[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

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

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             MARCH 24, 2021

                               __________

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

                              ----------                              

                       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

                              ----------                              


                       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

                              ----------                              


               Material Submitted for the Hearing Record
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                 [all]