[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

                               __________

       Printed for the use of the Committee on Veterans' Affairs
       
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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

                              ----------                              

                           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.]

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