    [Senate Hearing 116-479]
    [From the U.S. Government Publishing Office]

                                                           S. Hrg. 116-479

                           S. 785: LEADING THE WAY TO
                      COMPREHENSIVE MENTAL HEALTH CARE AND
                        SUICIDE PREVENTION FOR VETERANS

    =======================================================================

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                         ONE HUNDRED SIXTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                               SEPTEMBER 9, 2020

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    45-284 PDF                  WASHINGTON : 2023

    -----------------------------------------------------------------------------------

                     SENATE COMMITTEE ON VETERANS' AFFAIRS

                         Jerry Moran, Kansas, Chairman
    John Boozman, Arkansas               Jon Tester, Montana, Ranking
    Bill Cassidy, Louisiana                  Member
    Mike Rounds, South Dakota            Patty Murray, Washington
    Thom Tillis, North Carolina          Bernard Sanders, (I) Vermont
    Dan Sullivan, Alaska                 Sherrod Brown, Ohio
    Marsha Blackburn, Tennessee          Richard Blumenthal, Connecticut
    Kevin Cramer, North Dakota           Mazie K. Hirono, Hawaii
    Kelly Loeffler, Georgia              Joe Manchin III, West Virginia
                                         Kyrsten Sinema, Arizona
                Caroline R. Canfield, Republican Staff Director
                    Tony McClain, Democratic Staff Director

                               C O N T E N T S

                                  ----------

                               September 9, 2020

                                    SENATORS

                                                                       Page
    Moran, Hon. Jerry, Chairman, U.S. Senator from Kansas............     1
    Tester, Hon. Jon, Ranking Member, U.S. Senator from Montana......     2
    Sullivan, Hon. Dan, U.S. Senator from Alaska.....................    10
    Brown, Hon. Sherrod, U.S. Senator from Ohio......................    11
    Boozman, Hon. John, U.S. Senator from Arkansas...................    13
    Manchin III, Hon. Joe, U.S. Senator from West Virginia...........    15
    Rounds, Hon. Mike, U.S. Senator from South Dakota................    17
    Tillis, Hon. Thom, U.S. Senator from North Carolina..............    20
    Blumenthal, Hon. Richard, U.S. Senator from Connecticut..........    23

                                   WITNESSES

    Katie Purswell, Deputy Director of Health Policy, The American
      Legion.........................................................     3
    Jeremy Butler, Chief Executive Officer, Iraq and Afghanistan
      Veterans of America............................................     5
    Jim Lorraine, President and Chief Executive Officer, America's
      Warrior Partnership............................................     7
    Matt Kuntz, Executive Director, NAMI, the National Alliance on
      Mental Illness.................................................     8

                                    APPENDIX
                              Prepared Statements

    Katie Purswell, Deputy Director of Health Policy, The American
      Legion.........................................................    33
    Jeremy Butler, Chief Executive Officer, Iraq and Afghanistan
      Veterans of America............................................    38
    Jim Lorraine, President and Chief Executive Officer, America's
      Warrior Partnership............................................    40
    Matt Kuntz, Executive Director, NAMI, the National Alliance on
      Mental Illness.................................................    44

                           Statements for the Record

    Senator Marsha Blackburn.........................................    51
    Combined Arms, John Boerstler, CEO...............................    52
    Disabled American Veterans (DAV), George Wolford, PhD, Vice
      Commander......................................................    60
    ETS Sponsorship, Wiliam H. Buck, Director........................    62
    Mission Roll Call, Garrett D. Cathcart, Executive Director.......    67
    The Warrior Alliance, Scott Johnson, President and CEO...........    70

                           S. 785: LEADING THE WAY TO
                        COMPREHENSIVE MENTAL HEALTH CARE
                      AND SUICIDE PREVENTION FOR VETERANS

                                   ----------

                          WEDNESDAY, SEPTEMBER 9, 2020

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 3:30 p.m., in
    Room SD-106, Dirksen Senate Office Building, Hon. Jerry Moran,
    Chairman of the Committee, presiding.
        Present: Senators Moran, Boozman, Cassidy, Rounds, Tillis,
    Sullivan, Blackburn, Cramer, Loeffler, Tester, Brown,
    Blumenthal, Manchin, and Sinema.

                  OPENING STATEMENT OF CHAIRMAN MORAN

        Chairman Moran. Good afternoon, everyone. The Committee on
    Veterans' Affairs will come to order. I am pleased to have this
    opportunity today to hear directly from organizations that work
    with, represent, or support millions of veterans, to support
    millions of veterans every day. This Committee is gathered here
    today to hear from those organizations about their firsthand
    perspective and their support for comprehensive suicide
    prevention legislation, S. 785, the Commander John Scott Hannon
    Veterans Mental Health Care Improvement Act.
        This is a piece of legislation that has been before this
    Committee and before the Senate, and I wanted to give the
    opportunity to those veteran service organizations and others
    the ability to tell us any thoughts they have in regard to this
    legislation as we negotiate with the House in its passage and
    its ability to be sent to the President.
        Additionally, tomorrow, September 10th, is Worldwide
    Suicide Prevention Day, and this hearing is our opportunity to
    call attention to the tragedy of suicide impacting so many
    Americans, and urge for swift passage of our legislation that
    will provide lifesaving measures for veterans who are at risk.
        Just yesterday I was notified of yet another veteran who
    died by suicide while on VA property. Despite years of
    increased investment in mental health care at the VA, there is
    a need for a new approach that places the veteran at the center
    of the system and focuses on new connections and new forms of
    outreach. This bill achieves those goals in many ways,
    including bolstering outreach to veterans not yet identified
    and organizations that are not yet serving them, directing
    cutting-edge research and greater data-sharing, exploring
    alternative suicide prevention programs, and to make certain
    there is no wrong door to accessing mental health care and
    suicide prevention services for our nation's veterans.
        As we know from VA data, 14 out of 20 veterans who die by
    suicide each day are not enrolled in the VA system. This bill
    will enable the VA to better work with and amplify the efforts
    of organizations already serving veterans across the country
    who are filling gaps, especially in rural and medically
    underserved areas.
        In our Committee's first markup, after I became Chairman in
    January, we reported this bill favorably with a 17-0 vote. I
    was pleased to work with Ranking Member Tester and our
    colleagues to pass this legislation out of the Senate
    unanimously last month. Senator Tester has been a leader in
    this legislation from the very beginning.
        While our country has faced unprecedented and unexpected
    challenges this year, we cannot lose focus on the need of our
    Nation's veterans. I look forward to testimony from everyone
    who will be taking part in today's hearing about your
    organization's reasons for supporting Commander John Scott
    Hannon Veterans Mental Health Care Improvement Act and your
    support for it becoming law, and how this bill will make
    meaningful impact on the lives of veterans.
        Let me now yield to the Ranking Member, Senator Tester.

                  OPENING STATEMENT OF SENATOR TESTER

        Senator Tester. Thank you for the opportunity to highlight
    the significance of the Commander John Scott Hannon Veterans
    Mental Health Care Improvement Act that was introduced, as the
    Chairman said, by the Chairman and myself a little more than a
    year ago.
        This bill is named for a former Navy SEAL who served our
    nation honorably for 23 years. It would expand and improve the
    services available to veterans struggling with the invisible
    wounds of war.
        After serving in combat, Scott returned to Helena, Montana,
    and he was open about his journey to recovery, getting involved
    in the Montana chapter of the National Alliance on Mental
    Illness and animal therapy programs at Montana Wild.
    Unfortunately, he died by suicide on February 25, 2018.
        This bill honors his legacy by supporting the types of
    programs that improved Commander Hannon's quality of life and
    by expanding our understanding of mental health conditions and
    their treatments, which may have made diagnosing his conditions
    easier.
        There are a lot of important provisions in this bill. It
    represents compromise in a time when compromises are hard to
    come by. This legislation prepares all VA hospitals to employ
    at least one suicide prevention coordinator. It bolsters VA's
    research efforts, particularly in identifying and validating
    brain and mental health biomarkers and studying the effects of
    high altitude on mental health and the risk of suicide. It
    provides tools for effective VA suicide prevention and mental
    health outreach. It helps expand rural veterans' access to VA
    telehealth care. It requires VA to take a hard look at its
    mental health professional staffing levels.
        It directs the VA to establish a scholarship program for
    students pursuing a degree in psychology, social work, marriage
    and family therapy, or mental health counseling. Those students
    will enter into an agreement to work full-time at a Vet Center
    for a period of time following completion of their program of
    study.
        It would allow the VA to award grants to community
    organizations to provide suicide prevention services to
    veterans and their families. And as part of this grant,
    veterans will be able to receive necessary emergency care when
    they are in crisis, and if they need ongoing care they can get
    that care at the VA.
        I encourage my colleagues in the House to support the
    Commander John Scott Hannon Veterans Mental Health Care
    Improvement Act so we can move this bill forward. And as the
    Chairman has indicated, we are ready and eager to work with our
    House counterparts to advance additional legislation that could
    improve health outcomes for our veterans. Our work can send a
    very important message, not only to veterans but to the
    American public, that we can come together during potentially
    turbulent times to do what is right, in this case provide
    critical support to those who have sacrificed so much, and to
    connect more of them to lifesaving mental health care that they
    need.
        In particular, I want to thank the Hannon family for
    continuing to be a partner in this effort to improve the
    services available to veterans who need some help in improving
    their mental health. And I would like to recognize a witness
    from Montana, Matt Kuntz, who remains very close to the Hannon
    family and whose tireless advocacy helped make this legislation
    possible.
        Again, I want to thank you, Mr. Chairman. It has been a
    pleasure working with you, and I appreciate your dedication to
    getting things done. With that I yield.
        Chairman Moran. Senator Tester, thank you for your opening
    remarks, and you and I have been involved in many pieces of
    legislation, many of them related to the care and well-being of
    our Nation's veterans. None should be considered more important
    than the efforts that we are about today, and I thank you for
    the way that we have been able to come together, work together,
    and hopefully achieve an outcome that is significantly
    beneficial to those who served our Nation.
        Let me now introduce our witnesses. Ms. Katie Purswell is
    the Deputy Director of Health Policy at The American Legion.
    Mr. Jeremy Butler is the Chief Executive Officer of Iraq and
    Afghanistan Veterans of America. Mr. Jim Lorraine is President
    and CEO of America's Warrior Partnership. Mr. Matt Kuntz is
    Executive Director of NAMI, the National Alliance for Mental
    Health.
        Thank you all for being with us in some form or another
    today, and we will now being hearing from our witnesses. Ms.
    Purswell, you are recognized for five minutes to deliver your
    testimony.

                      STATEMENT OF KATIE PURSWELL

        Ms. Purswell. A heartbreaking truth of veteran suicide is
    that nearly every veteran has been touched by it in some form
    or fashion. Many of us know someone who died by suicide,
    attempted suicide, or had thoughts of suicide. If you have
    never felt it, it is hard to comprehend what could be so
    painful that ending your life would seem like the only
    solution. Good or bad, the things that we have done and seen
    are now a part of us and affect us in ways that we can have
    trouble understanding. From complications with assimilation
    into civilian life to reliving past traumatic experiences, we
    struggle at times to find a way to cope.
        It is crucial that veterans understand there are a
    multitude of resources available to them. Even more important,
    these resources must be thoughtful and accessible. S. 785, the
    Commander John Scott Hannon Veterans Mental Health Care
    Improvement Act of 2019 addresses these multifaceted issues by
    focusing on research initiatives, health care modernization,
    oversight, and adaptive suicide prevention programs.
        Chairman Moran, Ranking Member Tester, and distinguished
    members of the Committee, on behalf of National Commander James
    ``Bill'' Oxford, and our nearly two million members, thank you
    for inviting The American Legion to testify on this critical
    piece of comprehensive legislation.
        Through transition assistance, prevention, research,
    awareness, and appropriate mental health care services, we feel
    this whole health cycle approach will be effective in reducing
    veteran suicide. As a Legion member and as a veteran who has
    been touched by this tragedy, I am proud to say The American
    Legion supports this bill in its entirety. For generations,
    veterans have struggled to reintegrate back into civilian life.
    Through strengthening the Transition Assistance Program,
    reviewing lessons learned, and expanding VA services to
    eligible veterans, S. 785 ensures a safety net is in place
    during this critical first year.
        Through our own research we have found that many
    servicemembers have difficulty enduring the emotional strain
    associated with traditional, evidence-based psychotherapies. As
    such, we support the use of complementary and integrated health
    services endorsed by this bill. S. 785 creates and expands
    access to diverse treatment options, including animal therapy,
    agritherapy, and sports and recreation therapy.
        I think we can all agree that success of these programs is
    dependent on proper staffing. Through our System Worth Saving
    program we have found that staffing and retention are often the
    culprit of delays in accessing mental health care. These
    findings are in line with the VA's Office of Inspector General
    report which determined mental health providers are among the
    most critical in need. As recruitment and retention have long
    been a major focus for The American Legion, we are pleased to
    see legislation that addresses this issue.
        As reflected in our System Worth Saving annual report,
    staffing issues expand beyond mental health to other areas like
    women veteran health care. While we understand the gap analysis
    and report on women veteran utilizing of health care sections
    have been moved back to the Deborah Sampson Act, we are proud
    to say that we support both bills and their focus on improving
    care for all eligible veterans in a more inclusive manner.
        The American Legion feels inclusivity also involves
    minority and rural veterans who have remained underserved for
    far too long. S. 785's expansion of telehealth services in
    conjunction with The American Legion ATLAS Pilot Program will
    bring services to these underserved populations in need of
    comprehensive health care, to include mental health care
    access.
        Our organization understands mental health care does not
    have a one-size-fits-all solution in preventing suicide. It is
    a complex problem that needs to be treated at an individual
    level, as each veteran situation is unique, for example,
    Commander Hannon's unique battle was with PTSD, TBI, severe
    depression, and bipolar disorder. He was a decorated Navy SEAL,
    and while battling his own invisible wounds he spoke candidly
    about his mental health journey and advocated for mental health
    treatments and alternative therapies. It is in his honor this
    legislation was introduced.
        While in the end we lost Commander Hannon to suicide, we
    can learn from his story and from others to further the
    conversation in awareness and prevention through action, action
    like the passing of this bill. While we support S. 785 as
    currently written, we appreciate the House Veterans' Affairs
    Committee's research-based additions surrounding mental health,
    and are open to exploring those recommendations in the future.
    We strongly urge that the committees in both chambers of
    Congress move expeditiously to reconcile their versions of S.
    785 to ensure that this important legislation is passed before
    the end of the 116th Congress.
        Thank you, Chairman Moran, Ranking Member Tester, and
    distinguished members of the Committee for your commitment to
    this difficult subject and for continually keeping veterans at
    the core of your mission. It is my privilege to represent The
    American Legion before this Committee and I look forward to
    answering any questions you have.

        [The prepared statement of Ms. Purswell appears on page 33
    of the Appendix.]

        Chairman Moran. Ms. Purswell, thank you very much for your
    testimony and thank you to The American Legion.
        I now recognize Mr. Butler.

                       STATEMENT OF JEREMY BUTLER

        Mr. Butler. Chairman Moran, Ranking Member Tester, and
    distinguished members of the Committee, on behalf of Iraq and
    Afghanistan Veterans of America and our more than 425,000
    members, I would like to thank you for the opportunity to
    testify here today.
        For nearly a decade, IAVA and the veteran community has
    called for immediate action by our Nation's leaders to
    appropriately respond to the crisis of over 20 military and
    veterans dying every day by suicide. Thanks to the courage and
    leadership of veterans, military family members and our allies,
    there has been progress, but the tragedy continues.
        According to VA data, post-9/11 veterans aged 18 to 34
    continue to have the highest rate of suicide. And while not
    always an indicator of suicide, mental health injuries continue
    to disproportionately impact the post-9/11 generation. In our
    latest Member Survey, 65 percent of IAVA members reported
    service-connected PTSD and well over half report anxiety or
    depression. Over 60 percent know a post-9/11 veteran who
    attempted suicide or who died by suicide, an alarming 22
    percent increase rise since 2014.
        Every day we are losing more of our brothers and sisters to
    suicide. IAVA will continue to maintain our leadership in
    fighting to bring these numbers down.
        In March, I testified before a joint hearing of the Senate
    and House Veterans Affairs Committees on IAVA's Big Six
    priorities for 2020. The number one issue for IAVA was and
    remains our Campaign to Combat Suicide and the centerpiece of
    that campaign is the legislation we are talking about today,
    the Commander John Scott Hannon Veterans Mental Health Care
    Improvement Act. IAVA is extremely proud to have worked with
    both Chairman Moran and Ranking Member Tester on this landmark
    legislation, and we thank them for their important leadership
    on this critical issue.
        In March, I applauded this Committee on its unanimous
    passage of S. 785, urged your House colleagues to follow, and
    for the President to sign it into law. I am here today to
    reiterate our strong support for this legislation and to thank
    the Committee again for your action which led to unanimous
    passage out of the Senate a month ago.
        The primary message I want to deliver today is to
    reemphasize my belief that it would be completely irresponsible
    if the 116th Congress ended its legislative work this December
    without having at least passed the Commander Hannon Act. There
    has been plenty of talk but not nearly enough action to address
    the worsening crisis of veteran and military suicide, and we
    are literally at a crossroads. 2020 can be the year where we
    join together to pass much-needed legislation to take the next
    big step to combat this crisis.
        However, IAVA is deeply concerned for the current path
    forward for the Commander Hannon Act. While we appreciate the
    House Committee's well-intentioned efforts to add new
    provisions to the legislation, we have strong concerns that
    given the limited number of legislative days and the upcoming
    elections, there will likely not be enough time to negotiate
    and pass this legislation by the end of the year. We believe
    that the best and most responsible way forward for our Nation's
    veterans is for the House to take up S. 785 as passed
    unanimously by the Senate. Following enactment, we strongly
    encourage the Committees to consider additional provisions in a
    new package of legislation.
        While passage of the Commander Hannon act will go a long
    way in improving the delivery of mental health care to our
    veteran community, we know that our job will still not be done.
        Thank you again for the opportunity to share IAVA's views
    and to express the importance of passing the Commander John
    Scott Hannon Veterans Mental Health Care Improvement Act this
    year. I look forward to answering your questions and continuing
    to work with the Committees. Thank you.

        [The prepared statement of Mr. Butler appears on page 38 of
    the Appendix.]

        Chairman Moran. Mr. Butler, thank you very much for your
    clear testimony.
        I now recognize Mr. Lorraine for his testimony for five
    minutes.

                       STATEMENT OF JIM LORRAINE

        Mr. Lorraine. Chairman Moran, Ranking Member Tester, and
    members of the Committee, thank you for the invitation to
    testify today. I would like to ask that my written testimony
    and our joint letter from August 18, 2020 be added for the
    record.
        Since the 116th Congress convened on January 3d, 2019, the
    President, the Department of Veterans Affairs, and both the
    Senate and House VA Committees committed to addressing the
    veteran suicide epidemic. In those 615 days, approximately
    12,300 veterans died by suicide, and despite increasing the
    VA's suicide prevention budget to stem veteran suicides, the
    number continues to rise.
        In the last 18 months, the President signed an Executive
    order to prevent veteran suicide, the VA established the
    PREVENTS Task Force, and the Senate passed one of the most
    impactful veteran suicide prevention bills of the last 10
    years, yet we continue to lack a comprehensive, integrated law
    that can be implemented by the VA to end veteran suicide.
        In early August, America's Warrior Partnership and 30 of
    our community partners provided this Committee and the House VA
    Committee a letter strongly supporting Senate bill 785, also
    known as the Commander John Scott Hannon Veterans Mental Health
    Care Improvement Act of 2019.
        Senate bill 785 is essential in both breadth and depth to
    getting upstream of veteran suicide. Innovative is the
    integration of community grants to proactively connect with
    veterans before the crisis of suicide, combined with community
    enablers such as research studies correlating opioid related
    deaths; programs providing veteran access to complementary and
    integrative health services through animal therapy,
    agritherapy, sports, post-traumatic growth, and recreation
    therapy; research on mental health biomarkers; and increasing
    the capacity of VA and Vet Center counselors.
        Solving the veteran suicide crisis requires a holistic
    solution. Veterans, their families, and the Nation are losing
    hope that the government will act, especially during these
    unknown times. You have done your job, and I hope the House of
    Representatives will pass Senate bill 785 immediately.
        The need is now and the need is great. America's Warrior
    Partnership is leading a nationwide veteran suicide study
    called Operation Deep Dive. In partnership with the University
    of Alabama and funded by the Bristol Myers Squibb Foundation,
    this four-year study is showing that some of the States
    undercount veteran suicides by as much as 25 percent. To date,
    we have learned that suicide amongst those dishonorably
    discharged is far less than those honorably discharged
    veterans, veterans younger than 64 die from all causes of death
    at a rate four times greater than non-veterans, and sadly,
    veterans between the ages of 18 and 34 die at a ten times
    greater rate than non-veterans.
        I would like to publicly thank Karin Orvis and her suicide
    prevention team at the Department of Defense for partnering
    with us as we peel back another layer of the suicide onion.
    Without DoD, these findings would not be possible. Operation
    Deep Dive is currently working with four State datasets, and we
    welcome incorporating the Committee members' States in the
    future.
        Operation Deep Dive seeks to provide communities insight to
    help them get upstream of veteran suicide, to increase the hope
    and quality of life for veterans and their families. Getting
    upstream is reducing homelessness, increasing access to
    reliable transportation, maximizing educational opportunities,
    working in sustainable employment, increasing volunteer
    opportunities, and having access to 22nd century physical and
    mental health care. Getting upstream is achieved when veterans
    look to the future with hope. But again, on this issue, time is
    not our friend.
        Our nation's veterans and their families provided their
    opinion through our program Mission Roll Call. When we asked
    over 600,000 veterans and their families, we learned that 95
    percent do not believe our country is doing enough for the
    mental health of our veterans; 77 percent do not believe that
    dishonorably discharged servicemembers should receive VA health
    care, and 86 percent feel that the VA must partner with non-
    government organizations to prevent veteran suicide.
        In summary, the time to act is now. Senate bill 785 is the
    right bill for right now. I join the leaders of our country's
    largest veteran collaboratives in urging the House of
    Representatives to adopt and pass 785 immediately.
        I am hopeful, hopeful for our military, hopeful for our
    veterans, and hopeful for our success in ending veteran
    suicide. Thank you for the opportunity to present to the
    Committee.

        [The prepared statement of Mr. Lorraine appears on page 40
    of the Appendix.]

        Senator Sullivan [presiding]. Thank you, Mr. Lorraine. I
    appreciate your passion on the issue.
        Mr. Kuntz, you are now recognized for five minutes.

                       STATEMENT OF MATTHEW KUNTZ

        Mr. Kuntz. Chairman Moran, Ranking Member Tester, and
    distinguished members of the Committee, on behalf of NAMI, the
    National Alliance on Mental Illness, I would like to extend our
    gratitude for the opportunity to testify on the Commander John
    Scott Hannon Veterans Mental Health Care Improvement Act. NAMI
    is the Nation's largest grassroots mental health organization
    dedicated to building better lives for the millions of
    Americans affected by mental illness. NAMI applauds the
    Committee's dedication in addressing the critical issues around
    veteran suicide.
        I met Commander John Scott Hannon in the fall of 2013, when
    he retired from his service with the Navy SEALs to live on his
    family's homestead in Colorado Gulch, outside of Helena,
    Montana. Commander Hannon's family and friends called him by
    the name of ``Scott.'' I will use that name throughout this
    testimony.
        Scott and I met for coffee that fall because his mother,
    Gretchen, thought we might strike up a friendship. Neither
    Scott or I were especially social, and we struggled to find
    something to talk about. Thankfully, we realized that we both
    loved designing custom outdoor adventure gear. That mutual
    obsession formed the basis of what would become a strong
    friendship in the following years.
        Scott served in the SEALs from 1991 through 2012. He
    accrued major awards during this service and more than his fair
    share of hidden wounds that followed him back to his family's
    idyllic mountain hideaway. His journey towards recovery was
    courageous and it took years of persistent work.
        Scott was able to turn the tide against his post-traumatic
    stress injuries and alcohol addiction. He had amazing
    therapists and a broad traditional treatment team both in and
    outside of the VA that provided for his care. Scott benefited
    from the experience helping heal injured raptors at the Montana
    Wild rehabilitation center. He teamed up with the Montana VA to
    incorporate this type of experience into the inpatient, dual
    diagnosis treatment program. He worked to help document the
    outcomes of this important effort. I can imagine Scott's broad
    smile while looking at Section 203 of this legislation, which
    provides a pathway for research-proven complementary
    treatments.
        Scott was adamant that the system for caring for veterans'
    brain health issues needed to improve. Scott volunteered with
    NAMI in our efforts to support, educate, and advocate for
    Montanans who live with mental illness and their families.
    Scott also talked about how NAMI's Family-to-Family program
    helped his family better understand his condition and support
    his journey toward recovery.
        Through all the work to regain his health, Scott was able
    to hit the point in his recovery where he rebuilt the emotional
    bond with his daughter, Keira Vida Hannon White. I can still
    remember the twinkle in those eyes when he described how
    amazing it was to spend weeks of the summer of 2017 with her.
    Those wonderful weeks with Vida were the best weeks of Scott's
    life.
        Part of Scott's successful recovery after years of
    struggling and care was that his clinicians were finally able
    to diagnose and treat the bipolar disorder that was hiding
    behind the post-traumatic stress and alcohol addiction.
    Unfortunately, Scott's symptoms of bipolar disorder reemerged
    hard in the fall of 2017. Scott, his family, and his support
    system worked to help him overcome the mania that began the
    episode and the deep depression that followed, but we lost him
    in February 2018.
        Scott's family and I have cried and laughed together in
    remembering him. One of those conversations remains with me and
    is essential to understanding the Precision Medicine Initiative
    in Section 305 of this bill. Scott's sister, Kimberly Hannon
    Parrott, said, ``I just wish that we had known about the
    bipolar disorder earlier. Scott overcame everything else. He
    just needed more time to work on that one.'' I could not agree
    with her more.
        Scott had spent more than half a decade in intensive mental
    health and substance abuse treatment, both in the VA and the
    Department of Defense. How much different would his trajectory
    have been if Scott, his loved ones, and his care team knew
    exactly which mental health conditions he had at the beginning
    of his treatment, and what types of care they would respond to.
    Instead, the care and his recovery flailed for years with
    treatments that were not targeted toward one of his key
    conditions.
        I believe that Section 305 of this legislation will help
    more veterans receive the right care at the right time, helping
    to ensure that the hidden wounds of war will not take them away
    from their life and the people who love them. It will be a
    powerful and appropriate legacy to a dear friend who served
    this country honorably.
        Thank you again for the opportunity to testify in front of
    this Committee. Your attention to this issue means a lot to me,
    the Hannon family, and the NAMI organization. We look forward
    to working with you to save the lives of America's injured
    heroes, and I look forward to questions. Thank you.

        [The prepared statement of Mr. Kuntz appears on page 44 of
    the Appendix.]

                          SENATOR DAN SULLIVAN

        Senator Sullivan. Well, I want to thank everybody. It is
    Senator Sullivan. I am stepping in for Chairman Moran, as he is
    voting right now. I want to thank Chairman Moran and Ranking
    Member Tester for convening the hearing today. I think
    everybody knows it is Suicide Awareness Prevention Week,
    September 6 through September 12, and National Suicide
    Prevention Awareness Month, which is the month of September.
        You know, in my State, the great State of Alaska, we have
    more veterans per capita than any State in the country, but we
    also, unfortunately, have very, very high suicide rates,
    particularly among our veterans, and it has certainly been a
    priority of mine in the Senate to advance legislation that
    brings greater awareness and services to the devastation that
    too many of our finest fall sway to. As a Marine, it is a
    personal issue to me. I have seen it, unfortunately, up close
    and personal in some of my units, and certainly one of the
    first bills that I focused on as a new Senator was the Clay
    Hunt Suicide Prevention Act, which was focused on these issues,
    but we still have much more work to do.
        I want to thank the witnesses today. I know this is not an
    easy topic.
        The good news is S. 785, the Commander John Scott Hannon
    Veterans Mental Health Improvement Act of 2019, which I have
    co-sponsored--actually, over half the U.S. Senate has co-
    sponsored--was going to help us make progress. That legislation
    includes a bill I introduced, the Veterans Overmedication and
    Suicide Prevention Act. But this bill, the broader bill, has
    very strong support in the U.S. Senate, bipartisan support,
    because members recognize that we must not relent in our fight
    against the scourge of suicide among our military veterans and
    veteran populations, and it builds on the Clay Hunt Suicide
    Prevention Act. That was, I believe, the first bill I co-
    sponsored as a new Senator.
        So I think a lot of us, on both sides of the aisle, view
    this as must-pass legislation. I certainly hope the House
    leadership takes it up as soon as possible, and I urge all my
    colleagues who have connections, and we all do in the House, to
    make sure our House colleagues move on it, and we can send it
    to the President's desk where it needs to be signed into law.
        So let me begin with a couple of questions for our
    witnesses. Mr. Lorraine, can you please share with the
    Committee about the data you referenced in your testimony in
    regards to Operation Deep Dive, research progress, and how do
    you believe S. 785 can assist you in your efforts?
        Mr. Lorraine. Senator Sullivan, thank you, and thank you
    for all you do in Alaska. We have a great partnership with
    Alaska and we look forward to continuing it.
        To your question, the data that we have, we have, as I
    said, four datasets. The State of Minnesota and the State of
    Florida provided us all of their death data for the last five
    years, and through our partnership with the Department of
    Defense we send all of the names and social security numbers to
    DoD, who then provided us back with a confirmation of who
    served in the military, and then a little bit of a history of
    their service experience--their characterization, their
    discharge, their dates of accession and then their dates of
    discharge.
        What we have been able to do with that data, with the
    study, is to really get to not an aggregate data, aggregate
    records provided by the States, but individual records. So we
    know the person who died, when they died, how they died, and
    their causes, around suicide. But then we can also correlate it
    to their military service. That is how I am able to say, so in
    the State of Minnesota, where over the last five years they
    have only had three veterans with a dishonorable discharge who
    passed away, and none of them were from suicide. In Florida
    there was five in five years, and one was from suicide.
        We were fortunate to go through this. The next two datasets
    that we are looking at are Massachusetts and Alabama, and then
    teed up we have North Carolina, Wisconsin, Wyoming, Montana,
    Senator Tester, and Tennessee.
        How the 785, so I think your section, which is Section 102,
    about the opioid, what we see is because we can see all deaths,
    we can see not only those that were classified as suicide, we
    can see those that were classified as overdoses, and what the
    opioid impact is that are not counted as suicides. So opioid
    deaths from overdose that are not categorized by the coroner or
    medical examiner as suicide.
        I think it is important for us to get there. I think it is
    important for us to get to the impact of suicide shortly after
    transition from the military. One of the data points we are
    looking at right now is of those 18- to 34-year-olds who died
    within the last five years of discharge, 25 percent were by
    suicide. So I think one of the sections that you talked about
    is critical to that.
        Senator Sullivan. Well, I appreciate that, and that is the
    kind of data we need. Again, this Committee has been very
    focused on it, but those are sobering statistics that you just
    highlighted, that we all need to be aware of, so we can
    continue to focus our efforts in the Senate and in the Congress
    on this issue that really unites members here.
        I will now turn the questioning over to Senator Tester.
        Senator Tester. Thank you, Senator Sullivan. I know that
    Senator Brown has a hard stop in about 15 minutes so I will
    yield to him for his questions and I will follow him for the
    next Republican question. Thank you, Senator Sullivan.
        Senator Sullivan. Senator Brown.

                         SENATOR SHERROD BROWN

        Senator Brown. Thank you, Senator Tester, for your
    important work, all of you on this Committee.
        Over the years we have worked in a bipartisan way, as a
    number of people have said, to help improve access to mental
    health services. When the Senate passed the Commander John
    Scott Hannon Veterans Mental Health bill it is a step in the
    right direction. We should continue to push forward until that
    bill becomes law, as my colleagues have said.
        I wanted to ask the witnesses about veterans' health and
    mental health, especially during the COVID-19. My first
    question is to Deputy Director Purswell. Thank you for your
    testimony. You discussed Project ATLAS. In my State of Ohio
    there has been a push to have our county VSOs--we have a
    counter veteran service officer and an organization office in
    every single of the 88 counties--to use them as connection
    points for veterans and their families as they attempt to
    access VA care and benefits.
        Has VA asked you or others in the VSO community involved
    with Project ATLAS how VA can better connect to veterans during
    the pandemic by leveraging other organizations like county
    VSOs?
        Ms. Purswell. Thank you, Senator Brown. Yes, VA has been
    very forthcoming with contacting us and trying to help us in
    any way that we can, trying to identify locations that would
    best serve the veteran population. We have mostly been looking
    into the most underserved areas, rural areas, where we know our
    veterans struggle to find care or have difficulty getting to
    those locations that are very far away.
        So yes, VA has been in touch with us. We are continuing
    that conversation weekly. We are also speaking with Phillips
    and the ATLAS program providers that are helping us identify
    those locations, helping us identify what our needs are, what
    our infrastructure needs are, how we set up those locations,
    and really trying to get this pilot program underway, really as
    quickly as we possibly can, so that we can really blow this up
    and help as many rural veterans as we possibly can.
        Senator Brown. Thank you. Mr. Kuntz, thank you for your
    work with NAMI. As you know, in your home State of Montana you
    have one of the best advocates for veterans' mental health in
    the U.S. Senate, so you should be proud of that.
        During the pandemic we know that veterans have faced even
    more challenges, whether it is waiting because prescriptions
    are delayed. I talked to a disabled vet, a woman in Dayton, the
    other day, who for 15 years has gotten her VA prescriptions on
    the day she expected. She is given a tracing number by the
    Postal Service and the VA. Because of the change in the Postal
    Service, that seems to have been disrupted. She is not getting
    what she has needed. So those are some of the sort of unforced
    errors that veterans have faced.
        Each of those kinds of issues could be an additional mental
    health stressor for a veteran. What advice would you give
    veterans who are facing additional mental health stresses
    during the pandemic? How can the Department better meet
    veterans' mental health challenges at this time?
        Mr. Kuntz. Senator Brown, thank you so much for your
    question and for highlighting Senator Tester's work. We have
    worked together for years and I am really grateful for that.
        When we talk to people that are really struggling right
    now, and there are so many, we just say, ``Don't give up.'' You
    know, the main thing is we will get through this, and there are
    places that will help. And then it is really important, no
    wrong door. You go to the VA, you go to the Vet Center, you go
    to that FQHC or the Rural Health Center, but you find a place
    to go. And if it is that emergency department, find something
    to engage in. There are online apps. This is a tremendous
    struggle, but there are options. And I just tell people, try to
    engage. Try to keep going. And the reality is sometimes they
    cannot, but I do think that there is still a lot of work to do.
        Senator Brown. Thank you, Mr. Kuntz. I just want to thank
    you again, Senator Tester, for yielding the time. I want to
    close by saying I hope we can join together as members of this
    Committee in expressing outrage and disgust at the comments by
    the President that were confirmed by multiple news outlets last
    week. I look at this Committee and you cannot tell the
    Democrats from the Republicans of this Committee, whether it is
    Senator Manchin or Tester or Rounds or Sullivan or Moran.
        There has always been, in the Committee, and in the Senate,
    a deep reverence for servicemembers who made the ultimate
    sacrifice, and that is what makes the President's comments
    particularly outrageous. These are Americans who have laid down
    their lives because they love what this country stands for, and
    they understanding something this President never has, the idea
    of service, of giving your all, something greater than
    yourself.
        So they were moms and dads and sons and daughters and aunts
    and uncles and colleagues to some of us. Senator Inouye and
    Senator McCain stand out. Senator Duckworth today, but so many
    others. Our veterans deserve better than those comments from
    the President.
        So I yield back time. Thank you, Senator Tester.
        Chairman Moran [presiding]. Senator Brown, thank you very
    much. I recognize Senator Boozman.

                          SENATOR JOHN BOOZMAN

        Senator Boozman. Thank you, Mr. Chairman. Mr. Lorraine, in
    your experience with community collaborative programs, how
    helpful would grants be to community organizations when it
    comes to outreach, to servicemembers, veterans, and their
    families? How have some of your community organizations used
    grants successfully in the SSVF program to address veteran
    homelessness, and do you believe the grant program in S. 785
    can replicate the SSVF program's success to reduce and prevent
    veteran suicide?
        Mr. Lorraine. Senator Boozman, thank you so much for the
    question. It is great.
        When we were started--by the way, we are based out of
    Augusta, Georgia--but when we were started one of our key
    successes was the SSVF grant. The SSVF grant not only provided
    us with the funding from the VA to plus up our manpower to do
    outreach and engagement, and at the time when we started in
    Augusta, Georgia there were 157 homeless veterans. But really
    what the grant provided was the authority to work in
    collaboration with the VA. So the funding was important but
    that authority was key, because now our teams, our staff, could
    work in conjunction hand-in-hand with the VA staff.
        I will tell you that within two years we had the homeless
    number in Augusta, Georgia, down to seven. So we went from 157
    homeless veterans down to 7 in 24 months, and it was because of
    the SSVF grant, the funding that it provided, but more
    importantly, the authority it gave us, as a nonprofit, to work
    with a government agency such as the VA.
        Senator Boozman. Very good. That is remarkable. We had a
    similar situation in Arkansas, which just shows the importance.
        Mr. Lorraine. Yes, sir.
        Senator Boozman. Your Operation Deep Dive, getting the data
    that you mentioned, for example, 25 percent of newly
    transitioned veterans who die within five years of discharge
    die by suicide, and some of the other statistics that you
    mentioned. Can you explain your work with DoD and how you
    capture the data and provide the Committee recommendations on
    how we may be able to work better with DoD and VA in the future
    regarding the challenges facing transitioning servicemembers?
        Mr. Lorraine. Yes, sir. Thank you. So, you know, I have to
    thank Florida and Minnesota for starting us off. Florida and
    Minnesota provided us, as I said, the full dataset for all
    their deaths in the last five years. With that, DoD was able to
    confirm who actually served and who did not. We were more
    interested in--our goal was veterans, but what we looked at was
    what former servicemembers died in those States in those five
    years, and then we drilled in from there.
        I think DoD is key. We have never been able to do this, and
    from what we have seen it has not been done before. Without
    them we could not have done it.
        But the next piece that we have is the VA. And so one of
    the things that we are seeking to work with the VA on is a
    data-sharing, is to confirm of those former servicemembers who
    died, how many of them were enrolled in VHA, VBA, or both, so
    that we can come back and say, all right, let's look at what we
    have been talking about, of the 20, 16 are not in the VA. We
    just wanted to be more exacting in the work that we do, and I
    think this helps us get there.
        Again, one of the big pieces in the big successes that we
    have seen in Operation Deep Dive is the fact that we are
    sharing data securely, through research entities, to get to a
    better understanding of veteran suicide.
        Senator Boozman. Yes, and that is so important, and
    congratulations and thank you for the great work that you are
    doing in that regard. To solve a problem you have to have the
    information as to what the extent of the problem is to begin
    with, so that is very, very helpful.
        I just want to thank the rest of the panel for the great
    work that they are doing, and thank you, Mr. Chairman and
    Senator Tester, for getting this great group together with such
    an important subject.
        Chairman Moran. Senator Boozman, thank you very much. Thank
    you for your leadership chairing MilCon/VA, and we look forward
    to continuing to find the right results for those who served
    our country, in this arena and others.
        Senator Tester, I believe you yielded your time. It is your
    turn.
        Senator Tester. Chairman Moran, I am going to yield to
    Manchin and go after the next Republican. So Joe Manchin.
        Senator Boozman. Such a servant leader.
        Chairman Moran. Senator Manchin.

                          SENATOR JOE MANCHIN

        Senator Manchin. He is our leader. That is for sure. And
    thank you, Senator Tester. I appreciate it very much.
        This is to everyone on the panel. On average, one West
    Virginian dies by suicide every 24 hours. In a recent report by
    the Centers for Disease Control and Prevention, the Mountain
    State has experienced a 37 percent increase in suicide deaths
    since 1999, and there is no group more impacted than our
    military veterans.
        The Department of Veterans Affairs estimates that more than
    17 veterans die by suicide every single day across the United
    States, 20 a day if you include military members. That means
    that the suicide rate among veterans is nearly twice that of
    the general population, and for some groups like the 18- to 34-
    year-old groups it is increasing rapidly.
        It is a national tragedy. I think we all agree on that. The
    brave men and women who have fought for our country and have
    served, risked their lives for our nation deserve nothing less
    than the very best we can offer. So I am proud to be an
    original co-sponsor of Senate bill 785, which would give a new
    approach, and I join our colleagues in calling for the House to
    pass the bill also.
        My question would be, what do you think, or why do you
    think the VA's efforts to date have not reduced the 17 suicides
    per day? I know that we have all seen it and we have all
    acknowledged it, but nothing has worked to date. Can you give
    me any reasons, if anyone wants to speak up, of what we have
    not accomplished and what we could do better?
        Mr. Lorraine. Senator Manchin, if you do not mind me
    stepping in, and my other panelists.
        Senator Manchin. Please.
        Mr. Lorraine. This is Jim Lorraine from America's Warrior
    Partnership. I think that the key is knowing who the veteran
    is, first and imperative, the relationship. I think suicide
    prevention is holistic. It is relationship based. The fact that
    in the most recent study 16 of the 20 were not enrolled in the
    VA. Those are veterans who are outside the VA system, they are
    not seeking assistance, they are not asking for help, and it
    takes getting into the community, getting to know who the
    veterans are.
        To Senator Brown's point, in Ohio, the county VSOs are key.
    I think county VSOs are important. I think the big VSOs are
    important. I think all of us working together to get to know
    who the veterans are, build a relationship, connect them to the
    services that they need, and then help them move forward in
    their life.
        Senator Manchin. Let me say one more thing if I can, and
    anybody can jump in on this also. One of the first lines of
    defense that we have preventing veteran suicide is the Veterans
    Crisis Line and the National Suicide Prevention Lifeline. That
    number is 1-800-273-8255. How many veterans or family members
    or caregivers do you think have that number memorized? How many
    do you actually think could have that number ready to dial
    during a time of crisis? I would hate to say that I do not
    think many do, or know that number by heart, which is why I
    have advocated, with my colleagues, for a three-digit dialing
    code for hotline.
        I am pleased that the FCC followed our calls and approved
    988--I repeat, 988--as the three-digit dialing code for the
    Veterans Crisis Line and National Suicide Prevention Lifeline.
    Again, that number will be 988. It will go into effect on July
    16, 2022.
        What does the VA and the Veterans Crisis Line need to do to
    prepare to launch 988? It might be the first time some of you
    have heard. I do not know how well it has been publicized. But
    it is something that we desperately need, and we are hoping
    that you all would jump right in.
        Mr. Butler. I am happy to add to that, Senator Manchin. I
    completely agree and would support that lifeline, absolutely.
        I think one of the things that we at IAVA find is that many
    veterans, and especially veteran family members, do not know
    who to reach out to in a time of crisis. I think more often
    than not we get people that realize that a family member, a
    friend, maybe the veteran himself, is in a time of crisis, but
    they do not know where to turn to. They do not know how to turn
    to that.
        We have program called the Quick Reaction Force, and since
    its foundation in 2012, one of the top reasons why veterans and
    their family members reach out to us is for help connecting to
    mental health options that they can turn to. Sometimes it is
    because they do not want to use the VA. Maybe they have had a
    bad experience. So S. 785, we really support the grants option
    to that, because I think it can get community support services
    where local people can realize where they can turn to and get
    veterans help in a quick and timely manner. Thank you.
        Senator Manchin. I thank all you panelists for what you do.
    I mean, we are all so patriotic in our State and every State,
    and we are, as Americans, very patriotic. But there are
    somewhere close to 40,000 nonprofits that work for veterans in
    some way, shape, or form. That is in addition to what the VA
    and all the other public organizations that deal with veterans'
    issues.
        So I would say, what have we found, whether it be a
    program, an intervention, treatment, therapy, et cetera, that
    is actually proven to prevent veteran suicide? What do we know
    that works, and what evidence-based research is out there that
    shows links between intervention and lower veteran suicide? So
    anybody that would have any comments on that, that will be the
    end of my questions. Again, I want to thank you, Senator
    Tester, for being so kind, and I would like to hear anybody
    have any thoughts on what we can do to make the system we have
    working. Forty nonprofits are concerned about this.
        Mr. Kuntz. Senator Manchin, one of the things that I think
    is really exciting about this bill is that emergency department
    measure, and that is a research-proven program that has been
    worked on for 10 years. It has now become one of the top two
    clinical priorities for the VA. That is a place where we can
    connect with veterans who are in need of suicide, there is no
    question why they are there, and deliver that intervention. It
    cannot be delivered through telehealth. This bill has a report
    to help support that.
        Right now the VA has the goal of expanding that out to 94
    percent of VA emergency rooms. Personally, I believe that needs
    to be in every emergency room in the country, because it is a
    proven intervention, and with what we can do with telehealth
    right now there is no reason it should not be right there and
    accessible every time a man or woman walks into the emergency
    department in crisis. Thank you, sir.
        Senator Manchin. Thank you all so much. I appreciate your
    service. Thank you.
        Chairman Moran. Thank you, Senator Manchin. Senator Rounds.

                          SENATOR MIKE ROUNDS

        Senator Rounds. Thank you, Mr. Chairman. First of all I
    want to just say thank you to everybody on this panel. This is
    a very important issue and I thank the Chairman and the Ranking
    Member for them bringing it to our attention and also to try to
    promote the passage of this in the House of Representatives
    before the end of the year.
        My first question is for Ms. Purswell. First of all, I want
    to thank you for your service in the United States Army and for
    being here today to represent The American Legion. In your
    written testimony and your remarks you talked about the
    importance of Project ATLAS. This is where the Legion is
    partnering with the VA to install technology at Legion posts in
    rural areas to make sure veterans have access to telehealth.
        Based on your expertise, if S. 785 does not get passed in
    the House and then sent to the President's desk, what kind of
    an impact will this have on access to mental health care for
    our rural veterans?
        Ms. Purswell. Thank you for your question, Senator Rounds.
    If this bill does not go forward I would like to say that we
    will strongly pursue every method that we can to make sure that
    ATLAS and our service with VA is continued and pushed and
    expanded as much as we can. However, without this bill and
    without the help of grant money dedicated to expanding that
    program, it will slow. It will slow. We will not be able to get
    the infrastructure in. We will not be able to get all of the
    things that we need to get in, whether it is the ADA compliance
    needs, the broadband infrastructure, the tablets that are
    needed, the staffing that is needed. All of those things take
    money. And while The American Legion was happy to give our own
    grant to get the Springfield, Virginia, location up and
    running, we do not have the ability to continue to do that for
    other locations.
        So it is vital that this bill get passed so that we can
    have those funds allocated, to make sure that our rural
    servicemembers can get the care that they need, whether it is
    mental health care or any other kind of comprehensive medical
    care that they need. We are really pulling for it.
        Senator Rounds. Well thank you, and I could not agree with
    you more. I think this is really important. In so many parts of
    our country, the rural parts of our country, telehealth is not
    only accepted, it has now become the norm, in many cases. And
    so this would be very beneficial, I believe, to our rural
    communities in South Dakota as well as the Great Plains region.
        My second question is for Mr. Butler. Mr. Butler, thank
    you, first of all, for your 20-plus years of service in the
    Navy and Naval Reserve. You called attention to a sobering fact
    that veterans aged 18 to 34 have the highest rate of suicide.
    That really struck me because in South Dakota we have over
    11,000 veterans under the age of 40.
        So I would like to know, what are a couple of the
    provisions in S. 785 that you find most helpful to preventing
    suicide among our younger veterans?
        Mr. Butler. Thank you, sir, for the question. Yes, as I
    mentioned earlier, I think, briefly, I think one of the biggest
    provisions that we support is the grants going to community and
    local providers. I think that is one of the biggest ways in
    which we can bring this number of 20 a day down, by providing
    resources in the local community where veterans and their
    family members and their friends will know about them. When the
    veteran gets to a time of crisis they are not going to have to
    struggle to find where they can turn for help.
        I think one of the other issues, and why, perhaps, the
    number is so high for the younger cohort of veterans, and the
    provision that would help that, is the work to connect and
    research the possible connection between TBI, PTSD, and mental
    health problems. As we know, TBIs are a signature wound of war
    from the last 20 years, and I think better understanding the
    connection to mental health problems, potentially to suicide
    and things like that, would really go a long way to helping us
    solve this problem.
        Senator Rounds. Thank you, and I think you hit it on the
    head, and I think that it is very important that we draw
    attention to TBI and the possible connections with the mental
    health challenges and with the attempted suicides and suicides
    with this younger generation. So I thank you for your service
    and I thank you for the insight that you bring to the Committee
    today.
        Mr. Chairman, thank you.
        Chairman Moran. We will see if Senator Tester wants to be
    gracious one more time. Senator Tester?
        Senator Tester. No, I have got a hard stop too so I am
    sorry. But I do want to say thank you, Mr. Chairman. And
    listen, I have listened to the folks who have given testimony.
    Veterans are very, very lucky to have the four people who gave
    testimony today on their side. I cannot think of four better
    advocates for veterans than the folks who have testified in
    front of this Committee today. And I just want to say thank you
    all very, very much for not only your testimony but what you do
    every day to try to solve problems for veterans, and in this
    case, a very, very important problem, maybe the most important
    problem that we are facing right now amongst our veterans.
        Matt Kuntz, who I have known for a good long time now, is
    somebody that I think the people on this Committee need to
    know, that every time he is hit with adversity he turns it into
    a net positive. And I have seen it time and time and time
    again, and the suicide of John Scott Hannon is another prime
    example of Matt Kuntz going to work and trying to make the best
    out of a really, really bad situation.
        And so I am going to start with some questions for you,
    Matt. I know we need to continue to make improvements to
    quality and timeliness in mental health provided by the VA, and
    I do believe this bill, through your good work, I might add,
    hits that mark. And I want to thank you and NAMI for urging the
    House to seize this opportunity to getS. 785 passed. Scott, as
    you have already referenced, was a friend of yours, and you
    have already shed a lot of light on it. But I just want to have
    you talk a little bit about Scott's involvement in community
    mental health organizations and how the provisions of this
    legislation would further those efforts of mental health
    organizations to help fellow veterans.
        Mr. Kuntz. Okay, sir. Thank you. And I could say, you know,
    Scott's work with us, we were a community health organization.
    We were exactly the kind of nonprofit that these kind of funds
    could go to. Our relationship got really--went beyond the
    professional pretty quick. I know he really did engage with his
    local AA group.
        You know, there were a lot of different folks that were
    there for him, and even like the non-traditional support
    through his involvement with Lewis and Clark County Search and
    Rescue. Two weeks before he died, Scott saved the life of a
    young college kid that jumped in at the Passion Plunge, wearing
    a banana suit. And, you know, it was just one of those things
    that even at his worst times he was able to help others, and
    those community organizations allow our veterans to do that.
        Senator Tester. Thank you, Matt. I have a question for Mr.
    Lorraine, and it goes back to the conversation that you had
    with Senator Sullivan, and I do not know that we have ever
    heard it in this Committee before. But I think the answers to
    his questions would indicate--and the testimony too--would
    indicate that we are undercounting the number of suicides,
    maybe pretty significantly.
        I just want you to kind of flesh that out. Am I reading
    what you said wrong, or do you believe that the suicide rate is
    much higher than we are counting?
        Mr. Lorraine. Senator, thanks. Great question. I think that
    based on the data that we have collected to date, it indicates
    that the suicide rate is higher than we think it is. What we
    are doing is as we are aggregating more States together, you
    know, you get a bigger numerator and it sort of balances out so
    that you can say yes in the country.
        But the third-largest State for veterans in the United
    States was 20 percent undercount, and Minnesota, which is one
    of those smaller States, was 25 percent overcount. Alabama
    looks like it is going to be an undercount also, in the 20
    percent mark.
        So the point is, yes, I think it is higher than we think it
    is. I think we do not know as much about veteran suicide as we
    think we do, and I think that we need to dive deeper into
    understanding the community factors of veteran suicide and how
    they relate to the outcomes. So to Matt's point, Scott had a
    great community wrapped around, but what was the last year of
    his life? What did it look like and how could we have
    intervened somewhere in that? That is another part of Operation
    Deep Dive.
        Senator Tester. Well, I think that point further
    exemplifies the fact that we need to get the House to move on
    this bill, and we want it quickly. The more tools we have out
    there in people's hands who can utilize them to help veterans,
    the better off we are going to be. And I think if nothing else
    has happened today, it just shows that we have no time to wait
    here. We have got to get this done.
        Katie and Jeremy, I just want to say thank you. I have got
    a bunch of questions but there are other people on this
    Committee that want to ask them. But I just once again want to
    thank you all for your advocacy. It is stellar. Thank you.
        Chairman Moran. Senator Tester, thank you very much. I
    recognize Senator Tillis.

                          SENATOR THOM TILLIS

        Senator Tillis. Thank you, Mr. Chair and Ranking Member
    Tester, and I thank the panel for being here. If I had time I
    was going to ask this question on the end but it touches on
    what Senator Tester finished on. I understand that we are going
    to have a markup in the House this Thursday, I believe. I also
    understand that the Chairman of the House Committee is going to
    introduce or allow the introduction of some 35 amendments.
        And I would like to know, to the extent that you all have
    done the research, if there are any of those amendments that
    you think are particularly helpful or particularly harmful to
    getting this to the President's desk. And we will start with
    Mr. Butler.
        Mr. Butler. Thanks, Senator. Yes, I would say kind of
    quickly, and to give the others time, we are not against what
    the House is trying to do. Our concern is that we are running
    out of time. We have been working on this for so long. You know
    that. We appreciate what the Senate has done. We, and so many
    VSOs, have been and are behind passage of the Commander Hannon
    Act.
        Senator Tillis. Mr. Butler, that is the reason for my
    question. There are very few things that go through this
    Committee that I ever have an objection to. I am worried about
    runway at the end of Congress, and also whether or not the
    amendments can be viewed as being additive to the core of what
    we are trying to do with Senate bill 785. If there are other
    good ideas then I would not necessarily want to attach it, you
    know, as a vehicle for getting something done at the expense of
    getting nothing done.
        Anyone else on the panel have any comments?
        Ms. Purswell. Yes, sir. This is Katie from The American
    Legion. The American Legion, we are really passionate about
    research, and we really strive to identify the gaps in care in
    order to be able to confidently support legislation like S.
    785. We did extensive reviews of the House 35 additional
    sections, or sections that were pulled out that they did, and
    we are very much in support of all of the efforts that they
    have put in there for research, and we really want to be able
    to partner with them in the future to be able to get those
    passed.
        However, we really do feel the need, as everybody else,
    that this bill gets passed in the 116th Congress. But again, we
    really do appreciate the work that they put into those
    additional pieces of legislation, and we really hope that they
    stick with it for the next Congress so that we can revisit
    those.
        Mr. Lorraine. This is Jim Lorraine. You know, just to
    answer your question, Senator Tillis, you know, we asked
    600,000 veterans and their families, and 77 percent do not
    believe that dishonorably discharged should have access to VA
    health care. I do not know if everyone understands what a
    dishonorable or a bad conduct discharge entails in terms of
    punitive action and court martials and the extent of murder,
    rape, pedophilia, et cetera. But they are pretty serious crimes
    and I think when you open that up, that is in one of the bills
    that the House is proposing.
        For us, we also look at Senate 785 allows communities to
    identify the best way that they should approach doing
    community-based care. The House companion mandates its
    collective impact, which works in some areas but does not work
    in rural areas. That has been well documented.
        So if there are two things that we would focus on it would
    be those two. But to go to what my colleagues have said, my
    fellow panelists, 785 is a fully packaged, integrated bill.
    What I like is that it is built on each other. And I just do
    not see that on the other side.
        And then I think most American people are not sure what is
    going to happen in Washington, DC within the next month to two
    months, and what they are interested in is let's get a bill
    passed while we know where we stand, before we get into a point
    post-election where it may be delayed out--a vote may be
    delayed out and get us past the 116th Congress. And then we
    have to start from scratch again.
        This is the right bill for right now. That is the reason
    why we support it.
        Senator Tillis. Thank you. Any other comments from the
    panel, the virtual panel?
        Mr. Chairman, I used all my time on that one question, but,
    you know, when you have thousands of veterans dying every year,
    losing their lives to suicide, I believe there are a lot of
    great ideas that we should work on. But just exactly what Jim
    said there toward the end, this is an integrated bill. If there
    are amendments that make it better, that focus on the core
    objectives of this bill I think that they would be welcomed.
    They would probably make it through conference fairly quickly.
    But if this becomes a vehicle for other matters that are very
    important, you can take a very impressive list of VSOs that
    support this bill and have it fragment, and then thousands more
    lives may be lost because we are not getting this core bill
    through.
        So I just encourage my House colleagues and all the VSOs to
    go in and think about how does this make this foundation, this
    bill foundation better, and then let's work on all the other
    things. We will never fully repay the debt. We are making
    installments every time we do something here. I think this
    would be a major installment if we could move it through
    quickly in this Congress.
        Thank you, Mr. Chair.
        Chairman Moran. Senator Tillis, thank you very much, and
    perhaps even more importantly, thank you for teeing up our
    witnesses and the comments they made in response to your
    question. Those comments were very helpful and needed.
        Perhaps this is a point in which I should say that we have
    ongoing conversations with the House Veterans' Affairs
    Committee. My absence from time to time is an attempt to visit
    with Chairman Takano today. But on a staff level we have
    reached an understanding that the House will take up this bill
    on September 21st or 22nd, and pass it, presumably with the
    attempt to pass without any amendment. That is exactly what we
    are looking for.
        While Senator Tillis mentioned the concept of a conference
    committee, the delay that could occur as a result of any
    amendment to the bill in the short time that we have. We are at
    a stage in which we--it is our understanding that this is a
    bill that would be signed by the President and so would become
    law, and any delay in getting us to that position, in my view,
    costs those who served our country the potential loss of life.
        And we want our VSOs and community organizations, our
    research efforts, to have the tools that this bill, the John
    Hannon bill, provides. And so it is, again, my understanding
    that in return for that expeditious effort by Chairman Takano
    and the Ranking Member, Congressman Roe, that we will then make
    every effort to pass, by unanimous consent, a number of bills
    that are priorities of Chairman Takano related to this topic.
    Meaning that there are those that can pass by unanimous
    consent, and in addition to that we will work on ones that are
    less capable of being passed by unanimous consent, to be put in
    a package and considered by the Senate, all with the goal of
    passage, not just with the goal of consideration.
        So I do not know that Chairman Takano would be listening to
    this conversation at the moment, but I would convey to him,
    again, my commitment to see that there is a victory, not for
    the Senate Veterans' Affairs Committee, not for the House
    Veterans' Affairs Committee, but a victory for those who served
    our country, our veterans, and the organizations that are
    attempting to save their lives and provide mental health care
    and treatment, and to accomplish a goal that both Committees,
    both House and Senate, have in mind.
        There is no reason that whatever appreciation that comes
    from the passage of this legislation cannot be shared by those
    who serve on the Veterans' Committee in the House, and I will
    work in every way to accommodate the priorities that our staff
    have talked about today's, yesterday's, this week's
    conversations, of legislation that the Chairman of the House
    Committee is most interested in, and do what I can do in
    working with Senator McConnell, Republicans and Democrats, on
    this Committee, to see that there is a success in the items
    that that success could be achieved and avoid any kind of time
    delay in what we might be able to do in the Senate.
        I do know what the Senate's schedule is going to be, but a
    continuing resolution is in the works, and elections are
    pending. Nothing ought to stand in our way of protecting those
    who served--protect the lives of those who served our country.
    And again, I would reiterate to Chairman Takano, my goal is not
    a victory for the Senate Committee in passage of a bill that we
    passed, but to utilize this opportunity where a bill that
    passes, as rarely happens, 19-0 in this Committee and by
    unanimous consent of the United States Senate, to use that
    momentum to get us to a point that has long been awaited.
        So again, there are developments that appear to be
    concluded or concluding today, and I thank Chairman Takano for
    his willingness to work with us in accomplishing a goal that
    our witnesses and many other veteran service organizations find
    desirable.
        So thank you for your question, Senator Tillis, and thank
    you for the responses and the testimony of the witnesses here
    today, and many others in veteran service organizations around
    the country who are advocating for this opportunity to see this
    to final conclusion.
        I would recognize Senator Blumenthal.

                       SENATOR RICHARD BLUMENTHAL

        Senator Blumenthal. Thanks, Mr. Chairman. I appreciate
    those remarks, and if I can sort of encapsulate them in five
    sentences or less, we are going to get the job done, whatever
    the steps necessary to do it, counting on your leadership,
    which has been really admirable, on this bill. And I appreciate
    it both on your part and the Ranking Member's. We are going to
    get it done, and hopefully we will have the good faith efforts
    by the House, on amendments, if necessary, that are in
    accordance with the purposes of the bill.
        So I very much appreciate that statement, and it eliminates
    a number of the questions I was going to ask.
        Chairman Moran. Senator Blumenthal, that was my goal.
        Senator Blumenthal. We have worked together so well that
    you now read my mind.
        Chairman Moran. I allowed you to encapsulate my thoughts.
        Senator Blumenthal. Anyway, I really do appreciate your
    leadership.
        Let me just say that this exchange and the conversation we
    have been having with the witnesses here I think demonstrate
    the very strong bipartisan tradition of this Committee, our
    approach to these issues, which is to hold our veterans as
    heroes in the highest regard.
        Unfortunately, there have been statements by the President
    that I think belie that spirit. My recounting them is
    unnecessary for members of this Committee. I am sure you are
    aware of them. And I am also sure that you never would have
    called fallen heroes in cemeteries abroad ``losers'' or
    ``suckers,'' that you never would have precluded amputees from
    marching in any of our parades, and that you never would have
    called John McCain a loser.
        Nor am I in any way doubtful that you would have given the
    highest regard to John Scott Hannon, whose name is on this
    bill, and he, among all the members of our military who are
    driven by these invisible wounds, whether it is post--traumatic
    stress or traumatic brain injury or, as he did, suffer from
    bipolar disorder, to take their own lives. Still, 20 veterans a
    day do so.
        I authored a veterans' protection measure with John McCain.
    It was passed by this Committee a number of years. It was
    signed by then President Obama, with John McCain at his side as
    he signed the bill. I stood next to both of them. Think of it
    for a moment--two Presidential opponents, side by side.
    President Obama elected, Senator McCain the loser in that race.
    But the bigness and stature of his spirit, John McCain's
    spirit, I think was so powerful in the East Room on that day,
    and it is the spirit that should bring us together here.
    Unfortunately, it has not with the President.
        So I want to say that the Senate should be proud of this
    measure. We should be proud that we worked together on a
    bipartisan basis and that every member of the Senate deserves
    credit for it.
        I want to ask the witnesses a question about the Postal
    Service, which I understand my colleague, Senator Brown, asked
    as well, whether you have heard that there are delays in
    delivery of veterans' prescriptions. Eighty percent of all
    veterans' prescriptions are delivered by mail. Are you aware of
    these prescriptions being delayed by delays in the mail that
    may have occurred? And we can just go right down the line.
        Mr. Butler. Yes, sir. I will very quickly respond. We did
    an informal survey, admittedly, on Facebook, and got mixed
    responses. We certainly heard from veterans who said that their
    prescriptions were delayed but we also heard from many who said
    that they have not had any trouble whatsoever. My kind of
    takeaway, very briefly, is that I think in many respects it is
    regional, the results that you are finding.
        Senator Blumenthal. Thank you. Others?
        Mr. Lorraine. This is Jim Lorraine. America's Warrior
    Partnership runs a network that is connected to 302 communities
    throughout the United States. We have heard nothing from the
    communities nor from veterans about a delay in medicine.
        Senator Blumenthal. Thank you.
        Ms. Purswell. This is Katie from The American Legion. I
    just wanted to say that we have not, here at the national
    level, had any reports of our local levels stating that our
    members have been having delay in service with their
    medications. I can speak personally that my husband and I have
    both been receiving our medications on time. In fact, one that
    was supposed to be delayed ended up being shipped, I believe,
    UPS, which we were not expecting, and actually arrived earlier
    than we had expected. So for any issues that may be occurring I
    do believe they are trying to find ways around any types of
    delays.
        Senator Blumenthal. Why was it shipped by UPS?
        Ms. Purswell. I am not sure why it was shipped by UPS. It
    was something that he needed, and that they did not tell us
    why. They said there might be a delay. I am not sure if that
    was--they did not have it in stock, you know, at the local VA
    pharmacy. But we did receive it well ahead of time.
        Senator Blumenthal. Thank you.
        Mr. Kuntz. Senator, I have not personally worked with any
    veterans that have delays. I certainly have seen that in some
    of our Facebook conversations as well, but it is not something
    I can personally vouch for.
        Senator Blumenthal. Thank you. Thanks, Mr. Chairman. I just
    want to say that, you know, on the bill that we are
    considering, all of us know someone who has been affected. My
    State of the Union guest was the uncle of a young Marine named
    Tyler Reeb, who was a sniper deployed twice, took his own life,
    and he was certainly a hero, and his memory, I think, will be
    all of us who knew him in Connecticut. Thank you.
        Chairman Moran. Thank you, Senator Blumenthal. Senator
    Tester, anything further from you?
        Let me ask my usual question then. Do any of our witnesses
    have anything they would like to add, augment what they said,
    correct what they said, tell us something that we failed to ask
    them? Anything that you would like to make sure we hear before
    I conclude this hearing?
        Mr. Butler. I will just very quickly say on behalf of IAVA,
    thank you, sir. I think it would be incredible if we could come
    to that bipartisan result that you discussed, especially in
    this Congress, I think not only passing the Commander Hannon
    Act but if there are additional things that can be done, as I
    said in my testimony. We know that the Commander Hannon Act
    will not solve the problem of veteran suicide. It will make
    great progress in getting us there. But if we can do even more
    this congressional cycle I think that would be incredible. So
    thank you for your work.
        Chairman Moran. Thank you, Mr. Butler. Anyone else?
        Mr. Lorraine. Jim Lorraine.
        Chairman Moran. Yes, sir.
        Mr. Lorraine. Mr. Chairman, Jim Lorraine here. I wanted to
    thank you for the opportunity to speak. I wanted to thank you
    also for working with the House to hopefully reach a solid
    conclusion to pass this bill immediately.
        I think, you know, all of us working together have a big
    collaboration, but all of us working together--IAVA, American
    Legion, America's Warrior Partnership, our communities--and
    everyone else out there who wants to serve veterans is
    critically important. I think the addition in the bill of post-
    traumatic growth of equine therapy, of recreational therapy,
    and the importance in recognizing that. We do a survey every
    year and the top three things that veterans are seeking is
    sports and recreational activities, connection to other
    veterans, and volunteer opportunities. If this bill can help us
    get there, which it will, that would go a long way.
        Thank you, sir.
        Chairman Moran. Senator Tillis.
        Senator Tillis. Mr. Chairman, again I appreciate the work
    you are doing with the House Chair, and you can count me in to
    support these other measures that have merit but could slow
    down Senate bill 785. And I also just wanted to thank the
    minority staff. I hear that we are making great progress on the
    TEAM Act, which is something that I look forward to having the
    same outcome, with 30 veteran service organizations also behind
    that. So I just want to thank the staff for working together
    over the recess, and look forward to bringing that before the
    Committee. Thank you.
        Chairman Moran. Senator Tillis, thanks for your consistent
    dedication to that issue and all these veterans affairs issues.
        Any of our other witnesses?
        Mr. Kuntz. Yes, sir. This is Matt Kuntz and I just want to
    say one last thank you to everyone that was involved to help
    name this bill after Scott. I know it really means a lot to his
    family, especially to his daughter, Vida. And I also just want
    to say that both the majority and the minority staff have been
    remarkable to work with on this bill. I cannot say how just
    professional and in-depth they have went in on every single
    section. It is just an honor to work with them. Thank you, sir.
        Chairman Moran. I appreciate you saying both of those
    things. Thank you very much. I met Commander Hannon's family
    when this bill was introduced, with Senator Tester, and every
    suicide has a story. Every suicide involves a human being, and
    their moms and dads and brothers and sisters and sons and
    daughter, all are worthy of our recognition. And it was an
    honor to utilize this bill to recognize Commander John Hannon,
    and I appreciate the opportunity I had to get acquainted with
    his loved ones.
        Let me do just a couple of more things. First of all, in
    regard to the efforts to resolve the opportunity to pass the
    bill in the House, to our witnesses and other veteran service
    organizations, to NAMI and community organizations, our ability
    to do that has been helped immensely by your efforts and your
    work with the House Chairman and Ranking Member, and I thank
    you for that.
        I would also indicate to my colleagues that, first of all
    to the House, maybe, that we need the Senate bill 785 to pass
    as is, and I will work hard to get--excuse me, let me say it
    differently. I will get a list of those House bills that have
    been discussed as ones that can move initially by unanimous
    consent and others grouped to be packaged together for
    consideration by the Senate. I will work to get that list to
    colleagues on this Committee so that you can understand the
    direction that we are going.
        My assurance has been these bills that we have agreed to
    move are one that would have support of all four corners,
    Senator Tester and I as well as the House Chairman and Ranking
    Member, Mr. Roe.
        And then finally, let me take a moment. I am a House
    member. I was a House member. I remember--I smiled a moment ago
    because I remember thinking that when I was a member of the
    House Veterans' Committee we sent bills to the Senate where
    they died. I am not interested in that. I am interested in
    results.
        And it is especially a remembrance for me today, and maybe
    Senator Boozman will remember this, but the passing occurred
    this week of John Bradley, who was a Vietnam veteran, an
    advocate for veterans in a tireless way. He, when I chaired the
    House Veterans' Affairs Health Subcommittee, was my staff
    director. He has battled cancer for a long time. When he
    returned from Vietnam he went to work for the Department of
    Veterans Affairs, he worked for the Senate Veterans' Affairs
    Committee, and he was the House Veterans' Committee staff
    director as well. And I would use this moment to express my
    gratitude for this veteran who served other veterans.
        There is no one that I hold in higher regard than those who
    serve us in uniform, perhaps other than those who served in
    uniform and then served other veterans as well. And John
    Bradley did that in innumerable ways and in a consistent manner
    until his health prevented him from doing so. And so I use this
    moment to--probably unlikely that there will be another
    opportunity to express my gratitude to him for his service to
    our Nation, for his service to other veterans, and to pay my
    respects to him and to honor his family now, at the time of his
    death.
        Senator Boozman. Can I say, Mr. Chairman, that I----
        Chairman Moran. Senator Boozman.
        Senator Boozman [continuing]. Second that, and having
    served with you on the House Veterans' Affairs Committee and
    again getting to know him very, very well, you know, it is just
    a very sad thing. But we do appreciate his service in so many
    different ways, seeing his finger in so many different bills
    throughout the years. He had a profound impact for our nation's
    veterans. It is big deal.
        Chairman Moran. I appreciate you recognizing John Bradley.
    Thank you, Senator Boozman.
        I thank all the organizations who delivered their comments
    today in regard to Senate bill 785. I appreciate the important
    work you do each and every day in your partnership in serving
    those who served our Nation. I would ask unanimous consent that
    members be given five days to revise and extend their remarks
    and include any extraneous material. And with that our hearing
    is now concluded, adjourned.
        [Whereupon, at 5:05 p.m., the Committee was adjourned.]

                                A P P E N D I X

                              Prepared Statements

    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                           Statements for the Record

    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                        [all]