    [Senate Hearing 119-60]
    [From the U.S. Government Publishing Office]

                                                             S. Hrg. 119-60

                    BRIDGING THE GAP: ENHANCING OUTREACH TO
                        SUPPORT VETERANS' MENTAL HEALTH

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

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 APRIL 29, 2025

                                   __________

           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
    60-293 PDF                  WASHINGTON : 2025

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

                     SENATE COMMITTEE ON VETERANS' AFFAIRS

                         Jerry Moran, Kansas, Chairman
    John Boozman, Arkansas               Richard Blumenthal, Connecticut,
    Bill Cassidy, Louisiana                  Ranking Member
    Thom Tillis, North Carolina          Patty Murray, Washington
    Dan Sullivan, Alaska                 Bernard Sanders, Vermont
    Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii
    Kevin Cramer, North Dakota           Margaret Wood Hassan, New
    Tommy Tuberville, Alabama                Hampshire
    Jim Banks, Indiana                   Angus S. King, Jr., Maine
    Tim Sheehy, Montana                  Tammy Duckworth, Illinois
                                         Ruben Gallego, Arizona
                                         Elissa Slotkin, Michigan

                         David Shearman, Staff Director
                    Tony McClain, Democratic Staff Director

                               C O N T E N T S

                                  ----------

                                 April 29, 2025

                                    SENATORS

                                                                       Page
    Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     1
    Hon. Richard Blumenthal, Ranking Member, U.S. Senator from
      Connecticut....................................................     2
    Hon. Kevin Cramer, U.S. Senator from North Dakota................     9
    Hon. Patty Murray, U.S. Senator from Washington..................    10
    Hon. Marsha Blackburn, U.S. Senator from Tennessee...............    12
    Hon. Mazie K. Hirono, U.S. Senator from Hawaii...................    13
    Hon. John Boozman, U.S. Senator from Arkansas....................    15
    Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    16
    Hon. Angus S. King, Jr., U.S. Senator from Maine.................    18
    Hon. Tammy Duckworth, U.S. Senator from Illinois.................    19
    Hon. Ruben Gallego, U.S. Senator from Arizona....................    21
    Hon. Elissa Slotkin, U.S. Senator from Michigan..................    24
    Hon. Tommy Tuberville, U.S. Senator from Alabama.................    36

                                     GUEST

    Hon. Mark R. Warner, U.S. Senator from Virginia..................     4

                                   WITNESSES
                                    Panel I

    Thomas O'Toole, MD, Acting Assistant Under Secretary of Health
      for Clinical Services and Deputy Chief Medical Officer,
      Veterans Health Administration, U.S. Department of Veterans
      Affairs accompanied by Michael Fisher, Chief Officer,
      Readjustment Counseling Service, Veterans Health Administration     5

                                    Panel II

    Jim Lorraine, President and CEO, America's Warrior Partnership...    26

    Gilly Cantor, MPA, Director of Evaluation and Capacity Building,
      D'Aniello Institute for Veterans and Military Families (IVMF),
      Syracuse University............................................    27

    Steffen Crow, SSG Parker Gordon Fox Grant Program Manager,
      Oklahoma Veterans United.......................................    29

    Heather Barr, U.S. Marine Corps Veteran..........................    30

    Austin Lambright, U.S. Marine Corps Veteran......................    32

    Lindsay Church, Executive Director and Co-Founder, Minority
      Veterans of America............................................    34

                                    APPENDIX
                              Prepared Statements

    Thomas O'Toole, MD, Acting Assistant Under Secretary of Health
      for Clinical Services and Deputy Chief Medical Officer,
      Veterans Health Administration, U.S. Department of Veterans
      Affairs........................................................    47

    Jim Lorraine, President and CEO, America's Warrior Partnership...    67

    Gilly Cantor, MPA, Director of Evaluation and Capacity Building,
      D'Aniello Institute for Veterans and Military Families (IVMF),
      Syracuse University............................................    75

    Steffen Crow, SSG Parker Gordon Fox Grant Program Manager,
      Oklahoma Veterans United.......................................    80

    Heather Barr, U.S. Marine Corps Veteran..........................   102

    Austin Lambright, U.S. Marine Corps Veteran......................   104

    Lindsay Church, Executive Director and Co-Founder, Minority
      Veterans of America............................................   106

                            Questions for the Record

    Department of Veterans Affairs response to questions submitted
      by:

      Hon. Jerry Moran...............................................   143

      Hon. Angus S. King, Jr.........................................   144

      Hon. Marsha Blackburn..........................................   145

                           Submissions for the Record
                      (From Minority Veterans of America)

    Memorandum to Interagency Task Force on Outdoor Recreation for
      Veterans.......................................................   151

    Minority Veterans of America resignation from Interagency Task
      Force on Outdoor Recreation for Veterans.......................   155

    Final Report by Interagency Task Force on Outdoor Recreation for
      Veterans, September 2024.......................................   156

                           Statements for the Record

    Hon. Sheri Biggs, U.S. Representative from South Carolina........   191

    American Psychological Association Services, Inc., Katherine B.
      McGuire, MSc, Chief Advocacy Officer...........................   196

    AMVETS, Joseph R. Chenelly, Executive Director...................   201

    Blue Star Families, Brooke Blaalid, Associate Director of Policy.   203

    Boulder Crest Foundation, Josh Goldberg, CEO.....................   210

    Combined Arms, Mike Hutchings, CEO...............................   215

    Community Building Art Works, Seema Reza, Chief Executive Officer   216

    Disabled American Veterans, Naomi Mathis, Assistant National
      Legislative Director...........................................   219

    EveryMind, Ann Marie Mazur, CEO..................................   228

    Modern Military Association of America...........................   230

    Paralyzed Veterans of America....................................   232

    The American Legion, Sri Benson, Health Policy Analyst...........   237

    The American Legion, Mario A. Marquez, Executive Director,
      Government Affairs.............................................   248

    Tragedy Assistance Program for Survivors, Bonnie Carroll,
      President and Founder..........................................   249

    Veterans of Foreign Wars of the United States, Meggan Coleman,
      Associate Director, National Legislative Service...............   251

    BRIDGING THE GAP: ENHANCING OUTREACH TO SUPPORT VETERANS' MENTAL HEALTH

                                  ----------

                            TUESDAY, APRIL 29, 2025

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 10:36 a.m., in
    Room SD-106, Dirksen Senate Office Building, Hon. Jerry Moran,
    Chairman of the Committee, presiding.

        Present: Senators Moran, Boozman, Cassidy, Tillis,
    Blackburn, Cramer, Tuberville, Sheehy, Blumenthal, Murray,
    Hirono, Hassan, King, Duckworth, Gallego, and Slotkin.

        Also present: Senator Mark R. Warner.

                 OPENING STATEMENT OF HON. JERRY MORAN,
                   CHAIRMAN, U.S. SENATOR FROM KANSAS

        Chairman Moran. All right. Good morning, and welcome.
    Before we begin the hearing, I want to highlight that today at
    3 o'clock in Emancipation Hall, a Congressional Medal that was
    authorized by the Senate and the House will be presented to The
    Six Triple Eight, the African American women who in World War
    II delivered the mail by the millions.
        And we would welcome you to participate, to attend, or at
    least honor those women today who served our country, and in it
    is a really touching story. I think a number of networks across
    the country have carried this story about these women who
    rolled up their sleeves and got the mail delivered to service
    members during World War II.
        Today, we're on the topic of mental health and veterans'
    well-being. Nearly 5 years ago, the Commander John Scott Hannon
    Veterans Mental Health Care Improvement Act was signed into
    law. I led the introduction of this legislation with the help
    and support of many of the veterans and advocates that are here
    today. I also would indicate that this was a piece of
    legislation that Senator Tester was hugely engaged in.
        The Commander Hannon Act directed better collaboration
    between the VA and the Department of Defense, and made
    improvements to the VA's mental health workforce, and directed
    cutting edge precision health research. This landmark
    legislation also developed an authorized federal funding for
    the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant
    Program, which focuses on bolstering community organizations
    providing nonclinical suicide prevention services to veterans.
        It was the goal of Congress, and this Committee,
    specifically, for the VA to work more seamlessly with veterans
    serving community organizations to provide veterans lifesaving
    clinical care and nonclinical support services they deserve.
    This morning, we are here to discuss the nonclinical suicide
    prevention services and to hear directly what has worked well
    and what needs to be altered, with the goal of reauthorizing
    this impactful program.
        We will hear from the VA to receive the Department's
    perspective on implementation of this grant program. We'll also
    hear from advocates who represent grantee organizations from
    their perspectives, and from veterans who have benefited from
    the program.
        Additionally, we will be receiving input from the VA and
    feedback from advocates on four bills, which include Helping
    Optimize Prevention and Engagement, the HOPE Act, which is my
    legislation, the Building Resources and Access for Veterans
    Mental Health Engagement, the BRAVE Act, sponsored by the
    Ranking Member Blumenthal, the bill to reauthorize and modify
    Staff Sergeant Parker Gordon Fox Suicide Prevention Grant
    Program, sponsored by Senator Boozman and Warner. And Every
    State Counts for Vets Mental Health Act, sponsored by Senator
    Cramer and Senator Coons.
        With that, I yield to the Ranking Member, Senator
    Blumenthal for his opening remarks.

             OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,
             RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT

        Senator Blumenthal. Thank you, Mr. Chairman. Thank you for
    convening this hearing on this critically important topic.
    We're here today to discuss the issue of veterans' mental
    health, including their access to care from a safe, reliable
    provider. A safe, reliable provider who has the expertise and
    trust to provide the best possible care for each individual
    veteran.
        I welcome our colleague, Senator Warner, to testify on
    behalf of the Staff Sergeant Parker Gordon Fox Grant Program.
    It's been a game changer for so many veterans. It's geared
    toward meeting veterans where they are, providing access to
    services from trusted community partners and targeting
    underserved communities. And my hope is we'll have bipartisan
    support for reauthorizing the Fox Grant Program, and we will
    have bipartisan consensus on a couple of really essential
    points.
        The rate of veterans' suicide, 17.6 a day, is absolutely
    intolerable. The level of services to veterans for mental
    health is woefully lacking. The efforts underway to address the
    lack of mental health are completely inadequate. And my bill on
    today's agenda, the BRAVE Act, reauthorizes the Fox Program,
    but it goes further, and I hope we'll have bipartisan support
    to ensure, not only that this program, but others to address
    these issues are fulfilled.
        The fact is the Veterans Crisis Line has seen a dramatic
    impact in call volume, largely from veterans who are either
    terminated from the federal workforce, or who are concerned
    about losing their benefits, or both. And at a time when
    veterans are uniquely anxious, and apprehensive, and need our
    support the most, we're seeing the Trump/Musk/Collins
    conglomerate slashing and trashing their way through the
    Federal Government.
        Employee assistance programs and mental health support
    contracts for the VA workforce have been canceled. Some have
    been reinstated, but not before employees were left high and
    dry, and forced to choose between paying out-of-pocket or
    canceling their appointments due to contract cancellation.
    World-class researchers studying mental health and substance
    use disorders are among the ones who've been terminated. Makes
    no sense. It's nonsensical, it is shameful, and disgraceful.
        On the issue of privacy, a recent memo obtained by NPR,
    recommended VA mental health providers tell their patients,
    ``While I will do my utmost to maintain your privacy, I cannot
    guarantee complete confidentiality.'' They're telling veterans
    they can't maintain privacy or confidentiality due to space
    limitations caused by a rushed and reckless return-to-office
    mandate. Again, disgraceful, shameful. Concerns about privacy
    will destroy the hard-won trust VA has spent decades building.
        After this memo was disclosed, VA backtracked to say it was
    temporarily delaying its return-to-office requirements for
    telemental health providers. I want to note these providers
    haven't been exempted from the return-to-office mandate. The
    facilities have simply been asked to confirm their return-to-
    office spaces are private. This strategy of cut first-plan
    later, fire first-analyze later, terminate, cut, freeze, ask
    questions later apparently is continuing. And this failure of
    leadership is at the expense of veterans. And we have yet to
    hear in this Committee from the Secretary of the VA, despite my
    repeated requests for him to tell us what the rationale and
    reason is for these massive cuts and firings.
        So, we all know that even before the Trump administration's
    crusade against veterans, the VA projected a 59 percent
    increase in inpatient and outpatient mental healthcare demand
    in the coming years--59 percent increase. The Department was
    already suffering from critical mental health staffing
    shortages. There were already 40,000 open positions in the VA,
    some of them for mental health professionals.
        In his confirmation hearing, the Secretary claimed, he
    claimed, suicide prevention was a priority. But instead of
    bolstering access to life-saving mental health, he's fired
    thousands of critical employees, including veterans crisis line
    employees. Some have been reinstated, others have found new
    employment. That's understandable because they have bills to
    pay, they have lives to live and waiting for the administration
    to correct yet another unforced error can't be their burden.
        We have to make sure that the administration answers our
    question. Our responsibility is oversight, and scrutiny, and to
    prevent the firing of another 83,000 VA employees over the
    coming months. We know from this Committee, we've all been on
    it for a while, that outreach is essential to bring veterans
    into mental health. We can't rely only on veterans calling a
    crisis line or coming to the VA facilities.
        There has to be outreach. 10 of those 17 per day average
    veterans taking their own lives, 10 of them, have had no
    contact with the VA. If we can reach more, we can save more. If
    we fire the counselors and others who are doing outreach, it
    will cripple efforts to save veterans from suicide, including
    the Fox Program.
        So, while we're here today, I hope to hear from our
    witnesses about the importance of outreach and how it can be
    bolstered and strengthened. Thank you, Mr. Chairman.
        Chairman Moran. Ranking Member, thank you. We are now
    delighted to have before the Veterans Committee, on a temporary
    basis, the Senator from Virginia, Senator Warner, one of our
    esteemed colleagues. And this is a rare occasion when other
    Senators not on the Committee appear before us. But you are
    welcome to be here, Senator Warner.

                   STATEMENT OF HON. MARK R. WARNER,
                       U.S. SENATOR FROM VIRGINIA

        Senator Warner. Well, thank you, Mr. Chairman, and Ranking
    Member Blumenthal. This is obviously a very important topic.
    You've given me 4 minutes. I'll try to get it under 4 minutes,
    so I actually get asked back. But very much appreciate the work
    of this Committee. I know the issue of mental health of our
    veterans is extraordinarily important.
        And this is something I think we all realize is part of a
    core commitment. This is not a nice to do. This is an
    obligation we owe to the men and women who've served us. It is
    not charity. It is something that we must fulfill. And
    unfortunately, as the Chair and the Ranking Member, and I know,
    all the Committee members realize, veterans' suicide is a
    scourge that has to be addressed.
        For the past several years, Staff Sergeant Fox Suicide
    Prevention Grant Program, I think, has been an invaluable tool
    for the VA to use. Senator Boozman and I came up with an
    initial legislation back in 2019, a number of Members on this
    Committee were firm supporters. That turned into an effort that
    ultimately led to the Staff Sergeant Fox Grant Program.
        In that time, $150 million has gone out in my home State of
    Virginia. $4.5 million of that has gone out to organizations
    who are providing the kind of critical outreach to make sure
    that veterans who are in duress know that the services are
    available as Ranking member Blumenthal mentioned. We have a
    huge concentration of veterans down in Hampton Roads, and the
    fact that of these 17 suicides today, the fact that literally
    10 of those never interact with the VA, is a challenge that we
    have to overcome.
        This program was a temporary grant program. It is time for
    its permanent reauthorization. I've joined again with Senator
    Boozman on legislation to do that. I know the Chair, and the
    Ranking Member, and others on this Committee have similar
    legislation. I just want to add my voice that this is something
    we have to get done. The sooner, the better. Literally,
    veterans' lives depend upon it. And if any, in any way, I can,
    as an off-Committee member helping these efforts, please count
    me as one of your allies.
        I appreciate the opportunity, and I will note Mr. Chairman,
    that I'm seating back a minute and 40 seconds.
        Chairman Moran. A message. It's an opportunity for Senators
    to learn from Senator Warner. A message well delivered under
    the time allowed.
        Senator Warner. Thank you, Mr. Chairman.
        Chairman Moran. Thank you, Senator Warner. Thank you for
    joining us today. I remember the hard work that you and Senator
    Boozman did early on to get this legislation in place.
        Testifying on today's first panel is Dr. Thomas O'Toole,
    the Acting Assistant Under Secretary of Health for Clinical
    Services of the Veterans Health Administration. He's
    accompanied by Michael Fisher, Chief Officer of Readjustment
    Counseling Service of the Veterans Health Administration. Thank
    you both for being here.
        Dr. O'Toole, you're now recognized for your testimony.

                                PANEL I

                                  ----------

        STATEMENT OF THOMAS O'TOOLE, MD, ACTING ASSISTANT UNDER
      SECRETARY OF HEALTH FOR CLINICAL SERVICES AND DEPUTY CHIEF
        MEDICAL OFFICER, VETERANS' HEALTH ADMINISTRATION, U.S.
     DEPARTMENT OF VETERANS AFFAIRS ACCOMPANIED BY MICHAEL FISHER,
    CHIEF OFFICER, READJUSTMENT COUNSELING SERVICE, VETERANS HEALTH
                             ADMINISTRATION

        Dr. O'Toole. Thank you, Chairman Moran, Ranking Member
    Blumenthal, and Members of the Committee. Thank you for
    inviting us here today to present our views on several bills
    that would affect VA programs and services, particularly the
    Staff Sergeant Parker Gordon Fox Suicide Prevention Grant
    Program. Joining me today is Mr. Mike Fisher, Chief Officer of
    the Readjustment Counseling Service.
        The Staff Sergeant Parker Gordon Fox Suicide Prevention
    Grant Program enables VA to provide resources toward community-
    based suicide prevention efforts to meet the needs of veterans
    and their families through outreach, suicide prevention
    services, and connections to VA and community resources.
        In alignment with VA's National Strategy for Preventing
    Veteran Suicide, this grant program assists in further
    implementing a public health approach that blends community-
    based prevention with evidence-based clinical strategies
    through community efforts. The grant program is part of the
    Commander John Scott Hannon Veteran Mental Health Care
    Improvement Act of 2019, that was signed into law on October
    17th, 2020.
        The Staff Sergeant Parker Gordon Fox Suicide Prevention
    Grant Program began on September 19th, 2022 when VA awarded
    $52.5 million to 80 community-based organizations in 43 states,
    the District of Columbia, and America Samoa. Since its launch
    in September '22, VA has awarded $157.5 million to 95
    organizations across these 43 states, U.S. territories and
    tribal lands.
        Early results show that 33 percent of participants are new
    to VA services, and 75 percent of participants who complete
    services show improvement in mental health status, well-being,
    social supports, and financial stability, as well as a decrease
    in suicide risk. All of the bills on today's agenda would hold,
    or in part, mend the authority for the Staff Sergeant Parker
    Gordon Fox Suicide Prevention Grant Program.
        VA strongly supports the reauthorization of this program as
    it is critically important for sustaining and expanding the
    progress we have made so far. The initial grants have already
    shown promising results, and continued congressional support
    will be essential for ensuring that we can reach even more
    veterans in need.
        We greatly appreciate the Committee's interest in
    continuing this program and stand ready to implement the
    extension of this authority as soon as possible, because it's
    important to continue this work in fiscal year 2026. We welcome
    the opportunity to meet with the Committee to ensure that any
    amendments to the terms of the grant do not interrupt
    operations or delay these awards. The Department's position for
    each bill is detailed in my written statement.
        This concludes my statement, and we are happy to answer any
    questions you or other Members of the Committee may have.

        [The prepared statement of Dr. O'Toole appears on page 47
    of the Appendix.]

        Chairman Moran. Doctor, we'll begin a round of questions by
    the Members of the Committee. Let me start by asking you, as
    Congress looks to reauthorize, it's really pleasing, I think
    this has broad support in Congress and certainly strong support
    from the Department. But as we do this process and work to
    improve this program, what's the VA learned about grantee
    performance and outcome data so far? And what are the lessons
    that have been learned in shaping your approach to suicide
    prevention?
        I would add before you answer that, one of the challenges
    highlighted in the Hope for Heroes Act is a lack of awareness
    among VA staff about the Fox Grant Program. And I would ask,
    how is the VA working to make certain its own employees, and
    especially those in high needs areas, are fully aware of the
    program and collaborating with grantee organizations making
    this program even better?
        Dr. O'Toole. Thank you, Senator. As noted, the 3-year
    authorization for this grant program has really allowed us to
    be on a learning curve to try to do a better job. As has been
    noted, any suicide by a veteran is one too many. And so, we
    very much view this grant as an important part for reaching
    those veterans that we are not reaching.
        The lessons learned to date, and much of this is captured
    in the MITRE report that provided a snapshot view of early
    experiences, highlighted several areas that we need to continue
    to improve on. Obviously, enhancing our outreach and
    engagement, particularly for those disconnected veterans is
    critical. And I think ensuring that our grantees have all of
    the services they need as well as the expectations and skills
    that they require to be able to effectively engage not only in
    outreach, but in the services is critically important.
        The other area that I think is essential is making sure
    that the VA is there, ready, and has capacity, and a clear path
    for ensuring that mental health care is available to those
    veterans who need it. And obviously, that incorporates several
    different elements, but one of which you mentioned, which is an
    awareness of the programs by the grantees. It's something that
    we acknowledge, and I know it's addressed in several of the
    bills going forward as well.
        Chairman Moran. Let me ask you. You used the word capacity,
    clear path. So, how would you indicate that the Department of
    Veterans Affairs is prepared and capable on a clear path to
    reduce suicide by veterans in the country just more broadly
    than this legislation? Tell me about the capacity and
    capabilities.
        Dr. O'Toole. So, the capacity is we have a very robust
    mental health services program within VA that incorporates
    tiered levels of care, including screening throughout the
    agency and in our healthcare settings, not only just in mental
    health; integration of mental health care within our PACT or
    primary care teams through the PHMI program, behavioral health
    teams providing more intensive care as well as specialized
    services for higher need, higher risk veterans, including
    inpatient care and residential treatment programming.
        It's a continuum of care and continuum of services that,
    you know, as noted in Senator Blumenthal's statement, requires
    maintenance, requires an ongoing, you know, capacity to
    effectively serve the veterans in need. But it is also, I
    think, a more robust service than oftentimes we can find
    elsewhere. And it's one that, you know, I think our veterans
    benefit from greatly.
        Are there things we can do better? Absolutely. Are there
    things we need to be improving on? Absolutely. And, you know,
    I'm not here to try to defend things that aren't working, but
    more importantly, you know, be here to commit to our ongoing
    work with the Committee to do a better job.
        Chairman Moran. What would be those things that you could
    do that you see you can do a better job aside from what we've
    talked a lot about, which is outreach?
        Dr. O'Toole. Right. I think that, you know, the Veteran
    Crisis Line, I think has been a lifeline for a lot of veterans.
    We need to continue to be able to support that and do the best
    we can. What's critically important is clearly making sure that
    we have pathways to treatment and to ensuring safety for those
    veterans who do screen positive. And we actually do well in
    that capacity and support.
        Our ability to reach those veterans who are transitioning
    from the military is a critically important focus and capacity
    and interest. And I know it's one that our agency is working on
    several different efforts to try to improve and enhance. That
    becomes, I think, a critical piece, an element to it.
        It's also important to note that suicide risk extends
    beyond strictly a mental health approach and status.
    Oftentimes, there are economic drivers, there are social
    drivers, and others. And taking a whole-health approach to the
    veteran is critical to really ensuring that not only the
    immediacy of a suicide risk is addressed, but sometimes the
    underlying issues and drivers of that suicide are also being
    considered.
        Chairman Moran. I would note that I have utilized Senator
    Warner's extra minute and a half, and I now recognize Senator
    Blumenthal.
        Senator Blumenthal. Thanks, Mr. Chairman. I want to begin
    by thanking you both for being here, and for your service to
    our country and to the veterans of America. I know that this
    time in your professional careers is probably one of the most
    challenging that you have encountered, not because of anything
    you've done, but because the leadership at the VA is slashing
    positions, and freezing hiring, and cutting funding that is
    necessary for you to do your jobs and accomplish the mission
    you've devoted your lives to doing. And to you and all of the
    professionals at the VA, just offer my thanks for continuing to
    persevere in this very difficult time.
        Dr. O'Toole, you would agree with me that outreach is
    critical in preventing veteran suicide, and enabling them to
    what you have called a pathway to treatment.
        Dr. O'Toole. Yes, sir.
        Senator Blumenthal. And that takes human beings on the
    phone or in a meeting. It can't be done by an automated message
    machine. Correct?
        Dr. O'Toole. Yes, sir.
        Senator Blumenthal. What rationale, what reason could there
    be to cut those positions as is now happening?
        Dr. O'Toole. Well, thank you, Senator, and I appreciate
    one, your kind words as well as the attention that you're
    focusing on this issue. I am happy to report that, actually,
    the Veteran Crisis Line staffing numbers have gone up and not
    down since this last January. This is a, as you know, an
    exempted position from both return-to-office and along with
    300,000 other direct care positions exempt from any hiring
    freeze, or any hiring, or any firings.
        Senator Blumenthal. Those returns or reinstatements were
    done after vocal protest from myself, others on this Committee,
    in Congress, and across the country. So, yes, that's good news,
    but it's not just the crisis line, it's positions in the West
    Haven facility outreach counseling. There already were 40,000
    vacancies before this administration took over. Would you agree
    with me that a lot of those positions in the field are open
    now, and some people in those positions have been terminated?
        Dr. O'Toole. Thank you. And I'm just up the road from you
    in Providence, Rhode Island. So, I can appreciate the
    challenges of local staffing and local issues. Quite honestly,
    our challenges in maintaining the workforce in healthcare
    extend beyond this administration. The challenges that we're
    facing now, a lot of them----
        Senator Blumenthal. Well, I'm going to interrupt because
    I'm going to run out of time if I don't interrupt, so I
    apologize. But the fact is there are challenges in recruitment.
    Correct?
        Dr. O'Toole. Yes, sir.
        Senator Blumenthal. And those challenges in recruitment are
    deeply and dramatically aggravated when the prospect of firing
    83,000 employees is raised. Why I go to work for an institution
    that's about to fire probationary employees, the newest among
    them, when there are opportunities in the private sector where
    you get paid more, I mean, duh, you know, I know you're not in
    charge of personnel, but isn't that a recipe for disaster?
        Dr. O'Toole. Well, sir, I can't say that 300,000 positions,
    which are the direct care positions, are exempted from any
    hiring freeze. And this is a critically important element to
    trying to ensure that we are retaining and ideally growing our
    workforce as best we can.
        Senator Blumenthal. I am about to have my time expire, but
    I just want to say that we know that there have been firings of
    researchers, counselors, outreach personnel. There is simply no
    way to save veterans. And I've heard nothing here that would
    convince me otherwise if we engage in this slash and trash
    approach to the VA. And again, my thanks to all the
    professionals, to you, Mr. Fisher, and Dr. O'Toole, for what
    you're doing. And I have not gone over my time.
        [Laughter.]
        Chairman Moran. Only by 3 seconds. Senator Cramer.

                           HON. KEVIN CRAMER,
                     U.S. SENATOR FROM NORTH DAKOTA

        Senator Cramer. Thank you, Mr. Chairman, Ranking Member,
    for this important hearing. And thank you to our witnesses as
    well for your service, and for being here.
        I'm going to get right to the specific point that's
    addressed in legislation that I've introduced, an amendment to
    the Act before we reauthorize it, that I've introduced with
    Senator Coons. And to be clear, what resulted in this is the
    fact that as important as this program is, and it is important,
    and I strongly support it, neither North Dakota nor Delaware
    received any of the funds despite a very, very good
    application, particularly the one I'm most familiar with; the
    State of North Dakota through the North Dakota Department of
    Veterans Affairs. Important I stress the North Dakota
    Department of Veterans Affairs because of the five criteria
    that meets five of them, the five criteria for the grant.
        And so, we're a little disappointed, of course, that North
    Dakota's application was rejected. I don't know if it was not
    qualified, but at least wasn't prioritized. And so, I want to
    I'd like to have you, you know, maybe explain to me a little
    bit about why that happened. And then, also, you know, we
    received the testimony yesterday that the VA is opposing my
    language and my amendment, and I just want to give you an
    opportunity to explain that before I try to explain my position
    better.
        Dr. O'Toole. Thank you, Senator. And while I can't speak to
    the specifics of that individual grant application and the
    decision to it, I think it's important, first, thank you for
    your support of this. It's support that we're very appreciative
    of, and we share in our need, and want, and desire to really
    grow this program and grow these efforts. I think our challenge
    and our concern with an approach to increasing the number of
    grantees, which we acknowledge is important, and it's an
    essential aspect to being able to reach more veterans, engage
    more veterans, and get more veterans into care and services, is
    going to be--it's a shared objective.
        Having two potentially different or a prioritized pathway
    would be difficult to logistically administer, if we have two
    tiers. Our larger concern is that we want to make sure that all
    of the projects and all of the grants that are being approved
    are meeting the high-quality universal standard. And our
    concern was we do not want to create two standards for how a
    grant would be approved.
        Senator Cramer. And I appreciate all of that. I would
    state, however, that in the case of states and just to be so
    that people know what our bill does, Every State Counts Act, it
    recognizes that a couple of states didn't receive funds from
    the program, and we want to prioritize states that haven't
    received funds previously. It's a one-time deal. We want to get
    these other states in the loop, so to speak, and then clear the
    deck, particularly very rural states.
        I mean, North Dakota's a big state, 350 by about 200 miles
    rectangle in the middle of the North American continent,
    literally, we have a monument to prove it. And a lot of miles
    between veterans, but 55,000 of them that need this service. We
    think that's pretty important criteria. I've done this before
    with other bills that--Senator Heinrich and I did something
    similar when the discretionary grant programs at the Department
    of Transportation weren't reaching some rural states. We fixed
    that, got them back in the loop, and it's worked out very well.
        I would just state that, particularly, again, I've read
    that the objections, some of them reference, you know, multiple
    applicants within the state, the competitive nature, all the
    things that you've highlighted. But I think when it comes to an
    entire state, regardless of the small population, it is after
    all why there are two Senators from every one of them. Every
    state does matter. Our Founders made sure that.
        I just think it's worth fixing in a way that prioritizes
    states that have not received funding previously. And just
    adding that as a--it's not complicated. I know that testimony
    says it's complicated. It's not complicated. It's very simple.
    And we want to make it simple. If we make it simpler, we would
    like to do that.
        Dr. O'Toole. Thank you, Senator. And we agree we are very
    interested in working with the Committee to figure out a good
    way to approach it because we share that same----
        Senator Cramer. And I suspect more resources would be
    helpful.
        Dr. O'Toole. Yes, sir.
        Senator Cramer. All right. I yield 10 seconds since we're
    keeping track.
        [Laughter.]
        Chairman Moran. Senator Murray.

                           HON. PATTY MURRAY,
                      U.S. SENATOR FROM WASHINGTON

        Senator Murray. Thank you, Mr. Chairman, and thank you to
    both of you for being here. I think it's really important that
    in order to improve our mental health care outreach, we need to
    hear, all of us Members of Congress, need to hear from both
    veterans and VA providers about their experiences and the
    issues that they face every day.
        However, last week, the Trump administration denied VA
    Puget Sound in my state, the ability to both host and
    participate in my women veterans roundtable. I held the
    roundtable anyway at a local VFW, but VA would not participate.
    And the conversation certainly lacked, in my opinion, a much-
    needed perspective. I have never seen this sort of blatant
    barrier to outreach before in my entire time of Congress.
        Dr. O'Toole, can you explain why having both the VA and
    veterans together is important for a robust conversation?
        Dr. O'Toole. Well, thank you Senator, and I appreciate it.
    I'm not familiar with the situation you're describing, so
    unfortunately, I can't comment to that and to the specifics, or
    to the approval, or lack of. But absolutely, we are informed by
    our veterans. It helps us to be a better agency and a better
    organization, and it's something we try to encourage in as many
    capacities as we can.
        Senator Murray. Well, do you know if the new policy that
    prevents elected officials from meeting with veterans at VA
    facilities comes from within VHA, or does it come from
    political leadership at VA central office?
        Dr. O'Toole. You know, I would have to defer that to our
    leadership in terms of describing it better than I can myself.
        Senator Murray. Okay. Well, Mr. Chairman, this is really
    important, and I really hope that Secretary Collins, who says
    he is running the most transparent VA in history, decides that
    VA can be transparent enough to let a Senator hold the
    discussion about VA healthcare onsite at the local VA as I have
    done for over 30 years, and I know other members have as well.
    So, I am not done with this topic.
        Let me ask you, though, Dr. O'Toole, even though women are
    more likely to seek care through VA, they're also more likely
    to be dealing with depression, and anxiety, or sexual trauma.
    In 2022, suicide rates for women veterans with histories of
    military sexual trauma, were 75 percent higher than those
    without. So, getting into contact with these veterans and
    providing them the resources they need can truly be life or
    death.
        However, in February, President Trump and Musk fired more
    than 2,400 VA employees, including dedicated health
    professionals who staff the phones at the VA's Center Veteran
    Crisis Line. What steps is VA taking now to reach out to
    survivors of military sexual trauma?
        Dr. O'Toole. Thank you, Senator. Well, first, in relation
    to the Veteran Crisis Line, that decision was reversed and we
    have actually seen a net increase in staff working in the
    Veteran Crisis Line. And, you know, I'm happy to report that
    outcome.
        The outreach and specific efforts for women who are victims
    of military sexual trauma has been incorporated into our REACH
    VET and REACH VET algorithm so that we are specifically
    identifying and engaging those women to make sure that we are
    providing better care. I'd like to defer to Mr. Fisher, who can
    also speak specifically to some of the efforts at the veteran
    resource centers as well.
        Mr. Fisher. And thank you, Senator, for the question. So,
    Vet Centers have historically gone out and reached out to any
    veteran cohort and service member cohort that's eligible for
    Vet Center services. That includes women veterans, that
    includes individuals who experience military sexual trauma.
    We've continued to do this since the change of the
    administration.
        Our outreach staff, as well as our counseling staff at Vet
    Centers are exempted from any hiring freeze. And what we can
    say specific to women veterans is that we every year see
    increases in the number of women veterans that are coming into
    Vet Centers. We also see high trust scores with women veterans
    who received Vet Center services. Last year, it was at 93
    percent.
        Senator Murray. Okay. And I'm running--almost out of time,
    but I don't see how 80,000 more employees being removed will
    help the VA provide services. I just wanted to ask about the
    return-to-office policy. I have been talking to a number of VA
    providers who tell us about VA's new rule that forces them to
    work in person. Those providers have been working remotely
    since before the pandemic, and now instead of being able to
    take video calls in private offices, they're speaking with
    veteran patients in open floor spaces where there's no privacy.
    This is a violation of veterans' privacy. It's a violation of
    HIPAA. It is leading doctors and counselors to look elsewhere
    for work.
        I am almost out of time. I just want to say that the
    elimination of telework agreements is really affecting our
    veterans access to mental healthcare, and we need to have a
    further conversation with you about how we can fix that.
        Chairman Moran. Senator Blackburn.

                         HON. MARSHA BLACKBURN,
                      U.S. SENATOR FROM TENNESSEE

        Senator Blackburn. Thank you, Mr. Chairman, and thank you
    for being here and for approaching this subject today. This is
    one--the veterans that are a part of our team talk with me
    about this access to mental health services all the time, and
    the grief that people experience when there is that loss of
    life of someone that they have served with. And putting
    attention on the mental health needs is something that, we,
    each and every one should spend more time doing and making
    these services available that our veterans need. This is
    something that is also very important.
        Dr. O'Toole, I want to come to you because we've talked
    about this, and thank you for your testimony. We've talked
    about what you're doing to make services available. What you
    have not addressed is the fact that there seems to be
    inconsistency of access, and there seems to be gaps in this
    service. So, if you would build that out a little bit. How are
    you addressing those gaps in the inconsistencies and what is
    the strategy for moving forward so that people know that at the
    VA there is a standard of care that they can expect?
        Dr. O'Toole. Thank you, Senator. I appreciate that, and I
    appreciate the way you framed it. I think this really
    underscores the importance of the Fox Grants. And, you know, I
    think it is important to put into context of the 17.6 veterans
    that complete a suicide every day, 10 of them have no contact
    with the VA, as has been noted earlier.
        We need to be doing a better job of engaging those veterans
    in care. We need to be able to reach out to them. We need to be
    able to meet them on their terms, in their homes, in their home
    communities, to be able to provide those services. And this is
    what the Fox Grants are providing for us. And this is what the
    preliminary evidence of the Fox Grant grantees to date are
    showing progress in.
        So, I think your question is spot on, but it very much
    underscores the strategic public health approach we have to
    really using these grants and these grantees to create that
    connection. And use then those connections to facilitate the
    trust that's needed to break down the barriers that individuals
    may have to actually being able to engage in care, which the
    Vet Centers are a great example of that occurring.
        Senator Blackburn. So, how do you simplify the ability for
    individuals to access that care in their communities? Because
    we know the telehealth is important. We know that easy access
    is important when you're dealing with the mental health issues,
    but if you've got to wait on the VA and a caseworker to make up
    their mind, then it is something that delays you getting the
    care. So, talk to me about simplification of that access.
        Dr. O'Toole. Well, I think one of the best examples of
    the--there's two points, actually three points, I'd like to
    bring up with that. The first, is the issue of outreach and
    engagement, which again, is critical to those 10 veterans a day
    who are committing suicide without having connections to the
    VA. The second, is ensuring that we are effectively screening
    those veterans that do receive care in the VA to make sure that
    we are determining if they are at risk for suicide. And our
    risk ID, you know, universal screening of all veterans is very
    much that strategy.
        The third issue that is critically important is that when
    veterans are in crisis, that we are able to effectively and
    meaningfully respond. And this is where I would highlight the
    successes of the Veteran Crisis Line that truly provide that
    safety net for veterans in crisis.
        And, you know, both the uptake and increased utilization of
    the Veteran Crisis Line and the responsiveness of the Veterans
    Crisis Line to be able to engage individuals in care are great
    examples. Is this saying that it's perfect? By no means. Can we
    do better? We have to. But I'm saying those are our three
    strategic approaches.
        Senator Blackburn. Well, I appreciate that. I also am
    concerned, and I'll send you a question for the record on the
    continuum of care from active duty to veteran status with those
    EHRs. And Mr. Fisher, I'm certain you deal with this every
    single day, and people trying to make certain they have access
    to their records so that they can get the care that they need.
    Thank you all for being here.
        Chairman Moran. Thank you Senator. Senator Hirono.

                         HON. MAZIE K. HIRONO,
                        U.S. SENATOR FROM HAWAII

        Senator Hirono. Thank you, Mr. Chairman. So, as you testify
    about the need to reach out and provide the kind of services
    that you need to--for that, you need workers and the VA has
    always had thousands and thousands of positions that have been
    needed to fill, to be filled then to the point where we enacted
    legislation to make it easier for the VA to hire people faster.
        And so, my colleagues have pointed out several, and I'm
    going to add to that because does it make sense to you, this is
    for Dr. O'Toole, that at a time when there are some 300,000
    positions that need to be filled, and you have 2,500 or so
    already fired, another 83,000 to be fired. Does it make sense
    to you that this is happening to the VA?
        Dr. O'Toole. Well, thank you, Senator. And just a
    clarification, the 300,000 positions in the VA are positions
    that are exempt from any hiring freeze.
        Senator Hirono. Well, then, can you tell me how many
    positions are needing to be filled in the VA?
        Dr. O'Toole. I don't have that information readily
    available.
        Senator Hirono. But we're talking about thousands and
    thousands, I can tell you. So, does it make sense to you that
    this is an environment that you have to live with to provide
    the kind of services that you're talking about, which need
    workers. Does it make sense to you that this is happening to
    the VA? Yes, or no?
        Dr. O'Toole. Well, ma'am, we are trying to do the best that
    we can with the resources that we have. The focus of the cuts
    to date have been of administrative personnel and not direct
    care providers.
        Senator Hirono. Let's face it. There's utter chaos going on
    as far as I can see in the VA. So, we know that a lot of
    veterans make up the workforce. We know that the slash and burn
    of the federal workforce has also impacted veterans. We know
    that the VA's 2024 annual report on veteran suicide identify
    financial loss as a significant risk factor for suicide.
        Do you know which veterans have lost jobs in the Federal
    Government, knowing that some 30 percent of federal employees
    are veterans, and knowing that loss of a job is a risk factor
    for suicide? Do you know the veterans who have lost their jobs
    in this administration who have been fired?
        Dr. O'Toole. I do not, ma'am. And we can--I can defer that
    to leadership that may.
        Senator Hirono. Well, it's amazing to me that how are you
    supposed to help these veterans with a significant risk factor,
    which is a loss of job, if you don't even know who they are.
    So, it really concerns me that as you talk about the need to
    outreach and suicide prevention, which is an ongoing issue that
    with homelessness to the VA, that you don't have the kind of
    information that, in my view, you should have to provide the
    support that you need to provide.
        So, with everything that's going on, and with the tariffs,
    and the impact on our communities of the fear that the tariffs
    and the potential for tariffs and the impact, do you have a
    sense of what the impact will be on the veteran community, of
    which we have millions and over 100,000 just in Hawaii? Do you
    know what kind of impact the tariffs situation is having on the
    cost of everything for the veteran community?
        Dr. O'Toole. I do not have that information. No, ma'am.
        Senator Hirono. Well, you can see that this is the kind of
    information that I would think that you would have to prepare
    for this hearing.
        For again, for you Dr. O'Toole. So, as I mentioned, veteran
    suicide and homelessness is an ongoing issue for the VA. And
    knowing that the loss of economic security would increase
    homelessness among the veteran community, do you think that
    what is happening to the veterans in terms of loss of their
    jobs, et cetera, that homelessness among veterans will
    increase? And what are you doing about it?
        Dr. O'Toole. Well, thank you, ma'am. So, this obviously
    shifts gears a bit to the Homeless Program Office. I'm happy to
    speak to some of the different----
        Senator Hirono. Well, I would say the homelessness also has
    an impact on veteran suicide.
        Dr. O'Toole. Absolutely, it does. And as a social
    determinant of health and economic stability, it's critically
    important. We do have several programs in place for those
    veterans. I think our supportive services for veterans and
    families, and the bridge support that provides our vocational
    rehab programming, and others are clearly intended to provide
    greater economic supports for those veterans who are at risk.
    And clearly there is an overlap between suicide risk and
    economic instabilities associated with homelessness.
        Senator Hirono. Oh, the thing is, Mr. Chairman, with all
    the chaos that is going on, not just to the VA, but every
    single department, except for possibly the DOD, which is
    actually seeing increase in potential funds, there's going to
    be an increase in the risk factors that would lead to veteran
    suicides, I have to say so. So, there you have it. Thank you.
        Chairman Moran. Senator, thank you. Senator Boozman.

                           HON. JOHN BOOZMAN,
                       U.S. SENATOR FROM ARKANSAS

        Senator Boozman. Thank you, Mr. Chairman, and thank you,
    Senator Blumenthal, for calling this hearing. I was really
    proud to have partnered with Senator Warner years ago to
    introduce legislation that would eventually become the Staff
    Sergeant Fox Suicide Prevention Grant program. This program
    created out of a dire need to improve community-based resources
    to address the veteran suicide crisis.
        While veteran suicide remains a critical issue, the VA's
    work and success with the Staff Sergeant Fox Suicide Prevention
    Program deserves recognition. Veterans who battle mental health
    challenges respond best to support from those that they know,
    and trust, and needs this program is critical in meeting. I
    look forward to discussing how we can reauthorize and update
    this support for veterans and communities across the country.
        Dr. O'Toole, it's great to hear from VA how successful the
    program's been. In your testimony, you mentioned that VA
    supports increasing the authorized funding for the program.
    What kind of an impact would this funding increase have on the
    program, and what results should we hope to see?
        Dr. O'Toole. Thank you, Senator, and thank you for your
    work and efforts to get this legislation passed. Initially, our
    hope with a reauthorization and appropriations is that we would
    be able to expand the number of grantees that that expansion of
    the grantees would both cover all of our states and geographic
    need areas, particularly those where access to care, access to
    VA care may be particularly thinned. And also, to ensure that
    the grantees are able to effectively engage specific population
    groups that may be at higher risk for suicide as well. And that
    is our hope and aspiration with the reauthorization and
    appropriations.
        Senator Boozman. What aspects of the program do you think
    have made it such a success story, and where do you see the
    program going?
        Dr. O'Toole. I think the fact that these are community
    groups that have credibility in the communities where veterans
    live. These are peers. These are also organizations that are
    engaging families of veterans are all critical to this. The
    wraparound and holistic approach to really supporting those
    veterans is complementary to what VA does, and it really,
    again, creates a public health strategy and complements a
    public health strategy for how we're looking at suicide in a
    way that reflects the complexity of all that goes into it.
        Senator Boozman. The legislation that Senator Warner and I
    introduced included reporting requirements for VA. What metrics
    would VA likely identify as important to collect and share with
    Congress?
        Dr. O'Toole. I think the measurement dynamic is obviously
    critical. We need to be good stewards of the resources that
    Congress provides to us, and make sure that the money is going
    where it needs to go and is having an effect.
        The key as we see it, is not just in terms--it's obviously
    important that as many veterans are being reached as possible,
    but we also want to make sure that it's not just a throughput
    for lots of veterans, but without also looking at the quality
    of the care that they are getting, the comprehensiveness of the
    screening so that the care and the services they are getting is
    matched to the need. And also, that we are outcome driven.
        We have to be focused on using this grant mechanism to be
    making a difference in these communities. How many of those
    veterans are doing better as a result? How many of those
    veterans are connecting in VA for VA services, or in the
    community for community services as healthcare would require?
        But these are the accountabilities. These are the trackable
    metrics that we need to be really looking at.
        Senator Boozman. Very good. Well, that's good to hear. I
    agree with you 100 percent, I think, as does to the rest of the
    Committee. Thank you, Mr. Chairman.
        Chairman Moran. Senator Hassan.

                       HON. MARGARET WOOD HASSAN,
                    U.S. SENATOR FROM NEW HAMPSHIRE

        Senator Hassan. Well, thank you, Mr. Chairman, and Ranking
    Member Blumenthal for this hearing. And thank you, Dr. O'Toole,
    and Mr. Fisher for the work that you do to serve our veterans.
        Dr. O'Toole, over the past few months, I've been asking VA
    officials and nominees if they can guarantee that the Trump
    administration's plan to fire 80,000 VA employees will not
    result in longer wait times for veterans to get appointments
    and receive care.
        In response, the administration's nominees have told me
    that wait times at the VA have been increasing and reform is
    necessary, but they've never explained how firing 80,000
    employees will help solve that problem. That's indicative of
    the way the administration has approached things these past few
    months. They have been making drastic changes without, as far
    as any of us can tell, any analysis or plan.
        Dr. O'Toole, you've worked at the VA for almost 20 years,
    and you're currently the VA's top doctor. Has anyone asked for
    your analysis on how firing 80,000 employees will affect
    veterans care?
        Dr. O'Toole. Thank you, Senator. And I appreciate the
    question. I do not--I am not involved in that--those
    discussions. And it is--I will say that we actively monitor and
    track wait times. We actively monitor and track access.
        Senator Hassan. I understand that. And, again, my time is
    short, but the answer to my question is no, they haven't asked
    you for your analysis. And, obviously, wait times is a piece of
    this, but affecting veterans care, you know, if somebody's been
    laid off who orders supplies, and a doc runs out of critical
    supplies, that affects veterans' care. Right? So, have you seen
    or been provided with any analysis as to how firing 80,000 VA
    employees might affect veterans care?
        Dr. O'Toole. I have not, ma'am.
        Senator Hassan. Have you been directed to perform or
    oversee any analysis as to how firing 80,000 VA employees might
    affect veterans care?
        Dr. O'Toole. Well, again, ma'am, I will say, you know, I am
    prepared here to be able to speak to this grant. I don't have
    the information you're asking to that.
        Senator Hassan. Right? But I'm taking that you would know
    if you have been directed to perform or oversee an analysis.
    So, I'm going to take that as a no as well.
        Last year, the VA's Inspector General released a report on
    several occupational staffing shortages within the VA. These
    are jobs that the VA was having the hardest time filling. The
    IG's report stated that the top clinical job in the VA with a
    severe staffing shortage was psychology. A whopping 61 percent
    of Veterans Health Administration facilities reported having
    such a shortage. Psychiatry came in third place; 47 percent of
    Veterans Health Administration facilities reported psychiatry
    as a shortage.
        As a career VA doctor, can you please discuss the role that
    mental health professionals, like psychologists and
    psychiatrists, play in supporting our veterans?
        Dr. O'Toole. Thank you, ma'am. They are critical. I think
    that goes without saying. And the complex needs and care
    requirements of our veterans, obviously, require the engagement
    of a very robust mental health service.
        Senator Hassan. Yes. I continue to be concerned then about
    the Trump administration's policies of hiring freezes, firings,
    and general disruption. You've talked about the exemption for
    about 300,000 employees, but it's really difficult to see how
    the chaos that is churning is going to help recruit and retain
    mental health professionals that our veterans really deserve
    access to. And you've just acknowledged, and Mr. Fisher, too,
    has, about how important they are to our veterans.
        Last question Dr. O'Toole. You were the founding director
    of the VA's Homeless Patient Aligned Care Teams program, HPACT.
    This program utilizes clinics with co-located medical staff,
    social workers, mental health, and substance use counselors,
    nurses and homeless program staff that form a team to provide
    veterans with comprehensive individualized care. I really want
    to thank you for your leadership on this important work.
        Can you please discuss the benefits of holistic wraparound
    care like this, and how this model utilizes expertise across a
    variety of fields within the VA?
        Dr. O'Toole. Well, thank you, Senator. I appreciate those
    kind comments. And I think the hosting of that initiative in
    the VA speaks to a culture in the VA of trying to reach the
    veteran where they are, and meet them and their comprehensive
    needs on their terms, not necessarily our terms. And I think
    the HPACT successes in engaging those veterans, and really
    providing that stability that allowed them to move on with
    their lives, and engage more fully in programming reflects it.
    And it reflects, I think, a culture of the VA that I'm very
    proud to have been a part of.
        Senator Hassan. And I think it does, too. And I think one
    of the things we could really work on with that culture in
    place with so many veterans being willing to do peer-to-peer
    outreach, is reaching those veterans who haven't engaged with
    the VA who we are especially concerned about as we look at the
    suicide statistics. So, thank you very much. Thank you, Ranking
    Member Blumenthal.
        Senator Blumenthal [presiding]. Thanks, Senator Hassan.
    Senator King.

                        HON. ANGUS S. KING, JR.,
                        U.S. SENATOR FROM MAINE

        Senator King. Thank you, Doctor O'Toole, and thank you for
    your long service, and your dedication to veterans. One of my
    mottoes in life is that implementation is as important a
    vision. And we're talking about the vision now of the Fox
    Program, but the question is, what are the implementation
    steps, and how is it working?
        One of the things I've heard from the field is that the
    intake process is intrusive and burdensome, and we're losing
    veterans who are just basically dropping out of the process.
    For example, in Maine, we've had 311 veteran screened since
    they started the program. 96 of those 311 refused to
    participate because of burdensome paperwork or the required VA
    connection. Veterans who make it through the initial screening,
    5 percent have stopped partway through because of the intrusive
    questions.
        Here's a practical implementation. One of the feedback I've
    gotten is, don't ask all those questions at the first
    interview. Let the professional establish a relationship. And I
    understand the screening is important, but we're losing some
    very at-risk people through the implementation process. Can you
    discuss this problem?
        Dr. O'Toole. Well, thank you, Senator, and I appreciate the
    perspective you bring to this, because obviously implementation
    is the--you know, a great vision. But if it can't be
    implemented, it doesn't do as much good. I think it's important
    to put in context these findings. You know, this program was
    established as a 3-year temporary grant program to really learn
    from this. And those types of observations are critical.
        You know, we need to find that balance between ensuring
    that we are asking the right questions to determine risk, and
    to match those needs to the services, and be able to engage as
    much as possible. But being able to do so without scaring
    people away and without turning them off from those care and
    services is critically important.
        And, you know, I would defer to my colleague, Mr. Fisher,
    because I think the Vet Centers have been working in that space
    for quite some time. But these are the lessons we have to be
    using to learn to get better and do better.
        Senator King. That's my suggestion. We are talking about
    reauthorization. Let's talk about examining. And, I mean, this
    isn't a malicious process. It's to try to determine the risk
    factors and the qualification. But if that in itself ends up
    knocking somebody out of the process, that seems to me that's a
    problem, should be considered and addressed as we're talking
    about reauthorization, and then re-implementation.
        I would suggest, and this has been discussed to some
    extent, outreach is critically important. If 10 out of the 17
    suicides are people with no connection to the VA, that tells
    you something. And we need to connect those people, and we need
    to reach out to them. And for whatever reason, they're not
    reaching out themselves. So, again, it just hits me. That's a
    piece of data.
        I want to turn to one other point. 74 percent of veteran
    suicides involve firearms. With female veterans, it's even
    higher. Senator Sheehy from Montana, and I, have a bill that
    basically would have the VA provide a free lockbox to veterans
    who ask for them. They don't have to be connected to the VA,
    they just have to be veterans.
        It's a voluntary program. But the whole idea is, I'm sure
    you realize, is to have some space between the idea of suicide,
    and I almost said the execution, that's not the right word, but
    going through with it, and lockboxes are one way to do that. Is
    this something that makes sense to you?
        Dr. O'Toole. It is, Senator, and I think anything we can do
    to create space between the idea and the action is critically
    important. And the literature and the data support that. I know
    that's not one of the bills that we're here to discuss today,
    but the notion of lethal means safety and strategies for how to
    best facilitate that, including the use of lockboxes, is
    something that the VA is very interested in working with the
    Committee to identify.
        Senator King. I'm hoping to get that bill in the next, in
    the next round. But it just seems to me that the glaring
    number, 74 percent, involve firearms that gives us a place
    where we need to focus, it seems to me.
        Dr. O'Toole. Fully agree.
        Senator King. Thank you very much for your testimony, and
    for your hard work on behalf of America's veterans. Thank you.
        Senator Blumenthal. Thank you, Senator King. Senator
    Duckworth.

                         HON. TAMMY DUCKWORTH,
                       U.S. SENATOR FROM ILLINOIS

        Senator Duckworth. Thank you, Mr. Chairman, Ranking Member.
    Three months of unjust, unconstitutional attacks on our
    veterans and against critical services of the United States
    Department of Veterans Affairs have divided this traditionally
    bipartisan Committee, sadly. I hope that today's focus on a
    matter that should transcend Presidential loyalty; ensuring
    that our veterans have access to robust mental health and
    suicide prevention resources will reflect a new, renewed
    commitment that this Committee will once again faithfully
    fulfill its constitutional responsibility to serve as an
    independent check on any Presidential administration.
        Under normal times, the renewal of the Fox Grants Program
    will be an important step in enabling the VA to continue
    providing critical community-based suicide prevention resources
    for veterans, and to reach even more veterans who need this
    lifesaving care. However, I am concerned that the Trump
    administration's policies continue to undermine the mental
    health and well-being of those patriotic Americans who have
    served our Nation honorably. For the mass reductions-in-force
    of federal workers, including veterans working on the crisis
    line, to canceled contracts, and continued attacks on veterans
    belonging to underserved communities, Donald Trump and Elon
    Musk are intentionally attacking morale and exacerbating the
    Department of Veterans Affairs mental health workforce
    shortages.
        This threatens the ability of the VA to distribute the Fox
    grants rapidly. We're talking about real lives, someone's
    parents, child, sibling, aunt, or uncle, grandparent, friend.
    We cannot endure more chaos at the risk of delaying the
    provision of mental health care and suicide prevention
    services.
        Dr. O'Toole, what specific steps are you taking to ensure
    that there are sufficient staff and resources on-hand to
    administer the Fox Grant Program and to provide timely care for
    veterans seeking Fox Grant resources?
        Dr. O'Toole. Thank you, Senator. And thank you for your
    service, as well as for your advocacy for our veterans. It's
    much appreciated. You're absolutely right. This is about
    ensuring that we have resources in place and a commitment to
    making sure that the grantees are going to be as effective as
    possible.
        The Suicide Prevention Program reports to me. I have a
    weekly meeting with their leadership team. These are some of
    the things that we discuss, and this is a priority for us. You
    know, if we're going to have to--if it's going to work, we have
    to make sure that we have people in place to work it.
        Senator Duckworth. Well, what are you doing to ensure that
    they are there? I mean, my own office worked a case of several
    folks who work on the Veterans Crisis Hotline who were in that
    mass firing. Two of them have gotten their jobs back, but one
    of them still hasn't. And we're talking about people who, you
    know, may not be the ones answering the phones. We're talking
    about the trainers, the people who train the other folks, the
    supervisors, some of them still have not gotten their jobs
    back. What are you doing to make sure that there's enough
    people to work those hotlines and the suicide prevention
    programs?
        Dr. O'Toole. Well, as I mentioned Senator, with the Veteran
    Crisis Line, that is exempt from any hiring freeze. And we've
    actually seen a growth in the numbers of employees on the
    Veteran Crisis Line, something though that we have to stay
    vigilant in ensuring that direct care is not impacted, and
    these programs are able to function at their highest
    capabilities.
        Senator Duckworth. Will you commit to hiring some of those
    people back that were fired by Elon Musk?
        Dr. O'Toole. Well, we're happy to follow up with you on any
    specifics, by all means, ma'am.
        Senator Duckworth. Oh, I think it should be more than just
    the one people being handled by my office. There are many
    people across the country who have now been laid off, who've
    worked on veterans' mental health programs. Those people need
    to have their jobs back, especially if they themselves are
    veterans. Do you commit to safeguarding and strengthening VA
    mental health workforce, including making sure they have the
    appropriate resources and work spaces?
        Dr. O'Toole. Yes, ma'am. I'd like to speak a little bit to
    that in more direct terms. It's been referenced several times
    in terms of the return-to-office and the impact on
    confidentiality. We are very committed, and our leadership
    within VHA, has been very committed to ensuring that privacy is
    maintained and confidentiality is maintained, including
    ensuring that if employees need dedicated private workspace for
    engaging in telemental healthcare services and other services
    that require confidentiality and HIPAA rules are being complied
    with.
        When those are not being able to be met, we have processes
    in place to work with the facility to ensure that either space
    is found or that there are appropriate pauses to the return to
    office. This is critically important. We cannot let this
    compromise the care we provide to our veterans.
        Senator Duckworth. Well, will you commit to advocating for
    protecting these mission-critical staff from adverse
    administrative actions, especially if they report that they're
    not getting the resources that they need?
        Dr. O'Toole. Yes, ma'am. And we do that now.
        Senator Duckworth. Okay. Because I, again, we've dealt with
    people who've had to take phone calls in their cars in the
    parking lot because there was no confidential space for them to
    do their work, their jobs.
        Dr. O'Toole. And we have mechanisms in place to try to
    ensure that that is not happening. And if those are happening,
    you know, we need to know about it.
        Senator Duckworth. Okay. Thank you, Mr. Chairman.
        Senator Blumenthal. Thank you, Senator Duckworth. Senator
    Gallego.

                          HON. RUBEN GALLEGO,
                       U.S. SENATOR FROM ARIZONA

        Senator Gallego. Thank you. I was just going to ask, moving
    on to Mr. O'Toole, following President Trump's executive order
    on the return to work, the VA issued its return-to-work mandate
    requiring most employees to return in-person work.
        So, kind of following up on the therapists who are hired as
    remote workers and kind of what Senator Duckworth had just
    said. Have you heard of any instances where therapists have
    had, had awkward and/or, I would say, not professional settings
    when they're having their healthcare or when they're having
    their--the veterans are having the therapy sessions?
        Dr. O'Toole. I have not heard specific situations where
    that may have occurred. I have obviously heard it second- or
    third-hand. We have a mechanism and process in place. Those
    work environments and work scenarios are not acceptable to us.
    That's not appropriate care standard for the VA. And if they do
    occur, we have mechanisms to ensure that they can be
    remediated.
        Senator Gallego. Okay. And then just kind of along the
    lines, there's an 83,000-person cut of VA workers coming. Is
    there a standard of who is going to be in that cut? You know,
    how many will be therapists? How many are going to be different
    professions, because that will also obviously affect the
    healthcare outcomes?
        You know, it's hard to get some of these therapists into
    this job. Some of them can be much better paid in the private
    sector. So, losing therapists to these arbitrary cuts, in my
    opinion, it's going to be very detrimental to the mental health
    of these men and women.
        Dr. O'Toole. I do not have specifics on that information.
    It would have to defer. And we'll have to get back to you on
    that.
        Senator Gallego. Yes. I mean, for example, my Phoenix VA,
    the VA that I've belonged to, has a memo out that they have to
    cut 15 percent. But what does that mean? You know, who is that
    that they're cutting?
        Mr. Fisher, I'm sorry, I can barely see your name. I have
    bad eyesight. So, I placed a blanket hold on all President
    Trump's nominees to the VA, especially following the fact that
    they're cutting 83,000 jobs because I just don't see how it's
    possible for the VA to fire so many of their employees without
    it affecting care for veterans, especially in mental health
    care.
        You lead the office of the VA in charge of helping veterans
    transition from military to civilian life, which is extremely
    important. Right? If we can make that transition, the
    likelihood of people falling into some bad times, you know,
    reduces tremendously. So, it's extremely important work.
        Now, do these cuts, veterans can lose access to that mental
    healthcare and potentially, you know, creating and rising
    instances of suicide. What directions have you received
    specifically from the Trump administration in order to enact
    these cuts to the VA workforce when you commit to ensuring that
    the VA mental health providers are not among those fired or
    other positions that are very important in kind of keeping that
    network together of a very important job that you have and we
    all have here?
        Mr. Fisher. Thank you Senator for the question. Similar to
    what Dr. O'Toole brought up, I have not received guidance. Our
    focus at Vet Centers has been the hiring of our counselors as
    well as our outreach staff. We continue to do that in locations
    where we have a hard time hiring those. We leverage all
    existing authorities, whether that's our scholarship program or
    other special incentives to be able to ensure we're bringing
    those staff into Vet Centers.
        Senator Gallego. And just to be clear, you haven't received
    any directive and any orders from VA Collins or anyone else
    from the VA saying you have to cut X amount of people by X
    amount of date from the programs you guys oversee. Is that
    correct, Mr. O'Toole?
        Dr. O'Toole. That that is correct.
        Senator Gallego. Okay. And then, Mr. Fisher?
        Mr. Fisher. Same answer. Yes.
        Senator Gallego. Okay. And from your general understanding,
    what is the deadline that the VA has set for them to cut these
    83,000, let's say, positions?
        Dr. O'Toole. Sir, I don't know, and I would have to defer
    on that.
        Senator Gallego. Mr. Fisher, do you know?
        Mr. Fisher. I would have to defer as well, sir.
        Senator Gallego. Okay. Well, my concern is because in
    Arizona, the memo that was laid out was that they wanted cuts
    to go into effect by July 1st, and were already in May. And,
    you know, such sudden cuts, especially when it comes to kind of
    mental health care clinics, VA clinics and suicide prevention,
    could be extremely damaging since you're trying to recruit
    people into this very hard work. And at the same time, they're
    hearing about these firings. It's going to be hard to recruit
    and retain.
        And I don't know if you've had any conversations with some
    of these potential therapists that are asking questions about
    whether or not they can come on board with the assurances that
    they're not going to be fired or let go later? And Mr. O'Toole,
    have you heard anything from potential employees, please?
        Dr. O'Toole. I have not. I will note, though, that the
    direct care providers of whom therapists are exempted currently
    from any of the hiring freezes that are taking place.
        Senator Gallego. So, they're exempted from the hiring
    freeze, but not necessarily from the attrition or from the
    potential elimination?
        Dr. O'Toole. I'm not--again, sir, I would have to defer on
    that because I'm not aware.
        Senator Gallego. Okay. So, I yield back my time. Thank you.
        Senator Blumenthal. Thanks Senator, Gallego. I have a few
    questions while we're waiting for the Chairman to return and
    start the second panel. And I don't know whether--I don't think
    anyone has asked about this fact, but the veteran suicide rates
    in Connecticut seem to have been highest among veterans who are
    over 75 years old, lowest in the age group, 18 to 54. Is that
    true nationally?
        Dr. O'Toole. I don't know, sir. I'd have to look at that.
    There is a bimodal nature to the incidence of suicide. We see
    it very high in the 18 to 39 range for different reasons than
    we see it in the older populations where chronic disease,
    chronic pain, and other factors can play in a more active role.
    But I don't have the specific data that you're referencing. I
    would have to take it for the record.
        Senator Blumenthal. Could you try to provide that data? I
    assume that if it's available for Connecticut, it's available
    elsewhere. And is there any explanation for disparities between
    different parts of the country or different states so far as
    you're aware?
        Dr. O'Toole. Again, I'd have to defer that to our subject
    matter experts. It's an important questions. It has a lot to
    do, I think, with levels of engagement, lethal means
    availability, and so forth. But I would prefer deferring that
    and we can get that information to you.
        Senator Blumenthal. I think it's an important question,
    both of those are important question. Because if there are
    lessons to be learned from some states and what they do in
    preventing veteran suicide, maybe they can be adopted more
    broadly.
        And I want to just finally ask you to have a look at the
    BRAVE Act. You know, if we had a few hours more for this panel,
    I could go through each of the provisions. The standard
    response of the VA to many of these provisions was to oppose it
    because they said it was not necessary. Now, an example would
    be to give more priority to women's health, mental health care.
    And they're saying to me that, for example, the requirement for
    the Department of Veterans Affairs to modify the REACH VET
    program to incorporate risk factors weighted for women
    veterans, it's not necessary because we are already on top of
    it. We got that problem.
        Well, I'm not so sure that's accurate. If it ever was
    correct, it certainly is not. Now, I would ask you, Dr. O'Toole
    to please go back and look at the BRAVE Act and perhaps speak
    with your colleagues about giving me some more, maybe
    different, and more constructive reactions to the BRAVE Act.
        Senator Blumenthal. Thanks, Mr. Chairman.
        Chairman Moran [presiding]. Thank you, Ranking Member.
    Senator Slotkin.

                          HON. ELISSA SLOTKIN,
                       U.S. SENATOR FROM MICHIGAN

        Senator Slotkin. Thank you, Chairman. And thank you to our
    nominees for being here. I'm a former CIA officer. I did three
    tours in Iraq alongside the military. I've served very proudly
    both Democrat and Republican administrations as a civil servant
    before I was elected to Congress. And I think everyone on this
    panel, Democrat or Republican, believes that when we make the
    choice to send men and women into war, we have a responsibility
    when they return, and that veterans deserve the gold standard
    of care.
        And as I've been on this Committee, and I was on the VA
    Committee in the House, it seems like every time there's a
    threat to veterans' care or we need to expand veterans care,
    it's veterans who are pushing and advocating for that change.
    It doesn't happen in a big bureaucratic system just by sitting
    there.
        I'm concerned that mental health occupations are the ones
    where we have significant vacancies across the VA. Over 60
    percent of VA facilities report shortages of psychologists, and
    nearly half reported shortages of psychiatrists. And I was just
    at the VA hospital in Saginaw this past week, and there's
    definitely shortages across the mental health architecture. And
    there's no way for me to square that with the threat of
    potentially cutting 70 to 80,000 VA employees. I don't
    understand how we can add by subtracting.
        And while I keep hearing from the Secretary of the VA that
    we're not going to cut the hospitals and the nurses and all
    that kind of stuff, all those support steps, the suicide
    hotline, all the folks who process claims so that veterans can
    get care, they are quite literally seem to me to be on the
    chopping block.
        So, tell me, what are you going to do Mr. O'Toole, in this
    moment of subtraction from the VA, to actually ensure that our
    veterans get the mental health care that they need?
        Dr. O'Toole. Thank you, Senator, and I appreciate the
    comments and the observation. And it's shared. You know we have
    the healthcare workforce, not limited to the VA, is struggling
    to fill needed positions across the board. And, you know, long
    before this past year, we've actively tried and have been
    trying to continue to attract people to work at the VA, which
    is, I've been here for 20 years, you know, it's where I choose
    to work.
        The commitment is to ensure that direct care is provided
    and not compromised by these cuts. I am not privy to the
    decisions, and the discussions, and would have to defer on the
    specifics to that. But just as I mentioned in relationship to
    telehealth care, our utmost and absolute commitment is to
    providing the best care possible and not compromising it by any
    means in the process of the changes underway.
        Senator Slotkin. I do not doubt not for one minute your
    mission and your belief in this mission. It's my concern is
    that you could be overseeing a component of the VA when you say
    we don't want to compromise care. In fact, we have an
    obligation as a country not to compromise veterans' care. And
    yet, we're talking about cuts of potentially 80,000 people.
        And the Secretary of the VA refused to dismiss those cuts
    when he came to Howell, Michigan a few weeks ago. He was asked
    directly and he said, ``well, difficult choices essentially are
    going to have to be made.'' So, I'm not seeing how the math is
    going to work out there.
        I also want to note that in the 2024 National Veteran
    Suicide Prevention Annual Report, which you may have had a hand
    in it, said that most veteran deaths by suicide are among
    veterans who have not had access to VA care in the prior two
    years. Right? That if you're kind of in the system getting
    care, you have a better chance of being helped. But if you're
    out, you're not connected to the VA.
        So, I would actually posit that we need to be getting to
    more veterans. We need to be doing better outreach. The VA
    needs to be talking to people when they separate and getting
    them in the routine of accessing all those services. So, in
    fact, on this mission, not only are we understaffed right now,
    but I think the mission is greater than what the VA is already
    doing. So, I would just note you are going to be the guy in the
    room when these cuts come down from on high.
        Mr. Collins sat in your very seat and said, ``I'm not going
    to let anything compromise care,'' and then seems to be
    supportive of 80,000 cuts. I'd ask you to stand up for
    veterans. It's bigger than any one administration. We have a
    responsibility, and I know you care about that mission. So,
    appreciate that and appreciate you being here.
        Chairman Moran. Thank you, Senator. Dr. O'Toole, let me
    just ask a quick question. It's a bit outside, I think, the
    realm, but there's been a lot of conversation about staffing at
    the VA from my colleagues and I, and I want to highlight the
    importance of community care. The MISSION Act, in the way I
    look at things, is a way that in fact choice came about in an
    effort to help further staff the VA, and particularly in mental
    health, where there's a shortage of mental health providers
    everywhere. It would be comforting to me for you to confirm the
    value of the MISSION Act and community care.
        Dr. O'Toole. Thank you, Senator. And absolutely, community
    care provided in settings that are not VA for our veterans is
    very much part and parcel of the package of care that we
    provide, and needs to be considered because the bottom line is
    we want our veterans to get care.
        Chairman Moran. Thank you. We'll dismiss Dr. O'Toole and
    Mr. Fisher. Thank you for your testimony. Thank you for your
    service to veterans, and for your appearance here today. And
    we'll call the second panel to the table.
        Testifying on today's second panel is Jim Lorraine, the
    President and Chief Executive Officer of America's Warrior
    Partnership. Gilly Cantor, Director of Evaluation and Capacity
    Building, D'Aniello--there's no reason for me to make a fool of
    myself one more time, so, thank you for being here. She is with
    the Institute for Veterans and Military Families, Syracuse
    University.
        Steffen Crow, Staff Sergeant Parker Gordon Fox Program
    Manager, Oklahoma Veterans United, Heather Barr, U.S. Marine
    Corps veteran, assisted by a grantee organization, and Austin
    Lambright, U.S. Marine Corps, a veterans assisted by a grantee
    organization, and Lindsay Church, Executive Director and co-
    founder, Minority Veterans of America. Thank you-all for being
    here. And Mr. Lorraine, let's begin with you.

                                PANEL II

                                  ----------

    STATEMENT OF JIM LORRAINE, PRESIDENT AND CEO, AMERICA'S WARRIOR
                              PARTNERSHIP

        Mr. Lorraine. Chairman Moran, Ranking Member Blumenthal,
    and esteemed Members of the Committee, thank you for the
    opportunity to testify today on behalf of America's Warrior
    Partnership.
        You're considering four important bills that impact the
    well-being of all veterans. I'll focus on the impact of the
    Staff Sergeant Parker Gordon Fox Suicide Prevention Grant
    Program, commonly known as the Fox Grant. At AWP, we view
    suicide and deaths of despair prevention, not as a single
    program, but as an outcome of veterans restored sense of
    purpose and improved quality of life. Our model is rooted in
    proactive outreach and engagement, trust building, and
    sustained relationships, which we do at scale. We strive to
    forge these connections before the crisis begins. That's where
    the Fox Grant has been essential.
        Of the 545 veterans we've screened who reported suicide
    risk, 94 percent were not initially seeking mental health
    support. They face challenges such as economic insecurity,
    navigating the VA system, and fractured personal relationships.
    The importance of asking the right questions early and having
    someone listen cannot be overstated. Thanks to the Fox Grant,
    we've interviewed or we've intervened early, connected veterans
    to local resources and remained a consistent presence.
        Just halfway through this grant year, AWP's screened 1,300
    veterans, with 10.8 percent disclosing suicide risk. Since the
    grant's inception, that number has totaled 2,100, with 25
    percent of the people that are veterans that we talked with and
    screened, disclosing some level of risk. These are not just
    statistics. They are lives saved because someone cared enough
    to ask and listen. However, there is room for improvement.
        While the HOPE Act makes great strides, outreach must be
    reestablished as the program's singular focus. We must get
    upstream and follow the data of who is at greatest risk. The
    who is so important. Our study, Operation Deep Dive in
    partnership with Duke University School of Medicine allows us
    to follow the data of the ``who'' is most at risk based on the
    community where they live in.
        The pathway from community identification to VA must be
    more transparent, quicker, and less burdensome. Congress should
    require the VA to establish a simplified intake process for
    veterans already screened by grantees, one that avoids
    redundant questions in respects to the veteran's time in a
    critical situation.
        We also support codifying the emergent suicide care
    section. In many cases, AWP uses the 988 Crisis Line for
    veterans for immediate need. Formalizing this connection
    enhances safety and saves lives.
        Accountability is another key. AWP holds itself to the
    highest standards; routine audits, transparent reporting, and a
    sharp focus on Title 38 beneficiaries. Title 38 funding must
    focus on veterans and their families. We recommend that
    Congress require verifiable metrics from all grantees, and a
    regular reporting to ensure the taxpayer's trust is upheld, and
    that those not meeting the standard are reevaluated.
        We support the use of the Columbia Protocol as the sole
    requirement screening tool. The current requirement of multiple
    follow up assessments is overwhelming and deters engagement.
    Let's reduce bureaucracy and focus on care. We strongly support
    the provisions in the HOPE Act, and that allow the Fox Grant
    funds to be used for transportation. We do a survey every year,
    and the lack of transportation is the top barrier veterans
    face, especially when those are in crisis.
        Grantee funding is another consideration. AWP could double
    its outreach efforts if the funding ceiling was increased to
    $1.5 million. While this isn't necessary for every grantee,
    organizations that have proven outcomes and capacity should be
    empowered to do more provided the metrics and reporting
    structure are in place.
        Regarding the BRAVE Act, we support a deeper analysis of
    veteran suicide and its risks factors. Still, discussions also
    must address the role of traumatic brain injury, a silent
    killer we are not doing enough to confront. Finally, we support
    the Every State Counts Act to expand the Fox Grant access to
    underserved states. In the meantime, AWP stands ready with our
    national network to assist when necessary.
        Members of the Committee, thank you for your continued
    leadership, and support your efforts to saving lives. At AWP,
    we stand ready to keep doing our part to serve, to listen, and
    to ensure the vets are known. Together, we can do better.

        [The prepared statement of Mr. Lorraine appears on page 67
    of the Appendix.]

        Chairman Moran. Mr. Lorraine, thank you. Ms. Cantor.

      STATEMENT OF GILLY CANTOR, MPA, DIRECTOR OF EVALUATION AND
        CAPACITY BUILDING, D'ANIELLO INSTITUTE FOR VETERANS AND
             MILITARY FAMILIES (IVMF), SYRACUSE UNIVERSITY

        Ms. Cantor. Mr. Chairman, Ranking Member, Members of the
    Committee, thank you for the opportunity to offer testimony on
    behalf of the D'Aniello Institute for Veterans and Military
    Families at Syracuse University.
        The IVMF perspective is rooted in research, along with more
    than a decade of experience working with 26 communities across
    the country. These communities are connected by a common goal,
    improving coordination between organizations that provide
    clinical and non-clinical care. So, together, we can help
    veterans thrive.
        So, what have we learned? As we know, the rate of suicide
    among veterans remains too high, higher than among civilians.
    Data has also shown that each additional non-clinical stressor,
    such as financial and housing instability, is linked to
    increases in the likelihood of suicidal ideation. States,
    counties, and community-based organizations can often best
    address these needs.
        In a study we conducted with the VA, we found a majority of
    veterans served by our partners were also enrolled in VA
    healthcare. For these veterans, their stressors were most
    effectively addressed when communities and VA medical centers
    worked together. At the same time, the study demonstrated that
    communities are in fact reaching many veterans not connected to
    VA healthcare, a group that represents over half the veterans
    that died by suicide.
        The Fox Grants Program recognizes and leverages the role
    communities play in suicide prevention. It creates new
    formalized avenues into clinical care, and it supplements that
    care with wraparound services so that we can address root
    causes, at the same time. We are grateful to this Committee for
    looking upstream as part of the Hannon Act to invest in this
    evidence-based coordinated approach.
        The reauthorization currently under consideration is
    therefore critically important. Since the program's launch, the
    IVMF has offered ongoing support for 11 of our partners who
    have been awarded these grants. They have stress-tested this
    program and identified its strengths and challenges. While
    there's always more that can be done, many of the proposed
    changes directly respond to their feedback.
        There are three main target areas that I'd like to address
    today. First, program coverage and expansion. Increased
    funding, both overall and for administrative and incidental
    costs, will enable grantees to scale and reach more veterans in
    a way that builds trust in non-clinical settings. These
    individualized peer-based approaches to outreach are both
    backed by evidence and just common sense.
        A simple gathering over pizza or coffee can open the door
    for a veteran to reach out for help. Allowing reimbursement for
    transportation and ride-shares to appointments will also be
    beneficial. Whenever possible, the cost of an Uber ride should
    not be the barrier that stops a veteran from getting the
    critical care that might save their life.
        Second, screening and eligibility. While some of our
    partners support the Columbia Protocol as the main required
    screening, others would prefer more nuance on when and how it's
    used. The proposed training on the tool will mitigate some of
    these difficulties. But overall, we hope that the intake
    process can balance evidence-based assessments with burden
    considerations for both veterans and program staff.
        And third, VA collaboration and compliance. Most
    importantly, we strongly support the provisions designed to
    hold the VA accountable for their role in making this program
    successful. Our partners have routinely experienced
    inconsistencies in awareness and compliance by their local VA
    medical centers. Once a veteran has been deemed eligible for
    the program, VA enrollment must be streamlined with a dedicated
    process such as an automatic high priority group assignment.
        We also appreciate the proposal to expand emergent suicide
    care coverage if the VA is not responsive. This provision will
    ensure grantees can effectively help veterans get the care they
    need.
        In conclusion, the evidence for reauthorizing the Fox
    Grants Program is clear, and the proposed legislation aligns
    with many improvements sought by our partners. We deeply
    appreciate the Committee's steadfast commitment to increasing
    our investment in prevention so that this critical program can
    reach more veterans before they're in crisis. Thank you.

        [The prepared statement of Ms. Cantor appears on page 75 of
    the Appendix.]

        Chairman Moran. Thank you. Steffen Crow.

    STATEMENT OF STEFFEN CROW, SSG PARKER GORDON FOX GRANT PROGRAM
                   MANAGER, OKLAHOMA VETERANS UNITED

        Chairman, Ranking Member, and Members of the Committee,
    thank you for the opportunity to testify today. My name is
    Steffen Crow, a retired gunnery sergeant of Marines with tours
    in Afghanistan, Asia, Africa, Europe, and Central America. I
    now serve as the Program Manager for the Staff Sergeant Parker
    Fox Suicide Prevention Grant at Oklahoma Veterans United.
        Our program exists to prevent suicide among our Nation's
    veterans by removing barriers to care. The Fox Grant was
    created precisely because the system was not working for too
    many veterans. Through the Fox Grant, OKVU has built a
    statewide veteran-centric approach that reaches across rural
    and urban communities. Over the past three years, we have
    engaged over 5,000 veterans and supported or led more than 800
    outreach events.
        We have formal collaborations with major veteran employers
    across the state, consistent engagement at Fort Sill, and we
    hosted the first multi-grantee veterans stand down in the
    country alongside the Cherokee and Choctaw Nations, drawing
    veterans from across Oklahoma and five other states.
        At the core of our work is sustained trust and empowerment.
    Veterans who succeed often ask, how can they help others,
    proving that when we lift one, they turn to lift many. However,
    we face significant barriers. Chief among them, is the required
    use of the Columbia screening tool. Though well-intentioned, it
    often drives veterans away.
        At a recent grantee conference, it was reported by one
    grantee that 13 veterans died by suicide after either refusing
    to complete the Columbia or answering no to every question
    despite the clear need these veterans were in. Worse, grantees
    are instructed not to track veterans deemed ineligible for the
    program, which creates a very dangerous survivorship bias.
        Another persistent challenge is the absence of a national
    referral process between grantees and the VA. No two facilities
    operate the same way, and even within a single state, these can
    differ dramatically. Local VA staff often defer to central
    office guidance, which is not materialized into actionable
    support.
        Veterans like Parker found solace in physical activity and
    music. Yet, grantees are restricted from funding low-cost gym
    memberships or instruments despite VA's own research supporting
    these therapies. VA guidance currently prevents us from
    delivering the very solutions their studies endorse.
    Transportation remains another major barrier. Guidance
    recommends Uber and Lyft. Yet, these services are non-existent
    in rural communities, and these are the areas that we primarily
    serve.
        We currently need a national community of practice to unify
    efforts, and I can say Oklahoma Veterans United has already
    developed internal models for cross-county collaboration, and
    is ready to lead this initiative across the Nation. Another
    great benefit that would be a good add to this program would be
    the ability for grantees to hire an LPC or an LCSW to be that
    gap fill whenever there is a wait time for veterans to get care
    at their local VAs.
        We think that in a 2-month period, four to six sessions
    with an LPC or LCSW in our direct team could be a very critical
    gap fill that would get someone into VA, and let them have the
    patience to wait for those appointments to materialize.
        In the military, I was taught, if you see something, say
    something. For three years, we have raised these concerns to VA
    leadership without meaningful action. Veterans mistrust of the
    VA did not happen overnight, and winning it back requires a
    real tangible change. If the rate of 17.6 veteran suicides per
    day is accurate, then we have lost over 16,000 veterans since
    this grant started. Yet when a veteran stabilizes, the first
    thing they ask is, ``How can I pay it forward?'' Veterans want
    to be the champions of the system, and if the system works for
    them, I guarantee they will be.
        The VA has good intentions, but they lack timely execution
    and consistent communication. We believe that with clear
    guidance, national coordination, and policies grounded in real-
    world realities, we can save lives and help veterans live lives
    worth living. We believe Parker's legacy must guide the future
    of this program. If he had access to these tools we propose, he
    might have remained with us longer. Let us not waste the
    opportunity to honor him through this meaningful change.
        And thank you for your time, and your commitment to our
    Nation's heroes.

        [The prepared statement of Mr. Crow appears on page 80 of
    the Appendix.]

        Chairman Moran. Thank you. Ms. Barr.

                       STATEMENT OF HEATHER BARR,
                       U.S. MARINE CORPS VETERAN

        Ms. Barr. Good afternoon, Mr. Chairman, good afternoon,
    Members of the Committee, thank you for this opportunity to
    share my story about this program and how it helped.
        My name is Heather Barr. I was a sergeant in the Marine
    Corps, served for just over five years, did two deployments;
    one to the Middle East, one to the Indo-Pacific. I was
    honorably discharged from the Marine Corps in September 2023. I
    went on terminal leave a month before that. So, this was two
    months post-deployment. Turned from a deployment next week,
    transition seminar, and then was out in two months.
        I had no plan, no idea what I was supposed to do. Just was
    moved back into my family's home in South Carolina. Felt like I
    was back at square one, basically. Living with my mother, no
    prospects for the future, and didn't know what I was doing.
        I ended up reaching out to the local Vet Center to try to
    find counseling and a therapist for mental struggles that hit
    me during deployment, and then just were expedited and grown by
    transitioning out of the Marine Corps. They then pointed me to
    the Upstate Warrior Solutions who are in Greenville, veterans'
    organization who are partially funded by the Staff Sergeant Fox
    Program.
        While I was there, I was screened, found at risk, and they
    set me up for success, basically. Made sure I was continuing to
    go to therapy and things like that at the Vet Center. Were able
    to actually provide a way for me to get a job. Showed me ways
    to do that. That was the first employment out of the military,
    thanks to Upstate Warrior Solutions.
        Part of the big change in transitioning for me was being
    completely disconnected from the military lifestyle and people
    I had been around for the past five-plus years. Coming back
    from a deployment, trying to transition to just normal military
    life and then to civilian is what put me in just a tailspin. It
    felt like I was just drowning, and was pointless, and
    purposeless without any guidance.
        So, Upstate Warrior Solutions Staff Sergeant Fox Program
    helped provide that to me. They helped me get a job, made sure
    that I was engaging with veterans in community where I could
    actually relate to, and I could realize that I wasn't actually
    completely alone, and there were other people who actually
    understood what I had was going through or had been through.
    So, I was extremely, extremely grateful for that.
        My scenario is an ideal scenario. My family was available
    for me to move back in with. Financial struggles were there,
    but thankfully, within a few months of getting out of the
    military, I was set up with Upstate Warrior Solutions in the
    program.
        That is not always the case. I know many people who have
    gotten out, they do not have families to go back to. They have
    either poor relationships, or they're just non-existent. So,
    mine is basically the best-case scenario. I had family to go
    back to, but not all do. And regardless of if you're an
    enlisted officer, female or male, you have dependents, don't
    have dependents, all these things add up. Both financial
    difficulties, and then some have PTSD, anxiety, stress-related
    things that just compound on the already trying time that
    transitioning out of the military is.
        And the Upstate Warrior Solutions and the Staff Sergeant
    Fox Program was definitely a life ring that I was very, very
    fortunate to be provided. It did take a lot of searching, but I
    was very, very fortunate to be thrown that life ring that not
    all people are.
        I finished--completed the Staff Sergeant Fox Program in
    August 2024. When I left the state, they reached out to me
    multiple times, even though I was out of the program, actually
    showing they cared, dependent or not, if I was relying on them
    for anything, they wanted to make sure that I was taken care of
    as a veteran. I'm very, very grateful for that.
        Since 2022, UWS has also completed the Staff Sergeant Fox
    Program with 20 other veterans, and currently have 164 active
    members within their program. And it's just a great outreach
    for those who have struggles finding other outlets, or just
    need help when they need. So, thank you. I appreciate.

        [The prepared statement of Ms. Barr appears on page 102 of
    the Appendix.]

        Chairman Moran. Heather, thank you for your service to our
    country, and thank you for your testimony. Austin.

                     STATEMENT OF AUSTIN LAMBRIGHT,
                       U.S. MARINE CORPS VETERAN

        Mr. Lambright. Good afternoon, Chairman Moran, and Members
    of the Committee. My name is Austin Lambright. I just want to
    start by thanking everyone for the opportunity to be here. I'm
    deeply humbled not only for the opportunity to serve my
    country, the greatest country in the world, but also to be here
    and speak on behalf of the veteran community, and offer some
    insight on support based on my experiences.
        I'm here from South Carolina. In 2006, at the age of 18, I
    enlisted in the Marine Corps to serve as an infantry machine
    gunner. I did two deployments; to Iraq in 2007, and then 2008
    and 2009, and I was honorably discharged from the Marine Corps
    in 2010 at the rank of corporal as a squad leader.
        During my time in the Marine Corps, I completely engulfed
    myself with the mentality of going to combat during the peak of
    two wars in the harshest conditions possible that Marines are
    sent to. I earned my Combat Action Ribbon when I was 19 years
    old in Ramadi. I was just a kid and at the time, I felt about
    as close to invincible as I could possibly feel. Although
    foolish, that was my feeling.
        I had a purpose and a driven focus for my life with the
    support from loved ones at home that projected me into being a
    successful Marine and squad leader on my second deployment.
    Both of my deployments were to combat zones. I'm very fortunate
    to have the family that I have at home. Very hardworking
    father. He's a deacon at church and a mother that's as close to
    an angel as any human that I've ever met.
        When I transitioned out of the Marine Corps in 2010, I
    moved back to my hometown in Easley, South Carolina, bought my
    first house, and I was somewhat of a reckless wrecking ball at
    first. I was mad at the world from my experiences, the outcomes
    of how the war played out, and just the current state of
    Americans in my generation.
        In those 18 months' time from my EAS, I had been arrested
    three times for driving under the influence. I went to jail a
    handful of times on violent-related charges, and I had an
    unexpected child who is now 12 years old; my son. During this
    time of those 18 months, one of my Marines had committed
    suicide. The first experience that I had with a Marine of mine
    committing suicide actually happened on my second deployment
    where Lance Corporal Robert Ulmer took his own life in our
    living quarters.
        So, during this time when I was struggling really bad with
    some of the decisions that I was making, that 17.6 per day
    suicide number really started creeping in the back of my mind
    and became an option. In fact, five guys, five Marines that I
    deployed with to Iraq since we've gotten out, have committed
    suicide to this date.
        Moving forward, you know, I said I had an unexpected child.
    So, my child, Jackson, he gave me a new purpose, and made
    suicide feel like it just couldn't be an option because I would
    leave my son alone in this world. My son's birth was a turning
    point in my life, and it's when I became connected with Upstate
    Warrior Solutions.
        I began reaching out for help to better myself because I
    wanted to be the best father I could for my son. I quickly made
    common connections with other veterans at UWS, for example,
    Nate, back here, and another gentleman named Scott Hicks. Both
    of them I had strong connection to because of similar
    experiences, and they had been through some of the dark tunnels
    that I was going through at the time. However, they had made it
    through and were living very successful lives, good fathers,
    and they had something that I really wanted.
        I found a commonality and mindset. I felt as if I was not
    just alienated in the general public. I was able to be real
    about my problems with these gentlemen and gain advice from
    them who have experiences similar to mine, but overcome the
    same struggles. I learned that I'm not invincible by any means.
    My choices and decisions moving forward directly influenced my
    way of life and leadership for my son.
        This was the key period in my journey that really turned
    the course positive. I would've been suicidal or landed myself
    in prison or the grave. Surely enough, had I continued down the
    road I was on before my son was born, and I got connected with
    UWS. As time progressed, I went through a divorce, job changes
    that really got me in the dumps at times. And these times, I
    would reach out to UWS for support to keep my head on straight.
    I was invited to and participated in golf tournaments, dinners,
    hikes, other events that gave me a sense of positive community
    that I could take a pride in being a part of.
        In October 2022, Upstate Warrior Solutions helped me get
    connected to the Vet Center for mental health counseling. I was
    in one of my darkest ruts at the time. I was suicidal for
    months. And in February 2023, I reached out to Upstate Warrior
    Solutions for help again, and agreed to participate in the
    Staff Sergeant Fox Program.
        As a Staff Sergeant Fox participant, I received inpatient
    and outpatient care from both VA facilities and non-VA. I
    received care for PTSD and alcohol abuse, with a lot of time
    and focus spent on post-combat stress and my personal
    experiences. I also participated in Upstate Warrior Solutions's
    recreational programs, and received peer support from them.
    When I went to get inpatient mental health therapy, I missed my
    son's 10th birthday. However, the way I explained it to my son
    and the mentality I had was, I can either miss his 10th
    birthday, or I can miss all of them.
        So, I took that opportunity and it was one of the best
    things I ever did. I also want to note that I've always claimed
    to be a Christian man since I was saved at 12 years old.
    However, I never truly followed the lifestyle and choices that
    Jesus had directed me by his actions and words in the Bible.
    Last year, in April 2024, I was rebaptized in the presence of
    my son, my mother and father, and my life drastically changed.
        Seeking God's purpose for my life and putting all my focus
    and energy on that cause for myself has been life changing for
    the better. The care and help that I received through the Staff
    Sergeant Fox Program saved my life. I had been out of the
    Marine Corps for 12 years before I asked for help. It took me
    12 years to get to rock bottom. And at rock bottom was the
    untouched trauma that I experienced while I was in the Marine
    Corps, and the losses I experienced since that time as well.
    Loss of veteran friends, loss of marriage, loss of purpose.
        For over two years, my mental health and well-being were
    made a priority by the VA, Upstate Warrior Solutions, and my
    community, but most importantly, by me. I exited the Staff
    Sergeant Fox Program in April of this year. When families,
    friends, local organizations, and fellow veterans actively
    participate in creating a supportive environment, it helps
    build a strong network of care and understanding. This sense of
    connection and shared responsibility makes a profound
    difference in the lives of veterans, reminding veterans that
    they're not alone, and that our lives really do matter.
        Completing the program gave me the tools not only to take
    better care of myself, but to be there for my brothers and
    sisters in arms. I'm proud to have taken that step because
    asking for help is a strength, not a weakness. I hope and pray
    that this program, the Staff Sergeant Fox program, will not
    only be continued, but also expanded to include other avenues
    of resources like legal assistance, financial literacy, that
    will also include veterans with eligibility limitations.
        Thank you for your time, and God bless.

        [The prepared statement of Mr. Lambright appears on page
    104 of the Appendix.]

        Chairman Moran. Thank you for your presence here today,
    your ability to tell us your story, and thank you for your
    service to our country. Thank you.
        I'm going to go vote. I'm going to call on Lindsay Church,
    and then I'm going to yield my time to Senator Tuberville, and
    then Senator Blumenthal will chair the meeting until I return
    from the vote. So, Lindsay Church.

    STATEMENT OF LINDSAY CHURCH, EXECUTIVE DIRECTOR AND CO-FOUNDER,
                      MINORITY VETERANS OF AMERICA

        Ms. Church. Thank you. Chairman Moran, Ranking Member
    Blumenthal, and Members of the Committee, thank you for the
    opportunity to testify today.
        My name is Lindsay Church, and I'm the Executive Director
    of Minority Veterans of America. Our organization serves
    veterans who have been historically excluded and underserved;
    women, people of color, LGBTQ+ individuals, religious
    minorities, folks with disabilities, and those living in rural
    communities. We're not side stories in American military
    service, we're central to it. Yet, when we return home, we face
    systems not designed with us in mind.
        Today's hearing acknowledges a crisis many of us have been
    warning about for years; the growing distance between service
    and survival, especially for those at the margins of
    visibility. Since October of last year, we know of at least 13
    veterans who died by suicide on VA property. Another 13,
    transgender, non-binary, and intersex veterans have attempted
    suicide compared to just one last year. If this rate continues,
    we're on pace to exceed the highest number of veteran suicides
    recorded on VA campuses in a single year.
        These aren't isolated incidents. They're a reflection of a
    system that is not only broken, but actively weakened by policy
    choices that erase the unique experiences and barriers faced by
    our Nation's most vulnerable veterans. Instead of fostering
    trust, transparency, and targeted services, we've watched as
    this administration has taken steps that endanger the veterans
    most in need.
        In the past 100 days, VA rescinded VHA Directive 1341,
    eliminating protections for respectful, clinically informed
    care for transgender and intersex veterans, as well as access
    to crucial life-saving healthcare. Critical language,
    acknowledging race, gender, sexual orientation, disability
    status, and accessibility was stripped from the forthcoming
    congressionally mandated report of the Outdoor Recreation Task
    Force for Veterans, which we sit on, effectively erasing
    marginalized veterans from national policy recommendations.
        Outreach materials, acknowledging LGBTQ+, veterans, women,
    veterans of color, and disabled veterans have been sanitized or
    eliminated altogether. Efforts to suppress data collection on
    sexual orientation, gender identity, race and ethnicity have
    intensified making disparities easier to ignore and harder to
    address. These aren't bureaucratic oversights. They're
    deliberate choices with deadly consequences.
        When we erase identity, we erase risk. When we erase risk,
    we erase responsibility. When we erase responsibility, veterans
    die. We confront these realities every day. Not in theory, but
    in lived experience. That's why our organization provides
    transitional housing for LGBTQ+ veterans experiencing
    homelessness. We deliver flexible financial assistance to
    veterans in crisis. We train minority veteran leaders and
    providers in culturally competent care, and we create spaces,
    indoors and outdoors, where veterans can heal without hiding
    who they are.
        These interventions are suicide prevention. We've learned
    that connection saves lives. That trust saves lives. That
    access to mental care, healthcare that affirms identity rather
    than denying it, saves lives. That's why the bills before you
    today matter. They offer opportunities to not just bridge gaps,
    but repair the foundation of trust that's been so badly
    damaged.
        That opportunity will be lost if we fail to embed equity at
    every step. We must prioritize equity in grant funding, not as
    a bonus, but as a core requirement. Mandate cultural competency
    training for all providers serving veterans. Require
    disaggregated data collection so we can identify and address
    the disparities that put minority veterans at greatest risk.
    Invest in partnerships with trusted community-based
    organizations already doing this work.
        Outreach without intention isn't outreach, it's optics.
    Access without safety isn't an access, it's abandonment. And
    visibility without action isn't progress, it's betrayal. We're
    not simply facing an outreach problem when veterans drive onto
    VA campuses and take their lives in their cars, or when
    transgender veterans struggle to walk into VA clinics because
    they're afraid to reveal their identities. It's not just an
    outreach problem when women veterans report being re-
    traumatized by providers who don't understand gender-based
    trauma.
        We must acknowledge it that we're facing a systems design
    failure, one worsened by political decisions to erase the
    identities most in need of protection. We cannot afford half
    measures or sanitize language that hides disparities behind
    one-size-fits-all solutions. We cannot afford to lose another
    life to silence, indifference, or fear. This isn't just a
    matter of mental health policy, it's a test of whether our
    government is willing to see and serve all who have served.
        Veterans deserve more than visibility. We deserve systems
    that are worthy of our trust, our lives, and our sacrifices.
    This is our chance, right now, to build these systems. To not
    only acknowledge veterans like me and those sitting behind me,
    but to fight for us regardless of our identities. Not with
    empty promises, but with bold action, bold enough to save our
    lives.
        Thank you for the opportunity to testify. I look forward to
    your questions.

        [The prepared statement of Ms. Church appears on page 106
    of the Appendix.]

        Senator Blumenthal [presiding]. Thank you. Senator
    Tuberville.

                         HON. TOMMY TUBERVILLE,
                       U.S. SENATOR FROM ALABAMA

        Senator Tuberville. Thanks Senator. Good morning everybody.
    Thanks for being here and thanks for those of you that have
    served this great country. Thanks for your service.
        Since I've been on this Committee now going on five years,
    we have not improved prevention of suicides. Matter of fact, in
    a lot of areas it's gotten worse. I know in my State of
    Alabama, you know, you can throw all the money at it you want,
    but at the end of the day, it's about attitude. It's about the
    people that work in these hospitals and these care units that
    show care and humility for the veteran.
        I've had friends that have committed suicide. I've had
    friends that have almost committed suicide. It's a sad state of
    affairs. But again, I think it's more about people. We have to
    have people that's going to do the right thing. Veterans,
    there's no area that we need to concentrate more in our
    country, other than obviously our economy and things that are
    going on, but the care of the people that have put their life
    on the line for our, for our country.
        Mr. Lorraine, opportunity for oversight on these grants. Do
    we have enough oversight, in your eyes, for the grants that
    we're putting out of the Fox Grants?
        Mr. Lorraine. Thank you, Senator. I think if there is
    oversight, it's not transparent. We do participate. America's
    Warrior Partnership participates in all the meetings that the
    VA holds. We provide our reports, we just don't know how we
    rack up against others, and we don't understand where we are,
    you know, how we can improve what we're doing.
        So, if the outcome of oversight is to change the process
    and improve the process, we're seeing it a little bit. The
    technology system that the VA was using previously has improved
    greatly, but, I would say it's not exceeding expectations and
    oversight.
        Senator Tuberville. How can this VA and this administration
    stop the bad actors from taking these grants away from people
    who actually need these grants?
        Mr. Lorraine. Well, sir, you know, there's an example of a
    grantee in the Northeast who was prosecuted for taking $50,000
    from the grant. I think that type of oversight is needed. We
    just went through our audit. We did very well with it. But I
    think more audits--I hate to say that, but I mean--I think more
    audits for organizations with clear guidelines that don't just
    look at how many hours are you spending doing the work, but
    what are the outcomes of the work that you're doing?
        Senator Tuberville. Yes. And the data that we get, a lot of
    it is not accurate. How can we overcome? How can we get better
    if we don't get accurate data? Are you seeing, any of you, are
    you seeing a better use of data that we're accumulating? Ms.
    Cantor? Anybody?
        Ms. Cantor. Thank you. I think that the types of measures
    that we've historically looked at in similar models, but not
    necessarily only models connecting people to VA care, but ones
    making referrals to organizations for services, have also
    included things like timeliness and accuracy of those referrals
    and whether they were referred for the right thing. And then if
    they were treated successfully.
        So, to me, it's on a continuum of how many people are you
    reaching through your outreach, converting to how many people
    are you screening, converting to how many people successfully
    get to VA, converting to how successful is their treatment? So,
    it's really following that path. I think it's possible with a
    lot of the systems that many of us have used. I just think it's
    not, to Jim's point, as transparent as it could be about what
    information is available, particularly as a nongrantee, we know
    very little about how things are going.
        Senator Tuberville. Yes. I'll ask you this question. Do you
    think merit-based system of people that are showing better
    data, better accomplishments, you know, more positive
    outfluences and influences, do you think they should get more
    grants?
        Ms. Cantor. You're asking that to a seasoned program
    evaluator. So, I'm going to say absolutely, yes. And I think
    some of the provisions account for that in the new legislation.
    Allowing for potential additional funds to people who, like
    Jim, who have demonstrated good performance or like Steffen's
    team that could serve more with more funds.
        Senator Tuberville. You know, the grant program started
    what in 2020, set to expire this fiscal year if we don't re-up
    it. Any of you want to answer this question? Are there any
    other suicide methods that we've seen? I'll ask the veterans.
    Any other suicide methods that we've seen to help to prevent
    suicide? Anything that you'd like to suggest in your
    experiences? Any of you want to answer anything that you've
    seen?
        I have personally offered up to this Committee about
    hyperbaric chambers. People say that helps in some areas with
    PTSD, some people say they don't. Well who cares. If they help
    anybody, if they help one person, we should use them. Anybody
    want answer that question through experience?
        Mr. Lambright. There are a couple of non-conventional ways
    that I've experienced personally that have helped. I don't know
    if you're familiar with DMT or psychedelics, but those helped
    me quite a bit using those, personally, just to be able to get
    past the trauma and be able to--you know, it gives you a
    supernatural way to kind of look at yourself and get over the
    things that haunt you so bad. I think those work in general. I
    think anybody could use those to their advantage.
        Senator Tuberville. Were they provided by the VA?
        Mr. Lambright. No, sir. I don't think it was an option.
        Senator Tuberville. Yes, probably not.
        Mr. Lambright. While I'm here, I wanted to mention one
    thing. You know, there's been multiple comments from Senator
    Moran and others about the VA and funding, and the budget cuts
    due to the amount of funding. I just want to give you one
    example from me personally. When I went to Willingway Hospital
    that the VA sent me to in Statesboro, Georgia, I saw the bill
    that ended up getting sent to the VA from Willingway Hospital.
    It was $90,000 for a 30-day inpatient program. The exact same
    person who got the exact same care, but not billed through the
    VA, instead billed through their insurance, was $21,500.
        So, I think there's a lot of irresponsible, maybe invoicing
    or spending. That's just one example. You know, if 50 guys go
    to the same program, you're talking about a substantial amount
    of money. So, there's--I feel like just the audits, like we
    were just talking about that was brought up, I think that'd be
    a really good situation just to mitigate all the unnecessary
    spending or maybe careless spending that that goes on. That way
    there's more funds available for veterans that need and could
    use it.
        Senator Tuberville. Yes, I think our VA Secretary now is on
    top of that. We've got to stop the fraud and the theft. We
    don't do that. We don't have money for people that actually
    deserve that. Thank you, Senator.
        Senator Blumenthal. Thanks Senator. I have a few questions
    for Ms. Barr and Mr. Lambright. Both of you as Marine Corps
    veterans went to Upstate Warrior Solutions. You didn't call the
    VA directly. You didn't call the Veterans Crisis Line. Could
    you talk about why you went there and not to the VA directly?
        Ms. Barr. Thank you, Senator Blumenthal. So, I, myself,
    actually searched through the VA first to reach out to try to
    find any type of mental health, anything. Something I had been
    trying to get into through the VA while I was in. Just try to
    get it worked out prior to getting out, and kept getting phone
    numbers for people who were no longer in service, or no longer
    connected to the VA, or just stonewalled over and over again
    through them.
        I thankfully found a Vet Center in town, and they were
    actually the ones who pointed me to Upstate Warrior Solutions.
    And the Upstate Warrior Solutions were the ones to keep working
    through that. I think part of it is partially just due to, like
    in our area there in Greenville, South Carolina, there's a very
    large veterans presence. And the VA does not reach out very
    much nor does it announce its capabilities as often. It's
    definitely very much up to the veteran to try to find
    resources.
        Upstate Warrior Solutions is one that presents itself and
    puts itself out there more so than the VA and the Vet Centers
    do. So, I think that's most likely the reason most people have
    found Upstate Warrior Solutions before the VA, just because
    they're out there putting themselves out to help and present
    themselves instead of making it a chore or an extreme task to
    try to make their way through the VA process of getting help,
    so.
        Senator Blumenthal. Thank you. Mr. Lambright?
        Mr. Lambright. Thank you for your question, Senator
    Blumenthal. I think what you had asked was why did I go to
    Upstate Warrior Solutions and not the VA. I had in fact went to
    the VA first. In South Carolina, there's multiple outpatient
    clinics, but there is one main VA hospital in Columbia where
    the state capital is.
        So, when I was first initially struggling with suicide, I
    went through divorce, and I drove myself to Columbia,
    unbeknownst to my family or anybody, and checked myself in
    where they have a mental health facility there in Columbia. So,
    they basically took my clothes, put me in a gown and some foam
    slippers. And for five days I played Scrabble, and it was
    basically a waste of time.
        When I left, I was more upset and in a worse place than
    when I got there. I discussed that with Upstate Warrior
    Solutions, which provided me the insight and the direction to
    use another facility, like a civilian facility if the VA can
    direct me there, where I can get the care that I needed.
        So, I did in fact, go to the VA first. However, I had a
    relationship with Nate and with Scott Hicks, that I mentioned,
    and they had experience with other veterans that were in a
    similar position that had gotten help from a civilian entity.
    So, I chose that route instead, and honestly, it was the best
    decision I ever made, and I owe my life to these guys.
        Senator Blumenthal. Thank you. Thank you both for your
    service and for being here today. Mr. Lorraine, have you seen
    evidence yet of the VA cuts in staffing so far as it affects
    veterans?
        Mr. Lorraine. No, sir, we haven't. We haven't seen any.
        Senator Blumenthal. How about other members of the panel?
    Have you seen--and when I say evidence of the cuts, I don't
    mean only people leaving, I mean also the sense of anxiety,
    worry, and so forth.
        Mr. Crow. I would say I have heard that just in phone
    conversations, following up, trying to build more program
    agreeances between us and VA, and just in general asking. I
    mean, they're our peers, we care about them as well, so we ask
    how they're doing and what's going on. And there's definitely
    some mixed anxieties and some fears. We just haven't seen
    personally any of that come to fruition yet.
        Senator Blumenthal. Have you heard veterans discuss it?
        Mr. Crow. It's definitely asked about, sir. I mean,
    veterans that come into our programs or that we talk to at
    events. They are curious. It's in the news, so they ask about
    it. With us just being a grantee, I don't really have the
    expertise to tell them anything. I may mainly just direct them
    over to like public affairs offices and things like that to
    field those questions. But it's discussed.
        Ms. Church. Can I jump in, Chairman, or recommend--excuse
    me, Ranking Member?
        Senator Blumenthal. Thank you.
        Ms. Church. First, and anecdotally, you are seeing that the
    centralized services that VA relies on for things like their
    operator services, you can call--in order to reach the VA
    providers, you have to call them main central, like, operator.
    Took me seven and a half minutes to get to the operator the
    other day. It normally takes 12 seconds. Just sitting there
    waiting, on hold, trying to get a hold of anybody to get you to
    the dental clinic. You are trying, because that's the only way
    that you can call the actual hospital.
        You have providers who are worried because their schedulers
    are getting cut and are getting riffed. You have providers who
    are worried because anybody that helps support them to deliver
    the services are starting to get those. While the providers
    themselves might be exempt, the people that support them, and
    the support staff, and the schedule of the billing, all of
    those things are now landing on the provider's desk.
        And to the point that was made earlier today, VA does not
    pay well enough to make them do three or four jobs in support
    of delivering these services. So, there's a ton of anxiety, a
    lot of frustrations, people making impossible decisions about
    whether or not to take the deferred resignation, to take the
    early retirement, to take it and/or to chance whether or not
    they're going to have a job in a few months.
        So, there's a lot of anxiety, which to the point earlier,
    talking about VA employees being veterans themselves, you've
    got a dual crisis happening here. You have veterans who in our
    community most of us are worried about what's going to happen
    with the future of this agency that provides most of our
    healthcare.
        Then you turn to the actual side of people who work for VA.
    They're experiencing the mental health crisis of the VA maybe
    being dismantled, but also, they have to work for the agency,
    worry about their jobs. Many of them work in billets that are
    now outlawed in the agency themselves. You've got a surging
    crisis underneath the underbelly of the veteran community that
    we are going to see in next year's suicide report.
        Senator Blumenthal. Thank you. I want to thank all of you
    for being here today. The Chairman, Senator Moran, has another
    obligation, so, I'm going to finish the hearing. Thank you for
    your participation. Been very meaningful and important to the
    Committee.
        The hearing record will remain open for five legislative
    days should any Committee members want to submit additional
    statements or questions for the record. And I'm going to ask
    all of our witnesses if there are any questions, to please
    respond to them.
        And once again, thank you all for being here. This hearing
    is adjourned. Thank you.
        [Whereupon, at 12:54 p.m., the hearing was adjourned.]

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