[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
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 9, 2020
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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
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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
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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
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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.]
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