterans and suicides, resources are needed across the nation's over 2000 jurisdictions to a date vet equate systems, ensure that investigators have the resources to conduct comprehensive investigations, add to more quickly and accurately transmit the stated to cdc. better quality data is also needed. -- investigations could routinely collect data on sexual orientation and gender identity and -- this is especially important for american indian and alaska native individuals, who have the highest rates of suicide in the united states, but whose race is often incorrectly reported on this reports. the second strategy for preventing veteran suicide is tuesday to better understand veterans health care experiences outside of va. while we know much about the key va care that veterans are receiving, 75% of veterans
7:25 pm
receive at least some care outside of being, and we know very little about this care. one place to start can be the focus on veterans who are receiving care through other federal programs, like medicare and the indian health service. marching health care utilization data from these systems with data on veterans suicide's would help identify when veterans who died by suicide last accessed care, the settings in which we they received this care, and the type of kid they received. these data would help identify where suicide risk may cluster within health systems, so that tailored interventions can be created and interventions to address suicide in the places where it's concentrated. the third critical strategy i'd like to point out today is the need to collect better and more comprehensive data on veteran firearm ownership and storage. over two thirds of veterans who died by suicide used a firearm to end their lives. many suicide of crises are short duration, and experts
7:26 pm
argue that placing time and space between a person in crisis and his firearm by storing it unloaded and locked can be life-saving. many suicide prevention strategies are focused on encouraging such storage practices, but without timely data on how veterans are storing their guns, it will be impossible to know whether these efforts are effective. the final strategy i will mention today is the need for data on suicide outcomes for novel treatments. as new treatments are developed and tested for patients with mental health conditions and substance use disorder, data is needed on whether these therapies specifically affect suicide risk. but currently, most experimental trials for new mental health treatments exclude individuals with lots of suicide or past suicide attempts. proactive strategies are needed to actively recruit and people with suicidal thoughts so that we can understand the benefits
7:27 pm
of these treatments have for reducing suicide. this includes the trials underway for new treatments for post traumatic stress disorder, like mdma assistant psycho therapy, can be, mindfulness, and still i can glean brock. too many americans and too many veterans die from suicide each year. i'm convinced that we can prevent many of these deaths, but we need to invest in data and science to do so. my testimony today, i recommended for strategies. improve the national mortality data infrastructure, better understand experiences outside of va, collect data on fire firearm ownership and storage, and stats specifically whether novel and promising treatments affect risk. thank you again for inviting me to speak with you today, and i look forward to your questions. >> so i think all the witnesses for their testimony. i'm going to call for a recess, and for the committee to return
7:28 pm
as soon as possible after the last vote -- votes, which i say will be in about an hour and 20 minutes. so we'll resume in about an hour and 20 minutes. members do need to proceed to the floor to cast their votes on the next, on the six questions before the house. and with that, i call every says until the time that i mentioned. the committee will reconvene and come to order. i now recognize myself for five minutes of questioning. i'll begin by questioning with miss bartlett. miss bartlett, i'm very happy to see that -- support some legislation that will mandate more thorough training for va's community health providers. i also -- your testimony about the importance of including phoebe in the va suicide prevention. what can you say more about
7:29 pm
your position related to these -- legislation? go ahead. >> yes, thank you chairman chicago for that question. in regards to the community care partners, unfortunately, we've heard some berries and challenges with our membership here in the last few months, and that barrier and challenges that -- often that time it is for mental health, are being delayed in. so that means with a veteran, that that care is being delayed or, you know, they may have to start back up with a new mental health provider within the va. in regards to what we are seeing with the ace national survey, suicide reports, yes. speaking on behalf of the bba programs, we know, oftentimes, veterans more veterans do use
7:30 pm
bba programs to seek health care within. this is the final touchstone that -- we can see that amazing things have happened especially when we're talking about education systems over the past ten, 12, 15 years. we see how that's benefiting very veterans with suicide. thank you for that. it does make sense that we have more veterans using the va. that's important. ms. silva, i continue to be impressed with the services that the wounded warrior project has designed. i know that we have studied the issue of member substance abuse in-depth. can you say more about what the vba needs to do to provide more accessible substance use treatment for veterans?
7:31 pm
>> well, we were grateful to work with rand. we didn't know what we were going to find related to substance use co-occurring injuries. substance use disorder or traumatic brain injury. so we looked at the space -- including va -- and at the outcomes of the services, when they are provided concurrently. and at one time. actually, the outcomes are very positive. the problem is, there is not enough of those facilities available to veterans. they have to go longest in's is. there are just not enough of them. and i look at civilian as well. it's not just a va issue. it's across the board. but we are very concerned with the gaps in treatment. when you treat substance use disorder, sequentially, before post traumatic stress disorder treatment, which is often the protocol, you have that gap in services. that gap in treatment and that's where wounded warriors, veterans, are most at risk.
7:32 pm
and that's the barrier we were trying to tackle. so we have been able to invest in that, within our own care network facilities. and that will help, to be able to get that treatment, treating the whole warrior at the same time, with ptsd, substance use and traumatic brain injury. i think it will be helpful if the va is able to implement that on a broader scale. they do have, it they are just not enough geographically. >> -- well, thank you for that. ms. hetrick, i am pleased that you are representing the vso here specifically. i was very interested to hear about the iva's quick reaction force program and you desire to see veterans compact act and others implemented. what kept you see remaining for us to address gaps for veterans?
7:33 pm
>> as mentioned in my testimony, the issue of domestic violence can obviously contribute to veterans who experience thoughts of suicide. and as i mentioned, there has been almost no communication over the past year and a half when it comes to resources for domestic violence an intimate partner violence. so, va really needs to ramp up this type of messaging. there were veterans that were unable to leave their homes for long periods of time. and they've been trapped in situations that were not okay. so, making sure that the aid puts out enough information to let veterans know what resources they have and ways that va can help them through those types of things. >> well, thank you so much. i'm going to now we recognize the ranking member -- we will go through a couple more rounds of questioning,
7:34 pm
since there are a few members back. and get to again the witnesses who have made themselves available. ranking member bost, go ahead, take five minutes, then we will switch. >> thank, you chair. mr. armendariz, i someone who served in afghanistan and lost friends there, what has it been like watching the failed withdrawal, knowing that so many veterans and allies were left behind? you are still muted. you are still muted. thank you. >> it's interesting for a lot of us that i have seen. there is a mixed effort and there is definitely, you know, indications that this is a very stressful environments for a lot of these veterans who have spent the last 20 years overseas. and a lot of them, as i stated before, wonder if it was all for nothing, which is why, case
7:35 pm
in point, i stated that we at the independence fund have started working with our coalition named save our allies, to not only evacuate americans from afghanistan but also to provide assistance to both the afghan refugees that arrived here and support the veterans struggling to make sense of recent events. unfortunately, we find that many of the veterans we serve do not trust the va due to perceived prior treatment from the va. or they just fear that the va will report them to authorities, replace them involuntarily into the fiduciary program. >> so what would be your main message to any veteran that might be listening to your testimony in your experience, and your struggles? what would you suggest and encourage them to do? >> i would encourage them to reach out to the va crisis line, as well as, as i stated in the
7:36 pm
coming weeks, the independence fund will roll out the independence line, a professionally manned call center and hotline where afghans seeking refuge assistance and veteran seeking mental health care can call and get assistance. >> appreciate that. ms. hetrick, you testified that the events in afghanistan will have tragic effects on veterans. what do you think the lasting effect will be and how should the va and this committee moved forward in pushing forward and making sure that the va makes the right decisions? >> thank you so much for that question. as we mentioned, making sure that pushing our resources for veterans who are experiencing -- who are being triggered by the events. the lasting effects could be a different opinion of the war in afghanistan, as i said. our survey has shown a 10%
7:37 pm
decrease in veterans who feel that the war in afghanistan was worth it. and also, just making sure that we support veterans, and many veterans are trying to still work to get afghan interpreters out of afghanistan, putting out positive messages to ensure that they are being helped in this very difficult time. >> wonderful. mr. smith, a quick question if i can, for you, because you represent a unique group as well as vietnam era. have you seen an uptick after this problem in afghanistan? and has it affected those vietnam veterans with your groups, at the level that we've seen with others? >> it has. in 1975, we had the same thing with vietnam. and you would see how people on
7:38 pm
the aircraft were -- but we left the enemies just like we did those in afghanistan. we left people that worked with us to fend for themselves. and as a vietnam that, i see this with the taliban coming over and taking over, you are seeing that women's rights are completely useless. the veterans, they feel the same way, when we talk to our brothers and sisters. from iraq and afghanistan and all over. it is not the warriors fault that we got out this way. but it hurts. we leave people behind, we left people in vietnam in 1975, when the tanks from the north were coming down from saigon, from ho chi minh city. and the people that we couldn't
7:39 pm
get out and can't get out, i believe some of them are alive today because of what happened and the way the withdrawal was. as a veteran and someone who volunteered to serve my country and who served in vietnam, this is -- this is tragedy. we have welcomed our brothers and sisters home, we never had that. we also stand with them to know that what we did in vietnam and what they did in afghanistan was right. we kept the bear at bay. but the way we withdrew is a disgrace. is it going to hurt our veterans? yes, it is. >> we want to make sure that we are there with you. with that, i am aware of my time and i yield back, mister chair. >> thank you. i see the chairwoman brown has joined us. thank you, chair brownley.
7:40 pm
>> thank you, mister chairman. i'm sorry i missed some of the testimony but i had another meeting that i had to attend. anyway, ms. hetrick, i want to ask you, in your written testimony, you talked about the risk of homelessness and the impact on mental health. and you specifically mentioned that runs with families. and so, last year i had a bill signed into law to permit the va to pay a per dm for housing for homeless veterans with children. it passed and i'm just wondering if you know the va has begun and the issuing of prayer dm payments for homeless veterans with children. >> at this moment i do not know. but i can definitely look into it.
7:41 pm
>> okay. it was to provide a per diem for the children as well, so that when they go into the community and look for housing, they have the resources, hopefully, to secure that housing. so i would appreciate it if you would look into it and to give me an idea if it is actually being implemented or not. that would be terrific. so, chief smith, how are you? and thanks for being with us. i know in your testimony you noted my bill and i thank you for that. my bill about requiring va to train minority veteran coordinators in culturally competent care. and we know that our native veterans have a high suicide
7:42 pm
rate, of any cohort within the veteran community. i just wanted you to talk a little bit about culturally competent care. and probably, you know, the lack of culturally competent care and whether the impacts and indications for that. >> thank you. thank you for that. competent care, when we talk about going to our sweat lodges, and things like that, through the traditional ways, the best way that i know for a veteran who is in crisis is to talk to another veteran. as for tribal veteran representatives, tvrs, it is trying to get us to talk to a lot of the vietnam vets that did not come back to the va. and you stand by our afghanistan and our great --
7:43 pm
all the rest of, them are brothers and sisters who come home -- by treating them in sweat lodges and traditional healing. like, when a warrior comes back -- right now, they are -- of how we left afghanistan. and the people that served over there is an all volunteer army. back in my days, they were volunteers and they were draftees. i am a volunteer just like the rest of my brothers and sisters. and it needs to have, in the indian nation, being able to work between the two systems. indian health service, in traditional medicine, healing through the pot latches and everything else to calm the warriors spirit. i mean -- when you are back on the block, you could be in vietnam and three days later you are back on the block. your body is still over there.
7:44 pm
my body is still over there. my mind is still over there as a young kid. i fell back and learned from my warrior brothers. and the only thing that got me to start working is my brother was in vietnam before i was. and it took us 35 years to talk to each other. and that's where you do it, another veteran talking to another veteran, saying, let me hear your stories. i will tell you mine but let me listen to you and hear how you found the road to recovery. because after for divorces, and classes, that my company saw value in me, i realized i was still in vietnam instead of here. and how i get home, --
7:45 pm
that's what we are going to have to do. to make sure our brothers and sisters know that they have someone to talk to and say, welcome home brother, welcome home a sister, here is what i needed here. the other thing, we have a long number to call for help. if it's an emergency, it's 9-1-1. if i need to dig in my property, it's 8-1-1, and i can get the water company, gas company, cell phone company, to come out on a violent. why can't the veterans have just a simple number instead of one that is pre-loaded on a phone? why don't we have a simple three digit number for veterans to call in? and get to a center and say, hey, i am here. >> well, hopefully -- >> time, so -- >> three digit number in any case -- but i thank you for your response and we are so delighted that you are here with us. again, thank you for your testimony and i yield back,
7:46 pm
mister chairman. >> thank you, chairwoman brownley. we are also proud of the work you have been doing in indian country and the historic deal tearing in indian country. i just cannot say enough about the work you are doing. and chief william smith, just know that the crisis line is nine eight eight, it goes live in 2022. we have some issues with getting the fcc approvals for 988 and all that. but it's been a big push to come. folks like you. but know that we have the three digit number that goes live in 2022, 988, that's why i said, put it on your phones, the veterans crisis line number.
7:47 pm
i announce it. and you saw ranking member bost say the same thing. so i now want to recognize the gentleman from montana, for five minutes, mr. rosendale. >> thank you mister chair, thanks everyone for joining us. what a wonderful committee we have here. a panel. mr. armendariz, my first question is for you. i'm alarmed by the claims in your written statement, that you regularly hear from veterans who cannot access mental health care from the va and are not being given the choice to receive care in the community, as required by the admission act. we heard testimony today that that isn't the case and veterans can receive treatment on the day it was requested. so why do we have a discrepancy in these two descriptions about the delivery of care?
7:48 pm
and could you tell me about that? >> yes, sir. so, i can speak on personal experience and i can speak on lived experience, having seen the treatment of fellow veterans and service members that i work with who have been turned away at the door. but i will say, we regularly assist numerous veterans who cannot get access to va mental health care and cannot trust it. and they should be addressed by the va. more than 25% of the veterans we assist for mental health care refused our referral to the va because of the mistrust. or because of poor prior experience or medication mismanagement mishaps in the past. more than 25% were critical cases requiring the escalation and safety planning and highlights the fact that by the time a veteran asks for mental health care, they are likely at
7:49 pm
the end of their rope, now that the beginning. almost one third of all caseworker request we have received this month we're for mental health care. with regard to those veterans who say they cannot get timely access to mental health care, we have veterans who are told by va schedulers that they cannot be seen for eight or ten weeks. when they ask for community care instead, they are told that they shouldn't go to community care, because it's not as good, or because they don't believe that they will be able to get appointments. and the government accountability office reported that va suicide prevention teams are overlaid with cases. and that the administration has not conducted comprehensive evaluations of local suicide prevention teams. so, you know, therefore, i would say, the independence fund recommends that this committee actively exercise its oversight responsibilities on
7:50 pm
community care. to find out how long the va is taking the process for community care, mental health referrals. how long between the requests for care and when the care is actually being delivered. are there additional mental health providers at the va is not presently using? >> thank you, so much, and i will be requesting that information to make sure that we can fulfill those needs. because i don't like hearing different stories, if you will, from folks that are supposed to be delivering this care and then hearing that it is not getting discrepancies. -- warriors have individualized paths of recovery, ms. hetrick, you said in your testimony. do you think that the va's mental health programs offer sufficient flexibility to tailor treatment to veterans
7:51 pm
individual needs, including a more holistic approach, as you were talking about? considering the total health? pain and how that interacts with mental health? and could you describe the process in order to do that evaluation? ms. hetrick? >> thank you for the question, sir. i believe that the va, there is evidence-based clinical care, the veterans are receiving it, it has been shown to be very impactful. i do believe, as we said in a written statement and oral remarks that having a more holistic approach, adding the augmented therapies -- we have seen, internally, when we have warriors in our physical health programs, they are sometimes -- their mental health programs are better than our singular mental health programs internal to us. i know that they take a more whole health approach, and that's the main part of one of their programs.
7:52 pm
that's why it was used. my own belief, the data that we have, shows that the warriors will gain lots of outcomes related to better sleep, better pain management and increase mobility. we get very nervous about the increases in chronic pain and the decreases in sleep quality. so those need to be attended to in a whole health way by the va. >> thank you so much. and mr. chair i see i am at my limit, thank you so much, i yield back. >> thank you, mr. rosendale. let me just say, we know there are wait times in almost every community, in almost every community, not just the va, because the entire nation has a shortage of mental health professionals. that is why in the reconciliation markup i was insistent on including at least
7:53 pm
700 slots -- i would have liked more -- 700 slots for residents in training for mental health professionals. it's different types of medical professionals but also including other types of mental health providers. but we do have mental health workforce shortages in the country, no question. so the shortage -- the wait occur as well in for veterans and in the community. -- it's anecdotal but from what i am hearing, it does happen. so i am not contradicting what mr. armendariz is testifying today. let me return to mr. mrvan for five minutes. >> thank, you chairman.
7:54 pm
ms. silva, as chair of technology modernization committee, i read with interest your discussion on telehealth. one of the ongoing barriers to veterans access to telehealth that persist following the implementation of the va -- in 2015? what congressional action is needed for this moving forward? >> thank, you sir, for the question. i think it can be summed up in kind of two ways. number one, the inter state licensure obstacles, or the compact, our problem. we have warriors that, if they are stationed in and around fort hamilton, kentucky, they've got to drive to be in kentucky if they live in tennessee. or in that state or in that base. straddling both states. it's just -- we need, i believe, some more common sense licensure agreements between states. we do have that shortage of
7:55 pm
mental health care providers, this can help with that. so i do think congress can help by having the states recognize that and join the -- and other measures to decrease the obstacles for inter state licensure. secondly, building up infrastructure, so rural warriors can get broadband access. to populations that would benefit from our virtual programs were women warriors and rural warriors. we will lawyers who had access to the platform -- we need to make sure that all week warriors, no matter where they are, have that access. those two would be really important for congress to lean in on. >> thank you very much. -- i share your concerns around execution for success, for specific veterans, whether it's the lgbt individuals, with a
7:56 pm
elevated risk of suicide. how would you suggest that we -- investigations into potential veteran suicides? and are there any specific recommendations for improving coordination between cdc, d.o.t. and the va in this way? >> thank you for your question, congressman. i do think there is evidence to suggest that lgbt individuals are at increased risk for suicide as well as lgbt veterans being at increased risk for suicide. this is done by, to be honest, some pretty fancy statistics, and we need national language processing to understand as clinical notes. but in va, i think we are talking about culturally competent care. and that is, you know, providing culturally competent care, understanding how people identify themselves. during death investigations, there are trainings that are available, conducting death
7:57 pm
investigations. and reporting on sexual orientation and gender identity. los angeles is one death investigation jurisdiction that currently requires all deaf investigators to collect data on sexual orientation and gender identity. and i think that that is a model that i think we could use, the evidence from los angeles county death investigations and the success they are having. i think sometimes it's just a barrier that people don't want to ask. but if it struck them and show them that other your sections are collecting this information, that is a pathway forward. >> and then, quickly, you also discussed in your testimony, the potential for improving veteran suicide prevention. by utilizing data from a variety of sources, including medicare, could you explain the value of encouraging health care utilization data, as well as any barriers around this data to improve service for our
7:58 pm
veterans? >> i'm not sure why the barriers may be. i am sure that there are technical ones. but i think it is doable. i mean, the value here is that we know that there are so many veterans who receive care outside of the va. many of them are enrolled in federal programs. and we can identify concentrations or pockets of risk where or when they last had access to health care. where they had access to the type of care. and really target suicide prevention resources. this was done really successfully with respect to our emergency department -- on screening for suicide risk for emergency departments. and then following up, with emergency departments, especially around self harm, with targeted resources and care. i think it's a successful model, with evidence that it works. and that's kind of what i see the promise for doing this and this type of care in other
7:59 pm
health systems. >> thank you. with that, i would also like to -- as i always do, think all our veterans for our service -- and i would like to thank chief smith for his service to our country. thank you. >> thank you, mr. mrvan, i now will recognize representative moore for five minutes. i'd>> thank you, mr. chairman. ms. barlet, it's heartening to hear about how the vfw stepped up in response, particularly around the failed afghanistan withdrawal. what more can we do to assist vso organizations? >> thank you for that question.
8:00 pm
... >> it appears ms. barlet's connection is mr. moore, why don't you pose a question to another -- >> yes, thank you mr. chairman, i can do that. this will be a question for ms. tetric. you note that stigma prevents veterans from getting the help they need, what should this committee do to combat that? >> i feel like this gets that often and i probably already said it, but messaging. the stigma probably stems from the fact that in the military when you seek mental healthcare services you're told you're at risk for losing ability to be deployed our losing your career.
8:01 pm
the stigma then follows into the veteran community. if we can let service members know that seeking healthcare is not going to make them lose their jobs, i think that will carry over into helping veterans feel comfortable seeking mental healthcare. again, with the messaging, making sure that va and rsos are putting out effective messaging at how great va services are, how highly rated they are and ensuring the va works with the community groups to ensure the veterans not seeking care at va are still being helped. >> thank you. mr. moore, it looks like ms. bartlett has relogged on, so -- >> thank you, ms. bartlett, did you hear the question okay or do i need to repeat.
8:02 pm
>> there she is. ms. bartlett, do you need the question repeated for you? >> no, i do not, chairman, thank you, thank you representative moore for that question. like i mentioned, be involved. reach out. find a facebook group that your vfw or other vfs may be doing, sometimes not even a veteran organization, may be a local church in your area who took it upon themselves to help the community with these refugees settle here in the united states. >> mr. moore, go ahead, continue. >> okay. so i guess, my question specifically is i think that we're going to have trouble with some of the veteran, as, you know, the afghan, we had a lot of interpreters who work close to our soldiers so i think as a group, we need to be mindful that we're probably going to have, and i think it's been
8:03 pm
reported there's been increased calls, ranking member mentioned that, some of our veteran health organizations. so that was the kind of thing i was wondering, what can we do to support the vsos going forward to make sure you have the support you need, i think there are going to be increased calls, increased distances, based on what i'm hearing in the district and with that, mr. chairman i'll yield back my time. >> i now call upon dr. reese, five minutes. >> thank you, mr. chairman, for holding on such an important topic. the va must continue to stay focused on. we owe it to our service members
8:04 pm
to take care of them when they come home and that includes mental as well as physical health. one of my staffers, fellow wounded warrer, his unit lost 47 marines in combat, he lost 37 fellow marines to suicide after they were back in the united states. it's a heartbreaking experience to say out loud, let alone live through. and it is unacceptable. i know that the va has prioritized this issue, and i want to make sure congress is doing everything we can to support those efforts. one thing that has struck me is that as part of the va's suicide prevention effort, there seems to be an emphasis put on the
8:05 pm
ving to aed vkt for themselves. for example, the veterans crisis lines help with care and support for the networks, but it requires the veterans pro actively make that phone call. i also noticed when they seek mental health treatments through the facilities, must receive suicide or self-harm in order to receive rapid intended care. so while this may not be the official policy of the va, it is the experience of the veterans that i represent. ms. hetrick, as a doctor, i know patients aren't always forth coming to forcing veterans to explicitly state suicide to have treatment, isn't appropriate, how can we provide help in the district without them expressing suicide thoughts or self-harm. >> thank you for that question,
8:06 pm
dr. ruiz. i'm not 100% on how, i guess the va could be a little, help a veteran communicate that and get more effective care in that type of situation. my guess would be -- i'm also not a clinical provider but my guess would be when a veteran does mention anything to do with mental health in one of their appointments, that there be more of an emphasis on getting them care at that moment, instead of waiting for them to have to use trigger words like suicide or self-harm. obviously, if they're bringing up the fact that they are struggling with something, mental health related, then they are to the point where they feel they need to bring it up often, we don't bring up those types of things until we're really feeling that push, so when they are choosing to bring that up, making sure that's taken as effectively as it would be with the previous statements. >> thank you, and i understand
8:07 pm
there is a need for additional mental health professionals to meet the demand for america's veterans, and earlier this year went to the house committee for significant increase in funding for the prevention out reach funding. i'm proud to say the bill includes $286 million increase for suicide outreach almost doubling this funding, it's critical to get this right. must reach the veterans before the crisis point and i think part of that is helping reduce stigma on mental health issues so veterans feel more comfortable seeking help in the first place. how would you recommend we use this funding to help veterans? >> i think public awareness campaign would be great showing it takes a lot of strength, it's actionable and a strong action,
8:08 pm
but investing in the peer connection across the communities is an important up stream intervention. if a peer is telling you they got help, and that it worked for them, that's, that's the biggest yeah, it's really important, the more they see stories in buddy that is do that, i think that can be the best psa for getting that care. >> thank you. >> whether it's within the va or other opportunity. >> thank you, i thank you all for your incredible work. mr. chairman i ask unanimous consent to submit this new york times article from 2015 about the marine's regiment for the record. >> without objection, so ordered. thank you so much, dr. ruiz for that enlightening line of questioning it brings to mind
8:09 pm
something we know from research that when someone you know dies from suicide, your own suicide risk increases. and this is why, it is this phenomenon of suicide actually being contagious and that is why evidence-based prevention is critical to lowering everyone's risk of suicide, thank you so much, dr. ruiz. ranking member, i am, to not do a second line of questioning. we have such a line of expertise today. we do have a mark of an oni i have to get started, and it's with a deep amount of regret i won't do another question. i normally would have done that to take advantage of this expertise. i thank our veterans on this
8:10 pm
panel for your service, always moving. chief smith, i can't say enough to you, because we didn't say it then, welcome home, brother, welcome home, nick. we thank you for your service and that, you know, we do stand in solidarity with all the veterans across our country who have been triggered, who have been, you know, especially suffering since withdrawal from afghanistan so we thank all of you for your service. and i want to thank all three of the women veterans as well with us, ms. hetrick, ms. silva, and ms. bartlett. thank you all for your service as well. and thank you for all the work that all of you continue to do
8:11 pm
for our veterans and thank you for the service you're bringing to our country. >> chairman, can i -- >> of course, ranking member baus, i wouldn't want to adjourn this meeting without you weighing in. >> in particular, mr. mendez, there is, to take and share your thoughts and chief, yours as well, with the committee. you know, i also want to apologize to the witnesses on our second panel who had to wait through a very long vote series, that's kind of houf this place is and our witness's time and testimony is valuable, i don't want you to think it's not and i hope the chairman and i can work together and move forward to try to respect that even doing mark-ups and everything like that. i don't want anyone, in particular any veteran, who is
8:12 pm
invited to testify before this committee to have to wait hours for the opportunity to answer questions for their representative and see that being said, it's very clear, after all of you have delivered your testimony, that we've done a lot of good work that we should be proud of, but it's also clear that there's a lot of good work still to be done and we need to keep working together and i look forward to continuing to do that work until not a single, i say that again, not a single visit reason is at risk of taking their own life. and to follow, the fellow veterans, i want to say this. i know times are tough, we all have struggled. there is no shame or weakness in admitting that you're going through a hard time. there is no shame or weakness in asking for help. no matter what, suicide is never the answer. and if you think that it might be the case, i beg you, and i'm knowing to say this, we know the three numbers are coming in a few years but right now still
8:13 pm
1-800-273-1855 or visit the veteran's crisis lines, you are not alone, you're worth it and you matter and with that, mr. chairman, i think we had a great period and i yield back. >> thank you, ranking member bost, thank you for being such a relatable peer. a peer, who is reaching out to other veterans. you are exemplary of our peer outreach specialist who serve on committee, thank you all six of you who are veterans, thank you mr. rachad also for your expertise today. my heart goes out to all the veterans across the country and my gratitude for you all for serving our country and continuing to serve our country. thank you,
8:14 pm
8:15 pm
8:16 pm
this is two hours, 45 minutes.


info Stream Only

Uploaded by TV Archive on