[Senate Hearing 117-94]
[From the U.S. Government Publishing Office]
S. Hrg. 117-94
COPING DURING COVID:
VETERANS' MENTAL HEALTH AND
IMPLEMENTATION OF THE HANNON ACT
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
MARCH 24, 2021
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Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
46-079 PDF WASHINGTON : 2021
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COMMITTEE ON VETERANS' AFFAIRS
Jon Tester, Montana, Chairman
Patty Murray, Washington Jerry Moran,Kansas, Ranking Member
Bernard Sanders, Vermont John Boozman, Arkansas
Sherrod Brown, Ohio Bill Cassidy, Louisiana
Richard Blumenthal, Connecticut Mike Rounds, South Dakota
Mazie K. Hirono, Hawaii Thom Tillis, North Carolina
Joe Manchin III, West Virginia Dan Sullivan, Alaska
Kyrsten Sinema, Arizona Marsha Blackburn, Tennessee
Margaret Wood Hassan New Hampshire Kevin Cramer, North Dakota
Tommy Tuberville, Alabama
Tony McClain, Staff Director
Jon Towers, Republican Staff Director
C O N T E N T S
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Wednesday, March 24, 2021
SENATORS
Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............ 1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas...... 2
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire...... 14
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 16
Sullivan, Hon. Dan, U.S. Senator from Alaska..................... 18
Brown, Sherrod, U.S. Senator from Ohio........................... 19
Kevin Hon. Cramer, U.S. Senator from North Dakota................ 21
Hirono, Hon. Mazie, U.S. Senator from Hawaii..................... 23
Tuberville, Hon. Tommy, U.S. Senator from Alabama................ 25
Manchin III, Hon. Joe, U.S. Senator from West Virginia........... 33
Boozman, Hon. John, U.S. Senator from Arkansas................... 35
WITNESSES
Panel I
David Carroll, PhD, Executive Director, Office of Mental Health
and Suicide Prevention, Veterans Health Administration,
Department of Veterans Affairs Accompanied By: Lisa K. Kearney,
PhD, ABPP, Acting Director, Veterans Crisis Line, and Deputy
Director, Suicide Prevention, Office of Mental Health and
Suicide Prevention............................................. 4
Tammy Barlet, MPH, Associate Director, National Legislative
Service, Veterans of Foreign Wars.............................. 5
Thomas Porter, Executive Vice President, Government Affairs, Iraq
and Afghanistan Veterans of America............................ 7
Lt. Col. Jim Lorraine, USAF (Ret.), MA, President and CEO,
America's Warrior Partnership.................................. 9
Panel II
Clifford A. Smith, PhD, ABPP, Director, Field Support and
Analytics, Office of Mental Health and Suicide Prevention,
Veterans Health Administration, Department of Veterans Affairs
Accompanied By: Matthew A. Miller, PhD, MPH, Director, Suicide
Prevention, Office of Mental Health and Suicide Prevention..... 26
Karin A. Orvis, PhD, Director, Defense Suicide Prevention Office,
Office of Force Resiliency, Office of the Under Secretary of
Defense for Personnel and Readiness, Department of Defense..... 27
Chad Bradford, Capt.,MC, USN, U.S. Navy, Director of Mental
Policy and Oversight, Health Services Policy and Oversight,
Office of the Assistant Secretary of Defense for Health
Affairs, DoD................................................... 28
APPENDIX
Witnesses prepared statements
David Carroll, PhD, Executive Director, Office of Mental Health
and Suicide Prevention, Veterans Health Administration,
Department of Veterans Affairs................................. 40
Tammy Barlet, MPH, Associate Director, National Legislative
Service, Veterans of Foreign Wars.............................. 46
Thomas Porter, Executive Vice President, Government Affairs, Iraq
and Afghanistan Veterans of America............................ 49
Lt. Col. Jim Lorraine, USAF (Ret.), MA, President and CEO,
America's Warrior Partnership.................................. 54
Karin A. Orvis, PhD, Director, Defense Suicide Prevention Office,
Office of Force Resiliency, Office of the Under Secretary of
Defense for Personnel and Readiness, Department of Defense and
Chad Bradford, Capt., MC, U.S Navy USN Director, Mental Health
Policy and Oversight Health Affairs............................ 60
Statements for the Record
Paralyzed Veterans of America.................................... 65
Joy J. Ilem, National Legislative Director, Disabled American
Veterans....................................................... 71
Katherine B. McGuire, Chief Advocacy Officer, American
Psychological Association Services Inc......................... 77
Syracuse University, Institute for Veterans and Military Families 81
Military Officers Association of America......................... 84
National Association of County Veterans Service Officers......... 91
Questions for the Record
Response to hearing questions from VA submitted by:
Hon. Moran..................................................... 95
Hon. Blumenthal................................................ 100
Hon. Sinema.................................................... 107
Hon. Hassan.................................................... 115
Response to hearing questions from IAVA submitted by:
Hon. Blackburn................................................. 118
Response to hearing questions from VFW submitted by:
Hon. Blackburn................................................. 119
Response to hearing questions from DOD submitted by:
Hon. Blackburn................................................. 120
Resources on Mental Health and Hannon
S.785 Commander John Scott Hannon Veterans Mental Health Care
Improvement Act Section-by-Section............................. 119
Montana Veteran Suicide Data Sheet, 2018......................... 130
The Veterans Health Administrations's Rapid Conversion to Virtual
Mental Health Care During the Covid-19 Pandemic................ 132
Commander John Scott Hannon Veterans Mental Health Care
Improvement Act (P.L. 116-171) Implementation Kick-Off and
Special Provision.............................................. 160
COPING DURING COVID:
VETERANS' MENTAL HEALTH AND IMPLEMENTATION OF THE HANNON ACT
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WEDNESDAY, MARCH 24, 2021
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3 p.m., via Webex
and in room SD-G50, Dirksen Senate Office Building, Hon. Jon
Tester, Chairman of the Committee, presiding. Present: Senators
Tester, Brown, Blumenthal, Hirono, Manchin, Hassan, Moran,
Boozman, Sullivan, Cramer, and Tuberville.
OPENING STATEMENT OF CHAIRMAN TESTER
Chairman Tester. The hearing will come to order. I want to
welcome everybody to the Senate Veterans' Affairs Committee
hearing. Today we have got a great hearing scheduled, and I
want to welcome everybody.
I have got good news today. The President signed our
bipartisan Saves Lives Act into law. For those who do not know,
this new law expands options where veterans and their families
can receive the COVID-19 vaccine, ensuring that every veteran
and their spouse and their caregiver will have access to
protection they need from the VA, and it follows through on our
shared goal of getting as many shots in the arms of veterans as
possible.
I want to thank our great Ranking Member, Senator Moran,
along with Senator Boozman and Senator Blumenthal and our House
colleagues for helping all of us work together to push this
bill through and get this pandemic behind us or take a step
toward that and move our country forward.
As you might recall, it was just a month ago that we were
sitting together in this room, at a VA vaccine hearing, and the
idea of this bill came up, and I think it really speaks to the
bipartisan nature of this Committee and how fast we can all
work together to solve a problem when we recognize that there
is a need out there.
I am looking forward to seeing what comes out of today's
hearing, which is focused on veterans' mental health, a huge
issue. Now I thank the veteran service organizations as well as
the Department of Defense and Veterans Affairs officials that
are with us here today.
Many of our men and women in uniform face isolation and
mental health challenges when they return home from their
service, and more than a year into his pandemic we now know
that veterans across the country experience mental health
concerns at higher rates than ever, and that is why it is
important that we gather today to talk about the challenges
veterans have faced accessing mental health care during this
pandemic, and to hear from both the VA and the DoD about what
they are doing to address those concerns.
I want to commend the VA for its use of telehealth services
and its quick shift to virtual operations for the Veterans
Crisis Line when the virus took hold of the Nation.
As we know, the effects of this pandemic are far from over,
and the number of veterans who die by suicide remains way too
high, and that is why it is even more critical that the VA and
the DoD takes swift action to implement the Commander John
Scott Hannon Act, my bipartisan bill with the Ranking Member
Moran, that was signed into law last fall. Named after a former
Navy SEAL in Montana, Commander John Scott Hannon, this law
honors his legacy and reaffirms our commitment to those who are
selflessly served by taking aggressive action to approve mental
health access in this country for our veterans.
The Hannon Act combines some of the best ideas from
veterans, VSOs, VA, and mental health professionals to improve
veterans' access to mental health care. It does so through
strengthening telehealth and alternative therapies, better
connections to care in the community, research through
evidence-based treatments, and accountability for the VA's
management of suicide prevention resources.
It also provides more local and complementary health care
options, which brought Commander Hannon comfort back to
Montana, by working in nature with other veterans. And it
bolsters VA's mental health work force through a scholarship
program to get more mental health professionals into our vet
centers. There is no time to waste in implementing the
important provisions of the Hannon Act, and I know Senator
Moran and members of this Committee share that important goal.
Further, the transition from servicemember to veteran can
also be very difficult for many. That is why I think it is
essential that we have the DoD take part in these conversations
as well. They have an important responsibility, shared with the
VA, to implement the Hannon Act and improve the transition
experience, make connections to mental health resources, and
contribute to joint VA-DoD mental health programming. We need
to continue to reduce the stigma of accessing mental health
care, making sure our vets have every option available to them.
I would like to thank all that are here today for your
commitment to bettering the health and well-being of our
service men and women, veterans, and their families.
With that I will turn it over to you, Senator Moran.
OPENING STATEMENT OF SENATOR MORAN
Senator Moran. Chairman Tester, thank you. Senator Tester
and I serve on five of five committees together, and we share
that joy or burden almost every day. Mr. Chairman, it has been
a pleasure to work with you on a number of pieces of
legislation, including the Save Act, and I thank President
Biden for signing it into law today. I cannot imagine there is
another member of the United States Senate that I have teamed
up with that has resulted in more legislation being passed and
more legislation being signed into law. So thank you for your
efforts to put up with me on five committees and to work
together on legislation.
This issue, for me, arose when I was visiting the Topeka
Colmery-O'Neil VA Medical Center and their vaccine site, now
perhaps 3 weeks ago, and one of the items that was brought to
me by the director, as well as by veterans, is a reluctance on
the part of veterans to take the vaccine, to get the vaccine,
in the absence of their spouse or caregiver being able to get
it as well. And just common sense indicates that is a problem
waiting for a solution, and I am pleased to see that that is
taking place, and I thank the folks at Colmery-O'Neil for
hosting me to see and talk to veterans about the vaccine, which
led to my interest in this topic.
I am pleased also to be here this afternoon to discuss one
of Senator Tester and I's top priorities, this Committee's top
priority on veterans' mental health care as well as the
comprehensive veteran suicide prevention legislation that we
worked on last year, the Commander Hannon Act, which became law
last year.
I want to thank all of our witnesses for being here today,
and I extend a special welcome to Jim Lorraine for joining us.
He is with the America's Warriors Partnership.
COVID-19 pandemic has exposed substantial gaps in America's
mental health care system, both within the VA and throughout
communities across the Nation. Many Americans have experienced
devastation due to the loss of family members or friends, while
others have experienced joblessness and financial uncertainty.
While it is important we continue to prioritize vaccinations
for all American adults as soon as possible, it is also
critical that we do not forget about the mental health toll
that this pandemic has taken on Americans, and especially on
our veterans.
We know this pandemic has led to a rise in anxiety,
depression, suicides, and overdose deaths. In fact, a study
recently published by JAMA Psychiatry illustrated that
emergency department visit rates for suicide attempts and
overdoses were much higher from mid-March through October 2020,
compared to the same period of time in 2019. For many veterans
who already live with mental health conditions or an addiction,
the added social isolation and the fear due to this pandemic
has heightened these conditions.
A survey released last December by the Wounded Warrior
Project found that 30 percent of the 30,000 veterans polled
reported recent suicidal ideation, and roughly 60 percent
reported symptoms of moderate to severe depression. This is
another wake-up call for all of us.
Thankfully, Congress worked in a bipartisan manner last
year to pass the Hannon Act. Now it is up to the VA, with
alacrity, to implement this comprehensive suicide prevention
law, consistent with congressional intent.
Getting results for veterans is what matters, and I am glad
our oversight today is oriented toward that goal.
Taking into account the high rate of veteran suicide is now
more important than ever for the VA to execute the lifesaving
provisions contained in the John Scott Hannon Act. We know that
connectedness to one another, to other veterans, to family, to
community is an important protective factor for suicide.
We also know that two-thirds of veterans who die by suicide
have no meaningful contact or interaction with the VA prior to
their deaths. It is imperative that the VA move quickly to
implement the Staff Sergeant Parker Gordon Fox Suicide
Prevention Grant Program. This program will extend VA's reach
to vulnerable veterans not under the Department's care and
enable us to bolster organizations already serving veterans in
communities across America.
Additionally, I was encouraged by the recent update my
staff received on a provision in the Hannon Act regarding the
VA's implementation of Safety Planning in the Emergency
Department, SPED. SPED is an evidence-based intervention
program that is shown to decrease suicide by 45 percent in the
6-month period following intervention. While SPED was
originally rolled out in October 2018, only about 28 percent of
VA facilities use this intervention. In January 2020, the VA
had only marginally improved to 33 percent of facilities using
this evidence-based intervention. Now, because of this
Committee's oversight, the actions by the Department of
Veterans Affairs, over 82 percent of all VA facilities have
adopted it, and I applaud the Department for this dramatic
improvement. I look forward to hearing from our witnesses
today.
Before I close, though, I would indicate to any veteran
that is in the crisis mode, anyone who is listening now that
has an ideation about suicide or needs mental health
counseling, please call 1-800-273-8255, and press 1. That is 1-
800-273-TALK, and then press 1. And I yield back, Mr. Chairman.
Chairman Tester. Thank you, Senator Moran. At today's
hearing we are going to have a two-panel format. In the first
panel we are going to hear from VA and veterans advocates about
veterans' access to mental health care during the pandemic and
beyond. Then, in the second panel, we are going to get to an
update from the VA and DoD officials on the implementation of
the Hannon Act.
I want to first introduce the panelists for our first
panel. Some will be here virtually, others will be here in
person. I first want to introduce Dr. David Carroll, head of
the VA's Office of Mental Health and Suicide Prevention, to
deliver the VA's opening Statement. Dr. Carroll is accompanied
virtually by Dr. Lisa Kearney, Acting Director of the Veterans
Crisis Line and Deputy Director for Suicide Prevention at the
VA.
Then we are going to hear virtually from Ms. Tammy Barlet
with the VFW, then in person from Mr. Tom Porter from IAVA, and
Lt. Col. Jim Lorraine, who will be here in person, from the
America's Warrior Partnership.
Dr. Carroll, we will start with your presentation. Go
ahead.
PANEL I
STATEMENT OF DAVID CARROLL, ACCOMPANIED BY LISA K. KEARNEY
Mr. Carroll. Good afternoon, Chairman Tester, Ranking
Member Moran, and members of the Committee. Dr. Kearney and I
are pleased to be here to discuss VA's delivery of mental
health care and suicide prevention services during the COVID-19
pandemic. Nothing is more important to VA than advancing the
health and well-being of the Nation's veterans and their
families, and suicide prevention is our No. 1 clinical
priority. Our national vision for preventing veteran suicide is
grounded in three tenets: suicide is preventable, it requires a
public health approach, and everyone has a role to play in
suicide prevention.
We know that pandemics, especially those involving
quarantines, create psychological distress and negatively
impacts society beyond the period of the pandemic itself. So
guided by our public approach to suicide prevention and recent
research, VA created a Mental Health COVID-19 Response Plan,
organized around universal, selective, and indicated
strategies. Our plan focuses on both the immediate and long-
term impacts on mental health and suicide prevention, including
support for the most vulnerable veterans, as well as for all 20
million veterans, as well as for all providers and leaders
across VA.
The plan includes adaptations of our Suicide Prevention 2.0
initiative and our Suicide Prevention Now initiative, to
include new COVID-19-related suicide prevention efforts.
VA has maintained continuity in mental health care and
suicide prevention services during the pandemic, and we have
conducted surveillance on the trends and facility-reported
suicide-related behavior. Findings to date do not indicate
there are pandemic-era increases in veteran suicides, non--
fatal suicide attempts, or in the volume of emergency
department visits related to suicide attempts, as reported by
our facilities. However, the long-term impact in the rest of
the data remain unknown.
We have worked to increase our communication and to bring
veterans, providers, and leaders closer together across VA
during the pandemic, and our work has been informed and
influenced by the recent legislation, giving us opportunity to
further expand our public health approach to suicide prevention
and mental health. We appreciate the Committee's continued
direction, support, and partnership in this shared mission.
Mr. Chairman, this concludes my Statement. My colleague and
I are ready to answer any questions you and the members of the
Committee may have. Thank you.
Chairman Tester. Thank you, Dr. Carroll. And I assume that
Dr. Kearney is there to support you?
Mr. Carroll. Correct.
Chairman Tester. Okay. So next we will hear from Ms.Tammy
Barlet from the VFW.
STATEMENT OF TAMMY BARLET
Ms. Barlet. Chairman Tester, Ranking Member Moran, and
members of the Senate Committee on Veterans' Affairs, on behalf
of the men and women of the Veterans of Foreign Wars of the
United States and its Auxiliary, thank you for the opportunity
to provide our insight pertaining to veterans' mental health
during the COVID-19 pandemic and the use of ATLAS pod sites.
Linesville is a small, rural town in northwestern Pennsylvania,
and is vulnerable to 81 inches of snow per year due to the Lake
Erie snow effects. The nearest VA medical center is in Erie,
which is over an hour's drive on days with normal weather
conditions. This past February in Linesville, a Vietnam Navy
veteran left his home, drove to a VA video-connect VVC
appointment and returned 35 minutes later, thanks in part to
the ATLAS pod at the VFW Post 7842.
He admitted that he is not the most tech-savvy guy and
expressed his gratitude for the short drive to the post and the
onsite attendant to help guide him through the check-in
process. He also mentioned that this relieved him of stress and
hassles having to drive to Erie or try to connect to the video
appointment on his own.
The VFW released a survey at the end of April 2020, through
which VFW members provided a snapshot of their health care
experiences 6 weeks into the COVID-19 national emergency.
My written testimony has a detailed breakdown of these
statistics. The majority of the respondents stated they were in
good health, with five or fewer days of poor physical health
and poor mental health, which had little interference on their
daily activities in the last 30 days. Although but a part of
the remaining respondents expressed their experiences were
either 6 to 10 days or 26 or more days out of the month. The
VFW plans to conduct a following survey.
Telehealth plays a critical role in maintaining veterans'
mental and physical well-being during the time of social
distancing quarantine. The urgent transition from in-person
appointments to telehealth left both patients and physicians
relying on communication via telephone, which made up 81
percent of those encounters, according to a recently released
Office of Inspector General VA report. But making eye contact
and seeing facial body cues is essential to successful
appointments, and the OAG sent a questionnaire regarding VVC
barriers to the Veterans Health Administration primary care
providers. The providers identified veterans' lack of internet
connectivity and equipment, insufficient training and support
for veterans, which included the test of it prior to the
scheduled appointment and the problematic, two-system process
for face-to-face care. The OIG recommended that VA assess VVC
and take appropriate action to address the digital divide.
The VFW is proud to be part of this solution. Through the
ATLAS pod sites the VFW worked with VA and Philips to leverage
VA's anywhere-to-anywhere authority, to expand telehealth
options for veterans who live in rural areas, or may have lack
of access to internet, necessary equipment, and knowledge to
facilitate VVC. In addition to secure and private VVC
connectivity, the ATLAS locations contain a full suite of
telehealth devices.
The first VFW post with the ATLAS site was in Eureka,
Montana. Eureka is more than 60 miles from the nearest VA
clinic, and more than 250 miles from the nearest VA hospital.
The Eureka ATLAS site had many appointments before the
temporary shutdown of the post due to the State's COVID-19
pandemic precautions, but since then the post as reopened,
appointments continue, and several have been scheduled for the
next 30 days.
The second VFW location is Linesville, Pennsylvania. The
Post Commander, Norm Haas, is humbled to have this valuable
resource for the veteran community. He would like to expand the
hours of operation 15 hours a week to 40 hours a week. In the
meantime, the Erie VA Medical Center has mailed out postcards
announcing the ATLAS pod availability and hours of operation to
eligible veterans in the area.
Two additional VFW ATLAS locations are scheduled to open
within the next month, VFW Post in Los Banos, California, and
the other in Athens, Texas, and there is interest for 22 more
locations. The VFW commends the Senate for passing the
Commander John Scott Hannon Veterans Mental Health Care
Improvement Act of 2019, and the additional legislation to fund
expansion of VA's telehealth services into law. The VA urges
congressional oversight to ensure VA implements the legislation
as written and intended, so VFW posts can continue to expand
telehealth capabilities, which include mental health programs
and suicide prevention to veterans in rural and highly rural
areas.
Chairman Tester and Ranking Member Moran, this concludes my
testimony. Thank you for the opportunity to present the VFW's
input today, and I look forward to engaging in any further
discussion you or any members of the Committee may have.
Chairman Tester. Tammy, thank you for your testimony, and
there will be some questions coming up. I have got a few myself
for you, and I appreciate your testimony. Next we have Tom
Porter, who is Executive Vice President of Government Affairs
for Iraq and Afghanistan Veterans of America. Tom, the floor is
yours.
STATEMENT OF THOMAS PORTER
Mr. Porter. Thank you. Good afternoon, Chairman Tester,
Ranking Member Moran, and good afternoon, Senator Tuberville.
Thanks for having me here today. I appreciate the opportunity
to testify.
Before I get started I would like to welcome our members
who are virtually watching today. We normally have an in-person
fly in for a week a few times a year but we cannot do that, so
they are all watching from around the country, but meeting
virtually with many of your offices. You can follow along this
week with the hashtag allstaradvocacy on Twitter.
So as with everyone else, the last year has been
challenging for IAVA. This time last year we had just wrapped
up a very successful member fly in. Within a week of saying
goodbye, we were in quarantine, and working remotely. Despite
the challenges, IAVA was successful in adapting to continuing
our advocacy.
We were able to help pass critical reforms, and we thank
you for passing the Hannon Act, Deborah Sampson Act, and
protections for student veterans as schools went online.
Additionally, we helped to pass legislation to establish a
three-digit national suicide hotline to improve access to
suicide prevention resources. The pandemic has affected almost
every facet of our lives. Our members report feeling more
isolated than ever.
According to VA, almost a quarter of all veterans live in
rural communities, areas that tend to have higher poverty rates
and more elderly veterans. As VA focused more on telehealth at
the start of the pandemic, rural veterans had particular
challenges since a quarter of them do not have internet access
at home. We are pleased that the Hannon Act expanded tele-
mental health to increase accessibility.
According to recent VA data, veterans age 18 to 34 have the
highest rate of suicide, and in our last survey, 65 percent of
IAVA members reported service-connected PTSD, and over half
reported anxiety or depression. COVID has exacerbated the
issue, and data from last year's IAVA Quick Reaction Force
demonstrates this. QRF is a safety net that provides free,
comprehensive care and peer support for any veteran or member
in need, regardless of service era or discharge status.
The needs of veterans remain high, particularly in light of
the pandemic, and in 2020, QRF saw a 400 percent increase in
clients served from 2019. QRF is built to address all aspects
of a veteran's life and are in need of intervention and
support, and we do this by providing holistic and comprehensive
care. In 2020, more than 15 percent of all requests were mental
health related. Additionally, IAVA continues a partnership with
the Veterans Crisis Line and also has 24/7 in-house clinical
support for those at suicide risk who reach out to us.
Outside of mental health needs, 56 percent of QRF requests
were related to emergency financial assistance, the threat of
homelessness, or both, which directly impacts one's well-being.
Recent HUD data, released last week, shows that veteran
homelessness increased before the pandemic hit. Between 2010
and 2019, homelessness decreased by over 50 percent. However,
in January 2020, the number of homeless veterans had increased
from the previous year.
This troubling data predates the pandemic. Data from HUD,
coupled with IAVA's QRF data shows that veteran homelessness
remains a problem.
Housing has been a concern while transitioning from
service. In IAVA's last survey, 24 percent reported being
homeless for over a year after leaving the military, and 81
percent reported couchsurfing temporarily. We must ensure that
recently separated veterans are aware of benefits available to
them during this difficult time.
Additionally, homeless veterans may have families to
support, and women veterans are historically at higher risk for
homelessness than civilian counterparts. Providing safe
facilities for women that accept children is critical. Others
are younger veterans who must need temporary support. The VA
must continue partnerships to align services to adjust for
these demographic shifts. Unemployment is also a concern. In
February, the unemployment rate for all veterans was 5.5
percent below the 6.2 average nationally. However, the post-9/
11 rate remains higher than their peers.
I want to thank Chairman Tester and Ranking Member Moran
for passing the Veterans Economic Recovery Act, which will be
very impactful in lowering unemployment. Strong oversight of
this new law is necessary for it to be successful. Women
veterans are more likely than males to face economic and
personal challenges. They have higher unemployment, are more
likely to be homeless, and be single parents. These issues have
increased during the pandemic.
Women veterans are also at more than twice the risk of
suicide than civilian peers, making it more imperative to
address these issues. For these reasons, the Hannon Act must be
quickly implemented. The community grant program is designed to
identify the 14 veterans per day who die by suicide who are not
participating in VA service, and connect them to lifesaving
resources. The provision could not be more important now, when
veterans are more disconnected than ever.
VA still faces a shortage of mental health professionals.
Recent legislation targeted deficiencies in recruitment and
retention by creating scholarship and student loan repayment
programs by adding $65 million to VA's recruitment, relocation,
and retention bonuses.
However, these scholarships are limited. VA needs to move
psychologists under the hiring authority which provides more
competitive salary than the Federal GS scale. The Hannon Act
will have long-lasting effects, and veterans need those
provisions today. So we ask for your oversight to ensure quick
implementation.
Thank you again for the opportunity to testify for IAVA,
and I look forward to any questions.
Chairman Tester. Tom, thank you for your testimony. I
appreciate it very much.
Next up we have Lt. Col. Jim Lorraine, United States Air
Force, Retired, and he is the President and CEO of America's
Warrior Partnership. Jim?
STATEMENT OF LT. COL. JIM LORRAINE
Colonel Lorraine. Thank you, sir. Chairman Tester, Ranking
Member Moran, and members of the Committee, thank you for the
invitation to testify today.
COVID-19 has devastated the United States over the last
year. This devastation manifested itself in death, long-term
illness, financial ruin, isolation, emotional strain, and loss
of hope. Military-connected citizens were not immune to this
devastation. However, in many cases veterans and their families
led efforts to help fellow citizens and supported community-
based programs to empower others to move forward, despite the
adversity. At America's Warrior Partnership we recognize,
through our studies, that local programs that had proactively
developed relationships with their community veterans ahead of
the crisis were much more prepared to serve during the pandemic
than others.
In South Carolina, an affiliate community, Upstate Warrior
Solution, used their close relationship with over 7,000
veterans living in the region to meet the majority of the
needs. They connected by phone, text, email, and physically
distanced check-ins. Programs like UpState Warrior Solution
were able to mitigate many of the stressors facing veterans and
their families. In the Arizona Navajo Nation, our veteran
service program, the Dina Naazbaa' Partnership, reconnected
with more than 300 veterans in the tribal areas, bringing them
food, water, blankets, and firewood. However, the greatest gap
for veterans during COVID is reduced access to health care.
Syracuse University Institute for Veterans and Military
Families identified medical care as the No. 1 resource need,
followed by financial assistance and community support. Wounded
Warrior Project surveyed more than 28,000 post-9/11 disabled
veterans, finding that 59 percent reported that their physical
health appointments and 38 percent that their mental health
appointments had been postponed or canceled.
Additionally, Wounded Warrior Project found that lack of
medical care compounded the negative response to COVID
pandemic, and as the Ranking Member mentioned, 30 percent of
the respondents expressed suicidal ideations. Similarly, Blue
Star families found that access to medical care and overall
mental health status of parents and children to be a leading
concern. And still, a year later, we have heard from our
communities and county partners that access to care is not
improving.
On March 2020, Ranking Member Moran had concerns about the
temporary pause in community care. And a year later, just this
month, USA Today cited a congressional letter from the
northeast detailing the cancellation of almost 20 million
medical appointments to veterans during the pandemic. Last
week, the Secretary of Veterans Affairs said that the VA is
facing a significant backlog in health care.
Members of this Committee, we cannot wait for another
crisis to occur. We believe COVID-19 pandemic impact will not
be fully recognized for many years, and it is clear that access
to care, by all means, is essential to stem the backlog. This
cannot be done by consolidating care within the VA, but
instead, maximizing the use of the MISSION Act, which you
brought to us, and rapidly implementing the Hannon and COMPACT
Act.
Yet, despite the polls and surveys, much of the impact of
COVID-19 is difficult to fully identify without additional
data. Through Operation Deep Dive, America's Warrior
Partnership's nationwide veteran suicide study that seeks to
identify data-driven, community-based suicide prevention
measures, 15 percent of the States in the United States have
provided death data covering the last 5 years. To date, the
major takeaways indicate that States are undercounting former
veteran suicide by approximately 20 to 25 percent. Overdose is
the greatest contributor to non--natural causes of death, and
dishonorable discharge status has little impact on the suicide
rate of this population.
We are fortunate to share this data with the Department of
Defense to validate which of the deceased had served in the
armed forces. This partnership with the Department of Defense
and a panelist in the next panel, Dr. Karin Orvis, has provided
us with critical insight, not only into former servicemember
suicides but natural and non-natural causes of death, such as
cancers, overdose, strangulation, drowning, and firearms.
This relates to the impact of COVID, because Florida and
Minnesota will be the first States to provide their 2020 death
data this summer, which we will provide for greater insight
into the impact of the pandemic, because we will be able to see
the entire death rate for those two States. While we await the
2020 State data, we are missing VA data, which will allow us to
connect the dots between State death details, DoD experience,
and VA participation.
In summary, we have been changed by the pandemic. Secretary
McDonough inherited a significant backlog that will require the
VA to use all the tools at their disposal, especially the
MISSION Act. The VA must rapidly implement the Hannon Act and
COMPACT Act. And lastly, we hope that the VA will share
critical data outside of the Department. Thank you for the
opportunity to present to the Committee.
Chairman Tester. Jim, thank you for your testimony, and I
want to thank everybody who provided testimony this afternoon.
I appreciate it.
We are going to start with questions. The first two
questions I am going to ask are directed at you, Ms. Barlet,
and I want to thank you for talking about telehealth. I think
just about everybody did, that provided testimony.
And look, I think for the VA this can mean a video visit
with a provider or sometimes just a phone call. The opening up
of the ATLAS pod sites at the VFW posts can be another avenue
for veterans to access mental health care from the VA, and I
want to thank the VFW for opening their doors and providing
this improved access to veterans in this country, especially in
my home State of Montana and beyond.
I will tell you, Eureka, Montana is one of the most
beautiful places in the world. It is not only rural, but it is
frontier. So those pods are critically important if we are
going to have veterans access health care.
But Ms. Barlet, the question is, what are the main barriers
that veterans face in accessing care via telehealth? And can
the ATLAS pod sites be something that we can implement all
around this country? Will they be effective?
Ms. Barlet. Thank you, Senator Tester for that question. As
far as the main barriers veterans face in access to telehealth,
we are seeing the strongest one is broadband connectivity,
followed by insufficient equipment and technology illiteracy.
Like I mentioned earlier, with story from the gentleman at the
VFW ATLAS pod, he was appreciative of that assistant who was
there to connect him to the appointment and then troubleshoot,
which they see at the ATLAS post. There is someone there to
help troubleshoot in case they need it.
The ATLAS location pods itself, whether it is in the VFW or
a Walmart, will have that technology to perform that VVC
appointment, such as a suite of telehealth equipment.
Chairman Tester. You know, it has been a few years ago now,
I believe, they set up a pod here in the Russell Building,
Philips did, and one of the things that really appealed to me
is that you could go into these pods, and you might go in to
have your blood pressure checked, or you might go in for a
mental health issue you might be having, or you might be going
in just because you have got a sore throat. How have you seen--
and maybe you know maybe HIPAA will not allow you to know
this--but how are veterans using those pods? Are they using it
for more than just mental health, or is primarily just mental
health care?
Ms. Barlet. Especially right now with the COVID pandemic we
are seeing it used for both. As far as being specially equipped
to have the sites for tele-mental health, you know, these pods
on these sites are a secured, private space, where the veteran
can talk to their provider, one-on-one. Like I mentioned
earlier, the eye contact and body cues can definitely help the
provider and the veteran in that appointment. There is also
lighting color within these pods, that the veteran can adjust
if they feel necessary. So the tele-mental health services can
help provide group therapy sessions for connecting veterans who
have similar experiences, in a safe, supported setting,
regardless of where they live.
Chairman Tester. That is great. So as the VA sets up grant
programs for telehealth sites, what could organizations like
the VFW use from the VA to make sure that these sites are
successful in providing high quality telehealth care to
veterans? That is for you, Ms. Barlet.
Ms. Barlet. Sure. Thank you, Senator Tester. To ensure that
these sites are successful we need to ensure that the
facility's infrastructure, electrical, and broadband
connectivities are there and prepared to support the ATLAS
location.
Chairman Tester. That is good. Dr. Carroll, I would like
you or Dr. Kearney to speak about any outreach the VA has done
during this pandemic to COVID-positive veterans, to ensure that
their mental health care needs are being met.
Mr. Carroll. Yes, sir. Thank you for the question, and we
appreciate the support of VFW in the ATLAS project. To your
question about outreach, we have been able to identify veterans
who test positive for COVID or are otherwise diagnosed with it,
and then put into place a caring outreach program to them,
particularly for anyone who we know may be already at high risk
for suicide. We have set up programs to do very proactive
outreach to those who have been diagnosed.
Chairman Tester. How well has that been accepted by the
veterans that have been diagnosed? Is it something that they
have resisted or have they welcomed it?
Mr. Carroll. To my knowledge, sir, it has been very well
received, as well as by their family members.
Chairman Tester. Okay. I will turn it over to you, Senator
Moran.
Senator Moran. Chairman, thank you. First of all, Ms.
Barlet, thank you and the VFW for your support of the pod, and
I appreciate particularly the selection of a location in
Kansas, Emporia, and we look forward to coming online and being
of value to veterans in that area.
Lt. Col. Lorraine, let me thank you for you highlighting
Community Care. It is a significant component of how we can
deliver care and should deliver care to veterans who are
distanced or their specialty is something that is best suited
in that community, in a community. And I have never understood
the decision by the Department of Veterans Affairs to reduce
Community Care during the pandemic, if it was available. It was
the perfect place for care to be provided so that veterans were
not traveling distances and congregating in a way that lent
itself to the spread of the virus. We will continue to monitor
that circumstance, and the Secretary and I have had this
conversation, as well as the previous one.
Let me start with you, Mr. Lorraine. Your testimony talked
a lot about data-sharing and exchanges with the Department of
Defense. What caught my attention is you did not mention the
Department of Veterans Affairs. And so do you not currently
share data with the VA?
Colonel Lorraine. We do not currently share data with the
VA.
Senator Moran. Is there an explanation for that?
Colonel Lorraine. The HIPAA compliance and the PAI for the
VA, in terms of releasing data. That is what the last word we
heard back was.
Senator Moran. Dr. Carroll, anything that you would tell me
about the lack of sharing of data in this circumstance?
Mr. Carroll. Sir, we are very eager to work with Mr.
Lorraine and the America's Warrior Partnership on this. We do
have an agreement to work with them in some other areas, and so
we are working on what more we can do in terms of data-sharing,
but very eager to do this.
Senator Moran. Is the problem that Mr. Lorraine mentioned,
are they insurmountable?
Mr. Carroll. We are looking into that. I do not think there
is an insurmountable problem here, sir. I think we have to make
sure that we are able to protect, you know--we have information
security requirements, HIPAA requirements. But those generally
are manageable tasks, but we just have to work through them.
Senator Moran. Thank you, Dr. Carroll. When the story
becomes more clear would you please report to me or to the
Committee staff and let us know what the status is? It seems
odd to me that the Department of Veterans Affairs has not found
the right security path to allow this, but the Department of
Defense has, and it seems to me that this information-sharing
is important.
Let me ask you, Dr. Carroll, about, again, the COVID-19
pandemic. We know that social isolation has an effect upon the
topic of the day, mental health well-being as well as suicide
and suicide prevention. Numerous conversations with the
Department in the past have routinely informed me about the
purchases of iPads. It was a very common response for meeting
the needs of veterans with this virtual care.
I do know that many communities in Kansas and across the
country still lack connectivity, and I am curious if there are
other ways that you can share with me and with the Committee
that there are proactive ways that the Department has worked to
prevent suicide.
Mr. Carroll. Yes. Thank you, sir, and I think Ms. Barlet
teed up the issues very well before, in terms of thinking about
bandwidth, equipment, and familiarity with using telehealth
connections. And so VA has tried to address all of those over
the last year. We have distributed over 109,000 iPads to
veterans so they could connect into care. In the VA we have
also provided hotspots where there would be an opportunity, but
they do not have the bandwidth capability right now. We have
also worked with veterans to engage them in the FCC's Lifeline
program.
But we know that even under all of those circumstances, for
some veterans there still may be a problem, which is why the
ATLAS project is so incredibly important.
The other thing that we have done is for those who are not
well familiar or comfortable we have put in place what we call
a White Glove Program. So someone will reach out to that
veteran and help them get connected, help them understand how
the iPad works, and then they are ready for their appointment.
Senator Moran. Dr. Carroll, thank you, and I know what
challenging times this has been for individuals, including you,
but your team and workers, those who work at the Department of
Veterans Affairs, and thank you for those efforts during
difficult times and for your continued effort to reduce this
challenge that we face of suicide and mental health issues. I
will ask this just for the record, but I will say it verbally,
and then my time is 10 seconds expired.
Mr. Lorraine, I understand the America's Warrior
Partnership works with local veteran-serving organizations to
build communities for veterans near their homes. We know that
connectedness with your organization helps to build a
protective factor against suicide for veterans. I would like to
have you elaborate a bit more on how the VA could be more
helpful in this partnership, in addition to quickly
implementing the John Hannon Act, Section 201. I do not think I
have time for your response, but if you would make sure that I
learn what your suggestions are.
Colonel Lorraine. Yes, sir.
Senator Moran. Thank you.
Chairman Tester. We appreciate that, Senator Moran, and
that is a great question, so thank you. Next up we have Senator
Maggie Hassan from New Hampshire.
SENATOR MARGARET WOOD HASSAN
Senator Hassan. Thank you very much, Mr. Chair and Ranking
Member Moran for holding this hearing, and to all of our
witnesses for being here today but also for the work that you
do. Dr. Carroll, I want to start with a question to you. I am
concerned about veterans who are transitioning from military to
civilian life, especially over the past year. Rates of death by
suicide for veterans are historically twice as high during
their first year after leaving the military. The VA's Solid
Start program, through which the Department contacts new
veterans three times in their first year of civilian life, is
another important tool to help improve this transition. And I
will be reintroducing the bipartisan, bicameral Solid Start Act
in the coming weeks to amplify and expand this program. Dr.
Carroll, can you talk to the value of efforts like Solid Start
during the pandemic and what else the VA can do to help serve
this population of new veterans who are transitioning to
civilian life at this challenging time.
Mr. Carroll. Thank you, Senator, for the question, and it
is an issue of great concern to us as well, obviously, and the
Solid Start program is a wonderful resource to help
servicemembers make that transition. I think from listening to
the stories of servicemembers, they have often underestimated
the challenges of that transition, going through that switch
from one way of life and one sense of purpose and belonging to
another. Family members are concerned about that as well.
So our Solid Start program is important. The improvements
that we have made with DoD in the Transition Assistance Program
is important. We have some special resources, online resources
for women veterans, focused on their special needs during that
period of time. I think what we can do with our communities,
throughout our Governor's Challenge program under our suicide
prevention activities is incredibly important. So it is not
just the VA that is reaching out but it is communities, and I
think the more that we can do with our Federal partners, with
this Committee, and other Members of Congress to really make
sure that our communities are there to recognize and welcome
veterans back into their midst and help them make that
transition successfully over time.
Senator Hassan. Well, thank you for the answer, and I do
think when I talk to people back in New Hampshire they are
really eager to know who the veterans are in their midst,
because they do want to be supporting veterans. They also want
to be supporting active servicemembers' families, so something
we all continue to work on.
I have another question, Dr. Carroll. From 2005 to 2018,
veteran suicide rates increased by 25 percent among veterans
with a recent VA health care use. But over the same period, the
suicide rate increased by more than 57 percent among veterans
who had not recently used VA health care. This data shows that
we need to continue to improve VA care, but also shows how
important it is that we engage with and support veterans who
are not routinely coming to the VA for their care, to your
point just now.
Dr. Carroll, can the VA support these veterans, and what
tools or resources should Congress be exploring outside of the
VA in order to reach these veterans? You talked a little bit
about the community, but what else can we be doing?
Mr. Carroll. Yes. Thank you, ma'am. I am going to ask Dr.
Kearney to comment on this in just a moment. But I think I want
to begin by saying our commitment, our desire is to help
veterans connect to care wherever it makes sense for them.
Certainly we welcome them into the VA. We know that our care is
effective. But if, for some reason, they are not going to join
us or cannot, we want to make sure that they get connected.
But, Dr. Kearney, can you please elaborate?
Ms. Kearney. Absolutely, and thank you for the question. I
think one of the important points for us to emphasize is VA
knows we need a public health approach to address suicide
prevention, and that is going to be community-based prevention
plus clinically based intervention strategies.
So there are three particular prongs of what we call
Suicide Prevention 2.0, where we are trying to reach out into
the community. One is the Governor's Challenge, that Dr.
Carroll just mentioned. One, that is a State level. There is
interstate level, in which we are hiring CEPC, Community
Education Partners, to work with communities to create suicide
prevention coalitions and build on those already there, to
strategize for suicide prevention.
And last, more rural-based, in which we are doing together
with the veterans in helping to train veterans to outreach into
their communities. So combined together, we are really focused
on three priorities there. One is identifying who those
servicemembers and veterans are and being able to screen for
suicide, getting them into care, transitioning into care, and
also helping with lethal means safety planning. So we
absolutely agree with you that we need to do more, and we are
doing that.
Senator Hassan. Well, thank you very much. Thank you both,
and I will followup with a question for the record,
particularly about some of the rural issues we have. Thank you,
Mr. Chair.
Chairman Tester. Thank you, Senator Hassan. Are you ready,
Senator Sullivan.
Senator Sullivan. No.
Chairman Tester. Okay. Senator Cassidy from Louisiana.
Senator Sullivan. I will go next. Is that all right? I
mean, after----
Chairman Tester. Yep. No, you forfeit to the very end of
the Committee meeting.
Senator Sullivan. No, no. We cannot do that.
Chairman Tester. I am just kidding.
Senator Sullivan. Thank you, Mr. Chairman, for asking me,
though. I obviously did not look ready.
Chairman Tester. Senator Cassidy? Senator Cassidy?
[No response.]
Chairman Tester. Okay, Senator Blumenthal from Connecticut.
SENATOR RICHARD BLUMENTHAL
Senator Blumenthal. Thank you, Mr. Chairman. Ms. Barlet, as
you know, 19 States have procedures in law for separating
individuals who are in imminent risk of danger to themselves,
or others, from their guns. The statistics, I think, show that
two-thirds of all veteran suicides are done by firearm. Would
you favor using those statutes, where someone is shown to a
court, and a court issues an order to separate that person from
his or her firearm, for some limited period of time when help
could be provided?
Ms. Barlet. Thank you for that question, Senator
Blumenthal. We do need to keep in mind of everyone's safety,
including that veteran and their family. And I do know, in the
House, Representative Underwood has a lethal means training
legislation to be introduced as it was introduced in the past
legislation. So we are looking to support that along the way
and ensure VA employees throughout VA, just not VHA, have the
knowledge and training to be able to have that type of
conversation with their veterans.
Senator Blumenthal. Would you be in favor of other States
adopting those kinds of statutes?
Ms. Barlet. Senator Blumenthal, I would have to take that
for the record and get back to you on that question.
[Response to Senator Blumenthal's Question: We continue
to gain an understanding of the statues in the 19
states, and are expanding our knowledge to states who
currently do not have legislation on the books or in
the process of creating legislation.]
Senator Blumenthal. I would appreciate that. Mr. Porter, do
you have a position on these kinds of extreme risk?
Mr. Porter. Thank you, Senator. I would agree with my
colleague at VFW on the lethal means training. We are very
strongly supportive of expansion of that, so I would look more
into it. At the States, I think it would depend a lot on where
the States were on each of those issues, but I would want to
look at it more closely.
Senator Blumenthal. Do any of your members ever, peer-to-
peer, take action to try to protect veterans from that kind of
danger when they are in danger of taking their own lives?
Mr. Porter. I would not want to speculate, Senator. I am
sure they take lots of different actions. Our members, we hear
often that they are very engaged in extending help in any way
possible in any of those situations, whether it is pushing them
to the Veterans Crisis Line or local assistance. But a variety
of different means.
Senator Blumenthal. Mr. Carroll--I am sorry, Dr. Carroll--
could you talk a little bit about how peer specialists are
helpful, peer-to-peer? I was proud to sponsor the Peer Act,
which was included in the 2018 MISSION Act, and required the VA
to carry out a program to establish at least two peer
specialists in patient-aligned care teams at VA medical
centers. How has that program been working?
Mr. Carroll. Thank you, Senator, and peer support has been
one of the most transformative things that we have added to the
VHA mental health and suicide prevention continuum. As you
know, it has been in place for several years, and thank you for
your support, the support of this Committee, and other Members
of Congress in doing that.
We have over 1,100 peer support specialists working in
mental health programs. Currently we have peer specialists
working alongside our primary care integration providers, as
well as many providers. We have both men and women peer support
specialists. We are currently expanding peer support for women
veterans by bringing the WoVeN program into VA. It is an
incredibly important aspect. It is that veteran-to-veteran
connection and that opportunity to talk with someone who has
walked that same journey with you, and for the support and
encouragement to continue and to do the things that are going
to make a difference in your life.
Senator Blumenthal. Thank you. Let me ask, finally,
Mr. Porter and Ms. Barlet and Mr. Lorraine. How can the VA
further reduce the stigma, in so far as it continues to
persist, of seeking mental health care, in addition to the peer
specialists?
Mr. Porter. I think I can answer that, sir. I think it
takes a lot of communication, over-communicate, as we like to
say. I think in the veteran and military community I think
there is a lot of communication about suicide and mental health
and needing to be able to go and seek help when you need it.
But I also think in the broader community--not in the
community, in the United States, Americans broadly, I do not
think that that was far in the civilian world as we are in the
military. So I think to be able to communicate about what all
Americans can do to support veterans and avoiding suicide, and
that is key, and also being able to communicate specifically to
the veterans and military community about specific resources
that are available. And I also want to point out that IAVA has
a Quick Reaction Force at QuickReactionForce.org, and that we
provide mental health resources to any veteran of all eras, for
free, and their family members.
Senator Blumenthal. Thank you. Ms. Barlet or Mr. Lorraine?
Colonel Lorraine. Yes, Senator Blumenthal. You know, I think
one of the things I would recognize is that suicide is more
than just mental health. Mental health is a piece of it, but it
is housing, employment, relationships, financial. It is a big-
picture piece. To keep looking at suicide prevention as solely
a mental health solution is somewhat alienating, but if you
look at it holistically, that will reduce the stigma, and then
it will bring people in enough to look and see, are there needs
to be met.
So I think in order to do that it is to take suicide out of
the mental health bucket and move it into the greater holistic
bucket of how do we increase the hope of veterans overall.
Thank you, sir.
Senator Blumenthal. Thank you.
Ms. Barlet. And real quickly, Senator Blumenthal, the two
gentlemen made some amazing points and very valid. But I also
want to bring awareness of vet centers. These are out in the
community, and not many veterans or family members realize that
they do have access to these great, valuable centers.
Senator Blumenthal. Thank you. Thank you, all. Thank you,
Mr. Chairman.
Chairman Tester. Thank you, Senator Blumenthal. Senator
Sullivan from Alaska.
SENATOR DAN SULLIVAN
Senator Sullivan. Thank you, Mr. Chairman, and thanks for
convening this important hearing. I appreciate the witnesses
being here. You know, like many of us who have served
significant time in the military this issue confronts us all.
It certainly confronted me in a personal, tragic way, in my
Marine Corps career. And I am proud of the work that this
Committee has undertaken. My first bill that I ever co-
sponsored as a U.S. Senator was the Clay Hunt Suicide
Prevention Act, which was signed into law by President Obama.
But despite the passage of legislation, including the Hannon
Act, we are seeing a rise in suicides. You know, Mr. Chairman,
you and I worked hard on this issue of suicide prevention
coordinators. They need to be fully resourced.
That is going to be an important issue. I had the
opportunity to meet with a great group of veterans just this
past weekend, on the Kenai Peninsula in Alaska, led by a strong
veteran named Brandon Miller, who brought together a small
group of vets to talk about these topics. And these veterans,
my God, have seen a lot of combat but they have also seen a lot
of suicide. And one of the issues they raised with me, it looks
like the VA is starting to clear this procedure, which two of
these veterans swore by as really saving their lives. It is
this issue of stellate ganglion block treatment. I just got
word, and we pressed this--I raised this with Secretary Wilkie
a couple of years ago, that it is starting to be approved,
starting to be approved in Alaska. Can you, gentlemen, comment
on this quickly, just with regard to the importance of this
issue and where the VA is on it?
Mr. Carroll. Thank you, Senator. We are always looking for
new, effective treatment for mental health conditions, and I
would like to take this for the record so we get back to you
with the most recent and current information.
Senator Sullivan. Good, Doctor. This is something that my
veterans back home, again, just this past weekend, really think
is important, and I have been raising this for a couple of
years, from the evidence we have seen. It does not work for
everybody, but it clearly is saving lives. So if you can get
back to me and my constituents on that, that would be very
helpful.
Dr. Carroll, let me ask, I want to followup here on this
issue of some of the provisions in the Hannon Act. One of the
things that I was part of the group of Senators that
contributed to in that important act was this directed study
with the VA to work with the National Academy of Sciences,
focusing on the effects of opioids on all-cause mortality of
veterans, specifically suicide. This goes into the whole issue
of the overmedication of veterans, which has been a common
problem at the VA. I think the VA is getting its arms around
it, but there has been a lot of tragedy as it relates to this.
I know during the negotiation process of this legislation
the VA opposed this provision, which essentially is an
independent study, not a VA study. Now that the bill has been
signed into law I am hearing that the VA is seeking the
opposite of what was directed by Congress and is not going to
implement or support an independent study by the National
Academy of Sciences. Is this true? And if it is true, I find it
completely unacceptable. Congress gave you a directive, you
might not like it, but sometimes independent studies are what
is needed. So can you give me a very up-front, no-wavering
answer on what the heck is going on with this provision?
Mr. Carroll. Yes. Thank you, Senator. I appreciate your
question, and certainly VA's intention is to fully meet the
intention of the direction given to us by our oversight body.
As we said earlier, we are very grateful for the opportunity
that this legislation provides us.
We want to make sure that we meet your intention, and I
know that there are some studies currently underway, and I
think that may be a point of a discussion that we would like to
have at some point, I think, to talk through the details.
We would be very happy to sit down with you and other
members of the Committee to talk through what may be some ways
to address the full spirit and intention of the law and to see
if that makes sense. Otherwise, we are fully prepared to move
forward in whatever way the Committee feels is appropriate for
us.
Senator Sullivan. Okay, Dr. Carroll, I appreciate that
answer. I think, as I mentioned, we know that this was not a
provision that was particularly liked by the VA. We still
thought it was necessary. Mr. Chairman, I hope that, you know,
in our oversight role we can work with the VA to institute the
spirit, the intent, and the letter of the law, which I think is
actually quite clear. But I appreciate you getting back to us
in that spirit.
So let's make that happen, an independent study on an issue
that we all care about here, overmedication of our vets, and
the suicide issue. And we will work with you on that, but we
want to make sure that what we directed the VA to do is what
the VA does. So I look forward to working with you on that, Mr.
Chairman and Dr. Carroll. Thank you.
Mr. Carroll. Thank you, sir.
Chairman Tester. Thank you, Senator Sullivan, and
congressional intent is very important, so thank you.
Senator Brown?
SENATOR SHERROD BROWN
Senator Brown. Thank you very much, Mr. Chairman and
Ranking Member Moran. Thank you both for this really good
hearing. I appreciated the comments of Senator Hassan, the
questions and comments of Senator Hassan and also from Senator
Blumenthal about suicide, and Senator Sullivan just now,
particularly Senator Blumenthal's discussion about the role of
guns and suicide. There was a 2018 article, ``Firearm Storage
Practices Among American Vets'' in the American Journal of
Preventive Medicine, that said one in three veteran firearm
owners store at least one firearm, loaded and unloaded.
If there is any good news in this it is that recently, for
the first time after 20 years of Republicans cutting funding,
and then banning funding to first CDC and then NIH to research
this public health crisis of gun ownership and gun usage and
situations like this, we are at least going to, for the first
time, follow science when we gather this data--I can see Dr.
Kearney nodding; thank you for that--and what that means. So I
just associate myself with some of those other comments.
I have two questions, and both, I guess, of Mr. Porter.
Yesterday I had a wonderful discussion with IAVA members in
Ohio. Several were national, a couple were from Ohio. We are
working on some Agent Orange sort of burn pit issues, at least
Agent Orange, because we are working toward presumptive
eligibility, I hope, Mr. Chairman, on burn pits. And I hope if
we do it we can do it a lot faster than the Vietnam era
continued denials of Agent Orange damage, and the same kind of
burn pit issues.
But the handoff between DoD and VA is so important, so many
issues including homelessness. Mr. Porter, we urge agencies to
work together. It has been a long-time problem, as long as I
have been in the Senate, way before that. What steps should we
focus on now to make sure that that handoff does not end up
resulting in homelessness, when people leave the service that
they hand off as ready? Mr. Porter, if you would.
Mr. Porter. Thank you, Senator. First I appreciate you
meeting with our members. Again, before you arrived I pointed
out that we are on the Hill virtually this week, from all
around the country, and one of the top issues is toxic
exposures. So we really strongly are communicating that we want
a presumptive service connection for those exposed to burn pits
and other toxic exposures.
But on the broader issue that you are talking about in
terms of transitions, it is important for veterans to take
advantage of their post-9/11 GI Bill, period. I think, as my
friends at SVA like to talk about, they see the GI Bill as the
gateway to the VA. So once you are using that GI Bill then you
are going to find out about your access to the other VA
benefits. So they need to find out what is out there for them
and use that to be able to make a successful transition,
professionally and educationally. Also they need to know about
resources that they have available at the VA, at the local
level, at the State level.
But then also IAVA has a pretty solid program called the
Quick Reaction Force. You can call up QuickReactionForce.org,
and we provide support to all veterans and families of all eras
and discharge statuses. And that is from emergency housing
assistance to navigation of Federal bureaucracies, and mental
health and suicide prevention.
So all of the above, Senator, we would like to get people
involved in more.
Senator Brown. Expand on that, Mr. Porter. We know that
thousands, probably way more, probably tens or hundreds of
thousands of servicemembers and veterans have fallen behind in
their mortgage payments or their rentals, rental payments. We
know it is affecting millions of people around the country. We
put some money in the bipartisan bill at the end of the year,
and then put a bigger chunk of money into the still bipartisan
bill, bipartisan in terms of public support, that we passed
earlier this month, to help with forbearance, that forbearance
on servicemembers and veterans, forbearance on their mortgages,
or helping with emergency rental assistance.
What do we need to do, Mr. Porter, or anybody else can
weigh in here, but what do we need to do jointly, you and we,
to make sure that our veterans and servicemembers can stay in
their homes? These dollars are available, and we try to make
sure that people who are months behind their rent or months
behind their mortgages are not getting foreclosed on or made
homeless through eviction or moving into their cousin's home or
whatever. How can we work with IAVA and with the VA and other
veteran groups or the VA to make sure that veterans are taken
care of with this program, where there is money available if we
reach them?
Mr. Porter. Sure, Senator. Thanks for the question.
The recent COVID rescue plan, the American Rescue Plan, I
know that it has got significant help for veterans, and
especially for homelessness and home ownership. I know that
there is, gosh, over $20 billion for emergency rental
assistance, housing counseling for people in danger of
homelessness, and then you have got a lot of money to help
communities provide supportive services for veterans and their
families in danger of becoming homeless.
So execute all of that, that you just passed, that is
significant, but also I keep going back to our Quick Reaction
Force, that provides significant benefits to veterans and their
families that are in imminent need of funds if they are having
trouble playing their rent or their mortgage.
Senator Brown. Well, thank you, and if I could, Mr.
Chairman, thank you for saying ``execute that.'' I would also
hand it to you, that the Chair and the Ranking Member of this
Committee also serve with on the Housing, Banking, and Urban
Affairs Committee, and both are very interested--and I can
speak for them in this way for a moment--both very interested
in what we do to make sure we do reach people.
You are right, there is $25 billion in this last plan, the
American Rescue Act. We have got to make sure that veterans and
other people who are on the verge of foreclosure or on the
verge of eviction in their rental units are aware of this and
the money gets out quickly, so they can stay in their place and
landlords get paid and all that.
So my plea to you is just work with us to help make sure
this happens.
Chairman Tester. Thank you, Senator Brown. Senator Cramer
of North Dakota.
SENATOR KEVIN CRAMER
Senator Cramer. Thank you, Mr. Chairman, and thanks to all
the witnesses for being here.
You know, one of my top priorities in the last Congress was
the implementation of hyperbaric oxygen therapies for veterans.
And I included language in the bill, the Hannon bill that we
have been talking about, and will be talking about in the next
group as well. And I am just going to give you a few of the
highlights of the bill. It authorizes the Secretary of the VA
to enter into public-private partnerships to research the
effectiveness of hyperbaric oxygen therapy, it requires the VA
to use an objective test to measure the effectiveness of HBOT,
and it commissions a comprehensive review and study of HBOT,
both within the VA and with outside organizations. And this
study would be completed with a recommendation from the VA
about the effectiveness of hyperbaric oxygen therapy.
And this is something I have talked to the Secretary about,
both before his confirmation and after his confirmation and
during the hearing, and it means a great deal to me.
Now through the law that I talked about we have provided VA
these authorities related to HBOT, but it can only work,
obviously, if the VA actually utilizes the authorities and
cooperates in the research and the partnerships that have been
authorized.
Now I have seen real benefits to this innovative therapy. I
have met dozens of veterans that have used it, as well as
athletes and others, and I just want to get an update, maybe
from you, Dr. Carroll, what you know about the legislation and
where the VA might be in that process. And probably even more
importantly, frankly, get your views, just your experiences if
you have observed any HBOT users, patients, and circumstances,
and what you might know about it.
Mr. Carroll. Thank you, Senator, and I appreciate the
question, and as I said earlier, we are eager, as always, to
expand the frontier of what we know and what we can bring to
bear for the benefit of veterans in terms of their care and
treatment and moving forward in their lives.
I know our teams that are working on the implementation of
the Hannon Act are dug in on this and are moving forward.
We have some studies--well, we have some pilot programs,
some clinical pilot programs underway that do include an
evaluative component. I think this is one of those sections
under the Hannon Act.
We are absolutely committed to meet the full intent of
Congress in implementing this. There may be some opportunities
to think about the format for this evaluation that has to be
independent. I agree with you, it has to be a rigorous and fair
evaluation. But we are also trying to reconcile that with the
fact that we have many veterans already engaged in this, and
how do we respect their information and also bring that forward
into an evaluative process.
So this is one of those sections where we are totally on
board with you and with the Committee in moving forward, but we
would like to sit down with you and have the opportunity to
talk about some ways that we think we can move this forward,
perhaps very quickly, that we would like to discuss.
Senator Cramer. Yes, no, you make a really important point,
I think. There are a number of veterans that have utilized it.
It has probably not been super coordinated.
There is no point in losing all of that good data and
experience and it should become part of the discovery of the
effects of this, while also working with other groups,
communities, and treatment facilities.
So I am all about that. Any way we can get the most good
information evaluated in an objective way and come up with an
analysis that helps, I am all about that. I am grateful for
that commitment and that restatement of commitment, and want to
be as helpful as I can, from my end, as well. So thank you for
that.
And with that, Mr. Chairman, I would yield the balance.
Chairman Tester. Thank you, Senator Cramer. Senator Hirono
from Hawaii.
SENATOR MAZIE HIRONO
Senator Hirono. For Dr. Carroll, in the 2018 data analyzed
in the 2020 National Veteran Suicide Prevention Annual Report,
AAPI veterans had one of the highest suicide rates of any
ethnic group among VHA users. Since these are veterans we know
to be using VA health services, has VA done any outreach
specific to this community, meaning the AAPI veteran community,
especially with the uptick in hate speech and attacks on Asian
Americans over the last year? What kind of outreach, if any,
are you doing to this particular community?
Mr. Carroll. Thank you, Senator. I am going to ask Dr.
Kearney to comment on that.
Senator Hirono. All right.
Ms. Kearney. Thank you, Dr. Carroll. Yes, I think one of
the important things this particular year is the first year in
our annual report where we have been able to begin to dissect
some of our data by race and ethnicity, which is really
critical for us to begin to identify how can we vary our
community outreach with our Governor's Challenges for specific
populations. What are the specific needs in each area?
So we are taking these data from our annual report and
including it in our policy academies with the Governor's
Challenges, and helping to inform localized strategies for
outreach, and that is a critical piece in next steps. But we
also need to continue more study and analysis across this
population.
Senator Hirono. So apparently this is the first time that
you are basically doing disaggregated data collection, so you
have not done or developed any kind of specific outreach
program to the AAPI veteran community, I take it.
Ms. Kearney. Within suicide prevention we are working with
coordinated communities locally to begin to initiate for every
community what is needed in their particular area.
Senator Hirono. Okay. So in other words you do not have any
specific programs yet for this community or developing it. So I
encourage that. Thank you.
For Mr. Lorraine, Col. Lorraine, I appreciate your
willingness to continue to meet with this Committee to discuss
veteran mental health. Since you testified on this subject in
June 2019, has the VA improved its coordination with community
partners when it comes to providing mental health support and
services? This is for Mr. Lorraine.
Colonel Lorraine. Yes. Thank you, ma'am. You know, in my
opening remarks and in my written testimony what I note is that
the number of appointments that have been deferred or canceled
during the pandemic is actually very high. I think the VA is
starting to come back on board. I think, from what we hear from
the communities is that they are working to get there. But what
the communities are concerned about is the backlog that exists,
and how do we get ahead of the backlog. How do we get ahead of
the backlog so we can get back to normal operations? I think
using the VFW's pods and others in these remote areas is fine,
and telehealth, but telehealth still requires a capacity issue
on the VA side, and if you want to increase the capacity what
we are hoping is to use the community services that are already
available.
Senator Hirono. Did you say that you need to increase your
telehealth capacity, because it is one of the ways that
veterans who are in remote area can get access to services.
Colonel Lorraine. Yes, ma'am. I said not only increase the
telehealth capacity but then that calls into question, does the
VA have the capacity to handle the backlog of more than 20
million appointments that were canceled or deferred. And so
what I am saying is not only telehealth but to use all the
tools that are available.
Senator Hirono. I hope that you can provide this Committee
with some approaches that we can take, funding or programmatic,
to deal with the backlog and the other issues you just
mentioned.
This is a question for Mr. Porter regarding veteran
homelessness. You mentioned in your testimony housing
insecurity directly impacts, of course, mental and physical
well-being, and as you mentioned, for the first time in several
years we saw veteran homelessness increase nationally, between
2019 and 2020. And while this data does not include the impact
of the COVID-19 pandemic, we do know that housing insecurity
among the general population has increased greatly over the
last year.
So have the current programs, Mr. Porter, directed at
alleviating and preventing veteran homelessness, are they
sufficiently responding to any uptick in homelessness caused by
the pandemic, among veterans?
Mr. Porter. Thank you, Senator. I think what a lot of us
point to are the HUD-VASH vouchers that have been available. I
know the last year there was a number of them, quite a few of
them that were left on the table. So we want to make sure that
the VA is communicating to the veteran population about the
availability of those vouchers, to be able to avoid a lot of
the homelessness from veterans and their families. I hope that
answers your question.
Senator Hirono. Do you have a breakdown of how much of
these vouchers were left on the table, by State?
Mr. Porter. I do not. I am sorry, Senator.
Chairman Tester. Thank you, Senator.
Senator Hirono. Is this information unavailable?
Mr. Porter. I would have to look at it, Senator, and get
back to you, if I could.
Senator Hirono. Okay. Please get back to me. Thank you, Mr.
Chairman.
Chairman Tester. Thank you, Senator Hirono. Coach
Tuberville, you know, I know you have got connections with the
Auburn Tigers, but you have got to be saying ``Roll Tide''
right now. You are up.
SENATOR TOMMY TUBERVILLE
Senator Tuberville. I cannot say it too loud, Mr. Chairman.
Thank you very much. Thanks for being here today. Thank you for
your work with our veterans.
I want to reiterate a little bit what Senator Cramer said.
I have dealt with head injuries all my life in football. We had
a lot of them. We have got a lot more of them. And we have had
some success with hyperbaric chambers, but, you know, that is
for further discussion.
I think we should do anything to help our veterans. I have
got a lot of buddies that have gone and come back and cannot
sleep at night, explosions in their head. When you cannot sleep
you do crazy things, so we need to do as much as we possibly
can.
But, you know, just talking about the Hannon Act, you know,
it has been 158 days since we enacted this law, 18 suicides a
day. That is 2,844 suicides since then, we have not really
gotten going good in it yet. But we need to, and implementation
needs to be a priority.
Jim, in your testimony you talked about a study your
organization led in partnership with the University of
Alabama--Roll Tide--that seeks to identify data-driven,
community-based suicide prevention measures. Can you talk a bit
more about the study and what data is being collected, and how
the data is being used?
Colonel Lorraine. Yes, sir. Thank you. War Eagles, right?
Senator Tuberville. I love it.
Colonel Lorraine. There you go. If you can say ``Roll
Tide'' I can say ``War Eagles.''
Senator Tuberville. That is right.
Colonel Lorraine. Yes, sir. So Operation Deep Dive is a
suicide study that we lead, America's Warrior Partnership, in
partnership with the University of Alabama. It is funded by the
Bristol Myers Squibb Foundation. It is a 4-year study. We are
coming up on the end of it. But what we have right now is that
we have ten States that either have given us data or are about
to give us data. By the way, Alabama and Montana and
Massachusetts came in yesterday, so we were able to take a look
at that a little bit.
But what we have found is--Minnesota and Florida led the
way, and they gave us not only all their data about the deaths,
but the benefit is we have a relationship with the Department
of Defense where we provide the names and Social Security
numbers of those who died to DoD, and they come back and say
this is who was in the military and served, and this is who
were not.
What we are able to get with that, because when DoD sends
us back their data, to Senator Hirono's question, we get the
nationality, we get the name and age, we know the day that they
came in the military, we know the reason why they left the
military, we know the day they left the military, and we know
the day they died. And so we can measure how long post-service,
we can measure down to the county level what the impact has
been on that community, with our goal of being able to
hypothetically say, in Mobile, Alabama, the veteran who is most
likely to take their life has this characteristic, as compared
to Tuscaloosa it might look different, in Huntsville it looks
different, because we know the community factors play a lot
into that.
So we are really happy to have our great partners at the
University of Alabama. To the States that you asked, we have
Florida, Minnesota, Alabama, Montana, and Massachusetts. On
deck are New Hampshire, Maine, Oregon, and Michigan. And then
once those come in we will be able to generate the same data.
And we look forward to our great partners. We believe strongly,
and our communities believe that we cannot do any work,
communities cannot serve veterans without the VA. And so we
look forward to partnering very closely with the VA to make
sure that we can characterize the type of veteran who is most
likely to take their life and get ahead of the curve and
prevent it.
Senator Tuberville. Thank you. For the 400,000 veterans
that call Alabama home, I thank all of you for your hard work
and efforts. Thank you very much.
Colonel Lorraine. You bet. Thank you, sir.
Senator Tuberville. Thank you, Mr. Chairman.
Chairman Tester. Yes, thank you, Senator Tuberville. And I
want to thank all the panelists for their input and expertise
on this panel on it has affected the veterans' mental health
during this pandemic. It is clear we have more work to do to
ensure veterans can access mental health services.
Now I want to introduce the second panel, which will focus
on implementation of the Hannon Act. I am pleased to have
witnesses from both the VA and the DoD here to discuss their
progress so far.
First we are going to hear from Dr. Clifford Smith, who is
the Director of Field Support and Analytics for the VA's Office
of Mental Health and Suicide Prevention. He is accompanied by
Dr. Matthew Miller, Director of Suicide Prevention at the VA.
Then we are going to hear from Dr. Karin Orvis, Director of
Suicide Prevention Office, and Captain Chad Bradford, Director
of Mental Health Policy and Oversight at the Department of
Defense. Dr. Smith, you have the floor.
PANEL II
STATEMENT OF CLIFFORD A SMITH ACCOMPANIED BY MATTHEW A. MILLER
Mr. Smith. Good afternoon, Chairman Tester, Ranking Member
Moran, and the members of the Committee. I am pleased to be
here today to discuss VA's implementation of the Commander John
Scott Hannon Improvement Act of 2019. I am accompanied by Dr.
Matthew Miller, National Director for Suicide Prevention.
Nothing is more important to the VA than supporting the health
and well-being of the Nation's veterans and families.
The Hannon Act supports the improvement of mental health
care and suicide prevention services for veterans under three
broad areas of focus. First, by improving access options to
mental health and suicide prevention services via community-
based prevention strategies, accomplished through a new grant-
making authority. Second, by improving rural veterans' access
to care by expanding telehealth technology.
And third, by directing the VA to develop a strategic plan
on how VA can provide health care to veterans during the first
year following discharge or release from military service.
Further, the Hannon Act looks to expand the scope and
breadth of services available to veterans by increasing
research and investments in innovative and alternative
treatment options. This expanded scope includes enhancing
veterans' access to complementary and integrative health
programs, such as animal therapy, agritherapy, and sports and
recreation therapy. The final area highlighted seeks to improve
equity for subpopulations of veterans, with the expansion of
capabilities of the Women Veterans Call Center, to include text
messaging and updating VA's websites to provide more
information services available to women veterans.
Each of us has a role in suicide prevention and in the
implementation of the VA National Strategy for Preventing
Veteran Suicide. Community prevention efforts are as critical
as VA intervention efforts. We are grateful for the Hannon Act
to assist in further implementation of the public health
approach to prevent veteran suicide and to improve veterans'
mental health and well-being over the course of their lifetime.
We appreciate the Committee's continued support and partnership
in this shared mission.
Mr. Chairman, this concludes my statement. My colleague and
I are ready to answer any questions you and the Committee may
have.
Chairman Tester. Thank you, Dr. Smith, for your testimony.
Next we have Dr. Karin Orvis, Director, Defense Suicide
Prevention Office, Office of Force Resiliency, Office of the
Under Secretary of Defense for Personnel and Readiness for the
Department of Defense. Karin, the floor is yours.
STATEMENT OF KARIN A. ORVIS
Ms. Orvis. Thank you. Chairman Tester, Ranking Member
Moran, and distinguished members of the Committee, thank you
for the opportunity to appear before you with our colleagues
from the Department of Veterans Affairs. Both departments work
together in strong partnership. Like you, we are steadfast in
our commitment to the well-being of our servicemembers and
veterans.
This is even more important now given the coronavirus
pandemic. During this time, servicemembers and veterans may be
feeling heightened stress, anxiety, and disconnectedness.
For some, such experiences can also be associated with an
increased risk for suicide. My office, the Defense Suicide
Prevention Office, works to enhance holistic, data-driven
suicide prevention through nonclinical policy oversight and
engagement.
With me today is my colleague, Captain Chad Bradford, the
Director of Mental Health Policy and Oversight, who works on
the clinical side. We recognize a fundamental truth: there is
no one single solution to prevent suicide.
As such, we are committed to addressing suicide
comprehensively, through a public health approach, which
incorporates both community-based prevention efforts as well as
clinical care to address suicide thoughts and behaviors.
We also leverage best practices from the scientific
community, including the Centers for Disease Control and
Prevention. DoD has many efforts underway, including cross--
cutting research collaborations and several evidence--informed
pilots related to help-seeking, problem-solving, and mean
safety, which I am happy to discuss.
The Department is committed to successfully executing our
responsibilities within the Hannon Act. As DoD Health Affairs
has oversight of clinical and mental health policies and
programs, Captain Chad Bradford can address any specific
questions you may have on DoD's implementation of the Act.
I am grateful for the opportunity to appear before you
today and to share more information about suicide prevention
efforts. Thank you for your unwavering dedication and support
of the men, women, and their families who greatly defend our
Nation. I look forward to your questions.
Chairman Tester. Thank you, Dr. Orvis. Next up we have
Captain Chad Bradford, United States Navy, Director of Mental
Policy and Oversight, Health Services Policy and Oversight,
Office of the Assistant Secretary of Defense for Health
Affairs, DoD. Captain, Bradford, you have the floor.
STATEMENT OF CHAD BRADFORD
Mr. Bradford. Thank you. Good afternoon, Chairman Tester,
Ranking Member Moran, and members of the Committee.
[Pause.]
Mr. Bradford. Good afternoon.
Chairman Tester. Good afternoon. Go ahead.
Captain Bradford. Chairman Tester, Ranking Member
Moran, and members of the Committee, thank you for the
opportunity to testify before you today, along with our
colleagues from the Department of Veterans Affairs. The
Department of Defense is committed to providing the highest
level of mental health care to servicemembers and veterans.
The Department is excited to share with you the important
work we have undertaken in support of the Commander John Scott
Hannon Veterans Mental Health Care Improvement Act of 2019, and
to address the mental health needs of our servicemembers during
the COVID-19 pandemic.
We would also like to inform you of our continuing efforts
to combat the stigma associated with seeking mental health, and
to help servicemembers address mental health needs during
periods of transition.
Regarding the Mental Health Care Improvement Act that was
signed last year, the Department has initiated collaborative
work with the VA to ensure all elements of this important
legislation are completed, and Congress has kept informed of
our progress. Additional details of our work were included in
our written Statement.
For many people, the mental health effects of COVID-19 are
as important to address as the physical effects. The Military
Health System has worked on two fronts to ensure that
behavioral health needs are met during the COVID-19 pandemic.
The first is delivery of quality behavioral health care to our
enrolled population, whether that is through face-to-face
encounters or through our significantly expanded virtual
behavioral health care offerings. And the second is
preservation of the work force throughout our health system.
MHS has sustained its commitment to decreasing the stigma
associated with mental health treatment throughout this
pandemic. DoD policy and procedures are designed in a manner to
remove the stigma associated with servicemembers seeking and
receiving mental health services. The Real Warriors Campaign is
DoD's award-winning, multimedia, public awareness campaign
designed to combat the stigma associated with seeking care and
encourage servicemembers to reach out for treatment. The
Embedded Behavioral Health and integrated primary care
behavioral health programs are also efforts to decrease stigma
associated with mental health treatment by increasing immediate
access and improving mental health literacy.
In order to help the transitioning servicemember's mental
health needs, the DoD and VA work together to make the In
Transition Program a vital resource. The In Transition Program
is a free, confidential program that offers specialized
coaching and assistance for all servicemembers and veterans,
regardless of duration of service, time since discharge, or
category of discharge.
We are grateful for the opportunity to speak with you today
and discuss the Department's efforts in collaboration with the
VA to support our servicemembers and veterans, including
various resources, support care to addressing their mental
health and well-being, among other needs.
Thank you for the opportunity to provide further detail on
the DoD effort in support of the Commander John Scott Hannon
Veterans Mental Health Care Improvement Act of 2019, and our
other vital efforts to address the mental health needs of our
servicemembers. We thank the members of this Committee for your
commitment to the men and women of our armed forces and
veterans, and the families and communities who support them.
Thank you.
Chairman Tester. Thank you, Captain Bradford, and I want to
thank you all for testimony. Now for the questions, over to
Senator Moran.
Senator Moran. Chairman Tester, thank you for that
consideration. Let me begin with Dr. Smith and Dr. Miller. My
understanding is that the VA provided a briefing recently to my
staff, on our staff, on the implementation of the John Hannon
Act, and discussed a few items that the VA was pushing back
deadlines or alternative approaches to accomplishing provisions
included in the legislation.
And I just want to underscore for you that the provisions
that are in the John Hannon Act were negotiated with the VA and
with their agreement in the last Congress, both majority and
minority, and we worked with the VA to get things that were
contentious or difficult to be acceptable to both the Congress
and the VA.
And I just hope that you would commit to continuing to work
with us to ensure that the VA implements the John Q. Hannon
Act, the provisions in it, in as timely as possible fashion,
but also in fulfilling the agreements that were reached during
the negotiations between this Committee and the VA.
Mr. Smith. Senator, this is Dr. Smith. Absolutely, we are
committed to meeting the spirit and the intent of the Hannon
Act. There are, indeed, as we brought up at the briefing last
week, several areas we would like additional discussion, just
offhand, thinking one instance the date that the action was due
has actually passed, due to the timing of when the bill was
signed on October 17th.
So we would love, and it is our intention, to have honest
conversations going forward about the actions that are required
and our work in completing those actions.
Senator Moran. Doctor, thank you for that. You are very
good. You certainly brought up an example in which I do not
know how to argue back that you should implement it in a date
that has already passed.
Let me ask Dr. Miller, I mentioned in my opening Statement
about SPED. At what point do you think the VA will be 100
percent implementation with this intervention at all medical
centers?
Mr. Miller. I am glad you asked that, sir. We are there. We
are at 100 percent implementation with safety planning in the
emergency department. It is a part of our Suicide Prevention
Now plan, and incremental improvements within SPED
implementation. We just received our February data for SPED
performance across the Nation in all our facilities, and we
noticed, and noted, as a matter of fact, today in a
presentation to the Under Secretary's Health Operation Center
team, notable improvements within SPED implementation,
particularly engagement of the CSRE, when appropriate, in the
emergency department and urgent care setting, as well as
implementation of safety plans in the applicable situation,
which, as you mentioned at the outset, saves lives, 45 percent
out of the Brown study. So we are at 100 percent, sir.
Senator Moran. Dr. Miller, I too am glad I asked the
question and I appreciate very much the answer. When you say
``VA facilities,'' what does that mean? If I am in Kansas that
means the three medical centers, or something more than that?
Mr. Miller. That means any medical center, any VA medical
center that has an emergency department or has an urgent care
center.
Senator Moran. Okay. Thank you very much.
Dr. Orvis, can you provide the Committee with an update in
regard to the progress that DoD and the VA have made on the
alternative of analysis to establish a joint VA-DoD Intrepid
Spirit Center?
Ms. Orvis. Hi there. Actually, I would like to defer that
question to Captain Chad Bradford, as that falls within Health
Affairs at DoD.
Senator Moran. Thank you. That is fine.
Captain Bradford. Yes. Thank you, Senator. So currently we
have eight Intrepid Centers. The Intrepid Centers take care of
our servicemembers who have been injured and diagnosed with
PTSD and TBI. Comprehensive care is provided to them, including
treatment for PTSD, neurologists, nutritionists, et cetera. Two
more Intrepid Centers are in the works. We are currently in the
process now of researching and determining whether or not
additional centers are beneficial and cost-effective. Thank
you.
Senator Moran. And that research or that analysis is
expected to be completed at some point in the near future, or
do you have a timeframe?
Captain Bradford. I do not have a timeframe, but I could
take that for the record and respond back to you.
Senator Moran. Thank you very much for that. Mr. Chairman,
thank you.
Chairman Tester. Thank you, Senator Moran. This question is
for Dr. Smith. Vet centers have been a huge success, and I will
tell you they have been a great resource for mental health care
for veteran servicemembers and their families.
Section 502 of the Hannon Act requires the VA to create a
new scholarship program for students pursuing a degree in
mental health discipline. These scholarships would then result
in the student working full-time at a vet center for 6 years,
and quite potentially would stay much longer after that.
Dr. Smith, my staff tells me that the first scholarship
awards may not go out until 2023, almost 2 years after the
required date and 3 years after the enactment of the Hannon
Act. Could you tell me what the current status of the
implementation for the vet center scholarship program, Section
502, and if, in fact, the awards are not going got go out until
2023, how can we expedite, or help the VA expedite that
rollout?
Mr. Smith. Thank you for the question, Senator. Yes, so
immediately with the signing of the law there are four
specialties noted--psychology, social work, marriage and family
therapy, and counseling, or LMHPCs. The initial work was
reviewing all of the qualification standards for each of those
specialties, and they have been drafting the regulation
language that will be needed to be implemented to issue those
scholarships. That draft language of regulations is currently
under review at this time. Once that is returned back to us it
continues down the journey, through OGC comment, through the
Office of Regulations comment, et cetera.
It is anticipated that outside of an interim final rule,
the process that it would take for public comment, letting the
professional bodies, the American Psychological Association,
the National Association for Social Work, et cetera, time to
respond to the regulation change or addition, all of that
process to take place and completed, the Readjustment
Counseling Service does anticipate the April 2023 timeline.
That sets up the timing for when students are applying for
scholarships versus 2022, which they do not feel can make it
through the regulation process.
But we would be very happy to sit down with the Committee
and work through that timeline with our professionals from RCS,
who are very excited about this opportunity.
Chairman Tester. We will take you up on that offer. And I
would just say that you are right, as students tend to apply
for scholarships more in the spring than they do in the fall. I
have a notion this particular case these may be more
nontraditional students, though, and so I would not write off
the potential of getting this rule out earlier can help a lot
of folks. But we will take you up on your offer.
This is for the VA and the DoD both. You both play
essential roles in improving mental health for our
servicemembers and veterans. I have a new role as Chairman of
the Defense Appropriations and I want to make sure that these
departments are collaborating as much as possible, the VA and
the DoD. I would say the last administration made a lot of
promises that were not kept, about expanding VA mental health
care to those transitioning out of the armed services.
And we know that the first year out is the most critical
time for suicide prevention. Section 101 directs the VA and DoD
to create a plan to extend a full year of VA health care to
servicemembers transition to veteran status.
Dr. Smith, what progress has the VA made in implementing
this provision, in coming up with a plan to offer VA health
coverage to transitioning servicemembers?
Mr. Smith. Thank you, Senator. Indeed, Section 101 calls
for the VA to outline a plan. Currently, we have put in place a
large workgroup that was empaneled and met for the first time
in early January, consisting of broad SMEs from the VA and DoD,
VBA. So it spans across multiple offices.
That workgroup has divided and built multiple sub-
workgroups, looking at opportunities for enhancing information,
looking at IT changes that will be needed, looking at
eligibility criteria that may have to be updated through
regulation. That group meets on a regular basis.
It is chaired by Dr. Matthews from our office in the VA and
working closely with DoD partners alongside to fully implement
the provision of health care in the first year of transition.
Chairman Tester. Thank you. Dr. Bradford and Dr. Orvis, I
would like you to respond to that question in writing.
With that I will go to Senator Boozman for questions. One
more time for Senator Boozman. It looks like you are up, Coach,
Coach Tuberville.
Senator Tuberville. The early bird gets the worm, Mr.
Chairman. Thank you very much.
Before I start I would just like to thank anybody who had a
hand in the enactment of the Save Lives Act for our veterans
and their spouses, for the vaccine, people in Alabama are very
excited about that, so we appreciate President Biden signing
that, I guess just very recently.
You know, the Hannon Act directed that within a year of
enactment each VA medical center have at least once suicide
prevention coordinator role, and that the VA conduct a study to
determine how to align and reorganize the coordinators.
Dr. Smith, what do you envision the role of the suicide
prevention coordinator to be right now, and what do you foresee
changing under a potential realignment and reorganization of
the coordinators?
Mr. Smith. Thank you for the question, Senator. As part of
our work with the Hannon Act we divided all of the sections up
into a single point of contact. This section is actually with
Dr. Miller as the point of contact and subject matter expert,
so I will hand this off to him.
Mr. Miller. Sure. Thanks, Dr. Smith. Thank you for the
question, Senator. The suicide prevention coordinator is well
defined and is elucidated within a suicide prevention
coordinator guide that we have recently published. In it, it
outlines, I believe, in a very thorough way the expectations,
the roles, the responsibilities, and applicable procedures and
policy within the role.
Having one suicide prevention coordinator, and that one
being defined as one FTE, across VA facilities is not a new
standard, from our perspective. It is something that we measure
and monitor on a monthly basis and work with facilities to
correct. I am happy to report that as of today, exactly,
literally today, all suicide prevention coordinator FTEs, in
terms of one FTE per facility, have been satisfied, except for
one that is OCONUS, and they are exploring possibilities for
seeking an exemption, given the services that they offer and
where they are located.
What we are finding with the staffing and documentation of
the staffing, there is a particular portal where staffing
numbers are entered in locally, and we have been able to work
with facilities to discover errors in the documentation and
reporting within this portal, and that has helped us to clarify
present standings. So again, all positions, save one, and that
one is exploring exemption opportunities.
With regard to the restructuring that you mentioned, that
Section 506, thank you for bringing that up and raising it. We
will be doing a feasibility and advisability analysis to
thoroughly explore the advantages, the potential disadvantages
of a shift in the organizational structure, which would have
the suicide prevention coordinator instead of reporting
locally, reporting nationally to the Suicide Prevention Office
within Central Office.
The contract for that study has been awarded and we had our
kickoff event earlier this week. We look forward to the results
of that study and will receive an update regarding progress in
approximately 2 months from now.
Senator Tuberville. Thank you very much. Mr. Chairman, I
yield the rest of my time to the West Virginia Mountaineer,
Senator Manchin.
Chairman Tester. You have got it. Senator Manchin, you are
up.
SENATOR JOE MANCHIN
Senator Manchin. Hey, Coach, thank you. I appreciate that.
Senator Tuberville. You are welcome.
Senator Manchin. Dr. Carroll, with our older veteran
population increasingly becoming disconnected from the
communities over the pandemic, especially in rural areas such
as mine in West Virginia, they have lost the majority of their
support networks. Just 2 months ago, we had a 70-year-old who
committed suicide in the parking of the VA, which is
unbelievable. So how are we tailoring outreach and care for
older veterans?
Mr. Miller. Senator----
Senator Manchin. Mr. Carroll?
Mr. Carroll. Mr. Chairman, may I respond?
Senator Manchin. Yes, anybody. There we go. Jump right in
there.
Mr. Carroll. Thank you, sir, for the question, and Dr.
Smith, Dr. Miller, since I was called upon I will kick it off,
but you are welcome to join.
Thank you, sir. We are trying to tailor our outreach, our
services in mental health and suicide prevention to all
veterans, but to do it by groups, whether it is demographic
groups, whether it is based upon age, whether it is based upon
diagnosis or service status, whatever it is. Our outreach--and
to the point of your question, I think that is probably the
most critical piece--our outreach campaigns are tailored to
different age groups, and we try and reach them through
different means and resources. Our Make The Connection website
has stories of veterans telling what they have done to move
forward in their lives, based upon age and based upon period of
service.
Senator Manchin. Let me throw this one at you then, because
I know our time is going to be short. Let me throw this at you.
Many people in rural areas, such as mine and the Chairman's
here in Montana, do not have internet service. Telehealth has
been a big thing. What do we do with those who do not have
access or do not use the internet? How are you reaching out to
them, making sure we are not missing somebody?
Mr. Carroll. Through the communities is the shortest
answer, sir. You know, we are working to expand the reach of
telehealth through the broadband expansion, working with our
VFW partners and other organizations who were with us in the
first panel and otherwise. But I think trying to, through all
of our suicide prevention activities, working with local
communities, so promoting together with veteran programs in
local communities so it becomes more of a veteran-to-veteran,
community-based program, recognizing the unique circumstances
and the unique----
Senator Manchin. I have another question for you then, OK?
Speaking of the veterans being able to access the help they
need, mental illness help and keeping them hopefully safe, we
have a National Suicide Prevention Lifeline, the 800-273-8255.
I do not know how many people can memorize that one. That is
why we passed the three-digit dialing code for our hotline,
which will not start until July 16, 2022.
So how are we getting this information out that they have
help just a phone call away? How are we pursuing that, or how
are we getting it out to the general public?
Mr. Carroll. Dr. Miller is on the panel here, sir.
Senator Manchin. Whoever can answer that, we appreciate it.
We will take anybody.
Mr. Miller. Yes, sir. We have a paid media campaign active
right now, targeting Veterans Crisis Line services and
informing veterans as well as those who love and support
veterans regarding VCL and how to get in touch with us, whether
it be telephone, whether it be text, or whether it be chat.
The VCL paid media program is one of our most frequently
utilized in terms of our statistics program----
Senator Manchin. Okay. I have got another question for you.
Mr. Miller [continuing]. and engagement.
Senator Manchin. I have got another one for you. Thank you,
Mr. Chairman. I appreciate it.
This one here has to do with the veterans in community, how
they are overseeing non-VA care providers. This is about
opiate. Opiate has been rampant throughout my State, the opiate
addiction, and it has really hit my veteran population
extremely hard.
What we do not know, we cannot follow to find out when they
come to the VA, where they have been before that and how we can
follow. Are you all tied into the prescriptions from the drugs,
all the drugs that have been prescribed throughout the State,
in my West Virginia or any other State, so you do not
overprescribe to a person who has already gotten their pills
someplace else?
Mr. Miller. Yes.
Senator Manchin. Anybody.
Mr. Miller. Yes is the answer.
Mr. Smith. Senator, Mr. Smith. The answer is yes.
Our prescribers, our primary care providers are able to
check the State data bases for the prescribing of opiates.
Senator Manchin. Let me just say, though, I thank you all.
I know it is a tough job. I mean, there are so many, but we
have so much need out there, and these are the people that
basically were willing to give their life for us, and that is
why we feel so passionate.
I will say this too. The veterans are still the glue that
holds this country together. They hold us together in
Washington. They really do. They bring Democrats and
Republicans together. And thank God for our veterans and our
servicemembers that we have serving, because without them I do
not know if we would be able to talk about much that we would
agree on. But we do agree how special our veterans are, and
that is why we just are so diligent and vigilant about the
services that we are expected to give and that you all are
doing. And we appreciate that, but we always need to do better.
Thank you.
Chairman Tester. Thank you, Senator Manchin. Senator
Boozman, are you there?
SENATOR JOHN BOOZMAN
Senator Boozman. Yes, I am. I have finally figured the
audio out and the video, and I know that you can relate to
that. Dr. Miller, the John Scott Hannon Act was signed into law
last October. Section 201 of the bill establishes a grant
program that enables the VA to provide resources to community-
based organizations to help reduce and prevent veteran suicide.
The intent was to empower community organizations as quickly as
possible to find veterans in the community and assure they had
access to help.
Could you please give an update on what the VA has done
since the bill was signed into law 6 months ago, what has
happened up to today, and when can we expect the first grant to
be awarded?
Mr. Miller. Yes, sir. There are--and this gets to what Dr.
Smith talked a little bit about with Senator Tester regarding
the scholarships and grants. There are three phases within the
process. The law is written very well in terms of outlining
specific stipulations and procedures inherent within each of
the three phases necessary to do this efficiently, right, and
effectively. And I think we all can agree that those are top
priorities, because we all agree that this has immense
potential in terms of saving lives for veterans and working
with the community.
Because of that, we understand the attention that is paid
to, and we respect the attention that is paid to timelines and
timing. Currently, we are in Phase 1 of the process. We are on
the cusp of the step within the process that entails consulting
the public. There is a requirement, as Step 1 in the process,
of consulting the public, and that is what is called a Request
for Information that is published to the Federal Register.
We are closely approximating that point, but we are also
going to take an extra step during the consult the public
aspect. We are going to add two town hall listening sessions to
the process, which will require a second RFI, and going through
the process for that.
Nonetheless, we believe that it is essential to maximize
community input on the structure and the issuance of these
grants. So over the next few months you will see us, and you
will hear about us engaging these town hall sessions to hear
from stakeholders and the public to help us shape this so that
it can be done efficiently, right, and effectively.
Senator Boozman. So when do you think the first grant will
be awarded?
Mr. Miller. There are, within each of the three phases--
sir, I cannot give you a date. I do not want to dance around
it, so I am going to respect your time and I am just going to
tell you, honestly, I cannot give you a date.
Senator Boozman. The VA has well-established grant programs
like the Supportive Service for Veterans Families----
Mr. Miller. Yes.
Senator Boozman [continuing]. which helps prevent
homelessness, and it has really been a great program. Some
argue what makes the SSVF grant program so effective is its
reflexive and adaptive nature to meet the ever-changing
demands.
Mr. Miller. Yes.
Senator Boozman. The program is a flat organization with
direct report from regional service directly to leadership. Can
we expect that the grant program, as it is set up, to be
organized and operated in a similar manner, building on that
model, and what lessons were learned when standing up the SSVF
program that are being applied to this program?
Mr. Miller. Yes, sir. You can fully expect everything that
you are asking for and outlining, and we fully agree with you
regarding SSVF in terms of the efficiency, effectiveness, and
rightness of the model that it presents.
They, and their leadership team, are on our steering
committee for Section 201. They are serving in an advising and
consulting capacity, helping us to understand steps along the
way and helping us to navigate those steps, based upon lessons
learned.
I will also note, sir, and I think you will appreciate
this, that the Suicide Prevention Program has partnered with
SSVF over the last year to support, as you mentioned, and I
think so appropriately so, a flexible and adaptable
implementation of SSVF. We are working together to fund
particular at-risk populations and services going to them.
These are veterans at risk for suicide who have been
homeless within the last 30 days and are living in a motel or a
hotel.
So far, the collaboration that we have with SSVF on this
has reached over 7,100 veterans. We are looking to double down
on that effort this year as we are working through the
implementation process of the Staff Sergeant Parker Gordon Fox
Program.
Senator Boozman. That is a great story. And do not
misunderstand. What we want to do is help you cut through the
bureaucracy. So I think I can speak for Senator Tester and
Senator Moran, and then also my counterpart on the
Appropriations, Chairman Heinrich. We really would like to be
informed as to the progress. Can we get you to provide our
staffs, within the next 2 weeks and then quarterly until the
program is operational, exactly where we are at so that we can
help you break down whatever barriers occur?
Mr. Miller. We have a journey map graphic, sir, that
outlines this process from start to finish. We would be more
than happy to transparently sit down with you, your team, and
interested stakeholders therein and walk through the journey
map and answer questions that you may have.
Senator Boozman. Good. Thank you so much. Thanks for all
you do. Thank you, Mr. Chairman.
Chairman Tester. Yes, thank you, Senator Boozman, and you
can count, I think both Senator Moran and my staff is in on
that briefing. It is a great question, Senator. Boozman.
I just want to thank our VSO representatives, VA officials,
and DoD officials for being here today. The issue veteran
suicide is of utmost importance to this Committee, and the
Hannon Act sets a new landmark for veterans' mental health
care. But it is up to us to make sure that it is implemented as
intended, and with so many struggling due to this pandemic time
is of the essence. So I want to thank everyone for
participating today. We will keep the record open for a week.
This hearing is adjourned.
[Whereupon, at 5:03 p.m., the Committee was adjourned.]
APPENDIX
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