[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


                INVISIBLE WOUNDS: PREVENTING SUICIDE IN
             OUR NATION'S MILITARY AND VETERAN COMMUNITIES

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

                                HEARING

                               BEFORE THE

                   SUBCOMMITTEE ON NATIONAL SECURITY

                                 OF THE

                   COMMITTEE ON OVERSIGHT AND REFORM

                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                           NOVEMBER 17, 2021

                               __________

                           Serial No. 117-53

                               __________

      Printed for the use of the Committee on Oversight and Reform
      
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                       Available on: govinfo.gov,
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                             docs.house.gov
                             
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
46-260 PDF                 WASHINGTON : 2022                     
          
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                   COMMITTEE ON OVERSIGHT AND REFORM

                CAROLYN B. MALONEY, New York, Chairwoman

Eleanor Holmes Norton, District of   James Comer, Kentucky, Ranking 
    Columbia                             Minority Member
Stephen F. Lynch, Massachusetts      Jim Jordan, Ohio
Jim Cooper, Tennessee                Paul A. Gosar, Arizona
Gerald E. Connolly, Virginia         Virginia Foxx, North Carolina
Raja Krishnamoorthi, Illinois        Jody B. Hice, Georgia
Jamie Raskin, Maryland               Glenn Grothman, Wisconsin
Ro Khanna, California                Michael Cloud, Texas
Kweisi Mfume, Maryland               Bob Gibbs, Ohio
Alexandria Ocasio-Cortez, New York   Clay Higgins, Louisiana
Rashida Tlaib, Michigan              Ralph Norman, South Carolina
Katie Porter, California             Pete Sessions, Texas
Cori Bush, Missouri                  Fred Keller, Pennsylvania
Danny K. Davis, Illinois             Andy Biggs, Arizona
Debbie Wasserman Schultz, Florida    Andrew Clyde, Georgia
Peter Welch, Vermont                 Nancy Mace, South Carolina
Henry C. ``Hank'' Johnson, Jr.,      Scott Franklin, Florida
    Georgia                          Jake LaTurner, Kansas
John P. Sarbanes, Maryland           Pat Fallon, Texas
Jackie Speier, California            Yvette Herrell, New Mexico
Robin L. Kelly, Illinois             Byron Donalds, Florida
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts
Mike Quigley, Illinois

                      Russ Anello, Staff Director
              Daniel Rebnord, Subcommittee Staff Director
                    Amy Stratton, Deputy Chief Clerk
                      Contact Number: 202-225-5051

                  Mark Marin, Minority Staff Director
                                 ------                                

                   Subcommittee on National Security

               Stephen F. Lynch, Massachusetts, Chairman
Peter Welch, Vermont                 Glenn Grothman, Wisconsin, Ranking 
Henry C. ``Hank'' Johnson, Jr.,          Minority Member
    Georgia                          Paul A. Gosar, Arizona
Mark DeSaulnier, California          Virginia Foxx, North Carolina
Kweisi Mfume, Maryland               Bob Gibbs, Ohio
Debbie Wasserman Schultz, Florida    Clay Higgins, Louisiana
Jackie Speier, California
                         
                         
                         C  O  N  T  E  N  T  S

                              ----------                              
                                                                   Page
Hearing held on November 17, 2021................................     1

                               Witnesses

Ms. Alyssa M. Hundrup, Director, Health Care, Government 
  Accountability Office
Oral Statement...................................................     6
Brigadier General Jack Hammond, Executive Director, Home Base
Oral Statement...................................................     8
Dr. Carla Stumpf-Patton, Senior Director, Postvention Programs, 
  Tragedy Assistance Program for Survivors
Oral Statement...................................................    11
Staff Sergeant (ret.) Johnny Jones, Board of Directors, Boot 
  Campaign
Oral Statement...................................................    13

Written opening statements and statements for the witnesses are 
  available on the U.S. House of Representatives Document 
  Repository at: docs.house.gov.

                           Index of Documents

                              ----------                              

No additional documents were entered into the record for this 
  hearing.

 
                INVISIBLE WOUNDS: PREVENTING SUICIDE IN
             OUR NATION'S MILITARY AND VETERAN COMMUNITIES

                              ----------                              


                      Wednesday, November 17, 2021

                   House of Representatives
          Committee on Oversight and Reform
                          Subcommittee on National Security
                                                   Washington, D.C.

    The subcommittee met, pursuant to notice, at 10:02 a.m., in 
room 2154, Rayburn House Office Building, and via Zoom. Hon. 
Stephen F. Lynch (chairman of the subcommittee) presiding.
    Present: Representatives Lynch, Welch, Johnson, DeSaulnier, 
Mfume, Wasserman Schultz, Speier, Grothman, and Higgins.
    Also present: Representative Maloney.
    Mr. Lynch. The committee will come to order.
    Without objection, the Chair is authorized to declare a 
recess of the committee at any time.
    I now recognize myself for an opening statement.
    Good morning, everyone. Continuing in the spirit of 
Veterans Day, which we celebrated last week, I'd like to again 
thank our nearly 18 million veterans and their families for 
their distinguished military service and sacrifice on behalf of 
our Nation.
    And keeping faith with our Nation's obligation to our 
Active military personnel and all those who are veterans, 
today's hearing will examine the devastating suicide crisis 
that continues to affect the health and well-being of America's 
Active military and veteran communities.
    Since 2001, the suicide rate among our Nation's veterans 
has risen by 57 percent, and, on average, more than 6,300 
veterans have died by suicide each year. The more than 65,000 
veterans that have died by suicide since 2010 exceeds the total 
number of combat deaths from the Vietnam War and the U.S. wars 
in Iraq and Afghanistan combined.
    According to recent data from the Department of Veterans 
Affairs, the suicide rate among veterans in 2019 was 52.3 
percent higher than for nonveteran adults.
    Moreover, Active Duty suicide rates have increased across 
every single service branch since 2011. In its most recent 
annual suicide report, the Department of Defense reported an 
Active Duty suicide rate of 28.7 suicides per 100,000 
servicemembers in 2020, the highest rate reported by the 
Department since it began compiling such data in 2008.
    Last year alone, 580 servicemembers died by suicide, 
including Active personnel, National Guard, and Reserve.
    The suicide epidemic among our military and veteran 
communities is an enduring public health crisis that also 
carries profound implications for U.S. national security.
    As detailed by Brown University in one of its recent 
``Costs of War'' reports, our men and women in uniform have 
been operating at a persistently high operational tempo since 
the commencement of the global war on terrorism in 2001. The 
unyielding pace of deployment has significantly strained U.S. 
military readiness, intensified the pressure on military 
personnel and their families, and exacerbated the mental health 
challenges already facing our military and veteran communities.
    To their credit, both the VA and DOD have prioritized the 
military and veteran suicide crisis within their respective 
organizations. The VA is increasingly using a public health 
approach to suicide prevention that employs evidence-based, 
clinical intervention strategies while also promoting 
partnerships with community and mental health organizations. 
And, within the last year, DOD has implemented several pilot 
programs designed to identify suicide warning signs on social 
media, encourage servicemembers to seek mental health services, 
and to promote the safe storage and handling of firearms, 
medications, and other lethal means.
    I look forward to discussing the recommendations issued by 
the Government Accountability Office detailing improvements 
that both agencies can make to enhance their suicide prevention 
and outreach programs.
    I'm also very pleased that earlier this month President 
Biden released a new comprehensive national strategy on, quote, 
``Reducing Military and Veteran Suicide.'' The strategy 
outlines a governmentwide cross-section and data base approach 
to addressing the public health and national security crisis.
    In particular, the Biden strategy seeks to expand the use 
of data to target suicide risk factors, advance suicide 
research and evaluation, promote skills development to lessen 
the risk of suicide, and ensure access to high-quality mental 
healthcare.
    President Biden's new strategy also recognizes the 
important work of community-based organizations and other 
private-sector stakeholders to prevent and reduce military and 
veteran suicide.
    In the city of Boston, where I live and which I am proud to 
represent, Home Base, an innovative, family based clinic 
established in 2009 through a partnership between the Boston 
Red Sox Foundation, the Massachusetts General Hospital, and 
Harvard University provides critical, life-saving care to 
servicemembers, veterans, and military family members as they 
heal from traumatic brain injury, post-traumatic stress, and 
other invisible wounds.
    I'm extremely grateful to Home Base's executive director, 
Brigadier General Jack Hammond, for testifying before our 
subcommittee in person today about their important work.
    I'd also like to thank Dr. Carla Stumpf Patton from the 
Tragedy Assistance Program for Survivors, or TAPS, and Staff 
Sergeant Johnny Jones from the Boot Campaign for testifying 
before our subcommittee today.
    As well, I know you both are deeply and personally invested 
in this issue, and we all look forward to hearing your views 
and perspectives.
    I thank all of you for your service and your sacrifice on 
behalf of our Nation.
    I will now yield to the subcommittee ranking member, the 
gentleman from Wisconsin, Mr. Grothman, for his opening 
remarks.
    Mr. Grothman. Thank you, Mr. Chairman, for holding this 
hearing to address the public health and national security 
crisis that is veteran and military mental health and suicide.
    I want to personally thank Mr. Jones and Mr. Hammond for 
serving our country and continuing to fight and work on this 
issue. I also want to thank Dr. Stumpf Patton for her tireless 
work on this issue.
    Before we get started, I want to play a voicemail Mr. Jones 
sent us from a veteran he references in his testimony. As you 
will hear in Mr. Jones's testimony, our government failed this 
veteran, and he unfortunately is no longer with us because of 
that failure.
    We must not discuss this issue in the abstract. This can be 
difficult to hear, so if you need to mute or leave, please do 
so now.
    [Audio clip begins.]
    Sergeant McDonald. Hi, brother. What's up? It's me. Just 
give me a call. I need some help, man. Like, the VA told me, 
you know, they take it by a case-by-case basis. And they're 
telling me to try to find a local facility and go in on my own 
dime and my own insurance. And they said, after I find out 
about if my insurance will pay for it or whatever, they told me 
to contact them back. But, like, basically, them outsourcing 
it, I guess, like, they don't want to spend the money on it or 
whatever else. But I was just seeing, like, what steps you 
think I need to take, because, you know, they're telling me one 
thing, and then my insurance, like, it ain't gonna cover more 
than, like, five or six days. And I just wanted to see what you 
wanted me to do. Dad thinks I can--have to start contacting 
newspapers, TV, everything else. But I just want to get your 
take on it, brother. All right, call me back.
    [Audio clip ends.]
    Mr. Grothman. Thank you.
    To all the veterans, servicemembers, or military families 
that may be listening, if you or a loved one needs assistance, 
we encourage you to reach out to one of the many services 
available. You can call them at 1-800-273-8255 or text them at 
838255 or chat at their website.
    I'd also ask that each of the nonprofits here today submit 
their contact information for the record or start their 
testimony with it.
    Thank you.
    We are here today to discuss the heartbreaking and largely 
preventable crisis of veteran and military suicides. In 2019, 
6,261 veterans died by suicide, 580 servicemembers, and 202 
family members. That accounts for 15 percent, about one in six, 
of all suicides in America.
    Those who choose to fight for our collective freedom should 
not return home to strife and turmoil and struggle without 
options for help. This must be a multi-agency and private-
sector effort.
    The Department of Defense needs to do more for those 
actively serving. They need to prepare servicemembers for 
discharge. The Department of Veterans Affairs needs to provide 
more services, and they need to actively identify vets who are 
in trouble. And the private sector, primarily nonprofits, need 
to continue to step up and fill the void by providing services 
on the ground to the vets and their families. We all need to 
step up.
    The GAO recently released two reports, one regarding DOD 
and one regarding the VA. It does not appear that either the 
DOD or the VA have completed any of the recommendations made by 
GAO. I wish they were here to testify--quite frankly, they 
should be here to testify--because, otherwise, you really 
can't--there are so many questions that only they would be able 
to answer.
    Additionally, the DOD Inspector General found that the DOD 
did not screen for suicide risk or provide uninterrupted mental 
healthcare to transitioning servicemembers, as required by 
Federal and DOD guidance.
    Mr. Chairman, the DOD and VA have failed to protect our 
servicemembers from the tragedy of suicide. I hope we have a 
hearing on this topic with the DOD and VA as soon as possible.
    This topic is especially important considering the recent 
images from the Biden administration's withdrawal from 
Afghanistan. It's vital we remind veterans, particularly that 
fought in Afghanistan, that they served their country with 
honor and worked within the rules of engagement, operating 
their best, and their actions had demonstrable positive effects 
on the people of Afghanistan. In fact, because of the resolve 
of these vets and the determination of Americans, American 
allies even got evacuated.
    Finally, it's important to focus on positives and hope--the 
VA calls these ``anchors for hope.'' Suicides dropped 399 in 
2019, making it the lowest single total since 2017. The 
reduction of 399 was the largest ever in a single year, so 
that's good news. There was a 13-percent decrease in deaths by 
suicide among women, the largest decrease in 17 years.
    Well, I'd like to thank the witnesses for being here today, 
and I look forward to hearing from you.
    And I yield back. Thank you.
    Mr. Lynch. The gentleman yields back.
    At this time, I'd like to recognize the chairwoman for the 
full committee, Chairwoman Carolyn Maloney, for an opening 
statement.
    Mrs. Maloney. Thank you, Chairman Lynch, for holding this 
critically important hearing and for your unwavering commitment 
to our military servicemembers, veterans, and their families.
    In the 20 years since 9/11, almost 3 million soldiers, 
sailors, airmen, and marines have answered the call to serve 
our Nation overseas. Tragically, more than 7,000 servicemembers 
have made the ultimate sacrifice fighting terrorism in 
Afghanistan, Iraq, and around the world.
    Tens of thousands more have returned home with both visible 
and invisible wounds of war. Too often, these servicemembers 
and veterans fight their own battles that the rest of us cannot 
see. Sadly, many of these battles end in suicide.
    While we may never fully understand why any servicemember 
or veteran chooses to take their own life, we know that certain 
risk factors can make that tragic outcome more likely. Post-
traumatic stress, clinical depression, and other mental health 
struggles can contribute to feelings of loneliness or 
helplessness. So can economic insecurity, a lack of access to 
healthcare or good-paying jobs, and other daily stressors and 
challenges that we all may confront at some points in our 
lives.
    We also cannot escape the fact that firearms are the most 
common method that servicemembers and veterans use to take 
their own lives, and they do so at a much higher rate than the 
general population.
    I applaud President Biden for taking key steps to address 
this tragedy, including releasing a new strategy earlier this 
month for reducing military and veteran suicide. This plan 
adopts a whole-of-government approach to addressing the public 
health and risk factors that contribute to suicide, while also 
increasing access to clinical care and improving lethal means, 
education, and safety.
    This is an important framework for reducing military 
suicides, but it must be implemented in coordination with 
nongovernment veteran and community organizations. I am pleased 
that we have representatives here from three organizations to 
talk about how they are working with DOD and the VA to achieve 
this objective.
    Finally, just as we honor, respect, and care for those 
military families who have lost a loved one in combat, we owe 
the same duty of care to those who have lost a family member 
due to suicide. According to the CDC, family members that have 
lost a loved one to suicide can experience anxiety, depression, 
post-traumatic disorder, and can be at heightened risk of 
suicide themselves.
    Chairman Lynch, you have movingly said before that when a 
young man or woman puts on the uniform of the United States 
military, they become our children. So, too, are the families 
of our Nation's servicemembers and veterans our family, and we 
have a solemn moral obligation to care for them.
    This is a very personal issue to me. My brother served our 
country in Vietnam, and he came home a changed man. He 
struggled for years after his military service, and he later 
took his own life. That was years ago, but the pain of my 
brother's passing is still with me today.
    So, Chairman Lynch, thank you for holding this important 
hearing. I am hopeful that we can make meaningful progress 
today in protecting those who have served our country and their 
families.
    I'd like to thank all of our witnesses for testifying 
before our committee.
    And, with that, Mr. Chairman, I yield back. Thank you.
    Mr. Lynch. The gentlelady yields back.
    I would now like to introduce our witnesses.
    Today we're joined by Ms. Alyssa Hundrup, who is the 
Director of Health Care with the Government Accountability 
Office.
    We're also joined by Brigadier General Jack Hammond. 
Brigadier General Hammond is a retired U.S. Army officer and a 
veteran of both Iraq and Afghanistan, serving in the Army for 
more than three decades. He has led at every level of command, 
from platoon to brigade, during peace and war.
    In 2012, General Hammond was invited to lead Home Base, 
which is a unique partnership between the Boston Red Sox and 
Massachusetts General Hospital. Home Base established the 
Nation's first private-sector center of excellence for the 
mental health and brain injury impacting our wounded veterans 
and their families. This clinical program was designed to 
leverage the faculty and deep clinical resources of 
Massachusetts General Hospital and Harvard Medical School in 
order to deliver the best possible clinical care in the country 
for our veterans and families at no cost to them.
    Home Base has reimagined what is possible in the treatment 
of these complex injuries and developed new and innovative 
solutions, saving thousands of lives, and caring for more than 
25,000 veterans and their families through the funding support 
from a grateful Nation.
    Next, we are joined by Dr. Carla Stumpf Patton, who is 
senior director for postvention programs at the Tragedy 
Assistance Program for Survivors, or TAPS, which provides care, 
resources, and a support system to military families who have 
lost a loved one.
    And, finally, we are joined by retired Staff Sergeant 
Johnny Jones, a veteran of the wars in Afghanistan and Iraq, 
who now works on the board of the Boot Campaign, which works to 
connect veterans and servicemembers with access to health and 
wellness resources. Staff Sergeant Jones is appearing remotely 
before us today.
    Thank you all for attending. We look forward to your 
testimony.
    It is the custom of this subcommittee to swear all 
witnesses. Would you all please stand and raise your right hand 
so we can swear you in?
    And, Mr. Jones, will you be unmuted so we can swear you in 
remotely?
    Staff Sergeant Jones. Yes.
    Mr. Lynch. Do you swear or affirm that the testimony you're 
about to give is the truth, the whole truth, and nothing but 
the truth, so help you God?
    Staff Sergeant Jones. I do.
    Mr. Lynch. Let the record show that the witnesses have all 
answered in the affirmative.
    Thank you. Please be seated.
    Without objection, your written statements will be made 
part of the record.
    With that, Ms. Hundrup, you are now recognized for five 
minutes for your testimony. Thank you.

  STATEMENT OF ALYSSA M. HUNDRUP, DIRECTOR, HEALTH CARE TEAM, 
                GOVERNMENT ACCOUNTABILITY OFFICE

    Ms. Hundrup. Chairman Lynch, Ranking Member Grothman, and 
members of the subcommittee, thank you for the opportunity to 
be here today to discuss our work on DOD and VA's efforts to 
help prevent suicides among the military and veterans.
    Suicide is a devastating public health problem that has 
been a persistent and growing issue for our servicemembers and 
veterans. As noted, the latest report from DOD shows an 
increase in military suicide rates in 2020, with an increase of 
over 40 percent in the last six years. Similarly for veterans, 
the most recent data from 2019 shows a suicide rate almost two 
times higher for veterans than nonveterans.
    My testimony today includes information from three recent 
reports we issued examining various DOD and VA prevention 
efforts. Specifically, since September 2020, we have made three 
recommendations to DOD and six to VA to improve their efforts. 
Both agencies have taken initial steps to implement most of our 
recommendations, and we will continue to monitor their actions 
to fully address them.
    First, regarding DOD, in our April report, we looked at 
DOD's nonclinical suicide prevention efforts. We found that DOD 
and the military services have implemented a number of 
initiatives aimed at reducing the risk of suicide in the 
military population, such as through specific trainings and 
educational efforts. And, in 2020, DOD's Defense Suicide 
Prevention Office, or DSPO, published a framework for assessing 
these efforts collectively.
    However, DSPO's framework does not provide DOD with 
information on the effectiveness of its individual initiatives. 
Given unique risk factors the military population faces, such 
as higher likelihood of experiencing trauma, it is imperative 
that DOD also ensure that each of its individual efforts are 
fully assessed to understand how well they are working, and we 
recommended that DSPO collaborate with the military services to 
develop a process to do just that.
    DOD agreed with our recommendation and, in June, reported 
that it is beginning discussions with the services on how to 
standardize an evaluation approach.
    Second, regarding VA, we recently looked at VA's use of 
suicide prevention teams. These teams are used at local 
facilities to implement VA's Suicide Prevention Program, which 
includes various activities such as tracking and reporting on 
veterans at high risk for suicide and conducting trainings.
    VA has added a number of new initiatives to be implemented 
by these teams. However, the addition of these many initiatives 
has led to a considerable increase in the team's workload, 
which, in turn, has led to burnout and turnover at some 
facilities.
    VA officials said they're developing new guidance for their 
Suicide Prevention Program, but the agency has not conducted a 
comprehensive evaluation of the effects of the program's 
growth, and it is using a staffing model that does not account 
for the increasing workload resulting from the many new 
initiatives.
    We believe these shortcomings could put the suicide 
prevention teams, and ultimately the care they provide to the 
veterans they serve, at risk of falling short of the program's 
goal to reduce the incidence of suicide among veterans.
    We made recommendations to strengthen VA's use of and 
staffing for its suicide prevention teams. VA agreed with these 
and has since outlined a number of actions it is taking.
    Finally, in 2020, we issued a report that found VA had not 
taken enough steps to develop a full understanding of the 
prevalence and nature of suicides taking place on its campuses, 
including making use of all relevant information it collects 
about these deaths in order to prevent future cases.
    We recommended that VA more accurately identify all on-
campus suicides as well as expand the information it analyzes. 
We believe such analyses could, in turn, help prevent future 
suicides.
    In closing, suicide is a tragic issue that needs 
significant attention and action. DOD and VA have both 
emphasized the importance of suicide prevention and have 
several efforts underway. It is critical that they now fully 
address our recommendations and ensure the quality and 
effectiveness of their efforts so they can take every step 
possible to help prevent suicide among servicemembers and 
veterans.
    This concludes my prepared remarks. I would now be happy to 
answer any questions that you may have.
    Thank you.
    Mr. Lynch. Thank you very much.
    General Hammond, you're now recognized for a five-minute 
summation of your testimony.
    General Hammond, can you make sure your mic is on and that 
it is close to you?
    There you go. Thank you, sir.

    STATEMENT OF BRIGADIER GENERAL JACK HAMMOND, EXECUTIVE 
                      DIRECTOR, HOME BASE

    General Hammond. Chairman Lynch, Ranking Member Grothman, 
and members of the subcommittee, I greatly appreciate the 
opportunity to speak with you today on this national tragedy of 
military and veteran suicide.
    Home Base can be reached at HomeBase.org.
    This is an issue of profound importance and is deeply 
important to me. In speaking with my good friend and Medal of 
Honor recipient Staff Sergeant Ryan Pitts, he describes this as 
the number-one threat facing our veterans from this generation.
    I hope to provide you with an alternative perspective on 
the challenge, one that is based on my personal experience with 
PTSD, experience leading troops in combat on multiple 
deployments to Iraq and Afghanistan, and, of course, my decade 
of work assisting veterans who desperately want to put the 
pieces of their lives that were broken on the battlefield back 
together. When they lose hope for a day without pain or their 
ability to move forward, then they give up and take their 
lives. We are in a race against time to reclaim that hope.
    There is an implied trust made between our warriors in this 
Nation that if they are injured, wounded, or killed, we as a 
Nation have their backs and we will be there to provide them 
with the care they need, and if they die, we'll care for their 
families. Ladies and gentlemen, we are failing in this mission.
    Three million men and women from two generations of 
Americans answered the call and deployed to war. They followed 
the footsteps of our previous generations who came before them 
and did not question the challenge. They did their job and kept 
the rest of us safe from harm, asking only to be made whole 
when they return home.
    This is clearly a difficult task, but a veteran will tell 
you that getting into a canvas-door Humvee with no body armor 
and driving into Fallujah while people are shooting at you and 
trying to blow you up is also quite difficult. But they did it.
    This country was bred to accomplish impossible things from 
its birth to the Moonshot, but sometimes we forget this. Time 
is not our friend, and each day we waste is costing lives of 
brave Americans, who leave behind a wake of destruction with 
their broken families.
    For the past decade, as the chairman mentioned, I've had 
the honor to lead an organization that has reimagined what is 
possible with veteran care. More than 25,000 folks have been 
treated by the incredible, talented clinicians at Home Base, 
all at no cost. And Home Base does draw its faculty from Mass 
General Hospital, Harvard Medical School, and the Mass General 
Brigham system, demonstrating what is possible.
    Home Base launched a groundbreaking, two-week, intensive 
clinical program for PTSD and traumatic brain injury six years 
ago in partnership with the Wounded Warrior Project and three 
academic medical centers across the country. This program 
compresses two years of therapy into 14 days. And every two 
weeks, 24 veterans are flown to Home Base for this care.
    Three years later, we modified the clinical program for the 
surviving spouses of military and veteran suicide, in 
partnership with our good friend at TAPS.
    In 2019, the Naval Special Warfare Medical Command 
requested a pilot program for traumatic brain injury to address 
the complex medical needs specifically for these unique 
warriors. More than 200 Navy Seals, Green Berets, and Delta 
Force members and other SOF troops have completed this unique 
program, and 300 more are currently on the waitlist for this 
care. Seventy percent of these men are on Active Duty, and, 
remarkably, 97 percent of them return to full duty.
    In 2015, we expanded our work to the five counties of 
southwest Florida, first creating a wellness program and then 
building clinical capacity with two local hospital systems in 
order to improve access to high-quality clinical care. These 
clinicians were flown to Boston and trained in evidence-based 
treatment, and then funds were raised to support 50 percent of 
their salary to deliver care to our veterans at no cost.
    Additional partnerships are currently underway with Tampa 
General Hospital and the Florida legislature to expand this 
further. And, most recently, we have met with leaders from 
Navajo Nation and Governor Ducey of Arizona to grow clinical 
access, capabilities, and capacity for veterans and families in 
the Tribal lands and in Arizona.
    This work to grow clinical capacity began in Massachusetts 
through a statewide suicide prevention program that partnered 
125 police departments, the VFW, VSOs, and we trained 75 
clinicians across the state in underserved communities. We also 
trained first responders and veteran service officers to 
recognize veterans exhibiting at-risk behavior.
    We can do the difficult things, and with a limited budget 
resource, we've successfully piloted many of the key elements 
contained in the White House strategy.
    I believe that the strategy is spot-on, but the most 
crucial element of the plan is to improve access to high-
quality, evidence-based care. However, the six agencies tasked 
with this have been given a year to develop a plan, and this 
could mean a three-year delay in implementation, at the cost of 
another 18,000 lives.
    We know how to grow clinical capability. Home Base has 
accomplished this on a shoestring budget and improved access to 
high-quality care in multiple states across the country, to 
include our work with the Navajo Nation. What we need now are 
actionable plans and funding strategies for each of the 
priorities in the White House strategy. An 80-percent solution 
today is much better than a 100-percent solution that never 
becomes a reality.
    My second recommendation is to engage our private-sector 
hospital systems and academic medical centers. The VA has been 
in this fight alone, and it is an insurmountable task. They 
need to look at funding tools used by elements like the 
National Institutes for Health in its fight to cure illnesses, 
rare disease, and injury.
    Dr. Richard Stone from the VA testified last year that only 
6 of the 20 veterans who die by suicide each day had received 
VA care within the past two years. This means that those 14 
received care in the private sector, and that is where we need 
to recalibrate our focus a bit.
    Congress has provided billions of dollars to improve access 
to private care, but many of these efforts continue to fail 
because of an inability to create funding mechanisms to pay for 
that care.
    Home Base has met all the requirements to be a VA Choice 
Provider, was approved as a VA Community Care Partner, but has 
never received an official referral for care or reimbursement, 
despite the fact that we've received hundreds of informal 
referrals from VA providers.
    Home Base has delivered high-quality care for more than 
25,000 veterans at a cost of $165 million from a grateful 
Nation. The National Institutes for Health, by contrast, 
routinely support extramural care through grants, contracts, 
and cooperative agreements. We need to implement these tools 
and train and fund clinical care for veterans at the point 
where it is needed, in many of our community-based health 
centers. Each of our systems can play a role in the strategy, 
but a vision without resources is a hallucination.
    My final recommendation is for the DOD, and it has to take 
a more aggressive approach toward suicide prevention in a 
proactive manner. This work can begin and follow the pathway 
established by the Special Operations Command through their 
universal mental health plan and the Preservation of the Force 
Program.
    We must do better to get upstream of these injuries. And, 
last year, I was asked to join a group of doctors and 
researchers from Harvard and provide the Army leadership with 
actionable recommendations to reduce soldier suicide. An 
amazing team of experts from Harvard and MGH volunteered to 
serve on this: Dr. Jordan Smoller, Dr. Matt Nock, Dr. Greg 
Fricchione, and Dr. Ron Kessler, clinical researchers who 
routinely advise both the World Health Organization and NIH on 
these same issues.
    They developed a plan that leverages and advances on 
machine-learning-based prediction algorithms to identify 
soldiers at greatest risk for suicide. They are then matched up 
with the most optimum, individualized prevention plans 
available.
    This two-pronged strategy first focuses on enhanced risk 
assessment that will identify those at the greatest risk for 
suicide. Studies have shown that clinicians perform no better 
than chance at predicting suicide. This two-pronged approach 
also focuses on an enhanced risk assessment tool that will 
identify who is at greatest risk.
    And then a second component of this plan will be to 
implement a risk assessment, mitigation, and maintenance tool 
using the data from a decision support tool that is developed 
that will provide data-driven solutions to match at-risk 
veterans with suicide prevention strategies that meet the 
particular needs of the individual at that time.
    This entire effort can be accomplished by using existing 
DOD resources, and it will provide DOD with the greatest 
predictive modeling capability in the world.
    The DOD and VA have both done incredible work to stem the 
tide of veteran and military suicide, but without engaging the 
full resources of a grateful Nation, which has demonstrated 
their support by raising billions of dollars in private funds 
to care for our veterans, we are attempting to accomplish this 
task with one arm tied behind our back.
    All the while, 20 veterans each day lose hope for a day 
without pain and take their lives. This leaves many families 
asking the question, how their veterans could survive the 
rigors of combat but not peace when they returned home.
    I look forward to answering any questions you have. And I'm 
grateful for the opportunity to speak with you and the 
attention you're paying to this important matter.
    Mr. Lynch. Thank you, General.
    Dr. Stump Patton, you're now recognized for five minutes.

STATEMENT OF CARLA STUMPF PATTON, ED.D., LMHC, SENIOR DIRECTOR, 
 POSTVENTION PROGRAMS, TRAGEDY ASSISTANCE PROGRAM FOR SURVIVORS

    Ms. Stumpf Patton. Chairman Lynch, Ranking Member Grothman, 
and distinguished committee members, the Tragedy Assistance 
Program for Survivors thanks you for the opportunity to testify 
on behalf of the 100,000 military and veteran survivors that 
TAPS supports, including the nearly 19,000 who have lost a 
military loved one to suicide.
    My name is Dr. Carla Stumpf Patton, and I serve as the 
senior director for TAPS' suicide prevention programs. I'm a 
surviving spouse of a Marine Corps drill instructor, Sergeant 
Richard Stumpf, who died by suicide at the age of 24 on October 
31st, 1994.
    I was pregnant full-term with our first child, who was born 
several days later when I was rushed to the hospital during the 
funeral. The devastating tragedy propelled me to find ways to 
survive and eventually dedicating my professional career to 
suicide prevention and postvention efforts for 27 years.
    To do so, I earned multiple degrees in the fields of 
psychology and mental health and completed my doctoral 
dissertation on military families bereaved by suicide. By 
trade, I'm a licensed psychotherapist and subject-matter expert 
in the fields of trauma, suicide, and bereavement.
    I am remarried to a Marine who also lost his military 
dependent spouse to suicide, wherein our two blended military 
families have experienced this tragedy on multiple levels.
    This statement is a representation of the countless 
individuals, our loved ones, who died by suicide after 
prevention efforts failed. The emotional crisis they were 
experiencing did not simply disappear with their suicide but, 
rather, is often transferred and absorbed by those coping with 
the death.
    Postvention for survivors is imperative to reduce risk and 
increase prevention, as those who have been impacted must be 
offered the same care and services offered to the servicemember 
or veteran prior to their death. It is of equal vital 
importance that we also include military dependents in 
prevention initiatives, as the death of a family member can 
have detrimental effects on the servicemember or veteran. 
Postvention must be a critical component of any comprehensive 
suicide prevention strategy.
    Based on best practices, the TAPS Suicide Postvention 
Department developed the field-leading TAPS Suicide Postvention 
Model. This decreases isolation as well as risk for mental 
health issues, such as suicide, addiction, anxiety, and 
depression, and, therefore, increases social connection, peer 
support, and growth that all promote healing following a 
suicide death.
    TAPS is the only organization formally working with 
military families coping with a suicide loss, thus contributing 
to life-saving prevention with information gleaned from our 
postvention work.
    When reflecting on suicide deaths, we often find that 
military culture does not incorporate mental healthcare as a 
vital part of wellness and readiness. A significant concern is 
that prevention initiatives often fail to address what TAPS 
families have identified as a missing component: that military 
operations lack the time, attention, and significance needed to 
tend to mental healthcare, wherein daily readiness often fails 
to incorporate mental fitness and where access to mental 
healthcare can be challenging.
    Through years of advocacy toward reducing stigma 
surrounding suicide in the military, TAPS recognizes the most 
alarming concern being that of the fear of how seeking mental 
healthcare could negatively impact career development and 
advancement opportunities.
    Many survivors, myself included, share how either they or 
their loved ones were afraid to discuss or disclose to anyone 
about such struggles, where far too often there had been 
tremendous psychological and/or physical suffering that became 
contributors to the suicide.
    Suicide prevention requires a holistic public health 
approach. Messaging must instill hope and be encouraging. In 
many cases, suicide is preventable, not inevitable. People must 
know that the help is available, that it works, and with it 
comes the possibility to stabilize during an emotional crisis 
and eventually go on to live a healthy, fulfilling life. The 
overwhelming majority of people who struggle with thoughts of 
suicide do not go on to die by suicide but, instead, access the 
resources and learn the skills needed to cope in safe ways.
    This all cannot stem from a single approach but, rather, 
must consider long-term prevention strategies and comprehensive 
crisis responses, including postvention care. Also vital to a 
public health approach is increasing the education that anyone, 
all of us, can participate in suicide awareness and prevention 
efforts.
    On behalf of TAPS and the survivor community that I 
represent, I am grateful for the opportunity to testify today 
and look forward to answering any questions that you may have. 
Thank you.
    Mr. Lynch. Thank you, Doctor.
    Staff Sergeant Jones, you are now recognized for five 
minutes for your testimony. Welcome.

   STATEMENT OF STAFF SERGEANT (RET.) JOHNNY JONES, BOARD OF 
                    DIRECTORS, BOOT CAMPAIGN

    Staff Sergeant Jones. Thank you all for having me here 
today. It's an honor to testify before the subcommittee in 
honor of my friend Sergeant Christopher McDonald.
    The issue of veteran suicide has become a trendy topic. 
Awareness, it seems, is the cheapest currency for the problem, 
so deeply misunderstood that we continue to lose lives at an 
astonishingly consistent rate.
    As an eight-year Marine Corps veteran with combat 
deployments to both Iraq and Afghanistan, the latter of which 
took both of my legs above the knee in August 2010, this trend 
stormed into my own life the Friday before St. Patrick's Day in 
2012, when my high school best friend, Marine Sergeant 
Christopher McDonald, took his own life.
    At the time, I was working as a fellow for the House 
Veterans' Affairs Committee. My friend Chris was four years 
removed from a combat deployment where he suffered both 
physical and mental health injuries. He was prescribed 180 5-
milligram tablets of hydrocodone a month for a hip injury he 
had suffered in Iraq in 2008 but received no treatment for his 
mental trauma.
    Chris was the epitome of hard work and discipline. His 
father, our middle school football coach and high school 
technology teacher, is a Marine Corps combat veteran from 
Desert Storm. And whether it was football, baseball, or 
academics, Chris gave everything 110 percent and could not 
accept failure.
    The months prior to Chris's suicide, he became extremely 
addicted to opioids and began to lie, cheat, and steal from his 
closest friends and family to supply his destructive habit. 
Finally, at Christmas in 2011, his parents, his roommate at the 
time, our mutual best friend and Army veteran, and I 
intervened. We submitted a written affidavit to the local 
authorities that he was a danger to himself and others, and he 
was taken to a mandatory 72-hour detox hold. Afterward, Chris 
admitted his problems and asked us all for help.
    Unfortunately, help wasn't what the VA offered. Not real 
help. He was told his case wasn't severe enough for in-patient 
rehabilitation. He came to me, desperate. And, even working in 
Congress, or maybe especially working in Congress, I felt 
helpless to save my best friend's life.
    Ultimately, he decided taking his own life was the only way 
to ensure he no longer hurt or let down those he loved. But as 
anyone who's lost a loved one to suicide knows, that couldn't 
be further from the truth. This one act of finality hurts the 
innocent every day for the rest of their lives.
    We can't stand by and allow those who serve to think this 
is the only option. Today, I work with many nonprofit groups to 
identify, assess, treat and/or facilitate treatment for 
veterans struggling with post-traumatic stress, traumatic brain 
injury, addiction, chronic pain, and insomnia.
    Veterans are turning to organizations like Boot Campaign, 
Boulder Crest Foundation, Brain Treatment Foundation, the 
Shepherd Center's SHARE Program, Camp Southern Ground--and let 
me add, the organizations that are also testifying today have a 
great reputation and are those organizations as well--and 
veterans turn to others to find quick, individualized, and 
nontraditional treatment protocols developed independently from 
the catacombs of bureaucracy and antiquated, one-size-fits-all 
methods that currently plague our VA.
    I'm not a physician, a psychologist, or a psychiatrist. I 
don't have a doctorate or masters in any field, much less 
mental health or medical treatment. But I challenge you to find 
someone with more passion and concern on this topic. I have 
dedicated the last decade of my life to understanding this 
issue in its entirety, not just through the lens of some 
awareness campaign or appeasement initiative.
    With that experience and with the help of some of the 
aforementioned organizations, working on this issue every 
single day, I've identified the following areas I feel are 
either overlooked, oversimplified, or misunderstood altogether.
    First, the role of prior-to-service trauma and trauma not 
directly caused by military or combat experience. Many, if not 
most, veterans who legitimately claim what is commonly known as 
post-traumatic stress, sometimes disorder, experienced trauma 
as a child. Many others experienced trauma from life, like 
infidelity, guilt from not being close to a dying relative, not 
seeing their children grow up, financial stress, and other 
everyday American experiences that can contribute and sometimes 
cause the deterioration of mental health.
    Second, the DOD must take responsibility for vetting, 
treating, and transitioning veterans. The VA gets all the 
blame, and it is clear, more must be done to improve how we 
treat veterans. But to have a paradigm shift in this issue, we 
must look at root causes.
    We spend 3 to 12 months training a civilian to be a 
servicemember, we train them for six months to deploy, and we 
spend years grooming them for their next promotion. But when it 
comes time to leave the military--for many, facing their first 
experience with civilian life as an adult--we spend two weeks 
or less training them in this transition.
    As someone who has seen the worst horrors war has to offer, 
I can honestly and earnestly say that transitioning out of the 
Marine Corps was the single most traumatic and least-trained-
for experience in my entire military career.
    And, last, we must acknowledge and assist the good work 
that is being done by nonprofit organizations and private 
healthcare providers. The VA and the Federal Government at 
large move slow. Sometimes that's by design, and sometimes 
ulterior or even partisan motives are at work. I'm not here to 
demonize the VA or complain about how things get done in 
government, but I can tell you that there are treatment 
protocols and outreach successes being made by these 
organizations that are absolutely saving lives. Many of these 
organizations need grants and financial resources, while others 
merely need a seat at the table and access to data to expand 
the reach of their success and save more lives. We won't solve 
this problem with a government-only solution.
    I want to thank you all for this opportunity. I know 
government often seems like nothing more than a team sport, 
but, for this issue, I commend you all for leaving your 
partisan politics at the door and standing ready to do your job 
with integrity and selfless concern for America's heroes.
    As a veteran and a grateful American, please consider me a 
resource and a dedicated soldier in this fight against our 
third war and most deadly war over the past two decades. It is 
our responsibility to do everything we can to save our military 
servicemembers from the enemy within, a war fought here at 
home, fought in our homes and among our friends and family.
    And, with that, thank you.
    Mr. Lynch. Thank you, Sergeant. Thank you for your 
testimony and your perspective and for the good work you 
continue to do.
    Before moving to questions, I understand that 
Representative Tlaib, a member of the full committee, has asked 
to be waived on to the hearing so she can submit a statement 
and questions for the record.
    So, without objection, the gentlewoman from Michigan, Ms. 
Tlaib, shall be permitted to join the subcommittee and be 
recognized to submit her questions.
    Mr. Lynch. I now recognize myself for five minutes for 
questions.
    First of all, I want to say thank you to all of our 
witnesses. You enrich this whole process, and you help us 
grapple with this difficult issue. And thank you for your work, 
your service within government and within the military, but 
also thank you for your continued service outside of that on 
behalf of veterans and Active military.
    General Hammond, we have a dual system here that we've all 
talked about. One is, the VA provides services to veterans, and 
then we've got DOD for Active military. I want to talk about 
the situation with the VA right now that the good sergeant just 
raised.
    So I'm blessed in my district, I've got three VA hospitals. 
I've got one in Brockton, one in West Roxbury, one in Jamaica 
Plain. Yet, when I read the data on the suicide report, so many 
of the veterans who are victims of suicide are not 
participating in the VA system, they are not registered, or 
they're not getting their mental healthcare from the VA. So 
there's a disconnect.
    And look, my VAs do a great job, but if someone is not 
coming in the door, then there's that disconnect, right? You 
can't help somebody who doesn't enroll and participate in the 
VA.
    So there's a disconnect there that--I believe, listening to 
what Boot Campaign is doing and what your organization is doing 
and what TAPS is doing, it seems to me that, in a way, you're 
filling that gap, you're curing that disconnect.
    Can you talk about that? And, Dr. Stump Patton, I think you 
have a similar perspective on how that works and how that fills 
that gap. But, General Hammond, why don't you have a crack at 
it?
    General Hammond. Yes, sir. Thank you.
    So one of the things that oftentimes gets lost in 
translation is, throughout the last 100 years, 15-20 percent of 
our veterans receive care from the VA. When they come home from 
war, they begin their lives, they get jobs, they have 
insurance, and they go that way. And, oftentimes, there was 
always a hesitance to receive care, because it was like a zero-
sum-game mentality, where the veterans didn't want to take some 
of that care from somebody who might need it worse, because 
``I've already got my Blue Cross.'' So, if you've got a good 
health system, you're part of that, you don't think to go into 
that system. And it's not a reflection of the VA; it's just a 
fact of life.
    Mr. Lynch. Yes.
    General Hammond. In 2001, when this all started, there were 
25 million veterans in the country, and only 3.9 received care 
from the VA. That's a significantly small percent. That's grown 
a bit, but we've also lost--from 25 million, as you mentioned 
earlier, we're down to 18 million, and in the next 20 years 
we'll be down to about 12 million.
    So we can't keep making a 550-percent increase in the VA 
budget to try and grow it at a time when the veteran population 
is shrinking. We have to think smarter, how to sustain this and 
how to give the best possible care under the rubric of the VA 
but by reaching out to community-based health centers and 
hospitals that are willing to do the work.
    They just need the resources, and we need to figure out a 
way to get those resources to those community-based health 
centers where veterans live, where they go for care routinely.
    Mr. Lynch. All right.
    Dr. Stumpf Patton, any perspective on that, on filling that 
gap between the VA and the people who need the services?
    Ms. Stumpf Patton. I think working collaboratively is a 
very powerful point. Suicide is a very complex, widespread 
problem that cannot be, you know, answered or responded to with 
any one single agency or organization. So, when we're all 
speaking the same language, when we're all on the same page, 
working in tandem, we present, you know, a united front.
    And I think the military Reserves members, family members, 
the military community need to know that they are not only 
valued, but there needs to be a message that this care is there 
for them, that they should want to seek care and know that 
they're going to be in the trusted hands of people who are 
there to serve them, rather than feeling a mistrust and not 
choosing to go to the systems that are theirs, you know, to be 
there to serve them.
    Mr. Lynch. Thank you.
    And, Sergeant Jones, you touched on this very issue in your 
opening testimony. Any perspectives on that, on how we might--
and how Boot Campaign actually fills that gap on behalf of the 
veterans that you serve?
    Staff Sergeant Jones. There's really two issues at--and 
thank you for the question. There's really two issues at once 
here. One is, how do we look at those dealing with suicidal 
thoughts that are already veterans, that have already left and 
disconnected and now we're trying to reengage them.
    The second part of your question, really, and the answer 
is, the solution is, to never have them be disengaged to begin 
with. And that goes back to the DOD and their responsibility to 
properly assess veterans leaving the military from every aspect 
that causes mental health issues, from finance to family 
situations, the whole nine yards, so that, as they transition 
out, that line of communication is already there.
    One of these issues is, how do we address the population we 
already have? But it'd be irresponsible to acknowledge that 
problem and not look back and say, how can we preemptively stop 
that problem from persisting as those leave the military.
    And, statistically, you're going to have more veterans come 
to the VA after a war than during a war, because they're going 
to finally say, ``You know what? I've got problems, and there's 
not a mission in front of me that I feel obligated to, so I'm 
going to go ahead and get out and get treatment.''
    And so now is the time that start looking at this. 
Obviously, any day before today would've been great, but now is 
a very important time.
    Mr. Lynch. Thank you very much.
    My time has expired.
    I now yield to my friend, the gentleman from Wisconsin, Mr. 
Grothman, for five minutes.
    Mr. Grothman. Thank you so much.
    My first brief question--you know, we're given some papers 
before we come here, and there's a graph here showing veteran 
deaths by suicide from 2001 to 2019. We're around 6,000 in 
2001.
    Does anybody know where we were 20 years before that? I 
kind of wish that graph went further. How many suicides in, 
like, 1980, 1990? Nobody knows?
    OK. That's the type of thing I think the VA would know, and 
that's why I kind of wish they were here, because it would give 
us greater perspective.
    My next quick question--and this is something I don't know 
what to make of. I think referencing the same graph, in 2001, 
it says 20.2 percent of the people who committed suicide in 
this country were veterans. In 2019, that was down to 13.7 
percent. So that's a significant drop of veterans compared to 
the rest of society.
    Can anybody comment as to why that is, make any 
observations on it?
    General Hammond. I would just offer this: that, No. 1, when 
we look at our veteran population and our military population, 
it's drawn from the top 30th percentile of the American 
population. As of today, roughly 70 percent of young Americans 
of military age do not meet the minimum requirements to join 
the military and become a private in the United States Army 
based on physical, mental, legal, and moral issues. And so we 
start with a very high, healthy, mentally healthy, physically 
healthy population that's been screened, not extensively but 
screened to the point where 70 percent don't meet that 
requirement.
    So we're starting off with a good group, and then we work 
on resiliency issues. And, traditionally, in peacetime, that's 
worked. When we add the complexity of combat, the transition 
issues, and all these other pieces, that's when we see these 
rises.
    And, starting in Vietnam, we started seeing increases in 
suicide with the Vietnam generation during the war. And you 
look at the treatment they received, and we start looking at 
bad transitions when you leave the military, questioning your 
service. We're starting to see some of that----
    Mr. Grothman. OK.
    General Hammond [continuing]. With this generation, 
because, you know, there's been this dichotomy----
    Mr. Grothman. OK.
    General Hammond [continuing]. Where a lot of folks want to 
support the troops, but----
    Mr. Grothman. Yes.
    General Hammond [continuing]. It's been pretty vocal about 
getting out of Afghanistan, getting out of Iraq, whether it was 
worth it. And when you question your service and sacrifice, it 
does play with your mind a bit.
    Mr. Grothman. Yes. Well, the question was actually why are 
things getting proportionally better.
    But, Mr. Jones, your testimony highlights three 
recommendations. I want to ask you about two.
    First, the DOD needs to take more responsibility in this 
space. And a DOD IG report recently said that Department of 
Defense failed to screen for suicide risk for transitioning 
servicemembers. How does the IG finding make you feel?
    Staff Sergeant Jones. It's unsurprising. The biggest 
problem--I mean, even when you lose your legs and can leave the 
military, the number-one problem is the VA and DOD's inability 
to communicate with one another. I don't know what this root 
cause is, other than the VA is incredibly resistant to 
transitioning lines of communication and platforms and things 
of that nature.
    When I worked for the House Veterans' Affairs Committee, 
the Improvised Disability Evaluation System, which, I mean, 
simply allowed the VA and DOD to assess your injuries at the 
same time, was borderline controversial, because there was 
agreement on doing it but no agreement on how to do it.
    And so it's very difficult to get the DOD and the VA to 
communicate. And so it's much--very difficult to get the DOD to 
assume responsibility for something that probably most in the 
DOD see as a VA problem.
    Mr. Grothman. OK.
    You also said that the VA needs to do more work closely 
with nonprofits. Last year, President Trump signed a bill, S. 
785, that gave the VA additional resources to do that. Has the 
VA done so? And, if not, what do they have to do?
    Staff Sergeant Jones. That's a good question. I've spoken 
with a gentleman named Ken Falke, who started Boulder Crest 
Retreat and the Warrior PATHH transition program. He testified 
before Congress on behalf of that bill. I spoke with him about 
that bill, and the frustration was just through the roof with 
him.
    What we do at Boot Campaign is largely detached, actually, 
from the VA. We really don't have an opportunity to work with 
the VA because--if I were going to put this in layman's terms, 
I would say the government would rather spend money on a study 
to find out something doesn't work than spend money on 
something that anecdotally very much is working but doesn't 
want to spend a million dollars to study it, or doesn't have 
the scientific recognition from a traditional medicine 
community to get that type of data.
    I understand the necessity to be responsible, especially 
fiscally responsible, but we have organizations that get good 
work done every day, that literally save and change lives, and 
because they haven't done some expensive research packet or 
study, they have less of an opportunity to get Federal grants. 
And I think that's the problem.
    I think that the government is overlooking nontraditional 
treatment. And, to an extent, I understand why the VA leans 
into what is, you know, acceptable in the medical community but 
maybe not so much what is actually working today, with 
technology and other things that just haven't been around for a 
very long time.
    Mr. Grothman. OK.
    Could I--just in general, like I said, when it comes to 
inadequacies of the VA, it would be nice if they were here.
    Do you feel, Mr. Jones--or I will also ask Dr. Stumpf 
Patton--should we have the VA here today, the VA and the DOD, 
do you think?
    Staff Sergeant Jones. Absolutely.
    Mr. Grothman. OK.
    Ms. Stumpf Patton. Yes, sir.
    Mr. Grothman. Thank you. Four for four. Good.
    OK. That's enough. Thank you for the time.
    Mr. Lynch. The gentleman yields back.
    The chair now recognizes the chairwoman for the full 
committee, Mrs. Maloney, for five minutes.
    I think we're having trouble with the technology there.
    We will recognize the gentlelady from California, Ms. 
Speier, for five minutes.
    Welcome.
    Ms. Speier. Mr. Chairman, thank you.
    And thank you all for your presentations this morning.
    I am deeply concerned about the level and increase of 
suicides among our servicemembers and our veterans. And I chair 
the Military Personnel Subcommittee, and, in the NDAA this 
year, I have language in there that will require an independent 
review committee to look at the three highest incidence of 
suicides at three installations, to look at why it's happening 
at those locations and what we need to do.
    Let me start with you, General Hammond. To what extent does 
the OPTEMPO impact the likelihood of suicide ideation?
    General Hammond. I think as we saw back in the early 
2000's, that OPTEMPO where soldiers, marines, airmen, and 
sailors deployed for a year, sometimes 18 months, came home for 
six months, redeployed, we did see a spike in that.
    We also saw the impact on their families. And you can't 
discount that because we look at the external stressors. So not 
only do you have the challenge of going and putting yourself in 
harm's way, but you know that you're placing your family in a 
very difficult situation. And sometimes there are those 
external stressors, to include food insecurity, housing 
insecurity, with a family behind for 12 to 18 months.
    So I think the OPTEMPO certainly played a big role in this, 
as did the type of battle that was fought in that asymmetric 
environment, where it was not on a linear battlefield, and 
greater numbers were exposed to combat action. And when I say 
that, there was no safe place in Iraq or Afghanistan. You could 
be in what we consider support troops that normally are well 
behind the lines and aren't exposed to danger, and every one of 
those bases was rocketed, shot with mortars, or had insider 
threats that were constantly on someone's mind. And so you had 
high stress and anxiety that many of these young men and women 
came back with----
    Ms. Speier. Thank you, General.
    General Hammond [continuing]. In addition to the traumatic 
injuries.
    Ms. Speier. Thank you.
    I'd like to go to Dr. Stumpf Patton.
    In your testimony, you said that ``the military has no room 
in its schedule for mental health care . . . there is not 
enough downtime to care for mental health in the military. 
Daily readiness does not incorporate mental wellness.''
    There's also a reference in, I believe, one of the reports 
that one-third of our servicemembers are afraid to seek mental 
health services because they fear it will affect their 
promotion.
    Can you speak to the OPTEMPO, the stigma, what we need to 
do to address that?
    And I'd also like our representative from GAO to do so as 
well.
    Ms. Stumpf Patton. Thank you. I think that's a very 
important question.
    I would say, what we are doing here is a perfect example of 
that. We have to talk about this openly, directly. We cannot be 
afraid to talk about suicide. Prevention really starts in being 
proactive before a crisis ensues, before somebody is in an 
emotional crisis. So we need to be aware of what we're looking 
for. We need to be comfortable with having those conversations 
with one another and promoting the idea that help exists.
    I just want--can you just rephrase one more time the 
question that you had? I'm sorry, I just lost my train of 
thought.
    Ms. Speier. It was about the stigma associated with----
    Ms. Stumpf Patton. OK. And so, by doing so--that's the 
point--by doing so, we therefore are already reducing some of 
the stigma around help-seeking that is so critical.
    I know for myself and countless survivors that we represent 
and work with at TAPS, that stigma is often one of the largest 
barriers when it comes to seeking care, of how that is going to 
impact one's career through, you know, advancements and 
promotions, how they might be considered and viewed among their 
counterparts.
    I think ultimately what we need to do is, addressing the 
mental wellness here is just as critical as we would look at 
physical fitness, which is--you know, we acknowledge that that 
is critical to being ready for operations. So when we look at 
that equally, that if somebody were suffering from any type of 
other medical injury or illness, we would treat that with 
emergency care, that when left unaddressed that could be----
    Ms. Speier. Thank you, Doctor. I just want to get----
    Ms. Stumpf Patton. OK.
    Ms. Speier [continuing]. Ms. Hundrup to be able to respond 
as well.
    Ms. Hundrup. Thank you. I would just add very quickly that 
we have seen in our work as well as our research that stigma 
certainly is an issue, in terms of the concern about having 
career implications.
    In terms of finding ways to overcome that, I think that, 
clearly, access, ready access, to mental healthcare is going to 
be very important. And we've seen anecdotally that even just 
doing things like allowing telehealth or allowing care that can 
be in a private setting--you know, we've heard that sometimes 
just going into the office, and they have to wear the uniform, 
and they're concerned about perhaps seeing others, that there 
might be perceptions of negativity there.
    So I think we have to get creative in thinking about ready 
access to that mental healthcare and how to do that in a way 
that's comfortable and appropriate and, of course, of quality.
    Ms. Speier. I totally concur.
    I yield back.
    Mr. Lynch. Thank you.
    The gentlelady yields back.
    The chair now recognizes the gentleman from Louisiana, Mr. 
Higgins, for five minutes.
    Mr. Higgins. Thank you, Mr. Chairman, for holding this 
hearing. And I thank my veteran brothers and sisters for being 
with us today.
    We should discuss, as a committee, from our heart, exactly 
what is impacting our veterans across the country. I've buried 
many friends. You know, a lot of veterans move into police 
work. It's sort of a natural transition, especially if you have 
combat experience and, you know, you have certain skills that 
have been honed through the years in the military. It's a 
common thing, to find that your tactical police officers across 
the country are prior military. And a lot of cops commit 
suicide. When they do so, it's considered a veteran suicide, 
because a lot of the cops that commit suicide had been 
veterans.
    So PTSD is a very real dynamic and in my own history. And 
my heart goes out to my brothers and sisters across the country 
and the world that suffer.
    I think we have to be courageous as a committee and deal 
with a couple of things that we're facing right now that's 
going to exacerbate what we have already experienced as a 
Nation regarding PTSD within our veteran populations: the 
disgraceful retreat from Afghanistan, turning the Afghanistan 
theater over to the Taliban and arming them with scores of 
billions of dollars of American weapons systems, abandoning 
Americans and American allies.
    You know, many of my friends that are veterans, you know, 
they're very discouraged about that. And this has injured them, 
I think, on a very deep level. They're asking why--you know, 
why did they risk their lives? Why were they maimed? Why were 
they left with the endless horrors and nightmares of war? This 
is a significant question.
    And I'm going to turn the floor over to my veteran brother, 
Staff Sergeant Jones.
    As a veteran of the war in Afghanistan, I'm going to give 
you the floor, sir. You have a couple of minutes. I ask you to 
just take a deep breath. I'm going to give you the remainder of 
my time so that you can--you just speak to America from your 
heart and reflect upon our retreat from Afghanistan and what 
impact you would feel as an Afghanistan veteran and how you 
think it would impact our veteran brothers and sisters across 
the country.
    I give you the floor, good sir. And thank you for your 
service.
    Staff Sergeant Jones. Yes, sir. Thank you.
    I have to give an honest opinion on this. What happened in 
Afghanistan shook me. I've buried two dozen Marine EOD techs 
that come from the job that I came from in the last six or 
seven years--I guess over the last 10 or 11 years, longer than 
I remember, I guess--and each one of them hurt. Afghanistan was 
the first time that servicemembers I didn't know hurt almost as 
bad. Maybe it's just age and maturity, or maybe it was the, 
obviously, looking on and seeing, man, this didn't have to 
happen.
    But I'll be honest, it was a straw on the camel's back. It 
was not a definitive moment for me. As someone who lost my legs 
above the knee and several dozen friends in 2010, I've seen 
this coming for a long time, quite honestly. I've seen four, if 
not five, administrations in a row play the partisan politics 
of war, rather than the strategic advantage of what we should 
or shouldn't do. It's my belief we haven't spent 20 years 
fighting a war; we've spent 10 two-year wars. Because, for some 
reason, Presidential elections and midterms really shape how, 
in my opinion, Members of Congress view the war and want to 
talk about it publicly.
    And that's not to point a finger. It's just to say, if 
that's the only time it's being talked about, then I'm led to 
believe that's the only time it matters. And then our defense 
strategy is playing second fiddle to, you know, the age-old 
questions of will this get me reelected or will it stop me from 
getting reelected.
    That's the frustrated Marine in me talking. I don't mean 
any disrespect to anyone. That's the feeling I have as a 
private citizen and an American who sits and watches--you know, 
I was a part of the push in al Anbar, I was a part of the push 
in Helmand. I fought in two surges under President Obama and 
felt like we were incredibly successful for both of them--and I 
guess the al Anbar surge actually was in 2008, so President 
Bush and President Obama--and then immediately watched both of 
those successes essentially be squandered.
    When I got to Afghanistan in 2010, President Obama had 
already told the world that we were going to retreat less than 
a year later, in 2011. And so we understood in that moment that 
the Taliban would bide their time and focus on a few key areas, 
one of them which I was fighting in, so fighting got much worse 
for me.
    I don't believe, you know, that's a partisan thing because 
I saw two Presidents do it. I saw President Trump announce a 
retreat from Afghanistan, and then I saw President Biden do it.
    And so I think that veterans sitting at home are just left 
with not a lot of faith in the leadership, both from our 
military and our government, when it comes to fulfilling their 
side of this commitment, which is, if I go die or my brother 
dies, we're going to make sure it's for a purpose. And so 
that's the tough part.
    I understand in my personal life and in the connections and 
conversations I have that there's more at play. But if you ask 
me, what are veterans feeling at home, a lot of veterans are 
sitting there going, ``Yes, well, that's about what I expected 
to happen, because that's about how it's been going for a 
while.'' And that was kind of the sentiment in the veteran 
community.
    Mr. Higgins. Thank you for sharing your heart. And God 
bless you, brother. You know, you are free to speak your mind 
in my office at any time.
    Across the aisle, in my colleagues' offices, I know their 
hearts are poured out and dedicated to our veterans. This is 
not a Republican or a Democrat concern.
    And I very much thank you, Mr. Chairman and Ranking Member, 
for holding this hearing today. And I look forward to working 
with my colleagues on both sides of the aisle to seek 
resolution for our veteran brothers and sisters.
    Mr. Chairman, I yield.
    Mr. Lynch. The gentleman yields.
    The chair now recognizes the full committee chairwoman, the 
gentlelady from New York, Mrs. Maloney, for five minutes.
    Mrs. Maloney. I thank you, Mr. Chairman.
    As they leave the structured life of the military, 
servicemembers and their families can lose a sense of purpose 
and belonging as well as the tight-knit support system that 
they had with their brothers and sisters in uniform. The 
transition period from Active Duty to veteran status can be one 
of the most vulnerable times for servicemembers. Some studies 
have found that the risk of suicide is two to three times 
higher for transitioning servicemembers.
    While the Department of Defense and VA have programs for 
servicemembers, too often these efforts fail to catch all of 
the servicemembers that are in need of the mental healthcare. 
The IG explained that these assessments are increasing over 
time. Very few have this help that they need.
    And I just would like to ask General Hammond, why is it 
important for transitioning servicemembers to have access to 
continuous mental healthcare?
    General Hammond. Thank you, ma'am. That's a great question. 
And, really, I believe the issue is, that is when they're at 
their most vulnerable.
    These men and women have served on high-performing teams, 
in their minds, in some cases, saving the world, right? That's 
what we tell them, that they're there, they have a sense of 
duty and purpose. And when this gets taken away from them, that 
identity, they hurt, and then they're in this state of flux.
    And when they leave the military and then suddenly they go 
from project-managing million-dollar construction projects with 
little or no training, serving as the equivalent to the Secret 
Service guard for the President of Iraq or Afghanistan, they 
have all of these important positions and they're on this 
amazing high-performing team, and then suddenly they're 
unemployed, underemployed, living back with their parents, 
feeling not so great, then they start to have some of these 
mental health issues start to weigh on them.
    And if they don't receive the care they need at that 
moment, they can start going down the drain, literally. They'll 
start putting on weight, they'll start self-medicating, and 
then these problems get worse and worse. And then they kind of 
retract further, and we see them withdraw from their friends 
and their family, and the situation gets worse. And when they 
lose all hope, that's that pivotal moment when they make that 
really horrible decision.
    And so that transition to get them moved from the military 
experience, that life, into a purpose-driven life, dealing with 
their medical and mental health issues, and then embracing some 
type of community or having a community embrace them, those 
three elements are key to a successful transition.
    Mrs. Maloney. Well, the IG also found that DOD was failing 
to provide uninterrupted care in part because it has, quote, 
``inconsistent processes for and oversight of suicide risk 
screening and mental health assessments for transitioning 
servicemembers.''
    Ms. Hundrup, I know you can't speak for the DOD IG, but why 
is it important for the Defense Department and the VA to have 
consistent procedures and up-to-date policies for providing 
mental healthcare to transitioning servicemembers?
    Ms. Hundrup. Yes, thank you. I think, certainly, the IG's 
recent findings shed light and bring, certainly, the troubling 
findings to start a clear demonstration of the need for 
consistent execution. I think, you know, they highlight what is 
called for, in terms of mental health screenings for all 
transitioning servicemembers as well as a warm hand-off.
    But what they don't have is a way to consistently execute 
that, so--which, you know, I think the IG's findings would show 
that what they do have captures, certainly, some segments of 
the population in the military, which is very important. But, 
for example, not having a consistent screening process, their 
current physical separation exam does not include mental health 
screenings.
    Now, they have indicated that they're developing a new one 
that will hopefully address this. But then they need to have 
consistent execution so that they're able to reach all military 
members.
    Mrs. Maloney. Is this an area GAO may be interested in 
examining further for the Oversight Committee?
    Ms. Hundrup. We would certainly be happy to work with your 
staff regarding potential work. As noted, of course, the 
transition is such a key time, and we do think, you know, 
continued collaboration and really examining how DOD and VA are 
doing that is certainly an area we would be happy to work with 
you on. Thank you.
    Mrs. Maloney. And, in closing, the men and women who serve 
in our Armed Forces have the--when they leave the military, 
their battles with their, what I would call, invisible wounds 
of war do not end. So it is our duty to ensure they continue 
receiving the care that they need and don't be forgotten, that 
they don't fall through the cracks.
    My time has expired, and I yield back. And thank you, 
Chairman, for this important hearing and focusing on this 
important need. Thank you.
    Mr. Lynch. Thank you, Madam Chair.
    The gentlelady yields back.
    I did see Mr. Welch earlier, but he is not visible on the 
screen, so we are going to ask the gentleman from Georgia--Mr. 
Johnson, you are now recognized for five minutes. Welcome.
    [No response.]
    Mr. Lynch. I now see Mr. Welch.
    Mr. Welch, you're recognized for five minutes.
    Mr. Welch. Thank you, Mr. Chairman. I really appreciate 
this.
    You know, I want to ask General Hammond: Your description 
of what the transition is was so compelling. You know, it's 
these young people, a lot of Vermonters, that had no idea how 
smart they were, they had no idea how qualified they were, they 
had no idea how brave they were, and suddenly they're, as you 
say, running these extraordinarily important operations, where 
the life and death of their comrades depends on them doing 
their job well.
    And you used that term, ``purpose-driven.'' And I'll ask 
your reaction on this, but whenever I talk to folks who have 
served--and I have not; I'm grateful to all of you have--what 
they say they're fighting for is oftentimes to save the person 
next to them. And they have this bond that only they can have. 
And then they come back, you know, to Winooski, Vermont, or to 
Brattleboro, Vermont, and all of us who've been living our 
daily lives have no idea of what it is they've been through.
    And I just wonder if you could comment on, what do you 
think some of us in the community can do to just acknowledge 
this extraordinary transition that folks have to undergo when 
they get back?
    General Hammond. Thank you, sir. And that's a big issue. As 
my colleagues at Mass General point out, in general, people are 
mammals, and mammals are pack animals, and we do find comfort 
when we're with our tribe, as they call it. And Sebastian 
Junger wrote an amazing book called ``Tribe'' that highlights 
the importance of that connectivity. And when that gets broken, 
it causes significant impact for our warriors.
    And, as we look at this, we've seen communities where our 
veterans and warriors are embraced. Any opportunity that we can 
pull folks together is a benefit. So, at Home Base, one of 
things we do are these things called Adventure Series events, 
where all sorts of people--and we have ski trips up in Vermont, 
New Hampshire, skating on Frog Pond in Boston. Whatever it is, 
it's designed to pull people together and----
    Mr. Welch. That's great.
    General Hammond [continuing]. Allow them to engage with 
people with a shared experience.
    Mr. Welch. So the connectivity is really essential, to 
reestablish it. Well, thank you so much.
    And, Dr. Stumpf Patton, your written testimony was quite 
eloquent, and I want to thank you for that. But one of the 
things you said is you felt completely alone, with no direction 
on surviving your devastating loss.
    Can you discuss some of the reasons you found it difficult 
to find help after and support after the terrible loss of your 
husband?
    Ms. Stumpf Patton. Thank you, sir, for asking that 
question.
    I will say, as a reminder, my loss was quite--you know, 
quite a few years ago, in 1994. And, at that point, there were 
no resources. There was no crisis line. There were no suicide 
prevention coordinators within the VA. This was not being 
addressed. It was something that was really kind of swept under 
the carpet and surrounded by a lot of stigma.
    And so it was very isolating. I was very alone. That was 
something that personally compelled me to try and find that 
support and, eventually, to try to be a part of that support.
    I know what I instinctively needed for myself and my 
family. I didn't know what it was called at the time. And what 
that was is ``postvention,'' the care and the services and the 
support that we give to those who have been impacted by a 
suicide loss. And that is our primary focus and what we do at 
TAPS, in providing that postvention care.
    This is critical when we are addressing suicide prevention 
because survivors are a very high-risk population, given the 
graphic and oftentimes traumatic loss that they have endured by 
suicide loss.
    So, you know, when we're talking about suicide prevention, 
that postvention aspect is something that we must look at in 
how we treat a suicide when it has occurred, how we talk about 
it, how we support all of those who have been impacted, 
including comrades and brothers and sisters in arms. They are 
survivors. They have lost their fellow servicemembers and 
veterans to suicide. And I believe that is a missing piece that 
we are not looking at, around the grief and loss issues of our 
servicemembers and veterans who are struggling with those 
losses, specifically if they have lost somebody to suicide, and 
could be vulnerable themselves.
    Mr. Welch. Thank you very much. Understood. Thank you very, 
very much.
    I yield back.
    Mr. DeSaulnier. [Presiding.] Thank you, Mr. Welch.
    We now recognize Mr. Johnson from Colorado for five 
minutes--Georgia.
    Mr. Johnson, the floor is yours.
    Mr. Johnson. Oh, do you mean Mr. Johnson from Georgia?
    Mr. DeSaulnier. Yes. It's yours.
    Mr. Johnson. OK. Thank you.
    Mr. DeSaulnier. Sorry about that.
    Mr. Johnson. Thank you. That's quite OK.
    Almost 10 years ago, I, along with other Members of 
Congress, sent a letter to the Senate and House Armed Services 
Committees to ensure that the high rate of suicides among 
servicemembers was addressed in the NDAA.
    Despite the attention and actions of Congress, the VA, and 
the private sector, servicemember suicides continue to 
increase. Almost three times as many Active Duty servicemembers 
and veterans of the global war on terror have died by suicide 
than those killed in military operations during the same 
period.
    Dr. Stumpf Patton, thank you for your work in ensuring that 
the families of servicemembers who fall victim to suicide are 
not left behind.
    To survive a loved one's suicide is a unique grieving 
process. In what ways can Congress provide families with more 
resources that they could use in the aftermath of a loved one's 
suicide?
    Ms. Stumpf Patton. Thank you so much for pointing that out, 
that important question.
    What we do at TAPS in providing the postvention support for 
survivors is critical at saving lives for this high-risk 
population. I think supporting one another, supporting 
nonprofits and other organizations and agencies who tirelessly 
do this work behind the scenes to be able to sustain the 
difficult work that we do. Survivors tell us what they need.
    We also know that, when they are connected to care, when 
they are connected to peer support, not only is it lifesaving, 
but this is instrumental in stabilizing them after their grief 
and getting them the resources that they need so that they can 
find a healthy journey and readjusting to their life through 
the grief of their loved one.
    I would also say, one of the most critical things that we 
need to address is that, in addition to the grief of loss these 
family members and loved ones often are enduring, there's an 
added element of trauma that is oftentimes overlooked. And so 
survivors and those who have been impacted and coping with a 
loss by suicide are oftentimes either coping with symptoms of 
trauma or developing post-traumatic stress, which oftentimes is 
going to need additional treatment.
    And TAPS is an honored partner to have worked with Home 
Base, where we have developed such a program so that the trauma 
piece is not being overlooked. And we know that to be 
lifesaving for our survivors who have been struggling with 
that.
    Thank you.
    Mr. Johnson. Thank you.
    General Hammond, mental toughness is of utmost importance 
in the military, as detailed on every branch's website and in 
articles on military.com, which gives steps on how to improve 
mental toughness.
    Can you talk about how the culture of mental toughness in 
the military and the stigma that accompanies mental health 
evaluation and treatment can discourage servicemembers and 
veterans from seeking mental health assistance during a crisis?
    General Hammond. Yes. Thank you for that question.
    I would tell you that their mental toughness and the 
resilience they buildup to be self-reliant problem-solvers that 
can play hurt, technically, is what saves them on the 
battlefields. And it's extremely important in that aspect. It's 
also the exact same issue that causes them the greatest amount 
of pain when they return home and they're suffering from these 
invisible wounds.
    We'll be quick to point out that there's two types of 
injuries. You're either hurt or you're injured, when you're in 
the military, when you're on a mission. And if you're hurt, you 
suck it up, as you mentioned, you push through it. If you're 
injured, you require a medevac.
    And for the mental health injuries, because there's no 
physical aspect to it and everybody else seems to be 
continuing, it leaves people feeling ``less than'' if they need 
help. And that's the crux of the issue. Getting them to 
understand and admit that they've got an injury that you just 
can't see and they need clinical care is a long pole in the 
tent.
    And through our work with our special operations team 
members, which are arguably some of the toughest people in the 
country, we've seen 200 warriors come through our ComBHaT 
Program, which is our Comprehensive Brain Health and Treatment 
Program. And, as we do our diagnostic evaluation, they're 
coming there primarily for brain injury issues and 
musculoskeletal injuries. Out of the 200, I would say 99 
percent of them do not have PTSD, according to them in self-
reporting, and almost 100 percent of them have it in their 
exfil report, where we give them their diagnosis.
    And the interesting question is, ``Well, I told you I don't 
have it,'' and the doctors will say, ``Well, I didn't ask you 
this time, and if you trust my judgment on these other issues, 
you'll trust it on this.'' Their response is unbelievable: 
Immediately, they say, ``All right, what do I do about it?'' 
Because, deep down, they knew they had these injuries; they 
just don't want to say it out loud.
    And, to your point, getting them to demonstrate the 
courage--and I can tell you from personal experience, the 
toughest step I took was walking into a clinic to get help. I 
would've rather went gone on another patrol in Fallujah before 
I did that. But based on the care and based on the impact, it 
enabled me to return back to Afghanistan healthy enough to do 
my duty.
    Mr. Johnson. Well, thank you for your service.
    And thank you, Mr. Chair, for holding this very important 
hearing. And, with that, I will yield back.
    Mr. Lynch. [Presiding.] The gentleman yields back.
    The chair now recognizes the gentlelady from Florida, Ms. 
Wasserman Schultz, for five minutes.
    Ms. Wasserman Schultz. Thank you, Mr. Chairman.
    Mr. Chairman, I have the privilege--and I appreciate you 
holding this hearing today--I have the privilege of chairing 
the Military Construction, Veterans Affairs, and Related 
Agencies Appropriations Subcommittee. And that's the committee 
in the Congress that touches the lives of our servicemembers 
throughout their entire lifecycle. And it's the only committee 
that has that jurisdiction.
    One of our top priorities as chair has been strengthening 
mental healthcare for our country's veterans and their 
families. For Fiscal Year 2022, our bill made significant 
targeted investments to improve veterans' mental health, 
including a record level of $599 million specifically for 
suicide prevention outreach programs, like supporting the 
Veterans Crisis Line, enhancing community-based efforts, and 
implementing proven clinical strategies.
    With suicide rates among Active military and veteran 
communities at crisis levels, we'll continue to be devoted to 
funding programs and services that can intervene and save 
lives.
    And I have a couple of questions focused on mental health 
and wanted to first start with General Hammond.
    General Hammond, you have worked with both Active Duty 
servicemembers and veterans throughout your career. Would you 
agree that the military should train soldiers to strengthen 
their mental health and resilience in the same way that they 
train for physical strength and endurance?
    General Hammond. I would agree with that 100 percent.
    As we look at our physical health--when I came in the Army, 
we ran in boots, we didn't stretch, and we did all of these 
things that can hurt yourself. And somebody had the brains to 
stay: Stop doing that, stretch before you work out, and you 
will last longer, your knees will last longer, et cetera. Now, 
soldiers would never consider starting their physical training 
without all these stretching exercises, because it works.
    We've done it with all these other things. There isn't a 
piece of equipment the military operates, whether it's our 40-
year-old helicopters and tanks that work great because we have 
a great maintenance program--we do a pre-maintenance and post-
maintenance on everything. But, when it comes to mental health, 
when we return from deployment, we'll get asked a question, 
``Do you have any mental health issues?'', and if you raise 
your hand and say yes, you go on medical hold, which is a real 
disincentive for somebody who's been away from home for a year 
to do that.
    Getting out in front of this and working--and I would tell 
you, the special operations community has embraced this, and 
they are working this mental-health-strengthening thing where 
they work on block breathing and all these issues to work on--
stress reduction, anxiety reduction--which enables them to do 
their job much better. So preventive maintenance is really what 
it comes down to for good health and readiness, is the key.
    Ms. Wasserman Schultz. I couldn't agree more. And as a 
softball player, I can tell you, when I didn't stretch before a 
game, I pulled a hamstring, and it caused me problems for 
months. So it only stands to reason that we should be also 
making sure that we're focused on mental health just as much as 
physical strength and endurance.
    Can you elaborate a little bit more on what types of 
programs and services we could implement in military units and 
at DOD and the VA to strengthen the mental health of our 
servicemembers and our veterans?
    General Hammond. Yes, ma'am. I would say, I'd start off 
with that first tool I talked about, that team at Harvard I 
worked with, especially on the suicide prevention: the risk 
assessment. You know, right up front when they first join the 
military, determining who's at risk. And the researchers I 
talked to from Harvard explained to me that 90 percent of our 
suicides come from about a 30 percent high-risk group that they 
can identify using machine learning and AI. And so we can focus 
those deep, deep resources for folks that need that level of 
care for high-risk.
    But the universal care that they have started in the 
comprehensive programs that the special operators use now 
ensure the readiness of these warriors. And if you look at 
their operation tempo over the past 20 years, especially the 
last 10, the operators we see have 15 to 20 combat deployments, 
which is remarkable. And to do that, they've got to manage that 
stress level. And when they don't do that, we see the outcomes 
of the 20 a day and the 300-percent increase in operator 
suicide from 2017 to 2018.
    Ms. Wasserman Schultz. Thank you.
    And talking about the much higher risk of our younger 
servicemembers, I want to just ask Dr. Stumpf Patton, why are 
our younger servicemembers and veterans among the highest risk 
for suicide, would you say?
    Ms. Stumpf Patton. Oh, gosh. You know, let me just 
respectfully say that, when we're speaking about suicide, when 
it's your loved one, it's an ``n'' of one, or a population of 
one. You know, every case is somewhat different.
    Each age demographic is going to have, I think, its unique 
challenges and risk factors. Sometimes with younger 
servicemembers, they might not have the long-term experience, 
the life experiences, some of the wisdom. Maybe they have not 
developed some of the coping skills that maybe older 
servicemembers have. But, you know, other senior servicemembers 
could have other risk factors as well.
    I mean, my husband's case, he was 24 years old at the time 
of his death. So he was a sergeant and kind of on the lower end 
of the spectrum, you know, beginning his career, about six 
years into it. He did have previous stressors in his life. He 
was a combat veteran from the Gulf War, went into a very highly 
stressful position as a drill instructor in the Marine Corps. 
We were a young military couple with a baby on the way. I 
thought, you know, we were working on our dreams, you know, had 
a house and a life together. Meanwhile, he was dealing with an 
extremely stressful job.
    I don't think he had the coping skills at that point. He 
also didn't trust the system about asking for the care that he 
needed, as far as being honest about some of the struggles that 
he was dealing with. He was coping in very maladaptive ways and 
turning toward things, you know, such as alcohol, probably to 
self-medicate with some of those stressors of life and being, 
you know, a young person within a marriage and developing a 
family and combining with that trying to balance a military 
career.
    But, ultimately, that really speaks to suicide, again, as a 
very complex phenomenon that has multiple factors that can 
contribute to that, which ultimately can kind of vary and be 
very unique in a case-by-case basis.
    Ms. Wasserman Schultz. Thank you. And I'm so sorry for your 
loss.
    And, Mr. Chairman, thank you again for allowing us the 
opportunity to really dive deeply into this multidimensional, 
multifaceted problem of suicide and how we can prevent it.
    I yield back the balance of my time.
    Mr. Lynch. I thank the gentlelady. And I thank her for her 
work on this issue as well.
    The chair now recognizes the gentleman from California by 
way of Chelmsford, Massachusetts. You're now recognized for 
five minutes.
    Mr. DeSaulnier. Yes, I'm a proud native of the great 
Commonwealth of Massachusetts, Mr. Chairman. I want to thank 
you, and I do want to thank the ranking member, as well, and 
the panelists.
    I am fortunate to chair the subcommittee of Education and 
Labor called ``HELP''--Health, Employment, Labor, and Pensions. 
And we've had really wonderful discussions about behavioral 
health, stress, depression, and suicide that have been 
bipartisan, ``wonderful'' in the sense that all of us, 
Republicans and Democrats, are focused, I think, very 
appropriately on the extraordinary discovery that we're living 
in about neuroscience, how our brain works and how we struggle 
with that.
    And as a survivor of suicide, I have strong feelings about 
this. Almost 32 years ago in April, my dad, who was a Marine 
combat veteran in World War II, took his life. He's buried in 
Arlington. I have been in therapy since then, and I came to 
accepting that and embracing the humanity of it without being 
self-indulgent, I think.
    And when my story got told by accident to my constituents, 
I found--first, I thought, in horror, that--I was filled with 
shame and stigma. My dad, a proud Marine--if there was TiVo 
when he was alive, we would have watched ``Flying 
Leathernecks'' every day.
    But dealing with that stigma and shame. And I'm so grateful 
that, in my lifetime, we've seen this opening up, that this is 
part of humanity. And the way we avoid it is not to try to 
repress it as a culture but to accept it, not that it has to 
happen, but we can address it.
    So, Dr. Stumpf Patton, I wanted to ask you, in your 
experience both personally and professionally, and 
understanding, to some degree, the grieving process, although 
my dad was 68--so, as painful as that has been, I can't imagine 
losing one of my sons to this--how do we deal with the 
generational and family support, now that we can identify these 
things, where we change that and get people the support?
    And I sense a real acceptance and joy in the fact that we 
are identifying these things. But when I talk to people at UCSF 
in the area that I represent, San Francisco, and their 
neuroscientists--all this discovery, but the deployment of that 
knowledge so we can avoid what happened to you, to my family, 
as soon as possible.
    So there's this sort of dichotomy, as I look at this, as 
I'm really encouraged by the progress we've made, but a sense 
of urgency that if we could deploy this knowledge accurately 
and more quickly to family members, support groups like yours, 
get you the resources, we could save so many lives. And then we 
could break the generational inheritance that too often are 
mistakes for thousands of years we have inherited and passed 
on.
    First, Doctor, and maybe the General could respond to that 
observation.
    Ms. Stumpf Patton. Thank you, sir, so much for 
acknowledging that. And I also honor the loss, and I commend 
you for speaking about that openly.
    I think that, again, is a first step here in this 
conversation. When we share that, it opens up the dialog, 
which, therefore, reduces the stigma. And in cases with 
suicide, the silence that often surrounds the stigma is what 
prevents people from seeking the care. It's an obstacle, and, 
ultimately, it can be fatal.
    And so talking about that really is the first step. Coming 
from an era, as you can understand, when it was not talked 
about, and seeing this transpire and grow over the years, I was 
and still am an eternal optimist about the fact that we are in 
a new window of time, that this is on the forefront, that we 
are talking about it, that the military community is addressing 
it directly, that we are here today. For me, this is 
monumental, that we are sitting here and we are addressing this 
topic to save lives. It is possible.
    And I think it's important that we send that message of 
hope, that this doesn't have to be inevitable. You know, people 
are not broken and beyond repair. The help exists. It works. 
And we can save lives in doing so.
    I think when it comes to postvention, we know the sooner, 
the better. If we can get to people in the hours, days, and 
weeks, the sooner we can get to them after a suicide--and this 
speaks even specifically within a military unit. When we can 
stabilize that and address those issues, we know that 
drastically reduces the risks of those people who have been 
impacted by that suicide where they, therefore, could be 
vulnerable and at risk themselves.
    It also sends the message that they are not alone, they do 
not have to go through this by themselves, which that, in 
itself, combats suicide because it reduces that isolation, and 
it promotes that sense of belongingness and connection that can 
save lives.
    And I will turn it back to you.
    General Hammond. I think one of the greatest challenges 
this generation has is the prevalence of veteran suicide, 
military suicide. I don't know a veteran of Iraq or Afghanistan 
that doesn't personally know someone who's taken their life, 
and usually it's two or three. And there's not another career 
path that anybody could make that claim on such a broad scale.
    Our work with TAPS is some of the most meaningful work we 
do at Home Base. And we consider the primarily women, the 
spouses, that have come in and the parents to be some of the 
most injured people we deal with, far more than any Navy Seal 
or Green Beret. Many of the women that have come to us from 
TAPS have witnessed a suicide, and you can imagine what that's 
like, at the kitchen table, with your children present. And 
we've talked to them about the fact that children as young as 
eight years old are now demonstrating ideations because of the 
trauma they've been exposed to.
    So, without treatment plans and programs for this, we're 
going to lose this next generation of folks because we can't 
intervene fast enough. And so we work very closely with TAPS to 
try and innovate and develop new types of programs, but the 
scale is not there yet to take care of everybody that needs it.
    I think the normalization of this has been incredible over 
the last 20 years. Most combat vets I know, especially that 
were in line units, whether they're Marine regiments, infantry 
battalions, they now have these buddy systems on Facebook where 
they watch closely when somebody starts talking about something 
that's a trigger. And guys will get in a car and drive to a 
house, they'll drive three states over, to go intervene if they 
don't pick up the phone.
    And so there's no stigma; it's anger about, ``Don't you do 
it.'' And we do see that effect that we spoke about a moment 
ago, that it can be contagious. You know, we see it in a unit 
where there's not a postvention, and then suddenly there's two 
or three more. And, frankly, I've lost more soldiers to suicide 
than I did in three combat commands. So it is prevalent, and it 
can cascade.
    Mr. DeSaulnier. Thank you, Mr. Chairman.
    Thank you. This is really terrific. I think I see real hope 
here. And I see an opportunity that I hear from my colleagues 
on both sides that we can be really supportive and 
transformative so that other families won't have to go through 
this.
    Thank you so much.
    Mr. Lynch. The gentleman yields back. I thank him for his 
participation as well.
    Before we close, I would like to offer to the ranking 
member an opportunity if he had any closing thoughts.
    Mr. Grothman. Could I ask one more question of Mr. Jones?
    Mr. Lynch. Please.
    Mr. Grothman. Mr. Jones, are you still on here?
    Staff Sergeant Jones. Yes.
    Mr. Grothman. OK. You gave us an anecdote before concerning 
an over-prescription of painkillers. And I think we've made a 
lot of progress on that in the civilian sector.
    Do you feel there are problems there in the military, where 
they maybe haven't caught up on the amount of painkillers you 
could prescribe? Like I said, I believe in the last four or 
five years we've made so much progress. But could you comment 
on where you think the military is on that?
    Staff Sergeant Jones. My friend--first of all, real quick, 
multiple members of this committee have asked about stigma, and 
I just wanted to, if I could, touch on that real quickly.
    Mr. Grothman. Sure.
    Staff Sergeant Jones. As the one person on this panel that 
I know--the General may have, but I was a troop, a low-ranking 
enlisted--stigma, that's a cultural problem, not an 
administrative problem per se. And what I mean by that is, 
you're not going to solve that problem with a PowerPoint and a 
policy. You're going to solve that problem by going where you 
make leaders and engraining it into leaders to treat their 
troops in a way that they can communicate with their troops 
about problems.
    It's a one-on-one conversation, not a classroom 
conversation. That removes that stigma and gives servicemembers 
the opportunity to be honest about what they're going through 
with people around them.
    It's cultural. And it's the hard way, not the easy way. 
It's not the ``let's write a policy and make a PowerPoint that 
everyone gets once a year.'' It's a ``when we make leaders, we 
instruct those leaders on how to communicate with their 
troops'' and do things, just like the General was saying, where 
we change the perspective from ``I can play hurt'' to ``I can 
play a heck of a lot better fully healthy.''
    And back to your question about painkillers, the anecdote I 
gave, the friend I had was being prescribed by the VA. I can't 
really speak in this moment how the DOD prescribes painkillers 
because I didn't even consider it an option when I was in the 
military. I didn't even know that was even something I could 
get.
    But with the VA, the problem there that my friend had, and 
it still persists, is the lack of communication between a 
physician in the VA assigned to mental health and the primary 
care manager for that servicemember.
    I belong to a VA in Atlanta. I've had so many different 
primary care physicians at the VA that I couldn't name them. I 
finally found one that I trusted and believed in, and when I 
went in for a monthly checkup last month, I was notified she's 
no longer there. And so, all that trust I built with that 
physician, she's not there anymore. If I went to a physician 
out in town, they've been there for 30 years.
    And so that type of trust, communication, and that primary 
care physician understanding everything that veteran is dealing 
with, that's the problem, because that primary care physician 
would be in charge of issuing me pain medication, and that's 
the person that would know I'm also seeking mental health or 
dealing with mental health issues.
    I went to the VA when I first moved to Georgia, and the 
doctor literally sat there at the computer and asked me these 
questions like, ``Have you thought about killing yourself?'' He 
never even looked away from the screen or introduced himself to 
me. I don't know anyone in this world that feels comfortable 
revealing that information to someone who has yet to introduce 
themselves or even look them in the eye.
    These are cultural problems. They're not something you just 
simply solve with a change in policy. It's a full education and 
cultural shift.
    And that's why I'm such an advocate for what is usually a 
much more intimate interaction with nonprofit organizations and 
private healthcare providers that want to work in concert with 
government entities like the VA, not aside from. They're being 
forced to work on their own. They want to work in concert with. 
And I think that it's the responsibility of you all to help 
make that happen.
    Mr. Grothman. Thank you.
    Mr. Lynch. The gentleman yields back.
    I just have a couple of quick questions, and one of them 
actually fits nicely--it's a nice segue from the Sergeant's 
comments. And that is, Ms. Hundrup, the Government 
Accountability Office, have we looked at that issue where we 
try to encourage collaboration between the VA, let's say, and 
some of the community organizations, whether it's the Home Base 
program or TAPS or even--in my district, we have a lot of 
community health centers that are aware of who the people are. 
And so it might serve us to, you know, make that connection.
    Has the GAO looked at any of that?
    Ms. Hundrup. I will just mention, we do have current work 
underway that's looking at VA suicide prevention and mental 
health agreements. That is something that's currently ongoing 
that we do anticipate issuing in early 2022.
    But I do think, given the complexity of the issue and the 
fact that there's not a single solution or a single entity, 
that looking at the partnerships and the possibility for VA and 
DOD to partner further with states, locals, the important folks 
at the table today, and the nonprofits, the community, it is 
truly not one single entity that is going to solve this.
    So I think that is an area that, you know, understanding 
where there could be some synergies and additional attention 
would certainly be warranted.
    Mr. Lynch. That's great. Thank you. I look forward to 
following up on that.
    The other question I had was really a followup to Ms. 
Speier's question. I notice she didn't ask you this, but, you 
know, as the chair of this committee and as ranking member in 
times when my Republican colleagues were in the chair, I've had 
the luck, I guess, to visit Iraq and Afghanistan between 30 and 
40 times and deal with some of the issues that some of our men 
and women in uniform are dealing with.
    And I don't know, it may be anecdotal, but I had always had 
a custom of asking every servicemember that I got to sit with--
and there were thousands--I said, how many tours have you done 
so far?
    And I remember, one of my most recent visits was during the 
withdrawal process in Camp Leatherneck in Afghanistan. And I 
was with a small group of about--it was a rifle company, maybe 
20 or 30 young Marines. And I asked them, how many here are on 
your first tour? And maybe two or three hands went up. And 
then, how many are on your second tour, how many are--I got all 
the way up to seven tours of duties before I ran out of 
Marines, right?
    And it just seems to me that that OPTEMPO, that wear-and-
tear--do we have any data? Have we looked at that? And I've 
asked others in the past if we've got data to show any 
correlation between the frequency that we ask these men and 
women to serve, pulling them away from their families--and you 
can only imagine the conversation telling your spouse that 
you're going on your third deployment or fourth deployment and 
what that means at home and the sacrifice that your family 
embraces.
    So do we have any data to reflect a correlation or, you 
know, what the connection might be there?
    Ms. Hundrup. We certainly know that's a risk factor, one of 
many risk factors. I am not aware of specific data on that, but 
that's a great question. And that could be something to target 
to our colleagues at DOD and VA, to see what information they 
have. And if that is a gap, that is perhaps an important area 
to be looking at.
    Mr. Lynch. OK. Thank you.
    Well, in closing, to our Active military and veterans, as 
the ranking member said at the outset, let me say as well, you 
are not alone. If you're struggling or need help, please reach 
out. If you or someone you know is experiencing a mental health 
crisis or contemplating suicide, the National Suicide 
Prevention Lifeline is available 24 hours a day, seven days a 
week. At any time you can call 1-800-274-8255 and dial 1 or 
text 838255. Again, that number is 1-800-274-8255 and then dial 
1, or you can text 838255.
    I want to thank all of our witnesses for their remarks 
today. And we are grateful for your continued service.
    I want to commend my colleagues for participating in this 
important conversation, both Republicans and Democrats.
    And, with that, without objection, all members will have 
five legislative days within which to submit additional written 
questions for the witnesses to the chair, which will be 
forwarded to the witnesses for their response.
    And I ask our witnesses to please respond as promptly as 
you are able.
    Mr. Lynch. This hearing is now adjourned. Thank you.
    [Whereupon, at 11:55 a.m., the subcommittee was adjourned.]

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