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tv   Experts Testify on Veteran Suicide Prevention  CSPAN  November 11, 2021 2:25am-5:53am EST

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chair takano: today, we come together to shine a spotlight on veteran suicide. the vsa, bso, advocates, families, caregivers, survivors, loved ones, the work we do every
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day all year to prevent veteran suicide is vital. we talk about systems of care for those in crisis, the veterans crisis line, and a key part of my compact act, which would ensure that any veteran at imminent risk of harm to self or others can receive free stabilization care at or paid for by v.a. i want to make sure all of you, veterans, family members, their givers, friends and colleagues, answer the veterans crisis line -- enter the veterans crisis line into your phones in case you or someone you care about needs it. the number is 800-273-8255. that is 1-800-273-8255.
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i will enter that into my phone. i do carry the card with me. it is important that all of us as members of congress enter it into our phones, for a town hall or a place where we address this topic. it is great to know that you have it you. i would note a true public health model of prevention is the most comprehensive, holistic approach to suicide prevention. everything we do upstream to give veterans and their families stability, purpose and joy in their lives is also suicide prevention. stable housing is suicide prevention. financial security is suicide prevention. food is suicide prevention. access to high-end quality, effective health care indicating mental health care is suicide prevention. education and employment with a
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living wage are suicide prevention. preventing and treating the effects of trauma, including sexual assault, is suicide prevention. addressing social selection and loneliness that social isolate -- social isolation and loneliness is suicide prevention. getting everyone to store their arms and ammunition safely is suicide prevention. and treating utterance with respect inclusive of their gender, race, ethnicity and sexual orientation is suicide prevention. the secretary opposite yes -- the secretary's don't ask don't tell is suicide prevention. -- we will hear about newcomb ongoing research studies about how science and innovation guide the v.a. broad and targeted
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efforts to prevent veteran suicide. we want to know what works and what looks promising. i am also eager to hear how v.a. has expanded mental health support and suicide prevention outreach in the wake of the pandemic, and the recent u.s. withdrawal from afghanistan. this hearing was planned before the most recent events in afghanistan, but i asked v.a., vs owes and veteran witnesses to share -- bso's -- vso's and veteran witnesses to share. my staff has been in contact with vso's. thank you for keeping veteran needs and your efforts. veterans serve this country and bring unique backgrounds and challenges to their service into
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the next phases of their lives. this means that just as there is no single cause of suicide, there is no single approach to preventing suicide. our shared goal is to dial down risk factors to veteran lives while dialing up protective factors. with this goal in mind, i directed my staff to put together a package of mental health and suicide prevention bills that we can move with urgency as warranted. they have or buy it -- they have invited republican staff to provide input. this suicide prevention package will include revisions to improve how v.a. frames its community mental health service providers -- community mental health providers, increase the number of specialists in v.a. medical centers, expand the v.a. safety, honorable service
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members suffering during the transition process, strengthening and adding resources for the veterans crisis fund, increase the number of that centers around the country and in short suicide prevention outreach and care reaches traditionally underserved veteran communities. i just introduced a bill with congresswoman porter and plunkett, the v.a. governors challenge act. our bill treats drives equal to states, and gives v.a. authority to use authority to help states and tribes develop and implement promising proposals tailored what veterans and their communities need. in 2019, the most recent year
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for which the cdc and v.a. have reliable suicide data, the rate of suicide among all u.s. adults, but especially veterans, the number and rate of suicide among veterans decreased for the first time in many, many years. while this is wonderful, it doesn't pause our commitment and our work for one second. when veteran dying by suicide is one too many. i look forward to hearing from the witnesses on both our panels. ranking member, i recognize you for five minutes. representative: i appreciate the opportunity to discuss the tragedy veteran suicide and how to prevent it. september is national suicide prevention awareness month and this september, there is cause for celebration and caution.
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two weeks ago, v.a. released 20 when veteran suicide data reported for the first time in a long time, the report contained good news. it showed 7.2% decrease in veteran suicide in 2019, the most recent year for which we have data that is available. according to v.a., that is unheard of progress. but as we all know, the last two years have brought unheard-of challenges as well. those challenges include covid-19 and more recently, the crisis caused by the biden administration failure to withdraw from afghanistan properly. veterans are disturbed in afghanistan and those who served elsewhere are under immense stress watching tragic events of the last several weeks unfold. i felt that same stress. according to the v.a., compared to the same time period in
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2020, august 13-september 15, the pattern crisis line experienced a 6% increase in calls, a 32% increase in cap and 71% increase in next. those increases are a 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 is why my fellow republicans and i have been calling on chair takano to call an oversight hearing to address the impact the afghanistan crisis is having on veteran communities. this is not that hearing. our calls of gone unanswered. we must use this opportunity nevertheless to shine a light on
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those in need. that is why i am honored to have nick here to testify as a minority witness today. nick is an army veteran who 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 has faced since then, and his own mental issues he has dealt with. he will bring -- he will be frank today about how devastating the last several weeks have been for him in many veterans. nick, we thank you for your service in uniform and your service you are 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
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experience, you are powerfully showing that veterans are not alone and that there is strength and hope on the other side of every struggle. it really is ok to not be ok. if you are a veteran who is watching this right now who needs help, please know, help is available to you anytime. and i know that the chairman mentioned this, but it is important that we mentioned this, you can receive help by calling 1-800-273-8255 and pressing one. that is 1-800,273-8255. you can text a 255 -- you can text 8255 as well.
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i yelled back. chair takano: i want to thank -- i yield back. chair takano: i want to thank the ranking member. whenever we talk about suicide prevention, we mentioned folks can get help. ranking member, it was a pleasure to spend time with you in southern california. i want to say much i appreciate the relationship that we are developing. we don't agree on many things, but we agree on a lot of things, and i think that typifies the membership of our committee. we are very passionate about our points of view, but i think we share a common passion for those who serve our nation in uniform. i want to express what an honor it is to serve with not only the ranking member, but someone who comes from a great military family. thank you.
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i will now recognize our first witness panel from vha. dr. kameron matthews, assistant undersecretary for health and political services. she is accompanied by dr. matthew miller. dr. lisa brenner, director of vha rocky mountain mental health research, education and clinic for suicide prevention. thank you for being here. i remind our witnesses to pause for two with three seconds before speaking and answering questions. dr. matthews, you are recognized for five minutes. dr. matthews: thank you. good morning.
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my colleagues and i appreciate the opportunity to talk about great things v.a. has done and will continue to do related to suicide prevention. i am accompanied today by dr. matthew miller and by dr. lisa brenner. we express 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 events in afghanistan, and all your commitment to veteran suicide prevention. i want specifically to think the house for passing a strong military construction/veterans affairs and related agent funding bill. the bill includes robust funding for mental health. it includes 590 $9 million requested specifically for suicide prevention. this funding is critical to the continued focus on suicide prevention efforts, and the dcl implementation. in 2019, 40 5861 adult americans died by suicide.
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-- 40,500 -- 45,861 adult americans died by suicide. with each loss for each family, we rededicate with each of you a commitment to the commission to address suicide is a national public health concern. suicide is no single cause and no one set solution. our work continues to operationalize a public health approach a national strategy for preventing veteran suicide with clinical strategies to reach all veterans. the plan is being implemented through the suicide prevention 2.0 initiative, the suicide prevention now initiative, the presidents wrote have to empower veterans, and the dcl expansion as well as implementation of research advancements and their
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translation into practice. in addition, our efforts are further fueled by the commander john scott hammond veteran mental hair improvement act of 2019, and the access to treatment dr. 2020, the contact act. the hammond act will provide critical mental health care resources and evaluate treatments for clinical care of the veteran population at v.a. as well as awarding grants entities that provide suicide prevention services. the contact act authorizes v.a. to implement policies related to transitioning service members, mental health education and treatment and improvement of services for women veterans. section 201 of the contact at requires v.a. to provide suicide care and the department pay for
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emergent suicide care to an eligible individual at a non-department facility or reimburse the individual for emergent suicide care provided to the eligible individual at a non-departmental facility. benefits under this new authority requires considerable time to implement. v.a.'s working rapidly develop a process to be notified when veteran sees care at a community facility paid the veterans benefits administration provides a variety of benefits and services to help reduce or eliminate risk factors associated with suicide and promote prevention for veterans. solid start, veteran readiness, employment and education assists veterans transitioning to civilian life, connecting with benefits, achieving career and vocational goals and supporting financial well-being. v.a.'s committed to suicide
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prevention research to inform and advance our knowledge. the v.a. office of research and development and the office of mental health and suicide prevention work together to ensure research and funding are synchronized so operational priorities align with the national strategy of preventing veteran suicide. we hold our core tenets, number one, suicide is preventable. number two, suicide prevention requires a public health approach providing -- combining clinical community based strategies and number three, everyone has a role to play in suicide prevention, all of us and all of you in all communities across the nation. we appreciate the committee's part is weight edify challenges and find new ways to care for veterans. my colleagues and i are prepared to respond to any questions. chair takano: thank you, dr. matthews. without objections, your written testimony in full will be included in the hearing record. i recognize myself.
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dr. matthews, i'm impressed with how v.a. provided resources for veterans in the wake of the u.s. withdrawal from afghanistan. this is of paramount importance to me and this committee. is there more you want to share about v.a. efforts? dr. matthews: iq for the acknowledgment that question. we -- thank you for the acknowledgment and that question. we were interested in a multipronged approach to ensure veterans affected by events in afghanistan new that they were not alone. that was shared through a multitude of opportunities and resources, blogs, resources, emails to millions of veterans, daily outlets through our veterans news network, through vet resource check ins, media interviews, even town halls, support groups. there is a multitude of
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resources that we have purposefully made widely available, just acknowledging that we need to talk about it. that is our tagline. let's talk about it there they are not alone. that was emphasized time and again, and the concept that v.a. is here for them, that we are available through a multitude of resources -- dcl, online opportunities and chat events or at a facility where they can sit face-to-face with a support team, these are numerous examples that we hope veterans have been benefiting from. we have been getting that feedback ourselves. even the proactive outreach we have done through emails alone, the response we get has been telling. and we will continue these efforts as much as needed to make sure they realize v.a. is here for each of them. chair takano: thank you.
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dr. miller, i am glad the v.a. is having conversations with veterans about their firearms. can you reassure my colleagues that this is not only important, but an expansion of something the v.a. is already doing to drop suicide rates among veterans? dr. miller: thank you. and thank you for the question about lethal means safety. especially firearms. in your introductory statement, you 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
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those risk and protective factors have to be explored and enacted across clinical and community-based settings. now, click the facts we just talked about with regard to multiple reasons, multiple causes, and think of it in terms of the following. all those multiple causes, almost multiple factors, 70% of the time come down to one lethal means. and that is firearms, for veterans. so, as our clinical practice guidelines demonstrate and the research demonstrates, when the most important things you can do in suicide prevention is yes, explore risks. explore preventative factors.
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explore policies and interventions that can address those. but as we are exploring the whys of suicide, don't forget the hows. when the how is explained 70% of the time by one thing, the firearm, that suggests that it is a very important area to focus upon. therefore, this year, we are addressing the issue aggressively through our lethal means safety. chair takano: thank you. [indiscernible] dr. brenner, v.a. research programs, can you say more about what v.a. has learned more about genome sequencing and the veterans project?
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dr. brenner: thank you. those studies are related. what we are 20 do is understand how to put different risk and protective factors together, and in doing so, do a better job at predicting suicide. both the m.v.p. project with genetics and the effects projects with information about suicidal behavior in veterans who may or may not seek care in the v.a., can be combined to look at predictive models and identify those who we may not always know are at risk. chair takano: thank you. i now want to yield back and call on ranking member bost. representative bost: dr. matthews, you kind of went into
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the afghanistan situation with what we are doing passively, and i was glad to hear we are talking to them, but i was alarmed to hear that v.a. never made a national outreach effort with a plan to connect with veterans who may have had increased risk for suicide due to the crisis in afghanistan. we know many veterans are suffering because of this failed withdrawal, and the problems that came out of it. what is the v.a. responsibility in reaching out and supporting them, and accurately -- and actually, we see the uptick, as i talked about in my opening statement. why has there been no national outreach that has been done by the v.a.? >> thank you for the question. there actually has been a considerable amount of proactive outreach, through even our vcl line, our office of social work,
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our post-9/11 case management program, individual facilities are reaching out to veterans who are at high risk for suicide and there is a considerable amount of engagement in that effort proactively. i don't know if there is additional information you can share. dr. miller: considering this from a public health perspective means we engage in outreach with at least three target populations -- universal, which means outreach to everyone in a population, selective, which means those who are at elevated risk, and then indicated, those who are at the highest risk. our paid media has been structured to outreach and target each segment of those populations. within the present month, we engaged two radio media tours and 50 plus markets to talk
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specifically about resources available to veterans, including post-9/11 veterans, and to offer follow-up resources and ways to connect. taken in total, we are looking at one point do billion -- 1.2 billion impressions for our paid media websites, 3.3 billion website visits, 404 million video views and 94,000 resource engagements, which means the veterans are diving deeper into links and resources that are provided. representative: on our next panel, a witness is going to testify he is hearing from veterans who cannot gain access to get mental health or do not trust it. here is the claim, and i need to
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find out. some veterans experience waiting times up to 10 weeks. they are not being given the option to seek care in the community, despite being eligible for it under the mission act. we heard about that quite a bit. those are various charges that are going to be out there, that will come up in the next hearing. can i have your response to that now? i wish we could put both of them together. dr. matthews: this is by all means unacceptable. through v.a., we would certainly like to address any individual concerns of veterans. please share that information, i would be happy to work the gentleman on the next panel.
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we are in every way looking to increase availability, capacity of mental health services, of ndaa's that are in every way supportive of ensuring veterans that need and eligibility for community care also receive those services in the community. representative: what should they do? if they are seeking an appointment or are told they have a long wait time or are not given the opportunity for community care, how do they reach out? dr. matthews: they can work with their patient advocate at the facility, but if you know of individuals who need assistance, they can work with our office directly. representative: i hope all the members are listening to that, that we would use our offices as that springboard to get to you, if need be. i yield back. chair takano: thank you. i call upon representative
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brownlee, chair of our subcommittee, for five minutes. representative: thank you, mr. chairman, and thank you, panelists. my first question to dr. matthews -- you stated in your testimony that there is a 13% decrease in the number of women veterans who died by suicide. can you talk about what v.a. is doing specifically to address the unique mental health needs of women veterans? dr. matthews: thank you. this is of paramount importance, as we strongly value our women veterans. we offer a full continuum of gender-sensitive vent evidence-informed mental health services to meet women veterans needs through either their mental health providers, half of which are females themselves,
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but also through our women's mental health champions designated in every facility to support them. we are also concerned about reproductive mental health needs , so our patient program is white strong. we focus supports on eating disorders and other more specific disease states. we acknowledge the clinical complexity around women veterans, being that over 40% of women veterans actually have been diagnosed with at least one mental health condition. so, the need for this sort of targeted service is paramount. our training initiatives are quite strong. we are aware of increases in health training through the stair program. we will continue to expand and most importantly, recruit additional providers with a focus on women's mental health. representative: i think in the deborah sampson bill, there was a piece around making a pilot
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program a permanent program in the v.a. for a retreat setting for women deemed successful mental healthwise. is that happening? dr. matthews i will get back to you but we are committed to implementing the entirety. representative: thank you. dr. brenner, i was excited to hear about the research you and your team were doing on suicide prevention. what are the biggest challenges doing your research, and how can congress be supportive of your efforts? dr. brenner: i had the opportunity to do research in different settings and i appreciate the question, congresswoman, because v.a. is an amazing setting to do research income and part of that is because veterans are so
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willing to participate. for example, on your last question about women veterans, we know that not only do women veterans need services, but they may need services that meet their specific needs. they may have different preferences than other veterans that we may need to do things a different settings. one of our researchers, lindsay monteith, has been using how we use reproductive peers settings and bring suicide prevention into reproductive care settings where patients trust their provider, and mass those two things. i think it is continuing to have access to the resources that we have, some of it very specific to technology, but v.a. is a terrific place to do research. representative: great. this question is to dr. matthews and dr. brenner both. one of the things the gentleman
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from rye yan is going to be testifying about in the next panel, he talks about the need for more current data. and in the v.a., the data lacks by usually eight two-year period. what can the v.a. do to have more current data, so they are dealing with real data, timely data, in terms of responding to programmatic needs within the organization? >> i am happy to respond, director matthews. some challenges relate to the data we receive from cdc. the lag is outside our control in terms of that data. but one thing leadership has done is funding this assent project.
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it lets us collect data in more real time about factors that are pertinent to veterans who are living in perhaps rural areas, women veterans, veterans we have had trouble reaching in the past, so we can have real-time data about things that drive risk and thanks that are protected. not only can we do this in real time, but we can also change questions in real-time. just recently, we added questions about covid and the impact of covid on suicide, and that lets us respond more quickly to current crises. representative: thank you. i yield back.
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representative: the improve act establishes a program for at risk veterans and their families. i have spent time over the past several weeks talking to veterans in my district and elsewhere and can tell you veterans are struggling the failure in afghanistan has brought painful memories to the surface. i worry we will be grappling with that for a long time. that makes the improve act much more important than ever before. what actions are you taking to expedite implementation of the improve act, and how soon will v.a. be able to deliver rants through the improve act -- deliver grants through the improve act? dr. matthews: this level of care is critical. with the mission act, we were able to add a lot of
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efficiencies to how we move forward with that care in the committee. we want to ensure we have good quality oversight over a lot of this care, and we are making sure that we are appropriately and unfortunately administratively making sure veterans are not facing bills for this care when they are seen in emergency rooms around the country, and are getting paid directly for the claim or reimbursed fort. with our claims backlog in the past, there was a huge disservice to veterans. so, we want to mixer we do this right. we want to make sure the regulations are appropriately reflecting how these claims will be built. it is not really an issue about where they will be receiving the care, but more about how we can ensure it is being structured
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appropriately. there is the additional expansion which we are equally committed to. this expanded the eligibility of individuals, including those not enrolled in v.a.. we do not structure this appropriately in terms of the process of how this care can be coordinated. they might as well be built and that is equally unacceptable. so, we are quickly moving forward with those regulations with our partners in omb and look forward sometime in 2022 to have those regulations published. representative: what do you specifically need from congress? dr. matthews: at this point, we are moving forward at a steady clip. no further assistance needed. we appreciate the legislation
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none looking forward to implementing it. representative: how much time do i have left? chair takano: one minute: 45. -- one minutes, 45. representative: the task force did excellent life-saving work under the trump administration and part of that was a role outside of the v.a. where they were able to leverage end all of government approach to veteran suicide prevention. that is critical. preventing suicide, everyone can play a role, not just those in the v.a.. the ranking member and i wrote to the v.a. earlier to express concerns about events inside the v.a., allegedly because there was not [no audio] so, what effect has that move had on prevents?
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dr. matthews: i will defer to dr. miller, who is serving in an executive director rollout events. we are in a forward motion of achieving the goals on the roadmap our safety campaign is move forward steadily, as dr. miller averred to earlier. i see no pause in those efforts at all. dr. miller? dr. miller: 100 percent correct, dr. matthews. we are in the implementation phase of the firearm lethal means safety outreach, which is directly tied to end a reflection of recommendations one and eight integrated together. in fy 22, we will move forward with that and be expanding across at least three tracks addressing lethal means safety, a track specifically for
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veterans, one for family, loved ones and community members, and one for health care systems. we are working from an interagency perspective within the government, where lethal means safety is one of four primary goals and domains for interagency collaboration and coordination. representative: thank you. i am sure my time has passed. i yield back. chair takano: thank you. i recognize representative lamb for five minutes. representative: thank you, mr. chairman, and the panelists joining us. good news in 2019, my strong suspicion is that in 2020, the numbers may be tougher to take when they come in, given the type of year it was. we know with respect to drug overdoses in our country, it was the worst year ever. i am sure the veterans
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population was affected as well. i wanted to ask after matthews about the peer support -- ask dr. matthews about the peer support program and p are support specialists. somebody i work with works in that capacity, who received excellent care and treatment over a long time at the v.a. outside pittsburgh and is now able to give back to other veterans. i was hoping you could delineate how that program is operating every day, particularly participation of people who suffered mental health conditions, non-substance related and those that are substance related. are those types of veterans targeting their own kind, or is everybody working together? and is this a program you can see us growing over time? we are going to have a lot of veterans suffered from these
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condition. do you think it is promising to bring more veterans into the fold to help their peers along the way? dr. matthews: i will defer to dr. miller. dr. miller: one important area we are very excited to share in terms of peer support, and monster to above expanding peer support services come is the fact that this year, the veterans crisis line initiated a peer support outreach call center. and that was developed with the mission to provide support, hope, recovery-oriented services to veterans who are identified as being at high risk. they are calling the vcl, but from a beyond the call perspective, it is getting veterans who are peers support specialists reaching out to those vcl callers and offering follow-up contacts, follow
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through with regard to access to services. that initiated earlier this year. we are very excited about it, and getting great feedback from veteran vcl callers who appreciate this extension of peer support services. representative: it is great work and it provides a very concrete future for people going through recovery in the v.a. system. is there any formal evaluation or data collection or research being done on the program to help us understand? sometimes, we feel like we are throwing a lot of things at the wall on mental health, as we should. but would you say v.a. is evaluating this program as we go with and i toward extending it if that is warranted -- with an eye toward extending it if
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that is warranted? >> program evaluation is a critical component of every program we initiate within suicide prevention, within mental health as a whole. we have program evaluation tied to our yonder the call efforts within the vcl, which include the peer support outreach center and the caring contacts we have initiated to veterans. that is also a peer-to-p based format. great program evaluation built in, and we will expect a report upon sp 2.0 in the clinical and community domains, an important area to watch in light of your questions, together with veterans programs on the progress being made with that. because that is a peer-to-p
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eer based program. representative: thank you. i have seen it up close and that idea of looking out to the person -- looking out for the person to your left and right is promising. please share that data as they come in. i am sure the whole committee will be interested. we are always looking for places that have a lot of success. i yield back. chair takano: thank you for those questions. i have seen some of the results of this up close. i know we have had bipartisan legislation on the peer support specialists, and i am currently watching what is going on with this program. i want to encourage our republican members to also look. this is an area i think we can build consensus around and ramp up our workforce more quickly,
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or expand our workforce more quickly and to be more diverse, so we have a more relatable mental health workforce. that is one of the complaints i have hearing from veterans, but the diversity of our workforce. representative meeks, i recognize you. representative: last congress, the ranking member and i were proud to introduce the support for suicide prevention coordinators act and president trump signed it into law. it required an assessment of the responsibilities, workload and vacancy rates of v.a. suicide prevention coordinators. in many instances, suicide prevention coordinators reported being overworked and unable to keep up with their responsibilities. some medical centers didn't even have an spc on staff. the ranking member and i
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co-authored the access to suicide prevention coordinators act, which was signed by president trump as part of the commander john scott hammond veterans care improvement act. this legislation required v.a. to employ at least one spc at each v.a. medical facility across the country and required the v.a. to implement findings of the gao report on spc's. dr. matthews, can you update the committee on whether the v.a. has or is close to implementing the spc staffing requirements or the findings of the report? dr. matthews: yes, we are moving forward with not only interning staff -- internal staffing assessments, but also the broader explanation as described. representative: do we have an spc on-site at each medical facility in the country today?
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dr. miller: yes. out of 140 facilities, and the information we have available, we have 135 out of 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 am sure you calculated in your head, that are below 1.0 right now, and we continue to work with those five facilities as well as the facilities as a whole with spc staffing. representative: an april 2021 report from the gao found vha has not conducted a comprehensive evaluation of local suicide prevention teams, including assessment of any
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challenges teams face in implementing vha policies and the effects of program growth on workload. the report goes onto say that without an evaluation, vha does not have a good understanding of how its various activities and initiatives are affecting teams, including any effects on care teams provided to veterans who may be at risk of suicide. dr. miller, does vha plan to conduct a comprehensive evaluation of local suicide prevention teams to address the challenges they face? dr. miller: yes, sir. it is in the process. we have two brought initiatives in process in response. first, you mentioned it, section 506 is the hammond act. we are pursuing a formal explanation engaged with an
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external contractor, to assist in terms of the best alignment, national to local, with regard to spc's, to make sure they are fully supported administratively and clinically. we have also initiated a suicide prevention coordinator staffing model. the review is completed in a preliminary format. it is a productivity-based model similar to the caregiver staffing model. and that has been in motion as well. representative: i appreciate those updates. thank you. i yield back. chair takano: thank you. i now recognize the chair of our economic subcommittee for five minutes. representative: thank you.
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dr. matthews, i appreciate your testimony about steps the veterans crisis line is taking to meet the needs of veterans who might be struggling with recent events in afghanistan. can you describe resources dcl collected from other agencies and disseminated to the call center staff? dr. matthews: i'm sorry, you broke up. i think you were asking about information collected by the dcl from other agencies? representative: that is correct. dr. matthews: i will defer to matt on some details, but, where the vcl not only is quite proactive in they can sure we are appropriately staffed through all shifts 24/7, that we are disseminating resources not only from other agencies like samsa and vha, but also the american red cross and resources
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like our national center. those resources are being disseminated throughout staff and critically, we need to recognize we are providing significant support for the staff themselves, many of whom are veterans, many of whom are feeling what we call vicarious trauma of working with others in these touching moments. matt? dr. miller: you covered it very nicely, dr. matthews. my summary would be, dr. lisa kearney in vcl has responded rapidly in at least five key areas in response to the afghanistan situation. number one, partnering with vhs. number two, dissemination of resources internally and externally through the federal working government groups.
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number three, identifying supports for vcl staff as they were engaged in their frontline work. number four, appropriate preparation for increased volume, adjusting capacity vis-a-vis demand. and finally, enhanced data monitoring which allowed us to quickly better understand what we were seeing in terms of demand. for example -- representative: let me get to my other questions, dr. miller, but i appreciate that response. perhaps my next question will allow you to continue your answer. i understand you have seen a surge in call, chat and texting the last couple of weeks. i am curious about calls related to events in afghanistan and secondly, while vcl is a vital resource to veterans in crisis, we have to work to connect with
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and support veterans before they reach that point. this month, i left colleagues a bipartisan letter to encourage the v.a. to develop a comprehensive veterans outreach plan. what is the v.a. doing to contact these veterans, especially those who served in afghanistan, and connect them local resources? dr. miller: you asked about themes and trends we are seeing within the dcl. because of the data monitoring and changes put in place, we can see that about 2% of the total incoming demand for the vcl during this time has been directly attributable to afghanistan, as stated by the responder who is working the situation. 5%-6% of the time on average,
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afghanistan is noted within the documentation, but is not necessarily cited as the primary reason for calling. so, 2%, five percent, important to understand contextually in light of the 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 play, which is a partnership between suicide prevention and prevent. we have been hitting radio media heavily this month to talk about the reach out campaign, to direct individuals, and that events direct resources including local resources based upon zip code. representative: dr. miller, i
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appreciate that and everything you aren't doing and encourage you to the in your outreach to our veterans as they are going through these challenges. thank you. thank you dr. matthews as well. i yield back. representative: -- chair takano: thank you. i recognize dr. murphy for five minutes. representative: thank you, and thank you the guests especially today for testifying. as a practicing physician of 30 years, i am terribly alarmed at the continued high rate of suicide that affects our veterans. i recently received the latest dod statistics on suicides for the active component, the reserve component and national guard for calendar 2020. they are alarming. i think this committee knows that. suicide rates are up in all these areas. i request we enter this into the
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record. as we know studies have shown posttraumatic stress disorder could play a major factor in veteran deaths by suicide. a 2015 study showed as many as 500,000 veterans who fought in i raq and afghanistan were diagnosed with ptsd. as many as 850,000 have returned with ptsd or injuries. although these service might have survived battle, often they do not survive from their own injuries, and tragically take their own lives. even veterans who do not fall victim to their own combat wounds must still cope with reliving their injuries from service abroad. this oftentimes has a tremendous destructive effect on relationships with spouses, children, family, friends and coworkers. unfortunately we are faced with
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the regrettable reality that there is no cure in the government's arsenal for ptsd or tbi, which needs to be expanded to include therapy. as a physician, i have found successful treatments were no other treatment resulted in good results, and suffering from combat wounds and debilitating symptoms on the impact of ieds on the brain. it is conducted in a pressurized chamber while breathing pure oxygen. their blood levels for oxygen deliver greater levels to heal vital organs including the brain. i have used hyperbaric oxygen therapy for 30 years for the treatment of wounds, and i believe these wounds to the brain are something worthy of
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investigating hyperbaric oxygen therapy. a double-blind study confirmed the effectiveness of treating ptsd and tbi. the majority of combat veterans who have used this therapy have helped restore their executive function and well-being. most important, the return of hope that they have lost that is responsible for the elimination of suicidal ideation. i'm not saying this will help everyone, but research shows it does help a statistically significant population. our veterans who have valiantly served our country sacrificed so much, deserve every remedy possible to reduce the suffering caused by combat. i believe every veteran if needed should be afforded the opportunity to get hyperbaric
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oxygen therapy to them. i introduced the injury act, if passed, my legislation will go to the secretary of the v.a. to create a program for veterans suffering from ptsd. i encourage committee members to become a cosponsor on this important legislation. it is already bipartisan, and we are working with senator tuberville. he introduced similar legislation in the senate. while i serve in the house of representatives, i provide this therapy also for folks in north carolina. the third district has 89,000 veterans, and i am working to make this potentially life-saving therapy available to all veterans. it is congress's duty to restore hope for each and every war fighter so we can start to see a
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rivers trend of these suicides. the background references on this, i would ask the chairman to place this into the record. chair takano: without objection, so ordered. representative: i would just ask one question to our committee members, where do they think -- what is their opinion, what do they believe is available to our veterans? chair takano: i will allow 30 seconds. >> i'm not sure if we can speak to research in this area. we do have partnerships we have been exploring. >> i have been involved in research in this area. we continue to want to provide the best care with the best evidence. i think we do have evidence-based therapy for ptsd.
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and then use the best science to explore new interventions. the findings so far are mixed. we are working diligently to provide this to veterans and explore different ways it may be used as part of a whole toolbox. chair takano: thank you, dr. murphy. representative: thank you for recognizing me. thank you to 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 is interesting to hear about the latest legislative efforts, how those are helping move us in the right direction.
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we know barriers continue to exist to access services. i want to zero in on one group that experiences barriers to get the help they need, and the support they have earned through their service, and that is that lgbtq+ community. monday marks 10 years since the don't ask don't tell policy was repealed. estimates say more than 13,000 service members were discharged under this policy many receiving dishonorable discharges or entry-level separations. it is clear across the board those who are connected to services, support, care at the v.a. have lower risk for suicide. as we continue with the legacy of don't ask don't tell, i wonder if you can offer comments on the directive issued by the v.a. monday which seeks to
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remove this barrier under statistics i have seen about lgtbq+ veterans, people who were not able to serve in the military, experiencing suicide at a much higher rate, 15% of all lgtbq+ attempt suicide according to one study, compared to 1% of the entire veteran population. i have legislation i introduced on this topic which reflects the priorities that were outlined in the directive, but i wonder if you can reflect on the experience of this group, what the v.a. needs to do to make sure we are removing barriers, and whether legislation will be needed to help support the direction the administration wants to move in. >> i'm so glad for this question, because you are hitting the nail on the head as far as a targeted population we
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need to bring attention to. our directive was speaking to empathize our current benefits policy, that this exclusion is unacceptable. we are charging our adjudicators to ensure any separation due to sexual orientation or hiv status are classified as eligible. that is affirming our policy. we are implementing a second look policy so we can ensure any veterans that might not have been provided benefits are having actions reconsidered. there is increased oversight and guidance. we agree with ensuring all of our lgtbq+ veterans are receiving the services they need. we are also moving forward with gender affirming surgery as a benefit. it was excluded. we are actively looking to ensure this population of
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veterans receives the services that they need. representative: will you commit to working with my subcommittee, my office on legislation that will be needed to make permanent the expanded access to benefits and services for lgtbq+ veterans. in the remaining time i have, i want to ask about v.a. police. this has been an issue this committee has looked at. the compact act required training for v.a. police to ensure appropriate response to incidents at hospitals involving those in crisis. v.a. police are often first on the scene during one of these incidents. i understand each facility's police force has a refresher training, and this curriculum will be developed in partnership with law enforcement training organizations.
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i wonder if you can tell us how far along the va hospital police forces are in implementing this requirement? dr. matthews: this is so important, and all v.a. police officers receive suicide training. initiation is a requirement of the training, but annually thereafter. this is affirming for us, and we are recommitting and trying to establish community partnerships so even a local contingent can ensure our crisis intervention concepts are further engaged. this is about partnership, training, comfort level. it has been a bit slower with the partnership due to covid restrictions. that has been the case, but that does not take away from the fact this training is in place and we are reiterating it every moment. representative: maybe we can
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connect about the implementation and moving forward. i yield back. chair takano: thank you. i now recognize representative miller-meeks. rep. miller-meeks: i know all of us were thrilled to learn 399 fewer veterans died by suicide in 2019 compared to 2018. that was much needed progress after many years of stagnation. how can that be replicated moving forward? you also have data and information on what conflict and the age range for the majority of suicide or suicide attempts that occurred.
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dr. matthews: i'm going to defer to dr. miller. i do not want to speculate on causes. dr. miller: as we have mentioned , the 2019 data reflects unprecedented levels of progress . that is within the context of the critical number zero versus one. one is too high. with that in mind, what we learned thus far from the data is 2019 represented the full start 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 --
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which was designed to focus on five target areas where we believe if we remain as a team across the v.a. significant meaningful changes, we would lower the suicide rate by 7%. that is exactly what we saw occur. i think it is an affirmation of the public health approach that espouses the importance of data following good data, and building strategies, policies and intervention 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 the highest count for suicide in veterans occurs in the age group 55 and older. we know the highest rate occurs
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in individuals aged 18-34. in both age groups, white males the predominant highest risk, and firearms are the most significantly employed lethal means. therefore that is where our firearm lethal means safety campaign comes in that is addressing both age groups and demographics within the campaign. rep. miller-meeks: i am a 24 year military veteran. the withdrawal from afghanistan has been problematic and led to mental health issues. dr. matthews, the wounded warrior project, testify about the availability of substance
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abuse, mental health treatment, and how it appears the v.a. does not combine these treatments or have a comorbidity treatment plan. what can the v.a. do to provide greater access to these programs? if you could be brief, i would appreciate it. dr. matthews: i will defer to dr. miller again. rep. miller-meeks: what could the v.a. learn from this? >> with operation resiliency, i have personally -- i have seen firsthand the impact it has on the overall population. chair takano: you will testify
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to the second panel. rep. miller-meeks: i yield back my time. chair takano: thank you. i now recognize the chair of our technology subcommittee. representative: thank you. as chairman of the subcommittee on technology, i am eager to use this hearing to gain a better understanding of the ways in which the electronic record monitor program can improve the v.a. suicide prevention efforts. do you believe the program will prevent suicides among patients,
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and additionally we talked about the function of the notification plan, and the challenge is to get them working properly. i have appreciated your forthrightness in those conversations. what is the current status of suicide, and can you ensure me they are fully functional and all appropriate personnel can see them? dr. matthews: thank you for the question, it is a critical connection, but our ability as care teams to prevent suicide is not hinging on electronic medical records. those tools are quite critical, they are in place. there were some initial glitches in the programming that has been clarified and cleaned up. the suicide prevention
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coordinator has been more fully defined to have access to different parts of the record. that has been clarified. it is a critical tool but the true action taken is through our care team. the staff there caught these issues, and allowed us to make the improvements needed. i have security and the fact we will be able to continue with the work we do with the care teams. representative: dr. miller, the 2008 national strategy for preventing suicide contain the important insight that not all veterans are at the same risk. are these specific resources available to women veterans,
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including during the claims process? if so, what are these interventions, and have they been effective? >> you are on mute. dr. miller: it was with regard to the 2018 national report you mentioned, and it was specific to what population? representative: are there specific resources available to women veterans including during the claims process? what are these interventions, and have they been effective? dr. miller: yes, there are specific interventions and programs available for women
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veterans, particularly women veterans who have experienced or are engaged in the mst evaluation process. i believe you are seeing from our 2019 data solid indications that the programming that has been engaged by the v.a. for women veterans is heading in a positive direction, and that is indicated by the 13% reduction in women veterans suicide rates in 2019. that took it to a level it has not been back since 2002. >> can i jump in? i want to highlight we have talked a lot about population and context. we are beginning to understand
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the context of these women's lives, many have experienced personal violence. how do we create treatment settings, resources, materials that will fit for them so they can benefit? chair takano: i recognize representative rosendale. rep. rosendale: thank you for participating in this important issue. i attended a veterans suicide prevention program about a week ago in bozeman, montana. it included a presentation from the overwatch project that
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featured a bunch of online resources where we as the general public could access that, veterans could access that so we can do our part supporting veterans. and they can help each other as well. while i recognize this is a real problem, the access to firearms and the amount of times 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 is a 10 minute period from one they decide to take their life and actually do it. if we can get time and distance between them and their firearms, that will be a good thing. i also recognize restrictions on veterans firearms who sought
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help would be very counterproductive and unacceptable to many members of this committee. 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. i want 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. dr. miller: there are two really important words to ensure i'm communicating with distinction between and where we land with regard to firearms and lethal means safety. the two words are "restriction" and "safety." we are not during any campaign or messaging towards
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restriction. we are gearing our messaging and campaign for safety. safety, in this context, is defined exactly as you said, 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. that is why you will 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. you are 100% correct that 60 minute window is critically important, and within that 60 minute window 10-20 minutes can
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be lifesaving. that is our recommendation and point of emphasis. rep. rosendale: i appreciate that, that makes me feel more comfortable. i cannot stress enough the mandated restrictions, or control of veterans firearms would be very problematic. dr. matthews, the crisis in afghanistan has led to a significant increase of the veterans crisis line over the last month. how can we adapt to those to ensure the veterans are well improperly served? dr. matthews: great question. to reiterate, we are definitely assuring that our staff has appropriate resources about the withdrawal, knowing how to interact with veterans. we make sure the staff is supported through wellness programs.
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we are anticipating increased volume, making sure we are appropriately staffing and have backup plans to take care of that volume. every call must be answered, and every call, text message or check must receive the attention it needs. we are monitoring appropriately so we can make sure we can continue. we are really providing that support. rep. rosendale: thank you so much. i yield back. chair takano: thank you mr. rosendale. i appreciate the responsible comments and understanding of the time and space campaign by the v.a. i appreciate what we can come together on for this sensitive topic.
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i want to express my appreciation for that. i want to recognize representative sablan. rep. sablan: thank you for holding this important hearing on suicide prevention. chairman takano, it is so good to be here in d.c. and join all of you. we usually bring up the comments of the veterans administration, i want to bring up a happy story with a happy ending. there was a soldier who grew up across the street from our
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family home, and who got out of the service in 2011. 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 a pretty broken man. last week he came home to retire , and he came to visit me. i was so happy with who i was talking to face to face. many issues he went through, and having to recover. the fact it took him several years to come home because he cannot get the services he needs at home. this is a soldier with purple
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hearts, a bronze star with valor , highly decorated infantrymen. dr. matthews, since veterans do not have the same access across the nation, i would like to know whether veterans in the northern marianas islands are benefiting? dr. matthews: unfortunately i cannot speak to that, i can take it for the record to get you specific information. they do have access to the vcl, and can readily use a lot of our online resources as well as chat functions if indeed that is necessary. unless, dr. miller, you have specific data around the marianas islands.
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dr. miller: i will add the focus of our governors challenge for this upcoming fiscal year is u.s. territories, and we are looking forward to the opportunity to learn ways we can improve access to services for veterans and u.s. territories, and further the suicide prevention mission in those areas. looking forward to that in 2022, sir. rep. sablan: maybe this is something you can look at without breaching confidentiality. can you also look at how many veterans in the northern marianas who you have offered support by the suicide prevention 2.0 initiative?
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what is the v.a. doing to make sure veterans are aware of the programs, and how this congressional office could help? i look forward to you looking at those and providing us with the information. dr. matthews, you stated in your testimony that most veterans who died by suicide are not receiving v.a. health at the time of their death. as i mentioned, there are any number of veterans, v.a. health care programs and services that are not available in the marianas. coming from a population of 55,000, one death is a death in the community by suicide really makes a profound impact. i know that we have had two
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deaths by suicide. if you can provide that with the same care available as the most of the united states. finally, in february of this year my office was briefed on hiring a primary care doctor [indiscernible] right now we finally, after years, we have a licensed social worker. i would like to know if this social worker could get up primary care provider to serve veterans on these islands as
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well. dr. matthews: i will get information back about that social worker. i am not familiar with the interaction they are having, but we can take that up. rep. sablan: thank you, my time has expired. >> i think there is a new, exciting program we are getting started, trying to understand individuals living in different parts, in the territories, to understand how we can better provide care to pacific islanders, asian american veterans, understanding the context in which they live. we will do key informed interviews, looking at different data so we can do better to understand individual drivers, contextual drivers that contribute to risk in your community. i hope you stay tuned for this new, important program we are just getting underway. rep. sablan: right.
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thank you, again. you do some really wonderful work. this soldier who returned home to retire, helping him get all of his records. chairman, i am way over time. chair takano: yes, you are. in the mental health passage, i will include a bill to get the marianas a vet doctor. rep. sablan: thank you, chairman for your support. representative: thank you, mr. chairman, pleasure to be here. especially for this important topic. i do not intend to use five
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minutes, but i would like to make a comment is a 20 year navy veteran, you end of the har the 911 for veterans everywhere. you have a thankless, stressful and difficult job to deal with the end result of how veterans handle their time in the military. for every veteran, whether they see combat or not, any deployments, they come back a little different. you are on the receiving end of that, and i would like to thank you for your hard work, and those on the veterans care line -- that is like a dispatcher for police departments. i hope those folks are adequately taking care of with that stressful job. we have the most well-trained military on the planet, and from the time you take your oath and are inducted in the military, you are trained and everything from how to fold a t-shirt to how to eat to how to fire your weapon.
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when we take people in, we are asking the best of us, the people who walk the old ladies across the street to do the worst thing a human can do, deliver ordinance on target, usually resulting in the loss of lives. that is a stressful thing, and every veteran deals with it differently. no matter how long you serve, the transition to being a veteran is nonexistent. the military does a great job training us to do everything we need to do, and then we have a two day transition, and they say, thank you for your service. that door over there is the v.a., go find it. that is a daunting task for someone for whom the military has been their family for so long. we have the best trained military on the planet, but the transition from servicemember to veteran does not exist.
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i would like to see greater collaboration in the future on health checkups, mental, psychological so they have every tool in their toolkit to break the transition to a life that is foreign to them, civilian life. i appreciate everything you do. it is a privilege to be here. chair takano: thank you for that, representative ellzey. i invite you to look at the bills we have included in the package. they address many things you just talked about. i welcome the minority to continue to contribute. the suicide prevention bill we will put forward. thank you very much.
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i do not disagree with anything you said in regards to the transition, ways we can improve it. there is tremendous bipartisan cooperation in terms of the topics you addressed. thank you. representative underwood, i recognize you for five minutes. rep. underwood: i join my colleagues and americans across the country grieving the deaths of u.s. service members killed in the august 26 terror attack in kabul. the v.a. responded quickly for mental health and crisis resources. i urge the department to continue to take every available step to assure veterans suffering from mental health conditions have access to the care and support they need. there have been reports of outreach on the veterans crisis line, including a 98% increase,
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and text messages to the hotline between august 14-29. the v.a. must continue to expand evidence-based factors to prevent veterans suicide, including lethal means safety training. given the proven effectiveness of lethal means safety training and reducing suicide rates, the v.a. requires all vha providers to take the lethal means safety training. compliance is already above 90% among newly mandated vha providers. however, the lethal means safety training course remains optional for other v.a. 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 anyone who regularly interacts with veterans and their work is prepared to have a conversation
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-- a conversation -- that can save a veterans life. dr. miller, in response to a letter i sent to secretary mcdonough and february, v.a. staff noted 30 community providers have completed the optional lethal means safety courses as of october, 2020. 30 providers across the country, unacceptable. the secretary further stated without a national mandate or incentive for non-v.a. community providers to take this course, the v.a. will likely continue face notable challenges advancing the mission of increasing the competency of the community, and community-based health care providers to better identify, intervene and treat veterans at risk of suicide. during the committee hearing with secretary mcdonough in march, i asked about opportunities we can pin on existing authorities to further expand lethal means safety training. i was encouraged by his
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commitment to looking at this critical issue. dr. miller, my question is, can you provide an update on any steps the v.a. has taken in the last six months, or other actions planned to expand lethal means safety training for v.a. staff, community providers and caregivers? dr. miller: thank you for being prompt on this important issue. we share the perspective that this is critically important for suicide prevention as a whole. it 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 for fy22, which
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includes training for community care providers who are working with veterans. rep. underwood: you set a goal, what does that mean? dr. miller: it means we have put in writing that it is officially an agency goal to increase and enhance training, not just for v.a. and vha providers and teams, but for community care providers as well. the first step of that is to take a look at ways 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 a preferred
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provider within the network for veterans based upon their increased awareness and acumen with lethal means safety. rep. underwood: is this the only criteria to obtain preferred provider status? dr. miller: this is the only criteria i am aware of, i am in the discussions with regards to legal means safety. i do not know if there are discussions outside of lethal means safety training and applied preferred provider. rep. underwood: do you know if this goal and the requirements will be complete by september 30 ? dr. miller: they would be complete by the conclusion of fy22, next september. rep. underwood: if you could get back to the committee in my office about the current status of this goal setting process and the preferred provider program,
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i think this is a little askew from the mandate we are looking forward to ensure any provider who is regularly interacting with a veteran weather in the community or within the v.a. is prepared to have a life-saving conversation. thank you to all the witnesses for your time. i yield back. chair takano: thank you representative underwood. you are always well prepared for a hearing. representative allred, you are recognized. rep. allred: thank you everyone for your testimony, and the researchers for sharing your research. preventing suicide and sharing access to mental health is one of our top goals. we are committed on this committee to working with you all to do that. i want to ask about the use of mdma and psychedelic drugs to
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combat pts. and where the v.a. is in terms of studying this. there was a recent "new york times" article discussing a study of 90 people who seem to show pretty good results from this. in my conversations with some of my constituents, veterans, some of them have sought this treatment out, even outside of the country. some found it to be effective for them. someone asked if this is something the v.a. is looking into, and if we do not, if we are considering it. >> happy to respond. we are also watching very closely both clinicians, researchers. we have researchers connected to
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the v.a. working on these projects with their affiliates. we are tracking closely. there are trials underway as you highlighted, and we are anticipating the results from those well-designed trials. once we are able to see those results, we will be able to think about the next steps, but along with you we will watch closely. rep. allred: would you need additional authorizations from congress to do that, or could those studies be done on your own? >> this is a complicated issue. i will take it for the record, but we are watching closely, and we will get back with you when we find out the results of the trial. rep. allred: generally the
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approach is to see how the outside trials function. i know one of your missions is research, and we do some of the best research in the world in the v.a. in this case, see how the outside trials, what the results are, and proceed from there? >> yes, that is correct. the trials, i am happy to say, are well-designed. we will use that resource to guide the next steps. rep. allred: these early trials could really be a breakthrough. i hope we continue to pursue that. if my office can help, please let us know. i want to return to dr. matthews
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and your testimony. the study -- do you have any indicators? dr. matthews: sir, i'm not familiar of any information we have as of yet. purely conjecture, everything that comes along with the pandemic including the risk factors of how the veterans. covid in the first place -- got covid in the first place are indicative of causing an increasing mental health concerns. we need to get back to you on any evidence. i am speculating at this point. unless, dr. miller, you know something more, but i have not
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seen any evidence as to the reasons why. dr. miller: there was a public study three or four weeks ago specific to the veteran population and covid. it found overall suicide behavior 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. rep. allred: thank you. since you find this is an ongoing problem, we should tie covid testing and diagnosis to our mental health
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resources immediately. dr. miller: we are doing that. the diagnosis and high-risk flags come together, and outreach kicks in immediately through local facilities. rep. allred: thank you for the work you do. i yield back. chair takano: thank you, representative allred. representative: thank you, chairman takano for this hearing today. my office focuses heavily on addiction and mental health, so this discussion today is meaningful and appreciated. last monday, i toured maryland's sixth district with secretary mcdonough, and we stopped by gaithersburg and had a
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roundtable discussion on mental health, suicide, and substance use disorder. during the roundtable, the d.c. v.a. mental health experts shared with us what she tells the patient that is skeptical about asking for help. she says, you are doing something wise, not weak. i think that is meaningful because mental health stigma still exists so much in our community, especially with our vets. we are lucky to have folks like that dr.. the committee recently passed a bill providing $18 billion for human infrastructure, more importantly, $375 million in residency slots which will help the v.a. train and retain excellent mental health officials. to better understand the
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population of veterans seeking health care, dr. matthews, if you could for a second compare the population of veterans seeking mental health today versus our vets 10 years ago. what is different, the availability of services? talk about that and the acuity of conditions. dr. matthews: 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 important a screen and evaluate. dr. miller: we have a significant difference 10 years ago to now with regards to access. we now are able to offer same-day access to mental health care, as well as primary care at
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every local v.a. facility. when we were discussing the question of what should a veteran asked for, have them get on the phone and call their local facility, and say, i am 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. they should have an s.o.p. and an answer for that, and if they do not, we want to be the first to know that has occurred. you are also going to see increased access to the veterans crisis line. 10 years ago versus now you will see texts and check, and we were phone based before. you will see "press 7" on the phone to any forward facing vha number. that was not in place with the veterans crisis line prior. finally, you will see increased access options that are not just
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limited to geographic related variables. for example, if i am interested in evidence-based treatment for suicide prevention, but i am in saginaw, michigan, and the second on v.a. is not able to provide that -- the saginaw v.a. is not able to provide that, i can receive those services through my phone, or my computer. i think those are notable examples. >> the v.a. has taken on the largest in the u.s., and the largest known universal screening program in health care system for suicide risk. we have been able to screen millions of veterans for suicide, and doing this in a universal manner decreases stigma. also identifying individuals who may not be prepared to talk
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about it. this new practice we have been rolling out, studying it, and looking at outcomes. i have been on several calls with other agencies and health care systems, and this is being seen as something that could be adopted by other systems. i think that is a completely different way of doing business. chair takano: mr. trone, your time has expired. rep. trone: i yield back. rep. kaptur: thank you, mr. chairman.
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i want to thank those dedicating their lives to health care for our veterans. thank you so much. as we can tell today, we are very concerned about the brain conditions, that onset during or as a result of military service. i was happy to hear about -- we need to understand who is coming into the military with conditions that were created before they came to the military. we know pts onsets faster for those who have experienced reenlistment violence. -- pre-enlistment violence. one of my goals is to improve the number of health care providers, doctors and nurses, who specialize in the psychiatric arena.
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that is a long battle but one i would welcome all of your recommendations for. i am interested in proving as well the diagnostic capability to identify brain related functions, particularly through high-frequency imaging to pinpoint where underlying conditions present. maybe we would have markers in biochemical interactions in a nervous system of brain function where we could predict better what can happen. to that end, i want to mention to you, i have worked with the committee for a number of years to work with the ohio national guard and western university in ohio for our enlistees to
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provide dna samples, particularly to understand why some people get pts and others do not. i will inform you of the results of that study, and that all of the dna samples are now located at the veterans education and research association of michigan, at the university of michigan. i believe it has not been fully probed, and more research can be done. we have spent millions of dollars along with the ohio guard to understand conditions. i want to let you know those exist. i think we should continue the science. the v.a. budget is smaller than the department of defense or energy.
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in terms of developing a research protocol for high-frequency imaging, and for the careful assessment of biochemical imbalances in the central nervous system that result in mood disorders. i am one member trying to help, but i think we can make scientific progress in our lifetime because of computing now. i would love to talk to you more along with my colleagues about research protocols we could work across government on that might be able to move us into the era or we could understand so much better how to treat and diagnose these conditions. there is a lot we could do together. if you want to give any reaction, you can. as others have stated, we are so grateful for your
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>> if there is no response, thank you representative kaptur. >> thank you, mr. chairman. and i hope that those who didn't have any reaction, i hope that we might have further conversation on how to move additional research forward of understanding how certain concussions and brain conditions so we are not just treating symptoms, the pre-markers that
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exists in the brain. >> i am excited to hear more. i want you to know that. i hear you and i am with you. >> thank you, miss brener. we have a project that is sequencing the genome with hundreds of thousands of samples. i see that we have mr. cochran, you are recognized for five minutes. >> i am pretty sure all of this -- us on this committee know
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that we are losing more and more veterans every day. when you are doing that push-up challenge, it is easy to say i did my 30 and move on. when you really sit down to think about it, these heroes who wear bulletproof vests and go fight for our freedoms abroad and make sure no attacks have been -- have been committing suicide once they come home. the idea they are a higher chance of dying once they come home then in active battle situations, it really hits home. it makes you feel that our country is failing them. that our v-8 has an abject failure to allow this to go unanswered. i do have some questions for our
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esteemed panel here. what is the fact that this catastrophic afghanistan withdrawal has had? >> we are limiting the questions. >> my apologies, sir. >> thank you, chairman. veterans' ability to access affordable mental health care, my bill is part of the act to free up out-of-pocket costs for native veterans. native veterans served -- have a disproportionate rate of ptsd and suicide rates.
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as such, can you share what native aid is in this provision and what is the timeline? >> the bill is drafted and is in the concurrence conversation now. there were some nuances about the definition of urban indian, because that is not necessarily a term. we have been working with indian health service is as well as other travel organizations. -- to get language correct to make sure we are referring to that right population. it unfortunately is probably not going to make mid-january timeline until the 2022 calendar
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year but it is moving forward. >> especially on the definition of urban indian, we would love to be held on that. i worked with you i owe salade, and i would like to make sure this is fully implemented. there was a letter sent that made several critical errors in the health of a mental health patient. we want to make sure that veterans are not falling through the cracks nationwide. the v-8 scented wordprocessing design is suicide prevention side pilot program, to prevent errors before they occur and can you share any update on that pilot program? this is open to anybody in the v.a.. >> i'm happy to say that the highlight of the program is in
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motion. we have the first visit selected for engagement of the site in the process, and we will be engaging the actual site within the next 30 to 45 days. the citizen leadership has concurred with the process and are looking forward to participating. it will be within 2022, which includes [indiscernible] >> keeping veteran safely houses one of the surest ways to prevent uttering suicide. -- veteran suicide. we know anecdotally how hard it has been on a veterans. does the v.a. have an updated data on how the pandemic has
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impacted veteran homelessness and suicide rates? >> this is really getting to an important point about the connection of these risk factors, risk for homelessness, homelessness prevention is suicide prevention. i unfortunately don't have data. that hasn't necessarily been updated. thanks to your support, we have been provided significant funding to our grant for housing to keep our veterans and save and more motels and hotels over the last year or so during the pandemic, that is much safer than that shelter or congregate setting. we will continue to promote with our grantees so they are looking
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for risk factors and connecting veterans back to care and being partners in that prevention strategy. those are changes and updates with the support of this body that we have been able to provide during this pandemic. >> for the record, do we have any data on how housing efforts are helping lower the suicide rate, or how the money is being spent anecdotally so far? >> just the impact. >> i yield back. >> thank you mr. gallegos for your absolutely amazing questions. the questioning of the first panel is now complete. i will now move on to our second panel.
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doctors matthew, miller, and brendan, you are welcome to listen to that testimony. i will now call up our second panel. the first person i want to introduce is the deputy legislative director of [indiscernible] , the governors affairs associate of the afghanistan veterans affairs of america, chief bill smith, mr. nick armendariz, an army veteran, and dr. aziz, codirector of a
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government policy institute and eight behavioral scientist. -- i will remind our with -- witnesses to pause -- >> chairman and members of the committee, on behalf of the men and women of the armed services, thank you for recognizing how the vfw is spreading awareness on suicide prevention. an upstream perspective is important. mental health is at a breaking point. the social and ecological model brings together individuals, family, friends and communities to create connectedness and coping skills, and address
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social determinants of health. one of the vfw's most prominent resolutions is to end veteran suicide. the vfw has multiple outreach opportunities, such as our has htag campaign. i will take this time to highlight of view. whether it is in response to a worldwide pandemic or natural disaster, we are still serving the community by opening contactless drive-through pantries, using technology to connect or rallying with other veteran organizations. thereby strengthening mental well-being and staying engaged. as the world watched u.s. troops withdraw from afghanistan, the collapse of the afghan government to tell a bedroll, some veterans questioned work they had done during their deployment. several vfw posts channeled this
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energy and urged veterans to check in with each other. vfw post 2974 in northern virginia collected 5000 items of clothing, shoes, and hygiene products and raised over $7,000 to donate to local nonprofit organizations assisting afghan refugees. the post also collaborated with the georgetown university citizen association v.a., and youth relief foundation to celebrate patriots' day. from the national level to the post level, the vfw does more for veterans to include supporting prevention. a vfw post in cheyenne, wyoming raises funds to study poppy donation. a local nonprofit providing
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suicide education did -- the vfw urges congress to expand eligibility doing clued -- to include veteran education assistance. we must also provide an increase . earlier this month, the vfw publishes 2020 one suicide prevention report. this report acknowledged progress, but the vfw remains concerned we do not have a complete picture on how this change occurred. we believe that vba has access to information to inform the decision-making and progress on the disability conversation, the g.i. bill, which are facets of critical social determinants of health. this data should be cross-referenced with it already in bha and now the national
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association to reduce suicide prevention report. the v.a. has either chosen not to elevated or does not want to share it. if the vs is serious about preventing suicide, we must demand a more thorough evaluation of v.a. programs. this is why the vfw calls on congress to direct the v.a. to include relevant data items are report for all programs. eliminating suicide among our nation's veterans will continue to be a top priority for the vfw. veteran suicide prevention awareness is not just a congressional or veteran organization issue, it is an everyone issue. this concludes my testimony, i am prepared to answer any questions you are the committee may have paid -- for the committee may have paid -- or
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the committee may have. >> i now recognize ms. hetrick. >> chairman to conneaut, and distinguished members of the committee, on behalf of our members i would like to thank you for the opportunity to testify on one of iba's top priorities. until health and suicide prevention. september 11, 2021 marked 20 years since the start of the war on terror. nor that created an entire new generation of veterans. before this anniversary, president biden announced american troops would withdraw by august of 2021, following a previous commitment by president trump. this effectively ended the two decade war. in august, we watch of the taliban quickly made their way throughout afghanistan and seized control.
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many veterans watched as their former bases were taken over by the animate, as they -- enemy, as they felt anger, sadness, and despair fill the hearts of our veterans and service members. this change the way that they viewed the world. iba regularly services -- surveys members to ask what needs to be improved upon by veterans. our most recent survey opened on september 8, just a week after the official withdrawal from afghanistan. preliminary data from our survey shows that only 52% of our members feel our engagement in afghanistan was where that, a 10% decrease from how they felt in 2020. the preliminary data shows that although 63% agreed with the need with draw troops, only 2020 -- 20% --and 86% agreed more
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should have been done towards the evacuation of afghan allies towards the withdrawal. the circumstances over the last month of half have had a lasting effect. a concierge helping veterans navigate and often complex roadmap to services saw an 80% increase in mental health august 16 to the 31st of 2021, the v.a. must continue to push out messages of support and available mental health resources for during this challenging time, both within and outside the v.a. arpa luminary data shows that 43% of survey participants have considered taking their life following joining the military, and only 10% considered it before. 2% said they personally know
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someone who has died by suicide. 25% stated they are not seeking help for mental health. when it comes to top reasons that our members are not seeking care, they said the negative stigma around mental health is too great, a common issue heard from both active duty and veterans. the issue of domestic violence has long been ignored when it comes to separation. a recent article following an investigation by cbs found 100,000 incidents of investigation have been reported to the military in 2015. incidents of spousal abuse on the military were more than twice that of the national population. iba's preliminary survey data shows that 51% feel that domestic violence is a serious issue within the military, and approximately 32% are uninsured. this is a testament to the severe lack of attention that domestic violence receives.
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our survey also showed that approximately 38% have experienced domestic violence and experienced it within the military and after they separated. it is well-known that increased stress exacerbates instances of domestic violence, and the last year and a half has been extremely stressful for the veteran community. even with this increased stress, messaging around domestic violence and intimate partner violence from the v.a. and dod has been almost nonexistent. veterans continue to be some of the most resilient members of our nation, but despite our abilities to adapt and overcome, the weight of the pandemic, the feelings of our military's withdrawal from afghanistan and many other situations have been brought to bear. we must do everything we can to help veterans through this difficult time. members of the committee, i thank you for the opportunity to share ideas on these issues and look forward to answering any questions at working with the committee in the future. >> thank you, i appreciate
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hearing from iba because you serve the cohort of veterans have served in afghanistan. miss silva, i recognize you for five minutes for your testimony. >> thank you members of the house committee on veterans affairs, thank you for inviting wounded warrior project testify on veteran suicide prevention. suicide prevention is essential part of our mission to honor wounded warriors. ed comes as an intervention during crisis, but most often as an interaction further upstream to ensure financial security and greater connection and the community or leader veterans to their first mental-health appointment. veteran suicide has always been a major challenge, but it has been exacerbated by the governor 19 pandemic and withdrawal of
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armed forces from afghanistan. during this time, we have proactively engaged to address these challenges. the first two months of the pandemic, we saw a 38% number for all through our -- referrals to our mental health program. many were feeling disconnected and isolated. we made over 40,000 outreach calls to veterans during those months. that led to more than 50,000 hours of clinical care, and conducting more than 7000 hours of weekly emotional support engagement. our commotion -- connection programs help connect warriors to their families and each other. we are conducting the same outreach to warriors who were deployed on a map dennis and. after 15,000 calls we see that wounded warriors is now the leading request. it is important to recognize your committees commitment to
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improving the mental health situation. most notably to accelerate biomarker research for ptsd and traumatic brain industry, to understand complementary and alternative treatment options and to launch new grant programs to build stronger alignment with nonprofit organizations working to prevent veteran suicide. as a program officer, i am pleased to share some of our insights that we believe will move our community forward to prevent losing more veterans, and helping those veterans thrive we must continue to find innovative ways term or barriers to care. there is insufficient accents -- excess -- access. treating these conditions concurrently can be lifesaving for veterans. after working to explore this gap, we are expanding outpatient services for these challenges
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through our academic medical center partners in our warrior network. we believe some of the life-changing care can be provided through the v.a. second, we must invest in the power of peer connections. we must create an environment where there is no wrong torture finding help. this includes training and suicide intervention for veterans in the clinical and nonclinical professional that we interact with. as v.a. extends its network of community care providers, we believe the same approach will save more lives. third, we must continue to expand access to mental health. when wade pivoted to provide more virtual program, we saw a great increase in women and veterans living in rural areas. as a wider group becomes accustomed to virtual platforms, we believe that using regulations on telehealth mental
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practice over state lines will improve on mental health care provider shortages, and connect veterans to the care they need. lastly, our statement how is the impact of both sleep and visible pain on mental health. veterans are at a high risk of poor sleep and chronic pain than those who have not served. both conditions can increase the risk of mental health symptoms. we believe that v.a. can do more to integrate physicals treatment into its work. this will address number -- veterans all help and affect mental health in the process. thank you to the -- we share a sacred obligation to serving our nation's veterans. i'm thankful for the invitation today and happy to answer any questions you may have. >> thank you, miss silva.
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i want to point out how pleased i am today to have panelists from both the v.a., on which the women are well represented as they should be. chief smith, you are recognized for five minutes for your testimony. >> good morning chairman and members. my name is chief william smith, i am chairman of the national indian health board. i'm a member of the tribe of alaska, and a vietnam vet. native veterans continue to suffer along -- along the greatest challenges in behavioral health and other veterans. the united states has a real
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responsibility to our native veterans. the other is due to our progress in the alaska, native american and indian people. native americans have served in every u.s. military context in the last 200 years. we have a higher rate than any other ethnicity of suicide. in 2019, there were over 217,000 native veterans that used the v.a. for health care. that is about 2.5% of all v.a. users. many received health -- services from both indian health and that v.a. to give you a better idea, let me tell you about my experience. as a vietnam that, we returned home to a country which did not thank us for our service. you are not provided care, the
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federal government tried to take our culture away from us. it did not provide our communities with basic resources like water. this difficult situation harmed mental health and data veterans and struggles, and unfortunately, we have too many of our native brothers and sisters take their lives. our people suffer from more posttraumatic stress to her than the average american. these are just some of the challenges that the tribal communities continue to face during the covid pandemic. across-the-board, native veterans report issues around quality of care, and veterans with outcomes including covid-19.
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by affecting generations of our people. in 2015, the suicide rate, 62%. native veterans suffered a more higher rate of mental health disorders compared to non-native utterance. it is essential that the veteran health administration work with indian tribes and the ihs command other agencies to create more resources for native veterans. as well as to increase behavioral health and prevent suicide. it is essential that the v.a. continue to engage with leaders or consultations, support and consult on their activities. it is the first step in building compassion, this improves the likelihood of building trust between patient and doctor, and increases the likelihood that a native veterans will seek care.
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as a tribal representative, i have seen the need to speak to native veterans and connect them with their deserved v.a. help on offense. many veterans are too proud to ask for help, and we must reach them. traditional healing includes physicals, mental, [indiscernible] that may be different from one indian tribe to another. it also includes the need to understand knowledge of the patient's background and recognize the history of, of native veterans. we will miss some of the native veterans that need help and will benefit from this practice. it is very important that parity
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be established preferring the v.a. and indian health service is, especially for mental and behavioral health care. without parity, the quality of care for native veterans will continue to suffer. thank you for holding this important hearing. we have a long way to go to improve care for native veterans , we will serve in this way as well. i yield back time. >> thank you, chief smith. i want to infuse all of our work with equity. this includes a seat at the table of those testifying on behalf of the traditionally underserved veterans they represent. their testimony was heartbreaking, but is so necessary for us to hear. i'm glad you are with us today, sir.
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mr. armendariz, you are recognized for five minutes for your testimony. >> excuse me, thank you. ranking member and members of the committee. thank you for your kind admitted -- invitation. my personal experience as an afghanistan veteran, and both before and after i became an employee, and fears raised by the chairman about afghanistan. in september 2006 i was in the u.s. army. i was honored to serve their combat tours in afghanistan, including some of the deadliest fighting out of the afghan war. all three deployments saw heavy fighting and significant casualties. during my deployment with proper company, we lost 51 total comrades to enemy action and many were wounded. one of those retired now is the husband of a chief caregiver.
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i've seen the impact of the trauma suffered both within myself and my fellow soldiers. while the losses sustained were significant, since that deployment countless men with whom i serve were lost to suicide. i left soon after my third appointment and found myself isolated and struggling with many of the same issues arising out of my posttraumatic stress that many of my fellow bravo company soldiers struggle with to this day. i was in a whole i could not climb out. some of the mistakes i made but me in a bind legally and delete, and put me in a position in which i did not feel i wanted to be here any longer and put me on a morbid pad. i was lucky by district attorney
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did not there the book at me, personally intervened, and recommended treatment. because of that, i got a second chance. i can't emphasize enough mental health and suicide prevention. that are in mental health has impacted my recent events in afghanistan. the v.a. so it up big them august of veterans engaging mental health resources. so much so that we founded a new coalition called save our allies to evacuate americans to the help of veterans trying to make sense of the events. we find many veterans do not trust the v.a. because of prior treatment, or the stigma as outlined.
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the end independence fund will roll out a professionally manned hotline where afghan refugees and veterans can call and get assistance. one thing that must be discussed is the role of combat. combat is often incredibly brittle, with the performance every other year. 35% of the years i spent were engaged in direct combat action. the annual suicide report is the only one i could find. while i detail these numbers in my written testimony, 18 to 24-year-old veteran suicide rate is two to three times higher than the average veteran suicide rate, similarly, 18-34-year-old
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veterans make up 77% of the increase in veterans reside, but represent only 9% of the veteran population. our community needs to further analyze this data and study the risk of combat deployment to veteran suicide. department of veterans affairs is provided the public data, which is too broad to use for useful analysis. involved with veterans reside. i encourage this committee to direct the department to release the information and resume reporting on suicide by cop that veterans. -- combat veterans. chairman, i thank you for allowing me to testify and i stand ready for your questions. i look forward to working with you as an individual veteran and as a member of a committee.
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>> thank you, i know i speak for all of us today in thanking you for the tremendous service you have provided to our country. and i think you for the work that you continue to do for the independence fund. it is clear that you continue to face the effects of your service today. we owe you and everyone of your brothers and sisters in arms support now, as long as you needed, as long as they needed. -- need it. >> good afternoon, chairman and members of the committee. i am a senior behavioral scientist at the nonprofit rand
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corporation. i also codirected the veterans policy research institute. i am going to address four strategies critical or preventing veteran suicide. one, improve the national mortality data infrastructure. two, use data to better understand that are in health care experiences outside the v.a. three, collect better and more comprehensive data on veteran our arm ownership and storage. at four, incentivize researchers to collect data on suicide when testing novel mental health treatments. first, the national mortality infrastructure needs to be improved. the v.a. just released it on veteran suicide in 2019, meaning that our data is over 20 months delayed. whether the impact of covid-19, or the withdrawal of u.s. troops
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from afghanistan have led to increased suicide rates among veterans are questions that are currently unanswerable due to the lack of timely data on suicide. to have more timely data on veteran suicide, resource or unneeded -- are needed from approximately 2000 jurisdictions to update integrated systems, and sure investigators have the resources to conduct comprehensive investigations. better quality data is also needed. [indiscernible] should routinely collected on sexual orientation and gender identity, and investors -- investigators -- this is especially important for native american and alaskan individuals who have the highest rate of suicides. the second strategy for
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preventing veteran suicide is to use data server -- to understand veteran help their experiences outside the v.a. 75% of veterans received at least some care outside the v.a.. we know very little about this care. one place could be the focus on veterans who are receiving care from modeler federal programs, like the indian health service. merging health care utilization data with data on veteran suicide would help identify when veterans lacked access to care, and the type of care they received. these data will help identify where suicide risk may cluster within health systems, so tailored implementation can be created to address suicide in the places it is concentrated. the third strategy i would like to point out is the need for better and more comprehensive data on veteran firearm
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ownership and storage. two thirds of veterans who died by suicide used a firearm. many suicidal crises are of short duration. placing time and space between a person in crisis and a firearm by storing it unloaded and locked can be lifesaving. many suicide prevention strategies are focused on encouraging such practices. without timely data on how veterans are storing guns, it will be impossible to know if these are effective. the final strategy i will mention is the need for data on suicide outcomes for novel treatment. as new treatments are developed and tested for patients with mental health conditions and in use disorders, data is needed on whether these therapies prevent suicide risk. most experimental transfer mental health treatment exclude
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individuals with thoughts of suicide. proactive strategies are needed to actively recruit and monitor people with suicidal thoughts that we can understand the benefits of these treatments have producing suicide. this includes the trials underway for new treatments for posttraumatic stress disorder, like mdma-assisted psychotherapy , and others. too many americans and to many veterans die from suicide each year. i'm convinced we can prevent many of these deaths, but we need data. i recommended four strategies. improve the national mortality data infrastructure, better understand health care outside the v.a., collect data on firearm storage, and how do novel treatments affect risk. thank you for inviting me to speak with you today. i look forward to your questions. >> i think all the witnesses
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for their testimony. i am going to call for a recess for the committee to return as soon as possible after the last vote. which will be in about an hour and 20 minutes. we will resume in about 20 minutes. members need to proceed to the floor to cast their votes on the six questions before the house. with that, i call a recess. >> the committee will reconvene and come to order. i now recognize myself for five minutes of questioning. i will begin my question with ms. bartlett. i am very happy to see that vfw will mandate training for
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community health providers. i was struck by her testimony about the importance of including v.a. suicide prevention work, can you say more about your position? >> yes. in regards to partners, we have heard some barriers and challenges with membership in the last few months. that barrier is mental health is being delayed in reauthorization, that means that care is being delayed, or we may have to start back up with any mental health or vita within the v.a. in regards to what we have seen with the v.a.'s national survey,
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the programs of the bbva, we know oftentimes veterans seek health care. we can see how programs have changed, we can see the amazing things that have happened when we are talking about education assistance over the past 15 years, and see how that is better fitting -- benefiting veterans. >> we have a lot more veterans using bbva. i continue to be impressed with the breadth of services that their wounded warrior project has in their continued care model. you have studied abuse and
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treatment in depth, can you say more about what the bbva needs to do to provide more accessible substance abuse treatment for veterans? >> we were grateful to work with rand, we didn't know what we were going to find related to substance abuse injuries or brain injury, so we looked at the space, including v.a., and saw that the outcomes of the services when they are provided concurrently and at one time, the outcomes are positive. the problem is there is not enough of those facilities available to veterans, they have to go long distance and there is not enough of them. and they looked at civilian as well. it's not just v.a., it is across-the-board. we are very concerned with the gaps in treatment. when you treat substance use disorders before posttraumatic
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stress disorder treatment, which is in the protocol, you have that gap in treatment, and that is where warriors and veterans are most at risk. and so, we have been able to invest in that with in our own network facilities that will help you to get intensive treatment at the same time in treating the whole warrior with substance use disorder, traumatic brain injury, and ptsd. it will be helpful if the v.a. is able to implement that on a broader scale. they have that, but it is not enough geographically. >> thank you for that. [indiscernible] i was very interested to hear about iav's quick reaction
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program. what do you see as gaps that remain for us to address? >> i mentioned the issue of domestic violence contributed to veterans' experience of suicide, there has been almost no communication over the past year and a half when it comes to resources for domestic and intimate partner violence. the v.a. needs to ramp up this type of messaging. there were veterans who are unable to leave their homes for long periods of time and may have been trapped in situations which were not ok, and so making sure that v.a. puts out enough information to let veterans know what resources they have and ways that v.a. can help them through those types of things. >> thank you so much.
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i'm going to now recognize the ranking member. we will go through a round of questioning. i want to get to the witnesses who have made themselves available. take five minutes, then we will switch. >> mr. armendariz, as someone who served in afghanistan and lost a friend there, what has it in like -- been like watching the withdrawal? >> for a lot of us there is a mixed effort. there is an indication that this is a stressful environment for a lot of these veterans that have
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spent the last 20 years overseas. and a lot of them wondered if it was all for nothing, which is case in point, we at the independence bun started working to provide that assistance to both the afghan refugees that arrive here and support the veterans that were struggling. many of the veterans we served do not trust the v.a. because of perceived poor prior treatment, or they feared that v.a. would report them to authorities or place them in voluntarily into the fiduciary program. >> what would be your main message to any veterans listening to your testimony and your experiences and struggles,
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what would you suggest and encourage them to do? >> i would encourage them to reach out to the v.a. crisis line, and as i stated, the independence fund will rollout the independence line, a professionally manned health care hotline for veterans and afghan refugees to call and get assistance. >> ms. hetrick, you testified about the tragic events in afghanistan and that they will have a lasting effect on the veterans. how should they v.a. position itself, and this committee move forward to make sure the v.a. goes on the right direction? >> as we mentioned, making sure that resources for veterans who are experiencing or being triggered by the advance.
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the last thing could be a different opinion of the war, as our survey has shown a 10% decrease in veterans who feel that the war in afghanistan was worth it. and it just making sure that we support veterans. many veterans are still working to get the afghan interpreters out of the stand so putting out positive messages to ensure they are being helped during that difficult time. >> justice -- just a quick question. you represent unique ethnic group, as well as the vietnam era, have you seen an uptick after this problem on afghanistan, and has it affected vietnam veterans to the level we
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have seen with them. >> in 1975, we did the same thing when we withdrew from vietnam. left hundreds and thousands of vietnamese that were our partners, just like we did in afghanistan. we left our people that worked robust to band for them -- worked with estevan for themselves. women's rights are completely useless. the veterans feel the same way. when i talk to my brothers and sisters who have come back from iraq and afghanistan, it is not the warriors fault that we got up this way. but it hurts. we leave people behind. we left people in vietnam in 75
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when the tanks were coming right into saigon. same thing at the airport. the taliban was coming in, and the people that we couldn't get out, i don't believe some of them are alive today because of the way for withdrawal was. as a veteran, this is tragedy, we welcomed our brothers and sisters home and we stand with them because what they did in afghanistan and in vietnam was right. the way we with drew -- is a disgrace. is it going to hurt the veterans, yes it is. >> i yield back. >> thank you for being here.
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>> i am sorry that i missed some of the testimony, i had another meeting. ms. hetrick, in your written testimony you talked about the risk of homelessness and the impact on mental health. you specifically mentioned women veterans and veterans with families. last year i had a bill signed into law to permit the v.a. to pay per diem for housing veterans with children. ed pastor. -- it passed. have there been issues with per
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diem payments for veterans with children? >> i do not know. but i can look into that one. >> it was to provide a per diem for the children as well. so when they go to look for housing, they have the resources hopefully to secure that. i would appreciate if you look at that, it gives me an idea if it is being implemented. that would be terrific. chief, how are you? thanks for being with us. in your testimony, you noted my bill and i thank you for that. about requiring v.a. to train minority veteran coordinators in
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culturally competent care. and we know that our native veterans have a high suicide rate -- highest suicide rate of any cohort within the veteran community. i just wanted you to talk a little bit about culturally competent care. and what are the impacts and indications for that? >> competent care. when we go into our sweat lodges to cleanse ourselves through the traditional ways. the best way that i know for a veteran that is in crisis is to talk to another veteran. that is where our tribal representative either -- is to
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talk to a lot of the vietnam veterans that never went to the v.a. to stand by our afghanistan and all the rest of them. by being treated with the sweat lodges and the traditional healing, like when a warrior comes back. it is a shame how we left in afghanistan. the people that served over there all volunteered. in my days there were volunteers and draftees. i am a volunteer, just like the rest of my brothers and sisters. and it needs to have the indian nation being able to work between the two systems. we need health services in traditional medicine and healing through the drumbeats and everything else to calm the warrior's spirit. when we come back we are all hyped up.
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when you are back on the block, in my days you could be in vietnam, and three days later you are back on the block. your body is still over there. my body is still over there. my mind is still over there as a young kid at 19. i learned that from coming back from my warrior brothers, i talked to them, and the only thing that got me -- my brother was in vietnam, and it took us 35 years to talk to each other. and that's what it's going to take to do it, another veteran talking. let me hear what your story is, not tell you monica, let me listen to you and show you how i found the road to recovery. after four divorces, and a couple of been nice to my neighbor glasses and accompanies all value in me, i realize that
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i was still back in vietnam. and had white get home? -- how do i get home? that's what i said, that is what we are going to have to do. hopefully there is another veteran there to say welcome home brother. we have a long number to call for help. if there is an emergency it is 911. if i need to dig in my property i call 811 and i can get the water company, the gas company to come out to my land. why can't the veterans have a simple number to call, why don't we have a simple three digit number for a veteran to call and say hey, i am here. >> i thank you for your
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response, and we are so delighted you are here with us. again, thank you for your testimony and i yield back. >> thank you. we are also proud of the work you have there doing. i'm just -- i can't say enough about the work you have been doing. chief william, just know that the crisis line 988 goes live in 2022. we had some issues getting the fcc approval and all that, i know there's been a big push from folks like you, but know that we have a three-digit number, 988, that goes live in
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202, it's not operating now, it's still -- that's why i said put on your phones the veterans crisis line number. i do it wherever i go. i announce it. you saw ranking member boston did the -- bost did the same thing. i now want to recognize the gentleman from montana, mr. rosendale, for five minutes' questioning. >> thank you, mr. chairman. i'm glad we're all here. i'm alarmed by your statement that you regularly hear from veterans who can't access health care from the v.a., are waiting months for an appointment and are not being given a choice to receive care in the community as required by the mission act. we heard testimony earlier today that that isn't the case and veterans could receive treatment
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on the day it was requested. so why do we have a discrepancy in these two descriptions about the delivery of care 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, you know, the treatment and that of fellow veterans and service members that i worked with who have been turned away at the door. but i will say, we regularly assist numerous veterans, we either cannot -- who either cannot get access to v.a. mental health care, do not trust it. both should be addressed by the v.a. more than 25% of veterans we assist for mental health care refuse our referrals to the v.a. because of the mistrust or because of poor prior experience or medication mismanagement mishaps in the past. more than 25% were critical
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cases requiring de-escalation and safety planning and highlights the fact that by the time a veteran asks for mental health care they're likely at the end of their rope, not the beginning. almost one third of all the casework requests we have received this month are for mental health care. with regard to veterans who say they can't get timely access to mental health care, we have veterans who are told by v.a. schedulers they can't be seen for seven, eight or 10 weeks when veterans ask for community karin stead they are told either they shouldn't go to the community because it's not as good or because v.a. staff don't believe they'll be able to get community care appointments for that rhett ran. i'll say that just this last april, the government accountability office reported v.a. suicide prevention teams are overloaded with cases and that veterans, health administration, not conducted a comprehensive evaluation, local suicide prevention team.
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so you know, therefore i say, the independent fund recommends this committee actively exercise its oversight responsibilities on care, find out how long the v.a. is taking to process community care, mental health care referrals, how long between the veterans' request for care and that care being delivered. and if there are additional mental health care providers the v.a. isn't presently using. >> thank you so much. i will be requesting that information to make sure that we can fill 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's not and getting discrepancies. i agree with the statement in your written testimony that stated, quote, warriors have individual -- individualized paths of recovery. it may not be optimal to engage all warriors with the same
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program or even in a linear fashion. do you think the v.a.'s mental health programs offer sufficient flexibility to tailor treatments to a veteran's individual needs including a more holistic approach as you were talking about considering the total health and pain and how that interacts with their mental health and could you describe the process in order to do that evaluation and treatment? >> sir, thank you for the question. i believe that the v.a., their evidence-based care, clinical care, is veterans are receiving it. has shown to be impact. i do believe, as we said in our written statement and our oral remarks, that having a more holistic approach, aing the augmented therapies we have seen internally, when we have warriors in our physical health programs, they are sometimes, their mental health outcomes are better than our true, our singular mental health programs
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internal at their peak. i know if they take a more whole health approach which is the name of one of their program, if that is more widely used, our belief, the data we have shows that warriors will gain outcomes related to better sleep, better pain management and increased mobile. 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 v.a. >> thank you so much. mr. chairman, i do see that i'm at my limit. i yield back. >> thank you. let me just say, we know that there are wait times in almost every community, in almost every community, not just the v.a., because the entire nation has a shortage of mental health professionals. that is why in the
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reconciliation markup i was insistent on including -- i would have liked more. i know 700 slots for residentiay training for medical professionals is not just psychiatrists but other types of medical professionals but also including other types of mental health providers. but we do have a mental health workforce shortage in the country. so the shortage, the shortage, the wait times occur not just with v.a. they also occur within the community. it is anecdotal that v.a. employees have not referred people to the community. it's anecdotal. but i -- from what i'm hearing it does happen. so i'm not contradicting what
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mr. amondares testified today. let me return to mr. mrvan for five minutes. >> thank you, chairman. as chairman of the subcommittee on technology modernization, i read this with great interest and discussion, the testimony regarding telehealth. what are the ongoing barriers to veterans access to telehealth that persist following the implementation of the v.a. mission act in 2018, and what congressional actions may be needed in order to improve such access going forward? >> thank you, sir, for the question. i think it can be summed up in two ways. number one, the interstate license durvetion re obstacles are a problem. we have warriors that if they're stationed in and around fort campbell, kentucky, they've got to drive to be in kentucky if they live in tennessee. and that state, or that base or post happens to be struggling both of those states, it just,
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we need, i believe, more commonsense licensure agreements between states. we do have a shortage of mental health care providers that can -- this can help with that. i believe congress can help by having the state recognize that and join in with other measures to decrease obstacles for interstate licensure. also getting warriors broadband access. two programs that benefited for us were wounded warriors and women warriors. they had access to a virtual platform. we need to make sure all warriors, no matter where they are, have that access so i would say those two things are important for congress to lean in on. >> doctor, i share your concerns
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with what we do not have enough data to assess specific individuals like lgbtq individuals, are at higher risk of suicide. how do you suggest we -- specific data are collected in investigations into deaths and suicides? and do you have recommendations for improving coordination between the d.o.d., c.d.c. and others in this regard? >> thank you for your question. there's evidence that suggests that lgbt individuals are at increased risk for suicide as well as lgbt veterans are at increased risk for suicide but this is done by, to be honest, some fancy statistics. national language processing to understand clinical notice. so i think that start, we can have routine collection of sexual oryebtation data in v.a. as we're talking about culturally competent care, i think that is providing
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culturally competent care, understanding how people identify themselves. during death investigations there are trainings that are available on conducting death investigations and reporting on sexual orientation and gender identity. los angeles is one death investigation jurisdiction that currently requires all death investigators collect data on sexual orientation, gender identity. i think that that's a model -- model. i think we could use the evidence provided from los angeles county and their death investigations and their successes that they're having in doing it. i think sometimes it's just a barrier as people don't want to ask but if you instruct them and show them other places are asking these questions, are collecting this information that's a pathway forward. >> and then quickly you also discuss in your testimony potential for improving veteran suicide prevention by merging health care utilization day tra from a variety of sources. can you explain the value of
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merging health care utilization data as well as discuss barriers at v.a. to leffering this data to improve health outcomes for veterans? >> i'm not sure of what barriers may exist. i'm sure there are technical ones. but i think that it's doable. i think the value here is we know that there's so many veterans who receive care outside of the v.a., many of whom are enrolled in federal programs and if we can identify concentrations or pockets of risk where, when they last accessed this health care, where they accessed it, the type of care, then we could really target suicide prevention resources. this was done really successfully with respect to emergency department care. right now on screening for suicide risk within emergency departments and then following up and providing those who are discharged from emergency departments especially with self-harm targeted resources and care. i think it's a successful model. there's evidence that it works and it reduces future suicide
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attempts and that's kind of what i see the promise for doing this type of merging with other federal health systems. >> thank you. with that i'd also like to, as i always do, thank all veterans for their service. i thank chief william smith for his service to our country. thank you. >> thank you mr. mrvan. i now will recognize representative moore for five minutes. >> thank you, mr. chairman. it's heartening to hear about how the v.f.w. posts and across the country are stepping up particularly in response to the afghan -- failed afghan withdrawal. what can go to support great work being done locally by state and local organizations.
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>> thank you. [no audio] >> it appears ms. bartlett's connection is frozen. mr. moore, why don't you pose a question to another -- >> ok, thank you, mr. chairman, i can do that. this will be a question for ms. hetrick. you say stigma prevents veterans from seeking help they need. what more can this committee and v.a. do to help that? >> i've said this before and i say it often but messaging. in the military when you seek mental health care services you're often told you're at risk for losing your ability to be deployed or even at risk for
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losing your career. and so the stigma then carry into the veteran community and so if we can help active duty service members know that seeking mental health care is not going to cause them to lose their job, then i think that's really going to carry over into helping veterans feel comfortable seeking mental health care. again, with the messaging making sure that v.a. and v.s.o.'s are putting out effective messaging about how great v.a. services are, how highly rated they are, as well as ensuring that the v.a. works with the community groups to ensure that the veterans who are not seeking care at v.a. are still being -- are still being helped. >> mr. moore, it looks like ms. bartlett has relogged on. if you would -- >> thank you, mr. chairman. ms. bartlett, did you hear the
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question ok or do i need to repeat? >> she's disappeared again there she is. ms. bartlett, do you need the question repeated for you? >> no, i do not, chairman, thank you. thank you, representative, for that question. like i mentioned, be involve. reach out. find a facebook group that your v.f.w. or other city is doing. oftentimes it's not even a veterans service organization, it could be a local church in your area who has taken it upon themselves to help out in the community, helping refugees settle here in the united states. >> mr. moore, go ahead and continue. >> i guess my question specifically is, i think that we're going to have trouble with some of the veterans -- we had a lot of interpreters that worked closely with our soldiers.
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so i think as a group we need to be mindful we're probably going to have -- i think it's already been reported there have been increased calls, the ranking mentioned, to some of our veterans organizations. what can we do to support v.s.o.'s going forward to make sure you have the support you need to make sure we -- it's going to be increased call, increased incidences going forward based on what i'm hearing in the district. and then with that, mr. chairman, i'll yield back my time. thank you. >> thank you, representative moore. i now call upon dr. reed. >> thank you for holding today's hearing on such an important topic. veteran suicide is far too pervasive, it's something the
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congress and v.a. must continue to stay focused on. we owe it to our service member who was risked their lives to take care of them when they come home and that includes their mental health as much as their physical health. one of my staffers, a previous wounded warrior fellow of mine, blake weller, is a marine who served in the second battalion seventh marine regiment. that unit lost 20 marines in combat and 37 to suicide once they came home from afghanistan. let me say it again. lost 37 fellow marines and corpsemen 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 v.a. has prioritized this issue and i want to make sure that congress is doing everything we can to support those efforts. one thing that has struck me is
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that as part of the v.a. suicide prevention effort, there seems to be an emphasis put on the individual to advocate for themselves. for example, the voten -- veterans crisis line helps connect veterans to care and peer support networks but requires a veteran to proactively make that phone call. i've also heard from veterans in my district that when they seek mental health treatments at v.a. facility, they must explicitly mention suicide or self-harm in order to receive rapid care. so while this may not be the official policy of the v.a., it is the experience of the veterans that i represent. ms. hettrick, as a doctor i know patients aren't always forthcoming so forcing veterans to explicitly state suicidal intentions to receive treatment isn't a viable solution. how can the v.a. improve the experience veterans are having
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when they need help but may not be explicit about suicidal thoughts or self-harm? >> thank you for that question, dr. ruiz. i'm not 100% on how the v.a. could be, i guess, 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 that when a veteran does mention anything to do with mental health in one of their poims 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
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are choosing to bring that up, making sure that that's taken as effectively as it would be with the previous statement. >> thank you. i understand there's a need for additional mental health professionals to meet the demand for america's vet and earlier this year wrote to the house appropriations committee supporting a significant increase in funding for the v.a. suicide prevention outreach program. i'm pleased the fiscal year 2022 military construction bill includes and increase for suicide prevention outreach, almost doubling the program's funding. it's critical we get this right. the v.a. must get to veterans before they have reached the crisis point. ainge big part of that is reducing stigma around mental health issues so veterans feel more comfortable seeking help in the first place. so ms. silva, how would you recommend they use this additional funding to end stigma to reach veterans? >> ainge public awareness
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campaign would be great that shows it takes a lot of strength, it's actionable and a strong action. but investing in the peer connections across the different communities is really an important upstream intervention and it's -- if a peer is telling you that they got help and that it worked for them that's the biggest -- it's really important and the more that there's peer connection and they see stories and buddies, battle buddies who do that,ic that can be the best p.s.a. for getting care whether within the v.a. or other opportunities. >> thank you. i thank you all for your incredible work. mr. chairman, i ask unanimous consent to submit this "new york times" article from september 1920, 15, about the second battalion seventh marine regiment for the record. >> without objection, so oard. >> thank you and i yield back my time. >> thank you so much, dr. ruiz,
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for that enlightening line of questioning. it brings to mind something that we know from research that when someone you know dies of suicide, your own suicide risk increases. this is why it is -- there is a phenomena of suicide being contagious. that is why evidence-based prevention is critical to lowering everyone's risk of suicide. so thank you so much, dr. ruiz. ranking member bost i am loath to not do a second round of questioning because we have such an assemblage of expertise here today. it takes a lot of effort to bring them together but we do have a markup at o.n.i. we've got to get started. it is with deep regret i don't do another round of questioning.
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i would love to take advantage of this expertise. i thank our veterans on this panel for your service. always moving. chief smith, i can't say enough to you because we didn't say it to you then, welcome home, brother, welcome home. welcome home, nick we thank you for your service and we do stand in solidarity with veterans across our country who -- who have been triggered who have been especially suffering since the 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 who are with us. ms. hettrick, ms. silva, and msr
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service as well, thank you for the work you all continue to do for our veterans and thank you for the service to our country. and -- >> mr. chairman, can i -- >> of course, ranking member bost, i wouldn't want to adjourn this meeting without asking for you to weigh in. >> i'm grateful for the opening dialogue of the hearing and the time of our witnesses and in particular, mr. hernandez, sharing your thoughts and chief yours as well for the committee. i want to apologize to the witnesses on our second panel who had to wait through a very long vote series, that's kind of how this place is. our witnesses' time and testimony is valuable, i don't want you to think it's do not i hope the chairman and i can work together and move forward to try to respect that even in a time
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when we're doing markups and everything like that. but i don't want anyone, and in particular, any veteran who is invite t.d. testify before this committee to have to wait hours for the opportunity to answer questions for their representatives. and that being said, you know, 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. we need to keep working together. i look forward to continuing to do that, work until not a single, i say that again, not a single veteran is at risk of taking their own life. and to 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, i'm
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going to say this, we know that the three numbers are coming in a few years but right now it's still 1-800-273-8255, press 1, or text 838255, or visit the veteran crisis lines. you're not alone. you're worth it. you matter with that, mr. chairman, i think we have had a great hearing 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 an exemplar of our peer outreach who serves on the committee. thank you all six of you who are veterans, thank you for also your expertise today. my heart goes out to veterans across the country and my gratitude to you all for serbing our country and continuing to
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serve our country. thank you. thank you, ranking member. all members will have five legislative days to revise and extend their remarks and include extraneous material. again, thank you for appearing before us today and>> stage i le
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in confirmation that the stage i lock load is complete.

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